Aug
1
Chlorpromazine
August 1, 2009 | Leave a Comment
Generic Name
Chlorpromazine (klor-PROE-muh-zene) Al
Brand Names
Sonazine Thorazine*
The information in this profile also applies to the following drugs: Generic Ingredient: Fluphenazine Hydrochloride RE Generic Ingredient: Thioridazine Hydrochloride 0 Generic Ingredient: Trifluoperazine Hydrochloride
‘Some products in this brand-name group are alcohol- or sugar-free. Consult your pharmacist.
Type of Drug Phenothiazine antipsychotic.
Prescribed For
Psychotic disorders; moderate to severe depression with anxiety; agitation or aggressiveness in disturbed children; intractable pain; and senility. May also be used to relieve nausea, vomiting, hiccups, restlessness, acute intermittant porphyria, and apprehension before surgery or other procedures.
General Information
Chlorpromazine and other phenothiazines act upon a portion of the brain called the hypothalamus. Phenothiazines affect parts of the hypothalamus that control metabolism, body temperature, alertness, muscle tone, hormone balance, and vomiting. Chlorpromazine is available in suppositories and as liquid for those who have trouble swallowing tablets.
Cautions and Warnings
Do not take chlorpromazine if you are AeTgic or sensitive to any oVilsingredients or to any phenothiazine drug. Do not take it if you have very low blood pressure, Parkinson’s disease, or blood, liver, kidney, or heart disease.
Chlorpromazine may depress the cough reflex. People have accidentally choked to death because the cough reflex failed to protect them. Because of its effect in reducing vomiting, chlorpro-mazine may obscure symptoms of disease or toxicity due to over-
dose of another drug.
Use chlorpromazine under your doctor’s strict supervision if you have glaucoma, epilepsy, ulcers, or urinary difficulties.
Avoid exposure to extreme heat, because this drug may upset your body’s temperature-control mechanism. Do not allow the liquid forms of this drug to come in contact with your skin because they are highly irritating.
Chlorpromazine may cause unusually high or low levels of cholesterol.
Possible Side Effects
♦ Most common: drowsiness, especially during the first or second week of therapy. If drowsiness becomes troublesome, contact your doctor.
V Less common: changes in blood components, including anemias, raised or lowered blood pressure, abnormal heart rate, heart attack, sensitivity to light, and faintness or dizziness.
V Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Jaundice (symptoms include yellowing of the whites of the eyes or skin) may appear; when it does, it is usually within the first 2-4 weeks of treatment. Normally the jaundice goes away when the drug is discontinued, but there have been cases when it has not.
Phenothiazines may produce extrapyramidal side effects, including spasm of the neck muscles, rolling back of the eyes, convulsions, difficulty swallowing, and symptoms associated with Parkinson’s disease. These side effects seem very serious but usually disappear after the drug has been withdrawn; however, symptoms affecting the face, tongue, or jaw may persist for as long as several years, especially in older adults with a history of brain damage.
Chlorpromazine may cause an unusual increase in psychotic symptoms or may cause paranoid reactions, tiredness, lethargy, restlessness, hyperactivity, confusion at night, bizarre dreams, sleeplessness, depression, decreased sex drive, increased appetite, or euphoria (feeling “high”).
Drug Interactions
• Be cautious about taking chlorpromazine with over-the-
counter cough, cold, or allergy medications, barbiturates, al-
cohol, sleeping pills, narcotics or other sedatives, or any other
drug that may produce a depressive effect.
• Aluminum antacids may reduce the effectiveness of phenothiazine drugs.
• Chlorpromazine may reduce the effectiveness of bromocriptine and appetite suppressants.
• Anticholinergic drugs may reduce the effectiveness of chlorpromazine and increase the chance of side effects.
• Phenothiazine drugs may counter the blood-pressurelowering effect of guanethidine.
• Taking lithium together with a phenothiazine drug may lead to disorientation, loss of consciousness, or uncontrolled muscle movements.
• Combining propranolol and a phenothiazine drug may lead to unusually low blood pressure.
• Combining tricyclic antidepressants with a phenothiazine drug can lead to antidepressant side effects.
• Chlorpromazine may reduce the effectiveness of epinephrine and norepinephrine.
• Cigarette smoking reduces the amount of chlorpromazine in your blood. Smokers may need larger doses.
Food Interactions
Take liquid chlorpromazine with fruit juice or other liquids. You may also take it with food if it upsets your stomach.
Usual Dose
Adult: 30-1000 mg or more a day, individualized according to your disease and response.
Child (age 6 months and over): 0.25 mg per lb. of body weight every 4-6 hours, up to 200 mg or more a day, depending on disease, age, and response.
Chitty (under 6 months): not recommended.
Overdosage
Overdose symptoms include depression, extreme weakness, tiredness, lowered blood pressure, agitation, restlessness, uncontrolled muscle spasms, convulsions, fever, dry mouth, abnormal heart rhythms, and coma. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or
container.
Special Information
Call your doctor at once if you develop sore throat, fever, rash, weakness, visual problems, tremors, muscle movements or twitching, yellowing of the skin or whites of the eyes, or darkening of the urine.
Do not stop taking chlorpromazine without your doctor’s knowledge. It may take several weeks before this drug takes effect.
This drug may cause drowsiness. Use caution when driving or operating hazardous equipment. Avoid alcoholic beverages.
Chlorpromazine may cause unusual sensitivity to the sun and may turn your urine reddish brown to pink.
If dizziness occurs, avoid rising quickly from a sitting or lying position and avoid climbing stairs. Use caution in hot weather, because this drug may make you more prone to heat stroke.
If you are using sustained-release capsules, do not chew them or break them—swallow them whole. Liquid forms of phenothiazines must be protected from light. Do not take them out of their opaque bottles.
If you take chlorpromazine more than once a day and forget to take a dose, take it right away if you remember within an hour. If you do not remember within an hour, skip the dose you forgot and continue with your regular schedule. If you take 1 dose a day and forget a dose, skip the dose you forgot and continue your regular schedule the next day. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Infants born to women taking this drug have experienced side effects—including jaundice and nervous system effects. Check with your doctor about taking chlorpromazine if you are or might be pregnant.
This drug may pass i”W breast milk. Nursing mothers who must take chlorpromazine should use infant formula .
Seniors: Seniors are more sensitive to the effects of this drug and usually achieve desired results with lower dosages. Some experts feel that seniors should receive ‘/,-1/4 the usual adult dose.
Aug
1
Chlordiazepoxide
August 1, 2009 | Leave a Comment
Generic Name
Chlordiazepoxide (klor-dye-az-uh-PDX-ide) 91
Brand Name
Librium
Type of Drug Benzodiazepine sedative.
Prescribed For
Anxiety, tension, fatigue, agitation, and withdrawal symptoms of alcoholism; also prescribed for irritable bowel syndrome and panic attacks.
General Information
Chlordiazepoxide is a member of the group of drugs known as benzodiazepines.
Benzodiazepines work by a direct effect on the brain. They can relax you and make you more tranquil or sleepier, or they can slow nervous system transmissions in such a way as to act as an anticonvulsant. Many doctors prefer benzodiazepines to other drugs that can be used to similar effect because they tend to be safer, have fewer side effects, and are usually as effective, if not more so.
