Day: 01/19/2012

Does Venous Thromboembolism Prophylaxis Lower 30-Day Mortality in Medical Inpatients?

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In a randomized trial, enoxaparin failed to do so.

Despite widespread use of low-molecular-weight heparin to prevent venous thromboembolism (VTE) in medical inpatients, the effect of this practice on mortality is unclear. In a trial conducted mainly in China and India, 8300 acutely ill medical inpatients were given graduated compression stockings and, additionally, were randomized to receive daily enoxaparin (40 mg) or placebo during hospitalization (6–14 days). Patients were eligible for enrollment if they had decompensated congestive heart failure; active cancer; or severe systemic infection plus chronic lung disease, obesity, previous VTE, or advanced age (>60).

All-cause mortality at 30 days, the primary outcome, was identical in the two groups — about 5%. All other efficacy endpoints (e.g., cardiopulmonary death, sudden death, pulmonary embolism) also occurred with similar frequency in both groups at 14, 30, and 90 days. Bleeding events occurred only slightly more often with enoxaparin than with placebo (2.2% vs. 1.5%), but this difference was statistically significant.

Comment: What should we make of this completely negative study? Were the compression stockings effective, thus diminishing the benefit of add-on enoxaparin? Can we generalize from these mainly Asian patients to other populations and other countries? The authors conclude that “pharmacologic thromboprophylaxis continues to have proven benefits in preventing VTE” in medical inpatients, but this comment refers mainly to preventing asymptomatic deep venous thrombosis.

A recent guideline from the American College of Physicians questions the trend to provide near-universal VTE prophylaxis to medical inpatients. This new study gives us further impetus to re-examine that practice.

Source:Journal Watch General Medicine

Erectile dysfunction and diabetes: Take control today.

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Erectile dysfunction is a common problem for men who have diabetes — but it’s not inevitable. Consider prevention strategies, treatment options and more.

 

Erectile dysfunction — the inability to get or maintain an erection firm enough for sex — is common in men who have diabetes. It can stem from problems caused by poor long-term blood sugar control, which damages nerves and blood vessels. Erectile dysfunction can also be linked to other conditions common in men with diabetes, such as high blood pressure and coronary artery disease.

Having erectile dysfunction can be a real challenge and can leave you and your partner feeling frustrated and discouraged. Take steps to cope with erectile dysfunction — and get your sex life back on track.

Talk to an expert

Many men are reluctant to bring up erectile dysfunction with their doctor. But don’t let embarrassment keep you from getting help. One small conversation can make a big difference. Here’s what to do:

  • Tell your doctor what’s going on. Your doctor will consider underlying causes of your erectile dysfunction, and can give you information about medication and other erectile dysfunction treatments. Find out your options.
  • Ask what you need to do to control diabetes. Careful blood sugar control can prevent nerve and blood vessel damage that can lead to erectile dysfunction. Ask your doctor if you’re taking the right steps to manage your diabetes.
  • Ask about other health problems. It’s common for men with diabetes to have other chronic conditions that can cause or worsen erectile dysfunction. Work with your doctor to make sure you’re addressing these other health problems.
  • Check your medications. Ask your doctor if you’re taking any medications that may be worsening your erectile problems, such as drugs used to treat depression or high blood pressure. Making a change to your medications may help.
  • Seek counseling. Anxiety and stress can worsen erectile dysfunction. A psychologist or other mental health provider can help you find ways to ease your stress level.

Consider your treatment options

A number of erectile dysfunction treatments are available. Ask your doctor if one of these may be a good choice for you:

  • Oral medications. Erectile dysfunction medications include sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca) or vardenafil (Levitra, Staxyn). These pills can help ease blood flow to your penis, making it easier to get and keep an erection. Check with your doctor to see whether one of these medications is a safe choice for you.
  • Other medications. If pills aren’t a good option for you, your doctor may recommend a tiny suppository you insert into the tip of your penis before sex. Another possibility is medication you inject into the base of your penis. Like oral medications, these drugs increase blood flow that helps you get and maintain an erection.
  • Vacuum-constriction device. If medications aren’t effective, you may try a penis vacuum-constriction device. Also called a penis pump or a vacuum pump, this device is a hollow tube you put over your penis. It uses a pump to draw blood into your penis to create an erection. This hand- or battery-powered device is simple to operate and has a low risk of problems. If a vacuum-constriction device is a good treatment choice for you, your doctor may recommend or prescribe a specific model. That way you can be sure it is approved by the Food and Drug Administration, suits your needs and is made by a reputable manufacturer. Vacuum-constriction devices available in magazines and sex ads may not be safe or effective.
  • Penile implants. In cases where medications or a penis pump won’t work, a surgical penis implant may be an option. Semirigid or inflatable penile implants are a safe and effective treatment for many men with erectile dysfunction.

