Pharmacy News. Lots of resources and information

LIPID-LOWERING DRUGS: NIACIN

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Niacin (nicotinic acid) is both effective and cheap. It is often used with bile sequestrants for better cholesterol control. It lowers LDL, IDL, and VLDL, and raises HDL. It also lowers triglycerides and is therefore useful in most types of hyperlipidemia (2, 4, and 5). Data from the Coronary Drug Project (Canner, et al. 1986) showed men with previous heart attacks using niacin had decreased rates of new infarction and lowered mortality; the use of niacin can extend life in those with coronary heart disease.

Since large doses of niacin are required, side effects are its biggest drawback. These include liver enzyme elevations, rashes, nausea, vomiting, flushing, and worsening of gout and diabetes. The intense flushing can be managed by taking an aspirin before taking the niacin, which blocks the prostaglandin-mediated flushing response. Lanolin creams help dry skin, but clearing rashes requires stopping the drug. In general, side effects can be minimized by starting at low doses and working up slowly. Your doctor will want to pace your niacin intake and test your liver enzymes periodically.

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ANGINA AND ALCOHOL: THE KING’S COLLEGE HOSPITAL GUIDELINES ON ALCOHOL

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Probably the team to have done more than any other to investigate the effects and ill-effects of different amounts of alcohol is thatmled by Professor Roger Williams, who was based at the liver unit at London’s King’s College Hospital for more than twenty years until he retired in 1995. This team’s study of the drinking habits of thousands of people have led to guidelines that have been accepted all over the world.

Doctors have accepted for many years that the main organs attacked by alcohol are the liver and the brain. Heavy drinking leads to cirrhosis and cancer of the liver, and can lead to a toxic encepha-lapathy in which the brain degenerates, leading to dementia and psychosis. It is also associated with cancers of the stomach and pancreas. However, until recently, it has not been particularly linked with heart disease.

How much is too much alcohol? With one unit of alcohol equaling twelve ounces of beer, five ounces of wine, or one “shot” of hard alcohol, it is recommended that you consume no more than two units a day. This recommendation may vary for women however. The difference is not just to do with their relative sizes, but to the fact that women’s livers have less capacity than men’s to deal with alcohol. This means that the regular male drinker may be able to handle more than the average female drinker. Professor Williams’s team recommend that you give your bodies a rest from alcohol on at least three days a week.

This advice was originally given to help people avoid liver and brain damage, but it is now seen as important for the heart, too. Alcohol in itself is not thought to cause angina or heart attacks, in that it does not cause arteries to narrow or accelerate the process of atheroma, or make the blood more viscous. By opening up blood vessels, it even gained a reputation for being helpful to the heart. Unfortunately, that reputation was wrong.

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ANGINA: WOMEN AND EXERCISE

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I write a regular column in the Sunday Mail, the most widely read Sunday newspaper in Scotland. In August 1995, I wrote about the sad fact that Scottish women, on the whole, appear to be becoming couch potatoes. Over the last twenty years, they have been getting fatter, exercising less, and younger women are actually smoking more—the reverse of the trend everywhere else, which is that more people are giving up smoking.

I pointed out that in the Great Scottish Run, a half-marathon held in August 1995, only one-fifth of the 7,200 runners were women, and I challenged them to improve that statistic in 1996.

I expected, and received, a few pointed letters from readers, but the gist of them was disappointing. Most of the women who wrote to me stressed that by the time they had done their own jobs, and added to that the housework and cooking, they were too tired to exercise, far less run half-marathons!

I understand their point and sympathize, but they were in fact shooting the messenger without listening to the message! It is up to women, if they also go out to work, to make sure that their spouses share the household jobs. That should free them to use their leisure time more effectively, together. If they are full-time housewives, then they can arrange their time to exercise appropriately.

Be sure to consult your physician before you begin any exercise program to determine whether it is appropriate for you.

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WHAT IS CHOLESTEROL?

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Before going into these trials, however, a few facts about cholesterol will be helpful. Everyone has been bombarded by the food industry and health pundits with the need to reduce cholesterol levels, but how many people really understand what it is? My guess is very few.

It is normal to have cholesterol in the bloodstream. It is a fatty substance used by the body to maintain organs such as the liver and brain, the structure of the cells of which is fat based. Cholesterol is a building block for complex steroid hormones such as cortisone and sex hormones.

Therefore you cannot do without cholesterol. However, you do need to keep its levels in the blood within certain limits. If it is too high, the excess appears to be deposited in the walls of the blood vessels, along with other fats (lipids). This produces first the fatty streaks, then the atheromatous plaques.

The same goes for another curious link to lowered cholesterol. Several early studies suggested that although lowering cholesterol reduced heart attack deaths, it was linked to increased deaths from accident, suicide, and violence. These have turned out to be statistical eccentricities, and not true differences. It is difficult to see how reducing blood cholesterol levels could make a person more vulnerable to a mugger’s attack or to death from a road accident!

