Aa
urinary tract
67 year old male, type II diabetes; insulin dependent 10u 2x, A1C = 7.2, reasonably good health. I have a weak urine stream and great difficulty achieving orgasm. It takes multiple attempts to achieve orgasm, most of the time the pressure gets intense and just stops. All of my blood-work is mostly in the normal ranges. My testosterone levels have been low, so I inject 10mg of testosterone once a week in my glutus maximus to bring it into a normal range. I also have hypothyroidism and take 65mg of nature-throid once daily. My sex drive is probably "normal" but: my body will not cooperate! Anything I can do? Is there anything that can help? VERY FRUSTRATING!
(diclofenac use) "the tendinitis doesn't flare up during the day ." well, yeah -- you're quite active and hard usage is very helpful with tendonitis symptoms. My theory is that activity pushes healing circulation into the problem area. As well, oiled firm massage (I used to also use a hard roller on my arm), and hot packs.
Weekly's pretty frequent for fast food indulgences considering your health condition and present state (I urge trying to transition to monthly, at least while trying to drop some pounds). I've lost interest in junk foods of that character merely for their own sake (doesn't bother me to indulge if it's for a special social occasion).
155-165 lbs, a reasonable guessestimate. What really counts is body fat content. Better I think, is aiming for a 34" waistline. Best, if you've access to a pharmacy's free fat content gadget, something like 12-15% body fat. I experienced a major drop in blood lipids and blood pressure, once I arrived at the low healthy BMI range (34" waist, I'm over 6', and 16% body fat). A lot of sleep apnea is fatty tissue related.
I'm with you on healthy foods and not trusting sources very much. But I'm pretty much a vegan vegetarian (no dairy, no meats at all, some fish). For protein I'm into sprouting / steam cooking dried whole beans (desi chick peas, 8 lb bags from WalMart).
Weekly's pretty frequent for fast food indulgences considering your health condition and present state (I urge trying to transition to monthly, at least while trying to drop some pounds). I've lost interest in junk foods of that character merely for their own sake (doesn't bother me to indulge if it's for a special social occasion).
155-165 lbs, a reasonable guessestimate. What really counts is body fat content. Better I think, is aiming for a 34" waistline. Best, if you've access to a pharmacy's free fat content gadget, something like 12-15% body fat. I experienced a major drop in blood lipids and blood pressure, once I arrived at the low healthy BMI range (34" waist, I'm over 6', and 16% body fat). A lot of sleep apnea is fatty tissue related.
I'm with you on healthy foods and not trusting sources very much. But I'm pretty much a vegan vegetarian (no dairy, no meats at all, some fish). For protein I'm into sprouting / steam cooking dried whole beans (desi chick peas, 8 lb bags from WalMart).
If my sleep tip (above) helps substantially (it's really turned my life around), you may find you can take the baclofen at a much different time. Waking up tired is a very bad sign (imo).
Another sleep tip is to consider using a Dawn Simulator. I've used mine for decades to good effect, it's long since discontinued but there are current versions readily available -- they're light alarms that gradually light up an incandescent light for your wake-up time. I see their biggest advantage is ensuring your alarm does Not interrupt your REM sleep which is unlikely to occur when the light's level high.
It's very easy to slip into a habit of taking an anti-inflammatory indefinitely (the diclofenac), I urge you to experiment with self-help steps too (some are mentioned above), I had lower arm tendonitis for a couple of months (a precursor to my two year adventure with Frozen Shoulder Syndrome) and while I found diclofenac transdermal salve invaluable (10%, and went through two 50 gram tubes of it over six weeks), hard massage on oiled skin (I used a roller) was helpful, along with hot packs. I now cope with arthritic knuckles and was on a milder diclofenac salve for a year until I chanced across the concept of using OTC chondroitin & glucosamine capsules, and am very pleased that it solves that pain problem (I'd read a double blind study with overwheming clinical evidence about it's application for osteoarthritis).
Buy a roll of one cent/penny postage stamps (or a sheet, but a roll's the better choice). Wet and apply a row around the base of your penis at night to encircle it. An overnight/nocturnal errection will have no difficulty bursting such an obstacle, which you'll see in the morning.
Of course, if you're heart healthy and don't mind the prospect of adding yet another med to your medicine chest, you could ask your doctor about E.D. meds. One popular one can be taken with food, in effect for 36 hours, vs another popular one which cannot be taken with food and is in effect for only 4 hours. They're Expensive but both can be readily split/crushed (which means it's usually far cheaper to buy the highest dose and split/crush them and then use the minimum that does the trick).
