pill^implant^device.. #mechnical

This bpost compares all non-psychological treatments. (… so “devices” must not disappear from the title.)

— Q: why over 17 ~18 May 2023, I experienced such a relief and excitement, that drove me to run 4km in stadium, swim 800m + 100 chin-up?

  • A#1: I confirmed with a SGH pharmacist that 25mg sildenafil (probably) helped me within 15 minutes. My amazing erection was unlikely to be unaided, but that would be a good thing in hind sight. The conclusion raised my hope of “try unaided -> fast pill”
  • … A: Now Spedra is another insurance-approved medication, and very fast.
  • A#2: I had long wanted to try the VED but was put off by a very high risk of dashed hopes. With the insurance approval, I now feel the door is open in front of me. The risk of disappointment is still high, but am emboldened.
  • A#3: I see some (small) hope of multiple effective solutions, fully insured.

— reliability可靠性/consistency .. After speaking to Dr Teo, I am convinced that the implant (and the pump) are truly mechanical, in both the positive/negative sense of the word, therefore guaranteed to work like anything mechanical, treating the penis like an opamp. They are unaffected by psychological factors.

Echoes https://augustams.com/how-does-somatherapy-ed-work/ — “penis pumps mechanically create an erection, bypassing nerve dysfunction, blood flow problems, psychological issues, and other causes of impotence.”

However the pump still needs incoming blood. The implant requires no blood.

ED-ring is also mechanical, but requires a lot of stimulations to get the initial engorgement. In contrast, pills require initial arousal, but subsequently “autopilot”.

How about frequency of intimacy that tends to reduce the strength of erection? I think pump is unaffected, and pill is slightly affected (arousal).

Q: what if the erection is mechanically created but there’s nothing emotional?
%%A: Not a big problem IMO. I guess it would be similar to a long-lasting erection, which can occur due to a ring or a pill.

— the full list of physical (non-psychological) treatments .. https://my-doc.com/sexual-health/erectile-dysfunction-singapore-treatment/ lists:

  • ESWT i.e. shockwave therapy.
  • self-injections
  • surgery
  • pills

These treatments are clinically proven, with documented success rates above 50% (or whatever rate documented). In contrast, all other treatments are clinically unproven, including natural supplements. When I asked Dr Teo, he said not worth trying. In contrast, he gave green light to sex toys.

EddieByGiddy .. is not medically proven, but medical grade.

devices like pumps, rings,,,
pills
ESWT
— self-injection .. most patients get used to using it and find it more effective (fast, more consistent) than oral medications, according to this Sgp clicnic.

Many lay men are horrified by the idea of self-injection, but some drug addicts are turned on by these needles. They feel a temptation, even though the needle brings (mild) pain.

More broadly, yoga, stair climb, mountaineering, endurance cycling, my 5.6k run,,, are painful self-tortures. In my early teenage years, I didn’t understand why people would choose them. Now I engage in these self-tortures myself.

==== implant .. Rather few people around me know the implant, but it is fairly safe and durable (10Y warrantee). Main drawback: irreversible — once the implant is worn out, you won’t get another erection without a replacement implant, since your spongy tissue is no longer present. As such, implant is suitable for me only at an older age, perhaps 60s.

Long development history, dating to 1950s (or earlier)

Each year nearly 25,000 inflatable penile prostheses are implanted in the USA alone.

Highest satisfaction and reliability:

~~ https://edition.cnn.com/2015/06/23/health/penile-implants-erectile-dysfunction/index.html quotes an expert “Penile prosthesis is the only thing that works for almost every man with ED – unlike injections and pills.”

“There’s a real need for penile prosthesis, but this isn’t generally recognized by the public and even some medical professionals…Not being able to have intercourse has been shown in numerous studies to cause low self-esteem depression.”

~~ https://www.mayoclinic.org/tests-procedures/penile-implants/about/pac-20384916 claims that “In fact, penile implants have the highest rate of satisfaction of all erectile dysfunction treatments.”

