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15
Dual Pricing in Thai Tourism: Economic Necessity or Hidden Bias?
The only person who notices is you. The higher prices does have the affect of you don’t get all the cheap Charlie riff raff in these places which is nice. A bit like a bar or restaurant with higher prices. It keeps the scum out. -
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Amnesty International "It's a Genocide in Gaza"
No excuse for Israel committing ear crimes and genocide per the source of the thread. -
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Prostate surgery user reviews .... turp? rezum? other ?
I am early 60's and retired, having worked in healthcare my entire career. I have been living with BPH for about 15 years. When considering prostate treatment options it is important to know your prostate size. This is generally obtained and calculated from a lower abdominal ultrasound. Another benefit of this procedure is that they may ascertain if you are retaining any urine in your bladder after you urinate (a post-void residual volume). Smaller prostates are generally more easy to treat than larger prostates. The ultrasound will not reveal detailed information about the condition of the lobes and zones of the prostate. Instead, a more invasive procedure called a cystoscopy is needed for this information. The prostate has four lobes- a left and right lateral lobe, an anterior lobe, and a median lobe. A large median lobe can complicate some surgical techniques. Medications are the first line of therapy and are usually quite effective. Alpha-blockers such as terazosin, doxasosin, tamsulosin, alfuzosin, and silodosin typically provide substantial relief of lower urinary tract symptoms. I find it easiest to think of alpha-blockers as muscle relaxers for the prostate that result in less impingement upon the urethra, thereby improving flow. I have tried all of these alpha-blockers and I can tell you from my experience I have 2 clear favorites: alfuzosin and silodosin. In Thailand these are available as Xatral XL 10mg and Urief 4mg. There are some less expensive versions of alfuzosin but I have found them to be inferior to brand name Xatral. Side effects with alpha-blockers can be high at first, but they tend to rapidly fade away over the first two weeks of treatment as your body adjusts to the therapy. Alfuzosin is idealy taken about a half hour after finishing dinner. Many patients including myself consider alfuzosin to be the superior alpha-blocker because it achieves clinically significant improvement in symptoms without dizziness or ejaculatory dysfunction. Silodosin is a newer alpha-blocker and it is unique in that it has a high degree of specificity for the alpha-1a receptor subtype. The specificity profile of silodosin makes it quite powerful and thus it will have more side effects such as ejaculatory dysfunction also known as retrograde ejaculation. The bladder neck muscle is a sphincter type muscle that sits at the junction between the bladder and the prostate. During normal ejaculation the body will tighten this muscle so that fluids flow out the distal end of the urethra. With a super potent alpha-blocker such as silodosin, the bladder neck muscle will be unable to close fully and ejaculatory fluids will typically take the shorter path and flow up into the bladder. For me and living with BPH for 15 years my regimen has become alfuzosin 10mg daily, half hour after dinner and silodosin 4mg once a week (taken together with the alfuzosin). I find the silodosin 4mg (Urief) to be so powerful that its effects last for days and for my particular symptoms and sleep interruption I don't need more at this time. I would recommend silodosin to any patients who were previously on other alpha-blockers but found them to be ineffective. I'd also recommend silodosin to any patients trying to pass a kidney stone. The other main class of prostate medications is the 5-alpha reductase inhibitors and these include finasteride and dutasteride. These medications work by shrinking the prostate slowly over time through their interference with the conversion of testosterone to DHT. This class of medication is much less effective in patients with smaller prostate sizes. The 5-alpha reductase inhibitors are also high side-effect drugs and can cause loss of libido, impotence, ejaculatory disorder, gynecomastia, depression, anxiety, and increase the risks of a more serious type of prostate cancer. Sometimes these drugs are marketed as combination therapies with alpha-blockers. The medication Duodart is a good example. I'd strongly advise against self-prescribing any 5-alpha reductase inhibitors and I think you can achieve superior therapy avoiding the marketed combination capsules such as Duodart. When the medications are not enough or not tolerated then it is time to evaluate surgical options to reduce the prostate. Surgical options include minimally invasive surgical therapies (MIST) that can generally be performed in a doctors office and all the traditional surgeries such as TURP which generally require some time at the hospital. The list of options for MIST continues to grow and now includes Rezum, UroLift, iTind, Optilume, and various injection types and histotripsy are currently undergoing studies. Though most of the literature describes aquablation as a minimally invasive technique I sure tend to disagree with that. This is generally performed in a hospital setting and In talking to my urologist this technique can result in a lot of bleeding which then needs cauterization. Perhaps it's more advanced, planned and guided than TURP, but in no way would I consider this minimally invasive. Most men, myself included, care quite strongly about preserving normal ejaculatory function. If this is the case you should extensively discuss this with your urologist and ask him in detail about what he intends to do when near your bladder neck muscle. Sometimes I feel like these urologists don't give a <deleted> about your ejaculatory function and just want you to urinate properly for the rest of your life so that you don't damage your kidneys. During a TURP or TUIP these guys will slice and dice your bladder neck muscle making a nice channel up to your ureters to give you a fantastically great flow, but you will never ejaculate normally again. If you don't care about ejaculatory function then don't waste time with the minimally invasive surgical techniques, just get a TURP and urinate like a teenager the rest of your life. I'm not going to discuss techniques for complete removal of the prostate as I really only see that as necessary or appropriate for patients who have a prostate cancer diagnosis. -
15
Dual Pricing in Thai Tourism: Economic Necessity or Hidden Bias?
06.00pm what kind of time is that -
5
2017 Ducati Multistrada 950 Adventurer tourer ( white ) for sale
If I wanted a motorbike, I'd buy a new one. -
34
Warranty case Electrolux - they don't seem to care
This is the sad ending to so many of the things I purchase here. That's why I choose many times to just tackle the problem myself rather than wasting time with the people that are so called experts on the problem. If nothing else it gives me it a reason to buy more tools! -
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