Jul
17
Celexa (Citalopram)
July 17, 2011 | Leave a Comment
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Celexa is a brand name of a popular and effective anti-depressant Citalopram. Buy Celexa at online pharmacies without prescription. Celexa is manufactured in form of 10, 20, and 40 mg pills. This anti-depressant is effective in relieving anxiety and panics attacks. Citalopram – the active ingredient of Celexa helps improve mood problems by controlling the amount of serotonin produced by your brain. When looking for Celexa for you, you have options to either get it as a brand medication Celexa, or as a generic one – Citalopram. Generic Celexa and a brand one are 100 per cent identical. No need to buy an overpriced Celexa, offered at your local pharmacy. Even a cheap generic Celexa, bought from any of thousands of trustworthy online pharmacies would help you eliminate depression and anxiety symptoms. Cheap generic Celexa may, as well, give positive effects to sufferers with manic, neurotic, and obsessive conditions. Thus we would like to stress it that, if you are looking for a best deal, than ordering a cheap generic Celexa online without prescription, may be exactly what you need. Moreover, getting Celexa online means a fast delivery to you in just a few working days, confidently packed. Do not miss your chance of saving both your money and time by ordering you Citalopram online.
Buy Celexa online without prescription and without quantity limits. Order Celexa in larger amount in the Internet pharmacies and enjoy quantity discounts on your purchase. Buy Celebrex without prescription, yet always ask your doctor’s advice before you start taking it. So make sure you consult your doctor first on your correct Celexa 10, 20 or 40mg dosage, duration of treatment, and possible interactions, contradictions to it and possible side effects. Mind that the misuse of Citalopram may have dangerous consequences. Do not use Celebrex if you are pregnant or breast feeding. In this case, before you start using Celexa, see your doctor. Also if you are younger then 18, do not take Celexa before you see your doctor. Patients with liver or kidney disease, bipolar disorder (manic depression), seizures or epilepsy need to inform their doctor and get help in Celebrex dosage adjustment. After the first 12 weeks of treatment with Celexa you need to get checked on how helpful Citalopram is in your case. Take your Citalopram responsibly: do not neglect the adequate medical care and supervision after you purchase Citalopram without prescription.
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Jul
15
Living with your Prostate. FAQ.
July 15, 2009 | Leave a Comment
Living with your Prostate
We hope we have shown you two things: firstly, you need to be aware of your prostate gland and what can go wrong with it, so that you can get treatment for any possible problems if they arise; and secondly, even if problems do arise, they are unlikely to be as bad as you may fear, and can probably be completely cured.
BE AWARE AND DON`T DESPAIR are the key words when it comes to the prostate. A positive outlook on life is one of the greatest weapons we have at our disposal. Never forget it.
BE AWARE
It is important to keep an eye on any changes in your urinary habits, particularly after the age of 50. Changes may creep up on you slowly over the years, but don’t use that as an excuse for not taking them seriously.
Ask yourself the following questions:
• Do you have to get up at night to urinate?
• Do you urinate much more often than you used to?
• Do you have difficulty passing water?
• Is your flow of urine particularly thin or weak, particularly in the morning’?
• Do you ever experience any pain when you urinate?
• Do you ever notice any blood in your urine?
• Can you urinate as high, or as far, as you used to’?
• Do you get pains in the region of your prostate, in the groin, or around your genitals?
• Do you sometimes find it difficult to start the flow of urine’?
• Do you sometimes find that you involuntarily stop and start urinating?
• Do you sometimes feel as though you haven’t quite emptied your bladder and there’s more to come?
• Do you have to strain to pass water?
• Do you ever suffer from incontinence?
• Does your urine continue dribbling, even when you think you’ve finished’?
• Do you sometimes need to rush urgently to the toilet to urinate?
• Do you ever notice blood in your semen?
Warning symptoms
If you have answered Yes to one (or more) of these questions, you may be experiencing problems with your prostate. Warning signs of this kind are there to be taken notice of and you should never ignore them. Men are notoriously good at sweeping under the carpet things that make them feel uncomfortable, and signs that all may not be quite as they should be on the health front come into this category. The reason why you should not do this is a straightforward, not to say obvious, one. It is, quite simply, because the sooner you do something about them, the greater your chances of doing something constructive about them and effecting a cure.