[20]serenity^zqbx: passive acceptance@bad situation

 


k_tectonic  k_mellow  k_def_of_success

See also

Executive summary of a paradox

  • Serenity .. a positive attribute (valuable and rare). True serenity in the face of adversity requires strength and is often (not always) supported by zqbx. As such, serenity is part of successE and successZ.
  • Passive acceptance .. a negative attribute.. often resembles serenity-without-zqbx.

In this blogpost, my (initial) focus is the widespread passive acceptance of … highly unsatisfactory, barely tolerable or dire situations. Surrender, give-up, 破罐子破摔 are some of the synonyms. These individuals accept the unacceptable (or nearly-unacceptable) and make do with what they have, without zqbx, or trying harder to improve the situation. The most visible example is the homeless beggar, and those sleeping rough in New York city.

On the other extreme, as illustrated through numerous examples in long-term ROTI=rare #600@高考 #Serenity, we should NOT beat ourselves up with unreasonable standards and self-hate. Self-acceptance is paramount. Some call it serenity. Mellow up if you can, and don’t beat yourself up if you can’t achieve it in a reasonable amount of time 🙂

So we sometimes need to strike a balance between ZZ) zqbx, not giving up even in a dire situation vs SS) serenity or self-acceptance of personal limitations. Here, fine judgement is a /rare virtue/. We pick our battles on the really important things. We also pick our battles where we fight to slow down or stop things getting worse. We need the “wisdom to know the difference” between (ZZ) and (SS).

In real life, some wise people might adopt passive acceptance (passive = without zqbx) and display serenity. We are digging into two unrelated phrases with subtle connotations and invisible overlaps. If you don’t want to avoid these two phrases, then you would need to accept and deal with the /messiness/.

In all the challenges listed below, whenever I choose ZZ, my personal-effectiveness shines through (interpersonal effectiveness seems to be less valuable). Over time, the difference between the proactive and the passive can become insurmountable. I’m far from the perfect role model, but my efforts were huge. My endurance was remarkable in the face of repeated setbacks. Thomas Edison said of his light bulb “I haven’t failed — I’ve just found 10,000 that won’t work.

— eg: EDyw .. Non-penetrative or fortnightly/monthly felt like poor choices, like those highly unsatisfactory, barely tolerable choices. How about the current weekly frequency?

I am adopting the zqbx attitude, esp. in exercise and active calendar management.

— eg: summer sleeping mats .. many disappointments with ice crystal cushions, bamboo, straw, synthetic rattan mats, and even plastic-straw mats,,, so my expectation (of their value) was reduced over and over again, so I wasn’t keen to re-consider them. However, some (not all) the cooling mats can alleviate a common but bad situation — growing dependency on A/C. Does it make a real difference? I think it can reduce the number of days I turn on A/C, by 5%…ctbz.

— eg: wordpress.com block editor… The company made it look like new editor is so entrenched as to wipe out any hope of using the classic editor. I was passive in my acceptance of this fate. Then I became proactive.

Harmony? I chose SS after trying for a long time. Serenity would be needed iFF no choice.

— defining eg: Singapore government didn’t accept congested city centers, runaway housing cost, tap water quality, seasonal flooding, declining standard of Chinese, limited local talent pool, over-reliance on MYS water supply, (During covid19) ICU shortfall, overwhelming workload of contact tracers, hopeless prospect of containment, growing threat to nursing homes … which many governments gave up on and accepted. SG leaders took actions , often over decades, to reduce each of these problems. Serenity? Irrelevant.

— eg: math practice — many math students accept that some problems are too hard, so they give up. In contrast, XA.S’s attitude is like zqbx. Also many girls (and some boys too) in my primary and secondary schools put in more practice and improve their pattern recognition. I’m somewhat more skilled than most students, so I didn’t need so much practice, but there are some topics that required me to practice a lot.

Jolt: I also accept that some topics and some problems (like competition level) are too hard for me , but only after I put in a lot of effort.

UChicago MSFM .. at age 42 my attitude was roughly the same. I sank in 30-40 hours a week, and then accept that some homework and past exam problems are too deep too hard and my understanding remained shallow and unconnected, esp. on FixedIncome. Did I give up? Not sure. I think I basically chose a time limit. Any additional effort would have taken up too much time and produced diminishing return.