I do a lot of brisk walking but don't get much out of it unless I carry a weighted backpack (I use sandbags in it as ballast if I'm not lugging much shopping around).
Another sleep tip is to consider using a Dawn Simulator. I've used mine for decades to good effect, it's long since discontinued but there are current versions readily available -- they're light alarms that gradually light up an incandescent light for your wake-up time. I see their biggest advantage is ensuring your alarm does Not interrupt your REM sleep which is unlikely to occur when the light's level high.
It's very easy to slip into a habit of taking an anti-inflammatory indefinitely (the diclofenac), I urge you to experiment with self-help steps too (some are mentioned above), I had lower arm tendonitis for a couple of months (a precursor to my two year adventure with Frozen Shoulder Syndrome) and while I found diclofenac transdermal salve invaluable (10%, and went through two 50 gram tubes of it over six weeks), hard massage on oiled skin (I used a roller) was helpful, along with hot packs. I now cope with arthritic knuckles and was on a milder diclofenac salve for a year until I chanced across the concept of using OTC chondroitin & glucosamine capsules, and am very pleased that it solves that pain problem (I'd read a double blind study with overwheming clinical evidence about it's application for osteoarthritis).
Buy a roll of one cent/penny postage stamps (or a sheet, but a roll's the better choice). Wet and apply a row around the base of your penis at night to encircle it. An overnight/nocturnal errection will have no difficulty bursting such an obstacle, which you'll see in the morning.
Of course, if you're heart healthy and don't mind the prospect of adding yet another med to your medicine chest, you could ask your doctor about E.D. meds. One popular one can be taken with food, in effect for 36 hours, vs another popular one which cannot be taken with food and is in effect for only 4 hours. They're Expensive but both can be readily split/crushed (which means it's usually far cheaper to buy the highest dose and split/crush them and then use the minimum that does the trick).
I do a lot of brisk walking but don't get much out of it unless I carry a weighted backpack (I use sandbags in it as ballast if I'm not lugging much shopping around).
The DICLOFENAC POT 50mg 3x is a new script for me. I just started taking it about 2 weeks ago. About 2 hours after my first dose; the pain and discomfort was completely gone. That, almost instant, effect concerned me; so I looked it up on the manufacturers web site and found it could be somewhat dangerous long term. I decided not to take it 3x and only in the AM. That dosage works for me, because the tendinitis doesn't flare up during the day .
About 2 months ago I purchased 2 of those copper elbow sleeves which have offered some relief and a copper back wrap for my lower back. The norco doesn't seem to have much effect on the tendinitis.
Because the BACLOFEN TABLETS, USP 20 MG 3X AS NEEDED is a muscle relaxer: I realize that has an effect on every muscle and possibly a cause of ED and prostrate function. I usually only take that at bed time as it helps me sleep better. Other than that: it doesn't seem to have much effect on my pain levels at 3x. My pain management doctor suggested mega doses of the fish oil supplement. I did notice some relief from that. I started taking the larger doses about 3 months ago.
I have an excellent pain management doctor who helped me go from 50mg hydrocodon daily to 30mg by introducing the baclofen, stretching exercises, dry needle therapy, and organic supplements.
The doctor who had me on 50mg hydrocodon also had me taking 30mg restoril (a "pam" as from the Valium family) at bed time for better sleep. I only took that a couple of times because it left me "hung over" in the AM. I was diagnosed with sleep apenia and learned that sleeping pills with that condition could prove fatal.
We bought a good bed last year, one that is adjustable with massage. $3 grand worth! A good bed really makes a difference. I know my sleep still isn't a quality sleep. I wake up tired most days. I go to bed the same time every night, between 9 and 10 PM. I wake up at 2:30AM every single day, and hardly ever feel refreshed. My sleep apenia makes me sleep on my left side with the head of the bed slightly elevated (about 5%). I tried taking 50mg benadryl at bed time which made me sleep longer, but I felt more tired than without it. My sleep is rarely interrupted, most nights; not at all, then: only once to urinate.
What is the "postage stamp test"? Every once in awhile (very rarely) when I wake up to urinate; I have an erection to be proud of, I wish they would happen when wanted!
