Jul
16
Adefovir
July 16, 2009 | Leave a Comment
Generic Name
Adefovir (ah-deh-FOE-veer)
Brand Name Hepsera
Type of Drug Antiviral.
Prescribed For
Chronic active hepatitis B in adults.
General Information
Hepatitis B is one of several different types of hepatitis, a viral infection of the liver. Adefovir is an antiviral drug that can reduce the amount of hepatitis B virus in the bloodstream and slow its spread to healthy liver tissue, however, it cannot cure chronic hepatitis B. People with chronic hepatitis B may develop liver cirrhosis or liver cancer and it is not known if adefovir can prevent these conditions from occurring. Like other viruses and bacteria, the hepatitis B virus can become resistant to the effects of adefovir.
Adefovir works against the hepatitis C virus in a way similar to that of certain human immunodeficiency virus (HIV) drugs. It interferes with an enzyme called reverse transcriptase, which is an essential component of the viral reproduction process. Almost half of each dose is eliminated via the urine within 24 hours of taking it.
Cautions and Warnings
Do not take adefovir if you are allergic or sensitive to any of its ingredients.
Adefovir can be toxic to the kidneys, especially in people who already have some kidney problems. Since it is eliminated from the body through the kidneys, people with kidney disease are often given lower doses of adefovir.
In some cases, hepatitis can become severely aggravated upon discontinuation of adefovir. Your doctor should check your liver for’ 2 weeks after the drug is stopped. it is possible that antiviral therapy may have to be re-started.
Adefovir has some activity against the human immunodeficiency virus (HIV). An HIV blood test is recommended before starting adefovir treatment. If you are HIV positive, adefovir could make the HIV virus resistant to future antiviral drugs.
People taking adefovir can develop liver disease, liver enlargement, fat degeneration, and lactic acidosis (potentially fatal metabolic imbalance). This may be a reason for your doctor to stop your adefovir treatment. This occurs most frequently in obese women.
Possible Side Effects
In studies, side effects reported in the treated group were similar in frequency to placebo.
✓ Most common: weakness, headache, stomach pain, and nausea.
✓ Less common: intestinal gas, diarrhea, and upset stomach.
Drug Interactions
This drug was studied extensively in an attempt to predict possible drug interactions. No major interaction problems have been revealed.
• Taking drugs that can be toxic to the kidneys (such as amino-glycosides, cyclosporine, nonsteroidal anti-inflammatory drugs (NSAIDs), tacrolimus, and vancomycin) together with adefovir can lead to the more rapid appearance of kidney damage.
• Ibuprofen, when taken in dosages of 800 mg 3 times a day, will increase adefovir blood levels by about 20 %, however the importance of this finding is unknown.
Food Interactions
Adefovir may be taken without regard to food or meals.
Usual Dose
Adults: 10 mg once a day. People with kidney disease requiring dialysis may take only 10 mg a week. The exact dosage is based on the severity of kidney disease.
Child: not recommended.
Overdosage
Gastrointestinal symptoms are the most likely outcome of an adefovir overdose. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Practice safe sex and safe needle use. People taking adefovir may still spread hepatitis B through sexual contact or by sharing needles. Practice safe sex using condoms and dental dams.
Do not share personal items that can have blood or body fluids on them, such as toothbrushes or razor blades.
Try to take adefovir at the same time every day.
Adefovir must be taken continuously to maintain its effectiveness. Be sure to keep enough adefovir on hand so that you do not run out of medicine.
If you take adefovir on a regular schedule and forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule. Do not take a double dose of this medicine. Call your doctor if you forget 2 or more doses in a row. Skipping or forgetting too many doses can make the hepatitis C virus resistant to adefovir.
Call your doctor at once if you feel very weak or tired, cold (especially in your arms and legs), dizzy or lightheaded, have unusual muscle pain, trouble breathing, stomach pain with nausea and vomiting, or have a fast or irregular heartbeat. These could be signs of lactic acidosis.
Call your doctor if you experience jaundice (symptoms include yellowing of the skin or whites of the eyes), appetite loss for a few days or more, lower stomach pain, nausea, dark urine, or bowel movements that are light in color. These could be signs of liver toxicity.
Special Populations
Pregnancy/Breast-feeding: Animal studies with adefovir have revealed a tendency for some birth defects when the dosage administered was more than 20 times the average human dose. There is no information on the effect of adefovir during pregnancy. The company that produces adefovir has established a registry to collect information on pregnant women who take this drug. When this drug is considered crucial by your doctor, its potential benefits may be carefully weighed against its risks.
It is not known if adefovir passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may be more sensitive to adefovir’s side effects because of the natural loss of kidney function that occurs with advancing age.
Jul
16
Acitretin
July 16, 2009 | Leave a Comment
Generic Name
Acitretin (ah-sih-TREH-tin)
Brand Name
Soriatane
Type of Drug Antipsoriatic.
Prescribed For
Severe psoriasis; also prescribed for a variety of other skin conditions.
General Information
Acitretin is related to vitamin A and prescription drugs such as etretinate and isotretinoin. Acitretin is produced when etretinate is broken down in the body and its effects are very similar to etretinate. The way that acitretin works is not known. Its full benefit is not likely to be seen until you have taken it for 2 or 3 months. Your doctor is urged to use this medication only in cases of severe psoriasis that have not responded to other treatments because of the risks associated with acitretin.
Cautions and Warnings
Do not take acitretin if you are allergic or sensitive to any of its ingredients. Women who take acitretin must not be pregnant during treatment or for 3 years after the completion of treatment. It is not known if acitretin taken by men before conception is also a risk to the fetus.
