Jul
16
Clomid (Clomiphene)
July 16, 2011 | Leave a Comment
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Aug
1
Cholestyramine
August 1, 2009 | Leave a Comment
Generic Name
Cholestyramine (kol-es-TYE-rah-meen) 0
Brand Names
LoCHOLEST Questran
LoCHOLEST Light Questran Light Prevalite
The information in this profile also applies to the following drugs:
Generic Ingredient: Colesevelam Hydrochloride WelChol
Generic Ingredient: Colestipol Hydrochloride Colestid
Type of Drug
Anti -hyperli pidemic (blood-fat reducer).
Prescribed For
High blood-cholesterol levels; generalized itching associated with bile duct obstruction—cholestyramine only; colitis; digitalis or thyroid overdose; and pesticide poisoning.
General Information
Cholestyramine resin lowers blood-cholesterol levels by absorbing bile acids in the bowel. Since the body uses cholesterol to make the bile acids—needed to digest fat—fat digestion can only continue by making more bile acid from blood cholesterol. This results in lower blood-cholesterol levels 4-7 days after starting cholestyramine.
Cholestyramine w3Cks entirely Within the bowel and is never absorbed into the bloodstream. Though usually given 3-4 times a day, there appears to be no advantage to taking it more often than twice a day. The cholesterol-lowering effect of cholestyramine may be increased when it is taken with an HMG-CoA inhibitor or nicotinic acid. In some kinds of hyperlipidemia, colestipol may be more effective in lowering total blood cholesterol than clofibrate.
Cautions and Warnings
Do not use cholestyramine if you are allergic or sensitive to any of its ingredients or if your bile duct is blocked. The powder form should not be taken dry; doing so may result in the inhalation of powder into your lungs or a clogged esophagus.
If you are being treated for hypothyroidism, diabetes, kidney or blood vessel disorder, obstructive liver disease, or alcholism, consult your doctor before taking cholestyramine.
Cholestyramine may cause or worsen constipation and hemorrhoids. Most constipation is mild, but some people may need to stop the medication or take less of it.
Possible Side Effects
✓ Most common: constipation, which may be severe and in rare cases result in bowel impaction. Hemorrhoids may be worsened.
♦ Less common: abdominal pain and bloating, and bleeding disorders or black-and-blue marks due to interference with the absorption of vitamin K, a necessary factor in the blood clotting process. One person developed night-blindness because the medication interfered with vitamin A absorption into the blood. Other side effects include belching, gas, nausea, vomiting, diarrhea, heartburn, and appetite loss. Your stool may have an unusual appearance because of a high fat level.
✓ Rare: Rare side effects can affect your mouth, stomach and intestines, muscles and joints, mental status, urinary tract, and breathing. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
O Cholestyramine interferes with the absorption of virtually all oral drugs, including acetaminophen, amiodarone, aspirin, cephalexin, chenodiol, clindamycin, clofibrate, contraceptive drugs, corticosteroids, diclofenac, iopanoic acid, iron, digitalis drugs, furosemide, gemfibrozil, glipizide, hydrocortisone, imipramine (an antidepressant), methyldopa, mycophenolate, nicotinic acid, penicillin, phenobarbital, phenytoin, piroxicam, propranolol, tetracycline, thiazide diuretics, thyroid drugs, tolbutamide, trimethoprim, ursodiol, warfarin and other anticoagulant (blood-thinning) drugs, and vitamins A, D, E, and K. Take other medications at least 1 hour before or 4-6 hours after taking cholestyramine.
Food Interactions
Take this medication before meals. The powder may be mixed with soda, water, juice, cereal, or pulpy fruits, such as applesauce or crushed pineapple. Cholestyramine bars should be thoroughly chewed and taken with plenty of fluids. Colestipol pills are swallowed whole.
Usual Dose
Cholestyramine: 4 g (1 packet) or 1 level scoopful taken 1-2 times a day or up to 6 times a day.
Colesevelam: 6 tablets once a day or in 2 divided doses. Colestipol: 2-16 g (1-6 packets) once a day or in divided doses.
Overdosage
The most severe effect of overdose is obstruction of the gastrointestinal tract. Take the overdose victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Do not swallow the granules or powder in their dry form. Prepare each packet of powder by mixing it with soup, cereal, or pulpy fruit or by adding the powder to a 6-oz. glass of liquid, such as a carbonated beverage. If some of the drug sticks to the sides of the glass, rinse it with liquid and drink the remainder.
Constipation, gas, nausea, and heartburn may occur and then disappear with continued use of this medication. If constipation is a problem, your doctor may recommend drinking more fluids and taking a fiber supplement. Call your doctor if these side effects persist or if you develop unusual problems such as bleeding from the gums or rectum.
If you miss a dose of cholestyramine, skip it and continue with your regular scheduke. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: While cholestyramine does not affect the fetus directly, it may prevent the absorption of vitamins A, D, and E and other nutrients essential to the fetus’ proper development–even when you take, a prenatal vitamin supplement.