Serenity needed…

— eg: Coding drill is similar. However, virtually all the web2.0 style coding questions can be solved in 45 minutes, not as hard as the toughest quant problems.

The situation is very bad for some older programmers as they couldn’t pass any speed coding test, or pure-algo test, or weekend assignment.

Harmony? They can choose either zqbx or serenity. Serenity smells like passive acceptance. I choose SS i.e. Serenity but not giving up completely.
— screen time .. I now perceive it as tolerable. XA.S (math!) seems to accept it
Harmony? I choose SS i.e. Serenity, but not giving up completely.

==== household living
existing A/C trunking .. I think most people would (passively) accept, due to high cost.
I think we have to accept the total cost of ownership of indoor cooling.
staying on low floor .. For years, wife accepted the unsatisfactory living conditions including smell (smoke), dim lighting, downstairs noise, pests.
— silver-colored personal chopsticks .. I prefer uniquely-colored chopsticks for unshared usage, but the silver-color drying rack makes my chopsticks hard to find. For years, I didn’t think of improving it. Now I use a unique dark color .. elegant solution.
— on many short pants

  • side pockets too wide-open for cellphone .. for more than a year I had to keep my phone in (more secure, less reachable) pouch or backpack
  • no hook for access cards.. For years, I accepted it, and had to clip my access cards on insecure belts.

==== career
— eg: SY.C said a friend in his 50s got a SWE job offer from Citadel .. Harmony? I choose SS more than ZZ.
— eg: Sunil was unsatisfied with 1) his AVP and the 2) underwhelming prospect of dotnet. Most people in his shoes would accept it, but Sunil took actions over many years and eventually broke through.

Similar eg: my java-}c++ transition, and web2.0 CIV — 99% of us find it hard to cross the moat. Most accept the result and give up. No shame. I didn’t give up on c++. I gave up on HFT interviews. Web2.0 CIV is within reach but am not in a hurry.

Sunil’s and my situations were sub-optimal but not really an example of hardship and passive acceptance thereof.

Harmony? a balance between zqbx and serenity.
— career longevity .. After talking to Miles Yang and XA.S, I felt most of my peers don’t have my dev-till-70 in the WStC harbor
Harmony? I choose ZZ, but I think my peers’ acceptance is not passive.
— job insecurity at a particular place — In today’s economy, most adults experience job insecurity at some points in their adult life. It’s more clearly felt for techies. Most of us accept the anxiety, the fear, the tangible potential impact on our families, and accept it as the norm. “This is the world we are in”. The individuals in ## Not alone2hit job loss were less worried than I was.

I worked very hard for decades, devising and strengthening my dev-till-70 plan for WallSt. Today, I feel more prepared, more confident than that majority I described.

I also learnt my lessons from my false starts, which tend to kill our long-timer plan. I think these disappointments define me and my peers. Some (who?) are even more resilient than me.

Harmony? I choose ZZ because I can.
— long commute .. most of my peers (NYC commuters) accept long commute with serenity
Harmony? I choose SS after deciding on the commute total cost.
— bench time — Probably half the adults in the developed countries I know are pessimistic about bench time after job loss. Jack Z is one example. For techies, median bench time is probably 2M+. One-month is considered rather quick. The higher your salary, the longer you need to sit on bench. These individuals (my sis?) accept it with serenity. In contrast, I choose ZZ. I work very hard to build up my cushions including

  • embrace 70% pay cut just to go out and work
  • constant interviewing even when not job hunting

==== wellness
intimacy ..for years I accepted (passively) the underfucked life, and frequent derailers to my intimacy. I have multiple emails, blogposts such as Xmas2021
— BMI — Rahul was very determined and in-control, but he might be somewhat overweight. Many of my colleagues are overweight. I tend to assume they have poor control over diet or exercise, but I could be very wrong. I think they accept it. Most people don’t i understand why I work so hard towards deeper-green zone. However, I did accept my weight may not go down to 61 kg again. This acceptance is sub-optimal but not unacceptable.

