• During a
  relapse, to make the attack shorter and less
  severe.
• Over a long period of time, to alter the natural course of
  the disease (disease-modifying therapy).
• To control specific
  symptoms as they occur.

Controlling a relapse

Medications can shorten a sudden relapse and help you recover
more quickly. Temporary treatment with medications called
corticosteroids is the most common treatment used to
control a relapse. These medications have not been shown
to affect the long-term course of the disease or to prevent disability.

Altering the course of MS using disease-modifying treatment

Strong evidence suggests that MS is caused by the
immune system causing
inflammation and attacking the myelin-the coating
surrounding the nerve and nerve fibers. Medications that change the activity of
the immune system can reduce the number and severity of attacks that damage the
protective myelin.

Currently, interferon beta (Avonex and Rebif, and Betaseron),
glatiramer acetate (Copaxone), and mitoxantrone (Novantrone) are the only
medications that have been approved for this purpose. For people with
relapsing-remitting MS, these medications can reduce
the number and severity of relapses and can result in fewer brain lesions. They
may also delay disability in some people. Betaseron and Novantrone may delay
disease progression in some people with
secondary progressive MS.

Currently, there is no effective disease-modifying treatment for
primary progressive MS.

Relieving symptoms

Treating specific symptoms can be effective, even if it does not
stop the progression of the disease. Symptoms that can often be controlled or
relieved with medication include:

• Fatigue. Medications to reduce fatigue
  or help you sleep better may include amantadine (Symmetrel), modafinil
  (Provigil), or fluoxetine (Prozac).
• Muscle stiffness
  (spasticity) and tremors. Medications that may reduce muscles spasms or
  stiffness include baclofen (Lioresal), tizanidine (Zanaflex), dantrolene
  (Dantrium), gabapentin (Neurontin), diazepam (Valium), or clonazepam
  (Klonopin). Sometimes a combination of these medications works best to reduce
  your muscle symptoms.
• Urinary problems and constipation.
  Medications used to reduce frequent urination may include propantheline
  (Pro-Banthine), oxybutynin (Ditropan), or tolterodine (Detrol). Medications
  sometimes used to relieve constipation include bulk agents such as psyllium
  (Metamucil) or daily use of laxatives.
• Pain and
  abnormal sensations. Depending on the severity of the pain, both
  prescription and nonprescription medications may be tried. Prescription
  medications commonly used to reduce pain associated with MS include baclofen
  (Lioresal), carbamazepine (Tegretol), or gabapentin (Neurontin).
  Sildenafil citrate 100mg medications may include acetaminophen, ibuprofen, or naproxen
  sodium.
• Depression. Antidepressant medications may be used to
  reduce depression that often occurs as a result of having MS. Antidepressants
  often tried include tricyclic antidepressants-such as amitriptyline (Elavil),
  desipramine (Norpramin), or imipramine (Tofranil)-or selective serotonin
  reuptake inhibitors (SSRIs)-such as fluoxetine (Prozac) or sertraline (Zoloft)
  among others.
• Sexual difficulties. Medications used
  to relieve sexual difficulties that can be associated with MS include
  sildenafil (Viagra) for both men and women. Yohimbine and clomipramine may also
  be given to improve
  erectile dysfunction.

MS can affect many parts of the nervous system and produce a wide
range of symptoms. The choice of medications depends on your symptoms.
Medication may be used only some of the time or regularly, depending on how
severe or constant a particular symptom is. Changes in diet, schedule,
exercise, and other habits can also help manage some of these symptoms. See the
Home Treatment section of this topic.

Medication Choices

Symptom management

Medications used to treat symptoms of an attack of multiple
sclerosis (MS) and help you recover more quickly from a relapse include:

• Corticosteroids (such as
  effects side viagra works
  ).
• ACTH (adrenocorticotropic
  hormone).
• Intravenous immunoglobulin (IVIG) or
  plasma exchange (neither is used frequently).