When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Cholestyramine is not absorbed into the body. However, reduced absorption of vitamins A, D, and E and other nutrients may make your milk less nutritious. Nursing mothers who must take cholestyramine should use infant formula.
Seniors: Seniors are more likely to experience side effects, especially those relating to the bowel.
Aug
1
Chlorpheniramine Maleate
August 1, 2009 | Leave a Comment
Generic Name
Chlorpheniramine Maleate
(KLOR-ten-ERE-uh-mene MAL-ee-ate) M
Brand Names
Aller-Chlor Efidac 24
Chlor-Trimeton Pediox S
Chlor-Trimeton Allergy 8 Hour Prohist+8 Chlor-Trimeton Allergy 12 Hour QDALL AR
The information in this profile also applies to the following drugs: Generic Ingredient: Cyproheptadine Hydrochloride 0
Generic Ingredient: Dexchlorpheniramine Maleate 19
Type of Drug Antihistamine,
Prescribed For
Stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal allergy, and other symptoms of allergy such as rash, itching, and hives.
General Information
Antihistamines generally work by blocking the release of histamine (a chemical released by body tissue during an allergic reaction) from body cells at the H, histamine receptor site, drying up secretions of the nose, throat, and eyes.
Cautions and Warnings
Do not use this drug if you are allergic or sensitive to any of its ingredients.
Use chlorpheniramine maleate with care if you have a history of thyroid disease, heart disease, high blood pressure, or diabetes. This drug should be avoided or used with extreme care if you have narrow-angle glaucoma, stomach ulcer or other stomach problems, enlarged prostate, or problems passing urine. It should not be used by people who have deep-breathing problems such as asthma, emphysema, or chronic bronchitis.
Possible Side Effects
V Less common: rash or itching, sensitivity to bright light, increased sweating, chills, lowered blood pressure, headache, rapid heartbeat, sleeplessness, dizziness, disturbed coordination, confusion, restlessness, nervousness, irritability, euphoria (feeling “high”), tingling in the hands or feet, blurred or double vision, ringing in the ears, upset stomach, appetite loss, nausea, vomiting, constipation, diarrhea, urinary difficulties, chest tightness, wheezing, stuffy nose, and dryness of the mouth, nose, or throat. Young children may also develop nervousness, irritability, tension, and anxiety.
Drug Interactions
• chlorpheniramine maleate should not be taken with a mono-amine oxidase inhibitQ(aMkdepiessank, because the combination may cause severe side effects.
• The effects of sedatives, benzodiazepines such as diazepam, and sleeping medications will be increased when any of these drugs is combined with chlorpheniramine maleate. It is extremely important for your doctor to know if you are taking any other medication with chlorpheniramine maleate so that the dosage of that medication can be properly adjusted.
• Anti chol inergenics may cause an increase in side effects of chlorpheniramine maleate.
• Be extremely cautious when drinking alcoholic beverages while taking this drug, which enhances the intoxicating and sedating effects of alcohol.
Food Interactions
You may take this drug with food if it upsets your stomach.
Usual Dose
chlorpheniramine
Adult and Child (age 13 and over): 4 mg every 4-6 hours; do not take more than 24 mg a day.
Child (age 6-12): 2 mg every 4-6 hours; do not take more than 12 mg a day.
Child (age 2-5): 1 mg every 4-6 hours; do not take more than 4 mg a day.
chlorpheniramine, Sustained-Release
Adult and Child (age 13 and over): 8-12 mg at bedtime, or every 8-12 hours during the day; do not take more than 24 mg a day. Child (age 6-12): 8 mg during the day or at bedtime.
Child (under age 6): not recommended.
Cyproheptadine
Adult and Child (age 15 and over): 4-20 mg a day; do not exceed 32 mg a day.
Child (age 7-14): 4 mg 2-3 times a day; do not exceed 16 mg a day.
Child (age 2-6): 2 mg 2-3 times a day; do not exceed 12 mg a day.
Dexchlorpheniramine
Adult and Child (age 12 and over): 2 mg every 4-6 hours. Child (age 6-11): 1 mg every 4-6 hours.
Child (age 2-5): 0.5 mg every 4-6 hours.
Dexchlorpheniramine, Sustained-Release
Adult and Child (age 12 and over): 4-6 mg every 8-10 hours and at bedtime.
Child (age 6-11): 4 mg once a day and at bedtime. Child (under age 6): not recommended.
Tripelennamine
Adult and Child (age 12 and over): 25-50 mg every 4-6 hours; do not take more than 600 mg a day. Adults may take up to 3100-mg, sustained-release tablets a day, although this much is not usually needed.
Child (under age 12): 2 mg per lb. of body weight a day in divided doses; no more than 300 mg a day should be given.
Overdosage
Symptoms of overdose include depression or stimulation, especially in children; dry mouth: fixed or dilated pupils; flushing of the skin; upset stomach; unsteadiness; and convulsions. Overdose victims should be made to vomit as soon as possible with ipecac syrup—available at any pharmacy—to remove excess drug from the stomach. Take the victim to a hospital emergency room immediately if the victim is unconscious.or if you cannot induce vomiting. ALWAYS bring the prescription bottle or container.