I'll try to lose more weight. About 10 years ago I topped out at 240 (when diagnosed with type II diabetes) and curbed some of my desires when it came to fast food (2 or 3 Big Macs at a sitting W/ fries and 2 apple pies) and soft drinks (6 to 8 20oz cokes daily). I only eat fast food once a week now; only as a "treat" if my blood sugar averaged less than 160 for the week. Smaller portions and more fiber should help? I set my sights on 185# for now and see I'll how that works. You mentioned "155/165#' in an earlier post. That weight sounds kind of weak and puny for my bone structure as a 36" waist band cuts into my hip bones. I do have a "pouch", it seems most of my body fat is there.
My lifestyle is moderately active. Some days I walk 7 miles or so (wear a pedometer on occasion), other days: maybe a mile. I do a lot of climbing, pulling, and stretching, in my profession; I'm a machinist and work on large, heavy equipment. I also grow a lot of my own fruits and vegetables, "organic" is preferred and I don't trust that label at WalMart! or anywhere else, so I have a garden. My own chicken and pork are next on my to-do list.
I appreciate your view and suggestions. I plan on sticking around for a VERY long time!
About 2 months ago I purchased 2 of those copper elbow sleeves which have offered some relief and a copper back wrap for my lower back. The norco doesn't seem to have much effect on the tendinitis.
Because the BACLOFEN TABLETS, USP 20 MG 3X AS NEEDED is a muscle relaxer: I realize that has an effect on every muscle and possibly a cause of ED and prostrate function. I usually only take that at bed time as it helps me sleep better. Other than that: it doesn't seem to have much effect on my pain levels at 3x. My pain management doctor suggested mega doses of the fish oil supplement. I did notice some relief from that. I started taking the larger doses about 3 months ago.
I have an excellent pain management doctor who helped me go from 50mg hydrocodon daily to 30mg by introducing the baclofen, stretching exercises, dry needle therapy, and organic supplements.
The doctor who had me on 50mg hydrocodon also had me taking 30mg restoril (a "pam" as from the Valium family) at bed time for better sleep. I only took that a couple of times because it left me "hung over" in the AM. I was diagnosed with sleep apenia and learned that sleeping pills with that condition could prove fatal.
We bought a good bed last year, one that is adjustable with massage. $3 grand worth! A good bed really makes a difference. I know my sleep still isn't a quality sleep. I wake up tired most days. I go to bed the same time every night, between 9 and 10 PM. I wake up at 2:30AM every single day, and hardly ever feel refreshed. My sleep apenia makes me sleep on my left side with the head of the bed slightly elevated (about 5%). I tried taking 50mg benadryl at bed time which made me sleep longer, but I felt more tired than without it. My sleep is rarely interrupted, most nights; not at all, then: only once to urinate.
What is the "postage stamp test"? Every once in awhile (very rarely) when I wake up to urinate; I have an erection to be proud of, I wish they would happen when wanted!
I'll try to lose more weight. About 10 years ago I topped out at 240 (when diagnosed with type II diabetes) and curbed some of my desires when it came to fast food (2 or 3 Big Macs at a sitting W/ fries and 2 apple pies) and soft drinks (6 to 8 20oz cokes daily). I only eat fast food once a week now; only as a "treat" if my blood sugar averaged less than 160 for the week. Smaller portions and more fiber should help? I set my sights on 185# for now and see I'll how that works. You mentioned "155/165#' in an earlier post. That weight sounds kind of weak and puny for my bone structure as a 36" waist band cuts into my hip bones. I do have a "pouch", it seems most of my body fat is there.
My lifestyle is moderately active. Some days I walk 7 miles or so (wear a pedometer on occasion), other days: maybe a mile. I do a lot of climbing, pulling, and stretching, in my profession; I'm a machinist and work on large, heavy equipment. I also grow a lot of my own fruits and vegetables, "organic" is preferred and I don't trust that label at WalMart! or anywhere else, so I have a garden. My own chicken and pork are next on my to-do list.
I appreciate your view and suggestions. I plan on sticking around for a VERY long time!
I suggest for your consideration:
- take the postage stamp test to check that you're getting nocturnal erections, fail that two nights in a row during a week or two and that's a concern imo (a different level of problem)
- you're on so many meds and supplements, I suppose a healthy blood pressure (< 115/75) is not a reasonable expectation
- drop even just 20 lbs and just maybe your diabetes II med can be downgraded to merely pills (and maybe the glimepiride and losartan-hctz can be dropped or at least reduced); and with lower body fat, just maybe BPH would become a lesser concern
Now, DICLOFENAC POT 50mg 3x -- of all your meds, this is the one I see as the most hazardous over the long term. This is for your tendonitis (have you tried other approaches, such as oil self-massage, hot packs, exercise)? Or, it's for your back/neck pain (have you received some guidance from a physio for stretching routines to loosen those up)?