Make good lifestyle choices

Don’t underestimate the difference a few changes can make. Try these approaches to improve erectile dysfunction and your overall health:

  • Stop smoking. Tobacco use, including smoking, narrows your blood vessels, which can lead to or worsen erectile dysfunction. Smoking can also decrease levels of the chemical nitric oxide, which signals your body to allow blood flow to your penis. If you’ve tried to quit on your own but couldn’t, don’t give up — ask for help. There are a number of strategies to help you quit, including medications.
  • Limit how much alcohol you drink. Drinking too much alcohol — more than two drinks a day — can damage your blood vessels and worsen erectile dysfunction.
  • Lower your stress level. Stress can reduce your erections. To keep stress under control, evaluate and prioritize your tasks. Set realistic expectations for yourself and ask for help when you need it. Try relaxation techniques such as meditation or yoga.
  • Get regular exercise. Regular exercise can increase blood flow, improve your mood and energy levels, and reduce stress. If you haven’t exercised for a while, start with something easy, such as a daily walk.
  • Fight fatigue. If you’re well rested, you’re less likely to struggle with erectile dysfunction. Make sure you’re not overdoing it and that you’re getting plenty of sleep.

 

Source:Mayo Clinic.

 

 

Inhalant abuse: Is your child at risk?

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What are the warning signs of inhalant abuse?

Inhalant abuse can be easy to conceal. Look for these warning signs:

  • Hidden rags, clothes or empty containers of products that could be abused
  • Chemical odors on breath or clothing
  • Paint or other stains on face, hands or clothing
  • Slurred or incoherent speech
  • Lack of coordination
  • Confusion
  • Irritability

What’s the best way to prevent inhalant abuse?

To prevent inhalant abuse, talk about it openly. For example:

  • Discuss the risks. Honest discussion can help prevent a tragedy. Talk about what products can be abused and slang terms for inhalants. State the facts clearly. Emphasize that inhalants are deadly chemicals — not a harmless way to get high.
  • Be a good listener. Encourage your child to come to you with questions or concerns.
  • Set expectations. Let your child know that you won’t tolerate huffing or other types of inhalant abuse. Remind your child that you love him or her — and safety comes first.
  • Stay involved. Meet your child’s friends and their parents. Know where your child is and what he or she is doing, especially after school. Support your child’s efforts to resist peer pressure.

What if I find my child huffing?

If you discover your child huffing, sniffing or bagging, stay calm. If your child is breathing, move to a well-ventilated area until the effects of the episode wear off. If your child is unconscious or not breathing, seek emergency medical help.

If your child has been abusing inhalants for some time, withdrawal symptoms — such as sleep disturbances, irritability, nausea, vomiting, sweating, rapid heartbeat and physical tics — are possible.

If your child can’t stop huffing, sniffing or bagging on his or her own, seek professional help. Start with your child’s doctor, a school counselor or a local drug rehabilitation facility. The support of a mental health professional can be valuable as well. With help, your child can end inhalant abuse and learn how to make healthy choices for a lifetime.

What are the warning signs of inhalant abuse?

Inhalant abuse can be easy to conceal. Look for these warning signs:

  • Hidden rags, clothes or empty containers of products that could be abused
  • Chemical odors on breath or clothing
  • Paint or other stains on face, hands or clothing
  • Slurred or incoherent speech
  • Lack of coordination
  • Confusion
  • Irritability

What’s the best way to prevent inhalant abuse?

To prevent inhalant abuse, talk about it openly. For example:

  • Discuss the risks. Honest discussion can help prevent a tragedy. Talk about what products can be abused and slang terms for inhalants. State the facts clearly. Emphasize that inhalants are deadly chemicals — not a harmless way to get high.
  • Be a good listener. Encourage your child to come to you with questions or concerns.
  • Set expectations. Let your child know that you won’t tolerate huffing or other types of inhalant abuse. Remind your child that you love him or her — and safety comes first.
  • Stay involved. Meet your child’s friends and their parents. Know where your child is and what he or she is doing, especially after school. Support your child’s efforts to resist peer pressure.

