That’s right. Zero. Statins—Lipitor, Crestor, Pravachol, Mevacor, Zocor, and their generic equivalents—today reside in the pill dispensers of a huge segment of the population over 45, but for heart-healthy patients, statins will not increase longevity, prevent a fatal heart attack, or avoid a life-ending stroke.

So if taking statins won’t keep you alive and healthy any longer than not taking the pills, Hadler asks—especially when you consider possible side effects ranging from muscle pain and fatigue to liver damage to increased risk of diabetes and even memory loss—what’s the point in knowing your cholesterol numbers?

Cardiologist Eric Topol is equally scathing about statins. Chief academic officer of Scripps Health, a nonprofit health care system based in San Diego, Topol has long believed that medicine must become personalized with treatments tailored to a patient’s DNA and other characteristics. Yet statins are the poster child of taking a drug that benefits some people and then prescribing it to many more. In his new book, The Creative Destruction of Medicine, Topol points out that only one or two out of 100 patients “without prior heart disease but at risk for developing such a condition will actually benefit” from a statin. To which he asks, “how about the 98 out of 100 patients who don’t benefit?”

To put these views in perspective, statins are associated with one of the greatest public health triumphs of the past 30 years: halving America’s death rate from coronary heart disease. From 543 per 100,000 men in 1980 the death rate fell to 267 deaths per 100,000 (adjusted for the aging of the population) in 2000. From 263 deaths per 100,000 women in 1980 it fell to 134 per 100,000 in 2000, data from the U.S. Centers for Disease Control and Prevention show.

Looking at it another way: As a result of the lower death rate from coronary heart disease, 341,745 fewer Americans died in 2000 alone.

That sounds pretty spectacular, but the crux of the debate lies in whether statins have a benefit in primary prevention—reducing heart attacks and strokes in patients without known heart disease. There’s no argument about the benefits of statins for secondary prevention—averting a heart attack or stroke in people who have already had one. For example, the 1994 Scandinavian Simvastatin Survival Study—still considered the definitive statin study—showed that treating patients with pre-existing heart disease decreased their chance of dying over five years from 12 percent without statins to eight percent with the drugs; their chance of cardiac death, heart attack, or needing heart surgery fell from about 30 percent without statins to about 20 percent with them also over five years. “If you’re in this category, you would definitely want to take a drug that decreased your chance of dying or having a major cardiac event by a third,” says Dr. Eli Farhi, an assistant professor of cardiology at the University at Buffalo School of Medicine and Biomedical Sciences.

Primary prevention is another matter, however. These are the people Hadler, Topol, and other critics focus on when they discuss the statin problem. Consider two of the most rigorous and widely cited clinical trials of statins: In one, three people of every 100 without pre-existing heart disease but with high cholesterol who took a placebo pill suffered a heart attack; two of every 100 such people taking the best-selling Lipitor did. In the other trial, four of every 100 volunteers taking placebo had a non-fatal heart attack or stroke while two of every 100 taking Crestor did. These results are typical of the findings of other studies. As Topol notes, the bottom line is that the most popular statins reduce the risk of having a heart attack or stroke from three or four percent to two percent.

That’s not very significant. A 2011 analysis that reviewed 14 randomized trials and over 34,000 patients compared the tiny benefit with the very real risks of diabetes and muscle pain or weakness the drugs pose and concluded, “there was no net overall benefit of statins for patients without pre-existing heart disease,” notes Topol.

The key phrase here is “without pre-existing heart disease.” But most general practitioners take their cue from cardiovascular specialists, and many of these experts believe that statins save lives, period. Theirs is a straightforward argument: Cholesterol is bad; therefore, lowering cholesterol is good. “If someone has high LDL as well as high blood pressure or a history of smoking or other risk factors such as age and gender, let’s take that one risk factor [elevated cholesterol] out of the equation,” says Cleveland Clinic’s Dr. Marc Gillinov, co-author of the new book Heart 411. (Indeed, Topol himself, once one of the fiercest advocates of statin drugs, wrote in The New England Journal of Medicine as recently as 2004 that “statin drugs have already surpassed all other classes of medicines in reducing the incidence of the major adverse outcomes of death, heart attack, and stroke” caused by atherosclerotic vascular disease.)