Does lowering cholesterol actually improve heart disease? Dozens of studies have set out to answer this question, but few have given adequate answers. This is mainly because of flaws in the design of the trials, rather than that cholesterol reduction was in fact a failure. The first few trials of cholesterol reduction were aimed at whole populations, without screening for cholesterol levels.

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PATTERNS OF ANGINA

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John Hunter

During a meeting of the Board of Governors of St. George’s Hospital in London in 1793, John Hunter became involved in an angry dispute with the other members of the board. He suddenly stopped speaking, struggled to control his temper, then hurried into another room. He died within a few minutes.

John -Hunter did not, of course, have the advantages of today’s knowledge of angina. Emotions such as anger or fear can increase the heart rate and blood pressure well beyond that to which the angina-affected heart can adjust, and the result is sudden heart failure. John Hunter’s death is still a lesson today: Attention to the psychological and emotional state is important for anyone with angina (Rozanski, et al. 1988).

James Fixx

James Fixx is my next example. He was famous in the 1970s for his book, The Art of Running, in which he recommended exercise, and particularly running long distances, for people with angina. His book was a best-seller, and was very influential in establishing today’s fashion for marathons, half-marathons, and “fun-runs,” in which thousands of people take part.

For that we have to thank James Fixx, but sadly he became more famous still when he died during one of his runs—from a heart attack. Some people have used his premature death as an excuse for not exercising. “Exercise killed Jim Fixx,” they reason, “so it may kill me!” That is not strictly true. Exercise may have allowed James to live much longer than he otherwise would have, but he relied too much upon it, and too little on other ways to improve his health.

The facts about James Fixx are as follows: In his midthirties he had a heart problem diagnosed. He weighed 220 pounds, and became breathless when trying to run fifty yards. He took up running, and ten years later, in 1978, he had lost 55 pounds, had run a distance equivalent to going around the equator, had completed many marathons, and was running ten miles every day.

He died in 1989, in his late fifties. James’ problem was that he believed that he could “run through” his angina, and became so engrossed in his running schedule that he did not seek help for his increasing angina. He had, in fact, severe coronary artery disease, which was probably a leftover from his days of being overweight. His father had died of coronary artery disease at a young age, which suggests that there might have been an inherited tendency to very high levels of fat (cholesterol) in the blood.

James Fixx made the mistake of thinking that exercise is everything—that it could reverse all the problems that his previous lifestyle (and perhaps his genes) had laid down in his coronary arteries. Unfortunately it can’t. If he had slowed down a little, and asked for medical advice, things might have turned out differently. Even in the 1980s, there were effective ways to reduce cholesterol levels and to improve the coronary circulation. James might well have been a good candidate for coronary bypass surgery. With better circulation through his coronary arteries, he might still be running today.

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10 SYMPTOMS OF MENOPAUSE

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Not every woman is affected in the same way or to the same degree by menopausal symptoms. There are many symptoms of menopause—some obvious, some subtle— and you may or may not experience any of them. However, the more symptoms you recognize from your own personal experience, the more you may benefit from medical treatment. For many women, the symptoms of menopause, listed below, are mild or non-existant, while for others they are very real, and very discomforting.

1) A change in monthly periods— studies show that four of every five women notice changes in the frequency, duration, or regularity of their periods. These changes usually occur gradually in the two to three years prior to menopause. The changes are usually the first indication that menopause is approaching.

2) Hot flashes— about 70 percent of menopausal women experience hot flashes— sensations of intense heat, sometimes accompanied by sweating—which usually begin in the chest and spread up to the neck and face.

3) Night sweats— a typical symptom in menopausal women, sometimes to such a degree that a woman will need to change her nightclothes or sheets.

4) Difficulty sleeping— some menopausal women have difficulty sleeping because of troubling emotions, night sweats, and hot flashes.

5) Vaginal dryness or irritation— lower levels of estrogen can cause the walls of a woman’s vagina to become thinner. The vagina itself can become more prone to infection.

6) Lost interest in sex— because of vaginal changes, some menopausal women find intercourse to be painful. Hormonal changes and fatigue can also reduce the sex drive.

7) Urinary problems— reduced levels of estrogen may have an effect on your bladder and urethra, causing pain on urination, increased frequency of urination, and urinary incontinence.

Sudden changes of mood— some menopausal women experience depression or sudden changes in mood for no apparent reason. This may be due to estrogen deficiency and to a woman’s specific response to the changes she is experiencing.

9) Anxiety and irritability— such symptoms, along with a lack of concentration and loss of confidence, may be brought about by fluctuations in hormone levels, stress and fatigue.

10) Dizziness and palpitation— headaches and dizziness sometimes occur in menopausal women as a result of changes in circulation and heart rate.

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7 WAYS TO PROTECT YOURSELF FROM MEDICAL FAKES

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According to a nationwide poll, as many as 1 out of every 4 Americans has tried a “quack” or “miracle” treatment. In 1990, the House Committee on Health and Long-Term Care estimated that fake medicines and cures bilk consumers out of as much as 10 billion dollars each year.