What if I find my child huffing?

If you discover your child huffing, sniffing or bagging, stay calm. If your child is breathing, move to a well-ventilated area until the effects of the episode wear off. If your child is unconscious or not breathing, seek emergency medical help.

If your child has been abusing inhalants for some time, withdrawal symptoms — such as sleep disturbances, irritability, nausea, vomiting, sweating, rapid heartbeat and physical tics — are possible.

If your child can’t stop huffing, sniffing or bagging on his or her own, seek professional help. Start with your child’s doctor, a school counselor or a local drug rehabilitation facility. The support of a mental health professional can be valuable as well. With help, your child can end inhalant abuse and learn how to make healthy choices for a lifetime.

Source:Mayo Clinic.

 

 

Psychological insulin resistance stems from fear.

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 Insulin dramatically increases the life expectancy of persons with type 1 diabetes. Those with type 2 diabetes have also benefited from modern insulins. However, about a third of those with type 2 diabetes are unwilling to take insulin. Here’s a few of the reasons that we hear for “psychological insulin resistance”:

  • Guilt — Beginning insulin therapy may make individuals feel that they have failed at managing their diabetes.
  • Needle phobia.
  • Insulin injections would restrict their lifestyle.
  • Insulin causes weight gain.
  • Fear their diabetes is now serious.
  • Fear of getting low blood sugars.
  • In western society, insulin is viewed as a last resort.
  • Association of insulin therapy and complications in close relatives.

Due to the progressive loss of beta cell function in type 2 diabetes, most of those with type 2 will likely require insulin at some point.

Complications of uncontrolled type 2 diabetes are well documented. Type 2 diabetes is falsely perceived as mild.

Beginning insulin therapy indicates to some people that their diabetes is now more serious. People with type 2 diabetes often feel fine and may wonder why they should start insulin. The greatest barrier to starting insulin is the fear of gaining weight, but with lifestyle counseling the weight gain overall is modest.

Healthcare providers are also reluctant to initiate insulin therapy even when a person has a high A1C. The provider’s attitude has a significant impact on the patient’s attitudes and beliefs regarding insulin. Often, insulin therapy is used as a threat to force people to make lifestyle changes. Or, clinicians can use it as a scare tactic — a threat if the person with diabetes does not comply with prescribed oral agents. Labeling insulin therapy negatively makes people with diabetes feel like they’ve failed.

Recently, I had a patient tell me she didn’t ever want to go on insulin. She wasn’t starting on it, but when she repeated the statement I asked her why. She said she didn’t want the hassle of having to give herself injections. I mentioned that when a person with type 2 diabetes needs to start insulin, they are often started on a once-daily long acting insulin injection. She was surprised, relieved and said that wouldn’t be bad at all.

Source: Mayo clinic Blog

Consider your treatment options

A number of erectile dysfunction treatments are available. Ask your doctor if one of these may be a good choice for you:

  • Oral medications. Erectile dysfunction medications include sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca) or vardenafil (Levitra, Staxyn). These pills can help ease blood flow to your penis, making it easier to get and keep an erection. Check with your doctor to see whether one of these medications is a safe choice for you.
  • Other medications. If pills aren’t a good option for you, your doctor may recommend a tiny suppository you insert into the tip of your penis before sex. Another possibility is medication you inject into the base of your penis. Like oral medications, these drugs increase blood flow that helps you get and maintain an erection.
  • Vacuum-constriction device. If medications aren’t effective, you may try a penis vacuum-constriction device. Also called a penis pump or a vacuum pump, this device is a hollow tube you put over your penis. It uses a pump to draw blood into your penis to create an erection. This hand- or battery-powered device is simple to operate and has a low risk of problems. If a vacuum-constriction device is a good treatment choice for you, your doctor may recommend or prescribe a specific model. That way you can be sure it is approved by the Food and Drug Administration, suits your needs and is made by a reputable manufacturer. Vacuum-constriction devices available in magazines and sex ads may not be safe or effective.
  • Penile implants. In cases where medications or a penis pump won’t work, a surgical penis implant may be an option. Semirigid or inflatable penile implants are a safe and effective treatment for many men with erectile dysfunction.