Statins, first introduced in 1987, lower blood cholesterol levels by affecting how much of the substance the liver produces, how much the intestines absorb, or how much circulates. Study after study, going back to the late 1980s, has concluded that statins lower the risk of heart disease, heart attacks, and stroke. Research into statins won the 1985 Nobel Prize in Medicine for Michael Brown and Joseph Goldstein. No wonder statins rang up U.S. sales of $14.3 billion in 2009. One-fourth of Americans 45 and older take statins according to the National Center for Health Statistics.

“Statins clearly decrease one’s chance” of having a heart attack or stroke, agrees Buffalo’s Farhi. But the real-life importance of the decrease depends on how high your risk is in the first place. If your 10-year risk is extremely slim—a value judgment, but many clinicians regard anything under 10 percent as low—then “it would be of minimal benefit to take a statin,” says Farhi. “You could treat thousands of such people without preventing a single event.”

One useful way to look at the data is to consider something called “number needed to treat” (NNT). NNT simply means how many people must be given a medication, undergo surgery, have a diagnostic test, or have any other medical intervention in order for a single one of them to benefit from it. That number can be surprisingly high even for interventions with unquestioned benefits. For instance, 16 people with open fractures need to receive antibiotics for one to benefit; eight people need to take inhaled steroids during an asthma attack to prevent one from going to the hospital. In each case the vast majority of people would not have developed infections or needed a trip to the ER, respectively, even without the intervention. The NNT in these cases is 16 and eight.

Statins for primary prevention have a stratospherically higher NNT. Sixty people would have to take a statin for five years for one to avoid a heart attack; 60 is the NNT for avoiding this outcome. And 268 people without heart disease would need to take a statin for five years for one person to be saved from a stroke; 268 is therefore the NNT for avoiding this outcome, explains Dr. David Newman of Mount Sinai Medical Center in New York, who maintains an NNT database at thennt.com.

It’s one thing to talk about population-wide research. The challenge, of course, is determining the risks or benefits to any individual. To use an extreme example, a person riding in an airplane that’s headed for the side of a mountain is at very low risk of dying from heart disease. On the other extreme, “If you’re a 50-year-old smoker with very high cholesterol and everyone in your family has died of a heart attack before the age of 40, you would probably be very interested in something that decreases the risk of a heart attack,” says Farhi. Most people fall between these two extremes. You can gauge your risk of having a heart attack in the next 10 years by visiting hp2010.nhlbihin.net/atpiii/calculator.asp.

The National Cholesterol Education Program calculator cited above can also be used to show why lowering cholesterol, as statins indisputably do, fails to make much difference in whether or not you will develop cardiovascular disease. After you’ve typed in your actual cholesterol, blood pressure, and other data, notice what happens if you change the cholesterol: In many cases, it alters the risk of a heart attack by little or nothing. A 55-year-old non-smoking woman with total cholesterol of 240 (high enough to make most physicians prescribe a statin), HDL (good cholesterol) of 50 (which is quite low), and systolic blood pressure of 110 has a 1 percent chance of having a heart attack over the next decade, for instance. Now change her total cholesterol to 190—a huge decline. Her risk is still 1 percent. A 65-year-old man with those first numbers has an 11 percent chance of having a heart attack over the next decade; lowering his cholesterol to 190 brings that down to 9 percent.

In other words, cholesterol levels are not as strongly predictive of cardiovascular disease as once thought. “This has shocked everyone,” says Newman. “Cholesterol levels are actually a fairly weak predictor of who will have a heart attack.”

Might statins provide benefits unrelated to cholesterol reduction? There is some evidence that they also decrease inflammation. (When inflammation occurs in the arteries, it is thought to increase the risk of heart disease.) A 2008 study called the JUPITER trial tested statins in about 18,000 people with normal LDLs but elevated C-reactive protein, a measure of inflammation. Statins reduced the risks of heart attack and stroke. That led proponents to conclude that by working through an additional mechanism—lowering inflammation, not just LDL—statins were helping even people with normal LDL levels. Critics of the study note that it was halted earlier than planned (when people on statins were having fewer cardiovascular events than those not taking the drugs), which can produce a misleading result.

