Your Health Checkup: Drugs and Daily Activity

“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

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Yesterday morning while exercising as usual, I inflamed an old biceps tendonitis that triggered pain whenever I moved my arm. I needed treatment with a nonsteroidal anti-inflammatory drug (NSAID).

While researching which drug to take, I came across an interesting article stating that administering NSAIDs during the daily activity period, i.e., in the morning for most people, resulted in better pain relief and healing than taking the NSAID in the evening prior to retiring.

The reason appears to be based on the body’s circadian rhythm; that is, the cyclical 24-hour period of human biological activity.

The mediators of most wound healing and connective tissue formation occur during the resting phase of the day, while pain and inflammation occur during the active period of the day. It follows that one would want the NSAID impact to occur during the period of pain and inflammation and not during the wound healing phase, hence the recommendation for taking the drug in the morning.

The opposite is true for blood pressure control. As I have written previously, the time to take blood pressure medication is in the evening, not the morning. Nighttime blood pressure is a stronger risk predictor of cardiovascular disease than is daytime blood pressure, and blood pressure control at night works better than control in the morning.

So, take NSAIDs in the morning and blood pressure medicines in the evening.

But here’s a drug you probably should avoid, if possible: azithromycin.

Azithromycin (AZ), an antibiotic in the same class as erythromycin, is one of the most commonly prescribed antibiotics in the U.S. despite an increased risk of cardiovascular death noted in some studies, perhaps related to changes in heart rhythm A recent study of almost 8 million antibiotic exposures (22 percent AZ; 78 percent amoxicillin) from January 1, 1998 to December 31, 2014, in patients with a mean age 51 years, and 62 percent women, found that AZ was associated with about a twofold increased risk of death during the first five days of exposure compared with amoxicillin. I would recommend that AZ be used with caution, particularly in patients who might be at increased risk, such as those with underlying heart disease, electrolyte abnormalities, or those taking other drugs that might affect the heart rhythm in a similar fashion.

Featured image: David Tonelson /

Pain Management in Pets: An Owner’s Guide

There are many parallels between people and pets when it comes to anticipating and addressing pain associated with surgical procedures.

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.