Make good lifestyle choices

Don’t underestimate the difference a few changes can make. Try these approaches to improve erectile dysfunction and your overall health:

  • Stop smoking. Tobacco use, including smoking, narrows your blood vessels, which can lead to or worsen erectile dysfunction. Smoking can also decrease levels of the chemical nitric oxide, which signals your body to allow blood flow to your penis. If you’ve tried to quit on your own but couldn’t, don’t give up — ask for help. There are a number of strategies to help you quit, including medications.
  • Limit how much alcohol you drink. Drinking too much alcohol — more than two drinks a day — can damage your blood vessels and worsen erectile dysfunction.
  • Lower your stress level. Stress can reduce your erections. To keep stress under control, evaluate and prioritize your tasks. Set realistic expectations for yourself and ask for help when you need it. Try relaxation techniques such as meditation or yoga.
  • Get regular exercise. Regular exercise can increase blood flow, improve your mood and energy levels, and reduce stress. If you haven’t exercised for a while, start with something easy, such as a daily walk.
  • Fight fatigue. If you’re well rested, you’re less likely to struggle with erectile dysfunction. Make sure you’re not overdoing it and that you’re getting plenty of sleep.

Source: Mayo Clinic

Is it safe to take Claritin or other allergy medications during pregnancy?

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Allergy medications are sometimes recommended during pregnancy. Before you take any medication during pregnancy, however, it’s important to weigh the severity of your symptoms against the possible risks to your baby.

For example, loratadine (Claritin, Alavert) is considered a category B drug — which means that animal studies haven’t shown any risks to unborn babies whose mothers take the drug. Although there are no guarantees about safety during pregnancy, drugs in this class are often the best option when medication is needed during pregnancy.

If you’re struggling with allergy symptoms, it might help to:

  • Avoid triggers. Limit your exposure to anything that triggers your allergy symptoms.
  • Try saline nasal spray. Over-the-counter saline nasal spray can help ease nasal dryness, bleeding and congestion. Use the spray as often as needed.
  • Rinse your nasal cavity with a neti pot. Neti pots are available in most pharmacies. Once or twice a day, fill the neti pot with an over-the-counter saline nasal solution. Then tilt your head over the sink, place the spout of the neti pot in your upper nostril and gently pour in the saline solution. As you pour, the saline solution will flow through your nasal cavity and out your lower nostril. Repeat on the other side. If you’d rather make your own irrigation solution, use water that’s distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller. Also be sure to rinse the neti pot after each use with similarly distilled, sterile, previously boiled and cooled, or filtered water. Leave the rinsed neti pot open to air-dry.
  • Include physical activity in your daily routine. Exercise helps reduce nasal inflammation.
  • Use nasal strips at night. Over-the-counter adhesive nasal strips — such as Breathe Right and Breathe Clear — can help keep your nasal passages open while you’re sleeping.

If these tips don’t relieve your allergy symptoms, remember that allergy medications aren’t necessarily off-limits during pregnancy. Work with your health care provider to choose the safest medication for you and your baby.

Source: Mayo clinic Blog

CT scan for cancer: Should you be screened?

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Findings of a large clinical trial showed that lung CT scan screening reduced lung cancer deaths among smokers. Find out more.

 

If you’re a smoker or former smoker, you may worry about your risk of getting lung cancer or dying from it. A major study of heavy smokers, called the National Lung Screening Trial (NLST), compared lung CT scans and chest X-rays and found that getting a lung CT scan lowered the risk of dying of lung cancer. This is the first study to show lung cancer screening may save lives. However, not all study details have been released for careful review by doctors and scientists other than those who conducted the study. For that reason, most medical groups, including the American Cancer Society, don’t yet recommend lung cancer screening to smokers and former smokers.

David Midthun, M.D., is a consultant in the Division of Pulmonary and Critical Care Medicine at Mayo Clinic, Rochester, Minn. He explains the results of the NLST study and the pros and cons of using lung CT scans for lung cancer screening.

Results of the National Lung Screening Trial suggest that smokers and former smokers might benefit from lung CT scan screening. Is that the case?