Cautions and Warnings
Do not take chlordiazepoxide if you are allergic or sensitive to any of its ingredients or to another benzodiazepine, including clonazepam.
Chlordiazepoxide can aggravate narrow-angle glaucoma, but you may take it if you have open-angle glaucoma and are receiving therapy for it.
Other condkjo(\SiVN\,NhjCb chlordiazepoxide should be used with caution are severe depression, especially with suicidal tendencies, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, drunkenness, and kidney disease.
Chlordiazepoxide should not be taken by psychotic patients because it is not effective for them and can trigger unusual excitement, stimulation, and rage. It has also produced similar reactions among hyperactive and aggressive pediatric patients.
Chlordiazepoxide is not intended for more than 3-4 months of continuous use. Your condition should be reassessed before continuing chlordiazepoxide beyond that time.
Chlordiazepoxide may be addictive. Drug withdrawal may develop if you stop taking it after only 4 weeks of regular use, but is more likely after longer use. It may start with anxiety and progress to tingling in the hands or feet, sensitivity to bright light, sleep disturbances, cramps, tremors, muscle tension or twitching, poor concentration, flu-like symptoms, fatigue, appetite loss, sweating, and changes in mental state.
Dosage of chlordiazepoxide should be decreased gradually over 4-8 weeks after prolonged use.
Possible Side Effects
Weakness and confusion may occur, especially in seniors and in those who are sickly.
♦ Most common: mild drowsiness during the first few days of therapy.
✓ Less common: depression, lethargy, disorientation, edema, headache, inactivity, slurred speech, stupor, dizziness, tremor, constipation, dry mouth, nausea, inability to control urination, sexual difficulties, irregular menstrual cycle, changes in heart rhythm, low blood pressure, fluid retention, blurred or double vision, itching, rash, hiccups, nervousness, inability to fall asleep, and occasional liver - dysfunction. If you experience any of these symptoms, stop taking the medicine and contact your doctor immediately.
♦ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Chlordiazepoxide is a central-nervous-system depressant. Avoid alcohol, other sedatives, narcotics, barbiturates, mono-amine oxidase inhibitor and other antidepressants, and antihistamines. Taking chlordiazepoxide with these drugs may result in excessive depression, tiredness, sleepiness, breathing difficulties, or related symptoms.
• Smoking may reduce the effectiveness of chlordiazepoxide by increasing the rate at which it is broken down by the body.
• The effects of chlordiazepoxide may be prolonged when it is
taken with cimetidine, contraceptive drugs, disulfiram, flu-
oxetine, isoniazid, ketoconazole, metoprolol, probenecid,
propoxyphene, propranolol, rifampin, or valproic acid.
• Theophylline may reduce chlordiazepoxide’s sedative effects.
• If you take antacids, separate them by at least 1 hour from your chlordiazepoxide dose to prevent them from interfering with the passage of chlordiazepoxide into the bloodstream.
• Chlordiazepoxide may increase blood levels of digoxin and the chances for digoxin toxicity.
• Levodopa + carbidopa’s effectiveness may be reduced by chlordiazepoxide.
• Phenytoin blood concentrations may be increased when taken with chlordiazepoxide, resulting in possible phenytoin toxicity.
Food Interactions
Chlordiazepoxide is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
Adult: 5-100 mg a day. This range is due to individual response related to age, weight, disease severity, and other characteristics.
Child (age 6 and over): may be given if deemed appropriate by a doctor. Starting dose-5 mg 2-4 times a day. Maintenance dose—up to 30 mg a day for some children, but must be individualized to obtain maximum benefit.
Child (under age 6): not recommended.
Overdosage
Symptoms of overdose are confusion, sleepiness, poor coordination, lack of response to pain such as a pin prick, loss of reflexes, shallow breathing, low blood pressure, and coma. The victim should be lakes to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Chlordiazepoxide can cause tiredness, drowsiness, inability to concentrate, or similar symptoms. Be careful if you are driving, operating machinery, or performing other activities that require concentration.
If you forget a dose of chlordiazepoxide, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Chlordiazepoxide may cause birth defects if taken during the first 3 months of pregnancy. Avoid chlordiazepoxide while pregnant.
Chlordiazepoxide may pass into breast milk. Nursing mothers who must take chlordiazepoxide should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of chlordiazepoxide and generally require smaller doses to achieve the same effect.
Jul
14
CASE HISTORIES OF PROSTATE PATIENTS
July 14, 2009 | Leave a Comment
CASE HISTORIES
OF PROSTATE PATIENTS
Over the years, urologists treat hundreds of cases of all types of prostate problems and they say that most of the cases fall into general categories not enough testosterone . But every now and then a case will come along that is different risperdal positive experience .
Let’s look at some case histories that more or less fit into the general types, but at the same time are somewhat unusual lithium imbalance symptoms .
Joseph W generic celexa no prescrition ., 61, a retired colonel from the U hernia and testosterone levels .S gabapentin and glaucoma . Marine corps clonidine patches from canada . After his discharge, he and his wife ran a used bookstore for several years and he played a lot of golf can i take ibuprofen with oxycodone . Then one day he realized he was getting up three times a night to go to the bathroom achilles plantar accutane . His wife chided him about his drinking so he quit drinking his usual three beers every night as he watched television fluconazole diflucan .
After that, Joseph still had to get up twice a night bulk motrin . A year later he was getting up four times a night lithium thyroid values . He went to his doctor who sent him to a urologist who tested him and together they decided he had an enlarged prostate, and there was no sign of any cancer recalls on motrin . A TURP operation would be best sporanox treatment .
After the operation, Joseph was home in two days how to go off of abilify . Two months later he said “everything” was back to normal getting pregnant with pcos and prozac . He was sleeping through the night now and his sex life was back on track prescribing information proscar . He said the reverse ejaculation felt exactly the same as it always did and it didn’t bother him in the least cymbalta switch to lexapro . He suffered no bad side effects, no incontinence and no impotence linezolid logp . Joseph W jittery synthroid . and his wife were one happy couple prilosec backorder .
Grant C high blood pressure aleve ., 55, a newspaper reporter one day realized lie was getting up twice a night to urinate and sometimes his urine stream was slow how johann arfvedson found lithium . He told his doctor about it soma technology inc . He learned for the first time about an enlarging prostate and what it could do gabapentin drug . The doctor said there was no sign of cancer and that he should simply moderate his way of life and live with the minor problems buy paxil online without prescription .
Grant learned as much about enlarged prostate as he could, talked with a urologist and decided to give up drinking coffee, tea and cola drinks with caffeine in them lasix administration . He didn’t drink beer or alcohol so that was no problem methotrexate and abortion .
Every year on his annual checkup, Grant had the doctor examine him and the doctor said there seemed to be little additional enlargement of the prostate cymbalta and sexual problems . Grant said his other symptoms such as hesitancy and frequency of urination were about the same ethics of depo provera . The doctor told him to continue on a “maintenance” program risperdal wikipedia .
After seven years of managing his BPH problem, Grant said that he felt just about the same way he did when it was first diagnosed minocycline 100mg capsule . He continues to stay away from caffeine, drinks one caffeine-free cola a day, and takes no fluids after six in the evening uses of penicillin .
