vimax penis enlargement surgery

Surgical castration by orchidectomy Surgical castration is the simplest and cheapest way to treat metastatic prostate cancer. The obvious disadvantage is the psychological effect of the loss of the testicles. LHRH-analogues LHRH-analogues and oestrogen achieve a "medical castration" by stopping the testicular production of testosterone. LHRH-analogues are injections that have to be given monthly or three monthly for the rest of the patient's life. They are effective but very expensive. Oestrogen Oestrogen can be taken orally on a daily basis. It has a high incidence of thrombotic complications such as stroke and myocardial infarction. Anti-androgens Anti-androgens oppose the action of testosterone by blocking the androgen receptors. The incidence of erectile dysfunction is less than with surgical or medical orchidectomy because testosterone levels are maintained in the bloodstream. Anti-androgens alone are probably not adequate treatment for metastatic disease. Total androgen blockade by a combination of steroidal anti-androgens and LHRH-analogues or orchidectomy has not been shown to be better than LHRH-analogues or orchidectomy alone. However, non-steroidal anti-androgens yields slightly better results than castration alone. Locally advanced disease without metastases. The overall results of treatment of patients with disease beyond the prostate are not good. Some patients with early disease beyond the prostatic capsule, and no evidence of metastases, benefit from radical treatment. The most widely used treatment regimens consist of a combination of radiotherapy and hormonal treatment. Treatment options for locally advanced and metastatic disease. · Early hormonal treatment · Watchful waiting with hormonal treatment once symptoms develop Disease that has spread to the seminal vesicles and beyond is not real curable. Prostate cancer is dependent on the male hormone testosterone. 80% of patients will respond to hormonal treatment that deprives the tumor of testosterone. This response usually involves the shrinkage of metastases and symptomatic improvement for the patient. The response to hormonal treatment is not a cure but can last for many years in some patients. The average duration of response is 2 years. Most cancers eventually escape hormonal manipulation. This is referred to as hormone independent disease and is usually followed by death within a few months. Controversy exists regarding the timing of hormonal treatment. Most studies indicate a survival benefit for early rather than late hormonal maneuver. Testosterone deprivation has side effects like erectile dysfunction, breast enlargement and osteoporosis. The earlier hormonal treatment is instituted the greater the chance of complications. Once again treatment has to be individualized to the needs of the specific patient. With our next information - we will inform you about the “Staging and grading of prostate cancer” - so you should have a look on this site in the next 2 weeks! If you have any question sends us your e-mail. result review vig rx compare penis enlagement pills penis enargement information vimax penis enlargement video free penile enlargement penis enlargement pic before and after cheap penis enlargment vimax male penis enlargement

vimax penis enlargement surgery

Gonorrhea is a common sexually transmitted disease that affects both men and women. New Gonorrhea infections are reported at over 600,000 per annum in US alone and of course many cases go unreported. The disease is common and if left un treated can be fatal. So, what exactly is it how do you know if you have it and how to you treat and prevent it? Let’s find out. Gonorrhea Definition Caused by bacteria know as Neisseria gonorrhoeae which grows and spreads in the warm, moist areas of the reproductive organs including the cervix, the urethra and the fallopian tubes in women The bacteria also grows in the anus mouth, throat and the eyes. Gonorrhea How Do you Catch It? Is spread through contact with the penis, vagina, mouth, or anus. Contrary to what some people believe ejaculation does not have to occur for gonorrhea to be transmitted and infect a person. Gonorrhea Symptoms Men with gonorrhea sometimes have no symptoms at all, others have some signs or symptoms that appear up to five days after infection; symptoms can take up to a month to appear. Symptoms include an intense burning sensation when during urination and or a white, yellow, or green discharge. Sometimes men also will see their testicles swell up. Most women who are infected however have no obvious symptoms. When a woman does have symptoms, they can be non-specific and are often mistaken for a bladder or vaginal infection. The initial symptoms in women include a burning sensation when urinating, increased vaginal discharge and vaginal bleeding. Symptoms of infection of the anus in both men and women can include discharge, itching, soreness, bleeding, or pain when going to the toilet. Rectal and anus infection also may cause no symptoms at all. In women, gonorrhea is a common cause of pelvic inflammatory disease (PID). PID can lead to internal abscesses and severe long term pelvic pain. PID can damage the fallopian tubes causing infertility or increase the risk of entopic pregnancy a potentially fatal condition where a fertilized egg grows outside the uterus, normally in the fallopian tubes. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that can lead to infertility. Gonorrhea can also spread to the blood stream and enter the joints and this can be fatal if left un treated. Finally, those infected with Gonorrhea are more likely to receive the HIV virus that causes AIDS. Gonorrhea Detection A doctor will normally obtain a sample from the parts of the body likely to be infected. Gonorrhea that is present in the cervix or urethra can be diagnosed by taking a urine sample. Gonorrhea Cure Several drugs can be used to cure gonorrhea. However, drug-resistant strains of gonorrhea as many people with gonorrhea also have Chlamydia, another sexually transmitted disease. Antibiotics for both infections are therefore given together. Although medication will stop infection, it will not reverse any permanent damage done. People who have had gonorrhea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhea. Gonorrhea Prevention Is a sexually transmitted disease, it is therefore advisable to know something of your partners sexual history and be sure they are not infected before sexual intercourse. Condoms can also reduce the risk of transmission of gonorrhea. Consult your doctor This is just a brief introduction to Gonorrhea and anyone thinking they have the disease should seek medical advice from their doctor. Gonorrhea as we have seen can cause serious health problems and even lead to death so make sure you consult your doctor and get help as soon as possible. penis enargement product com enlargement penile penile pump free penis enhancement truth about penis elargement penis enargement procedure penis enlarement before and after photo natural penis enlargement pill vimax penis girth enlargement vimax penis enlargement surgery

Your grandma just left you an oil painting and you need a few copies; one for appraisal purposes and two for your siblings who would love to have a copy, too. A trip to the professional photographer involves a set up fee, print cost, and a negative that is unavailable for sale. The painting is too big for a flat bed scanner so digital copies are not feasible. One solution is to copy it yourself. A good 35mm SLR camera with a normal lens will probably focus to two and one half feet. Even better is a six or eight megapixel DSLR or EVF camera. Use an ISO setting of 100 or slower. Critical is the correct use of lighting. Allowing the surface texture to show in your copies prevents displaying the true color and values of the picture. Ideally, two identical incandescent lamps in reflectors angled at forty-five degrees will minimize surface reflections. Place the painting vertically and line up the camera on a tripod exactly perpendicular to the painting. An alternative is to use the sun at a forty to fifty degree angle. Any other unbalanced source (single) is to be avoided. Fill the view finder to about 80% of the viewfinder and check to see that all edges are parallel. The circle of light cast by the lamps determines the distance from the lights to the picture. Make sure all of the painting surface is evenly lit. Use an 80B filter with outdoor film or set your digital white balance at incandescent. A filter is not needed if electronic flash is the source of light. Electronic flash must be metered with a flash meter or calculated using the guide on the back of the flash. Equalize the distance from each flash to the center of the painting and aim the center of the cone of light at the furthest edge of the painting. Bracket your exposure one stop over and under the recommended F stop. F8 or F11 are the sharpest F stops. The resulting proofs are NOT a good guide to choosing the negative with the best quality. If a digital camera was used then print a small test picture before making the enlargement. When viewed over a well lit white surface, it is not too difficult to choose the negative with the best color and contrast. A slight increase in contrast is generally considered a plus. When done properly, it is difficult for the average person to tell the difference between the copy and the original when viewed from a normal distance. penis enlargement system pennis girth enlargement easy enlargment free penis surgery way top rated penis enlargment pills cheap pnis enlargement pro solution wealth penis enlargment excersizes enlargment manhattan penile surgeon vimax penis enlargement surgery