Special Information
This drug may cause tiredness or loss of concentration: Be extremely cautious when driving or doing anything that requires close attention.
If you forget a dose of this drug, take it 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.
Special Populations
PregnancylBreast-feeding., Animal studies have shown that some antihistamines may cause birth defects. Do not take any antihistamine without your doctor’s knowledge if you are or might be pregnant—especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of some antihistamines pass into breast milk. NV ing mothers who must take chlorpheniramine maleate should use infant formula.
Seniors: Seniors are more sensitive to antihistamine side effects. Dosage reduction may be needed.
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
Acamprosate
July 16, 2009 | Leave a Comment
Acamprosate (ah-CAM-pro-sate)
Brand Name Cameral
Type of Drug
Synthetic neurochemical similar to the amino acid homotaurine.
Prescribed For Alcoholism.
General Information
Acamprosate is used to help alcoholic patients stay alcohol-free after they have stopped drinking. Unlike other drugs used to help people stay away from alcohol, it does not cause people to have a physical reaction to alcohol. Acamprosate restores the balance between two chemical systems in the brain, glutamate and GAGA, that are known to become unbalanced in alcoholics, but its exact action is not known. It may reduce alcohol craving. Acamprosate should be part of a program that includes counseling and support, and it should be started as soon as possible after alcohol withdrawal and continued even if the patient starts drinking again. This medication has not been proven to help patients if they are still drinking when they start treatment. Acamprosate has not been studied in patients who abuse other substances together with alcohol. Tolerance or addiction has not developed with acamprosate. It passes out of the body through the kidneys.
Cautions and Warnings
Do not take acamprosate if you are allergic or sensitive to any of its ingredients or if you have severe kidney disease. People with moderate kidney disease require a lower dosage of acamprosate.
Acamprosate does not eliminate or ease alcohol withdrawal symptoms.
People taking acamprosate may become depressed or have suicidal thoughts.
Acamprosate can affect your judgment, thinking, or coordination. Do not drive or operate dangerous machinery if you are taking this medicine.
Possible Side Effects
Almost 2 of every 3 people who take this medicine will experience a drug side effect.
♦ Most common: diarrhea.
✓ Common: headache, weakness, anxiety, depression, and sleep problems.
✓ Less common: pain, accidental injuries, nausea, stomach gas, dizziness, dry mouth, tingling in the hands or feet, itching, sweating, chest pain, loss of appetite, weight gain or loss, impotence, abnormal vision, rash, vomiting, and constipation.
♦ Rare: heart or kidney failure, psoriasis, hypothyroidism, rheumatoid arthritis, and urinary tract infections. 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
• Mixing acamprosate with naltrexone can increase the levels of both drugs in the blood, but no dose adjustments are needed.
Food Interactions
Acamprosate may be taken without regard to food or meals.
Usual Dose
Adult: two 333-mg tablets 3 times a day. Child: not recommended.
Overdosage
The only symptom associated with acamprosate overdose has been diarrhea. Overdose victims should be taken to a hospital emergency room for observation and treatment. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you are breast-feeding, pregnant, or thinking about becoming pregnant while taking this medicine.
Take care while driving a car or performing complex tasks.
If you forget to take a dose, take it as soon as possible. If you do not remember until it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Call your doctor if you forget to take 2 or more doses in a row. Do not take a double dose.
Acamprosate must be part of an ongoing treatment program. Do not stop taking it on your own, even if you start drinking again.
Special Populations
Pregnancy/Breast-feeding: Acamprosate can damage animal fetuses in doses that are approximately equal to those taken by people on this medicine. Women of childbearing age should use an effective contraceptive while taking this drug. The potential benefits of acamprosate must be weighed against its risks if your doctor considers it a crucial treatment during your pregnancy.
Acamprosate passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Dosage reduction may be needed in seniors because of a general decline in kidney function due to age.
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
16
COUGH
Trying to ease a cough ough can be a frustrating exper*ence. If it arrived with a cold or another upper respiratory tract infection, it’s likely to go away eventually, but those 2 or 3 weeks of suffering until it does can be miserable. Way back before the end of the last century, Americans could buy cough medicines that worked. Codeine-containing antitussive syrups were widely available without prescription. Physicians also recommended terpin hydrate, an expectorant, from the late 1800s until the early 1990s. In theory, an expectorant simply loosens up the stuff in the lungs and makes it easier to cough up. But many people found that terpin hydrate offered more benefit.
Q.For years I used terpin hydrate as an expectorant when I had a cough. It worked. It was sold over the counter and one small bottle would last me the entire cold season. Over-the-counter cough remedies on the market today are no better than water. They just do NOT work. Is terpin hydrate still available? I’ve never found another cough syrup that works so well, but I can’t find it in my local drugstores.
A. Terpin hydrate was a popular cough medicine from the late 1800s until the early 1990s. Then the FDA banned it on the grounds that it had not been proven effective.