Now after seven years, Grant is still getting up only once a night, and is careful about making sure that he always urinates before leaving the house, especially when going to a movie where a fast paced action film or horror story builds up tension and the need to urinate antid presseur effexor . He’s interested in the new drugs out that may shrink the prostate, and watching the development of the balloon treatment paroxetine side effect information . He’s not looking forward to the time when he has to decide what to do when his prostate grows to the point where it can’t be managed within reason soma stores .
Charles M taper off celexa ., 23, a young man who was drafted into the army during the Korean war and took basic training in California far from his native West Virginia acyclovir affecting birth control pills effectiveness . He bragged that he was the biggest stud in his town interaction claritin tylenol . He’d had sex with half the women in the county and they lined up for him soma intelligence llc . The troops didn’t know whether to believe him or not ndc for toradol .
He boasted that he had celebrated his drafting by having sex at least twice a night for his last 30 days before he was inducted trileptal mood stabilizer effect . Three weeks later in the barracks, he was groaning and moaning and complaining drug interactions claritin . The next morning he went on sick call and the doctor examined him alcohol prozac .
His prostate had grown used to the high production rate of fluid to help the sperm on their way during his 30-day sex spree adderall alcohol lexapro . Now even after his sudden celibacy his prostate kept right on over producing diclofenac sodium 75 mg . The result was his prostate became congested and extremely painful tetracycline treat pneumnia .
The urologist on the army base quickly found the problem and massaged Charles’ prostate relieving his congestion and stopping the pain can i take acetominaphin with meloxicam . The urologist said if Charles felt the same problem coming on again he should relieve it with intercourse or masturbation similar medicines to phenergan .
Back in the barracks that night Charles had a wild time telling everyone in exacting detail about his problem, how the doctorcorrected it and his suggestion about how to relieve it in the future methocarbamol a sedative .
Two weeks later the first passes were given to the troops to go to a nearby town for the day and Charles found another way to relieve his prostate provera fetus side effects .
Cecil U wellbutrin and weightgain ., 28, a motorcycle cop who loved his job what is keflex drug family . He rode his bike whenever he could, taking double shifts when he was needed other tacrolimus drugs . He was single and had as many women as he wanted naprosyn 500 . When he established a long lasting relationship with a young woman lawyer, he settled down how do i purchase viagra . His sex life was high powered and exciting pill making identification sertraline tab 100mg .
Then one day he exhibited all of the classic symptoms of congestive prostatitis side effects on lamictal . He developed a lower-back pain, pelvic discomfort, urinary urgency and pain after ejaculation is cymbalta a mao inhibitor .
His prostate was soft, boggy and filled with fluid but was not enlarged and did not have any hard lumps or nodules how to taper of neurontin . His doctor told him his problem metformin for diabetes .
After a long conference, they narrowed down the cause of his pain to an overly active prostate meneire’s cellcept . The constant vibration of the motorbike and the high speeds he often had to ride at, stimulated his prostate and it began to produce additional fluid as it would with sexual stimulation buy celebrex online vioxx vioxx vs .
But the bike ride did not result in ejaculation which would be a relief to the prostate with the expulsion of a large quantity of the fluid iv dilantin incompatible iv fluids . The excess fluid was stored in the prostate and soon caused the problem free sample of diflucan in canada .
Cecil told his sergeant his dilemma and Cecil was transferred to a patrol car for three months formulary nexium . His symptoms quickly faded and he felt fine again famvir medication . He went back on the motorbikes, considered the elite of the force in his city, and soon the prostatitis returned purchase metronidazole suppository .
Cecil talked it over with his live-iii woman friend and they decided that it would be best for his health if he made a permanent transfer off the bikes seroquel and lamictal . He did sildenafil and neonates . Three months later he became a detective and soon had his eye on a lieutenant’s rating diflucan interaction alcohol .
Don K rx generic viagra ., 71, was calm when he heard he had prostate cancer otc oral testosterone for women . He had been a bachelor most of his life, married only once when he was about sixty but it didn’t last bacteriostat tetracycline . He was a quiet man, retired, lived alone and spent his whole time collecting stamps and post marks and “round” cancellations from the smallest towns he could find lexapro prescribed for diet .
He was an expert on stamps, evaluated collections, bought and sold collections and helped young people start their own albums topamax and tremor .
His urologist told him the cancer had not advanced a great deal and there was a good chance to stop it if they removed his prostate can you mix tramadol and benedryl . In the counseling, Don was told that there was a high percentage chance that this operation would make him impotent promethazine 88 225 .
Don accepted the statement without blinking and said he would think about it and let the doctor know ic sertraline . A week later the urologist became concerned since he hadn’t heard from Don injectable testosterone and arimedex . When he could be pinned down, Don admitted that the idea of impotency frightened him more than the cancer drink female viagra .
Don said he would take the offered radiation treatments and chemotherapy rather than the operation to remove his prostate celebrex cheap next day . The radiation treatments had been explained to him, and he was told that there was a chance that the radiation and the chemotherapy might not stop all of the cancer cells and the disease could spread scared to take synthroid .
Don accepted this risk testosterone depo shot .
Six months later the cancer had spread to twenty three separate places in his body tegretol aspirin interaction . Three months later he died viagra cheap free shipping .
Fred G side effects of lotrel medication ., 77, retired landscaper and ex-navy man had a buildup of BPH symptoms twelve years ago when he was 65 and had a TURP caffeine drug reactions . He came through the operation fine with no harmful side effects seroquel interactions .
Today he’s 77 and his prostate has been growing slowly for twelve years, but his doctor says not to worry candida fluconazole . He’s a world traveler, widowed, spends his time visiting relatives in foreign countries and his children and grandchildren here at home how to take yourself off prednisone .
“I might need another operation, but not for a while flomax oxybutynin er semen enlarged prostate . Now my only symptoms are a small weak stream sometimes ultram . The rest of the time it’s full and strong nolvadex phoenix labs . So I don’t worry warfarin daily dosage calendar .
“Right now I figure I won’t need another operation until I have to get another new driver’s license zofran 20 mg iv . That won’t be for four more years when I’m 81 acyclovir autism side effects .”
There was no sign of cancer when Fred had his operation twelve years ago pravachol fatty liver . He’s still clear of it today and is checked regularly by PSA and ultrasound female viagra for men .
“I’m happy as a clam with relatives,” Fred said benadryl with singulair .
Marshal J pharmacy salary tech buy tramadol now ., 57, vice president of a large retail operation flagyl and marijuana . Salary about $150,000 a year vytorin safety . Marshal was a slight, smaller man of no more than 145 pounds men who take viagra results . He was sharp, intelligent, friendly, and on the fast track to the top of his firm as soon as the president and founder figured out that 75 was too old to be running the big chain store propecia rogaine side effects .
When Marshal was 55, he had his required company physical and passed with better than average findings erythromycin on . He didn’t smoke or drink, played tennis and golf, and was slim and trim diovan works great . His cholesterol was even within bounds how to snort pseudoephedrine hydrochloride .