Men also tend to be frightened of wasting their doctor’s time and being viewed as a nuisance. But you shouldn’t worry about this, your doctor is very unlikely to think this way. Doctors are there to look after your health, and if something is really worrying you that’s enough to warrant a visit. So the message is:
GO TO SEE YOUR DOCTOR
CONSULTING YOUR DOCTOR
First of all, your doctor will want to know all your symptoms. To make sure you don’t forget to tell him about any of these, make a list of them before you go to the surgery. You should also make a note of any questions you want to ask him. The doctor will take a general medical history, with particular reference to any serious familial diseases such as diabetes, heart disease or haemophilia, and any drugs you are taking. He will also want to know about any important changes in your health that you have noticed recently, such as general fatigue or lower back pain, which may not seem to you to be at all relevant but which could be important to the doctor. If you’re worried about your urinary habits, it’s as well to establish a relationship with your doctor, so you can get to know him and he can get to know you and your anxieties sting. If you’re just starting to have symptoms, he may not find anything much wrong now, but he will want you both to keep an eye on things and to monitor the situation. Above all, never be embarrassed to talk to your doctor about your urinary habits. He won’t be embarrassed and you shouldn’t be either.
YOUR LIFESTYLE
There are several changes you can make to your lifestyle which will help keep your prostate healthy.
Try to do the following:
• Don’t smoke. Smoking causes spasm in smooth muscle and may, as a result, make matters worse, particularly if a prostate problem has already been diagnosed.
• Keep your consumption of alcohol, which can irritate the bladder, as low as possible. In particular, avoid beer.
• Avoid coffee nexium swollen lip problems . Coffee has an irritating effect on the bladder at the best of times, and if the bladder is already
`unstable’, this effect is likely to be heightened.
• Try to keep stress in your life to a minimum, as it can intensify urinary problems such as hesitancy and urgency.
This is easier said than done, but you may benefit (wouldn’t we all?) from making every effort not to allow yourself to be too easily worked up by the pressures of modern-day life. Try learning some relaxation techniques.
• Try to avoid going out in the cold, which can often trigger bladder problems.
• Wrap up warm.
• Get plenty of sleep.
• Take regular exercise. In particular, it is thought that having played a lot of sport regularly as a child, particularly before reaching puberty, may have a protective effect against the development of cancer of the prostate. Exercise is still beneficial in adult life because it keeps the muscles around the abdomen active.
• Don’t regularly restrict your fluid intake because you are frightened of having to go to the loo too often. Drinking less may not actually help anyway. If you have an important meeting, or are going to the theatre, restrict your fluid intake from about three hours beforehand, which should help make it easier for you to go out. You can also restrict fluid intake at night, which may mean you don’t have to get up so often to urinate.
Jul
15
Prostatitis. DIAGNOSIS OF PROSTATITIS. CHRONIC PROSTATITIS. ACUTE BACTERIAL INFECTION.
July 15, 2009 | Leave a Comment
Prostatitis. DIAGNOSIS OF PROSTATITIS. CHRONIC PROSTATITIS. ACUTE BACTERIAL INFECTION.
Prostatitis is a catch-all expression covering various types of inflammation of the prostate. It is not as serious as enlargement of the prostate, and especially not as serious as cancer of the prostate. It can, however, be a very difficult condition to treat and can sometimes drag on for several years. In prostatitis, the tiny glands in the prostate become infected, inflamed or clogged - either with thickened secretions or with small gravel-like stones. As we have seen in Chapter 1, the prostate is a complex system of glands, cells, tubules and ducts. Once infection gets a hold in this complicated network, it is hardly surprising that it can be very difficult to eradicate.
Even when it has been treated - and even when it seems as though it has been successfully treated - it can still come back. And in the absence of successful treatment, it can flare up for years, with depressing regularity.
THREE TYPES OF PROSTATITIS
There are three main types of prostatitis. These are:
• Acute bacterial infection.
• Chronic infection, which may be bacterial or non-bacterial.
• Prostatodynia, which may cause the symptoms of prostate pain without any obvious signs of inflammation or infection.