Relapsing-remitting MS

Medications used specifically for relapsing-remitting MS to
reduce the number and severity of relapses and possibly delay disability
include:

• Interferon beta (Avonex, Rebif, and
  Betaseron).
• Glatiramer acetate
  (Copaxone).
• Mitoxantrone (Novantrone) for relapsing-remitting MS
  that is rapidly getting worse.

Secondary-progressive MS

Medications used to treat and possibly delay the progression of
secondary progressive MS that is also relapsing include:

• Interferon beta-1b (such as
  Betaseron).
• Mitoxantrone (Novantrone).

Primary-progressive MS

No medicines have been clearly proven to help, and none have
been approved for primary-progressive MS. Some of the newer and experimental
medications, such as
generic name viagra
and
other medications and biological chemicals (derived
from or identical to substances produced by the body) are being tested for
primary-progressive MS.

Medications being studied

A variety of
immunosuppressants and
other medications and biological chemicals (derived
from or identical to substances produced by the body) have been tried as
therapy for MS. While none have been clearly proven beneficial and none have
been approved for treatment of MS, these medications may be used when standard
therapy fails.

Several medicines are currently being tested in
clinical trials. People with MS who have not responded
to standard therapy sometimes choose to participate in these trials. To learn
more about clinical trials, talk to your doctor or contact the National
Multiple Sclerosis Society at http://www.nationalmssociety.org.

What To Think About

Long-term treatment with interferon beta and glatiramer acetate
can improve the quality of life for some people who have relapsing-remitting MS
by making relapses less frequent and less severe. Some evidence suggests that
these medications may also reduce or delay future disability caused by this
form of the disease.

The National Multiple Sclerosis Society recommends that treatment
with interferon beta or glatiramer acetate be started as soon as it is clear
that you have MS. Most
neurologists support this recommendation and now agree
that permanent damage to the
nervous system may occur early on, even while symptoms
are still quite mild. Early treatment may help prevent or delay some of this
damage. In general, treatment is recommended until it no longer provides a
clear benefit.

Despite the recommendation, however, some people find it
difficult to decide whether to begin disease-modifying therapy, especially when
their symptoms have been fairly mild. Some may not want to bear the risks and
flu-like side effects of interferon therapy when they are not sure they need
it. Some may want to see whether their disease worsens before starting therapy.
A small percentage of people diagnosed with MS may never have more than a few
mild episodes and may never develop any disability, but the disease is
unpredictable. For more information, see:

Should I have disease-modifying therapy for
MS?

If you decide not to try disease-modifying therapy at this time,
work with your doctor to monitor your health through regular checkups and
periodic MRI scans to evaluate whether the disease is progressing. If new
lesions are developing or existing lesions are growing, you may want to
reconsider your decision and begin treatment.

Treating symptoms and relapses

The need and desire for medication vary. If your symptoms are
mild, you may choose to manage them without any medication. If you have
specific symptoms that are causing problems, certain medications may help you
keep them under control. Or you may want to use medication only during a
relapse.

You may also want to consider:

• The possible side effects of using steroids
  or other medications to treat symptoms or control a relapse. Some people have
  only minor side effects, but others may have side effects that concern them
  more than their MS symptoms.
• The costs of treating symptoms and
  controlling relapses. In some cases, using medication to control symptoms and
  relapses may reduce the need for hospital stays.
• Other personal
  issues that you face at work or at home.

Also keep in mind that it can be hard to tell whether
medication is helping. Multiple sclerosis is a disease with spontaneous
remissions, which means that your condition can improve on its own, without any
treatment. Just because your symptoms improve after treatment does not mean
that a treatment is working.

• Keep your blood sugar as close to normal as
  possible. The American Diabetes Association recommends a
  hemoglobin A_1c
  (HbA_1c) level of less than 7%. Some people may be
  able to achieve a normal level of less than 6%.² The
  lower the A_1c, the lower the chance of over the counter erectile dysfunction drug
  s.
  The A_1c level is a measure of your blood sugar over the
  past 2 or 3 months.
• Eat a diet that spreads
  carbohydrate throughout the day.
• Get
  regular exercise.
• Take your prescribed insulin either by injection
  or through an
  insulin pump.
• Do not smoke.