How long have you been on diclofenac?
(rxlist.com) "Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals "
- take the postage stamp test to check that you're getting nocturnal erections, fail that two nights in a row during a week or two and that's a concern imo (a different level of problem)
- you're on so many meds and supplements, I suppose a healthy blood pressure (< 115/75) is not a reasonable expectation
- drop even just 20 lbs and just maybe your diabetes II med can be downgraded to merely pills (and maybe the glimepiride and losartan-hctz can be dropped or at least reduced); and with lower body fat, just maybe BPH would become a lesser concern
Now, DICLOFENAC POT 50mg 3x -- of all your meds, this is the one I see as the most hazardous over the long term. This is for your tendonitis (have you tried other approaches, such as oil self-massage, hot packs, exercise)? Or, it's for your back/neck pain (have you received some guidance from a physio for stretching routines to loosen those up)?
How long have you been on diclofenac?
(rxlist.com) "Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals "
Well, that's a lot to digest, which I'll poke away at. I assume you're familiar with sites that try to keep up with prescription med interactions.
What jumps out at me for the moment is that you might benefit from deeper sleep.
Blue light (from TVs/PCs, CFLs, street lamps, fluorescents but there's none of concern from incandescent lights) suppresses our body's melatonin production. Suggestion: wear sunglasses (or even better, yellow tinted sunglasses, since they don't block most of the brightness of your surroundings) two hours before bedtime, and see after a few nights if your sleep becomes: deeper and better quality, as well as less interrupted (eg. urine production is lowered since you're sleeping deeper, should that be an issue for you).
What jumps out at me for the moment is that you might benefit from deeper sleep.
Blue light (from TVs/PCs, CFLs, street lamps, fluorescents but there's none of concern from incandescent lights) suppresses our body's melatonin production. Suggestion: wear sunglasses (or even better, yellow tinted sunglasses, since they don't block most of the brightness of your surroundings) two hours before bedtime, and see after a few nights if your sleep becomes: deeper and better quality, as well as less interrupted (eg. urine production is lowered since you're sleeping deeper, should that be an issue for you).
There are a few other prescription meds: Altace 10mg 2x for blood pressure (typically runs 140/80), higher than the theoretical "normal" of 120/70 Altace also has a certain quality that protects the kidneys in diabetic patients. GLIMEPIRIDE 4 MG TABLET 1X, for blood sugar control, LOSARTAN-HCTZ 100-25 MG 1X for blood pressure and fluid retention, VENTOLIN HFA 90 MCG INHAL 18 GM 2 PUFFS 4-6 HOURS AS NEEDED (Only used rarely @ bedtime and upon awakening, sleep apnea), Tamsulosin HCL 0.4 MG 1X @ bedtime for BPH, BACLOFEN TABLETS, USP 20 MG 3X AS NEEDED, helps in pain management ( several bulging and one blown disk in lower back and a recent neck injury from a fall, passed out; BP 90/60 HR 44) SAW PALEMTTO 450 MG CAPSULES 4x (seems to be helping with BPH symptoms), D3 5000 IU 2x, DHEA 50 MG 2x (may be some help with sugar control), FISH OIL 1200 MG 360 MG OMEGA-3 4x and DICLOFENAC POT 50mg 3x for inflammation.
When I started taking the DHEA my insulin dependence went from 14u AM and PM to 9u AM and PM. The fish oil offered some relief of my tendinitis, I am a skilled tradesman which puts a lot of strain and repetitive movements on my arms and hands. I have 5 different doctors, 4 of whom are specialists. All are aware of their involvement, I make sure they do because I don't want the possibility of any drug related interactions to pop up or needless duplication of certain tests; usually blood work, I keep either a hard copy or digital readout of my most recent blood work. I prefer to use a holistic approach in my health care. A couple of the organics are working and probably reduced the needed dosage of prescription medications. I know the DHEA works, the fish oil and the saw palmetto. I had a history of BPH, about 2 incidents a year, going way back into my 30's. My GP at the time suggested the saw palmetto. I've been on the saw palmetto for over 20 years and hadn't had any problems with BPH until the last 2 years.
I am probably more proactive than most patients in my health care. I also try to learn as much as possible about treatment options. I'm not very fond of "big pharma" and their profit motive. However: I do follow my doctors advice and take my meds as prescribed. I rarely miss a prescribed dose, unless instructed before being sedated for a procedure such as a colonoscopy or that thing they do in your throat looking for varicosa, or minor surgery.