A small number of people taking this drug have developed liver damage including jaundice (symptoms include yellowing of the skin and whites of the eyes). Acitretin has also been associated with hepatitis. People with kidney failure have much less acitretin in their blood than people with normal kidneys. Caution is advised for people with liver or kidney damage.
Cholesterol levels rise in 25-560/6 of people taking acitretin. Very large increases in triglycerides may be responsible for the few cases of pancreatitis (pancreas inflammation) that have been reported. Your doctor should measure your blood fat levels before you start taking acitretin and monitor them weekly or biweekly until your response to the medication has been determined. People with diabetes, who are obese, or who have a history of these conditions are at increased risk for high cholesterol levels as are people who drink alcohol excessively.
Drugs similar to acitretin have been associated with pseudo-tumor cerebri (increased pressure in the brain). Symptoms of pseudotumor cerebri include visual disturbances, headache, nausea, and vomiting. Report these or any unusual symptoms to your doctor at once.
People taking acitretin who had spine or bone—including knee or ankle—problems before starting the drug may find that their problems worsen while on the drug.
People with diabetes may find it more difficult to control their blood sugar while on acitretin.
Possible Side Effects
✓ Most common: hair loss or change in texture, peeling skin, and inflammation of the lips.
✓ Common: dry eyes, chills or stiffness, dry skin, fingernail problems, itching, rash, tingling in the hands or feet, increased sensory awareness, loss of some sections of skin, sticky skin, and runny nose.
✓ Less common: drying and thickening of eye tissue; eye irritation; eyebrow or eye lash loss; changes in appetite; swelling; fatigue; hot flashes; flushing; sinus irritation; headache; pain; earache; insomnia; depression; Bell’s palsy; crusting of the eyelids; blurred vision; conjunctivitis (pinkeye); double vision; itchy eyes or eyelids; cataracts; swelling inside the eye; unusual sensitivity to bright light; dry mouth; nausea; stomach pain; diarrhea; bleeding gums; joint; back; and muscle pain; and worsening of existing spinal problems.
✓ 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
• People combining acitretin and glyburide (an antidiabetic) may have unusually low blood-sugar levels. Your doctor may have to adjust your diabetic treatment program while you are taking acitretin.
• Combining acitretin with methotrexate increases the risk of liver damage.
• Acitretin reduces the effectiveness of low-progestin oral contraceptives (the “mini-pill”). If you are taking one of these contraceptives, switch to another type of birth control and use at least one other contraceptive method for at least 3 years after treatment is completed.
• Combining alcohol with acitretin produces acitretin’s parent compound, etretinate. Etretinate stays in the body much longer than acitretin and may therefore affect the fetus for an even longer period of time than might acitretin. Avoid alcoholic beverages.
• Do not take a vitamin A supplement that has more than the standard minimum daily requirement (1000 mcg). Excess vitamin A plus acitretin exposes you to possible vitamin A toxicity.
• Combining acitretin with tetracyclines may increase the risk of severe pressure on the brain.
• Notify your doctor if you are taking etretinate, isotretinoin, oral or topical tretinoin, or cyclosporine.
Food Interactions
Acitretin is best absorbed when taken with food or meals. Usual Dose
Adult: 25-50 mg a day with your main meal. Dosage may increase after 4 weeks to 25-75 mg a day. Dosage must be individualized to your specific needs.
Child: not recommended.
Overdosage
Symptoms of acitretin overdose include vomiting, headache, and vertigo. Call your local hospital emergency room or local poison control center for more information. ALWAYS bring the prescription bottle or container.
Special Information
Contact your doctor at once if you become pregnant while taking acitretin or in the 3 years following treatment. The risk of birth defects persists as long as the drug is in your body. In one case,
small amounts of etretinate were found in blood plasma and fatty tissue more than 5 years after treatment.
Some people have experienced decreased night vision while taking acitretin. Be careful when driving at night.
Report visual disturbances, headache, nausea, vomiting, or anything unusual to your doctor at once.
Do not drink any alcoholic beverages during acitretin treatment and for at least 2 months after treatment has been completed. Avoid excess vitamin A (see “Drug Interactions”).
Some birth control methods, including low-dose progestin contraceptives and tuba) ligation may fail while taking this drug. Use at least one additional form of contraception while taking acitretin to avoid pregnancy.
You may have problems tolerating contact lenses while you are taking acitretin.
Do not donate blood while taking acitretin or for 3 years afterwards because your blood might be given to a pregnant woman.
Avoid exposure to excessive sunlight or to sunlamps because of unusual sensitivity caused by acitretin.
If you forget to take a dose of acitretin, take it with food as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
A worsening of psoriasis may initially occur with treatment, and the full benefit of acitretin may not be seen for 2-3 months.
Special Populations
Pregnancy/Breast-feeding: Acitretin causes birth detects and may damage the fetus. Women who take acitretin must be sure they are not pregnant before starting therapy by using reliable contraception for at least 1 month before starting the drug and taking a pregnancy test within 1 week of starting treatment. Women must use 2 reliable contraceptive methods during treatment and for 3 years following the completion of treatment.
Acitretin may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors have twice as much acitretin in their blood as do younger adults but may take acitretin without special precaution.