As an expectorant, terpin hydrate was supposed to loosen mucus and relieve coughs. It was derived from natural sources such as oil of turpentine or compounds found in oregano, thyme, and eucalyptus. Terpin hydrate is no longer available in the United States. Instead, you may want to try a different old-fashioned remedy. Vicks VapoRub contains similar ingredients: oil of turpentine, thymol, and eucalyptol. Don’t take it internally. Just rub it on the chest or the soles of the feet to ease a cough.
Another approach is thyme tea. Use 1/2 teaspoon of dried thyme leaves from the kitchen spice shelf per cup of tea. Some people like to add lemon and honey. Others prefer chicken bouillon for flavor. Terpin hydrate was removed from the market because the FDA did not receive enough data to support its use when they were reviewing over-the-counter (OTC) drugs for effectiveness. (A high-ranking FDA official admitted to us off the record that he had used it and found it helpful. But the agency needed real data, not testimonials.) Perhaps the fact that it had been around for so long and no one company had a strong vested interest in it meant that no one wanted to invest in research on tenpin hydrate. Or maybe it really doesn’t work quite as well as people believed. But in any event, after it was banned, Americans needed to look for other cough remedies.
Codeine Cough Medicine
Codeine at prescription doses is generally considered an effective cough suppressant, but even the lower-dose OTC forms are becoming much harder to find. If you have a cough, your doctor might write you a prescription. It is legal in some states for people to buy low-dose codeine cough syrups if they sign for them. Presumably, that step offers extra security against abuse. But even where OTC codeine is legal, many chain drugstores won’t sell it without a prescription. They simply don’t want to be bothered. If you live in a state where codeine may be sold without a prescription, check with an independent pharmacy. Otherwise, ask your physician about a prescription. Codeine can be constipating, and long-term use can lead to dependence. But for a short-term annoying hack, this is a very helpful medication. Codeine not only is a good cough medicine, it also is extremely good for relieving pain. When combined with aspirin or acetaminophen, it practically sets the standard for pain relief. Codeine can also be useful in alleviating diarrhea, though it isn’t necessarily the first choice for that problem.
Side effects: Constipation, drowsiness, upset stomach Downside: Can cause dependence. May require a prescription.
Cost: Approximately $6 to $10 for a bottle.
Dextromethorphan
By far the most readily available cough medicine is dextromethorphan. It is the primary ingredient in most OTC cough syrups, including Robitussin DM (the DM stands for dextromethorphan) and many other popular brands. Dextromethorphan has been almost the only choice for nonprescription cough relief for years. It is considered fairly safe because (unlike codeine) it is not classified as a narcotic. The effectiveness of dextromethorphan has been questioned, however. The American College of Chest Physicians issued guidelines in 2006 on the diagnosis and management of cough that discourage the use of dextromethorphan or any other OTC cough medicine. According to Richard Irwin, MD, the head of the committee that developed the guidelines, “There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough.” That’s a pretty discouraging view, since very few coughs actually warrant a doctor’s attention. If the cough has lasted for more than a couple of weeks, or if you are otherwise sick, then you should by all means see your doctor. But a regular cough from a cold probably won’t benefit from anything your doctor can do.
Home Remedies
There’s no good evidence for most of the home remedies that we are going to suggest. No one has done studies to see if thyme tea or horehound drops will really help. On the other hand, these approaches are inexpensive, so you can try them and judge for yourself if they work.
Vicks VapoRub
Vicks VapoRub shouldn’t really be classified as a home remedy. It is, after all, a perfectly respectable OTC product that has been a popular way to treat colds for more than a hundred years. According to the history, North Carolina pharmacist Lunsford Richardson set out to formulate a vaporizing cold’ salve for his own family. His children had come down with bad chest colds and the standard treatments of the day were messy and unsatisfactory.
The result of his effort was Vicks VapoRub. With its distinctive blue jar and unforgettable aroma, Vicks became known around the world as a remedy for congestion and other cold symptoms. It still contains the original formula: menthol, camphor, eucalyptus oil, cedarleaf oil, nutmeg oil, thymol, and turpentine oil in a petrolatum base. Parents everywhere rub Vicks VapoRub on their children’s chests to ease their coughs. Many of the herbal oils in this old-fashioned salve seem to help ease a cough. Menthol is found in many cough drops, and thymol has a reputation for fighting cough. VapoRub is even approved by the FDA for relieving congestion and cough. You could apply it to the throat and chest, as the instructions suggest, but go ahead and try it on the soles of the feet for a nighttime cough.
Downside: Not for internal use. Keep away from broken skin. Do not apply inside nostrils. No studies confirm that applying Vicks to the soles of the feet will work to calm cough. Cost:Approximately $6 to $10 for a jar, which will last quite a while
My son continues to have problems with ear infections, although he had tubes put in them at 8 months old. He is now 30 months old and has an ear infection with nasal and chest congestion.
I was looking for home remedies for coughs when I found your Web site. I read the idea of putting Vicks VapoRub on the soles of the feet Within 10 minutes be was asleep without a cough.