Whether cutting your risk of having a heart attack over the next 10 years from 11 percent to 9 percent, as in our hypothetical 65-year-old man who slashed his cholesterol, is meaningful depends on your perspective. But physicians who question the benefit of statins note that no medication is without risk—and statins are no exception. One known side effect is muscle pain or weakness. About five percent of people taking statins develop this, though in most it goes away when they stop taking the drugs. Another is diabetes. One person in 167 who take a statin for five years will develop diabetes. Newman points out that among people taking statins for primary prevention, the risk of diabetes is greater than the benefit in stroke reduction. Indeed, a 2012 study by the Mayo Clinic as reported in the Archives of Internal Medicine found that the use of statins in postmenopausal women is linked to an increased risk of new-onset diabetes of 71 percent. And in February, the FDA announced what it called “important safety changes” in the labels required on statins. Beginning immediately, the labels will have to warn patients that the drugs have been reported to cause certain cognitive effects in some patients, including memory loss and confusion; when patients stopped taking statins, these problems disappeared. The labels will also have to warn that increases in blood sugar (hyperglycemia) have also been reported, and that the FDA is aware of studies showing that statins may increase the risk of type 2 diabetes.

As we were going to press, a new study was reported in The New York Times suggesting that taking statins makes it harder to exercise. The study, by French scientists, found that lab animals taking statins couldn’t run as far as a control group on a placebo. And a 2005 study that looked at human subjects had similar findings: “It seems possible that statins increase muscle damage” during and after exercise “and also interfere somewhat with the body’s ability to repair that damage,” Dr. Paul Thompson, the chief of cardiology at Hartford Hospital in Connecticut and senior author of the study, told the Times.

How many people might be taking statins despite having only a slim chance of benefiting? Experts can give only rough estimates, but the numbers are clearly in the millions. No one currently taking a statin should stop the medication without talking to his or her doctor, of course, but “it doesn’t make sense to treat all these low-risk people with statins,” says Farhi. “The effect is indeed ‘cosmetic,’ improving their cholesterol numbers without producing any measurable difference in clinical outcome.”

He adds: “Doctors who put everyone on a statin without considering whether they’re likely to benefit are doing their patients a disservice.”

The Cholesterol Conundrum The Saturday Evening Post

Dr. Jordyn Boesch, a board-certified veterinary anesthesiologist at the University of Illinois Veterinary Teaching Hospital in Urbana, urges owners to talk with their veterinarian about the medications that will be used in their pets to control surgical pain and to work closely with their veterinarian to manage pain for optimal health outcomes.

“It is now accepted, thanks to a very large body of scientific evidence, that animals experience pain in much the same way that human beings do,” Dr. Boesch says.

While procedures like a spay, castration, tooth extraction, or lump biopsy may be necessary for the health of your pet, these procedures will cause pain if adequate pain medication is not administered. Pain medications are more effective when they are given both before and after such procedures.

Controlling pain is important not just for ethical reasons, but because studies show it can also speed your pet’s recovery.

“Pain causes the body to release a wide variety of stress hormones that interfere with tissue healing,” explains Dr. Boesch, “so decreasing stress can lead to faster healing.”

Dr. Boesch advises pet owners to discuss the pain management plan with their veterinarian before any surgical procedure and to ask specific questions: What kind of pain medication will be administered, and at what points in the procedure? What are possible side effects or risks of those medications? What are the instructions for administering any pain medication at home after the procedure? What signs of pain should you watch for at home?

Because the signs of pain may not be easily detected, it is important to consult your veterinarian for advice on general signs of pain as well as signs that may be specific to your pet’s species or the procedure performed. A pet in pain may simply appear more subdued, may stop eating or drinking, or may not want to engage in favorite activities. Cats may hide, stop grooming, or eliminate outside the litter box. The pet may look at or lick an incision site or “guard” the area that is painful. Unusual behaviors should not be ignored or attributed simply to the stress of visiting the vet’s office.