I've had testing done looking for the circulatory problems diabetic patients usually develop. Everything there looks good; no "diabetic nerve pain", good sensation in my feet for pain, pressure, temperature, excellent circulation in my lower extremities, the needles on my pen bend when I try to inject insulin in my thigh (On my feet all day), my belly is where I inject. You mentioned "erection" in your previous post: I haven't had a full erection in years, it takes hours to achieve a "working erection", the foreplay is the best part of the experience! I almost never ejaculate during penetration, I either lose the erection, or my breath, after 30 minutes or so.
About my weight; a pair of 38" trousers is too loose and a 36" cuts into my hip bones. I do have something of a "gut" that I'd like to lose! About a year ago, my Gastroenterologist suspected congestive heart failure because of edema in my lower extremities and a resting heart rate in the mid 50's. He referred me to a cardiologist for further testing. When I took that fall that injured my neck, the guys at work checked my vitals and my blood pressure was 90/60 and my HR at 44bpm. It turned out that I was being over-medicated by my GP with BP meds. I stopped taking 2 of them and now my BP is typically 130/80 and HR of 65. The edema is gone too. After all of the testing done by the cardiologist: he found nothing wrong and said "If the rest of your body can keep up; your heart will make it to 100". My gastroenterologist was treating me for HEP-C. I went thru the Solvaldi and Ribovirin treatment for 6 months a year ago. My viral load went from 6,000,000 to "undetectable" 3 months after treatment ended. This December I get another viral load test done. Once the effects of being over-medicated were gone: so were the various symptoms. Physically and emotionally; I feel pretty good right now.
I know my "junk" wont work as well as an 18 year old, that's no problem. It gets better with time and experience.....when it works!
I have an appointment coming up with my urologist and am looking for the correct questions to ask him, and perhaps some answers here as well. Nothing can beat a face to face with an MD. I appreciate your time and patience here. Best wishes.
When I started taking the DHEA my insulin dependence went from 14u AM and PM to 9u AM and PM. The fish oil offered some relief of my tendinitis, I am a skilled tradesman which puts a lot of strain and repetitive movements on my arms and hands. I have 5 different doctors, 4 of whom are specialists. All are aware of their involvement, I make sure they do because I don't want the possibility of any drug related interactions to pop up or needless duplication of certain tests; usually blood work, I keep either a hard copy or digital readout of my most recent blood work. I prefer to use a holistic approach in my health care. A couple of the organics are working and probably reduced the needed dosage of prescription medications. I know the DHEA works, the fish oil and the saw palmetto. I had a history of BPH, about 2 incidents a year, going way back into my 30's. My GP at the time suggested the saw palmetto. I've been on the saw palmetto for over 20 years and hadn't had any problems with BPH until the last 2 years.
I am probably more proactive than most patients in my health care. I also try to learn as much as possible about treatment options. I'm not very fond of "big pharma" and their profit motive. However: I do follow my doctors advice and take my meds as prescribed. I rarely miss a prescribed dose, unless instructed before being sedated for a procedure such as a colonoscopy or that thing they do in your throat looking for varicosa, or minor surgery.
I've had testing done looking for the circulatory problems diabetic patients usually develop. Everything there looks good; no "diabetic nerve pain", good sensation in my feet for pain, pressure, temperature, excellent circulation in my lower extremities, the needles on my pen bend when I try to inject insulin in my thigh (On my feet all day), my belly is where I inject. You mentioned "erection" in your previous post: I haven't had a full erection in years, it takes hours to achieve a "working erection", the foreplay is the best part of the experience! I almost never ejaculate during penetration, I either lose the erection, or my breath, after 30 minutes or so.
About my weight; a pair of 38" trousers is too loose and a 36" cuts into my hip bones. I do have something of a "gut" that I'd like to lose! About a year ago, my Gastroenterologist suspected congestive heart failure because of edema in my lower extremities and a resting heart rate in the mid 50's. He referred me to a cardiologist for further testing. When I took that fall that injured my neck, the guys at work checked my vitals and my blood pressure was 90/60 and my HR at 44bpm. It turned out that I was being over-medicated by my GP with BP meds. I stopped taking 2 of them and now my BP is typically 130/80 and HR of 65. The edema is gone too. After all of the testing done by the cardiologist: he found nothing wrong and said "If the rest of your body can keep up; your heart will make it to 100". My gastroenterologist was treating me for HEP-C. I went thru the Solvaldi and Ribovirin treatment for 6 months a year ago. My viral load went from 6,000,000 to "undetectable" 3 months after treatment ended. This December I get another viral load test done. Once the effects of being over-medicated were gone: so were the various symptoms. Physically and emotionally; I feel pretty good right now.