Jul
16
Dandruff Problem. Dandruff Treatment Drugs
July 16, 2009 | Leave a Comment
DANDRUFF
• Soak the scalp with Listerine original-formula
• Make an herbal rinse with sage or rosemary
• Slather yogurt on the scalp
• Use a dilute vinegar rinse after washing the hair
• Rotate dandruff shampoos to maintain effectiveness
• Shampoo with Nizoral A-D
Dandruff may be dastardly, but in general, it is not a serious medical condition. Though people who have it may by frustrated by it, or even desperate for relief, doctors don’t get too excited when they see it. The flakes are not life threatening. They never require surgery. They are not contagious and, unlike flatulence, they don’t drive others away. But a bad case of dandruff makes people self-conscious, and thanks to decades of advertising, may even carry a social stigma.
Skin cells die and are sloughed off every day, all over the body. But on the scalp, they may clump together and form flakes that stick in the hair or fall to the shoulders, and are unpleasantly visible on a black polo shirt. If the flakes are especially large and numerous and the scalp is particularly itchy and red, a dermatologist might identify the problem as seborrheic der-matitis. This condition may also affect the face. In some people, patches of skin on the forehead (including the eyebrows), the sides of the nose, and the chin seem to be especially susceptible to developing reddish, itchy scales. I fought dandruff for 30 years. Even my eyebrows itched I only bought light-colored clothing that wouldn’t show flakes. My dermatologist recommended various shampoos that didn’t work. When I changed doctors, my new doctor said my -dandruff was a yeast infection. She recommended Nizoral shampoo. I only have to use it about once a month and I have no more flakes or itching.
I know this story isn’t as dramatic as finding a cure for cancer, but solving an annoyance like this is truly liberating.
Dermatologists usually distinguish between dandruff and seborrheic dermatitis, but researchers now believe that both conditions can be traced to the skin’s reaction to yeast that lives on its surface. This fungus, Malassezia globo and related species, sets up housekeeping, especially where the skin is secreting oil&’66 The fungus then produces oils of its own, which irritate the skin.” The resulting reaction is the excessive flaking typical of dandruff or the redness and itching on the scalp and face that characterize seborrheic dermatitis. Presumably, the big difference between dandruff and seborrheic dermatitis is the amount of irritation that results.
Malassezia yeast normally inhabit the skin; nobody seems to know exactly why some people are more irritated by Wassezia by-products than others. It might have something to do with hormones, or diet, or the activity of the immune system. Because dermatologists don’t know how to change individual susceptibility, the basic approach has been just to kill off as many of the yeastie beasties as is practical without hurting the scalp. This not only makes sense, it actually works most of the time. And it also explains why some dandruff shampoos seem to lose effectiveness over time. Presumably, the yeast can develop resistance.
Once in a while, people taking an oral anti-fungal drug for another problem report that it gets rid of their dandruff. But even for super-dandruff (aka seborrheic dermatitis of the scalp), an oral antifungal is too big a cannon to consider seriously. Why risk potentially serious side effects over dandruff?
Q. I had dandruff for more than 20 years and tried all sorts of medicated shampoos with no success. About 2 years ago I got a fungus under the nail of my big toe. My podiatrist put me on Lamisil, a pill a day for 3 months. While I was taking it, my dandruff cleared up and quit itching. The Lamisil did not get rid of my nail fungus, but it seems to have cured the dandruff.
A. We’re not surprised to learn that the antifungal medicine you took for your nail infection cleared up your dandruff. Dermatologists think that dandruff is caused, in part, by yeast. Antifungal medicines could eliminate the yeast.
Home Remedies for Dandruff
Anyone who has had dandruff knows that ordinary shampooing, while it may help for a little while, just doesn’t make much difference. But a lot of people have discovered some rather interesting home remedies that can be helpful. We’ve collected a few that are low cost and low risk, even though there is not much evidence that they work more than occasionally. Use your own common sense in selecting those that seem worth a try.
Herbal Products
What would you think of putting mouthwash in your hair? It may not be the first thing that comes to mind, but quite a few people assure us that Listerine (the amber-colored original formula) can banish dandruff. We first heard this idea from a man who said his veterinarian recommended a mixture of Listerine and baby oil to treat itchy “hot spots” that caused his dog to keep licking its coat. It worked well for the dog, so he experimented on himself! We caution animal lovers to check with your own vet before trying this at home. And we would be especially wary about trying anything of this sort on cats, since they groom themselves so assiduously.
Q. Have you ever heard of using Listerine for dandruff? Someone told me he heard it on the radio.
A. A gentleman called in to our public radio show with an amazing story about Listerine mixed with baby oil. His veterinarian had recommended this combination for relieving itchy spots on his Dobermans and horses. He found that it worked and tried it for his own dandruff. He told us that it gets rid of dandruff in 2 to 3 days.
In the early 20th century and throughout the World War II era, Listerine was actually promoted as a dandruff treatment. Presumably the company dropped that claim when the FDA demanded proof. It’s not too far-fetched to believe, though. Listerine contains a number of herbal oils that have antifungal action, such as thymol, eucalyptol, and menthol. These ingredients might work together to knock down Malassezia and thus control flaking. The alcohol in Listerine might also have some antifungal action. I have suffered from severe dandruff all of my life, and nothing helped I tried washing my hair with Listerine, and have been dandruff free since. It’s nothing short of a miracle cure.
The ingredient list for Listerine overlaps quite a bit with the list for another familiar old-fashioned product, Vicks VapoRub. Vicks contains camphor, thymol, menthol, eucalyptus oil, turpentine oil, cedarleaf oil, and nutmeg oil. Although Vicks is not promoted as working against fungus, many people find it helpful in fighting nail fungus, which is notoriously difficult to treat. Others report that it can be effective for the red, itchy flakes of seborrheic dermatitis on the face or behind the ears.
The drawback to using Vicks against dandruff is that the base is petroleum jelly. Washing this goo out of hair could be a real challenge!