The result of the NLST is the first indication that any test can reduce deaths from lung cancer. The study involved more than 50,000 current and former heavy smokers — people who smoked the equivalent of a pack of cigarettes a day for 30 years — ages 55 to 74. Participants were randomized between low-dose spiral CT scan and chest X-ray at the start of the trial. They received annual screening tests for three years and then were followed for five years. The initial results of this trial revealed a reduction in lung cancer deaths with CT scan screening. The results showed 354 lung cancer deaths had occurred among those who had been screened with CT scan vs. 442 deaths among those who were screened with chest X-ray. That represents a 20.3 percent reduction with CT screening.

With some cancers, doctors encourage people to get regular screening. Will lung cancer be added to that list?

Currently, in most cases, screening for lung cancer is not recommended and not covered by Medicare or most insurance companies. However, the National Comprehensive Cancer Network (NCCN) has recommended screening for high-risk individuals ages 55 to 74 who have smoked a pack or more of cigarettes a day for 30 years or more, and who are still smoking or who quit less than 15 years ago. The NCCN also recommends screening for those 50 and older who have smoked a pack a day or more of cigarettes for 20 years or longer and have one additional risk factor for lung cancer. This could include a history of exposure to radon or occupational exposure to certain chemicals.

Screening for breast, cervical and colon cancers has been shown to reduce your risk of dying of these diseases when compared with those who don’t get screened. Doctors recommend screening for these cancers because doing so has proved beneficial for a group of people in the study setting. It remains to be seen whether the NLST results regarding lung cancer will lead to changes in screening guidelines by groups such as the American Cancer Society or U.S. Preventive Services Task Force.

Will lung CT scans help doctors diagnose lung cancer earlier?

Prior lung CT scan studies have shown that screening increases detection of early-stage cancer, and the NLST results provide evidence that those diagnoses end up being more beneficial than harmful in that they reduce the likelihood of death.

Being diagnosed with lung cancer at an earlier stage does make it more likely that surgery — the best treatment for most types of lung cancer — can remove and cure the cancer.

What are the risks of lung CT scans?

Risks of lung CT scans can include:

  • Finding abnormalities that are eventually determined to not be cancer. CT scans find abnormalities in about 20 to 60 percent of smokers and former smokers, but most of these abnormalities are scars from inflammation or other noncancerous conditions. The CT scan’s sensitivity can result in doctors suspecting the possibility of cancer where there really is no cancer, which results in invasive follow-up tests, unnecessary surgery, and anxiety for those getting screened and their loved ones. In other words, screening leads to necessary invasive tests and surgery for lung cancer, but these tests end up being unnecessary if it’s eventually determined that the spot first found on a CT scan isn’t lung cancer but instead something benign.
  • Finding very small abnormalities that require follow-up scans. CT scans are so good at seeing nodules or spots on the lung that they can see very small nodules that don’t need immediate testing, but do need follow-up CT scanning to detect any changes.
  • Exposure to radiation. CT scans expose you to a small dose of radiation. Compared with some other parts of the body, such as the breast, lungs have greater potential for developing radiation-induced cancer. Several studies have estimated an increased risk of developing cancer from CT scan radiation. The risk of developing cancers from CT scans is small, but it’s a reminder of the importance of weighing the risk vs. the benefit of any medical test.

What will you tell patients who ask about lung CT scans?

Currently, only one major medical organization — the National Comprehensive Cancer Network — recommends screening for lung cancer. However, with the results of the NLST, that appears likely to change. There is much to be learned about who may benefit from lung CT scan screening and who may not benefit. Until then, it’s best to discuss the potential benefits and risks of lung CT scan screening with your doctor. Despite the news about the potential benefits of lung CT scan screening, it’s still important to remain focused on risk reduction in trying to keep people from starting smoking and getting smokers to stop smoking.

Source:Mayo Clinic.

Blood glucose meter: How to choose?

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Many types of blood glucose meters are available. Here’s how to choose one that fits your needs and lifestyle.

If you have diabetes, you likely need a blood glucose meter — a small computerized device — to measure and display your blood glucose level. Exercise, food, medications, stress and other factors affect your blood glucose level. Using a blood glucose meter can help you better manage your diabetes by tracking any fluctuations caused by these factors.

Many types of blood glucose meters are available, from basic models to more-advanced meters with multiple features and options. The cost of blood glucose meters and test strips varies, as can insurance coverage. Study all of your options before deciding which model to buy. Here’s what to look for.