Were you ever mocked, bullied, or made fun of when you were growing up? Suppose you had some physical feature that stood out that caused others to make fun of you? Maybe you thought your nose was too big, or your ears stuck out, or you had big feet, or crooked teeth. The list is endless. However, one thing remained the same: Whatever this physical feature was, others zeroed in on it and with their taunts and mockery, made your life meserable. With me, my physical defect wasn't readily apparant. I looked like any other normal kid. That is, until I had to undress and get naked in the gym locker room, or change clothes at the local Y to go swimming. Then, it was there for all to see and poke fun of: My small penis. Only those who suffer the same as me can fully understand the embarrassment and humiliation I felt. Remember that popular movie, Porgys? Remember the guy named Pee Wee? Remember why they called him Pee Wee? Well, that was also my nickname in school. I even got into a couple of fights about it. I was so ashamed and humiliated about my small penis. It got so bad that I seriously thought about quitting school, or asking my parents to send me to another school in a different district. But how was I going to bring this up to my parents? I couldn't just walk up to them and say, "Hey, Mom, Dad, let's move to another town because I have a small penis and everybody is picking at me because of it." It sounded stupid, and in fact, it was stupid. Why couldn't people just leave me alone? Already shy and withdrawn, I became even more so. I was a bright kid, but my grades plummented, and my parents didn't know what was wrong with me. I was too ashamed and embarrassed to tell them. I had few friends, and didn't really want any. I just wanted to shrink from the world and become a hermit so that I wouldn't have to be around anybody who would pick on me. Of course, dating was out of the question when I got older. Most of the girls at my school were also aware of my nickname, and they would sometimes pass me and snicker and say, "There's Pee Wee. You know why he's called that, don't you?" Then they would hold up their little pinky and there would be more laughter, more humiliation. I even thought about suicide. I didn't know that there was help for my problem. I thought that I would have to live like this forever. Then, years later, while leafing through a men's magazine, I came across an ad for natural male enhancement pills. I was sceptical at first, but I was also desperate and emotionally scared from all of the past embarrassment and humiliation. So I sent off for them. To make a long story short, the pills did not do much for me, other than to relieve me of my hard-earned money. However, they did lead me on the road to discovery about natural male enhancement pills and male enhancement products. Here are some of my findings: * Pills should be manufactured in an FDA approved laboratory. * The penis pills should not contain FDA banned ingredients. * The pills should come with a full money back guarantee. * Delivery should be quick, tracked and discreet. * Customer support should be available via e-mail and phone. Please be careful where you purchase your pills, because natural male enhancement pills can be a large expense. To see the results you need to make an order of at least 3-4 months supply. With some lesser rated pills you may have to take them for even longer! Here are a few other factors to consider: *Exercises - do they include them in the program. *Performance - permanent penis enlargement gains. *Speed - how quick was the results? *Support - did they offer support for the pills. *Bonuses - any additional extras with purchase. *Claims - do they offer a guarantee? *Saftey - are the ingredients safe? Penis enlargement and natural male enhancement pills have prolifirated over the Internet in recent years. Paying attention to the above advice can help make you a better informed consumer, and guard you against some of the rip-off products that have swamped the Web. free pnis enlargement tip pennis girth enlargement penis enlagement program pennis enlargement supplement com enlargement penis penis pump male penis enlarement penis enlarement picture free pnis enlargement exercise vimax penis enlargement surgery