People have tried a lot of different techniques to get petrolatum out of hair. The one technique that appears to be most Original Listerine contains a mixture of herbal oils with anti-fungal action. Currently, it is not promoted as a dandruff cure, but it was once marketed for this purpose. Wet the scalp well with Listerine and leave it on for 5 minutes before shampooing.
Downside: May sting on application. Mouthwash aroma might linger after shampooing.
Cost: Approximately $8 to $10 for a 11/2-liter bottle (around 150 per treatment).
Q. I’ve been suffering with scaly dandruff for 3 years. I’ve spent an enormous amount of money on medicines prescribed by the dermatologist, but none is a cure.
Last year I read in your column about people treating fungus-infected toenails with Vicks VapoRub. I thought I would try it for my problem. A bottle of Vicks cost me just over $5.
The Vicks softened those itchy scales and in just 2 weeks I have no more nasty flakes. Thank you for helping people like me on a low income.
A. We’ve never heard of using Vicks VapoRub against dandruff. This condition has been linked to yeast on the scalp, however, and is treated with antifungal shampoo.
The essential oils in Vicks are reported to have some activity against fungus. We’re glad to hear it worked for you, but we wonder: How did you wash the Vicks out?
We heard from one individual who was experimenting with coloring her hair naturally. She made an herbal tea out of sage (but did not tell us how she made it). Then she used the sage tea as a rinse after each shampoo. To her astonishment, she realized that her dandruff had disappeared. Being of a scientific turn of mind, she stopped using the sage tea rinse. Sure enough, her dandruff came right back. She was very pleased to have found an inexpensive way to treat dandruff.
Q. I used to rinse my hair with a decoction I made from rosemary plants that I grew in my herb garden.
My hair tends to be the “fly-away” sort, but rosemary made it manageable and also eliminated dandruff. It made my hair smell nice, too. Growing the rosemary myself made my hair rinse a renewable resource that came from my own yard and saved me money.
A. Rosemary has a reputation as being good for hair, so we are not surprised that your home remedy is helpful. *Some people are sensitive to rosemary oil, however, and may develop a rash.
One of the important components of rosemary oil is camphor (along with cineole, alpha-pinene, and limonene). It also contains rosmarinic acid and carnosol. Sage, on the other hand, contains thujone, cineole, and rosmarinic acid.”‘ If you plan to try one of these herbal teas as a scalp rinse, use a teaspoon of dried herb for a generous cup (8 or 9 ounces) of hot water. Steep sage tea for 5 minutes before straining; let rosemary tea steep for 15 minutes. If you have fresh herbs from the garden, use a tablespoon of fresh leaves for your cup of tea. Let it cool before pouring it over your scalp so you won’t scald your scalp by accident.
Kitchen Magic
People can be quite ingenious when they are faced with a problem like dandruff, so it’s little wonder that some folks have tried putting common foods on the scalp. One herbal au-After washing the hair, rinse with a tea made of sage or rosemary leaves.
Downside: Some people may have an allergic skin reaction. To be safe, test a spot on your inner arm the day before you plan to use it on your scalp.
Cost: Varies. Using rosemary or sage from the garden is free. Buying herbs in bulk results in a cost of about 50 per dose.
thor recommends smearing yogurt onto the scalp after shampooing, allowing it to sit for 15 minutes, and then washing it out. Don’t use just any yogurt, though. It should be a type with active cultures (read the label). Yogurt is fairly acidic, and that may make the skin less appealing to fungus. Then again, perhaps those live cultures do their own bit to discourage yeast. We have not tried this remedy and don’t know how well it would work.
All my life I have used dilute vinegar to rinse my hair after shampooing. It works well against dandruff and you can also use it on your feet to stop odor. Best of all, it is cheap!
We have heard from a number of people who use vinegar as a rinse after shampooing. Some insist upon apple cider vinegar, while others go with inexpensive white vinegar. Like yogurt, vinegar is acidic. Acid disrupts the environment for many fungi that live on human skin. It stands to reason that it would also work against Malassezia.
In fact, when the problem is a fungal infection of the ear that makes it itch, one ear-nose-and-throat specialist recommends a solution made of one part white vinegar to five parts tepid water. The ear is flushed gently three times a day, and the fungus usually responds. Such a dilution might work as a scalp rinse. Then again, it is possible that a solution as strong as one part vinegar to two or three parts water would not be too harsh for the scalp.
One other food that could be used against dandruff could make you very popular with Pooh and other fictional bears. Honey, it turns out, is active against Malassezia yeast.171 This It may take a little experimentation to find the right dilution. One partminegar to fiveparts waterwould be safe, but might not be strong enough. One,part vinegar to,one part water Would probably.be strong enough to fight the fungus, but it might also sting the. scalp. Apply the rinse after shampooing, let it stay. on the scalp for 5minutes, then rinse it with dear water to get rid of the vinegar aroma.
Side effect: Possible skin irritation.
Downside: Without the final water rinse, you might smell like a pickle.
Cost: About. $1 per quart.
But if one were feeling brave, or extra-sweet, it would be possible to mix honey with water, apply it to the scalp for 10 or 15 minutes, and then wash it off. Honey probably wouldn’t be much messier than yogurt, though it certainly would be more expensive than vinegar.
Over-the-Counter Remedies
Dandruff shampoos are readily available, and most are backed up by research showing that they affect yeast on the scalp and reduce flaking and itching. Keep in mind, though, that Malassezia may develop resistance to shampoos they are exposed to on a regular basis. As a result, it makes sense to rotate the type of medicated shampoo you use every month or two.