Choosing the right meter

When selecting a blood glucose meter, it can help to know the basics of how they work. To use most blood glucose meters, you first insert one end of a test strip into the device. Then, you prick a clean fingertip with a special needle (lancet) so that you can draw a drop of blood. You carefully touch the other end of the test strip to the blood and wait for a blood glucose reading to appear on the screen.

Blood glucose meters are usually accurate in how they measure glucose, but they differ in the type and number of features they offer. Here are several factors to consider when choosing a blood glucose meter:

  • Insurance. Check with your insurance provider for coverage details before you buy. Some insurance providers limit coverage to specific models or limit the total number of test strips allowed.
  • Cost. Meters vary in price, so shop around. Be sure to factor in the cost of test strips, especially if insurance doesn’t pay for them. Test strips are the most expensive part of monitoring because they’re used so often. A meter may be the cheapest one on the market, but may not be a good deal if the strips cost twice as much. Also, individually packaged strips tend to cost more, but you might not use all the strips in a container before the expiration date or within the required number of days after opening the container. Figure out which type of strip is most cost-effective for you.
  • Ease of use and maintenance. Some meters are easier to use than others. Are both the meter and test strips comfortable to hold? Can you easily see the numbers on the screen? How easy is it to get blood onto the strips? Does it require a small or large drop of blood? Also, some brands of meters need to be coded and others have no coding. Code numbers are used to calibrate your meter with the test strips for accurate results.
  • Special features. Ask about the features to see what meets your specific needs. For example, some meters are large with strips that are easier to handle. Some are compact and easier to carry. People with impaired vision can buy a meter with a large screen or a “talking” meter that announces the results. Colorful meters that give a quick reading are available for children. Some models have a backlight, which is handy for nighttime readings. Others are manufactured to withstand extreme temperatures, which may be useful for people who spend a lot of time outdoors, such as hikers or construction workers.
  • Information storage and retrieval. Consider how the meter stores and retrieves information. Some can track all the information you’d normally write in a log, such as the time and date of a test, the result, and trends over time. Some meters offer the ability to download your blood glucose readings to a computer or your cell phone, then email the test results to your doctor.
  • Support. Many meter manufacturers include a toll-free number on the back of the meter or packaging that you can call for help. Look for a meter that includes clear instructions that demonstrate the correct way to use the meter. Some manufacturers offer user manuals on their websites.

Advances in monitoring tools

Although finger pricks remain the gold standard for blood sugar monitoring, researchers are developing products designed to take the “ouch” out of the process. You might ask your doctor about these alternatives.

Device

How it works

Considerations

Alternative site monitor Allows blood samples from areas likely to be less painful than your finger, such as your arm, abdomen or thigh Not as accurate as fingertip samples when blood sugar level is rising or falling quickly
Continuous glucose testing Uses a sensor placed under skin to measure blood sugar level; transmits each reading to a small recording device worn on your body; sounds an alarm if blood sugar level becomes too low or too high Expensive; requires sensor to be replaced every three to seven days depending on the brand; must check blood sugar level with a traditional monitor when dosing for insulin or treating low blood sugar to confirm readings

Infrared, laser light and electric current technologies are among a few of the possible offerings on the horizon for noninvasive methods of checking blood sugar levels. However, none have been approved yet in the U.S.

If you’ve looked at the costs, features and other considerations and are still unsure which blood glucose meter to buy, ask your doctor or diabetes educator for a recommendation. He or she can help you sort out the pros and cons and can answer questions about available models.

Source:Mayo Clinic.

 

Playing it safe with herbal supplements.

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Herbal supplements may not mix with heart medicines

Some herbal supplements can have dangerous interactions with heart medications.

Herbal supplements are natural, so they must be safe, right? Not necessarily. Herbal supplements can have strong effects in the body, and some can interact with prescription medications used to treat heart and circulatory problems, such as high blood pressure and heart failure. Some of these interactions can even be dangerous.

Herbal supplements and prescription medications

At least a quarter of adults who take prescription medications also take dietary supplements, including herbal supplements. That number is even higher among adults older than age 70 — three-quarters report using both prescription medications and dietary supplements.

Yet many herbal supplements interact with medications for cardiovascular disease — which are widely prescribed for older adults. The chances of herbs and drugs interacting are high. Indeed, 8 of the 10 most widely used supplements interact with the blood-thinning medication warfarin (Coumadin). Here are just a few of the herbal supplements that can affect warfarin:

  • Danshen
  • Dong quai
  • Evening primrose oil
  • Garlic
  • Ginkgo
  • Ginseng
  • St. John’s wort

That’s why it’s so important to talk with your doctor before taking herbal supplements if you take prescription medications. Your doctor and pharmacist can help you avoid risky interactions.