Some species may not show any signs of pain at all.

“Farm animals such as horses and cattle, as well as birds and small mammals such as rabbits, indicate pain even more subtly because, as prey species, they have evolved to hide signs of pain from predators,” says Dr. Boesch.

Just as in human medicine, veterinary medicine makes use of a range of pain medications suited to various conditions. Sometimes using more than one pain medication together, such as morphine (or related drugs) plus an anti-inflammatory drug, is needed and is more effective than either one used alone. And sometimes, other non-drug treatments such as physical therapy or icing an incision can help tremendously too.

Dr. Boesch stresses the importance of giving pets only the medications and doses indicated by a veterinarian.

“Pet owners should never take their animal’s pain management into their own hands,” she says. “Giving an over-the-counter human pain medication to a cat, for example, could kill the cat. Owners must consult their veterinarian before giving their pet any medicine or supplement.”

If you have any questions about pain management in your pet, please consult your local veterinarian.

Julia Disney is an Information Specialist at University of Illinois’ College of Veterinary Medicine.

Pain Management in Pets: An Owner’s Guide The Saturday Evening Post

Our Post pharmacy consultant relates this story:

“My friend reached for a spoon from the silverware drawer when she needed a dose of cough syrup. ‘What are you doing?’ I rather rudely exclaimed, expecting her to suggest that the spoon must be about the right size. But her response really surprised me. She said, ‘I thought it might look silly if I used the cheap spoon that came with the medicine!’”

Whatever the reason may be, using a silverware spoon often means getting too much or too little medicine, explains the pharmacist.

In a recent study, college students first measured out one teaspoon of liquid medicine into an actual teaspoon. Then they were asked to pour one teaspoon of the drug into a medium-sized spoon and then a large spoon.

The results? Even in a well-lit room in the middle of the day, participants poured an average of 8 percent less than prescribed into the medium spoon, and nearly 12 percent more into the larger spoon.

And in the middle of night, when you’re feeling miserable or stressed because a child is crying, the probability of error is undoubtedly much greater, said the Cornell University research team.

Getting the wrong dose of medicine may lead to ineffectiveness, or even danger. For an accurate dose—and the best relief—always use a measuring cap, spoon, dropper, or syringe. And if the pharmacy provides one, please use it.

The study is published in the Annals of Internal Medicine.

Get the Most Out of Your Liquid Medicine The Saturday Evening Post

Coughs caused by the flu are not the same as those associated with colds, says nurse practitioner Mary Ellen Roberts, who explains:

“Coughs have different causes and effects. People with a cold may need an expectorant such as guaifenesin to help clear out mucus. For dry, hacking coughs associated with the flu, patients should usually consider the cough suppressant dextromethorphan, as well as acetaminophen to reduce fever and pain.”

Over-the-counter cough relievers with ingredients to suppress coughs as well as clear mucus may be the best choice for coughs that disrupt sleeping, the most commonly reported consequence of severe coughs.

“Cough sufferers need to know that losing sleep because they don’t treat their symptoms properly can have ramifications at work or school,” said Roberts. “We frequently see patients continue normal activities regardless of how they feel. While this may be reflective of the current economic situation, people need to know that it may not be the wisest decision in the long term, and that available products can provide relief of their symptoms for up to 12 hours.”

Roberts adds that people should seek the advice of a health care practitioner for a continuous cough lasting more than seven days. Most coughs due to colds and flu will resolve on their own within three weeks.

Tips for Controlling Your Cough The Saturday Evening Post

Tylenol: Beware of Overuse The Saturday Evening Post

Tylenol: Use as Directed The Saturday Evening Post

Just ask football legend John Elway, who struggled with gastroesophageal reflux disease (GERD) for more than a decade. “I was totally in the dark about acid reflux,” Elway told the Post. “No one should tough it out like I tried to do.”

Not only does the uncomfortable condition land many people in the hospital, but over time the repeated exposure to stomach acids can irritate and inflame the lining of the esophagus, increasing one’s risk for ulcers and esophageal cancer, a rare but deadly complication of GERD.