You might start, for example, with a shampoo such as Head & Shoulders, Pert Plus for dandruff, or Suave Dandruff 2 in 1 that contains zinc pyrithione. Research has shown that zinc pyrithione kills Malassezia and other fungi,”‘ which is why these shampoos are usually effective for dandruff. After 6 weeks or so, though, you should switch to an entirely different category of dandruff shampoo.
A medicated shampoo like Nizoral A-D, which contains ketoconazole, would be one option. This antifungal drug also kills Malassezia and has some anti-inflammatory action as well. 173 This shampoo is to be used twice a week at first, then only as often as necessary once the flakes are under control. Keep the suds away from the eyes, of course, but you can use Nizoral to wash any skin affected by fungus (patches of seborrheic dermatitis, jock itch, athlete’s foot, and the like).
Selenium sulfide is yet another antifungal ingredient. It is found in Selsun Blue, Glo-Sel, and Exsel shampoos.
There are two other categories of dandruff shampoo. One contains coal tar (a category that includes Denorex, Ionil T Plus, Neutrogena T/Sal, and Zetar). This ingredient acts against flaking and helps quell itching as well. The other contains salicylate acid and sulfur, which loosen the flakes and help them break into smaller (and thus less visible) pieces. These are shampoos such as Meted, Pernox, and Sebulex.
It surely doesn’t make sense to try all of these medicated shampoos, or even all of the various categories. Switching back and forth among three different categories would probably be just fine. The idea is simply not to let Malassezia get too accustomed to whatever it is you are using.
Give any dandruff shampoo enough time to fight the fungus. That is, after first washing off the surface dirt with any shampoo you please, lather up the medicated shampoo and leave it on for at least 5 minutes. This is harder than it sounds. After all, you may not want to waste water in the shower, but standing around wet and shivering for 5 minutes is also not appealing. You’ll have to use your ingenuity to solve this problem, but if you can, you’ll find the dandruff shampoo is far more effective. Here’s a hint: Shampoo first, then wash the rest of your body while you let the suds sink in. This shampoo contains the antifungal drug ketoconazole. (Make sure you buy the medicated shampoo. Nonmedicated Nizoral A-D is also available, but it won’t fight dandruff.) Nizoral shampoo is also available by prescription at twice the strength (2 percent).
Side effects: Rash, allergic reaction. To be safe, test a spot on your inner arm before you use it on your scalp.
Downside: Relatively expensive
Cost: Approximately 80o to $1.30 per wash When you are done washing your hair, resist the urge to blow it dry, at least once in a while. Hair dryers are hard on the scalp and seem to make flaking worse.
Prescription Shampoos
A stronger formulation of Nizoral shampoo is available by prescription. Doctors have a couple of other prescription possibilities as well, in case the other options aren’t effective enough. One of these is Loprox shampoo (ciclopirox). This antifungal agent also has some anti-inflammatory activity, which is useful when skin is itchy and red.”‘ Needless to say, a prescription shampoo is more expensive than the nonprescription approaches. No head-to-head studies have been done to compare it and find out if it is also more effective.
Conclusions
Dandruff and seborrheic dermatitis both seem to result from a-reaction to yeast that normally live on the skin. Scientists don’t know why some people react while others do not, nor are they sure why Malassezia yeast seems to grow more vigorously on some people’s skin than on others’. But research has shown that making life hard for the yeast usually controls the flaking and itching that are so bothersome. If any of these remedies make matters worse, stop the treatment right away and give your skin time to recover before you try anything else. When in doubt, check with a dermatologist!
• Drench the scalp with Listerine original (amber) mouthwash before shampooing. The herbal oils and alcohol in Listerine discourage the growth of yeast on the scalp.
• Smear some Vicks VapoRub on itchy, red, scaly spots. It contains many of the same antifungal herbal oils as Listerine. It can be very difficult to remove Vicks from hair, though.
• Brew some herbal tea with sage or rosemary. Use it as a rinse after shampooing your hair.
• Slather yogurt containing live cultures on the scalp. Leave it for 15 minutes before shampooing it out. Unlike the petrolatum in Vicks VapoRub, yogurt should be fairly easy to wash out.
• Make a rinse with vinegar diluted at least two to one in water. Some people prefer apple cider vinegar, while others use the cheapest white vinegar.
• Switch from one type of dandruff shampoo to another every 6 to 8 weeks. Don’t give Malassezia a chance to adapt.
• Try using Nizoral A-D shampoo twice a week, then cut back and use it only as often as needed to keep flaking under control.
• If none of this helps, check with your doctor. Perhaps your condition is not ordinary dandruff.
*A prescription shampoo such as Loprox may help when other measures have failed.
Jul
14
CAN I STILL HAVE SEX AFTER PROSTATE TROUBLE?
This probably will be the most read chapter in the book, and rightly. The prostate is tightly bound up with a male’s manhood, and how he thinks of himself as a man. That’s why even the mention, let alone the discussion, of the prostate and its troubles, make most men uneasy, nervous and embarrassed. We’ll look at all problems with the prostate and how they may or may not affect a man’s libido, his attitude, his sexual performance and his sexual desires.
PROSTATITIS AND SEX
The first problem many men have with their prostate is prostatitis. Symptoms of this involve lower back pain, pelvic discomfort, a burning in the penis when urinating, urinary frequency and sometimes a slight pain after ejaculation. This form of noninfectious prostatitis may be caused by some infectious agent we know nothing about, or by some noninfectious form of inflammation. On the other hand, it also can be caused by a man’s sexual habits — too much sex or too little. During arousal, a man produces four times the prostatic fluid he usually does. If this fluid is not discharged by ejaculation, it remains in the prostate. If this happens often, the prostate can become seriously congested.