Herbal supplements may not mix with heart medicines

Herbal supplements and drug interactions

This table shows popular herbal supplements and interactions with common heart medications. It’s not a complete list, however, so be sure to discuss with your doctor the medications and supplements you take.

Herbal supplement

Medication

Potential effect
Garlic
  • Aspirin
  • Clopidogrel (Plavix)
  • Warfarin (Coumadin)
 Increases risk of bleeding
Ginkgo
  • Aspirin
  • Warfarin
 Increases risk of bleeding
Ginseng
  • Warfarin
 Decreases effectiveness of warfarin
Hawthorn
  • Beta blockers, such as atenolol (Tenormin), nadolol (Corgard) and propranolol (Inderal, Innopran XL)
 Increases blood pressure and heart rate
  • Calcium channel blockers, such as diltiazem (Cardizem, Dilacor, others), nifedipine (Procardia) and verapamil (Calan, Covera-HS,Verelan)
  • Nitrates, such as nitroglycerin (Nitro-Bid, Nitrostat,others) and isosorbide (Monoket, Isordil)
 Decreases blood pressure
  • Digoxin (Lanoxicaps, Lanoxin)
 Increases effects of digoxin
Licorice
  • Warfarin
 Decreases levels of warfarin
St. John’s wort
  • Calcium channel blockers
  • Digoxin
  • Warfarin
  • Dabigatran (Pradaxa)
  • Rivaroxaban (Xarelto)
  • Statins, such as atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor)
 Reduces effectiveness of drugs

If your doctor tells you it’s OK to use an herbal supplement combined with a medication, make sure you follow dosing instructions carefully. Watch for any unusual signs or symptoms that you could be having a drug interaction, such as rapid heartbeat, low blood sugar or changes in blood pressure.

Source:Mayo Clinic.

 

Complementary and alternative medicine: Evaluate treatment claims.

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Don’t take all CAM claims at face value. Do your homework when considering CAM therapies.

Complementary and alternative medicine treatments, such as herbal remedies and acupuncture, have become more popular as people seek greater control of their own health. But while complementary and alternative medicine, called CAM for short, offers you more options, not all CAM treatments have been proved safe or effective.

When considering CAM treatments, it pays to be a savvy consumer. Be open-minded yet skeptical. Learn about the potential benefits and risks. Gather information from a variety of sources and check the credentials of CAM practitioners. And be sure to talk with your doctor before trying any treatment — especially if you take medications or have chronic health problems.

How to evaluate claims of treatment success

Look for solid scientific studies
When researching CAM treatments, do like doctors do. Look for high-quality clinical studies. These large, controlled and randomized trials are published in peer-reviewed journals — journals that only publish articles reviewed by independent experts. The results of these studies are more likely to be solid.

Be cautious about studies in animals, laboratory studies or studies that include only a small number of people. Their results may or may not hold up when tested in larger clinical trials. Finally, remember that sound health advice is generally based on a body of research, not a single study.

Although scientific studies are the best way to evaluate whether a treatment is safe and effective, it isn’t always possible to find good studies about alternative medicine practices. Keep in mind that a lack of evidence doesn’t necessarily mean a treatment doesn’t work — but it does mean it hasn’t been proved. Don’t hesitate to talk with your doctor if you have questions.

Weed out misinformation
The Internet is full of information about alternative medicine treatments, but not all of it is accurate. To weed out the good information from the bad, use the three D’s:

  • Dates. Check the creation or update date for each article. If you don’t see a date, don’t assume the article is recent. Older material may be outdated and not include recent findings, such as newly discovered side effects or advances in the field.
  • Documentation. Check sources. Are qualified health professionals creating and reviewing the information? Is advertising clearly identified? Look for the logo from the Health on the Net (HON) Foundation, which means that the site follows HON’s principles for reliability and credibility of information.
  • Double-check. Gather as much information as you can. Visit several health sites and compare the information they offer. If you can’t find supporting evidence to back up the claims of a CAM product, be skeptical. And before you follow any advice you read on the Internet, check with your conventional doctor for guidance.

