Is it possible my Peyronies plaque or scar is like a piano wire?

Dr. Herazy, I wrote you last month and you really helped my confidence with what I am doing. Is it possible that my PD scar is like a piano wire from the base to the head? That is the only irregularity I can find. Thanks Dick R.

Greetings Dick,

Yes, it is certainly possible that your scar feels like a piano wire. The Peyronies plaque or scar material presents in a wide variety of ways, just as most everything about PD seems to be variable. 

Although you did not say so, I will guess the long ridge of scar material tissue you say feels like a piano wire is located on the top or dorsal surface of the shaft.  This is a very common location for long narrow PD scars.  It is the anatomical structure, called a septum, where the tunica albuginea of the two chambers meet in the mid-line, and it runs from the base of the penis to the head (glans).   This septum is especially susceptible to separation during trauma, and can consequently develop a long thin scar.  

You can assume this is your only, or your primary, Peyronie's scar if your curved penis is directed upward.  

While you might be correct that it is only as thin as a piano wire, I suggest that you examine this thin ridge again to determine if you can detect that it tapers down to a flat band.  Almost like the gable roof of a house, your piano wire structure might just be like the uppermost ridge of the roof that gets thinner as it slopes down laterally.  I mention this speculation because it is always beneficial to have a clear and accurate visualization of each scar so you can closely monitor it  for changes as you continue to treat your PD. 

You might find, if I am correct, that this flat tapered surface on either side of the piano wire will undergo changes in size, shape, density and surface features as your scar deteriorates as your treatment progresses. 

If you do not know it is there, you will not have this useful information available to you to guide your treatment.  You must try to know everything there is to know about each of your Peyronies scars.

TRH

Is it possible my Peyronies scar is like a piano wire?

Dr. Herazy, I wrote you last month and you really helped my confidence with what I am doing. Is it possible that my PD scar is like a piano wire from the base to the head? That is the only irregularity I can find. Thanks Dick R.

Greetings Dick,

Yes, it is certainly possible that your scar feels like a piano wire. The Peyronies plaque or scar material presents in a wide variety of ways, just as most everything about PD seems to be variable. 

Although you did not say so, I will guess the long ridge of scar material tissue you say feels like a piano wire is located on the top or dorsal surface of the shaft.  This is a very common location for long narrow PD scars.  It is the anatomical structure, called a septum, where the tunica albuginea of the two chambers meet in the mid-line, and it runs from the base of the penis to the head (glans).   This septum is especially susceptible to separation during trauma, and can consequently develop a long thin scar.  

You can assume this is your only, or your primary, Peyronie's scar if your curved penis is directed upward.  

While you might be correct that it is only as thin as a piano wire, I suggest that you examine this thin ridge again to determine if you can detect that it tapers down to a flat band.  Almost like the gable roof of a house, your piano wire structure might just be like the uppermost ridge of the roof that gets thinner as it slopes down laterally.  I mention this speculation because it is always beneficial to have a clear and accurate visualization of each scar so you can closely monitor it  for changes as you continue to treat your PD. 

You might find, if I am correct, that this flat tapered surface on either side of the piano wire will undergo changes in size, shape, density and surface features as your scar deteriorates as your treatment progresses. 

If you do not know it is there, you will not have this useful information available to you to guide your treatment.  You must try to know everything there is to know about each of your Peyronies scars.

TRH

Does this mean I have Peyronies?

In previous questions someone asked below "how do I find my PD scar?"

In your answer you stated: "…….it is important to know your scar is not located on the surface; it is located below the surface and cannot be seen……"

I have been informed that I have Peyronie's disease, however my erections are 100% straight.  They are just less flexible and half the top surface of my penis feels very hard, because of the scar tissue.  When my penis is flaccid and erect I can easily always see the scar tissue.

Does this mean I have peyronies, also does this mean the scar tissue is just below the external skin and not on the actual erectile tissue? Is this possible? I have spoken to you previously but I am not sure if I mentioned this.

 

Greetings,

If you have been medically diagnosed with Peyronie's disease, what you say does not give me reason to doubt that diagnosis.  

After reading your entire question several times I am unsure what you mean when you say "I can easily always see the scar."   If I were to try to hide a ball under the blanket on my bed, it would still be "seen" because of the way the ball would push up and distort and wrinkle the blanket.  I would not be able to see the ball directly, only able to see the effects of the ball on the blanket that is above it.  Is this what you mean when you say you can see your PD scar?