To prevent this problem, a normal, healthy sex life is the best course of action. If this is not possible, a massage of the prostate by a urologist will relieve the congested prostate and eliminate the pain. If that’s not desired, masturbation is a quick solution suggested by many urologists. Too much sex, too quickly, say eight or ten ejaculations in a two day period, can overwork the prostate and again cause problems. On the other hand, abstinence may cause a build up of prostatic fluids and lead to congestion so a massage is needed. Coitus interruptus, simply the removal of the penis before ejaculation, is a method of birth control once practiced by millions. If done often enough, and if it stops the man’s climax, this too, can lead to an oversupply of fluid in the prostate and bring about congestion and its symptoms. If coitus interruptus is used frequently by a couple, the man or woman should continue to excite the penis to a normal ejaculation to prevent buildup problems in the prostate. So for prostatitis, which can strike men of any age, sexual intercourse may be both the cause and the solution.
INFECTIOUS PROSTATITIS
This inflammation of the prostate is caused by some type of infection and can cause fever, chills, nausea and vomiting as well as an urgency to urinate, burning, pain and blood and pus in the urine. It’s more serious than the non-infectious type. There may be serious congestion of the prostate and urologists sometimes use a prostate massage to relieve it. Most urologists feel that sexual activity of any type that leads to ejaculation is the ideal way to empty the prostate and relieve the congestion.
BENIGN PROSTATIC HYPERPLASIA
With the enlargement of the prostate there will be some sexual changes, particularly if there is surgery involved. As you may remember, a man will have a normally enlarging prostate for ten to fifteen years, maybe more, before he notices it. The enlargement itself does little to sexual performance with the exception of a seriously pinched urethra that could reduce the amount and force of an ejaculation. When it comes to needed surgery for BPH, the question of sex becomes more important.
First, there should be no sexual intercourse for six weeks after a normal TURP surgery. This is to allow time for the “canal” dug through the enlarged prostate tissue to heal.
On a standard TU RP operation to remove enlarged prostate tissue, about six percent of all men operated on will become impotent. That means they will not be able to have a normal erection. There are bundles of nerves on each side of the prostate, and some of these control the impulses and nerve responses that combine to produce an erection. If these nerve bundles are damaged in any way, impotence can follow. Remember, this six percent figure may not be totally accurate. The figure is based on subjective information supplied by the patient. It wouldn’t be unusual for a man 68 or 70 or older to claim that he could have an erection before the operation, when in reality he had lost that ability due to natural aging or some other problem. It is a factor to consider. The other change in a man who has had a TURP operation is that the bladder neck may have been damaged or removed during the TURP. The bladder neck is like a “valve” that automatically closes when a man is ejaculating. It prevents the fluids from going upward into the bladder. The urethra muscles then force the fluid out the end of the penis. After a TURP operation, the bladder neck may no longer be there or it may be enlarged to such an extent that the fluids of the ejaculation take the path of least resistance, and flow upward a half inch or so and empty into the bladder. When this happens the man has exactly the same physical sensations that he had when the ejaculate emptied out the end of his penis. The feeling, the motion, the thrill is the same, only the path the fluid takes is different. This retrograde ejaculation is almost a one hundred percent probability in a TURP or open surgery for BPH. It’s simply a fact of life. However, with men who usually are in the operative stage, their age is often in the early to late sixties or later, and the lack of a penile ejaculation does not present much of a problem. This is especially true if the situation is carefully explained to the patient and his wife before the operation.
CANCER OF THE PROSTATE
Stage A and B cancer of the prostate will usually involve a radical prostatectomy, the complete removal of the prostate. This almost always harms the nerve bundles on both sides of the prostate and results in a man being impotent. However new techniques have now been developed to preserve these nerves. Some urologists say that in so doing, they may leave some cancer cells behind after the operation. At this point the cancer is the main concern, the life of the patient, and not his sexual function. The surgeon will try his best to get all of the cancerous growth. The nerve bundles are not a high priority. For the man who might be in his fifties, and is cured of a stage A cancer of the prostate, there are drugs and devices that can help him achieve an erection for satisfying intercourse. The cancer patient who is treated with radiation, internal or external, can usually continue his sex life without any problems. His sexual ability would be the same before or after the radiation with the exception of the normal radiation caused fatigue problems. When used in certain areas, radiation can also cause impotence. For the cancer patient with stage D cancer of the prostate, which is usually not operable, the man’s sex life would be in direct relation to where the cancer was situated and how it affected his ability to perform. At this point the patient is much more interested in extending his life, and not worried about his sexual function.
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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
Arthritis General Information
July 5, 2009 | Leave a Comment
ARTHRITIS
• Eat a diet rich in selenium
• Get 1,000 lU of vitamin D daily
• Follow a Mediterranean diet
• Take aspirin to relieve pain and control inflammation
• Try naproxen for pain relief
• Ask your doctor about a prescription for Pennsaid
(diclofenic)
• Experiment with fish oil and green-lipped mussels
• Consider Certo and grape juice
• Drink pomegranate juice
• Sip vinegar with apple and grape juices
• Drink cherry juice
• Consider acupuncture
No one really knows how many people suffer from arthritis and related inflammatory conditions. The folks at the CDC (Centers for Disease Control and Prevention), who are in charge of tracking such things, put the number at close to 70 million. That includes more than 43 million adults diagnosed by doctors and another 23 million who have symptoms but have not been officially diagnosed. That means one in three adults is afflicted with some form of arthritis.
