MASTERING MEDICATIONS: THE CARDIAC PHARMACY

It’s almost certain that your doctor has prescribed special medications for you as a heart patient. Some will be taken on a temporary basis, while you might need to take others for the rest of your life. And it’s just as certain that you’re more than a bit confused about those pills, capsules, tablets and whatnot.
Cardiac medications comprise a major segment of the entire pharmaceutical industry. There are hundreds of choices for your doctor to make in prescribing just the right drugs to put you on the road to recovery. What do the drugs do? How do they work? Why do you need this particular dosage? What about potential side effects? Will the medications interact with other drugs? How about with foods? Is it really important to take each and every dose? And if you miss a dose, should you take two the next time?
I took these and other questions to a man with the answers, a man who could help me sort through the vast amount of information available on each and every drug. Hiro Nishi, Pharm.D., is Senior Pharmacist at Daniel Freeman Memorial Hospital in Inglewood, California. When I told him what I wanted for my readers, his first reaction was, “Bob, you could write a whole book on that! It could be huge!”
The problem, indeed, was to limit the amount of information in this chapter. I want to simplify your life, not make it more complicated. So Dr Nishi and I worked together to provide general guidelines on cardiac medications and specific information on the drugs you’re taking. He designed the charts at the end of the chapter so that you can easily find the information you need about your own medications in a moment.
First let me say that no one likes the idea of taking medicine. Just the notion of swallowing this pill or that nostrum makes one feel like a sick person. I understand that feeling entirely, even though my own father was a pharmacist. But there ate two things you must keep in mind at all times.
One is that those medications are vital to your recovery and long-term wellness. Many have been introduced only during recent years and are directly responsible for the improved outlook for the heart patient. And the other thing is that by following the steps outlined in this book, you can gradually but dramatically cut back the amount of medication you must take.
So, if you really hate taking those heart medications, the best thing you can do is follow your doctor’s prescription to the letter and do e very thing in your power to convert yourself into a former heart patient.
But just keeping track of your medications can be difficult, especially with so many other things on your mind. To help you with that aspect I’d like to share a trick I learned at the Heart Institute of the Desert in Rancho Mirage, California. The nurses there help patients make their own, individualised medication charts. You can do the same for yourself.
Find a piece of stiff cardboard about the size of a sheet of typing paper. At the top write your name and “heart medications”. Tape one of each of the tablets, capsules and pills you’ve been prescribed to the cardboard and write the following information alongside each one with the help of your doctor or nurse.
Drug (brand name)
(generic name)
Take
Purpose
Precautions
Doctor’s Comments
As an example, you might write that the brand name of your drug is Inderal; its generic name is propranolol. Your doctor might tell you to take the table twice daily, once in the morning and once in the evening. The purpose of the drug is to help control blood pressure, to ease arrhythmias, and to slow down the rate of the heart so it won’t have to work so hard. Precautions might include a warning not to stop taking the medication abruptly. Your doctor’s comments may remind you that this drug might lead to drowsiness. Finally, you may wish to add something you’ve learned in this chapter to keep it close at hand.
By glancing at your heart medication chart now and then you’ll be able to easily keep track of your prescriptions. But, if you’re like most patients, you’re likely to be taking other medications as well. Another doctor may have prescribed tablets for arthritis, diabetes or other chronic, long-term conditions. Be certain to tell your cardiologist, and later your personal physician, about all the vitamins and medications you take, including those you can buy without a prescription.
On the other side of your heart medication chart, make a daily medication dosage plan. List the drugs you are to take in the morning, those to be taken with lunch, those for the evening, and at whatever special times your doctor might advise. On that dosage plan, include all the medications for the day, including both your heart prescriptions, those for other conditions and those you buy across the counter.
Each time you have a doctor’s appointment, be certain to take your chart in with you. You may have questions about a certain drug. Or your physician may wish to make an alteration in the type or dosage of a particular pill.
Now, certainly you’re not going to carry this chart along with you wherever you go throughout the day. But the chart will help you keep them organised in your mind and, after a while, you’ll probably rely on it less and less.
Dr Nishi offers the following 10 guidelines for all medications. Following these rules will help facilitate your recovery by providing your medications’ full benefit, with the least chance of complications.
Take medications specifically as directed. This will provide maximum effectiveness with a minimum of side effects.
Understand what your medications should do for you. This is the best way to avoid possible adverse reactions.
Plan medication taking around your regular routine so that it will become part of your lifestyle.
Leave reminders in conspicuous places, such as bathroom, mirror, television set, refrigerator, etc.
Keep all medications in their original containers labelled with specific directions even if hen travelling. (If you need another bottle to keep, say, at the office, ask the pharmacist to divide the prescription into two identically labelled bottles.)
If you consider taking any over-the-counter medication, consult your doctor first. Some medications may alter the effectiveness of your prescribed medications.
Never take anyone else’s medications, even if they have the same medical condition that you have. And never let anyone take your medications.
If you have questions about your medications, talk with your doctor and pharmacist. The more you understand, the more comfortable you’ll feel.
Be careful not to run out of your medication. Obtain refills before you run out. Plan for weekends and holidays.
Never take more than prescribed, even if you skip a dose. And never stop taking your medications without consulting your doctor first.
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Cardio & Blood/ Cholesterol