By definition the Peyronie's plaque or scar is not located on the top surface of the skin.  It is located within the layer of tissue called the tunica albuginea that is located well below the surface of the skin, by many millimeters.     The tunica albuginea is sitting right on top of and is in contact with the actual erectile tissue, making it anatomically impossible to directly see the Peyronie's scar.  

I have communicated with many men whose PD scars are so thick and dense that they distort the skin above, and thus they can see the outline of scar that lies below.  TRH

If I can’t find the Peyroinie’s plaque where is DMSO gel applied?

Dr. Herazy,

My order arrived last week, and today I started the treatment.  I’m very upbeat that I made the right decision. I have carefully reviewed all the documentation and explanations that came with my order.  It is very impressive how well you prepare your customers to work with their Peyronie’s treatment products.

The one item that I’m most confused about is the PMD DMSO gel.  Exactly where is this gel applied?  My instructions say that the topical therapies should be applied over or on top of the location of the Peyronie’s plaque or scar. I do not have any scar. I don’t have a problem shaving as described but I do not have a scar either on the part to be shaved or the penis. Or, when they mention scar, do they mean the part of the penis that is abnormally hard?  Please advise.  Randy

 

Greetings Randy,

Actually, if you have Peyronie’s disease you do have a plaque or scar.   However, the scar is not external or superficial, it is internal and below the surface. It is located under the skin surface and within the tissue of penis called the tunica albuginea.  The scar or plaque is not visible from the surface; you cannot see it.  The closest you can come to actually seeing it is if the scar is so large and thick that it raises or elevates the penile skin above it and you can see the raised lump of tissue because of the large scar below the surface.  

In order to be successful you really want to get to the point that you know the size, shape, density, and surface quality of your scar(s). If this is a new concept to you, I suggest you get the 1st book I wrote “Peyronie’s Disease Handbook.” It will help you immensely.

Scar location is sometimes a complicated topic, especially in the case of multiple scars or plaques. You can expect to find at least one scar at the point of greatest concavity of your distortion. Again, this is a topic of such concern and importance that you really should get at least that one book so that you know what you are doing in regard to monitoring your scar. The physical change in your scar is going to guide your therapy; it will direct you to the best use of your therapy plan. to assist you with this subject, please go to Difficulty Finding the Peyronie’s Plaque.

To answer your question about where to apply the DMSO gel and related external therapies, they should be applied directly over the area of Peyronie’s plaque or scar.  You do not need to apply these external therapies to the entire shaft, unless, of course, you have a wide spread pattern of scars over most of the penis.  TRH

Where is DMSO gel applied?

Dr. Herazy,

My order arrived last week, and today I started the treatment.  I'm very upbeat that I made the right decision. I have carefully reviewed all the documentation and explanations that came with my order.  It is very impressive how well you prepare your customers to work with their Peyronie's treatment products. 

The one item that I'm most confused about is the PMD DMSO gel.  Exactly where is this gel applied?  My instructions say that the topical therapies should be applied over or on top of the location of the Peyronie's plaque or scar. I do not have any scar. I don't have a problem shaving as described but I do not have a scar either on the part to be shaved or the penis. Or, when they mention scar, do they mean the part of the penis that is abnormally hard?  Please advise.  Randy

 

Greetings Randy,

Actually, if you have Peyronie's disease you do have a plaque or scar.   However, the scar is not external or superficial, it is internal and below the surface. It is located under the skin surface and within the tissue of penis called the tunica albuginea.  The scar or plaque is not visible from the surface; you cannot see it.  The closest you can come to actually seeing it is if the scar is so large and thick that it raises or elevates the penile skin above it and you can see the raised lump of tissue because of the large scar below the surface.  

In order to be successful you really want to get to the point that you know the size, shape, density, and surface quality of your scar(s). If this is a new concept to you, I suggest you get the 1st book I wrote “Peyronie’s Disease Handbook.” It will help you immensely.