If you think that’s a lot of folks, you ain’t seen nothin’ yet. Aging baby boomers are about to discover up close and personal what it’s like to suffer from chronic inflammation. The CDC estimates that by 2030 we will add another 22 million to the list of people in pain. Arthritis will become the biggest obstacle to enjoyable retirement for the boomer generation.
With so many suffering, it’s hardly any wonder we’re all desperate for relief. Shaking hands, buttoning a shirt, or typing on a computer keyboard can be difficult if your fingers hurt. But who can give up e-mail? We communicate with the world through our fingers.
Everyone tells us that exercise is the most important thing we can do for our overall health. Yet it’s hard to walk, jog, or play tennis or golf if your knees, hips, and shoulders are sore.
No wonder we turn to drugs to relieve our inflammation and ease the pain. A friend who hiked the Appalachian Trail dubbed ibuprofen “vitamin I.” Weekend warriors frequently rely on Advil (ibuprofen) or Aleve (naproxen) before, during, and after tennis matches, basketball games, or karate competitions. We now know that most of the medications used for arthritis can have potentially serious side effects.
We’re caught in a classic double bind. Without something to control inflammation, pain limits our activities, which is not good for our health. Take the medicine, however, and we risk all sorts of complications, from high blood pressure and kidney problems to heart attacks and strokes. Some popular anti-inflammatory drugs may even make our arthritis worse.
Jul
2
Isotretinoin in Acne Treatment
July 2, 2009 | Leave a Comment
Isotretinoin
Dermatologists have one last big gun, a powerful medicine to use in desperate cases when nothing else has worked. Isotretinoin has stirred a lot of emotions—from excitement to fear—because it is so effective but also has some extremely serious side effects. This drug is approved for severe cystic acne, and it really should be reserved for acne that is not responding to other treatments.
From the time of its introduction, the maker of Accutane Isotretinoin strove to get across the point that this drug can cause birth defects. Women who take this medication must. not get pregnant while they are on the drug or for several months after stopping it. (The compound stays in the body for a while.) Nonetheless, the manufacturer’s warnings have not been enough. Every year some women on isotretinoin do conceive, despite all the precautions. As a result, the FDA and the manufacturer have limited the access to this medicine. To prescribe it, a dermatologist must have enrolled in the iPLEDGE program, which educates physicians about the drug. Patients are also required to enroll in the iPLEDGE program and view the educational DVD before taking the first dose. The program uses telephone- and computer-based tracking to verify that female patients are getting Isotretinoin (Accutane, Amnesteem, Cla r a v i s, S o t r e t).
Isotretinoin is chemically related to vitamin A, so it controls cell division. Four to 5 months of treatment usually results in significant clearing of acne, sometimes lasting years.
Common side effects: Dry lips and mouth; dry, crusty skin; upset stomach; hair loss; nosebleed; sun sensitivity; elevated cholesterol; and reduced night vision.
Serious side effects: Birth defects; depression, potentially leading to suicidal thoughts or behaviors; inflammation of the pancreas; pressure on the brain (pseudotumor cerebri) causing severe headache.
Downside: Despite efforts to keep this drug away from pregnant women, each year some babies are exposed in utero and born with birth defects. Women must use two different and effective means of contraception throughout the time they are taking Isotretinoin.
Cost: Varies widely from about $100 to $400 for 1 month of treatment.
Q. I have been on Accutane to treat bad acne for almost a month. I have taken 26 tablets, but stopped taking it when I thought I might be pregnant.
I found out yesterday that I am indeed pregnant, and I am scared. I want to have this baby, but after reading about the drug causing birth defects, I am not sure. What should I do?
A. We were shocked to learn that you have become pregnant while taking Accutane. This acne medicine can cause very serious birth defects in a fetus. That is why the manufacturer recommends every woman have a pregnancy test before she starts on this drug and use effective contraception throughout therapy. Every time a pill is removed from its packaging, a symbol reminds the patient not to take this drug during pregnancy. Please discuss this serious matter with your physician and your partner. The drug company can provide further information about your odds of having a baby with severe health problems.
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2
Acne: Prescription Lotions and Gels
July 2, 2009 | Leave a Comment
Prescription Lotions and Gels for Acne Treatment
If treatment with benzoyl peroxide doesn’t get your pimples under control within a couple of months, check with a physician. Dermatologists often prescribe topical antibiotic gels or lotions in addition to or instead of benzoyl peroxide. Erythromycin and clindamycin are old standbys. Because they have been so widely used however, bacteria have begun to develop resistance to them. As a result, dermatologists have been restricting their use and instead turning to other approaches.
One other medication that is being prescribed is azelaic acid (Azelex, Finevin). Like benzoyl peroxide, this topical treatment seems to keep pores from clogging and to discour-age the multiplication and spread of bacteria. It too may result in burning, stinging, redness, or dryness of the skin. In rare instances, dark skin exposed to azelaic acid may develop lighter patches. If you have a cold sore or fever blister that gets worse while you are using an azelaic acid product, notify the prescribing physician immediately.
Isotretinoin or a similar compound in the vitamin A family can be very effective in treating acne and reducing the inflammation associated with severe acne. Using topical vitamin A–like compounds (retinoids) early in the course of acne lessens the likelihood of scarring, a complication of the condition. Some doctors prescribe tretinoin together with benzoyl peroxide or with an oral antibiotic such as doxycycline to clear the skin faster.