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BEATING THE BLOOD PRESSURE BLUES FOR A HEALTHY HEART: DRUG TREATMENT

The benefits of all the non-drug methods of controlling blood pressure we’ve discussed cannot be disputed. All contribute to substantial improvement and should be included in your complete program of recovery. But some patients, despite their best efforts and intentions, are unable to bring their blood pressures to a safe level without the aid of prescription drugs.
Your first reaction may be quite negative, since antihypertensive drugs have received a lot of bad publicity owing to adverse reactions such as fatigue, irritability and, most notorious, impotence. Rest assured that tremendous progress has been made since the early days of treating high blood pressure with drugs.
No doubt the most important factor is having a good doctor-patient relationship so you can work out the best possible drug treatment as part of a complete blood pressure control program. While one patient may do very well with a given drug, another will respond negatively. Some simply give up, refusing to take medications at all. That’s the wrong approach. Instead, you’ll have to find a drug or drugs tailored to your specific needs.
At the risk of being redundant, it’s vital to remember that there are no symptoms of hypertension. Just because you feel fine doesn’t mean that you can stop taking your medications. In fact, that’s the single biggest problem facing doctors and their patients. It’s vital, literally in many cases a matter of life and death, to remain on the drugs your doctor has prescribed.
By all means you’ll want to do everything in your power to keep the drugs needed to a minimum. You can do that by controlling your weight, getting plenty of exercise, quitting the cigarettes, curbing stress and limiting your alcohol and salt intake. But the drugs may give you the edge in keeping hypertension at bay.
You’ll find a complete listing of antihypertensive drugs used in medical treatment today in chapter 16. But I’d like to provide a brief overview of just how the drugs work and the various categories your doctor may prescribe for you.
First, you might ask, is taking antihypertensive drugs really worthwhile? Since you don’t feel any different, can you expect real benefits? The answer is an unequivocal yes.
Drug therapy to reduce blood pressure definitely decreases cardiovascular morbidity and mortality in those with diastolic blood pressures of more than 104. Studies of patients with mild hypertension, from 90 to 104, have shown that antihypertensive drugs protect against stroke, congestive heart failure, increases in hypertension severity, and all-cause mortality. And a 30- to 50-per cent reduction in both fatal and non-fatal strokes has been demonstrated in those taking medications. Needless to say, if one can prove the benefits of drugs so clearly in even mild cases of hypertension, the health advantages for patients with moderate and severe hypertension are even greater.
Be patient. Expect a period of trial and error as you and your doctor work together to find the winning combination of drug and non-drug therapy. Don’t be discouraged. Ask all the questions you want, make sure you understand the dosages and the schedules your doctor wants you to try. Find out if there are certain side effects or adverse reactions that you should be aware of. Let your doctor know if you’re taking any other drugs, since one drug may interact with another. Find out whether taking the drug while driving a car, working on hazardous equipment, or drinking alcohol is OK. In other words, become an active participant in your treatment.
Doctors most often initiate antihypertensive drug therapy with diuretics. These “water pills” lower your blood pressure by eliminating excess sodium and fluid the body would otherwise retain. By cutting down on the amount of fluid in the bloodstream, pressure in the arteries decreases.
At least for the first few days you’ll find yourself needing to urinate frequently. That’s because there’s been a build-up of fluid in your tissues. This will lessen over time. To avoid the need to wake up with a “bathroom call” in the middle of the night, don’t take your diuretic after about six in the evening.
For the most part, diuretics don’t pose significant problems, but the right dosage schedule is important. In the summer, for example, you may find that you lose more fluid than desired. This could lead to feeling light-headed or faint.
Because diuretics sometimes wash away potassium, you may be asked to eat more potassium-rich foods such as bananas, oranges and potatoes. Your doctor may even prescribe a potassium supplement. Again, each patient is different, and it’s important to keep your doctor informed on your progress and any difficulties you’re experiencing.
One distinct disadvantage of the diuretics is that they tend to elevate cholesterol levels in the blood. You’ll want to have your cholesterol count measured regularly to make sure this does not get out of control.
Diuretics are often prescribed in combination with other drugs. That’s because they help those other drugs work more effectively, and thus they keep the necessary dosage to a minimum.
Drugs in the category of sympatholytics act on the sympathetic nervous system. They lower blood pressure by reducing the amount of blood the heart pumps and decreasing the heart rate so your heart doesn’t work so hard. Other drugs in this classification work by relaxing the blood vessels indirectly by blocking nervous system signals that cause them to contract.
Drugs known as vasodilators relax blood vessels directly, causing a widening of the lumen and allowing blood to flow mote easily. They have a particular advantage for patients whose arteries are blocked by cholesterol build-up.
ACE inhibitors ate the newest drugs in the antihypertension atsenal. ACE stands for angiotensin converting enzyme. By reducing the production of angiotensin, a chemical produced in the kidney which controls blood pressure, one can regulate hypertension.
Here’s another incentive for you to work as hard as possible to get that blood pressure down: for patients with mild hypertension who have controlled their blood pressure for at least one year, doctors are now advising a stepwise reduction in drugs. This will be particularly effective if you’ve made some of those lifestyle modifications we’ve discussed. Conversely, if you don’t keep up the good work with those non-drug approaches, you may find that you’ll have to return to medications.
The progress made in controlling hypertension during the past 20 years has been nothing short of spectacular. Blood pressure reduction has resulted in a substantial reduction in the incidence of and deaths from strokes. While it has had much less effect on coronary heart disease when viewed alone, together with cholesterol reduction and other lifestyle modifications, controlling hypertension can significantly improve your chances for cutting your risks. This is definitely a risk factor that you can take charge of in a very positive way. It’s a major step forward in your complete recovery from heart disease.
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COMMON INFECTIONS OF CHLDHOOD: TONSILLITIS