Scar location is sometimes a complicated topic, especially in the case of multiple scars or plaques. You can expect to find at least one scar at the point of greatest concavity of your distortion. Again, this is a topic of such concern and importance that you really should get at least that one book so that you know what you are doing in regard to monitoring your scar. The physical change in your scar is going to guide your therapy; it will direct you to the best use of your therapy plan. to assist you with this subject, please go to Difficulty Finding the Peyronie's Plaque.

To answer your question about where to apply the DMSO gel and related external therapies, they should be applied directly over the area of Peyronie's plaque or scar.  You do not need to apply these external therapies to the entire shaft, unless, of course, you have a wide spread pattern of scars over most of the penis.  TRH    

Is it adviseable to needle the penis directly?

Dr. Herazy,

I am an acupuncturist treating a patient with Peyronie's disease.  I bought your "Peyronie's Disease Handbook,"  hoping you had included specifics on the use of acupuncture, especially whether or not you think it's advisable to needle the penis directly?  I know you advise to not cause additional injury to the penis, but needling near scar tissue on other parts of the body is not contra-indicated, but actually beneficial.

What are your thoughts on this please? My patient is willing to try anything.

Greetings Doctor, 

Yes, needling a superficial scar on other parts of the body is very often beneficial, but the penis is a different part of the body. I would not needle the penis for concern of puncturing the tunica albuginea and further extending his Peyronies problem.  My concept is never to puncture the tunica in an attempt to help this problem. 

However, local treatment has always been an important part of my acupuncture practice, such as the famous Circle the Dragon technique, and that is why I advocate heavy use of the Genesen Acutouch pens to treat the PD lesion in this particular way because it will not risk injuring the patient by avoiding compromise to the tunica.

If you feel required to needle, distal points are always advisable. I do not treat a lot based on Five Elements theory, but I believe you would likely benefit your patient by evaluating for an Excess Wood situation.  Bear in mind that the “Peyronie’s “scar” is not a scar in the traditional sense of being a superficially located skin lesion; it is below the subdermis and within the tunica so the standard methods of needling a scar – that I have done daily for over 35 years – does not apply to PD.  At least, that is how I understand it based on my concept and methodology in guiding Peyronie's treatment.

If you feel obligated to needle, distal points are always advisable such as SP3, SP6, K3, GB34, the master points of the Conception Vessel, Sedation points for the Wood element and and Stimulation points for the Fire element. as well as appropriate Eight Extraordinary Meridian points (Du Mai, Chong mai, Yin Wei mai, etc.)    TRH  

 

Should I continue penile injections for Peyronies treatment?

I have Peyronie's disease causing a bend to the left and downwards and it's closer to the tip then the base. I have seen a urologist who has injected it twice now. I haven't seen any improvement. both my doctor and myself have trouble finding any plaque. I'm 50 and in good shape….this just showed up a couple of months ago…there was no trauma…should I continue with the injections?  .

Greetings,

It is not my intention or desire to interfere between you and your urologist concerning your treatment or any other aspect of your relationship.  Nor will I answer your question directly if you should or should not continue with the penile injections you are receiving – I have no direct opinion or advice for your question.  That is a subject for discussion between you are your treating doctor.  My only interest and purpose in making this reply is to offer ideas, and pose questions to you, to broaden your discussion with the urologist about the progression of your care.

My opinion and ideas for you to consider are these:

    1. Any time you make a simple injection into the penis with anything, even sterile water,  you are physically traumatizing the thin tunica albuginea membrane where the Peyronie's plaque is located.  Many times when these injections are given at multiple sites of the tunica albuginea at one office visit, causing multiple trauma.  Yes, these are small needle holes, but they are holes none the less.  When given at multiple sites within a small area, and done on multiple occasions, that is still a lot of trauma (think of a shot gun blast which is just a lot of small holes). Your body has already demonstrated the tendency and ability to lay down excess collagen in the form of Peyronies plaque without any trauma or trauma so small that you do not remember it, so what will be its reaction when actually traumatized?  It is my opinion that any injection is a direct injury that could possibly cause more plaque or scar tissue to develop or worsen plaque already present. 

Avoidance of the trauma of needle injection is the reason that since 2002 I have counseled perhaps 20 or so MDs (of whom 2 were urologists) who had PD and wanted to avoid surgery, injections and drugs. 