We heard from a nurse who had learned from someone in her church that Vicks could be smeared on the soles of the feet to ease a nighttime cough. As she admitted, this sounded a little crazy, but she was desperate enough to try it on her 4-year-old daughter. When she did, they both finally were able to sleep through the night. We don’t know why Vicks on the soles of the feet would work any better than Vicks on the chest. Perhaps it doesn’t. But we do know that we have heard from hundreds of people who have tried this trick and had success. We have used it ourselves and been pleased. Be sure to put on socks to protect the bed sheets. Coughs frequently are a consequence of colds, and chicken soup is a time-honored cold remedy. Beyond its long history of use for this purpose (the Jewish philosopher Maimonides is said to have recommended it), there is even research to demonstrate its value or relieving congestion from colds. So it is little wonder that chicken soup flavored with thyme can be helpful.
Q. My husband recently had a spell of heavy, nonproductive coughing and couldn’t reach his doctor. Robitussin DM didn’t do a thing. He went 2 nights with very little sleep and was miserable. I made him some chicken soup for supper, and after he ate a bowl of it he stopped coughing. During the night he started up again. With more chicken soup, the coughing stopped immediately and he finished the night sleeping well. I recalled what I’d put into the soup, and zeroed in on two herbs from my garden—three fresh sage leaves and some dried thyme. On the Internet I found that sage can calm a cough and thyme has been widely used as cough medicine. I made him 2 cups of thyme tea before he went to bed the next evening and he slept the whole night through. I think our experience shows that thyme is a good remedy to keep around until the doctor calls back.
Thyme
Thyme contains compounds such as thymol and carvacrol. This herb is listed in the PDR for Herbal Medicines as indicated for cough. and bronchitis. One to 2 grams of dried thyme leaves (1/2 to 1 teaspoon) are used to make a cup of tea. The recommended daily dosage is 10 grams spaced over the course of the day. Chicken soup with thyme is one way to get the essence of thyme. Another is to make a cup of thyme tea. Ordinary thyme leaves from the kitchen spice cupboard will work just fine-1/2 teaspoon to a cup of hot water, steeped for about 5 minutes. One reader reported getting a cough remedy over the counter when traveling in Germany. She found it very useful, much better than Robitussin DM, and wondered what it was. The medicine, called Makatussin, came as drops to be put on a sugar cube or in tea and contained Thymianfluidextrakt and Sternanisol. These are extract of thyme and star anise oil.
The German government has approved both herbs for colds and coughs, confirming what our readers have found for themselves.
Other Herbs
A number of other herbs have traditionally been used for uncomplicated coughs. Licorice is classic for sore throat and cough. It can raise blood pressure, so we don’t recommend it for people with hypertension, but for short-term use, it could be helpful. Menthol seems to have been approved by the FDA, since it is found in most OTC cough drops (as well as Vicks VapoRub). Linden flower tea is a European favorite for cough, but may be difficult to find in this country. Elderberry flowers can also be collected and dried for use in tea as a “homegrown” cough remedy. You’d have a hard time finding elderberry flowers in a store, although there are some elderberry products that use the berries themselves, rather than the flowers.
Q. With my high blood pressure, it’s hard to find cold or cough medicine that is safe. My sister recommended black elderberry extract and zinc. It did the trick.
A. Elderberry-flower tea is a traditional remedy for colds and coughs. Many herbalists believe elderberry is more effective than echinacea.
Studies of zinc used against colds have produced mixed results, some positive but others negative. Neither remedy should increase blood pressure, though.
Ginger tea is one of our favorite cold remedies, and it also may help to ease a cough. One animal study found that a component of ginger called shogaol worked at least as well as dextromethorphan against cough. That may mean simply that shogaol is just as good as placebo, now that the effectiveness of dextromethorphan is in question. Nevertheless, ginger tea is tasty and not very expensive.
Another old-fashioned approach to calming a cough is horehound. Candies flavored with this herb are still available in some stores and catalogs (such as the Vermont Country Store) that pride themselves on carrying old-time products. There’s no good research for any of these herbal products, but also no indication that they would cause any serious reactions, either.
Some people find that sucking on a piece of hard candy works quite well to ease a daytime cough, whether or not the candy has any active ingredients such as licorice or menthol in it. One scientist has suggested that part of the reason most cough syrup is sweet is not only to mask the nasty flavor of dextromethorphan, but also to recruit the brain’s own opioids, endorphins, in calming the cough. 161 Since opioids are very effective against cough, this is an appealing hypothesis.
Chocolate
Another possible remedy fora simple cough may surprise you. Chocolate lovers though we are, we never suspected that theobromine, one of the essential components of chocolate and cocoa, would have any benefit against cough. But that is exactly what British researchers found in experiments with guinea pigs.” They gave the guinea pigs citric acid to make them cough, then gave them theobromine purified from cocoa. The theobromine overcame the induced cough. An experiment in humans confirmed that theobromine is also effective against coughs in people.
