Q: Ads for erectile dysfunction drugs always warn that "if you have an erection lasting more than four hours, see a doctor." So I have to ask, what are the chances and what makes it happen? -- Terry F., Sacramento, California
A: The condition is called priapism, and it is its own form of erectile dysfunction. A healthy erection happens when the penis fills with blood, becomes erect and then relaxes after an ejaculation, as the blood drains back into the circulatory system. Priapism occurs when the blood from the erection remains trapped inside the penis after it's held up its end of the bargain. Priapism can be quite painful, and may cause long-term nerve damage.
Most of the ED drugs you see advertised on TV are pretty well-tolerated, and there's not much risk that they'll trigger priapism. According to one study, in the U.S. for every 100,000 trips to the ER by guys, only about eight of them are concerning priapism. But that study also revealed that priapism is 10 times more common in the U.S. than in western Australia.
It could be that our male population takes more ED drugs. Also, in the U.S. one of the more-common reasons for priapism is sickle cell disease; it causes deformed red blood to get stuck in the penis, maintaining an erection. Sickle cell affects about 1 in 12 blacks and causes about 20 percent of ED cases seen in the ER. But more research needs to be done to find out what causes it in all cases.
If priapism does happen, there are effective treatments: Medications can be injected that help the blood drain, or stagnated blood can be extracted with a large needle.
And if you are thinking about taking an ED medication, talk to your doctor about its risks and benefits for YOU. The medication has been life-changing for many couples, and many who use it feel lucky that it's available when needed.
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Q: When my boyfriend started a job in a veterinary office, he got a rabies vaccine. Now he tells me that I need to have my cat vaccinated against rabies, too. Is that really necessary? -- Kimberly J., Rye, New York
A: It was a very good idea for your boyfriend to get a rabies vaccination, since he's working with animals all day. And by the way, Westchester County (which includes your hometown) ranks No. 1 in rabies cases in New York state.
You're required by state law (they vary from state to state) to have your cats, dogs -- and ferrets! -- vaccinated against rabies. And it's the widespread vaccination of pets that's made human rabies rare in the U.S. These days, nine out of 10 rabies cases in people are from wild animals, and half of those cases are from raccoons. You may remember in 2013, just down the road from you in New York City's Central Park, over 30 raccoons tested positive for rabies. (The sick raccoons were euthanized.) Out on Long Island, a vaccine-laden bait trail has immunized raccoon populations. These programs protect not just people, but their pets and other wildlife. There have been only 55 cases of rabies diagnosed in people in the U.S. since 1990.
The reason we do a pretty good job of keeping a lid on rabies fatalities here in the U.S. is because folks do get their pets vaccinated, and if someone gets bitten by a rabid or potentially rabid animal, a series of life-saving rabies vaccination shots are available.
Travelers alert: In Asia, Africa and Latin America, however, rabies is a big problem. A highly regarded study just out from the University of Glasgow reports that worldwide, almost 60,000 people a year die because of rabies transmitted just by dogs. But besides dogs, coyotes, raccoons, bats, skunks, ferrets and foxes carry the virus. Untreated, it's fatal. So make sure your pets are vaccinated, and you and your boyfriend can start a new tradition: celebrating World Rabies Day, Sept. 28.
(Mehmet Oz, M.D. is host of "The Dr. Oz Show," and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. Email your health and wellness questions to Dr. Oz and Dr. Roizen at [email protected].)