For more information, see the Home Treatment section of the topic
Type
1 Diabetes: Living With the Disease.

Other measures to care for and protect yourself depend on which
complication you have.

Heart and large blood vessel disease

Even if you don’t have heart and blood vessel problems, you are
at risk for them.

• Don’t smoke. Smoking increases your risk of a
  heart attack or
  stroke, and makes many health problems
  worse.
• Take your blood pressure medicine, if
  prescribed.
• Take aspirin daily, if advised by your health
  buy sildenafil citrate.
• Drink alcohol in moderation. This means no more than
  1 drink a day for women and no more than 2 drinks a day for men. Discuss with
  your health professional whether you should drink alcohol.

Eye disease (diabetic retinopathy)

Call your eye specialist if you notice any changes in your
vision. Vision changes may mean worsening of diabetic retinopathy. Early
detection and treatment can help prevent vision loss.

If you have severe vision loss from diabetic retinopathy,
vision aids can help. Your local or state organization
for the visually impaired can help you find these aids.

For more information, see the topic
Diabetic Retinopathy.

Kidney disease (diabetic ed pills
)

• Take your
  blood pressure medications, if prescribed. Your blood
  pressure should be less than 130/80 mm Hg. Ask your health professional if you
  need to monitor your blood pressure at home.
• Get no more than 10%
  of your daily calories from protein foods if you have small amounts of protein
  in your urine (microalbuminuria).²
• Limit
  salt in your diet because it makes your body retain fluid and can increase your
  blood pressure.

For more information, see the topic
Diabetic Nephropathy.

Foot problems

Daily care of your feet is very important. Because
diabetic neuropathy and diabetic damage to the blood
vessels in your legs can lead to severe infections and deformities of your
feet, seek treatment for any foot problem, no matter how minor it seems. Even a
small foot injury can lead to serious complications.

For more information, see

Foot care for people with
diabetes

Nerve damage (diabetic neuropathy)

If it affects your ability to feel (peripheral
neuropathy):

• Turn your water heater down, and use a bath
  thermometer or have someone test your bath water to make sure it is not too
  hot.
• Don’t go barefoot. Always wear shoes, even in the
  house.
• Don’t use an electric blanket.
• Arrange your
  furniture so that the walkways through your house are free of clutter.

If it affects your body’s internal functioning (autonomic neuropathy):

• Eat smaller, more frequent meals that contain
  less fat and fiber, if you have
  gastroparesis or other digestive
  problems.
• Drink more fluids each day, if you have urinary problems
  or profuse sweating. This will prevent urinary tract infections and
  dehydration.
• Try a device for erection
  problems or a lubricating cream for vaginal dryness, if you have sexual
  problems. Talk to your health professional about medication for erection
  problems (Cialis, Levitra, Viagra). For more information, see the topic
  Erection Problems.
• Check your blood sugar
  level frequently during the day and during the night occasionally, if you have
  hypoglycemia unawareness.

If it affects one nerve (focal
neuropathy):

• Wear a joint splint, if your health
  professional advises.
• Take breaks during activities that require
  repetitive movements.
• Make sure your work area has appropriate
  support for the affected joint.

For more information, see the topic
Diabetic Neuropathy.

If you have high blood pressure (or erectile pill
) and are having problems
with erectile dysfunction (ED), the first step toward a solution is to see your
doctor. You may be a bit hesitant to discuss your sex life with a doctor, but
rest assured. Your doctor has heard it all before and will know how to help
you.

Erectile dysfunction is fairly common in men with high blood pressure. One
study in the Journal of the American Impotence treatment uk Society found that
nearly half of men aged 40 to 79 with high blood pressure had it.