Supplements: ‘Natural’ doesn’t always mean safe

Herbal remedies, vitamins and minerals, and all types of dietary supplements are marketed as “natural” products, but they can have drug-like effects that can be dangerous. Even some vitamins and minerals can cause problems when taken in excessive amounts. So it’s important to do your homework and investigate potential benefits and side effects of dietary and herbal supplements. Play it safe with these tips:

  • Talk to your doctor before taking a dietary supplement. This is especially important if you are pregnant, nursing a baby, or if you have a chronic medical condition such as diabetes or heart disease.
  • Avoid drug interactions. Prescription and over-the-counter medications can interact with certain dietary supplements. For example, the herbal supplement ginkgo can interact with the blood-thinning medication warfarin and increase the risk of serious bleeding complications.
  • Before surgery, tell your doctor about supplements you take. Some supplements can cause problems during surgery, such as changes in heart rate or blood pressure or increased bleeding. You may need to stop taking these supplements at least two to three weeks before your procedure.

Watch out for CAM scams

Scammers have perfected ways to convince you that their alternative medicine products are the best. These opportunists often target people who are overweight or who have medical conditions for which there is no cure, such as multiple sclerosis, diabetes, Alzheimer’s disease, cancer, HIV/AIDS and arthritis. Remember if it sounds too good to be true, it probably is. Be alert for these red flags:

  • Big promises. Advertisements call the product a “miracle cure” or “revolutionary discovery.” If that were true, it would be widely reported in the media and your doctor would recommend it.
  • Pseudomedical jargon. Although terms such as “purify,” “detoxify” and “energize” may sound impressive and may even have an element of truth, they’re generally used to cover up a lack of scientific proof.
  • Cure-alls. The manufacturer claims that the product can treat a wide range of symptoms, or cure or prevent a number of diseases. No single product can do all this.
  • Testimonials. Anecdotes from individuals who have used the product are no substitute for scientific proof. If the product’s claims were backed up with hard evidence, the manufacturer would say so.
  • Guarantees and limited offers. These pitches are intended to get you to buy before you can evaluate the product’s claims.

Choose CAM practitioners wisely

Take care when choosing an alternative medicine practitioner. Picking a name out of the phone book isn’t the safest way to select a practitioner. Instead, try these tips from the National Center for Complementary and Alternative Medicine (NCCAM):

  • Talk with your doctor. Ask your conventional doctor for recommendations. He or she can also be a source of advice about any recommendations you get from an alternative medicine practitioner.
  • Contact a local hospital or medical school. They often keep lists of area CAM practitioners. Some have their own CAM practitioners on staff.
  • Check the national association. Alternative medicine associations will often provide a list of certified practitioners in your area. To find the addresses and phone numbers of these associations, check the Directory of Health Organizations online compiled by the National Library of Medicine.
  • Call your local health department. Ask if they know of state or local certifying, licensing or accreditation bodies for the alternative medicine practice you’re considering.
  • Ask questions. Ask CAM practitioners about their education, training, licenses and certifications. Ask if they specialize in particular diseases or health conditions and whether they frequently treat people with problems similar to yours. Also ask what treatments cost — and find out if your health insurance covers them.

Source:Mayo Clinic.

 

 

Oh, My Fallen Arch !!

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Some people are born with flat feet, but others acquire fallen arches due to poor footwear, pregnancy (which loosens the ligaments), standing for long periods of time, or medical conditions like diabetes and rheumatoid arthritis. The posterior tibial tendon, which helps you push off when you walk, is responsible for maintaining the foot’s arch. If it’s not supported, over time it can become weak and cause pain in the arch and heel, or swelling on the inside of the foot and ankle. That’s when it’s time to see a podiatrist.

Foot and ankle specialist Lisa Price, DPM of Scotland Podiatric, says that most fallen arches can be treated with orthotics. Orthotics, like eyeglasses, don’t fix the problem, but instead align the foot and lessen the pain. A good pair of shoes can also go a long way in foot preservation. Look for shoes with a slight wedge (running shoes are a good example) and steer clear of flat shoes like ballet slippers, moccasins, Chuck Taylors and “Ugg-like” boots. Although slippers feel great, opt for “house shoes” with an arch support. Curious about the state of your arches? Put a brown paper bag on the floor, wet your foot and step on the bag. If you see your full foot imprint, you have a flat foot. A space between the ball of your foot and heel means you have an arch.

Source:Podiatrics