Another report, issued by the American Medical Association’s Council on Scientific Affairs in 1990, estimated that 4 to 5 billion dollars a year is spent on unapproved and questionable cancer tests and treatment. The report also estimated that as many as 30 percent of all cancer patients paid for and underwent “worthless” treatments. Experts say that if people seek “traditional” treatment as soon as possible after being diagnosed, they stand a good chance of recovery in many cases. But, if you succumb to a promise of a “miracle cure” before you get conventional treatment, you may be risking your life.

Here are several things you can do to protect yourself from medical charlatans and worthless products.

1) If you need a specialist, get a referral from your family doctor or some other physician you trust. You can also get reliable referrals from hospitals that are affiliated with medical schools. 2) Discuss any treatment you are considering with your family doctor before you make any decisions.

3) Contact your state medical board if you have any questions about a specific doctor. The medical board will be able to tell you if any charges have been made against the doctor in question.

4) Don’t buy any unconventional products before you check them out thoroughly with the nearest FDA office, local consumer agency, or Better Business Bureau.

5) Be suspicious of advertising and phrases such as “miracle cure”, “secret formula”, and “amazing health care breakthrough”.

6) Stay away from any doctor who prescribes expensive vitamins and supplements, or who sells them in his office.

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For the purposes of the study, people were considered Type A if they: try to achieve several poorly defined goals; thrive on competition; crave recognition and advancement; are usually in a hurry; have intense concentration and alertness; and/or become angry easily.

AGGRESSIVE PEOPLE MAY LACK “GOOD” CHOLESTEROL

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For well over 30 years, scientists have suspected that people with aggressive or “Type A” personalities are more vulnerable to serious heart problems, such as heart attacks, than are people who are more “laid back”. But until now, the scientists had little scientific evidence to explain why this might occur. With the release of the results of a new study, medical experts say that low levels of high-density lipoprotein (HDL), the so-called “good” cholesterol, in Type A people may be responsible for the increased risk.

The study, directed by Dr. Joann Manson of Brigham and Woman’s Hospital in Boston revealed that the HDL levels in Type As were about 10 points lower than the level in Type B’s. Lowering HDL by a mere one point is believed to increase the risk of heart attacks by about 3 percent.

While the study does not prove cause and effect, researchers indicate that the stress which is common among Type As causes their bodies to produce a surplus of hormones that lower the HDL level.

Scientists agree that more research is necessary to know for certain whether low HDL actually causes the heart attacks experienced by aggressive personalities. However, if further research confirms the link between low HDL levels and heart attacks, it will provide more evidence to support the theory that stress reduction is good for the heart.

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Ticks can spread bacterial infection, Lyme disease and certain types of viral encephalitis.

BASIC EMERGENCY PROCEDURES: BITES AND STINGS

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Many different insects, snakes, and other animals are capable of inflicting injury through biting or stinging. Each type of injury requires slightly different treatment.

A) Insect stings— the most common stinging insects are honeybees, hornets, wasps, and fire ants. If such an insect “nails” you or a member of your household, look for a stinger. If you find one, remove it by scraping the skin carefully with a clean knife, a plastic card or a fingernail. Wash the area with soap and water and apply a cold pack to reduce swelling. Applying calamine lotion or a water and baking soda paste may help relieve discomfort.

Once you have removed the stinger and have cleaned the sting area, watch for signs of an allergic reaction- If you are going to have a reaction, it should happen within 30 minutes or so. Symptoms include difficulty breathing, wheezing, tightness of the throat or chest, nausea and dizziness, severe itching, and swelling of the tongue or mouth. If any of these symptoms occur, call the EMS or take the victim to a hospital or some other medical facility.

B) Scorpion stings and spider bites— keep the area of the sting lower than the victim’s heart. Wash the area of the sting or bite, cover it, and apply a cold pack. Also maintain an open airway and restore breathing and circulation if necessary.

Try to capture and/or identify the spider and call the poison control center or your doctor.

C) Ticks— using tweezers, remove the tick by grasping at its head and pulling steadily and slowly. Do not try to pull the tick out with your fingers. Clean the area with rubbing alcohol or an antiseptic and apply a cold pack to reduce swelling. If the tick head remains embedded in the skin, see your doctor immediately. Otherwise, watch for flu-like symptoms to develop. Such symptoms usually develop within two weeks. If the symptoms develop see your doctor.

D) Snake bites— clean the bite area with soap and water and immobilize the part of the body that was bitten. Try to keep the wound lower than the victim’s heart. Do not apply cold water or ice to the wound. In most cases, it is not recommended that you apply a tourniquet, or suck or cut the wound.

Try to identify the snake and its size. Call for an ambulance or take the victim to a medical facility immediately.

Animal bites

Bites by domestic pets and wild animals can become infected. They also carry the risk of tetanus and rabies.

Clean minor wounds with soap and water. Do not clean major wounds as they should be cleaned at a hospital or medical facility. Control any bleeding by applying direct pressure. If the bite is serious, or there is any possibility that the animal had rabies, call for an ambulance or transport the victim to the nearest medical facility.

Report the incident to your local health department or animal control service.

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