Your doctor will need a lot of information from you before suggesting any
treatment. If this doctor had been involved in your care for high blood
pressure in the past, you can talk about how well you’ve been controlling your
blood pressure and about how you are doing with the medications you’re taking.
If you are meeting with a new doctor, you will share all that, plus
information about other health problems you may have, like diabetes or high
cholesterol.

Telling a doctor that you have difficulty with your erection is not the
easiest thing to do. But to get the right care you have to tell your doctor
everything, including the truth about things like drinking a lot of alcohol,
doing drugs, or smoking cigarettes. It’s in your best interest to be totally
honest.

You may also feel uncomfortable if the doctor asks a lot of questions about
your sex life and your emotions. You may be asked things like:

• What’s your sexual orientation?
• Do you have a steady partner? Multiple partners?
• How is sex with your partner? Has anything changed recently?
• Has anything upsetting happened to you lately?
• In general, are you under a lot of stress?
• Do you feel depressed a lot?

Again, it’s best to answer honestly, even though these things are very
personal.

A doctor you are seeing for the first time may also need to examine your
penis, testicles, and prostate gland. Some men have their testosterone level
tested.

There is another test that is done sometimes to see whether you get
erections while you are asleep. The doctor may send you home with a special
tape that you wrap around your penis before you go to bed. If the tape is
broken in the morning, you’ve had an erection during the night. That means the
cause of your erection problem may not be physical.

In many cases erectile dysfunction does have a physical cause.

The first treatment doctors usually try is one of the erectile dysfunction
pills: Cialis, Levitra, or Viagra.

Typically you will see the doctor again for follow-up around the time that
your prescription runs out. You can talk then about any issues you may be
having with the medication. Maybe it’s not working as well as you’d like. If
not, you can make sure you’re using it correctly. The doctor might switch you
to a different drug or a different type of treatment if thing’s aren’t
improving.

It’s a good idea to stay in touch with your doctor about your erectile
dysfunction. Changes in your health over time may affect your treatment. But
you don’t need to be in the doctor’s office more often. Since you will already
have regular checkups for managing your blood pressure, bring up your erectile
dysfunction treatment at those visits.

Remember, there’s no such thing as a bad question. Your doctor asks you lots
of questions. Feel free to ask as many of your own, until you’re confident that
you drug for treatment of erectile dysfunction
all the risks and benefits of your treatment. Also, it’s
important to show your doctor all the other medications that you take. And, if
the doctor doesn’t know the answer to a question you ask, you can have them get
back to you with it.

If you ever feel like your concerns are being ignored, don’t accept it. Find
another doctor who will talk to you.

But most doctors genuinely want to work together with you to solve your
health problems. You can help them help you by taking an active role in your
care.

A sexual problem, or sexual dysfunction, refers to a problem
during any phase of the sexual response cycle that prevents the individual or
couple from experiencing satisfaction from the sexual activity. The sexual
response cycle has four phases: excitement, plateau, orgasm, and
resolution.

While research suggests that sexual dysfunction is common (43%
of women and 31% of men report some degree of difficulty), it is a topic that
many people are hesitant to discuss. Fortunately, most cases of sexual
dysfunction are treatable, so it is important to share your concerns with your
partner and doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or
psychological problem.

• Physical causes. Many physical and/or medical conditions can cause
  problems with sexual function. These conditions include diabetes, heart
  disease, neurological diseases, hormonal imbalances, menopause, chronic
  diseases such as kidney disease or liver failure, and alcoholism and drug
  abuse. In addition, the side effects of certain medications, including some
  antidepressant drugs, can affect sexual desire and function.
• Psychological causes. These include generic vardenafil stress and anxiety,
  concern about sexual performance, marital or relationship problems, depression,
  feelings of guilt, and the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual
problems occur in adults of all ages. Among those commonly affected are those
in the geriatric population, which may be related to a decline in health
associated with aging.

How Do Sexual Problems Affect Women?