    2.  The needle injection points are not the only potential trauma to the tunica.  Since you did not mention what drug was being injected by your doctor, I cannot comment specifically on that issue, but it is my opinion any drug has a potential to cause chemical trauma in the form of an allergic reaction, side effect or perhaps just a chemical irritation to the tunica in certain individuals.  If this is the case with you, this could result in additional irritation internally and further trauma to tissue that has already created Peyronies plaque for no apparent reason you recall.  It is my opinion that any drug reaction or unexpected side effect could possibly result in additional  plaque or scar tissue or further aggravate plaque already present.  

Unexpected drug reactions and unexplained side effects are a fact of life in medical practice.  This is such a large problem that there is a medical term for it, "Adverse Drug Reactions" or ADR.  In fact, a 1999 report in JAMA of a meta-analysis entitled "Incidence of Adverse Drug Reactions in Hospitalized Patients" by J. Lazarou concluded that

             "The overall incidence of serious ADRs was 6.7% (95% confidence interval [CI], 5.2%-8.2%) and of fatal ADRs was 0.32% (95% CI, 0.23%-0.41%)
             of hospitalized patients. We estimated that in 1994 overall 2216000 (1721000-2711000) hospitalized patients had serious ADRs and 106000
             (76000-137000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death.

 

 

             Conclusions.— The incidence of serious and fatal ADRs in US hospitals was found to be extremely high."

I am not at all suggesting that any penile injection could cause a fatal reaction, but I am suggesting that if in hospitals serious and fatal ADRs occur at the rate of 6.7%, the rate of less serious ADRs must be even higher.  All of this means that drug reactions occur at a seriously high rate, you are taking drugs directly into the penis, and you are already in a position in which you should be extremely careful because your penis will probably overreact if it is further injured.   

    3.  If you say that you and your doctor have trouble finding any plaque, then where are these injections being given?  If the exact location cannot be confidently identified by your doctor, then how accurate is the placement of these injections you are receiving?

    4. It is estimated that 50% of men who begin Peyronie's disease will self-limit or cure their own problem without any outside help or medical care.  The  Alternative Medicine treatment concepts of PDI is simply to do all that you can with natural methods to increase the natural healing ability of your own immune system to eliminate your Peyronie's plaque.  How to go about doing this is the subject of the large PDI website.  I suggest that you, and everyone else with Peyronie's disease, consider attempting conservative measures before undertaking more aggressive Peyronie's treatment that has potential for side effects and drug reactions.     

Good luck in discussing this subject with your urologist.   TRH    

What can I do to reduce the PD plaque?

i am 48 years old, and have had peyronie’s for approximately 5-6 years from unknown origin (but most likely from a crush injury). my condition has progressed to the point where i have a very significant plague that runs almost the entire length of my penis; the plague quite literally feels like bone, and is located more near the top of my penis (between the outer skin and urethra). my penis is not curved, but rather has shortened (fairly substantially) and has lost significant girth; while my erections are reasonably hard (though not as hard as previous to the condition), the overall size of my penis has reduced quite significantly. in addition, i seem to have lost nearly, if not all feeling in my penis, so much so that when i do have sex w/ my wife, i feel virtually nothing, where it takes me a very long time to reach orgasm, if at all. sadly, i most often fail to reach such; only very rarely am i able to achieve orgasm now. in fact, it is somewhat difficult for me to even know precisely how full/ hard my erection is unless i actually palpate such. i have recently returned to the united states (from living in china), and will now be able to resume taking a fairly substantial series of supplements recommended by you and provided from your company. what can i do to reduce the plaque, and to hopefully regain feeling in my penis? can i ever regain feeling? your assistance is greatly appreciated … eric

Greetings Eric,

Thank you for your detailed description and questions.

I am a bit confused by your description of the location of your Peyronie’s scar or plaque (part of your description sounds like your plaque is on the bottom/under side of the shaft and another part sounds like your Peyronie’s plaque is on the top/upper surface).

In my reply I will assume it is on the upper/top surface of the shaft as you are looking down at your erection, since this is by far the most common presentation of plaque that runs the length of the shaft. This plaque location is most often responsible for lost length and girth, such as you describe, and for generalized erectile dysfunction. Many men with PD experience localized reduction of erectile ability, resulting in soft spots, or nicks or dents or dings in various areas of the shaft. Yours sounds like the entire shaft is soft, often the result of plaque development within the septum of the penis (the point where the tunica albuginea that is around one corpora cavernosa touches or combines with the tunica albuginea of the other corpora cavernosa).

