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Medication Side Effects

Cholesterol medicines—Zocor/simvastatin, Pravachol/pravastatin, Lipitor/atorvastatin, Crestor:
Can cause mild achiness, but usually this is symmetric i.e. both legs or arms. This does not mean muscles are breaking down. Sometimes a sensation of weakness. If this occurs, tell the patient to call us, stop the medicine for two weeks and see if the symptoms resolve. Usually these symptoms are dose-dependent, meaning it occurs more often at higher doses. The symptoms are thought to be due to depletion of Coenzyme-Q10, a factor present in the body. Coenzyme Q10 supplements can be bought over the counter, and sometimes if a patient has had myalgias with all of the statin drugs, a low dose of the statin with the supplement CoQ10, can prevent the aches. If one drug causes the achiness, it does not necessarily mean the others would.

Usually when first starting the drug, the liver functions should be checked every three months for the first year, then once or twice a year. If the lab levels of the liver functions rise, this may not be a problem. Usually it is due to what’s called fatty liver, a condition of the liver in which fat deposits there, related to weight and high cholesterol or triglycerides. If the liver enzymes go up, it is invariably reversible, because it is due to overload of the liver, not liver failure! The guidelines are that if they rise less than twice of normal, it is okay to continue the medicine.

Glucophage (for diabetes or insulin resistance):
Start slow. Take one pill with the largest meal daily for a few days to a week. It is not uncommon to initially get diarrhea. This usually resolves as the body adjusts to the medicine. After it resolves, add another pill to go up to twice a day. The same symptoms may occur again, so go slow. Ideally, a patient should get up to 1000 mg twice a day, but go as slow as needed. Some patients are able only to tolerate 500mg twice daily. Always take with food.

Blood pressure pills:
Most should have no side effects other than feeling a little more tired initially as the person adjusts to lower blood pressure. However, beta-blockers (ziac/bisoprolol, metoprolol/Toprol, Bystolic) can sometimes cause more fatigue initially so should take at bedtime. Ace inhibitors (lisinopril, zestril, vasotec/enalapril, Altace) can cause a tickling cough in about 10% of people. If this happens, need to switch the medicine. Any other side effects, let me know.

Antidepressants:
SSRIS—Lexapro, Celexa/citalopram, Zoloft/sertraline, Paxil/paroxetine, Luvox, Prozac/fluoxetine can cause initial nausea and sleepiness for the first week as the body adjusts to the neurotransmitters. After the first week, this should improve.

SNRIs—Effexor/venlafaxine, Cymbalta, Pristiq: can cause initial headache, jitteriness, or “head cold” sensation for the first 3-7 days, and this should resolve as the body adjusts.

Excellent resources for health information

Beginning with this post I will make some book and website recommendations for good health information. There is so much research which suggests that diet and exercise have tangible benefits for your health that it is essential that you take heed of this information. So many diseases can be prevented and the effects can be lessened by changing your diet for the better. This is one of the easiest and cheapest forms of preventative care you can put into practice. Do it for your loved ones and do it for yourself!

9 more items that should be in everyone's pantry

Bananas: help control blood pressure, protect the heart, and strengthen bones

Blueberries: fight cancer, stabilize blood sugar, help prevent urinary tract infections

Ginger: fights cancer, aids digestion, soothes heartburn

Grapes: helps eyesight, prevents kidney stones, enhances blood flow

Green Tea: combats cancer, protects your heart, helps stop strokes, promotes weight loss

Honey: aids digestion, prevents ulcers, fights allergies, increases energy

Peanuts: protect against heart disease, prostate cancer, lowers cholestrol, increases energy

Rice: fights diabetes, kidney stones, and cancer

9 Items that should be in everyone’s pantry

Celery: Eaten raw (especially with a little peanut butter!) celery is a tasty snack but can also be used in dishes where you sauté onions and garlic such as a gumbo, many soups, and meatloaf. Celery many help lower cholesterol and combat some forms of cancer.

Cinnamon: Most people think of cinnamon as a candy flavor or something to add in some baking but not much else. In fact, it can be used in many dishes as an interesting and subtle flavor. It is very common in Indian cooking. Like turmeric, it can aid in digestion and also helps stabilize blood sugar making it helpful for those with diabetes.

Garlic: Not only does it taste good in so many dishes it also has been shown to lower cholesterol, control blood pressure, and combat some kinds of cancer.

Oats: Much has been made of oats and their ability to lower cholesterol. But they can also help combat cancer, help with diabetes, and reduce the risk of stroke. For those reasons (and their yummy flavor) they should be a staple in the pantry.

Okra: Taken alone some people find okra to be too slimy to enjoy. But, added to a gumbo or other vegetable soups and stews they add a rich (and surprisingly slime free!) flavor. In addition to this they help control blood pressure, strengthen your bones, and ease arthritis.

Olive Oil: For most cooking and sautéing (especially of your onions, garlic, and celery!) olive oil is a good healthy oil to use and adds flavor as well. And olive oil has many good health benefits including helping with arthritis, combating cancer, and battling diabetes.