If you’ve ever witnessed someone suffer a stroke, you understand the humbling nature of this disease. It can reduce the mightiest human being to an immobile, helpless creature. Impairment of crucial functions like speech, walking, and control of bowel and bladder can wrench control from the body in a moment. Even perpetually youthful TV personality Dick Clark was struck down by stroke at age 75, despite the outward appearance of perfect health. Clark’s stroke resulted in a six-week hospital stay and, judging from fragmented reports, significant disability. Stroke can be like a devastating fire that strikes without warning, leaving only smoldering rubble. Stroke can so ravage basic bodily functions that often all you can hope for is to regain a portion through rehabilitation. The disease process that underlies stroke requires decades—30 or 40 years—to develop. With that much lead time, why aren’t we better able to detect or stop this crippling disease? The truth is that we are able to predict many, if not most, strokes. Advances in imaging technology allow detection of atherosclerotic plaque that cause stroke years before it becomes a threat. Progress in deciphering the causes of stroke has also leapt forward. Unfortunately, your neighborhood physician still focuses on diagnosing the crisis rather than anticipating it. Physicians prefer to deal with catastrophes and are just not that interested in prevention. Most physicians ask: “Is it time to operate or not?” The medical community obsesses over procedures like carotid endarterectomy (surgical removal of plaque) or carotid stents. Even when a person is afforded the warnings of a “mini-stroke”, or transient ischemic attack (TIA), little more is done once it’s determined that surgery is not necessary—even though this person has high risk for future stroke (50% over 10 years). Let’s flip-flop this approach to stroke. Procedures represent a failure of prevention! Where do strokes come from? Stroke develops when some portion of the brain is deprived of blood. This usually results from a tiny bit of debris that dislodges from an atherosclerotic plaque along the walls of an artery (the same sort that accumulates in coronaries causing heart attack). The sources of debris have been a subject of controversy, but new imaging technologies have settled the question. Any blood vessel that leads from the heart to the brain can be a source. The two carotid arteries on both sides of your neck are a frequent source, as these arteries are prone to develop plaque. (Our discussion will be confined to what are called thromboembolic, or ischemic, strokes, i.e, strokes that occur from plaque that fragments, sending debris to the brain, and will not include the far less common hemorrhagic strokes due to rupture of small vessels in the brain, nor will we discuss atrial fibrillation and other heart causes of stroke. The thromboembolic strokes we discuss cause around 88% of all strokes.) Over the last 10 years, the aorta has been recognized as another important source of stroke. The aorta is the main artery of the body whose branches go to the head, arms, and legs. Atherosclerotic plaque is a live tissue that, through poor diet, inactivity, high cholesterol, overweight, etc., grows and becomes progressively more unstable. At some point, plaque fragments. Little bits break away, traveling to the brain. Fractured plaque also exposes its deeper structures to flowing blood, triggering blood clot formation, which in turn can also fragment and go to the brain. Atherosclerotic plaque is a prerequisite for the most common causes of stroke. If the majority of strokes originate from plaque, why not measure plaque to determine if you’re at risk for stroke? How can we easily, safely, and accurately measure plaque in the carotid arteries and aorta? And if plaque can be measured, can it be shrunk or inactivated to reduce or eliminate risk for stroke? How can plaque be measured? Just 20 years ago, the only practical method of identifying plaque in the carotids or aorta was through angiography, requiring catheters inserted into the body to inject x-ray dye. Angiography was impractical as a screening measure. CT scanning and magnetic resonance imaging (MRI) are emerging as exciting methods of imaging both carotids and aorta. Unfortunately, most centers and physicians are much more focused on the diagnostic uses of these technologies for people who have already suffered stroke or other catastrophe, and application of these devices for preventive uses is still evolving. One exception is when aortic calcification or aortic enlargement is incidentally noted on the increasingly popular CT heart scans; this is an important finding that can signal presence of aortic plaque. The one test that is widely available and can be performed in just about any center is carotid ultrasound. It’s simple, painless, and precise. Two basic observations can be made: 1. Plaque detection—Atherosclerotic plaque can be clearly visualized. If plaque blocks more than 70% of the diameter of the vessel, or if there are “soft” (unstable) elements in plaque, then stroke risk may be high enough to justify surgery or stents. However, if there are plaques that are less severe, substantial risk for stroke may still be present that can be reduced with preventive measures. 