When he was 56 he missed his checkup because he was vacationing in Hawaii and just never got it rescheduled zithromax psychological side effect . When he was 57 his doctor found hard lumps on his prostate msds of omeprazole . A biopsy showed them to be malignant lipitor stroke .
Marshal and his wife listened carefully to the urologist’s talk, looked at the diagrams and weighed the chances diltia xt . All of the advantages of a prostatectomy operation were laid out for them wbr sildenafil . The doctor said at this stage he thought it would be a better idea to do a retropubic prostatectomy with an incision otc substitute for nexium .
The doctor explained that to be sure to get all of the cancer they would have to remove so much of the prostate that the bundles of nerves controlling erection would be gone and Marshal would be impotent lipitor co pay saving .
Marshal shrugged, said it was better than being dead in a year why is norplant no longer available . His wife asked him if he was sure what is tramadol like . They left the office talking about it function help lung sporanox will . The next morning Marshal called and told the doctor to schedule the operation he thought was the best that would get all of the cancer rash and prozac .
The open surgery was done and the urologist thought that he removed all of the growth, but only time would tell them for sure cheap bupropion buy online . There was no way to be sure that the cancer had not already spread to other parts of Marshal’s body ramipril 1 25mg .
Five years later, Marshal collected the five dollar bet he had made with the urologist during Marshal’s regular checkup zocor numb finger . The cancer had not spread and had not reoccurred viagra levitra deals . Marshal and his wife had made the decision that saved his life famotidine for dogs . He worked with his doctor and selected a penile prostheses, and is happy tramadol and urinary retention .
Bob M cr2450 lithium ., 48, A high pressure businessman who was an expert at solving big business problems shea butter moisturizer w caffeine . He was at the height of his career, had a beautiful house, a lovely wife and a daughter lasix without prescription mastercard accepted .
He noted some changes in his urination, a slowing and sometimes hesitancy, but figured he was almost fifty and that was just a part of growing old penicillin and fluoroquinolones . That was Bob’s mistake preparation benzene to amoxicillin .
Six months later after a tough business conference, one of his legs began to hurt cialis price comparisons . The next morning it had swollen and was extremely painful why to avoid caffeine when pregnant . He went to see his doctor procardia atlas hotels . That afternoon he was referred to a urologist who made penicillin .
The urologist said Bob had the type of prostate cancer that was extremely aggressive chloramphenicol aplastic anemia . This type brings on BPH symptoms swiftly, perhaps in 6 months the BPH symptoms will be as severe as they might be with normal prostate growth in ten years percent of twin births with glucophage .
The swelling and pain came from cancer that had quickly left the prostate and spread into his bones and legs and lymph glands toprol high blood pressure .
Bob fought the cancer with all of his strength, angry because here was a problem that needed solving and somehow he didn’t have the right answers to solve it cymbalta falling .
He grew worse and worse, and at last he realized that the doctors didn’t have the answers either micardis risks . About a year after he was first diagnosed as having cancer, Bob died seminal vesicle infection ofloxacin .
In the last few months of his life, Bob and his wife established a foundation for cancer research that is a viable and progressive organization today in California levaquin 500 mg uses . His wife hopes that Bob’s foundation can find the answer to prostate cancer and save thousands of other fathers and husbands around the world ibuprofen and bone fusion .
Jake A iv ampicillin ., 73, an ex U zofran im dosing .S clindamycin 150mg capsuls . navy chief who had retired and was living the good life expiration date on ibuprofen . He went to his urologist complaining that he had to get up to urinate twice a night and asking what pill he could take to stop it post hallucinogenic perceptual disorder clonidine . The urologist explained to him about BPH and said they should do some tests to see if it was time to consider having a TURP operation caffeine reference value . Jake admitted that he never could empty his bladder and it gave him a strange feeling lithium polymer battery cut off . He said he’d get back to the doctor for more tests in a week side effects of pravastatin na 20mg .
Ten years later when this same Jack A tadalafil bargain medicine . was 83 years old, he went back to the same urologist for the tests prednisone tablet . By then he was getting up four times during the night, had serious urine retention in his bladder and his peak flow was about three milliliters, not the twenty that would be more normal, and he had a serious dribbling problem when he couldn’t hold his urine blue light photodynamic therapy isotretinoin . His prostate had enlarged to the point where a transurethral resection could not be done clozapine at western state hoospital .
The more complicated and longer recuperative operation was done, the suprapubic reglan in puppies . Jake was in the hospital for a week and a half and had a long recovery zyrtec s . Jake now tells his friends with BPH not to wait too long the way he did to have something done generika vardenafil .
Delbert B clomid affect hcg ., 82, was rushed to his urologist’s office in an ambulance complaining of severe lower abdominal pain evista glo . He had chills and a temperature and he couldn’t urinate sumatriptan tablets . The urologist soon found the problem and put a catheter into his bladder through his urethra and took out a large amount of urine caffeine in starbucks frappucino .
The chills and fever subsided but the doctors left the catheter in warfarin monitoring site . Later that day the urologist talked to him and he said that he’d never had any trouble urinating, no hesitation, no getting up nights, none of the typical symptoms of BPH com viagra .
The urologist took the man’s wife into his office and talked to her lexapro bad side effects . She said Delbert would never admit to any kind of problem reoccuring cyst from clomiphene . She said he had been getting up almost every hour during the night to go to the bathroom coumadin adverse reactions . His stream wasn’t a stream at all but a five minute series of drips and squirts lab prep lithium . She said often she found his urine soiled underwear and pants where he became incontinent flouride effexor .
Another talk with Delbert got to the truth naproxen ds 550mg . After several examinations it was determined that he had an advanced case of BPH with a large prostate prescribed glyburide 5 mg . They decided his general health and age made him a poor candidate for surgery, even a TURP paxil success story .
The result was that Delbert was given an indwelling tube into his bladder through his penis to a bag attached to his leg for urine drainage lithium ion recharge effeciency . Delbert used the indwelling tube for another six years until he died of a heart attack withdrawal effects of lexapro . Another case of a man who waited too long, and put up with pain and discomfort for too many years until the problem couldn’t be corrected ryobi lithium ion .
Maurice W side affects of citalopram ., 72, had a TURP operation and the pathologist found a few chips in the prostate scrapings that indicated an early cancer decadron opthamalic ointment .
Maurice’s doctor told him about the cancer scrapings but evidently in language that the patient didn’t fully understand radionecrosis treatment trental . Maurice’s urination was almost back to normal and he was pleased ibuprofen colon cancer . The doctor must have decided that the patient was too old and that the slow growing cancer would not create a problem for him silagra contraindications health . Maurice was not in the best of health having problems with gout and uremia how does plavix differ from bivalirudin . Here, the doctor decided for the patient that the cancer could be ignored metformin storage and stability .
Almost no doctor will do this, but in this case the medical expert felt it was justified does meloxicam slow down oesteoarthritis .
Maurice’s other ailments cleared up and about a year later he went to Dr zocor and rheumatoid arthritis . Israel Barken for a consultation about how he could improve his sex life prednisolone sodium phosphate growth stunting . When he came he brought with him his medical file from the otherdoctor testosterone treatment erection results . While leafing through the old file, Maurice saw the pathologist’s report and picked out the words “malignant neoplasm celexa indications .”