Your loss of feeling is not common; most men with Peyronie’s disease with have little trouble with loss of sensation. While lost penile sensation could be due to other factors unrelated to PD, I will assume it is related to the central location of your plaque compromising your nerve supply. If this is true, and I have no way of knowing for a fact that it is since I have not examined you, I assume that your penile sensation should return once your plaque is reduced. Besides reduced reduction of sexual sensation, do you also notice general loss of sensation to light touch or pain (as when you pinch the skin of penis)?

You ask what you can do to reduce the plaque. I saw in today’s list of orders that you purchased a large assortment of internal therapies (Acetyl-L-carnitine, MSM, Neprinol, Omega T, Quercetin-Bromelain, Factor 400/400 and Maxi-Gamma). However, you did not order any internal therapies (PMD DMSO, Unique-E oil, Super CP Serum, or Genesen Acutouch pointers). Both internal and external therapies are necessary for effective treatment. It is also necessary that you follow the dietary modifications outlined in “Peyronie’s Disease Handbook” to keep your blood pH toward the alkaline side. The stretching video contains detailed information how to address plaque formation found within the septum, such as you have. All of these therapies must be applied at the same time to achieve best results.

You will probably have to modify your plan to achieve favorable changes to the size, shape, density and surface features of your plaque. Do not be slow in making those changes to your plan when you see that after 10-14 days of treatment the plaque is not responding. For this reason it is absolutely critical that you clearly can identify the size, shape, density and surface features of your plaque. I know I might sound like a broken record when I continue to repeat this, but if you do not know these four aspects of your plaque description, you are only guessing at your treatment. Please, do not guess. Know what is going on down there below your belt and you will have an excellent way to direct and guide your therapy toward the greatest degree of success of which you are capable.

Please stay in close contact with me as you begin your self-directed therapies. Let me know of any problem or questions that arise, and I will be happy to offer you information and ideas for your consideration. TRH

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What can I do to reduce the plaque?

i am 48 years old, and have had peyronie's for approximately 5-6 years from unknown origin (but most likely from a crush injury). my condition has progressed to the point where i have a very significant plague that runs almost the entire length of my penis; the plague quite literally feels like bone, and is located more near the top of my penis (between the outer skin and urethra). my penis is not curved, but rather has shortened (fairly substantially) and has lost significant girth; while my erections are reasonably hard (though not as hard as previous to the condition), the overall size of my penis has reduced quite significantly. in addition, i seem to have lost nearly, if not all feeling in my penis, so much so that when i do have sex w/ my wife, i feel virtually nothing, where it takes me a very long time to reach orgasm, if at all. sadly, i most often fail to reach such; only very rarely am i able to achieve orgasm now. in fact, it is somewhat difficult for me to even know precisely how full/ hard my erection is unless i actually palpate such. i have recently returned to the united states (from living in china), and will now be able to resume taking a fairly substantial series of supplements recommended by you and provided from your company. what can i do to reduce the plaque, and to hopefully regain feeling in my penis? can i ever regain feeling? your assistance is greatly appreciated … eric

 

Greetings Eric,

Thank you for your detailed description and questions.

I am a bit confused by your description of the location of your plaque (part of your description sounds like your plaque is on the bottom/under side of the shaft and another part sounds like your Peyronie's plaque is on the top/upper surface). 

In my reply I will assume it is on the upper/top surface of the shaft as you are looking down at your erection, since this is by far the most common presentation of plaque that runs the length of the shaft. This plaque location is most often responsible for lost length and girth, such as you describe, and for generalized erectile dysfunction.  Many men with PD experience localized reduction of erectile ability, resulting in soft spots, or nicks or dents or dings in various areas of the shaft.  Yours sounds like the entire shaft is soft, often the result of plaque development within the septum of the penis (the point where the tunica albuginea that is around one corpora cavernosa touches or combines with the tunica albuginea of the other corpora cavernosa).  

Your loss of feeling is not common; most men with Peyronie's disease with have little trouble with loss of sensation.  While lost penile sensation could be due to other factors unrelated to PD, I will assume it is related to the central location of your plaque compromising your nerve supply.   If this is true, and I have no way of knowing for a fact that it is since I have not examined you, I assume that your penile sensation should return once your plaque is reduced.  Besides reduced reduction of sexual sensation, do you also notice general loss of sensation to light touch or pain (as when you pinch the skin of penis)? 