That’s the bad news.

There’s good news, too. Gastroenterologists say public awareness of GERD is on the rise. More people are seeking medical help and screenings for complications.
“Today, the public is clearly more aware of the potential importance of heartburn as a symptom of disease and not a trivial item” blamed on overeating, says Dr. Philip Katz of Albert Einstein Medical Center in Philadelphia. And more of us understand that a small percentage of people with chronic reflux symptoms are at risk of serious complications, including cancer, he says.

Just about everyone has an occasional bout of heartburn, or acid indigestion. That awful burning sensation around the breastbone develops when digestive juices—acids—back up in the esophagus, the tube that carries food and liquid to the stomach. When this reflux or regurgitation occurs, food or fluid can sometimes be tasted in the back of the mouth. Gastroesophageal reflux disease is diagnosed when reflux happens more than twice per week for many weeks. Between 25 percent and 35 percent of the U.S. population experiences GERD.

Not just painful, GERD can cause a variety of problems, including swallowing and sleeping difficulties, coughing, sore throat, hoarseness, chest pain, bleeding, and asthma. Over time, if the acid is not controlled, GERD can damage the lining of the esophagus leading to erosive esophagitis, Barrett’s esophagus, and, as noted, esophageal cancer.

The road to relief

Over-the-counter (OTC) antacids, such as Alka-Seltzer, or H2 blockers, such as Pepcid, which decrease acid production, can tame occasional, mild reflux. For more serious, chronic cases, the development of a class of drugs called proton pump inhibitors (PPIs) transformed treatment. Generally taken once per day, these drugs dial down the stomach’s acid pumps and help to heal the irritated lining of the esophagus.

In 2007, patients spent more than $14 billion on heartburn medications, second only to cholesterol-lowering drugs, according to IMS Health, Inc., a company that tracks prescription drug sales.

The popularity of PPIs is understandable, Katz says. “Proton pump inhibitors are such an exceptional class of drugs. They have such an excellent safety profile and are so effective at relieving symptoms due to acid that they have been widely prescribed.”

People with only occasional heartburn do not need the daily pill, but for those with GERD, “daily medication is safe,” he says. “People who take medication every day often feel better, have improved quality of life, and certainly have less symptoms” than those who take medicine intermittently.
People who require a prescription PPI, which can cost $90 to $265 per month depending on brand and dose, may soon have more and cheaper options. More PPIs are expected to become available in generic or over-the-counter forms in 2009 or soon after, joining the two generic PPIs and one OTC currently on the market. Prilosec OTC costs $19 to $26 per month and is a Consumer Reports Best Buy Drug.

“The patients do not have to worry about the expense nearly as much,” says Dr. Kenneth R. DeVault of the Mayo Clinic in Jacksonville, Florida.
Recently, the FDA approved a long-acting PPI for once-daily treatment of GERD. Kapidex (dexlansoprazole) was approved for healing all grades of erosive esophagitis for up to eight weeks, for maintaining healing of erosive esophagitis for up to six months, and for treating heartburn associated with symptomatic nonerosive GERD for four weeks, according to drugmaker Takeda Pharmaceutical.

Not Enough Relief

While PPIs are helpful to many, they are not a magic bullet.

“There’s a substantial group of patients who aren’t satisfied with the relief they get,” DeVault says. “The drugs don’t give you immediate relief. It really takes a few days to build up relief,” he says, adding that he hopes that a PPI containing sodium bicarbonate, an antacid that works quickly, will soon be sold without a prescription.
Another group of PPI users finds that the amount of acid suppression “just isn’t sufficient.” To cope, DeVault says some patients take more than the recommended one pill per day. “Probably 20 percent of people taking PPIs are taking them twice a day or more,” he estimated.

