Leading a sedentary lifestyle is a major risk factor for several diseases, including obesity, heart disease, stroke and diabetes. Vigorous exercise that makes you huff and puff and break out into a sweat is one of the best ways to raise your levels of HDL “good” cholesterol and lower LDL “bad” cholesterol. Studies have shown that exercising for approximately 30 minutes, between three and five times a week elevates HDL cholesterol levels.

Regular physical activity helps to keep you lean, and improves blood sugar control, thereby reducing your risk of developing Syndrome X and diabetes. Aerobic exercise also strengthens your heart and makes it more efficient. If we exercise regularly, our coronary arteries expand more and are wider than the arteries in people who do no exercise. This means our heart gets a better blood supply and we are less likely to suffer with a heart attack.

Smoking:

Smoking is a well known major risk factor for heart disease, and several other diseases. It is capable of raising LDL cholesterol as well as blood pressure levels. Nicotine stimulates the release of the stress hormone adrenaline, which in turn stimulates lipolysis (fat breakdown) and increases blood levels of free fatty acids. These then stimulate the liver to release VLDL and triglyceride into the bloodstream. Smoking may lower levels of the protective HDL cholesterol, and chemicals in cigarettes cause damage to the artery walls, making it more likely for fat deposits to accumulate there.

Smokers have a 70 percent greater chance of dying from coronary heart disease than non-smokers. Smoking doubles the risk of having a stroke, and women who take oral contraceptives and smoke have a ten times greater risk of having a heart attack. However, there is hope because according to the World Health Organization, the risk of having a heart attack, stroke or peripheral artery disease drops significantly after the first two years of quitting.

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short-term Incapacity Benefit at the lower rate for up to 28 weeks;

short-term Incapacity Benefit at the higher rate from weeks 29 to 52;

long-term Incapacity Benefit after the end of 52 weeks (this is the highest rate).

If you are not expected to recover from your cancer then after 28 weeks you may qualify for the long-term rate. Depending on how serious your cancer is, you may find you are advised to apply for this level of benefit by virtue of the very nature of your treatment and the uncertainty which often surrounds the prognosis for someone being treated for cancer. It can still come as a shock to be classified as ‘terminally ill’ for the purpose of State benefits – do not feel you are being written off.

Any savings you or your wife or partner have do not affect your entitlement to Incapacity Benefit. However, this benefit does count towards your ‘taxable income’.

If you do not qualify for Incapacity Benefit because you have not paid enough National Insurance contributions, you may be entitled to Severe Disablement Allowance.

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A fear of death is natural and inevitable, whatever your circumstances. Part of the process of coming to terms with your diagnosis is the fear that cancer is potentially a life-threatening disease, and that you are the person under threat. This is not at all the same as saying that all men with cancer have only a short remaining life span. It is rather that the experience of shock, disbelief and negative feelings is one of the stages of adapting to life with cancer.

As a society we shy away from talking about death, to the extent that it is regarded as a taboo subject. We use euphemisms such as ‘passing on’ to soften our words, rather than the harsher and final-sounding ‘died’. Discussing death is difficult and you may struggle to find the right words to express how you feel, wanting to acknowledge the seriousness of cancer yet avoiding brutal and harsh words: ‘This looks very serious and I’m frightened about the future’ or ‘I’m afraid the future is not looking too bright for me at the moment’. Your family and friends will find it a difficult subject to approach too, and you may find that some are unwilling or unable to discuss it. Responses like, ‘But you’re looking so much better, you’ll be well in no time’ or simply ‘Don’t talk like that’ can feel like a rejection of your need to talk about your fears. This is not a reflection on you, but an indication of other people’s inability (because of their own fear) to put your feelings before their own.

If you are willing to talk about fears for your prognosis, you may find that sympathetic family members and friends are relieved to have the opportunity to confide in you their own worries about your future, their fears of losing you and what that would mean to them. This can bring about some very emotional exchanges, but they can also bring huge relief that the subject is ‘permitted’ and that they can say what they really feel.

At times your feelings may become overwhelming and it is very important to have an outlet for them. If you do not feel able to talk to your close family or friends, then do try to speak with your doctors or nurses. They will be happy to spend time with you or to arrange for you to speak with a counsellor. Bottling up emotions on such a traumatic subject will not help you, either emotionally or in your efforts to maintain physical strength.