Maurice showed the report to Dr breast cancer tamoxifen depression . Barken and asked him what that meant lexapro akathisia . Dr manos magicas synthroid . Barken told him it meant cancer and they did some examinations at once does ultram help overcome hydrocodone withdrawl .
They found irregular hard lumps on Maurice’s prostate homeopathic remedy for indocin . A PSA test that showed the antigen level was up to over a value of twenty caffeine affect herpes . A rectal ultrasound probe showed there to be significant cancer in the prostate comparison chart of nexium .
After a consultation with the patient, Dr nortriptyline urinary tract . Barken suggested radiation treatment might be best for him and he agreed patient on spironolactone with elevated creatinine . After a series of radiation treatments the cancer was killed and Maurice is now in his 74th year and enjoying his daily golf game and swimming in his pool azt combination with acyclovir .
Walter G ezetimibe and atorvastatin in cholesterol treatmen ., 49, a plumber by trade, met his urologist at the emergency room of a hospital indicatons for amiodarone . He complained that he hadn’t urinated for two days and felt like he was going to explode seroquel and children . A catheter quickly drained off 500 cc’s of residual Urine and at once Walter felt better viagra lakeland fl .
In an hour he was joking about how both he and the urologist were in the plumbing business tramadol hcl is this a narcotic . Then he sobered and asked just what kind of operation did he need so this wouldn’t happen again sucralfate swallowing . He called it a “total replumbing of the house bad days on zoloft .” He was concerned about the cost, didn’t know if his insurance would cover it, but was determined to get himself fixed the right way amlodipine deplete potassium .
In a long talk, the urologist took a medical history on Walter and asked him about any medications he was on simple tadalafil online . He insisted that he wasn’t taking any kind of prescriptions, he was healthy as a horse azithromycin oral powder packets for sale .
His wife reminded Walter about his three day cold zoloft and ms . Then he remembered a specific cold remedy that he had taken dexamethasone pimple . The urologist smiled 112mcg synthroid . He told Walter he wasn’t positive but the cold remedy had probably been what caused his problem smoking effexor xr . The drugs in the pills could have constricted the urethra somehow, shutting off the urine cheaper alternative to nexium .
The urologist told Walter never to take that cold remedy again or any that had the same drugs in it withdrawal recovery effexor . After a week Walter called and said he felt great psychiatric medication paxil klonopin . After a month he was entirely normal with no urination problems pharmacia clindamycin phosphate .
A big name brand cold remedy had done it pravachol success stories . This urologist made a friend for life asthma carbamazepine .
Clyde D give a dog claritin or allegra ., 66 estradiol hormone therapy . Every urologist has a patient now and then who simply won’t face reality levothroid 150 micrograms . This one was named Clyde and he came in for a simple BPH problem sinemet hallucinations . He was getting up twice a night and knew about the condition, even the name and what was happening norvasc vs atenol . He was a well informed man does clomid cause dry skin .
He said it had been two years since he’d had an examination and decided it was time to check out his prostate surplus lithium ion batterys . A rectal exam revealed one small lump and Clyde was told about it 9 volt lithium batteries and charger . The urologist said why didn’t they do a biopsy right then while he was there with a skinny needle physical appearance of generic amlodipine . It would hardly hurt at all and it would save the man a trip tadalafil faq .
Clyde refused, said he had to get back to take care of his dogs lamictal and birth control . After a few minutes, the doctor convinced him now was the time to check it out cetirizine stability studies syrup .
The biopsy was done and sent to the pathologist squill and lipitor . Clyde said he’d be back in three days for an appointment to find out the results of the biopsy drug test for soma .
Clyde didn’t show up mexican pharmacy celexa . They tried his phone but it had been disconnected fluvoxamine and sedation . They sent him a letter urging him to come in and find out the results of the biopsy average cialis prices . He didn’t come adenosine receptors caffeine .
After a month they typed up a letter telling the patient that the biopsy was positive, that he had a malignancy and he should come in and talk about the next step, probably a radical prostatectomy still hard after i cum cialis . Time was a critical factor depakote ambien interaction . They said the cancer had been caught quickly enough that it could probably be cured since it most likely hadn’t spread outside the prostate norilet norfloxacin tablets usp 400 mg .
Six months later the urologist realized that the man had not contacted them zoloft safe in pregnancy . The registered letter return receipt had come back from another state, so they knew the man had received the letter probiotics and prednisone . He had been informed that he had prostate cancer lithium atom density .
He simply refused to face the reality that he had cancer and had to do something about it ibuprofen depo shot interference .
Arthur Z atrovent inhaler side effects ., 61, had a mild case of BPH aruba allegra map . He got up once a night to urinate, had a small hesitancy problem and now and then felt like he couldn’t empty out completely amber perry lariam . He made it clear the first visit that he knew about the TURP and the open surgeries and didn’t want any of them fluconazole bacterial vaginosis .
This was before the balloon dilation treatment cabergoline . He wanted to try everything else amantadine no response . They started with Zinc and vitamins, which had a good effect for a while, whether a placebo effect or not he never could tell paxil flomax interaction . Then that quit working and he wanted to test the bovine prostate regimen, which the urologist prescribed paralytic ileus tacrolimus .
The bovine pills didn’t seem to work so Arthur went back to the doctor lithium ion battary . This time they tried bio-feedback training, but that didn’t help him royobi lithium . Next they tried Alpha-One medication which didn’t work either fexofenadine in india manufacturer .
They went through most of the over-the-counter type pills and treatments, but every step of the way the urologist checked Arthur’s kidney function to be sure there was no damage baclofen addiction .
At last report Arthur was still trying new cures for his BPH, but his urologist was monitoring him ace inhibitors arbs and hydrochlorothiazide . Arthur shrugged and grinned is energizer lithium 2012 battery rechargeable . “When it gets bad enough, I’ll come in and we’ll have the surgery gabapentin for shinglrs . But not yet caffeine not wikipedia .”
George C effects of testosterone on the penis ., 58, is president of his own firm and must do a lot of business entertaining methotrexate drug interactions . He has a moderate case of BPH but simply can’t stop drinking any fluids after four in the afternoon gliclazide vs glipizide . His clients wouldn’t understand atenolol 50 .
After several sessions with his urologist, they decided to try the balloon dilation treatment bcp and no period estrace . George was told it could be done in the urologist’s office, that it was a simple procedure, and if it worked on him, he should have no problem with the former BPH symptoms for up to three years antidepressants and glucophage .
During the interview before the operation, George agreed that if this didn’t work, he’d come back for a TURP side effects of ciprofloxacin in dogs . He was at a point in his business that it was vital that he spend two to four nights a week with business prospects, eating, drinking and showing them a good time bioguard lithium hypochorite .
They scheduled the dilation and it went off well and without any complications zoloft for cats . Three days later, George called the urologist and offered to buy him a drink that night amitriptyline same s-adenosylmethionine interaction . He felt like he was thirty again and he had no more BPH symptoms sertraline zoloft hci .
A year after his dilation, George sold his business for twelve million dollars and is now looking for another business challenge does claritin work .