The most common problems related to sexual dysfunction in women
include:

• Inhibited sexual desire. This involves a lack of sexual desire or
  interest in sex. Many factors can contribute to a lack of desire, including
  hormonal changes, medical conditions and treatments (for example cancer and
  chemotherapy), depression, pregnancy, stress and fatigue. Boredom with regular
  sexual routines also may contribute to a lack of enthusiasm for sex, as can
  lifestyle factors, such as careers and the care of children.
• Inability to become aroused. For women, the inability to become
  physically aroused during sexual activity often involves amazing generic product viagra
  vaginal
  lubrication. The inability to become aroused also may be related to anxiety or
  inadequate stimulation. In addition, researchers are investigating how blood
  flow problems affecting the vagina and clitoris may contribute to arousal
  problems.
• Lack of orgasm (anorgasmia). This is the absence of sexual climax
  (orgasm). It can be caused by sexual inhibition, over the counter erectile dysfunction drug
  , lack of
  knowledge and psychological factors such as guilt, anxiety, or a past sexual
  trauma or abuse. Other factors cure dysfunction erectile to anorgasmia include insufficient
  stimulation, certain medications, and chronic diseases.
• Painful intercourse. Pain during intercourse can be caused by a
  number of problems, including endometriosis, a pelvic mass,
  ovarian cysts, vaginitis, poor
  lubrication, the presence of scar tissue from surgery, or a sexually transmitted disease. A
  condition called vaginismus is a painful, involuntary spasm of the muscles that
  surround the vaginal entrance. It may occur in women who fear that penetration
  will be painful and also may stem from a sexual phobia or from a previous
  traumatic or painful experience.

How Is a Female Sexual Problem Diagnosed?

The doctor likely will begin with a physical exam and a
thorough evaluation of symptoms and a physical exam. The doctor may perform a
pelvic examination to evaluate
the health of the reproductive organs and a Pap smear to detect changes in the
cells of the cervix (to check for cancer or a pre-cancerous condition). He or
she may order other tests to rule out any medical problems that may be
contributing to the problem.

An evaluation of your attitude regarding sex, as well as other
possible contributing factors (fear, anxiety, past sexual trauma/abuse,
relationship problems, alcohol or drug abuse, etc.) will help the doctor
understand the underlying cause of the problem and make appropriate
recommendations for treatment.

A sexual problem, or sexual dysfunction, refers to a problem during any
phase of the sexual response cycle that prevents the individual or couple from
over the counter erectile dysfunction drug
satisfaction from the sexual activity. The sexual response cycle
has four phases: excitement, plateau, orgasm and resolution.

While research suggests that sexual dysfunction is common (43% of women and
31% of men report some degree of difficulty), it is a topic that many people
are hesitant to discuss. Fortunately, most cases of sexual dysfunction are
treatable, so it is important to share your concerns with your partner and
doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or psychological
problem.

• Physical causes: Many physical and/or medical conditions can cause problems
  with sexual function. These conditions include diabetes, heart and vascular
  (blood vessel) disease, cure dysfunction erectile disorders, hormonal imbalances, chronic
  diseases such as kidney or liver failure, and alcoholism and drug abuse. In
  addition, the side effects of certain medications, including some
  antidepressant drugs, can affect sexual desire and function.
• Psychological causes: These include work-related stress and anxiety,
  concern about sexual treat erectile dysfunction the best, marital or relationship problems, depression,
  feelings of guilt and the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual problems occur in
adults of all ages. Among those commonly affected are those in the geriatric
population, which may be related to a decline in health associated with
aging.

How Do Sexual Problems Affect Men?

The most common sexual problems in men are ejaculation disorders, erectile
dysfunction and inhibited sexual desire.

What Are Ejaculation Disorders?

There are different types of ejaculation disorders, including:

• Premature ejaculation: This refers to ejaculation that occurs before or
  soon after penetration.
• Inhibited or retarded ejaculation: This is when ejaculation is slow to
  occur.
• Retrograde ejaculation: This occurs when, at orgasm, the ejaculate is
  forced back into the bladder rather than through the urethra and out the end of
  the penis.