Some slim individuals are not really better at self-control. I guess some of them are just lucky. I have many colleagues who said they are unable to put grow “stronger”.

This “control” is central to successZ, but if our body “system” is hard to control, then I think we need serenity.

Harmony? I choose non-passive acceptance, and mellow-up. Not really serenity. In fact, I think non-acceptance and zqbx is better for some individuals in my cohort.
— supper — I accepted that I would feel hungry if 1) i’m awake at 11pm and 2) there’s food at home beside fruits and veg.
This acceptance is non-ideal but remember my breakfast skip, delayed lunch and dinner. Overall, this is not an unhealthy habit.

Crucially, instead of surrender I fight a bao3shan1 battle by controlling starch and following late-sleep diet tactics 

There is some harmony in this battle. I choose ZZ but not extreme. There’s some crucial element of SS.
— workout 3/week — Most adults have inadequate workout, partly due to lack of time. They accept it. They point at “lower” societies (earlier, primitve or less developed), and conclude that in our advanced society, lack of physical activity is normal. I take it more seriously than the majority but only since 2018.

As of early 2020, I now accept 2-4 times a week for myself. I would say 1/month is barely acceptable and 1/wk is decent.

As of Oct 2020, I now push myself towards 5 times a weekI choose ZZ because the barrier is not so high.
— G3 defining example: yoga —  Most male adults have insufficient flexibility, but they accept it and put it aside as lower priority compared to strength, body shape, or endurance. Yoga is hard for me, but I take it very seriously.
Harmony? I choose ZZ, because my goal is high but feels achievable.
— pull-up — Most guys can’t do 10. The overweight guys can’t do one. They accept it. Similar to yoga, Pull-up is always challenging for me, but I don’t give up. I live with that sense of challenge, self-imposed pressure.

If you are overweight, then self-hate is counterproductive.  But don’t give up. Assisted pull-up is the way to go. Here is a good illustration of the balance between passive acceptance and self-hate. Zqbx vs serenity. I choose ZZ, becasue I can.
— G5 best example: belly fat — As described in why I feel successful, most guys above 30 have a visible belly and most just accept it. In this case, I didn’t have an uphill battle, but if I don’t exercise control, I’m sure to grow a belly.
I choose ZZ.
— longevity goal .. most of my peers seem to target 85. It’s not an unacceptable target. But I don’t accept it. I choose ZZ.
==== pff .. my favorite and strongest domain, so I won’t talk too much about myself.
— savings for retirement — Most adults seem to worry that they have insufficient financial resources to support their desired retirement lifestyle. (I suspect many realize retirement burn rate is much lower, like $2k/retiree.) Anyway, most seem to accept it and take almost no action.

I should ask those endowment salesmen “How many percent of the respondents actually feel well-planned for retirement?”
— savings rate — Most adults (my sis included) accept a brbr below 3/2, i.e. they save less than 1/3 of income. They seem to accept “saving 50% is too hard and unnecessary for me”.
Low saving rate is not a dire situation until a pandemic. OCBC survey shows 70%Singaporeans can’t last past 6M if jobless, due to insufficient savings.
— mortgage — Most buyers accept as unavoidable — “Except the super-rich, who else can avoid a mortgage”. I think they can, provided they save up higher, and buy lower as I did.
Well, mortgage is non-ideal, but not a hardship.
Harmony? I choose ZZ i.e. non-passive acceptance. I don’t give up.
— ECR 8% per year — I don’t think it’s common, so I choose SS.

##EDyw: underly`healthConditions

EDyw experience and the ensuing fear could be a powerful negative feedback for the “opamp” .. to reduce harmful lifestyle habits and  eliminate hazards and roadblocks.

— tobacco
— alcohol
— coffee
— hypertension
— t2dm
— workout .. is proven to reduce risk of EDyw.
Workout also reduces persistent stress, and improves blood circulation.