2. Carotid intimal-medial thickness—This is a measure of the thickness of the lining of the carotid artery in areas not involved by plaque, but often precedes the development of mature plaque. Carotid intimal-medial thickness also provides an index of body-wide potential for atherosclerotic plaque that can place you at risk for stroke. The aorta, for instance, cannot be well imaged by surface ultrasound but can still be a source for stroke. Increased carotid intimal-medial thickness and carotid plaque are closely associated with likelihood of aortic plaque. The Rotterdam Study of 4000 participants demonstrated that if carotid intimal-medial thickness is greater than normal (1.0 mm), then you can be at risk for stroke (and heart attack), even if no carotid plaques are detected. Carotid ultrasound is the one test you should consider that provides the most information with least effort. Ultrasound is harmless, painless, and can be obtained just about anywhere. Even if your doctor disagrees with your request for a carotid ultrasound, an increasing number of mobile services are popping up nationwide that make this test available for around $100. One important point: many scanners and interpreters will only report whether plaque is present or not. While this is important information, you should request that the carotid-intimal medial thickness be made as well. Not all centers can make this simple measure (because of software requirements), but it doesn’t hurt to try. Any amount of carotid plaque is reason to follow a preventive program, even if the plaque is insufficient to justify surgery. Can plaque be reduced? Can we shrink plaque in carotid arteries and aorta and thereby reduce, perhaps eliminate, these sources of stroke? That question is gaining momentum as effective therapies become available that pack real punch for reducing plaque. Study after study has now documented that plaque can be reduced and, with it, risk for stroke. Reduction in plaque of 10–20% is possible within a year or two. Let’s consider the most potent influences on carotid and aortic plaque growth that need to be considered in a plaque-reducing program. (I assume that you are a non-smoker—if you are a smoker, you first need to concentrate on quitting.) Hypertension Considerable experience documents the power of blood pressure-lowering for prevention of stroke. The most recently updated guidelines, the JNC–VII, recommends a blood pressure of 407 mg/dl heightens stroke risk six-fold. C-reactive protein (CRP) This measure of inflammation is proving to be a useful marker for identifying people at risk for stroke, with increased risk beginning at a level of 0.5 mg/l. High CRP also predicts more rapidly growing carotid plaque. Homocysteine Homocysteine is an important marker of increased likelihood of both carotid and aortic plaque, as well as stroke. In 1997, the European Concerted Action Project reported more than a doubling of stroke when homocysteine levels exceeded 12 mol/l. As homocysteine increases to 20 μmol/l, risk for stroke and heart attack increases an amazing 10-fold over that at a level of 9 μmol/l. Asymmetric dimethylarginine (ADMA) ADMA is recently discovered amino acid whose blood levels can skyrocket up to 10-fold in the presence of hypertension, metabolic syndrome, diabetes, high cholesterol and triglycerides, obesity, and high homocysteine levels. ADMA blocks the action of the amino acid, l-arginine. This mimicry reduces the availability of nitric oxide, a powerful dilator and protector of arteries. ADMA levels in the top 10% predict a six-fold heightened risk for future stroke, and ADMA levels in people with strokes are double that in other people. A carotid ultrasound study in 116 subjects showed that higher blood levels of ADMA are associated with more severe carotid plaque. Because of ADMA’s shared role across a variety of abnormal conditions, correction or blocking the action of ADMA has been suggested as a unique therapeutic tool to reduce stroke risk. Cholesterol Data suggest that lowering cholesterol with statin cholesterol-lowering drugs slows carotid plaque growth and reduce stroke