Tonsillitis refers to inflammation of the tonsils, and is part of the spectrum of upper respiratory tract infections in children.

Cause

Tonsillitis is caused most often by one of the common viruses, but sometimes it can be caused by a germ (bacterium). It is often impossible to distinguish between viral and bacterial infection. For this reason, many doctors will treat tonsillitis with a course of antibiotics, or even an injection.

Clinical features

The child will complain of a sore throat and sometimes of difficulty in swallowing. There may be a fever and the glands in the neck may be enlarged and tender. Very often he will have a headache, a runny nose and many of the symptoms of an upper respiratory tract infection as described above. The symptoms usually improve after a few days and disappear within a week.

Sometimes the doctor may order a throat swab to determine whether a virus or bacterium is causing the infection, and occasionally a blood test may be helpful. No other tests are generally useful or indicated.

Treatment

If the infection is a viral one, no specific treatment is necessary. However, it is often difficult clinically to distinguish between an infection caused by a virus and one due to a germ, so the doctor will often prescribe a course of antibiotics. This is given in the form of a mixture, tablets or capsules to be taken by mouth. Very occasionally, if the child is sick or has difficulty swallowing, the antibiotics are given by injection, but this is not usually necessary.

General treatment is similar to that suggested for a cold. Gargling with warm salt water may ease a sore throat, as will frequent warm drinks and lozenges. Specific food (e.g. ice cream and jelly) has no proven value, except that the child enjoys it.

When to see your doctor

See upper respiratory tract infection (colds).

Prevention

There is no effective way to prevent tonsillitis.