DIAGNOSIS OF PROSTATITIS
Prostatitis is sometimes difficult to diagnose. In general, the person best qualified to diagnose prostatitis is a doctor specialising in urology or genito-urinary medicine clinical trials. Your doctor may refer you to a special genito-urinary (GU) clinic. This does not mean that your doctor suspects that you are suffering from a sexually-transmitted disease. It simply means that genitourinary clinics have the best experience and equipment to investigate and treat your symptoms. The staff are used to dealing with this kind of problem, and will do so sympathetically and in confidence, so you have no need to feel embarrassed. You are likely to have a number of tests as part of the investigation of your symptoms. These may include some, or all, of the following:
• A digital rectal examination, which means that the doctor inserts a lubricated gloved finger into the rectum and gently palpates, or feels, the prostate through the front wall of the rectum, which lies against the back of the gland. If you have prostatitis, the prostate will feel boggy, soft and tender. A digital rectal examination should not hurt,
though it may be uncomfortable if the prostate is inflamed and therefore tender to the touch. A lot of men are embarrassed to have one, but they shouldn’t be: doctors are used to doing this and have a very matter-of-fact attitude to it.
• Swabs from the end of the penis, which are taken by gently inserting a sterile cotton bud into the end of the penis and taking any fresh discharge.
* Urine tests to check for cloudiness, signs of protein or blood, and threads of cellular niaterial, which are then examined under the microscope for pus cells or bacteria.
® Urine cultures to see if any bacteria grow, which should also distinguish between infection in different parts of the urinary tract.
• A blood test to check for a raised white cell count.
• Routine screening for sexually-transmitted diseases such as chlamyclia.
• The doctor will look for a discharge from the penis, and for signs of inflammation and soreness both on the penis and in the testicles. If prostatitis is untreated, or it’ drug treatment is unsuccessful, there is a risk that the prostate gland may become full of pus 5 online sildenafil citrate . Not surprisingly, this can have dreadful consequences. It may eventually burst, releasing pus into the urethra, which will discharge from the tip of the penis. And it may also result in severe infection elsewhere in the urinary tract.
ACUTE BACTERIAL INFECTION
This is an uncommon complaint. It is usually caused by bacteria from the intestines. These find their way into the urinary system, either through the urethra or through the bloodstream or lymphatic fluids.
Sometimes there is a link with organisms that cause a sexually-transmitted disease, such as gonorrhoea or chlarnydia. Sometimes, too, the fungus that causes thrush (Candida) is responsible.
Symptoms
These can happen suddenly and can include one or several of the following:
• Feeling generally under the weather.
• Chills or fever.
• An aching feeling around the thighs and genitals.
• A deep pain in the perineurn, which is the area between the pouch containing the testicles, known as the scrotum, and the anus.
• Low back pain.
• Pain in the lower abdomen.
• Pain on passing water.
• Blood in the urine.
• Difficulty in passing water.
• Increased frequency of passing water.
• Urine may be cloudy or smelly.
• Pain on ejaculation.
Diagnosis
The doctor will probably perform a digital rectal examination by inserting a lubricated gloved finger into the rectum. He will then feel the prostate through the wall of the rectum. If a man has prostatitis, the prostate will probably feel hot, swollen and tender. The doctor will then do a series of tests on a sample of urine and On urethral secretions obtained after massaging the prostate gland, in order to investigate the cause of the infection.
Treatment
Acute bacterial prostatitis, when symptoms come on suddenly, is the most dramatic form of the disease, but it is also the form that responds best to treatment. A prolonged course of antibiotic tablets is prescribed. This is usually for at least four weeks. Acute infection responds well to antibiotics, probably because the intense inflammation allows the drugs to penetrate into the interior of the gland. Symptoms should begin to show some improvement within the first few days. Sometimes, though, infection may persist in the prostate, in spite of treatment, and it is necessary to have careful follow-up treatment to make sure that the condition has cleared up. If this does not happen, the condition may tend to recur and chronic prostatitis will usually result. Occasionally, though rarely, infection may cause the gland to swell sufficiently for the urethra to be squeezed shut. This causes urinary outflow obstruction . It necessitates urgent admission to hospital, where urinary flow is eased by inserting a catheter directly into the bladder. With rest and the administration of antibiotics, the infection will usually clear up well in only a few days.