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close family members;

close friends;

your employer, if appropriate.

Basically, those people who you are closest to and who will be most affected by your cancer. The process of contacting people may take some time: devoting whole days to speaking with your family and friends is unlikely to feel like an easy option. Explaining the details of your diagnosis is a draining and emotional experience, and while many people will want to spend a lot of time with you or talking on the phone, you may want to keep your conversations quite short. You may also start to feel that you have related your story so many times that you can’t bear to have the same conversation yet again. Don’t rush the process, and consider who you want to see personally, who you can contact by phone, and who you can write to: this will help to spread the workload.

News travels fast, and you may find that your wider circle of friends, acquaintances, colleagues and so on become aware of your cancer sooner than you expect. If you want to restrict the news only to those people you tell personally, then do not be afraid to ask them to treat it confidentially, and explain to them that you do not yet feel ready to tell the world at large.

Assuming you are well enough to be mobile and go out of the house, you cannot avoid meeting people – neighbours, acquaintances, contacts – who do not know about your cancer. When people ask how you are, it can be difficult to know what to say: Should you deflect the situation and not tell them, or do you say, ‘Not too good – I’ve got cancer’? Your reaction will probably vary depending on how you feel that day. Remember that the most important person in this situation is you, and you are not under any obligation to pass on the details of your cancer to all and sundry if you do not want to.

Inevitably, tricky situations will arise when you meet people who are not aware of your cancer and who comment, for example, on your physical appearance. It may be that you lose your hair temporarily while undergoing chemotherapy and an acquaintance comments on your ‘dramatic haircut’, or on the fact that you have lost weight or don’t look as well as when they last saw you. Comments like these are not intended to be malicious or hurtful, but they can cause distress. Most people are deeply embarrassed and upset when told the actual reason for your bald head or your weight loss – if you choose to tell them. There is no formula for dealing with these situations, but it does become easier as you become more accustomed to talking about your cancer.

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digestive system, including the mouth. You may experience some nausea or sickness, although this depends on your drugs and can also vary from person to person. In any case, you will be offered anti-sickness drugs, which are extremely effective for many people in preventing sickness completely. It is important to stress that chemotherapy does not necessarily cause sickness, and that many patients nowadays have none at all. Your bowel habits may also be affected: diarrhoea and sometimes constipation can be caused by the effects of chemotherapy drugs. You may also find that your mouth becomes very tender, or that you develop mouth ulcers;

bone marrow, which produces new red and white blood cells and platelets. You will have regular blood tests throughout your treatment to monitor your ‘blood count’. If your red blood cell count is low, you may find that you become very tired, as the amount of oxygen being carried around your body is less than normal. This can be successfully treated by a blood transfusion. If your white cell count is low, you will be more prone to infection than usual, as the white cells are responsible for fighting off bacteria. This can be treated with antibiotics, if necessary. If your platelet count is low, you will find you bleed more than usual from minor cuts, and bruise more easily than normal. This can be treated by a platelet transfusion, which will help your blood to clot more easily;

hair. Some – although not all – chemotherapy drugs cause hair loss, which many people find a very distressing prospect. This is probably the most widely known side-effect of chemotherapy because it is so visible. However, it is not the case that all chemotherapy drags cause hair loss, and you should check with your doctor rather than assuming this will happen to you. Perhaps one of the reasons people find hair loss difficult to face is that it provides a constant reminder of your cancer, even if you are otherwise feeling relatively strong and well. Your hair will start to fall out a few weeks after your chemotherapy starts, and it will almost always grow back again once your treatment is completed.

There may also be more specific side-effects associated with your chemotherapy drugs: the staff who are nursing you will discuss these with you before your treatment starts.

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There has been much debate about the contribution of diet to the development of bowel cancers, and it is thought that too much saturated fat and too little fibre do increase the risk of bowel cancer. Your bowel habit can play a role: chronic constipation can be a contributory factor to bowel cancer. Family history is a very important factor in some cases.

Cancer of the bowel can be difficult to detect in its early stages, as the warning signs can be easily overlooked. The symptoms you may notice include blood in your stools, a change in your bowel habit to diarrhoea or constipation and abdominal pain and swelling. Blood in your stool can, of course, be caused by other conditions such as haemorrhoids – but you should still consult your doctor to check.