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PREMATURITY AND NERVE DAMAGE

A baby born before 37 weeks of pregnancy is called a pre-term infant.

Cause

The causes of most premature deliveries are unknown but certain conditions are associated with early labour. Malformations of the womb, an incompetent cervix, early breaking of the waters (premature rupture of membranes), multiple pregnancy (e.g. twins), and maternal diabetes or an acute illness in the mother, are all more likely to result in premature labour.

Clinical features

Premature babies are generally immature. They are smaller than full-term babies and usually require special care. Tiny babies may need intensive care. In general, premature babies are more prone to develop breathing problems, cardiovascular problems, anaemia, jaundice, feeding problems, low levels of calcium and glucose, hypothermia (low body temperature), and infection due to an immature immune system. With new sophisticated techniques available to highly skilled paediatric staff, most premature babies do very well nowadays, and do not suffer any long-term consequences. If your premature baby is at major risk of developing complications, he will usually be transferred to a hospital that has a neonatal intensive care nursery.

Nerve damage

If a nerve has been stretched during the baby’s passage through the birth canal, it may result in temporary weakness of certain muscles. This is more common in breech deliveries or if your pelvis is small and the baby is large. If the baby has been delivered by forceps, damage may have occurred to a nerve supplying one side of the face. The baby may not be able to move one side of the face very well. This usually improves without treatment after several weeks.

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YOUR MARITAL HEALTH/THE MOST OFTEN ASKED QUESTION: I CAN’T HELP FEELING THAT I AM DOING SOMETHING WRONG WHEN I HAVE SEX

“I can’t help feeling that I am doing something wrong when I have sex. Years of upbringing can’t be overcome. I’m still a Catholic boy at heart.”

ANSWER: There is no need to overcome those important years. The idea is to incorporate your feelings and memories and values from those years into your sexual life. If this seems almost impossible, I suggest you consult a clergyperson. Examination of belief and value systems is a key part of developing super marital sex for all couples, so your orientation gives you a head start here. The challenge will be in learning a new sexuality that is comfortable and nonoffensive to you both. I can assure you that in the years I have been doing therapy, I have never encountered a religious system that prohibits sensitive, caring intimacy between married people. The problem is usually not the religion, but the religiosity, the way it was taught and not what was taught. We must learn to look for the deeper messages in our value system, the messages about and not against sexual intimacy.

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TRUE HEALING – PRACTICAL ADVICE : DIET – MINIMISING THE INTAKE OF TOXINS

We have discovered the ultimate reason for all diseases: poisoning of our body beyond its capacity to purify itself.

Nearly 100% of such poisoning comes from our diet. We basically poison ourselves, simply because we do not care about what we eat.

In view of the above, our diet requires a basic revision

The wisdom of many civilisations in the past was expressed in their diet. Two key items in the diet are common for all civilisations without exception, from ancient India to modern Georgia :

1. PURE AIR

2. PURE WATER (from the spring)

I have not heard anyone objecting to this. However, the word to which we should pay special attention is pure.

Unfortunately, the criteria for purity have become quite arbitrary nowadays. The prevailing doctrine is, that there is a threshold of pollution in the water, which is acceptable and safe for humans to consume. Medical Authorities generally accept and recommend the chemical treatment of water, leaving chlorine and other chemicals in it. Poisons are added

(fluoride), in the name of sterilisation and safety of supply, despite the fact that their toxicity is beyond doubt, and they accumulate in our body causing chronic diseases (arthritis). Municipal water also contains heavy metals from pipes, pumps etc., traces of herbicides, pesticides and other chemicals. It is very difficult to obtain information about the levels of such ingredients in our water from the relevant authorities. They would prefer that we do not know and believe that the water is OK.

Do not consume such water. Do not use it for tea, soup on even in cooking. Use water obtained from natural springs. Alternatively, filter the municipal water yourself. Do not use chemical filters. They may initially work, but eventually they may leave even more chemicals in the water you drink. The best are multi-stage paper and active carbon filters, with the final stage that uses a reverse osmosis ceramic membrane. The process of reverse osmosis imitates the function of a natural spring: water runs over a stone (ceramic element) and minute quantities filter slowly through. For home installation, the rate is quite slow: about half a litre per hour. There are systems available, which store about 10 litres of filtered water under light pressure, ready for the immediate use.