risk approximately 22%. An interesting study from the Cardiovascular Institute at Mt. Sinai School of Medicine in New York using the precise measuring ability of MRI of the carotids and thoracic aorta showed an impressive 20% regression of plaque area with simvastatin (Zocor®) taken for two years. Although guidelines for cholesterol treatment recommend reduction of LDL cholesterol to 100 mg/dl in high-risk persons, a report from the Walter Reed Army Medical Center in Washington, DC, showed that carotid plaque was more effectively reduced when LDL cholesterol of 70 mg/dl or lower was achieved with statin cholesterol drugs. Lower LDL cholesterol may, therefore, be better. Treatment Strategies to Reduce Carotid and Aortic Plaque The essential question: How do we reduce carotid and aortic plaque? If we make this the focus of our efforts, many pieces begin to fall into place. If you’ve had any measure of carotid or aortic plaque such as a carotid ultrasound or aortic calcification on a CT heart scan, you know that you’re at increased risk for stroke. You also have a baseline for future comparison to gauge whether your program is working or not. Because most people have not one but several causes of carotid and aortic plaque, there is no one single treatment that effectively eliminates risk for stroke. Instead, most people require a comprehensive program of healthy diet, exercise, supplements, and medication when indicated. Here, we focus on the nutritional supplements that can be critical components of your plaque-reduction program. Fish oil Fish oil is a cornerstone of your stroke prevention program. Epidemiological observations suggest a strong relationship of fish intake and reduction of stroke risk. Carotid ultrasound studies demonstrate less carotid plaque with greater intakes of fish. A cleverly designed University of Southampton study made the fascinating observation that fish oil transforms the structure of carotid plaque. 150 people with severe carotid plaque scheduled for carotid endarterectomy (surgical removal of the plaque) were given fish oil, sunflower oil, or no treatment over several months while waiting for their procedure. (Delays in the British health system permitted this unique design.) Plaque was removed at surgery and examined. Participants taking fish oil had reduced inflammation in plaque and thicker tissue covering the fatty core, markers of more stable plaque. Those taking sunflower oil or no treatment had unstable plaques with greater inflammation and thinner, less sturdy covering tissue. This suggests that fish oil stabilizes carotid plaque, making it less likely to rupture and fragment. A standard capsule of fish oil (containing 300 mg of EPA + DHA) contains the same amount of omega-3s as a 3 oz serving of cod or halibut; three capsules (900 mg DHA + EPA) contain the equivalent of a serving of farm-raised salmon. The dose that seems to provide greatest protection from stroke, lowers triglycerides (that form abnormal lipoproteins; see above), and reduces fibrinogen, is four capsules per day (1200 mg EPA + DHA). Coenzyme Q10 (CoQ10) Although there are no data specifically addressing whether CoQ10 reduces plaque, it is a marvelously effective way to reduce blood pressure, one of the crucial factors causing carotid and aortic plaque growth. A pooled analysis of eight studies showed that, on average, CoQ10 in daily doses of 50–200 mg reduced systolic blood pressure by 16 mm Hg, diastolic pressure by 10 mm Hg. Data suggest that CoQ10 can reverse abnormal heart muscle thickening (hypertrophy), another manifestation of high blood pressure, strongly suggesting that CoQ10 has benefits beyond just reducing pressure. Supplements to correct the metabolic syndrome Weight loss is, without question, the most immediate and direct path to correction of this dangerous pre-diabetic condition. A drop of even 10–20 lbs yields improvements across the board: increased sensitivity to insulin, increased HDL, and reductions in triglycerides, CRP, fibrinogen, small LDL particles, and blood pressure. Diet and exercise are fundamental components of an effort to lose weight; low carbohydrate or reduced glycemic index diets (e.g., South Beach or Mediterranean) rich in fibers are clearly effective. Several supplements can amplify weight-reduction efforts and be useful adjuncts to your lifestyle program. Among them: White bean extract White bean extract blocks intestinal absorption of carbohydrates by 66%. 