You ask what you can do to reduce the plaque.  I saw in today's list of orders that you purchased a large assortment of internal therapies (Acetyl-L-carnitine, MSM, Neprinol, Omega T, Quercetin-Bromelain, Factor 400/400 and Maxi-Gamma).   However, you did not order any internal therapies (PMD DMSO, Unique-E oil, Super CP Serum, or Genesen Acutouch pointers).  Both internal and external therapies are necessary for effective treatment.  It is also necessary that you follow the dietary modifications outlined in "Peyronie's Disease Handbook" to keep your blood pH toward the alkaline side.  The stretching video contains detailed information how to address plaque formation found within the septum, such as you have.  All of these therapies must be applied at the same time to achieve best results.    

You will probably have to modify your plan to achieve favorable changes to the size, shape, density and surface features of your plaque.  Do not be slow in making those changes to your plan when you see that after 10-14 days of treatment the plaque is not responding.  For this reason it is absolutely critical that you clearly can identify the size, shape, density and surface features of your plaque.  I know I might sound like a broken record when I continue to repeat this, but if you do not know these four aspects of your plaque description, you are only guessing at your treatment.  Please, do not guess. Know what is going on down there below your belt and you will have an excellent way to direct and guide your therapy toward the greatest degree of success of which you are capable.

Please stay in close contact with me as you begin your self-directed therapies.  Let me know of any problem or questions that arise, and I will be happy to offer you information and ideas for your consideration.  TRH

Broken Penis and Peyronie’s Disease

Penile fracture can lead to Peyronies

The most frequently found explanation of Peyronie’s disease usually refers to it as an exaggerated healing of penile trauma. This injury can be so small as to be unnoticed or so severe as to be considered a broken penis or a penile fracture.

A fractured penis is also known as a broken penis syndrome.  It is a severe and painful form of bending injury that occurs to the erect penis typically during intercourse when a thin tissue membrane of the penis called the tunica albuginea becomes ruptured or torn crosswise, not along the length of the penis.  When a penile fracture occurs it is often accompanied by a popping or cracking sound that can be heard by the sexual partner, and results in immediate flaccidity. Because of the severe pain in the penis, bruising, and swelling, this is considered a medical emergency that often results in surgical repair. When the fractured penis is severe, the urinary tube within the penis that drains urine from the bladder (urethra) can be damaged, leading to blood in the urine.

All couples who use the woman-on-top intercourse position have experienced times when the woman will thrust back and lift off  the penis only to come back down again, forcefully pushing and bending the penis against her pelvic bone , groin or vulva region.  And all men have had the experience of missing the point of penetration at the opening of the vagina during intercourse.  These two are the most common way to cause a penile fracture.

Approximately 1,000 cases of broken penises are reported each year in the U.S.  Men in their 20s and 30s are a higher risk because they are more inclined to engage in vigorous or acrobatic sexual activity that result in a broken penis.   Men in their 50s and 60s are less inclined not only because of reduced frequency and vigor of sexual activity, but because their erections tend to be less rigid.

It is not necessary to stop sexual activity if you have Peyronie’s disease, only that you become more careful and conservative about a few aspects of your sexual repertoire.  Especially for a man who already has a penile problem, it is most wise to avoid additional injury of another fractured penis so that the Peyronie’s sex problem is not made worse.   Peyronie’s Disease Institute suggests the following safety steps to avoid reinjury and possible worsening of an existing case of Peyronies:

  1. The man should not allow himself to be so filled with sexual excitement and abandon that the throws caution to the wind during intercourse.   He must be the calm and sensible one who monitors and evaluates the strength and control of thrusting and selection of sex positions so as to avoid those that put him at risk for additional injury.
  2. The man should be the one who does primary thrusting in intercourse  to reduce the chance of  additional penile trauma.
  3. Use of additional sexual lubrication during  sexual intercourse.  Even if his sexual partner produces adequate natural lubrication, apply additional sexual lubrication to avoid dryness during intercourse that can lead to additional injury while thrusting.

After the broken penis has healed begin a treatment plan using Alternative Medicine measures found on the PDI website.