The question is, how much chocolate does it take, and in what form? Unfortunately, we do not have an answer to that extremely practical issue. The researchers used theobromine alone, which is not available to the rest of us. But all of us have access to chocolate. You could do some experiments of your own to find the most palatable and effective cough-suppressing chocolate. ,
Here’s what pediatrician Alan Greene, MD, says about using chocolate against cough:
How much chocolate would this be? Chocolate preparations vary widely, depending on their cocoa content but dark chocolate often has up to about 450 milligrams of theobromine per ounce. Milk chocolate has far, far less. Two ounces of dark chocolate was about the amount of theobromine used for the adults.
Theobromine has been tested and shown to be effective in suppressing a cough. We don’t know of any way to get theobromine except to eat some chocolate, preferably dark chocolate. Savor it, and remember that it has other health benefits if consumed in moderation.
Side effects: Allergy is possible.
Downside: Dose unknown. Excess chocolate consumption -may lead to weight gain.
Cost: Highly variable, no prescription dispensing fees
Half that maybe plenty for kids (but of course there is still a lotto learn about this marvelous food). Will that much chocolate keep them awake? Even though theobromine is structurally related to caffeine, studies have shown it doesn’t interfere with sleep at those amounts. I used some fine dark chocolate for my own family during our latest viral cough illness, and our coughs disappeared nicely. What a pleasant way to get through a cold!
One other odd cough remedy may be worth a try. This one has not been tested in guinea pigs, but some people find that drinking Concord grape juice helps to ward off colds and ease coughs. There is research demonstrating that Concord grape juice has measurable anti-inflammatory activity. But we don’t know what component of grape juice, if any, might be contributing to its cough-calming effect.
Q. My wife used to get sore throats every winter. They’d hang on for weeks and develop into aloud, hacking cough. Until she recovered, neither of us would get much sleep.
Then I remembered that my sister had a similar problem with her four growing boys. In desperation, she tried a remedy she read about. drinking -red” grape juice regularly.
My wife and I started drinking a glass of Concord grape juice every day fall through spring, and the prob-lem vanished. Since then, we’ve almost never had a bad cough.
We drink half a glass of grape juice and add a half glass of water. Do you know why this works?
A. Purple grape juice has a surprising number of potential health benefits. Research has shown that it can reduce bad cholesterol, lower blood pressure, and help keep blood vessels flexible. There are even some data to suggest that certain ingredients in grapes may support the immune system. Whether this effect would help ward off sore throats and coughs we do not know.
Treating Cough in Children
It is hard on parents to listen to a child coughing away. It may even be hard on the youngster. Sometimes coughs keep them awake at night. And because children are so susceptible to colds and other respiratory tract viruses, they seem to get a lot of coughs. But parents should refrain from rushing to the drugstore for cough remedies. A study published in Pediatrics found that the two main ingredients in OTC cough medicine, dextromethorphan and diphenhydramine, were no better at easing children’s coughs than a placebo syrup was.
According to the lead author, Ian Paul, MD, assistant professor of pediatrics at Penn State Hershey Medical Center, “One of the conclusions you could come to from the results of our study is that these medicines don’t work [for kids]. And in fact this is what evidence-based reviews of the medical literature have found before, that the existing evidence doesn’t support the use of these medicines for acute cough due to a cold . In addition, these medicines are not without risk. According to Dr. Paul, the children who received the standard ingredient in most cough medicines, dextromethorphan (DM), had a harder time falling asleep. That’s the last thing an anxious parent wants for a sick kid.
What to do? For a nighttime cough, we are partial to Vicks on the soles of the feet. Grape juice is certainly popular with most youngsters and would be worth a try.
Concord grape juice has anti-inflammatory properties, but we don’t know of any studies that confirm it has cough suppressant activity.
Side effects: None known.
Cost: About $4 to $5 for a 64-ounce bottle.
ing the day, a lunch of chicken soup with thyme in it would not be amiss. We don’t know for sure that any of these remedies will work for kids, though. We have received many testimonials on vanquishing kids’ coughs with Vicks, however, so we suspect it is likely to help.
Conclusions
These suggestions are not intended for a cough that has lasted longer than a few weeks, or one that is accompanied by fever, pain, or other symptoms of serious illness. They are aimed primarily at the annoying but not dangerous cough that often crops up at the tail end of a cold or the “flu” and hangs in there even though the patient is feeling much better otherwise.
When it comes to coughs and colds, be very cautious about medicating children. Although there are lots of products on the market aimed at kids, very few have been tested on children. And often, when they are tested on children, they don’t seem to work very well. For youngsters, less is definitely better.
• Codeine-containing cough syrup is one of the most effective remedies for cough. It may be difficult to purchase without a prescription. But if your cough is troubling you, ask your doctor to write one. Don’t overuse it, because it can be constipating.
• Vicks VapoRub, with its familiar aroma of menthol, camphor, and eucalyptus, is worth trying. If you don’t want to put it on your chest, try it on the soles of your feet (under your socks) for a cough-free night.
• Chicken soup with thyme is a comfort food that could help control a cough.
• Several herbal teas may be helpful. Try ginger, mint (menthol), elderflower, or linden flower tea. Sweetening the tea slightly with honey may help the brain’s own opioids kick in to help with that cough.
• Suck on hard candy flavored with licorice or horehound.
