This swollen knee led to a viagra prescription
When reactive care becomes proactive care
He walked in with nothing more than a swollen knee.
Just another everyday ache that seemed straightforward to fix.
But by the end of our consultation, we weren’t just discussing his joint. We were navigating uncharted territory about his heart, lungs daily habits and his sex drive.
He woke up in pain without an injury.
By the time I saw him, he had already taken over-the-counter anti-inflammatories and applied an ice pack.
I told him to keep up with the ice packs, rest it, and give it a few weeks to settle. If it didn’t improve, we could look into doing more tests.
If this were a purely reactive medical system, the consultation would have ended right there.
The routine visit took an unexpected turn
Just as we were wrapping up the knee discussion, he mentioned wanting a blood test. I asked if there was anything specific he was worried about.
“I’ve got no sex drive,” he said. “I don’t get erections anymore. I spoke to another doctor about it, but he just said it’s my age”.
The reality is, it isn’t just age. I have patients with very active sex lives in their 80s, so Dave, in his 50s shouldn’t be accepting this.
This was frustrating for him, affecting not just him as an individual but his relationship with his partner.
When a man experiences erectile dysfunction or a loss of morning erections, we have to look past this symptom. Erections are fundamentally a blood flow issue.
The blood vessels that supply the penis are very small. When a patient develops narrowing or stiffening of their arteries. It’s a process called atherosclerosis.
The smaller vessels to the penis are often the first to experience reduced blood flow.
Erectile dysfunction is the canary in the coal mine.
It’s the red flag that blood flow is compromised.
And if blood flow is compromised down there, it is highly likely compromised in the arteries supplying the heart and the brain.
This is what I believe holistic health looks like.
I asked him about his lifestyle. He’s a smoker, but has taken significant effort to improve his exercise, and is hitting weekly targets across different sports that enjoys.
His could certainly be improved, but he’s early to bed, early to rise, getting 7 hours a night, feeling energised in the morning.
We talked about his past history of atrial fibrillation, and noted the current medications he takes for his heart.
We weren’t just dealing with low libido and erectile dysfunction for Dave, we are also dealing with a higher risk cardiovascular profile.
A note on testosterone:
We seemingly can’t explain why testosterone is falling male populations.
But for a large part of this we can; expanding waist lines put people at risk of metabolic syndrome.
This is a condition characterised by raised cholesterol, high blood glucose (diabetes), increased weight and waist circumference, and a fatty liver.
And metabolic syndrome is rising in the population, so there’s no coincidence we are noticing falling testosterone levels globally.
Have you ever walked into a doctor’s office and asked them to ‘test for everything’?
When it comes to blood tests, we need to target them. So often patients come in say “test for everything”, but with such a wide range of tests, this doesn’t make sense.
Even though we’re doing a broader health check we do have to consider what is going to be useful and relevant.
Blood tests included an androgen profile to check his testosterone levels in case this was contributing to his libido.
With his wider waist line and higher risk of metabolic syndrome I know that his risk of testosterone deficiency is higher.
His blood tests included cholesterol, his prostate (PSA), kidney and liver function, thyroid and a diabetes check (Hba1c, which approximates an average blood glucose level over 3 months).
We’re moving from reactive to preventative care.
It’s very easy to write a prescription for Viagra and send Dave on his way. But this would only treat the downstream cause of his erectile dysfunction.
Let’s face it, this isn’t just the easy option for me, but it’s also the easy option for Dave. But it’s also appropriate to consider this to help treat some of his symptoms.
To consider going deeper, asking why, and addressing issues further upstream there’s the opportunity for a longer term impact.
It’s also a wider-reaching one, because when we go further upstream, we might be able to help prevent other conditions, including heart attacks, strokes and even dementia.
Handing out a pill without investigating the underlying cause is a missed opportunity.
It patches the immediate problem while ignoring the ticking time bomb of cardiovascular disease.
Lost libido, or erectile dysfunction?
There’s a difference between libido and erectile dysfunction.
Libido is a loss of interest in sex, whereas erectile dysfunction is the inability to maintain an erection.