CHRONIC PROSTATITIS
Chronic prostatitis is more common than acute prostatitis, but is much more difficult to eradicate. There are two types of chronic prostatitis, which can be bacterial or non-bacterial. Chronic bacterial prostatitis Swelling occurs rapidly and this traps the bacteria in the gland, as the usual drainage channels become blocked. Prostatic secretions may coat the offending bacteria, which then harden to form tiny stones, or crystals. This protects them from being attacked by the body’s immune system or by antibiotics. This explains the repeated flare-ups that tend to occur in chronic bacterial prostatitis. This means, too, that the condition can be difficult to treat successfully. Some sufferers may even be unlucky enough to suffer from recurrent symptoms throughout their lives.
Symptoms
These vary from one person to another. They may include any, or several, of the following:
• Frequency in passing water.
• Pain on passing water.
• Pain in the prostate, genitals or rectum.
• Swelling of the testes.
• Lower back pain.
• Watery discharge from the penis.
• Pain on ejaculation.
• Blood in the semen.
• Premature ejaculation.
• If the doctor feels the prostate during a digital rectal examination, it may feel boggy, soft and squelchy.
Fertility
There is some evidence that chronic bacterial prostatitis may impair. This may probably be true in all cases of prostatitis, but seems to be especially true of chronic bacterial prostatitis. Analysis of the prostatic fluid of men with chronic bacterial prostatitis has shown significant changes in both the physical properties and the chemical constituents of the fluid. It is thought that these changes may well affect the quality of the semen, and thus the level of fertility. It is not unusual for doctors to hear the wives of men with chronic bacterial prostatitis complain that they are finding it difficult to become pregnant. A sperm count and sperm quality assessment can be done to find out how much a man’s fertility has been affected.
Chronic non-bacterial prostatitis
This is a complaint in which inflammation is present without any signs of infection. In other words, prostate secretions contain white pus cells, but no bacteria. It is not known exactly what causes chronic non-bacterial prostatitis, but several theories have been suggested. One is that it is caused by abnormal emptying of the bladder, which forces urine into the prostate channels and ducts, where it causes irritation and inflammation. This may be triggered, or aggravated, if a man jogs or plays any strenuous sport on a
full bladder. Another theory is that some men produce thicker prostate secretions, which are perhaps more acid then normal. These secretions are unable to drain away through the narrow ducts and therefore build up to cause irritation and swelling.
Symptoms
The most common symptoms of chronic non-bacterial prostatitis are:
• Frequency in passing water.
• Pain on passing water.
• Pain or ache in the prostate, genitals or rectum.
• Lower back pain, especially after sexual intercourse.
• Discharge from the urethra, especially after intercourse.
Treatment
Any chronic infection is difficult to treat, particularly when inflammation and swellings trap the infection inside the gland. In the case of chronic bacterial prostatitis, a course of the appropriate antibiotic, depending on which bacterium is responsible for the condition, will be prescribed for at least six weeks. Sometimes antibiotics may be required for as long as three months, or even longer. Chronic non-bacterial prostatitis can be treated with a natural food supplement derived from rye pollen extracts, which
has been shown to reduce inflammation, irritation and swelling, though improvement may not be apparent for at least three months and full recovery may take as long as six months or even more. Swelling, inflammation and pain may be helped by anti-inflammatory painkillers such as ibuprofen.
Self-help
Chronic non-bacterial prostatitis is sometimes relieved by an increased frequency of ejaculation. This can be brought about through intercourse, of course, but if this does not happen it may equally be brought about by masturbation. Ejaculation drains the prostate of any excess secretions and causes a temporary increase in blood. Both these things help to flush away any toxins. In some cases, however, an increased frequency of ejaculation only makes the problem worse.
PROSTATODYNIA
This is characterised by the usual symptoms of prostate problems, including pain, but with no evidence of inflammation or infection in the gland. Prostate secretions look perfectly normal and contain no pus cells. Prostatodynia is surprisingly common and accounts for around one third of all cases where men experience the symptoms of chronic prostatitis.