In early 2008, the American Gastroenterological Association Institute surveyed 1,064 people who used PPIs and found that nearly 40 percent still experienced GERD symptoms, such as acid reflux. Half of those surveyed used over-the-counter remedies, such as antacids, to ease breakthrough symptoms.
DeVault notes several studies have suggested that taking acid suppressants for an extended period of time could have side effects, including a higher risk of hip fractures, pneumonia, and an infection with a bacterium called C. difficile. “Those studies probably are legitimate, although the absolute risk is very, very low. If patients need acid-suppressing drugs, they should take them,” he says, adding that the patients at higher risk of side effects seem to be those taking PPIs more than once a day.

Within several years, DeVault expects to see new drugs that improve the function of the lower esophageal sphincter, the valve between the stomach and esophagus. “To me, those (drugs) are some of the more exciting things out there. They’ll probably be given to patients along with one of the acid blockers, but they’ll take care of the symptom of regurgitation, or the feeling of food coming back up.”

GERD and Asthma

Scientists are also making progress in understanding the link between GERD and asthma and other lung issues.
Physicians have observed that treating one condition sometimes leads to relief of the other. “We see patients frequently who have asthma exacerbated by reflux, and conversely, we see patients with reflux that can be exacerbated by asthma,” Katz says. “There is a relationship. It’s not clear whether it’s cause and effect.”

Reflux should be considered when a patient has difficult-to-manage, nighttime, nonallergic, or late-onset asthma. Reflux is also a consideration in patients with chronic laryngitis, hoarseness, other voice disturbances, or chronic sinus problems.

“It’s very hard to make that connection sometimes, so it requires careful thought and a careful approach,” Katz says, noting that a patient can be monitored to determine if reflux and other symptoms occur simultaneously or independently.

Chest pain is another symptom that should inspire a visit to a physician, DeVault says. Reflux and chest pain can go together, he says, but “don’t assume chest pain is indigestion.” The problem might be heart disease. A couple of times a year, he says, he sees a patient who is worried about reflux but actually has angina, which is chest pain caused by an insufficient flow of blood to the heart.

Barrett’s Esophagus and Cancer

In a small percentage of cases, GERD is a precursor to Barrett’s esophagus, a precancerous condition in which the cells lining the lower esophagus change in color, texture, and composition because of repeated exposure to acidic stomach contents. A small number of people with Barrett’s develop esophageal cancer.
Considerable debate remains over who should undergo expensive screening tests, in which an endoscope is used to view the lining of the esophagus.

“While Barrett’s tends to be most common in white men older than 50, the disease occurs in both genders, as well as all ages and races,” Katz says.

GERD and Babies

It’s normal for babies to spit up once in a while. But some infants get irritable and uncomfortable after nursing. Some scream for hours. Some refuse to eat. Instead of assuming the child has colic, some doctors are diagnosing GERD and prescribing drugs called proton pump inhibitors.

Children with GERD may have symptoms, including: repeated regurgitation, nausea, laryngitis, coughing, or wheezing. The National Digestive Diseases Information Clearinghouse suggests consulting a health care provider if your child frequently has reflux-related symptoms that cause discomfort.

Frequent reflux can cause complications, including: heartburn; esophagitis, which can develop into swallowing problems; poor growth due to poor nutrition; and respiratory problems from stomach contents entering the nose or lungs, according to the Pediatric/Adolescent Gastroesophageal Reflux Association.

Heartburn: The Road to Relief The Saturday Evening Post

In your November/December 2008 issue I happened to read that leg and hand spasms could be caused by the cholesterol medicines. I had been having such severe pains that I would have to pull over in traffic because I was afraid to drive with them. I tried eating bananas and all the other things people said would help to no avail.

I showed the article to my doctor who took me off of the cholesterol meds. In the next two weeks, I had the beginnings of spasms, but they never got full-fledged. I am now free of the spasms and am greatly appreciative of that paragraph in From the Pharmacy. A heartfelt thank you!

Johanna

You’re welcome! Thanks for writing. It’s important to keep cholesterol in check so please consider discussing your lipid levels and necessary therapy options with your doctor.