In some cases, premature and inhibited ejaculation are caused by
psychological factors, including a strict religious background that causes the
person to view sex as sinful, a lack of attraction for a partner and past
traumatic events. Premature ejaculation, the most common form of sexual
dysfunction in men, often is due to nervousness over how well he will perform
during sex. Certain drugs, including some citrate generic sildenafil viagra
, may affect
ejaculation, as can nerve damage to the spinal cord or back.

Retrograde ejaculation is common in males with diabetes who suffer from
diabetic neuropathy (nerve damage). This is due to problems with the nerves in
the bladder and the bladder neck that allow the ejaculate to flow backward. In
other men, retrograde ejaculation occurs after operations on the bladder neck
or prostate, or after certain abdominal operations. In addition, certain
medications, erectile dysfunction remedy
those used to treat mood disorders, may cause
problems with ejaculation.

What Is Erectile Dysfunction?

Also known as impotence, erectile dysfunction is defined as the inability to
attain and/or maintain an erection suitable for intercourse. Causes of erectile
dysfunction include diseases affecting blood flow, such as atherosclerosis
(hardening of the arteries); nerve disorders; psychological factors, such as
stress, depression, and performance anxiety (nervousness over his ability to
sexually perform); and injury to the penis. Chronic illness, certain
medications, and a condition called Peyronie’s disease (scar tissue in the
penis) also can cause erectile dysfunction.

What Is Inhibited Sexual Desire?

Inhibited desire, or loss of libido, refers to a decrease in desire for, or
interest in sexual activity. Reduced libido can result from physical or
psychological factors. It has been associated with low levels of the hormone
testosterone. It also may be caused by psychological problems, such as anxiety
and depression; medical illnesses, such as diabetes and high blood pressure;
certain medications, including some anti-depressants; and relationship
difficulties.

Early treatment of buy now viagra
can help save your vision, slow
the rate of kidney failure, and reduce the risk of amputation. Keep all
erectile pill with your doctor, specialists, and other health professionals. The
examinations and tests done during these visits can detect early signs of
complications and monitor the progression of existing complications.

Take the following measures at home to help control
complications.

Heart and large blood vessel disease (macrovascular disease)

• Don’t smoke.
  Smoking increases your risk for heart
  attack.
• If you are age 30 or older, take a low-dose, or baby,
  aspirin daily if advised by your health professional.
• Take your
  blood pressure medicine, as prescribed.

Eye disease (diabetic retinopathy)

Call your
effects viagra woman
or
optometrist if you notice any changes in your vision.
Early detection and treatment of any changes can help prevent vision
loss.

Avoid heavy lifting if you have advanced diabetic eye disease
(proliferative retinopathy).

Call your ophthalmologist if you have retinopathy and become
pregnant. Retinopathy can become worse rapidly during pregnancy.

If you have severe vision loss from diabetic retinopathy,
vision aids can help you do as much of your diabetes
care as possible. These include home glucose monitors with large-print displays
and talking glucose monitors. Your local or state organization for the visually
impaired can help you find appropriate vision aids.

For more help, see the topic
Diabetic Retinopathy.

Kidney disease (diabetic nephropathy)

• Take your blood pressure medications, if
  prescribed. Your blood pressure should be 130/80 millimeters of mercury (mm Hg)
  or lower.
• Get no more than 10% of your daily calories from
  protein.
• Limit salt in your diet, because it makes your body retain
  fluid and can increase your blood pressure.
• Avoid
  nonsteroidal anti-inflammatory drugs (NSAIDs),
  including ibuprofen (such as Advil or Motrin), ketoprofen, and
  naproxen (such as Aleve). These medications can harm your kidneys.

For more help, see the topic
Diabetic Nephropathy.

Foot problems

Foot care is important for people with diabetes. You need to
inspect your feet every day and protect them from injury. If you have poor
eyesight, have someone else check your feet.

