Archive for April 2nd, 2009
Many people now take a small dose of aspirin every day or every second day to lessen their chances of getting a coronary heart attack. Aspirin helps them to do this by rendering their blood less capable of clotting (during most heart attacks, an artery in the heart that has become narrowed by deposits of cholesterol becomes completely blocked off by a clot of blood).
However, no drug, including aspirin, is without side effects of some sort, and in this case we need to be concerned that loss of clotting ability could be dangerous during surgery. In fact, Emergency Medicine (19#18:57) points out that aspirin significantly increases the incidence of complications due to blood loss after such procedures as tooth extraction, facial plastic surgery, tonsillectomy, and coronary artery bypass graft operations. Although less noticeable, this effect of aspirin could mar the result of any operation. Adequate clotting, of course, is necessary to seal off and stop oozing from blood vessels that are cut across during operations, even though they have been tied off by the surgeon.
To reduce this risk of postoperative bleeding as much as possible, aspirin should be discontinued for at least a week before surgery. When this is not possible, be sure the surgeon knows if you have been taking aspirin. He can then test the blood and decide whether something needs to be done to restore clotting to normal before he operates. Other medications that interfere with clotting include non-steroidal antiinflammatory drugs (NSAIDs) such as Advil, Clinoril, Feld-ene, Indocin, Motrin, Nalfon, Naprosyn, Nuprin, and Tol-ectin, which are used for arthritic pain, headache, and menstrual cramps, etc. Fish oil products, such as Maxepa, and vitamin E can do the same thing. Since several other drugs also have this effect, be sure to tell the surgeon about every medication that you are taking.
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Physicians at Yale University Medical School have found a lower than expected incidence of cataract (visual difficulty due to cloudiness in the lens of the eye) among arthritis patients who had taken aspirin for many years. In arthritis patients who had not taken aspirin, cataract was as common as usual. This protective effect, according to Internal Medicine Alert (2:77), was even more pronounced in patients with diabetes, a condition which greatly increases the prevalence of cataracts, but cataracts were present in seven of eight diabetics whose arthritis had been managed without aspirin.
Aspirin, taken in the high doses used for arthritis, causes many more side effects than most physicians would care to accept in a treatment used only for prevention. Long-term studies in people without arthritis are therefore needed to determine whether small, better-tolerated doses of aspirin can also prevent cataract. Because this form of blindness is so common in the elderly, the project should get priority.
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Even though babies can learn to swim quite well during their first year of life and may be relatively safe from drowning, there is a danger of water intoxication if one does not supervise them carefully when they are in the water. Pediatrics (70:599) reports the case of a 10-month-oldboy who, during a swimming lesson, swallowed nearly 10 percent of his body weight in water and, an hour later, became drowsy and had convulsive seizures.
Water intoxication, cautions Pediatrics, urgently needs treatment with intravenous injections of a special concentrated saline to “thicken” the blood, and quickly becomes life-threatening if overlooked and left untreated. So, if your children or grandchildren learn to swim when they are very small, watch them closely all the time they are in the water to make sure that they do not drink it.
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Some people may be getting treatment for hypertension unnecessarily, the American Journal of Cardiology (52:769) warns.This could be the case if their doctors did not know that they had been drinking coffee shortly before their blood pressure was tested.
In a double-blind study comparing the effects of a 250 mg capsule of caffeine (the equivalent of two or three cups of coffee) with those of a placebo, It was found that caffeine raised the blood pressure (BP) significantly. This effect was more marked in people older than 50 than in people younger than 30 and was most powerful in those who were not accustomed to drinking coffee.
The moral of this story is that it would be advisable to abstain from coffee entirely on days when one is to undergo BP testing, especially if one’s pressure is near the borderline between normal and levels that are hypertensive.
Hypertension that is not responding as well as expected to treatment may suddenly begin to come under control, the American Family Practitioner (34#4:182) reports, if the patient takes less alcohol. People usually lose some weight as well when they reduce their alcoholic intake, but this is not the mechanism of the beneficial effect upon hypertension, because the blood pressure usually falls even in those who do not lose any weight.