As a clinician it’s essential to look at Dave’s lifestyle if I want to support his health.
Frankly this is not ignored, but poorly understood and often little focus, time or thought is given to patients.
The more time we as doctors give to this, the higher its importance we can convey to patients too.
He wanted to quit smoking but struggled with the intense daily habit of it.
We had a frank, open discussion about how to break the cycle, and he’s getting close to stopping smoking now.
Stopping smoking conversations take time and repeated conversations with practitioners.
Time and time again I have noticed people are very ready, and it just requires a nudge from a health professional to support them with this.
In Australia, nicotine patches are funded on the PBS scheme for up to 12 weeks per year. Alongside support and counselling I have noticed continued demand for this approach.
There are also other medicines available which support patients in stopping smoking.
The Australian system is now supporting preventative care, because it reduces costs for patients.
Because he has a long history of smoking, he is now eligible for the newly rolled-out national lung cancer screening program.
Within eighteen minutes, we addressed his knee, evaluated his cardiovascular risk, built a realistic smoking cessation plan, and set up preventive lung cancer screening.
A note on lung cancer
In Australia and the UK, lung cancer is one of the most common causes of cancer-related death.
Screening programs can find lung cancer early, when it’s easier to treat, which lead to better outcomes.
Unfortunately lung cancer globally remains extremely difficult to treat and much lower chances of survival than other cancers, often because it is picked up so late.
The National Lung Cancer Screening Program may pick up cancers earlier, especially for people who are at higher risk, like long-term smokers.
It also appropriately incentivises doctors to take action.
The healthcare system in Australia pays us for the extra time we spend with patients.
It pays us to consider long term risk of heart attacks and smoking.
And it enables us to be paid to deliver prevention medicine and support healthy ageing.
For anyone interested in helping to prevent illness rather than treating them, the Australian system is gearing up not just to treat chronic disease, but prevent it, with public health actually backed up by doctors on the front line.
No doctor should force their patient to do anything.
Preventive medicine relies heavily on shared decision-making. I explained why we were checking his cholesterol alongside his testosterone.
I explained how the patches work and let him choose his own quit date. When patients understand the reasoning behind their treatments, they are infinitely more likely to engage with them.
He didn’t just receive medical advice; he received an education about his own body. He now understands that his lack of morning erections isn’t a failure of getting older.
It is a warning sign and he has the power to take charge.
Practical Takeaways for you
Whether you are a patient navigating your own health journey or a clinician helping others, there are clear lessons to take away from this story.
For Patients: Take Ownership of Your Health
Do not accept “it’s just age”: If something feels wrong with your body, push for answers. Symptoms like chronic fatigue, low libido, or brain fog are often brushed off as aging, but they can signal underlying metabolic or vascular issues.
Think holistically: Your body is a connected system. Your diet affects your joint pain, your stress affects your blood pressure, and your blood vessels affect your sexual health.
Ask for preventive screenings including for a ‘heart health assessment’: Don’t wait until you have a heart attack to check your cholesterol. Ask your doctor about a comprehensive cardiovascular risk assessment, including detailed lipid panels and blood glucose checks.
Have the awkward conversations: Doctors have heard it all. Well, mostly. If you are struggling with sexual dysfunction, mental health issues, or bowel habits, mention it. It might be the missing puzzle piece your doctor needs to protect your long-term health.
For Clinicians: Adopt a Patient centred Approach
It’s at the end of the consultation: Often, a patient’s true concern comes out right at the end of the consultation. Be ready for it, it’s no mistake it happens at the end, as people are often bringing up the courage to mention it.
Look past the primary complaint: A knee pain consultation is an opportunity to check blood pressure, review medications, or ask about smoking status.
Empower through education: Take the extra two minutes to explain why a symptom is occurring. When you connect erectile dysfunction to cardiovascular health, you immediately increase the patient’s motivation to quit smoking and improve their diet.
Create time at future appointments for prevention health
So next time you go to the doctor for your swollen knee you might just end up with a prescription for viagra; while we look towards the root cause.
That’s holistic care.