A Heartfelt Thank You The Saturday Evening Post

You have certainly been through a bunch of medications, but there are others you have not tried. For example, carvedilol is a unique type of beta blocker that has alpha and beta blocking actions. Pure alpha blockers like Cardura (doxazosin) might work. Other diuretics might be effective, as can combinations of drugs that have different actions. Finally, you don’t mention lifestyle modifications and they should be considered. These can include a low-salt diet, potassium supplements, moderate alcohol consumption, weight loss, exercise, and relaxation techniques. Check with your cardiologist or hypertensive expert.

Systolic Hypertension The Saturday Evening Post

Your left ventricular ejection fraction is indeed low, and it does not always correlate with symptoms, as you have found out. However, that amount of heart damage does put you in a high-risk category for a subsequent cardiovascular event, including sudden death. In fact, when the EF falls below about 35 percent, we generally recommend an implantable cardioverter defibrillator like the one Vice President Cheney received shortly after taking office. If your heart function remains stable and you continue to be asymptomatic, that (along with your medications) may be all that is necessary to do at present.

You don’t mention your age or the type of heart disease you have, both of which need to be considered before making any recommendations. However, should you experience further deterioration or become symptomatic and unable to function, a heart transplant or some other intervention might be considered.

Heart Weak But Stable The Saturday Evening Post

Coumadin (trade name warfarin) “thins” the blood by interfering with its normal clotting processes. This action is important in patients who have a condition that may predispose to the development of blood clots, such as some forms of phlebitis, a heart-rhythm problem called atrial fibrillation, foreign bodies in the bloodstream such as artificial heart valves, and a host of other conditions. In these patients, Coumadin can prevent blood clots from forming, and thus prevent dangerous complications such as strokes. The degree to which Coumadin is affecting clotting is monitored by a blood test called INR (international normalized ratio), generally checked monthly. Changes in the dose of Coumadin, diet, and the action of other drugs that can affect the metabolism of Coumadin can reduce or augment its actions.

When you say your blood was “dangerously thin,” it sounds like something enhanced the effects of Coumadin and your blood became excessively anticoagulated. Think back to whether you added a new medication, changed doses, altered your diet, or did something else that might have affected the Coumadin. Go over this with your doctor because it is important to prevent excessive anticoagulation from happening again. It sounds like you did not have a permanent complication, but that can happen if your blood gets too thin, and such a bleeding complication needs to be avoided.

Aspirin (Bufferin is just a trade name for aspirin) also affects the normal clotting process but by a different mechanism. Aspirin interferes with the ability of platelets to clump together to form clots. Sometimes aspirin and Coumadin are taken together, but that can increase the chance of bleeding.

Thinning Blood and Coumadin The Saturday Evening Post

The product is called Aquaphilic, manufactured by a small company in Iowa called Medco Labs. It was originally sold as a professional beautician product but is now sold by major pharmacies as well as to professional beauticians. Some pharmacies do not stock Aquaphilic, but all can obtain it within a few days. It only costs about $10 for a one-pound jar. Read about it on their website medcolab.com. I have no connection with Medco Lab, but this product has changed my life. I hope this information is of help to your many readers.

Gary

Shawnee, Kansas

Psoriasis Relief The Saturday Evening Post

I remember reading in Medical Mailbox that taking steroids can sometimes bring on a manic episode in people who are so inclined, but may not have yet been diagnosed with bipolar disorder. What about using eye drops that contain steroids? I have a family history of bipolar and don’t want to take any chances.

Margaret
Miami, Florida
A few years ago, we wrote about broadcast journalist Jane Pauley’s episode with mania after months of taking steroids to treat a physical problem. At the time, bipolar specialist and researcher Dr. John Nurnberger of Indiana University told us that Pauley’s experience was not at all uncommon.

The risk of psychiatric side effects seems to be dose-related—occurring especially in people taking more than 40 mg of steroids per day for two weeks or longer. In general, steroid eye drops do not deliver enough of the active ingredient to cause systemic reactions. A review of the medical literature shows no case histories of mania among patients using ophthalmic (eye) medicines that contain steroids.

Readers may send their letters to Medical Mailbox, 1100 Waterway Blvd., Indianapolis, IN 46202. Please include mailing address. Via email: medicalmailbox@satevepost.org.