• The theobromine found in chocolate is active against cough. Perhaps the best way to get it is to melt a square or two of dark chocolate in your mouth.
• Concord grape juice has its enthusiasts, and very little risk.
Jul
15
Recovery from Prostate Surgery.
July 15, 2009 | Leave a Comment
Recovery from Prostate Surgery
Whatever anyone tells you, a prostatectomy is a major operation and you need to allow yourself sufficient time to recover from it bupropion. Men are notoriously impatient, especially if they have to go back to work, but you must accept that you will probably have to slow down for a while. Don’t expect miracles, and don’t be too hard on yourself. You may not have had a leg amputated, but you have nevertheless had a major operation and you must make allowances for this. You must not expect too much of yourself during your recovery period in order to give yourself the best chance to get better as quickly as possible. Any impatience may, in
the long run, only make matters worse and set you back on your road to recovery. Exactly how long it takes you to get yourself back to a state of good health depends to a large extent on how fit you were before you had the operation. It also depends on how large your prostate gland was, and on whether or not there were any complications as a result of surgery.
Remember that old cliche about time being the great healer? It may not be very original but, like a lot of cliches, it’s true. So grit your teeth and take things easy for a while. It may take as long as three months before you feel completely well again, but once you do, you’ll be utterly convinced that it was worth every minute!
Your bladder
In the first few weeks after your operation, don’t be surprised if your symptoms do not seem any better than before. They may even seem worse. This doesn’t mean that the operation hasn’t been a success - only that you haven’t healed yet. It can take anything up to about six weeks for the cut surface inside the prostate to heal over completely. Expecting everything to work perfectly before this happens is unrealistic. Until then, you will have to be prepared to make allowances. Even when your urinary system returns to a state of good health, do not be surprised if you have problems getting used to this. You’ve probably spent a long time - years maybe - getting used to having to empty your bladder all too frequently, and it may take a long time -several weeks, probably, or even months - before you succeed in unlearning those habits. Be patient and you will gradually build up confidence in your bladder again until you are able to forget about it completely.
Medication
You will probably still be taking a course of antibiotics when you leave hospital. You must be disciplined about taking these. Remember to finish the course, and don’t just stop taking the pills as soon as you feel better. This could set you back a long way and allow any leftover bacteria to multiply and mount another attack just when you’re least expecting it and you’re congratulating yourself on getting better .
AFTER AN OPEN PROSTATECTOMY
If you’ve had an open prostatectomy, you will have stitches in your abdomen and you will have been given strict instructions on what you can and can’t do. You will be tired after your general anaesthetic and you will need to look after your wound. A district nurse will probably come to your house every other day to change the dressing, and she will take the stitches out when necessary. You will have been told what movements you can make to avoid putting too great a strain on both the scar and the surrounding muscles. You should also:
• Avoid carrying anything at all heavy - even a full kettle may be too heavy, so fill it only half full.
• Get out of your chair cautiously and gently by wriggling your way to the edge of the chair before getting up.
• Build up slowly to normal activities.
• Use your common sense at all times and don’t attempt to do too much.
• STOP immediately if you suspect you are doing too much.
Even when you’ve had the stitches removed, you will still need to be careful. It takes a good six weeks for the wound to heal itself, and several months before the abdominal muscles get back to their full strength.
AFTER A TRANSURETHRAL PROSTATECTOMY (TURP)
If, on the other hand, you’ve had the more common transurethral prostatectomy (TURP), you won’t have any visible signs of your operation, like a scar, and it’s all too easy to forget that you’ve actually had an operation at all. But you have, and you mustn’t forget it. Any operation puts a great physical strain on the body and, as a result, takes a surprisingly long time for you to get over. In hospital, you will have spent most of your time sitting or lying in bed. You probably won’t have done anything more strenuous than reading or watching television. As soon as you get home, the temptation will be to resume all your favourite occupations - going for a walk in the park, perhaps, or doing a bit of gardening. But it is not a good idea to get back into the swing of things too soon. This should be a slow and gradual process, and you must be careful not to push yourself too far, or to do more than you can genuinely cope with. In the meantime, make sure that you get plenty of rest. Get up late, have a rest whenever you feel you need one, and go to bed early. Whenever you are sitting, remember that a firm seat is more comfortable than a soft one that can press upwards between the buttocks.
The problem is obviously greater for people who live alone and who are looking after themselves. But even where this is the case -perhaps even more so, in fact, because you can’t risk driving yourself so hard that you make yourself ill - you must restrict yourself at First to doing the essentials. You’ll obviously need to do the cooking and washing, but most other things can wait. There is absolutely no shame in spoiling yourself at a time like this. Your priority is to get well, and everything else comes second to that average.
BLADDER CONTROL
The great majority of prostatectomies are successful, and recovery is usually straightforward. Having said that, though, recovery can sometimes be slow, and efficient urination is something you may have to work at will.