1500 mg twice a day with meals yields, on average, 3–7 lbs of weight loss in the first month of use. The only side-effect is excessive gas, due to unabsorbed starches. Glucomannan This unique fiber taken prior to meals absorbs many times its weight in water and thereby fills your stomach. You consequently take in less food. Most people lose around four lbs per month using 1500 mg prior to each meal. Interestingly, glucomannan also blunts the rise in blood sugar after meals, an effect that, by itself, may lead to weight loss. Be sure to take with plenty of water. DHEA This adrenal hormone is key to maintaining physical stamina, mood, muscle mass in men, and libido in women. A recent randomized, placebo-controlled study at Washington University in 56 subjects showed a 13% decline in abdominal fat (fat that drives resistance to insulin) measured by MRI with 50 mg of DHEA per day at bedtime, along with improved sugar control and lower insulin levels. Pectin, beta-glucan Pectin is the soluble fiber in citrus rinds, green vegetables, and apples, also available as a supplement. Beta-glucan is the soluble fiber of oats and is also available as a supplement. Both are wonderful fibers that provide feelings of fullness, lower cholesterol, slow release of sugars, and can yield modest weight reduction. A USC study in 573 subjects using carotid ultrasound showed that greater intake of healthy fibers like pectin and beta-glucan is associated with less carotid plaque growth. Folic acid, vitamins B6 and B12 Dr. Daniel Hackam at the Stroke Prevention and Atherosclerosis Research Centre in Ontario conducted a study using carotid ultrasound in 101 participants treated with folic acid 2.5 mg, vitamin B6 25 mg, and B12 250 mcg per day. Treatment resulted in plaque reduction, especially when homocysteine levels exceeded 14μmol/l at the start, compared to untreated participants who experienced substantial plaque growth. An attempt to clarify the role of homocysteine treatment was made through a National Institute of Health-sponsored study of stroke prevention. 3680 participants with a prior history of stroke were enrolled and given either a “low-dose” (20 mcg folic acid, 0.2 mg B6, 6 mcg B12) or a “high-dose” (2.5 mg folic acid, 25 mg B6, 400 mcg B12) regimen. Although starting homocysteine levels showed a graded association with stroke risk (higher homocysteine levels predicted greater stroke risk), the treatment groups experienced, on average, only a 2 μmol drop in homocysteine levels and no reduction in stroke risk over two years. The study investigators as well as critics have suggested that the study failed due to an insufficient treatment period and that the doses were too low. (The doses we use in our plaque reduction program are folic acid 2.5–5.0 mg, B6 50–100 mg, B12 1000–2500 mcg.) L-arginine L-arginine can be used to overpower the adverse effects of ADMA. L-arginine is emerging as an important carotid plaque-reversing tool. Early reports in animals showed that l-arginine completely halted growth of aortic plaque, and did so more effectively than lovastatin (a cholesterol-lowering drug). In humans, L-arginine reduces blood pressure, abnormal constriction of carotid and coronary arteries, blocks entry of inflammatory cells into plaque, increases sensitivity to insulin, and heightens exercise capacity. Following coronary angioplasty or stent placement, l-arginine results in up to 36% reduction in plaque growth. The average American takes in 5400 mg of l-arginine through food every day. Supplementing with doses of 3000–12,000 mg per day has proven useful to correct many of these phenomena. (We use a dose of 6000 mg of l-arginine powder, twice a day on an empty stomach, dissolved in water, for our plaque regression program.) Does this result in a reduction of stroke risk? The emerging data suggest that l-arginine is likely to exert a powerful plaque-reducing and stroke-preventing benefit, but we await more clinical trial data. Conclusion Reducing stroke risk by reversing carotid and aortic plaque is becoming an everyday reality, with better tools becoming available. To know whether you’re at risk, the best and most available imaging tool is carotid ultrasound, aiming to identify intimal-medial thickness >1.0 mm, or carotid plaque. Any degree of calcification of the aorta, such as on a CT heart scan, is another useful measure of risk. Treatment to reduce risk is multi-faceted but is based on examining all your sources of risk, including metabolic syndrome, small LDL, lipoprotein(a), and C-reactive protein. Fish oil is the one absolutely crucial ingredient in any stroke prevention program. Other supplements can be used in a targeted fashion, depending on the causes identified for your carotid or aortic plaque. Ideally, repeat scanning of your carotids should be done sometime after your program has begun to assess whether you’ve successfully achieved reversal of plaque growth.