Clindamycin Gel (Cleocin T, Clinda-Derm, Evoclin Topical Foam
Clindamycin is an antibiotic that can be applied to the skin to fight acne-causing bacteria. It may take 2 months to see significant improvement, but generally this treatment is effective. Other topical antibiotics such as erythromycin gel are also effective. Some prescription products combine an antibiotic with benzoyl peroxide for greater effectiveness. These include BenzaClin and Duac Gel (clindamycin plus benzoyl peroxide) and Benzamycin (erythromycin plus benzoyl peroxide). These are effective but expensive because no generic equivalents are available.
Side effects: Itching, burning, dryness, and peeling. A rare but very serious and dangerous side effect of clindamycin that is extremely unlikely to occur but still possible with the topical form is pseudomembranous colitis. Notify your doctor immediately if you develop persistent or bloody diarrhea.
Downside: Skin bacteria (P. aches) are beginning to develop resistance to topical clindamycin.
Cost: Approximately $50 for a 60-gram tube Tretinoin Gel (Retin-A).
Retin-A speeds up cell turnover and normalizes the lower levels of the skin. With 6 weeks or more of treatment, it is frequently very helpful against acne.
Side effects: Stinging, dryness, redness, flaking, and irritation.
Downside: Retin-A makes skin more sensitive to sunburn and sun damage, so stay out of the sun and use effective protection against ultraviolet rays.
Cost: $35 to $50 for 15 grams.
There is another prescription gel or cream that is based on a vitamin. Nicomide-T gel or cream contains nicotinamide, a form of niacin. Like Retin-A, it is topical but not an antibiotic, so theoretically bacteria should not develop resistance to it. A preliminary study showed that Nicomide-T gel is as effective as clindamycin gel in reducing blemishes.” Other research confirmed that it can protect the skin and is less likely to dry it than a number of other acne treatments. It is not clear whether Nicomide-T is as effective as Retin-A, though some studies conducted by the manufacturer, Sirius Laboratories, suggest that adding it to other treatments boosts the effectiveness of both.
Jul
2
Acne Home Remedies.
July 2, 2009 | Leave a Comment
Home Remedies
People have devised a number of potions to put on their faces as home treatments for blemishes. There’s really no good evidence that any of them work, but they might be worth a try. We heard from a man who had tried washing his face with milk every day as a teenager and found it helpful. He wasn’t able to convince his daughter to try the same approach, though. We haven’t seen any evidence that a milk face wash is effective, but it seems like a low-risk adventure. In India, milk is mixed with ground nutmeg and applied to blemishes as a treatment.
Another approach is the clay mask. Versions of this are sold in drugstores and at cosmetics counters. We don’t know why it would work, but it has been popular for a long time.
Q. I taught pottery at a vocational program in the Dominican Republic some years ago. My teenage students often smeared liquid local clay from our workshop on their faces as a cure for acne. The treatment worked.
A. We’ve never seen a scientifically solid study of clay for treating acne. But clearly, clay masks have been used as a complexion aid for centuries. We don’t know if American teenagers would be willing to embrace such a treatment, but stranger things have become popular.
Clay is not the only traditional “poultice” that has been applied to blemishes. We’ve heard of one home remedy that calls for mixing a teaspoon of powdered nutmeg with a teaspoon of honey and putting it on the zit for 20 minutes.’ Then it is rinsed off, just as the nutmeg-milk mixture or milk alone would be. Still another variant is to apply a paste of ground cinnamon and honey to the blemishes and leave it on overnight. Whether any of these will actually clear up pimples is a mystery to us. They have not been put to the rigors of scientific study.
One natural product that has been studied is tea tree oil in a 5 percent gel. An Australian study compared a gel composed of an extract of the Australian tree Melaleuca alternifolia to a standard over-the-counter (OTC) acne treatment, benzoyl peroxide.’ The scientists who conducted the 124-patient study wanted to see if the antimicrobial activity of the tea tree product would be useful. They found that although the initial response was slower, the benefits were comparable for non-inflamed lesions after 3 months of treatment. Benzoyl peroxide was significantly better at reducing inflamed lesions, but it also produced significantly more undesirable side effects, such as skin dryness, stinging, itching, burning, and redness. If you can’t find a water-based tea tree oil gel, look for a cleanser with tea tree oil, which should be readily available. Some people are allergic to tea tree oil, so try a bit on the inside of your forearm first to make sure you don’t have a reaction. Watch for redness, itching, or irritation.
Speaking of cleansers, it is a myth that acne is caused by dirt that needs to be scoured off with a harsh or gritty cleanser. Simply washing the face gently each morning and evening with a nondrying cleanser such as Dove, Cetaphil, or CeraVe is recommended. Cosmetics and sunscreens should be noncomedogenic, which means they don’t contribute to blackheads. This information should be on the label. As for prescription drugs Accutane is today a mostly prescribed anti-acne medical remedy, it is available online from internet pharmacy at a cheaper prices than offline.
Q. I am 39 years old and plagued with acne on my chin and neck. The dermatologist has given me topical prescription creams that haven’t done much good, and has said my only other choice would be oral antibiotics. Recently I started applying Neosporin ointment to the affected areas of my face. The difference is miraculous! I am practically blemish free after only 2 weeks of this treatment. Any blemishes I do get are very small and disappear within a few days of applying the Neosporin. Have you heard of this? My teenager tells me that some of her friends do the same.
A. Neosporin contains the antibacterial ingredients polymyxin B, bacitracin, and neomycin. It is used for first aid to keep minor cuts from becoming infected. Your use of Neosporin is new to us. If you stop getting good results, check back with your doctor. There are a number of other prescription treatments for acne that should help. Some people develop serious skin reactions to neomycin.
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