I know my "junk" wont work as well as an 18 year old, that's no problem. It gets better with time and experience.....when it works!
I have an appointment coming up with my urologist and am looking for the correct questions to ask him, and perhaps some answers here as well. Nothing can beat a face to face with an MD. I appreciate your time and patience here. Best wishes.
Are you on any other prescription meds? There are a few (especially mood meds, such as prozac) that will prevent ejaculation in some patients.
The weak urine stream may be benign prostate enlargement related. I assume without the injections, your testosterone is below the normal range. I gather you've no difficulty achieving useful erections, but are finding reaching the point of ejaculation challenging (correct?).
What is your waistline/belt setting? I assume it's more than 36". If you've handy access to a free pharmacy fat measuring gadget (works by impedance), you might be curious and find useful, your body's present fat percentage, an excellent though somewhat inaccurate measure of general body composition fitness.
Your BMI is 27.8. If you were much younger (say, 20-40) you would merely be overweight but close to obese at that BMI (of course, if a young you were very muscular such as a lumberjack or football player, BMI's misleading). More than 2/3rds of North Americans are now overweight or obese btw (you've lots of company).
At your present age you're at a point in life where, unless you're making extraordinary effort, you've lost 20-30 lbs of muscle mass over the decades. 205 lbs now is nothing like 205 lbs was back when you were 30 or 40.
Which is why I see your BMI as really comparable to someone younger of your height and with normal young musculature weighing 225-235 lbs (BMI 30.5 - 31.9, well into the Obese range). Obese men often have such difficulties I'm afraid, it just goes with the territory. They also accumulate other problems such as a predisposition to diabetes, serious cardiovascular concerns, along with a higher likelihood of various cancers (an indirect consequence of excess fatty tissue).
As to the solution? Bring your weight down. But, how far down?
Well, this will take you some time and application to do safely, comfortably, and sustainably but my recommendation's an ultimate target weight of 155-165 lbs. I urge focussing only on losing 20 pounds at a time, over something like four or five months. You should see noted improvement when you've gone from 205 lbs to 185 lbs. You should (imo) see massive improvement on many fronts once you reach: 165 lbs.
You will end up looking more wrinkled (fat's been filling up much of your wrinkles) but you will become far fitter, more energetic and I predict your problem will have long since faded away. No guarantees, but while perhaps a shock I hope the reasonableness of my suggestion comes to appeal to you over time.
What is your waistline/belt setting? I assume it's more than 36". If you've handy access to a free pharmacy fat measuring gadget (works by impedance), you might be curious and find useful, your body's present fat percentage, an excellent though somewhat inaccurate measure of general body composition fitness.
Your BMI is 27.8. If you were much younger (say, 20-40) you would merely be overweight but close to obese at that BMI (of course, if a young you were very muscular such as a lumberjack or football player, BMI's misleading). More than 2/3rds of North Americans are now overweight or obese btw (you've lots of company).
At your present age you're at a point in life where, unless you're making extraordinary effort, you've lost 20-30 lbs of muscle mass over the decades. 205 lbs now is nothing like 205 lbs was back when you were 30 or 40.
Which is why I see your BMI as really comparable to someone younger of your height and with normal young musculature weighing 225-235 lbs (BMI 30.5 - 31.9, well into the Obese range). Obese men often have such difficulties I'm afraid, it just goes with the territory. They also accumulate other problems such as a predisposition to diabetes, serious cardiovascular concerns, along with a higher likelihood of various cancers (an indirect consequence of excess fatty tissue).
As to the solution? Bring your weight down. But, how far down?
Well, this will take you some time and application to do safely, comfortably, and sustainably but my recommendation's an ultimate target weight of 155-165 lbs. I urge focussing only on losing 20 pounds at a time, over something like four or five months. You should see noted improvement when you've gone from 205 lbs to 185 lbs. You should (imo) see massive improvement on many fronts once you reach: 165 lbs.
You will end up looking more wrinkled (fat's been filling up much of your wrinkles) but you will become far fitter, more energetic and I predict your problem will have long since faded away. No guarantees, but while perhaps a shock I hope the reasonableness of my suggestion comes to appeal to you over time.
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