While cutting out alcohol entirely may be necessary for some, at least initially, many find that, by merely drinking substantially less, they can achieve the desired result. We are not discussing alcoholism, for which total abstinence is necessary, but rather, hypertension, in which it may be necessary to cut down from a moderate number of drinks to only a very few.
In fact, between 10 percent and 30 percent of people who have essential hypertension, according to the Archives of Internal Medicine (143:29), may be suffering from the effects of too much alcohol, even though they are by no means alcoholics. Merely by drinking socially acceptable amounts of alcohol a few times every day and without ever getting noticeably intoxicated, a great number of people get more alcohol than is good for them.
Just five drinks every day (one drink is defined as one can of beer, one and one-fourth ounces (one “shot”) of whiskey, one glass of wine, or one cocktail), even if some of them are taken at lunch and others with dinner and in the evening, are more than the average person can tolerate without risk. Small people, of course, would get the same effect from fewer drinks.
The blood pressure elevation caused by “moderate” drinking disappears within a few days after the habit is discontinued, only to return if the same amount of regular drinking is resumed.
Lest this information about the reversibility of alcohol-induced hypertension be used to justify continuing a potentially dangerous habit, it should be understood that the hypertension due to taking five or more drinks every day is associated with a much higher than normal incidence of stroke. Stroke, a potential complication of hypertension, regardless of its cause, produces irreversible brain damage, which may even prove fatal. In people who regularly take five or more drinks every day, the Archives reports, there is a three times greater than normal incidence of death from stroke.
In addition, medicines taken to lower the blood pressure (BP), the Lancet (1:647) reports, are antagonized by alcoholic drinks. Furthermore, researchers have found, the more alcohol one takes every day, the greater is this antagonistic effect. Thus the BP of those taking six drinks daily is significantly higher than that of those who drink only two.
If a person significantly reduces his alcohol intake, he may experience a considerable drop in BP, and as a result he will likely feel very tired and weak. Accordingly, those on BP medication who are accustomed to taking several drinks a day will probably need to reduce the dosage should they decide to start drinking less. A doctor’s help will be needed in readjusting the dosage so that one can continue to feel comfortable and well.
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When the house is heated and sealed against the cold outside, the warm, dry air indoors picks up water from wherever it can, including the mucous membranes of your nose, throat, and lungs. In yielding moisture to the air, your respiratory passages become dried out, and this can set the stage for repeated attacks of croup, nosebleeds, and middle ear infections in small children, and for sinusitis, chronic bronchitis, and asthma in people of any age. By adding water to the air of your home with a vaporizer or humidifier, you can do a lot to eliminate these problems.
Reviewing the various appliances that are on the market for this purpose, the U.S. Pharmacist (7#11:35) clearly favors humidifiers (which produce water droplets) over vaporizers (that produce mist or steam). The latter tend to use more energy, are more likely to cause burns and scalds, and require more attention to be kept working. While both kinds of appliance may harbor molds and bacteria that can be spread with water particles throughout the house, humidifiers are the more likely to become contaminated.
Allergies and infections have been reported in connection with the micro-organisms in humidifiers, but by far the most noticeable problem associated with them is their offensive odor. To prevent this, the U.S. Pharmacist reports, one should add a quarter of a cupful of household chlorine bleach to an appliance that has been nearly filled with water. Because chlorine fumes are hazardous, this procedure should be performed out of doors. After running the appliance with the diluted bleach solution for about one and a half hours, it should be drained and rinsed a couple of times with fresh water before being brought in and returned to use. Repeat this procedure every few weeks to keep your humidifier clean and odor-free. This is more efficient than trying to stop contamination by adding disinfectants or other chemicals to the water. They may smell nice, but they can be quite irritating to the respiratory passages and thereby do more harm than they prevent. None of this applies to the newest humidifiers that work ultrasonically. They, nevertheless, need to be occasionally cleaned.
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