Symptoms
The symptoms of prostatodynia are therefore similar to those of chronic prostatitis. They may often also include psychosexual problems.
Symptoms include the following:
• Frequency in passing water, sometimes with associated pain.
• Pain in the prostate, genitals or rectum.
• Lower back pain.
• Watery discharge from the penis.
• Blood in the semen (haemospermia).
• Premature ejaculation.
• Pain on erection.
• Pain on ejaculation.
• Low sex drive.
• A diminished volume of semen.
• Impotence.
• If the doctor feels the prostate during a digital rectal examination, it may feel boggy, soft and squelchy.
Treatment
Prostatodynia can be difficult to treat. Painkillers are not usually helpful. It is, however, likely to have a physical cause, such as spasm of the pelvic muscles, which may be brought on by stress and anxiety. In this case, tranquillisers may be prescribed in order to reduce muscular spasm in the gland, though it is not a good idea to take these in the long-term as they can become addictive. Recent studies have suggested that prostate pain can be relieved by microwave hyperthermia. The technique was originally developed at the Beilinson Medical Centre, Petah Tiqva, in Israel in the early 1980s and is now attracting a lot of interest in other countries. An hour’s treatment is usually given weekly for six weeks.
Other treatments that have been tried for prostatodynia include:
• Acupuncture.
• Laser irradiation.
• Muscle-relaxant drugs, such as diazepam.
• Antispasmodic drugs.
Self-help
As in chronic non-bacterial prostatitis, symptoms may be worsened when ejaculation is infrequent, in which case the pain may be caused by prostatic gland engorgement. Symptoms may therefore be relieved by an increased frequency of ejaculation, as a result of either intercourse or masturbation. Ejaculation drains the prostate of any excess secretions
and causes a temporary increase in blood supply. In some cases, however, an increased frequency of ejaculation only makes the problem worse. Sitting in a hot bath for half an hour can help to warm up the prostate gland. Relaxation techniques may also be used to relax the muscles and as an alternative to muscle-relaxant drugs. The combination of regular exercise and a high-fibre diet will help keep the bowels regular, which is particularly important for men suffering from prostatodynia. This is of special benefit to those men who sit at a desk for most of the day, as both constant sitting and constipation tend to increase prostate congestion. Symptoms of prostatodynia may be triggered by the nicotine in cigarettes and by alcohol or caffeine, so it is best to reduce consumption of all three. It may also be advisable to consult an allergy specialist who may be able to identify foods that you should avoid.
Natural treatments
Rye pollen extracts have been shown in clinical trials in Europe to help ease the symptoms of prostatitis, particularly chronic non-bacterial prostatitis and prostatodynia. They reduce inflammation and ease irritation. They may take as long as three months before they show any improvement, which may then continue over the next three months. Rye pollen
extracts, such as Cernilton and ProstaBrit, are available from health food stores.
Jul
14
PROSTATE CANCER WHAT’S THE DIAGNOSTIC SEQUENCE?
July 14, 2009 | Leave a Comment
PROSTATE CANCER: WHAT’S THE DIAGNOSTIC SEQUENCE?
A patient goes to a urologist for many reasons. More and more family physicians are doing rectal digital examinations and when they find a lump or nodule on the prostate refer the patient to a specialist. The urologist will confirm the digital diagnosis and then begin other tests to confirm or deny the first decision. He might do a biopsy of the prostate to test the tissue in the hard nodule. He almost certainly will do an ultrasound test and look at the findings on a sonogram or on a screen. There are also two blood tests he’ll do for further confirmation of a cancerous growth. As we pointed out before, there is no connection between an enlarged prostate and cancer. Usually the cancer does not press in on the urethra so there are none of the usual BPH symptoms which might get a man to go see his doctor. There could be some symptoms a man might feel such as pain in the upper thighs, the pelvis or lower back, serious weight loss and shortness of breath. Symptoms such as these might mean nothing unusual, or be a sign of some other physical problem or disease — or they could be from cancer.
If the pain is related to prostate cancer, it may be a sign that the disease has spread outside of the prostate, and often it is too late to save the patient. That’s why prostate cancer is often called a silent killer and the reason that preventive medicine must be practiced, the digital rectal exam, once a year.