Onions: During the Civil War Grant always made sure to have onions for the men in his armies. It’s another versatile item in any kitchen and can be used on many soups, stews, and dishes. Cooked or raw onions are a tasty addition to your diet. In addition to being tasty onions also can reduce the risk of heart attacks, lower cholesterol, and help stop strokes.

Tomatoes: Tomatoes, either by themselves or in a dish, either cooked or raw add flavor and health to your diet. Among their many benefits include lowering cholesterol, combating cancer, protecting the prostate, and supporting your immune system.

Turmeric: Mostly known as an Indian spice in curries, turmeric can add an earthy flavor to most any soup or stew. Try adding it to your chili for an interesting and subtle new flavor. Turmeric is an anti-inflammatory agent and also aids in digestion.

Third Party Payment

It's become very fashionable to blame insurance companies for many of the problems in health care these days. But, here's another perspective to think about since we are now having a national conversation about health care reform. The premise of insurance is to have a third party (the insurance company) pay for things. But, there are always problems when you bring third parties into such economic transactions. Ask yourself: If you were the third party how many treatments would you be willing to pay for? How many treatments would you deny payment for? If it were your business to provide third party payment would you be as generous with your money as everyone is demanding that insurance companies be with theirs?

There's no question that the way our health insurance industry is structured and regulated distorts any free market principles at work in health care. But, to find a solution we must first understand the problem. Any attempt to separate the physician from the customer will distort the system in some way. This is the system we currently have and, unfortunately, it looks to be the system we will still have once reform legislation passes.

What nobody seems to be asking is what would happen if we allowed health insurance to work as car insurance works. We don't expect car insurance to cover every expense associated with our cars such as gas, oil changes, and other routine repairs. As a result, these services are affordable as is insurance. Part of the reason they both are affordable is because there is a free market at work. Unlike health insurance, car insurance can be sold across state lines and unlike health care services automobile services charge clear prices for their products that consumers pay.

One of the worries is that if we let the free market dictate prices most people won't be able to afford health care. Why would this be the case? What business would charge more than any of their customers (or the vast majority) could not pay. They would soon go out of business. But, you might say, health care is already expesive. Well, if we leave payment to third parties this is an inevitable result. If neither the doctor nor the patient can engage in a negotiation for their health care services and what they will pay for them costs will continue to rise.

But, what about medical procedures that are inherently expensive since they use expensive technology not yet widely available. The best analogy here is with consumer electronics. When flat screen and plasma televisions first came out they were expensive and only affordable for a few people. But soon after this prices fell and now these technologies are widely available and affordable. The same would likely apply if we allowed health care technologies to be available in a free market.

What about those who still cannot afford these services. We can address that problem as we do other affordability problems with much less disruption and much more beneficial results. There is no question that the current system is in need of reform, the real question is will we pursue a course of reform that might yield beneficial health results or just beneficial political results for our elected officials. These will not necessarily be the same benefits.

Health and the Constitution

Article I Section 8 of the U.S. Constitution specifically outlines the powers that Congress has. What I would like to know is where in that section of the Constitution does it allow Congress to legislate with regard to health care. Here is the relevant text, please help me out!

Section 8. The Congress shall have power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts and excises shall be uniform throughout the United States;

To borrow money on the credit of the United States;

To regulate commerce with foreign nations, and among the several states, and with the Indian tribes;

To establish a uniform rule of naturalization, and uniform laws on the subject of bankruptcies throughout the United States;

To coin money, regulate the value thereof, and of foreign coin, and fix the standard of weights and measures;

To provide for the punishment of counterfeiting the securities and current coin of the United States;

To establish post offices and post roads;

To promote the progress of science and useful arts, by securing for limited times to authors and inventors the exclusive right to their respective writings and discoveries;

To constitute tribunals inferior to the Supreme Court;

To define and punish piracies and felonies committed on the high seas, and offenses against the law of nations;

To declare war, grant letters of marque and reprisal, and make rules concerning captures on land and water;

To raise and support armies, but no appropriation of money to that use shall be for a longer term than two years;

To provide and maintain a navy;

To make rules for the government and regulation of the land and naval forces;

To provide for calling forth the militia to execute the laws of the union, suppress insurrections and repel invasions;

To provide for organizing, arming, and disciplining, the militia, and for governing such part of them as may be employed in the service of the United States, reserving to the states respectively, the appointment of the officers, and the authority of training the militia according to the discipline prescribed by Congress;

To exercise exclusive legislation in all cases whatsoever, over such District (not exceeding ten miles square) as may, by cession of particular states, and the acceptance of Congress, become the seat of the government of the United States, and to exercise like authority over all places purchased by the consent of the legislature of the state in which the same shall be, for the erection of forts, magazines, arsenals, dockyards, and other needful buildings;--And

To make all laws which shall be necessary and proper for carrying into execution the foregoing powers, and all other powers vested by this Constitution in the government of the United States, or in any department or officer thereof.