Jul
14
PROSTATE CANCER
July 14, 2009 | Leave a Comment
PROSTATE CANCER
Cancer is the word that has brought agonizing pain and terror to the last half of the twentieth century does cialis have a taste . To most people cancer means death zelnorm drug recall . Many still think that a man with cancer has a death sentence prozac cause of extreme nervousness . Not true viagra trip in thailand .
Increasingly in this last decade of the century it is proving not necessarily so court order florida clonidine . There are hundreds of different kinds and types of cancers, the medical experts tell us, and some can and are being cured finasteride hair .
One of those types of cancer strikes men in their prostate luvox fluvoxamine obsessive-compulsive disorder . Cancer is described as being an uncontrolled growth of abnormal cells diludid and phenergan . Cancer cells can spread quickly throughout the body through the blood stream and the lymph system fortament compare glucovance . Wherever they lite they create new tumors that begin replacing the normal tissue ingredients of augmentin 1000 xr .
Some types don’t move at all, some are aggressive and attack different parts of the body quickly first testosterone mc 2 for women . Cancer can develop in the lymphatic system, in bones, a man’s lungs, chest, throat, colon, stomach, even his brain generic cialis united states .
One of the areas cancer hits in a man is his prostate does seroquel make you gain weight . When cancer strikes a man’s prostate it is usually what doctors call a primary cancer brand of coffee most caffeine . This simply means the cancer begins, originates, in the prostate and has not been transported there from some other cancer in another part of the body lexapro alturnatives .
WHAT CAUSES PROSTATE CANCER?
Scientists say there are hundreds of different kinds of cancer and they undoubtedly are caused by hundreds of different inciters propecia active ingredient . A few of the cancers have been researched enough so the medical people have the beginnings of the causes of them and can then go ahead and utilize some kind of anti-body to stop or kill the cancer amlodipine benazapril combination . Massive research is going on for many forms of cancer, but less than one percent of that work is being done on prostate cancer mylan omeprazole .
What this says is that there probably won’t be a miracle cure for prostate cancer within the lifetimes of most of us lasix surgery raleigh nc . That, like some of the preventive inoculation vaccines we have, will have to be applied to our children or our grandchildren concentration of levofloxacin on escherichia coli . So who can develop prostate cancer?
Unlike smoking and lung cancer, there isn’t even a hint of what might cause prostate cancer birth control and coumadin . Most researchers have ruled out any of the usual work and behavior activities such as alcohol, diet, work place, smoking, venereal diseases, too much sex or too little, or any other currently defined lifestyle louisiana medicaid zyrtec .
There is one exception: men who work in nearly constant exhaust fumes from cars and those exposed to cadmium in the work place, are found to be at slightly higher risks of prostate cancer than the rest of us evista tabs .
The one constant in prostate cancer and man seems to be age how can testosterone effect your body . As with the enlargement of the prostate, cancer seems to strike older men cymbalta and high blood alcohol count . Yes, some men die of prostate cancer in their forties, but most of the confrontations with the disease comes when men are over sixty d-l150 lithium ion .
One researcher reports that the average age of men who are diagnosed as having cancer is seventy-two 1 5mg propecia . Slightly over eighty percent of all prostate cancers reported come in men who are over the age of sixty-five myerstown pa manufacturing aleve .
Most doctors understand that by the age of eighty, nearly eighty percent of men have cancer of the prostate to some degree too much synthroid medication . It may have been dormant for years, or it may just be starting and of a type that will grow slowly under active thyroid metronidazole . Most of these men will never develop any symptoms of prostate cancer and will die of some cause not related to their prostate cancer soma by .
Most of our readers probably know someone who either has prostate cancer or has died of it generic equivalent for cozaar . The American Cancer Society says that one out of eleven white Americans will develop cancer of the prostate during his lifetime cipro tablets maximum dose . With black American men the figure is one in nine cardizem cr 30 .
Nearly 100,000 prostate cancer cases are reported by doctors each year strattera yeast infection . With men living longer now each year, there is expected to be an increasing number of prostate cancers 50 atenolol mg . Men are simply living longer now and that’s when the disease develops viagra for masturbation .
The American Cancer Society reports that nearly 28,000 men died of prostate cancer last year junel metformin .
WHAT CAN THE AVERAGE MAN DO?
The problem is far from hopeless antibiotic premedication either than erythromycin . They key to any cancer, and especially prostate cancer, is to catch the problem as early as possible dell laptop lithium battery . Some urologists suggest that all men over forty should have a digital rectal examination once a year prozac insomnia posts .
Most of these examinations will be negative, which is good news to the man examined penicillin on humans . We do dozens of examinations each year on people and expect negative results viagra online shop . Cholesterol testing is done routinely on people in their twenties and thirties, but the problem usually isn’t critical until much later in life 10mg zyrtec . Chest X-rays are done routinely with usually a 99% negative result atenolol increasing klonopin .
Testing for prostate cancer should be as routine for all men over forty quetiapine and fentanyl . Yes, it’s a bit uncomfortable, but not painful naltrexone for multiple sclerosis symptoms . It takes about three minutes in a doctor’s office viagra john bouchie . Some urologists say the digital exam of the upper two lobes of the prostate will reveal ninety percent of prostate cancer celexa and self image . Other urologists think this is a bit high, but the exam should be made expiration iv flagyl .
If such exams could catch 50% of starting prostate cancers in an early stage, most of those could be cured completely clozapine food interactions .
The big problem with prostate cancer is that it is a silent killer carisoprodol photo . It can show no symptoms at first paroxetine prescription medicine . By the tune it starts hurting, the cancer usually has spread into other parts of the body and it’s often a matter of time until it kills the patient wellbutrin nicotine patch .
SCARE TACTICS?
Yes ultram e r rash . Absolutely exelon invitiational . If your reading this book does nothing more than makes you decide to have a yearly physical examination including a digital rectal exam of the prostate, that will be reward enough wellbutrin xl and heart .
You could be saving your life with a digital examination by discovering a cancer early enough to cure it krypton lithium levels for tin .
Right now, about sixty-four percent of prostate cancers are discovered while they are small roberto tronchetti provera . Of these men, almost eighty-four percent are still alive five years after their surgery how to get cytotec . Doctors compile statistics on cancer patients and most consider a man cured after a 15 year free period use of ibuprofen after surgery . The secret is catching it early so all of the cancerous tissue can be removed so it can’t spread or grow again remission drug femara . Ann Landers in her syndicated column has repeatedly pushed for greater awareness of testing to catch early cancer development cymbalta vs effexor wr . In one recent column she urged women to do the job this way zerit j code . Whenever they go in for a mammogram, usually once a year, they should make an appointment for their husband to have his prostate checked by a digital exam or by the more expensive ultrasound probe ibuprofen and nephrotoxicity . She urges women to do this so they won’t become premature widows carafate indications . The lady has a good idea phenytoin nausea .
The American Cancer Society reports that currently seventy-one percent of all patients with cancer of the prostate live for five years or more after treatment paxil and exposure to sun . That’s for all cases whether diagnosed early or late bms clopidogrel oasis 7 .
The later the diagnosis, the worse the chance for a cure pantoprazole vs nexium .
HOW DOES YOUR DOCTOR KNOW
IT’S CANCER?