Now, back to those tests to determine if the lump or nodule is cancer of the prostate. The drawing on the following page shows one way that cancer might grow in the prostate. This is viewed from the two lobes of the prostate that can be digitally examined. A biopsy is the use of a needle inserted through the perineum or the rectum to remove a sample of tissue from the suspected nodule. This can be done by feel by the urologist or with the help of ultrasound to locate the specific area.
A biopsy can be done in the doctor’s office or as an outpatient at a hospital and requires a local anesthesia. A relatively new way to take a biopsy is with what is called a “biopsy gun”. It isn’t a real. It’s a biopsy needle that is used through the rectum and guided by ultrasound, but is “fired” in and out so quickly that the patient feels pressure and hears the sound the device makes, but he feels almost no pain. No anethesia is given.
One urologist says he shows the patient the device and the noise it will. During the actual biopsy the patient jumps when he hears the sound, not because of pain. For most the use of the biopsy gun is quick, simple and painless. A lot easier than going to the hospital for a biopsy the old way. And that means it’s less costly as well for the patient. One patient said it was less painful for him than a shot in the arm.
The tissue core taken in the biopsy is evaluated to see if it is cancerous. Another technique known as fine-needle aspiration cytology is often used these days. Here a urologist inserts an extremely fine needle through the rectum and removes cells from the prostate in three, four or five different locations. The technique results in minimum pain for the patient and no anesthesia is required. If the tissue shows evidence of cancerous growth, the urologist usually will do more testing. This is to find out the placement of the cancer and the extent of it. One of these tests is the PSA test, the prostate specific antigen test. If the prostate is producing a higher level of antigen than usual, it is a good indication that cancer is present.
The other test, the PAP, or the prostate acid phosphatase, may reveal if the cancer has spread to other parts of the body. If the PAP is elevated, the urologist will follow up with chest X-rays and X-rays of the pelvic area as well as bone scans and perhaps a CAT scan if equipment is available.
There is another way that many men learn that they have cancer of the prostate. This happens during a routine TURP operation where BPH has resulted in an operation. The scrapings of tissue from the prostate are examined to see if they are benign or cancerous. If the pathologist reports there are some flakes that show cancer, the doctor then does more tests to determine the placement of the tumor, and the chance that he has already removed all of the cancerous tissue.
When cancer is found in this instance, it is usually an early beginning of the disease, and one that was not found, or was not in the right place to be discovered, with the digital exam. Again here more tests would be done and the prostate examined again to determine what procedure might be needed. This would be after the regular BPH surgery, since most evaluations of prostate tissue by a pathologist take two to three days in most areas on a routine basis.
Jul
5
Aspirin-Like Drugs for Arthritis Treatment
July 5, 2009 | Leave a Comment
Aspirin-Like Drugs
One of the best arthritis buys in the pharmacy is a frequently overlooked prescription drug called salsalate. It has been around for so long that many physicians have forgotten about it. Because salsalate is available generically, the cost should only be the amount of your co-pay. Even without insurance, the cost shouldn’t be much more than $1 a day.
salsalate is a kissing cousin to aspirin (it is salicylsalicylic acid instead of acetylsalicylic acid). Because it lacks the acetyl group, salsalate behaves differently in the body. Studies done 20 to 30 years ago suggest that it may be a little less irritating to the stomach than aspirin because it is absorbed only from the small intestine. (There are no data on whether it irritates the small intestine the way enteric-coated aspirin does.)
Asalsalate is just as effective as aspirin at relieving joint pain or morning stiffness. Unfortunately, it probably won’t prevent blood clots or heart attacks the way aspirin does. salsalate may also be a little more likely to cause dizziness or ringing in the ears. It does require medical supervision, just as any NSAID does, and probably has similar side effects.
BRANDS OF SALSALATE
• Amigesic • Mono-Gesic
• Artha-G • Salflex
• Disalcid • Salsitab
Another aspirin-like arthritis medicine that is often overlooked is choline magnesium trisalicylate (Tricosal, Trilasate, Trisalicylate). It too requires a prescription and should cost a lot less than $1 a day. Like salsalate, it may be a little less irritating to the stomach than aspirin. Again, it provides no extra protection against heart attacks or strokes.