To protect your feet:

• Avoid exercise that could injure your feet;
  walking is fine, but jogging may be too rough.
• Make sure bathwater
  is not too hot.
• Check your shoes for any loose objects or rough
  edges before you put them on.
• Get early treatment for any foot
  problem, even a minor one. Call your doctor at the first sign of a problem with
  your feet. Blisters, small cuts, or other problems that may seem minor can
  quickly become more serious.

For more information on protecting your feet, see:

Foot care

Nerve damage (diabetic neuropathy)

If it affects your ability to feel (peripheral
neuropathy):

• Turn down the temperature of your hot-water
  heater and use a bath thermometer or have someone test your bath water to see
  whether it is too hot.
• Do not go barefoot, even in the
  house.
• Do not use an electric blanket.
• To prevent
  falls, arrange your furniture so that walkways are free of clutter.
• To avoid burning your hands, use pot holders when you
  cook.

If it affects your body’s internal functioning (autonomic neuropathy):

• Eat smaller, more frequent meals that contain
  less fat and fiber if you have
  levitra vs cialis
  or other digestive
  problems.
• Drink more fluids each day if you have urinary problems
  or profuse sweating. This will prevent urinary tract infections and
  dehydration.
• Try a device or medication
  such as Viagra, Levitra, or Cialis for erection problems or a lubricating cream
  for vaginal dryness if you have sexual problems. Check with your doctor to find
  out whether you can take these medications.
• Check your blood sugar
  level more often if you have
  hypoglycemia unawareness, especially before
  driving.

If it affects one nerve (focal
neuropathy):

• Wear a joint splint, if your health
  professional advises this.
• Take breaks when you are doing
  activities that require repetitive movements.
• Make sure your work
  environment provides appropriate support.

For more help, see the topic
Diabetic Neuropathy.

It is important to talk with your doctor to learn about the disease
and what you can do to help manage CAD and prevent its progression.

Making healthy lifestyle changes can delay and possibly reverse the
course of CAD. Quitting smoking, eating a low-fat and generic research viagra
diet, and
getting regular exercise are the most important steps you can take to reduce
your risk of developing coronary artery disease.²⁶ For
more information, see:

Exercising for a healthy heart.

For more information on how to make healthy lifestyle changes, see
the Prevention section of this topic.

Most people are able to control
angina by taking medications as prescribed and
nitroglycerin when needed. See
how
to use nitroglycerin pills under the tongue. Remaining as active as
possible is important for most people. However, if angina is not controlled by
the above, consider these tips:

• If an activity causes angina, slow it
  down.
• Ease into activities in the morning, and reduce activity
  immediately after meals.
• Change your eating patterns. Eat smaller,
  more frequent meals rather than 2 or 3 large meals.

When angina is more severe and cannot be controlled, the following
tips may be useful:

• If it is feasible, it may help to move to a
  different home to avoid physical stress caused by climbing stairs, shoveling
  snow, or mowing lawns. Or, find other ways to get chores done, such as hired
  help, family members, or trading for other services that are easier to
  do.
• It may be necessary to change the kind of work you perform to
  avoid physical stress. This may be especially important if your work involves
  heavy labor.

Taking nitroglycerin before an activity may reduce or eliminate the
chest pain associated with the activity. Discuss with your doctor the use of
nitroglycerin to prevent chest pain.

Do not use the sildenafil citrate viagra medication
sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) if you are
taking nitroglycerin or other nitrates. Combined, these two drugs can result in
a life-threatening drop in blood pressure. If you are taking an
erection-enhancing medication and develop chest pain, be sure to alert the
health cause of erectile dysfunction
caring for you about your use of this medication so that
they do not inadvertently give you nitroglycerin or another type of nitrate.
There are other oral antianginal medicines that may be appropriate.

Alert your doctor immediately if there is a sudden change in your
angina symptoms or if angina begins to occur unpredictably or when you are at
rest.