More and more these days there is a push to try to catch prostate cancer in its earliest stages soma eliason . This is a difficult job because very small cancers in the prostate traditionally have been from hard to impossible to detect by the traditional digital exam 194r fexofenadine .
Now there are new tools to use to find these cancers soma no-show panties . One of the best may be a simple blood test called the PSA granisetron base melting point . That stands for Prostate Specific Antigen lexapro mexico . Prostate antigen is a protein found only in the prostate tissue metabolism of caffeine . It has long been known that when the prostate is cancerous, the antigen level is elevated dhea and testosterone . The problem has been in finding how much this elevation may be made when the cancers are small and can’t be felt digitally avascular necrosis prednisone .
Now with the PSA there has been enough research to make some general pointings effexor vertigo .
Dr fluoxetine capsule description . William H zantac 3 diet pill . Cooney, of the Mobile Urology Group,
P acyclovir depression .A health solutions network tramadol . and the Section of Urology, Springhill Memorial Hos-
pital in Mobile, Alabama, reports several findings in the
Alabama Medicine journal of the state medical association allegra antiallergic .
He points out that PSA levels reflect the volume of prostate
tissue in the body, either benign or malignant, so will usually be elevated in the presence of BPH dexamethasone cleared .
He shows a table of a test conducted by Hybritech Inc levaquin and hearing loss . of San Diego, correlating the PSA levels in 352 men with BPH and 533 men with proven prostate cancer ibuprofen vs naproxen .
The tests showed that in the BPH men when the level of antigen had risen to 4 units, BPH was likely by a ratio of 4 to 1 warfarin affects on health . But when the antigen level lifted to 10 or more units, the likelihood of cancer was more likely by a ratio of 33 to 1 incidence of seizures with effexor .
Dr cheapest zyrtec . Cooner also suggests the use of prostate ultrasonography as another diagnostic tool for screening patients who fall in the over 50 year category induction misoprostol . This is done with a probe in the rectum and the use of ultrasound to reveal the tissue and mass in the prostate area maudit viagra .
Dr normal range testosterone level . Cooner concludes in his paper that we need to employ these two tools in a try to improve the ability to find curable cancers before they cause pain caffeine and dieretics . He suggests that all men over 50 years should have a digital rectal elimination, then a PSA blood test, and a prostate ultrasound sonogram done as a baseline for future comparisons macrobid can treat which infections .
In a study at Johns Hopkins University School of Medicine, in Baltimore, Dr quetiapine teva . Daniel Chan reports another PSA study oxcarbazepine pakistan . He says that on tested men at a level of 2 albuterol class action suit .8 units of antigen there was considerable positive cancer results zyrtec generic . He said that at 8 cipro hp .0 units there was a 94 % chance of cancer, and when the PSA level reached 20 swiss navy testosterone trigger reviews .0 all of the patients had prostatic cancer picture of paxil the prescription drug .
At this time PSA looks like a tool that the urologists need to make more use of biaxin xl stomach pain . What if it only catches two or three percent of early cancer cases aceon side effects . Those men, cured of their cancer, are going to be wildly enthusiastic about the benefits of the test penicillin cause yellow tongue .
As a parallel, how many positive readings do physical exams get these days from a routine chest X-ray? A dramatically low percentage strattera patient doctor ratings .
Jul
5
NSAIDs (nonsteroidal anti-inflammatory drugs) side-effects and downsides
July 5, 2009 | Leave a Comment
NSAID Nastiness
The biggest recognized drawback to NSAIDs has always been their tendency to cause digestive tract distress. That’s because of how they work in the body. These drugs block the manufacture of a class of chemicals called prostaglandins. These hormonelike compounds have a profound impact on cells throughout the body.
f you sprain your ankle, have a tooth extracted, or develop arthritis, you will experience pain, redness, warmth, and inflammation. This is in large measure due to prostaglandins made by a protein called cyclooxygenase-2 (COX-2). Blocking their formation with NSAIDs like ibuprofen or naproxen means there is less inflammation and pain.
But some prostaglandins made by another protein, COX-1, are beneficial. They protect the stomach lining from damage. If you disrupt their production by blocking COX-1 with NSAIDs, many people complain of symptoms such as nausea, indigestion, abdominal pain, constipation, and diarrhea. It is estimated that more than half of the people taking NSAIDs experience unpleasant gastrointestinal (GI) symptoms.68
Far more worrisome are ulcers, which can bleed or, in the worst case, perforate. A bleeding ulcer or a hole in the stomach wall can very quickly turn into a life-threatening crisis. All too often there are no early warning symptoms that someone is on the verge of disaster.
Although it is hard to know exactly how many people are affected each year, experts estimate that more than 100,000 are hospitalized because of complications caused by NSAIDs and more than 16,000 die.’ The researchers admit these numbers are probably conservative.
Although most physicians have known for a long time that NSAIDs can be hard on the stomach, they didn’t realize that the same drugs can be disastrous for the small intestine. That’s because until recently the small intestine could not be examined directly. Now a small video camera the size of a capsule can be swallowed and the image it transmits can be monitored on a television as the capsule passes into the small intestine.
“If deaths from gastrointestinal toxic effects of NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects remain largely a ’silent epidemic,’ with many physicians and most patients unaware of the magnitude of the problem. 70 Furthermore, the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDs “7l
—Michael M. Wolfe et al., The New England Journal of Medicine, 1999
Investigators discovered in a preliminary study that 71 percent of the patients taking NSAIDs had erosions or ulcers in their small intestine, compared to only 10 percent of those not taking these drugs.72 This unexpected finding suggests that NSAID damage to the intestinal tract is even more common and serious than previously suspected.
Frequently, aspirin is sold with an enteric coating that protects the stomach from harm. The coating is designed to dissolve in the small intestine instead, releasing the aspirin there. When we asked gastroenterologist Waqar Qureshi, MD, chief of endoscopy at Baylor University and the Michael E. DeBakey Veterans Affairs Medical Center in Houston, about such formulations, he said, “Enteric-coated drugs might, in fact, cause more damage than regular medications.”" This is because the damage occurs in the small intestine, where the tissue is less resistant to irritating chemicals than the stomach is and where the damage may go undetected.
The COX-2 Catastrophe
With such GI toxicity associated with_ NSAIDs, it’s hardly any wonder that doctors and patients were excited to learn about COX-2 inhibitors. Vioxx, Bextra, and Celebrex were introduced with the idea that they would be gentler on the stomach than other NSAIDs. That’s because these newfangled members of the class were supposed to be “selective.” They would block only the COX-2 enzyme, relieving inflammation as well as aspirin or other NSAIDs do. By sparing the COX-1 enzyme, prostaglandins would be created to protect the stomach from irritation. The promise: pain relief with much less risk of digestive upset or stomach ulcers.
As soon as COX-2 inhibitors were introduced in 1999, they took off like rocket ships. Aggressive advertising directed at consumers and enthusiastic prescribing by physicians turned Celebrex and Vioxx into overnight sensations. Tens of millions of people started popping these pills in the hope that they would relieve pain without the usual problems.