Ibuprofen and Naproxen
For those who cannot tolerate aspirin or who want a traditional NSAID to get them over a hump, which drugs would we consider using? This is an incredibly difficult call because of the new and alarming data linking these drugs to heart attacks. If forced to recommend something, we would probably fall back on naproxen. For one thing, it is a good deal. When prescribed generically the co-pay should be $10 or less a month. Even when purchased over the counter the cost should be no more than 15 cents per day. That compares to as much as $4 to $7 a day for Celebrex.
One study found that ibuprofen and naproxen are not associated with accelerated progression of hip and knee arthritis the way some other NSAIDs are.82 Another possible plus with these two drugs may be a somewhat safer cardiovascular profile. One epidemiological study demonstrated no increased risk of heart attacks or other cardiovascular complications with these two pain relievers when they were used for short periods of time. 13 Another study, unfortunately, found that NSAIDs like ibuprofen increase the risk of a second heart attack.” A Danish study of nearly 60,000 heart attack survivors showed that NSAIDs such as Celebrex, ibuprofen, and diclofenac were linked to an increased risk of heart attack death. This complication showed up within several weeks of starting on the pain reliever. The researchers concluded that heart attack survivors need to be very cautious about the kind of pain reliever they use.
N a p r o x e
Naproxen is an NSAID available both OTC and by prescription (Anaprox, Naprelan, Naprosyn). it does a reasonable job of relieving arthritis pain and the effect lasts a little longer than that of Ibuprofen. Some researchers believe that it may be less likely to pose cardiovascular risks than other NSAIDs. This is unconfirmed, and naproxen may not be as safe as we would wish.84
Downside: Damage to the stomach lining. Indigestion, gastritis, and ulcers. High blood pressure, kidney problems, liver complications, rash, constipation, diarrhea, dizziness, and ringing in the ears.
Cost: Approximately $4 to $5 per month SIGNS OF TROUBLE!*
• Chest pain
• Shortness of breath or sudden weakness
• Slurred speech or paralysis
• Severe stomach pain or indigestion
• Black, tarry stools
• Sudden weight gain
• Trouble removing a ring
• Skin rash, itching, blisters, fever
• Nausea, fatigue, yellow eyes, flu symptoms
*If any of these symptoms occur, contact your physician immediately or visit urgent care.
Even people who have not had a heart attack need to be wary about NSAIDs. Anyone with high blood pressure, high cholesterol, blockage in a coronary artery, or kidney problems is likely to be at increased risk of a heart attack when taking such pain relievers. Finnish investigators studied more than 33,000 heart attack patients hospitalized between 2000 and 2003. By comparing them to 139,000 control subjects, the researchers found that taking any NSAID increased the chance of a heart attack by approximately 40 percent.
For those who think taking aspirin together with a drug like Advil or Aleve might diminish any risk of a blood clot, think again. There are no clear-cut data to support that notion. There is even some worry that drugs like ibuprofen and naproxen might undo the cardiovascular protective benefits of aspirin.88,89 Be wary of interactions with other medications, especially blood pressure drugs (ACE inhibitors), furosemide (Lasix), lithium (Eskalith, Cibalith, Lithane, Lithobid, Lithotabs), methotrexate, (Rheumatrex, Trexal), and blood thinners like warfarin (Coumadin).
Of course anyone who opts to use an NSAID must treat these drugs with the respect they deserve. Treatment for more than 10 days requires medical supervision and great vigilance. Remember, there may be an increased risk for heart attack, hypertension, heart failure, kidney problems, and ulcers.
To counteract the risk of serious GI toxicity, many gastroenterologists now routinely recommend acid-suppressing drugs called PPIs (proton pump inhibitors) in combination with NSAIDs. Medications such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex) are supposed to diminish the likelihood of NSAID-induced stomach upset and ulcers.’ Despite this belief, there is no guarantee that such drugs can prevent all ulcers or perforations. A review of the use of low-dose aspirin in the New England Journal of Medicine cautions against any sense of complacency. This should apply to all NSAIDs.
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. If 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. 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 ”
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. 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.
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 .
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.” 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?
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 arteries. 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.
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
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.
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
• 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.