The diagnosis of bowel cancer involves physical examination, testing of the stool to check whether blood is present, a barium enema X-ray to look at the bowel in more detail and usually further scans to check whether any spread has occurred.

Surgery forms a major part of treatment for cancer of the bowel. Since the aim is to remove the tumour completely this may involve removing a significant portion of the bowel itself, depending on the size and position of the tumour. This may lead to a need for a temporary or permanent colostomy or ileostomy (these are discussed in Chapter 3), so it is very important to discuss the extent and nature of surgery in detail with your doctor to ensure that you fully understand the likely results and implications. If the cancer is still in its early stages, then surgery may bring a complete cure – although it will be some years before this can be confirmed. Radiotherapy may also be considered, usually in addition to surgery as a follow-up treatment, as may chemotherapy.

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First, let’s look at what we mean by men without partners. This is not a homogeneous group. A man who is recently divorced may be without a partner, but he has a history of social contact and intimacy with at least one woman. On the other hand, a man whose partner refuses to participate in therapy is alone in his quest for improvement, but is in a very different situation from the divorced man. Some therapists have noted that men in long-standing relationships whose lovers will not participate in treatment are least likely to improve. Problems in the relationship itself may be preventing the couple from dealing with sexual difficulties successfully.

And single men with erection problems who are socially inhibited can improve their communication skills and their potency in group therapy. For example, California therapists gave group members homework assignments emphasizing sensual pleasure (at first without intercourse), social skills and fantasy exercises. Learning about normal changes in erections was an important component of the therapy. Because female therapists participated, the men were able to role-play situations with women and then use their newly-developed communication skills in their private lives. At the conclusion of the therapy, 90 percent of the men said their erections were improved. Because these men had learned how to communicate more freely, the authors say, their erection problems decreased.

When it comes down to basics, communication is the primary key to satisfying sex. And if a therapist can help improve your style of communication, he can probably improve your sex life too.

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One of the best, and mutually satisfying, ways to reignite libido is to rediscover the pleasures of touching. Dr. Robert Broad suggests that partners need to steer away from focusing on the act of sex itself. “There are other ways to use tactile communication with your partner,” he states. “Zero in on touching, one of the most powerful components of human sexuality. Using tactile communication, including kissing, caressing, and petting, just as you did in early courtship, will help you to reexplore sexual sensation and bond you together. They can amp up your sex life because of the tremendous numbers of sensory receptors that are in the skin.”

Sexual researchers, therapists, and counselors have found communicating with your partner through increased touching to be one of the most effective means to expand intimacy and add vitality to a sexual relationship. Many couples find that giving each other a massage is a great way to enhance their mutual attraction as well as boost libido.

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As we age, the cumulative effects of this endless process begin to take their toll. Study after study has shown that free radicals increase the risk of all cancers, including that of the prostate. Free radicals also oxidize LDL (low-density lipoprotein) cholesterol on artery walls, producing a build-up of deadly plaque. If no intervention is made, the endothelial lining of the arteries is damaged. It is this impaired endothelial function that is believed to precede hardening of the arteries, which is the leading cause of heart attack.

Unstopped, free radicals have the limitless potential to harm every part of the body, including the arteries of the penis. However, there is an arsenal readily available that can stop free radical damage. Antioxidants can halt the injury that free radical molecules have wrought, and then repair cellular damage.

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In the upcoming years, the next generation of sexual pills will be available. They, like their groundbreaking predecessors, will allow a man to perform when he wants to, but with a very significant and potentially unsettling difference. Those pills will circumvent his “emotional system.” Unlike the present oral medications which require a physical attraction to a partner, those newer drugs may not. Some may affect chemicals in the brain, as opposed to the present pills which work in the penis. Other experimentation is ongoing. Studies currently being conducted may provide gene therapy to control ED via injections administered two or three times a year.

All of these interventions bring us to a new place in our culture. Today, we are on the cusp of a sexual revolution whose implications we can only begin to imagine. Those effects, both long- and short-range, are going to have a mighty impact on both sexes. Men have their own problems and perspectives about ED and its treatment. For women, however, there are different considerations and worries.

We know that the lives of millions of women have been altered by ED. So, it is very important to acknowledge that its presence and treatment can touch a woman in profound, and even disturbing, ways. For many women, this is the second time they have to deal with a pill that affects their own sexuality. Only this time, a man is taking it.

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