There was just one big oops. By selectively blocking the COX-2 enzyme to relieve inflammation, a crucial prostaglandin called prostacyclin was also reduced. This compound is our friend. It dilates blood vessels and keeps the sticky part of blood, called platelets, from clumping together to form clots. Without adequate amounts of prostacyclin circulating throughout the body, there is an increased risk of blood clots that can trigger heart attacks and strokes.
Early in the development of COX-2 inhibitors some researchers worried that there could be cardiovascular dangers. In 2000, a large Vioxx study suggested that the pain reliever could cause an increased risk of heart attacks and other vascular complications. 74
Neither the FDA nor the manufacturer acted on those early warning flags. In one of the darkest hours in the history of American medicine, millions were allowed to continue taking COX-2 inhibitors until the fall of 2004. By then the handwriting was on the wall. First Vioxx and then Bextra were pulled off the market. In the interim, it is estimated that more than 100,000 people who had been taking COX-2 inhibitors suffered heart attacks and strokes.75 According to FDA safety officer David Graham, MD, as many as 40,000 people may have died .71
The Broken Promise
If COX-2 inhibitors like Vioxx, Bextra, and Celebrex had truly protected the digestive tract from damage, it might have been easier to justify their approval, aggressive marketing tactics, and high prices. But an editorial in the Journal of the American Medical Association described the science behind COX-2 inhibitors as a “house of cards” based on wishful thinking. They were marketed “with unrealistic expectations about pain relief, marked gastrointestinal protection, and safety.”77
Canadian researchers tracked hospital admissions caused by gastrointestinal bleeding before and after the introduction of COX-2 inhibitors (Vioxx, Celebrex, and Mobic). Instead of dropping when the new drugs became available, as investigators had expected, the rate of hemorrhage and hospitalization for older people paradoxically rose by 10 percent .78 British researchers asked a similar question: Would COX-2 inhibitors be easier on the stomach than traditional NSAIDs? The an-
FDA NSAID WARNING
“NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, m ocardial infarction [heart attack], and stroke, which can be fatal.-71 rt
—FDA Public Health Advisory, April 7, 2005
saver: There was no evidence to suggest that the newer drugs were less harmful to the digestive tract.” In hindsight, it looks as if we were all sold an expensive bill of goods.
Other NSAID Troubles
No sooner did the FDA wake up to the risk of heart attacks and strokes associated with COX-2 inhibitors than the agency had to deal with the possibility that other NSAIDs might pose a similar problem. Decades after these drugs began to be marketed, the FDA reviewed the data and decided that all such prescription pain relievers should carry a stronger black-box warning.
The FDA goes on to warn that people with risk factors for cardiovascular disease are especially vulnerable to these life-threatening problems. That includes almost everyone with arthritis. If you accumulate enough birthdays to develop osteoarthritis, you are bound to have some hardening of the ar-
OTHER NSAID ADVERSE EFFECTS
• High blood pressure
• Fluid retention, edema
• Congestive heart failure
• Stomach ulcer (bleeding)
• Perforation of the stomach
• Perforation of the small intestine
• Perforation of the large intestine
• Kidney damage
• Severe allergic reaction
• Skin rash (toxic)
• Itching
• Stevens-Johnson syndrome
• Liver damage
• Blood disorders (anemia)
• Asthma worsening
teries. But that’s not all. The FDA has gone on to emphasize other problems with NSAIDs as well.
It is easy for your eyes to glaze over when looking at such a list. You may also assume that some of these potential side effects are rare events, but that could be a dangerous assumption. A study of older and potentially sicker patients revealed a startling incidence of kidney damage associated with Celebrex. More than 20 percent of the people taking this COX-2 inhibitor experienced kidney toxicity (fluid retention, high blood pressure, and kidney failure).81 If patients had some kidney impairment before the study started (a common situation in older people), the likelihood of kidney toxicity jumped to more than 50 percent! We assume other NSAIDs are likely to have a similar effect on kidney function.
NSAID Survival Strategy
By now it should be clear that nonsteroidal anti-inflammatory drugs, including the COX-2 inhibitors, can be trouble with a capital T! They aren’t all that effective for arthritis, especially of the knee. Some NSAIDs may actually contribute to joint deterioration if they are taken for years. Then there’s the risk of serious side effects like bleeding ulcers, hypertension, heart
Aspirin
Aspirin prevents blood clots and lowers the risk of heart attacks and strokes. Unlike other NSAlDsJt does not raise blood pressure.
Aspirin remains the best buy for pain relief. At pennies a day, it reduces the inflammation that is at the root of so many chronic ailments, including arthritis, diabetes, and Alzheimer’s disease. Regular aspirin users seem to develop fewer cancers of the colon, rectum, prostate, pancreas, ovary, skin, lung, and breast.
Downside: Damage to the stomach lining. The potential for indigestion, gastritis, and ulcers makes this drug inappropriate for many. Bleeding or perforated ulcers can be life threatening. Anyone on long-term aspirin therapy must be under medical supervision.
Cost: Approximately $2 to 5 per month
ASPIRIN AND BAKING SODA
Although it will not be identical to Alka-Seltzer, you can create your own buffered, soluble aspirin. In a glass, combine:
• 2 uncoated aspirins
• 8 ounces club soda or sparkling water
•’/p teaspoon baking soda
• Juice from 1/4 wedge lemon
Wait till the aspirins dissolve and then drink. This formula is not appropriate for people on a sodium-restricted diet.
attacks, strokes, and kidney or liver damage. Why would anyone in his or her right mind take such medicine?
The most obvious answer is that there aren’t very many pharmaceutical alternatives. Doctors have relatively little to offer beyond NSAIDs when it comes to pain and inflammation. And sometimes you hurt so much that you need something to help you move your bones around. When used in the short-term and with appropriate safeguards, it may be possible to take an NSAID. But which one should you consider?
Aspirin remains our first choice by far. No other NSAID or OTC pain reliever has ever been proven more effective. In addition, aspirin reduces the risk of heart attacks and thrombotic (clotting) strokes. As a bonus, there is growing evidence that aspirin may diminish the likelihood of developing many common cancers. We discourage the use of enteric-coated aspirin because this merely moves the aspirin to the small intestine, where it can do serious damage.
Our preferred method for taking aspirin is as a liquid. In Europe, Australia, Canada, New Zealand, and dozens of other countries you can find several soluble, effervescent aspirin products. Brands like Aspro and Disprin are very popular because all you do is drop the aspirin tablets into a glass of water, where they fizzle and dissolve within seconds. This makes them a little faster acting and possibly a little less irritating to the stomach (though there is no guarantee of protection).
Soluble aspirin never really caught on in the United States, except in the form of Alka-Seltzer. It is a combination of as-pirin, sodium bicarbonate, and citric acid advertised for relief of “acid indigestion, sour stomach, heartburn with headache, body aches and pains.” The trouble with Alka-Seltzer is that it’s way more expensive than plain aspirin and there’s too much sodium for folks who have congestive heart failure or salt-sensitive hypertension.
If you would prefer not to pay an arm and a leg for fizzy aspirin, you could make your own soluble aspirin for a fraction of the cost. All you have to do is buy some club soda or sparkling water. Drop two regular-strength aspirin tablets in the fizzy water and let them dissolve. It will take a couple of minutes.