Just after the operation, the urethra may be swollen, which may in turn be painful. This pain can make the urethral muscles contract from time to time, which can mean that the flow of urine is either slow or intermittent. Bruising of the tissues around the urethra can also prevent the muscles surrounding the urethra working properly, which can mean that the urethra neither opens nor closes completely. This can result in a low stream of urine, of continual leakage of urine. Such problems are, of course, unpleasant and debilitating, but they should disappear as soon as the swelling and bruising get better, which should take only a fortnight or so.
Another problem following the operation may be that you suffer from just as bad - if not worse - a degree of frequency and urgency of urination as you did before the operation. This is likely to be brought about by inflammation of the prostate and urethra, and may continue until the cut surface of the prostate is completely healed, which can take as long as six to eight weeks. It can last even longer 11′ you develop a urinary tract infection, which is a good reason to have your urine tested at your six-week check-up. It may surprise you to know that the opposite problem of an absence of urgency can, contrary to what you might expect, be
even more worrying than its presence. This is because if you suffered from chronic retention of urine before your operation, your bladder may have become so accustomed to holding a large amount of urine that it does not send the right signal when it is full. The danger, in this case, is that the bladder may become so full that it will be unable to contract properly and empty itself efficiently. You will have to empty it by the clock - say every hour or so - until you begin to feel the natural urge to urinate. This should happen spontaneously, if gradually. In short, you can expect your bladder to behaving abnormally for up to six weeks or so after the operation.
Bladder training
You will probably benefit from training - or retraining - your bladder to hold more urine and to last comfortably for longer periods of time. This should help reduce increased frequency and urgency of urination, as well as night-time urination.
Start by making a urination chart, or frequency/volume chart, detailing the time and amount of urine each time you go to the toilet. Equip yourself with a measuring jug, of the type you can buy in hardware or kitchen equipment shops, so as to measure the volume of urine. Continue keeping this chart while you are bladder training. You will probably be used to emptying your bladder each time you feel the slightest urge to do so, or even each time you pass a toilet ‘just in case’. Stop doing this and gradually increase the time between visits to the toilet. Start by holding on for another two minutes after you feel the need to go to the toilet, then increase this to five minutes, then another five minutes, and so on. All this is easier said than done, but there are a few ‘tricks’ that should make it easier for you to hold on between visits.
• Sit rather than stand when you feel the desire to urinate.
• Keep still rather than moving around.
• Pull up your pelvic floor muscles.
• Cross your legs.
• Hold your penis, if you can do this discreetly .
• Take regular, slow, deep breaths.
• Think about something else to keep your mind off your bladder.
• Try to do something else to take your mind off your bladder, such as making a telephone call, or reading the newspaper.
You will find that you can gradually manage to hold on for longer and longer intervals. Aim, ultimately, for an interval of three to four hours.
Bladder training can achieve a lot for most people in just four weeks. Try to keep it up for three months or, even better, six months. Don’t expect to have dealt with all your problems even after six months. Symptoms can continue to improve for as long as a year -or even longer.
RESUMING SEXUAL ACTIVITY
You can resume sexual activity as soon as you feel up to it. Some doctors are wary of advising patients to do this, in case of disturbing clots and scabs, others say that the passage of semen cannot do any more harm than the passage of urine. Be alert to how you feel, and follow your natural inclinations. You may, however, not feel like sex for some time after the operation. If this happens to you, you shouldn’t worry It does not mean that you have lost your sex drive or your potency as a result of the operation - it simply means that you have a natural degree of fatigue after what is, after all, a major operation side affects. This is even more likely if you have had a general anaesthetic.
Retrograde ejaculation
You are unlikely to ejaculate in quite the same way as you did before the operation and may experience retrograde ejaculation. This means that semen goes backwards up the urethra into the bladder, rather than forwards and down into the urethra. This often has the effect of making you sterile, and a lot of men find this a very difficult hurdle to deal with, even if they do not actually want to father any more children. In their eyes, the fact that they are now sterile seems to emasculate them in some way, to make them less of a man. It is important that a man is told that this is a likely side-effect of a prostatectomy before the operation, as this seems to help them deal with it better. Even if you do have retrograde ejaculation, this cannot guarantee that your partner won’t become pregnant and you should still use some form of contraception if this is an issue. You cannot rely on a prostatectomy to give you a reliable form of contraception medicare. It is estimated that between 5 and 10 per cent of men are still fertile afterwards. If you want a reliable and permanent method of contraception, you may want to discuss the possibility of having a vasectomy with your surgeon, as this can easily be done at the same time as a prostatectomy. Your urine will probably look a little cloudy after intercourse, as the semen that went into the bladder is washed out. You may also find that you bleed slightly after intercourse during the first six weeks or so after the operation - just as you notice a little blood in your urine - but as long as this is not a large amount of blood, you should not have anything to worry about.
YOUR SIX-WEEK CHECK-UP
By six weeks after the operation, most of your symptoms should have cleared up, though you may still be suffering from frequency and urgency of urination. You will probably have a check-up after six weeks, which is your opportunity to discuss anything that is worrying you. It is particularly important to have a test done on a urine sample, just to check that you are free of any urine infection. Some hospital clinics also like to repeat the urine flow test, which will indicate that the operation has been successful.
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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.