Steroid Eye Drops and Mood Disorders The Saturday Evening Post

In general, consuming up to 100 mg of vitamin B6 in supplements and foods every day is considered safe. The important nutrient supports the nervous and immune systems and helps maintain blood sugar within a normal range. It may, however, interact with a drug used for Parkinson’s disease called L-dopa. In addition, very high doses may damage nerves in the arms and legs.

Experts note that this type of nerve damage may be reversible, and stopping the supplements is a simple way to test for ill effects. Foods that add B6 to one’s diet include fortified breakfast cereals, salmon, pork, chicken, bananas, beans, peanut butter, and many vegetables.

Other B vitamins are key to overall health, too. Folic acid is recognized as a major player in protecting babies from devastating birth defects of the brain and spinal cord. Post readers tell us that taking extra B12 boosts energy levels and mood. No overdoses of B12 pills, shots, or nasal spray have been reported in the medical literature.

Reader Suggestion: I will tell you what has completely healed my foot. Clarks shoes! These are slip-on shoes with no strap around the back of the heel. Buy one size larger than usual so the foot rests flat. Good luck. The shoes are a great answer to a terrible problem.

Reader Suggestion:An orthopedic foot specialist advised wearing a knee-high cast prior to doing surgery for severe heel pain. Instead, I purchased a Velcro-type ankle brace to wear every moment except when showering. I also purchased some high-top athletic shoes that I lined with an IsoArch support. Within two weeks I noted improvement, but it took almost six weeks to get rid of the pain completely. Others have had the same success with this therapy. Good luck.

Reader Suggestion: Reading the July/August 2008 edition of Medical Mailbox, I was very empathetic with Edith, who is suffering from bone spurs in her heels. I, too, suffered for about a year. Shots did no good, and neither did very thin orthotics. Finally, a foot doctor made me a pair of good orthotics to be worn with New Balance tennis shoes, model #1123. I was pain free in about eight weeks, and after three years not an ounce of pain. I wear regular flat shoes once in a while, but I pretty much stick to the tennis shoes.

Reader Suggestion:I had a similar problem with heel pain as Edith M. Wubben. It was cured by six acupuncture treatments, and I never had a problem again.

Reader Suggestion: When I had heel spurs, someone advised me to drink one water glass of Ocean Spray Cranberry Juice three times a day. This worked for me after about six weeks. I continued for another six weeks just to be sure they were gone. They have not returned for 12 years. Hope this helps reader Edith Wubben from Virginia. I love this magazine and your column.

Medical Mailbox supplements the advice of your healthcare provider, whom you should consult for personal medical problems.

Heel Pain Advice The Saturday Evening Post

While vitamins can’t cure age-related macular degeneration (AMD), research suggests that eating plenty of fish, green leafy vegetables, and fruits may delay its progression and preserve vision. See below for a list of potentially sight-saving nutrients in foods and supplements.

Most people with macular degeneration have the “dry” form of the disease. It is characterized by the gradual breakdown of cells in the macula, the part of the eye responsible for detailed vision. In “wet” AMD, abnormal blood vessels damage the macula—disrupting vision in the process. Laser and drug therapies to eliminate the extra vessels may allow patients to see more clearly.

Periodic dilated eye exams help ophthalmologists and their patients monitor symptoms and make treatment decisions. Getting regular exercise, maintaining normal blood pressure and weight, and not smoking are also important. In the future, scientists hope that advances with stem cells and genes will prevent or cure the disease.

Data from the Age-Related Eye Disease Study show that taking the following supplements reduced the risk of vision loss in some people with intermediate or advanced AMD:

• 500 mg vitamin C
• 400 IU vitamin E
• 15 mg beta carotene
• 80 mg zinc (as zinc oxide)
• 2 mg copper (as cupric oxide)

More recent studies show that adding lutein and zeaxanthin to the diet may also reduce the risk of developing advanced AMD. These carotenoids are found in the macula. Food sources include Brussels sprouts, spinach, broccoli, kale, and greens.

Medical Mailbox supplements the advice of your healthcare provider, whom you should consult for personal medical problems.

Aging Eyes The Saturday Evening Post