— BMI.. Hopefully, this awareness, this knowledge can motivate us to improve our BMI
— protruding belly .. affects penetration and can increase likelihood of Edyw

non-penetrative

Non-pen intercourse is highly recommended for older people, as penetration becomes increasingly difficult. You can use medication or workout to fight it (zqbx) or consider alternatives (like non-pen), with a sense of serenity. I think it’s not passive acceptance.

Now at age 48, I feel luckier than in my 30s. At that time, non-pen ejaculation was utterly fake, ineffective for the main purpose of intercourse i.e. procreation.  It felt bad even if it was satisfying and met the sexual needs.

pill t$cost #+!bx

— due_diligence: tCosts

  • visit and queue up at SGH pharmacy or TTSH pharmacy
  • claim from Cigna .. Perhaps Shenton clinic is cashless

— due_diligence: $Cost

Over the long term, cost is sure to become more important as we age. Insurance will eventually become “excluded”.

Spedra has no generics. Four 200mg doses cost $92 from Guardian. To get $80 from TTSH, you need polyclinic referral. At SGH pharmacy, you can get $71.56/4doses even with my Urohealth prescription. The lower dosage versions would presumably cost less.

generic-Viagra is the best example of low-cost, and good quality.

Guardian has generic-Viagra (no generic-Cialis) — 100mg 4 tabs for $44.4. Unity $70/4x100mg. Both pharmacists said the pill can split into two halves to achieve 50mg dosage… can store long-term in a tight container.

I think Viagra is the most used ED pill partly because it is the most time-tested, and most affordable. Spedra with fewer side effects, is 15-minute-fast, the newest and fanciest i.e. high-end.

generic-Cialis is “mid-high-end”. 20mg  SGD 9.94/pill ($39.76/box) at SGH. The lower dosage versions would presumably cost less.

TTSH accepts Rx from subsidized clinics including polyclinics and SGH. For those non-subsidized prescriptions, I can warehouse for a year and use at SGH.

⮦single pill #generic UOS SGH#any Rx TTSH#subsidized Rx Watson Guardian [3]
sildenafil 100mg 44c/tab,$1.77
/4doses
60c/tab 9.49/tab $11.1/tab
sildenafil 50mg 40c/tab NA NA
tadalafil 20mg $9.94/tab no generics
Spedra 200mg #no generic $17.9/tab $20 NA $23.4

Q: will I ever buy at a _nearby_ pharmacy?
%%A: Yes for Spedra, the additional cost is minor. [3]At Guardian, you can pick up within a week, or you can buy on the spot at Takashimaya/Paragon/NovenaMtE
%%A: fastest 🙂 photocopy prescription reusable 🙂 … but higher cost when it comes to insurance claim

— (with t$cost implications) SGH digital prescription (no hardcopy needed) ..  is valid within a year from consultation date. You can pick up medication via two routes:

1) HealthBuddy  -> can retrieve the prescriptions (no need to keep paper copy :). You can order a specific quantity to be delivered to home, within a week. If inconvenient to wait at home, then collect from Guardian TPY #1-578.

In Sep 2023, my HealthBuddy can’t run. Hopefully wife can run it.

HealthHub is an APP for multiple hospitals. Also can order medication. Better log in by passcode (17xxxxxx) first, then singpass.

2) bring NRIC (can retrieve SGH prescriptions) to SGH pharmacy and wait for about an hour to pick up .. faster before 10am

👎 not as fast/convenient as TTSH or commercial pharmacies
🙂 no need to safe-keep paper prescriptions
🙂 with HealthBuddy, no need for a trip

— (with $cost implications) split and storage ..

My concerns would pressure me to consume that half quickly.. an unwanted pressure. Better go with the 50mg generic.

Some sildenafil pills are designed for 4-way split. Unused quarter an be kept in a tight box away from moist or sunlight, below 25 degree-C. I think fridge would prolong the shelf-life, provided no moisture goes in.

Spedra also can split. Minimum dosage 50mg. Better buy 100mg tabs, perhaps from SGH
Q: For 200mg, how do you split 4-way?
A: very hard, even if you are willing to discard debris.