Note, that most of the beverages, including fruit juices from concentrates, contain municipal tap water. It would be much better if you squeezed the juice yourself from fresh fruits, or bought the frozen concentrate and diluted it yourself with spring or filtered water.

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INDIGESTION – SYMPTOMS

Most are related to the gastro-intestinal tract, but the cause may be apart from this. It may occur from other areas of the abdomen such as the gallbladder or the pancreas or the liver or it may be due to a rise in blood pressure.

It could even be due to the presence of circulating toxins, poisons or drugs in the system. The commonest cause of indigestion originates in the stomach. This is a gastritis or inflammation of this organ.

This may be due to infection either from contaminated food or passed on from another person. It may arise from irritation from too much food, too rich a food, or from such things as pickles or spices. It may be caused by the irritation of too much alcohol, tea or coffee or cigarette smoke.

It may be due to the irritation of the stomach from aspirin or the anti-inflammatory drugs used in rheumatism and arthritis. Or the gastritis may occur as the result of stress or nervous tension.

An ulcer may form in the stomach or the duodenum, which is the first part of the small bowel, and the symptoms of this may be exactly the same as with the gastritis.

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ANTIBIOTICS – DESCRIPTION

These drugs are bacteriostatic — that is, they do not kill the germ but inhibit its growth, and the body’s own defence mechanism can then overcome the infection.

They still have some advantages in that they readily cross from the blood into the fluid inside the brain and spinal cord, which many newer antibiotics don’t. They are thus useful in treating bacterial meningitis, an infection of the covering membranes of the brain.

Insoluble forms, which are not absorbed, are used to sterilise the bowel.

Some people become sensitised to the sulphonamides and can develop an allergic rash or other allergic symptoms.

A recently developed antibiotic combines a sul-phonamide with an antibiotic of the tetracycline group, trimethoprim.

These complement each other’s action to a considerable degree and make the drug bacteriocidal in some circumstances — that is, it kills the germ rather than inhibiting its growth.

This antibiotic is marketed in Australia as Septrin and Bactrim.

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ENDOMETRIOSIS: CELLULAR IMMUNITY

Other studies examined lymphocyte activity among sufferers of endometriosis. In one such study, it was postulated that if an immune system misfunction were entirely the cause, women with endometriosis would show a higher incidence of infectious diseases and cancer. Increased illness, however, seems net to be a factor among the women who participated in this study. Newer experiments have focused on the effect of the cellular antigen CA-125, a cell that acts like a foreign substance in the body. How this antigen is produced by the body is unknown.

Two particular studies, one conducted by Dr. Donald Pittaway and colleagues at the Bowman Grey School of Medicine in Winston-Salem, North Carolina, and the other by Dr. Phillip Patron and colleagues at Minnesota’s Mayo Clinic, have both turned up evidence to show that women with advanced endometriosis had elevated levels of CA-125. as did women who had acute pelvic inflammatory disease (PID) and unexplained infertility. However, patients with less advanced stages of the disease, and women who did not have endometriosis, tended to have similar and lower CA-125 levels. Still, these investigators believe, this antigen bears further study because of marked elevated levels of kin women with endometriosis. They are also looking for a possible test for detecting endometriosis by analyzing CA-125 levels, and antigenic proteins like it, in blood samples.

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SKIN CARE: INFECTIONS

The four major types of skin infection are bacterial viral fungal and parasitic. These groups will be considered in turn and examples of the most common forms of infection described Bacteria live permanently on the skin surface, and are known as the permanent bacterial flora. In addition, transient organisms are constantly arriving at the skin surface but are usually prevented from multiplying by the normal defence mechanisms. Under certain circumstances either the permanent or transient organisms may become established, multiply excessively, and then cause disease or infection. The factors governing the host resistance or defence mechanism are several. Firstly there are the factors inherent in the skin itself, for example the amount of moisture or other secretions present, and whether there is a point of entry or an abrasion on the surface. Secondly there is the degree of interaction between the permanent flora and the invading organism. Finally, there is the factor of the various cellular and circulatory interactions provoked by the invasion. These may be influenced by the body’s general health or level of immunity.

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