Drug Interactions are Common in the Elderly

Many elderly patients take 10-12 prescription drugs. Dangerous drug interactions are frequently unavoidable with this many meds. Most doctors do not thoroughly check for interactions. If you are taking a lot of medicines, including over-the-counter drugs and supplements, ask your pharmacist to check you for interactions. Then ask your doctor about any issues that come up. Some interactions create potential problems but are being tolerated fine in your situation. Others might put you at risk. About 100,000 deaths are caused each year by properly prescribed drugs in hospitals. Finally, work with your doctor to minimize the prescription drugs you need to take. Often, a nutrient plan can help you do without drugs. This approach is much safer, and can save you money as well.

See Family Practice News (click here), July, 2010, p. 68.

On Becoming Addicted to Acid-Blocking Drugs for Reflux

The use of PPI drugs such as Prilosec, Nexium and Protonics for gastro esophageal reflux disease (GERD) has increased dramatically in recent years. A Danish study showed that discontinuing long-term use of these drugs was very difficult in most patients, even though patients had no abnormal endoscopic findings. When the drug is stopped there is a rebound of symptoms, just like withdrawal symptoms when a patient is addicted to a controlled substance. Long-term use of PPI drugs can increase the risk of hip fractures. Once a patient gets through a gradual tapering of a PPI over 3-12 weeks, he or she might be able to get off the drug, but additional therapy (like Refluxin from Cardiovascular Research) might be needed for some time.

See Family Practice News (click here), July, 2010, p. 59.

Sun Exposure and Melanoma Risk

Reports from Norway and Spain indicate that increased exposure to sun increases the risk of melanoma in exposed areas but decreases the risk of melanoma in areas not exposed, such as vulvar melanoma. Other studies have indicated that higher serum levels of vitamin D result in improved survival in melanoma patients. This is another indication that Vitamin D is the “wonder drug” of the 21st century.

See Family Practice News (click here)July 2010, p. 48.

Uncovering Suicide Risk in Patients that are Depressed

Dr. Guy Diamond has developed a web-based behavioral health screen to assess anxiety, depression, substance abuse and most importantly, suicide risk. This tool will become available in the fall of 2010 (about now). It takes about 10 minutes for a teenager or young adult to complete, and will be used primarily as a screening tool before the patient sees a doctor for a routine checkup. This area of health concern is often neglected. A pediatric task force is considering designating a Pediatric Mental Health Month, which I think is a good idea.

See the American Academy of Pediatrics Task Force on Mental Health Care.

Hair Mercury Testing in Pregnant Women

Dr. Gideon Koren of the Mother Risk Program, who is a regular columnist for Family Practice News, discussed recent FDA guidelines that pregnant women should avoid shark, mackerel, and swordfish altogether but are allowed only 12 ounces a week of fish and shellfish, due to their mercury content. Mercury is a potent neurotoxin that can cause birth defects. His organization gives these recommendations but also offers their women a hair mercury test, which he says is available at most university medical centers. This is quite a turn of events and an out-of-date statement at the same time. Twenty years ago, if an alternative doctor ordered a hair analysis, medical boards considered that grounds to threaten his or her license. Now few alternative doctors use hair analyses because they are only positive if the patient excretes the mercury instead of storing it. Much more accurate is a challenge test to see how much of the mercury in the body you can pull out (or chelate). Preferably, the test should be done before the pregnancy to develop the best treatment and prevention strategy if mercury or other toxic metals are present.
See Family Practice News(click here), July, 2010 issue, p. 37.

Onset of Menopause Correlates to Risk of Cardiovascular Disease

Dr. Melissa Wellons of the Multi-Ethnic Study of Atherosclerosis (MESA), funded by the NIH found that women who began menopause before the age of 46 y.o., had double the risk of cardiovascular disease in later life, regardless of other risk factors, race, ethnicity and whether the menopause was surgical or not. In another development, the Endocrine Society issued a formal statement that women age 50-59 y.o. have a 30-40% reduction in total mortality if they start hormone replacement therapy (HRT) and take it for 5 years compared to those who start the therapy in their 60’s or higher. The risk is almost all due to progestin therapy. Estrogen itself or mixed with bio-identical HRT (estrogen plus progesterone) does not appear to increase the risk of breast cancer. The usual cautions of individualizing the therapy and using the lowest dose for the shortest duration apply.

See Family Practice News(click here), July, 2010 issue, p. 36.

The HPV Vaccine for Teenage Girls to Help Prevent Cervical Cancer Controversy

Merck Pharmaceuticals continues to urge that all teenage girls receive this vaccine to prevent them from getting infected by the HPV virus, which is transmitted by sexual intercourse unless condoms are used. Most doctors agree that females in this age group who are sexually active, particularly with multiple partners, should be vaccinated. Last year a prominent editorial and article in the AMA journal questioned whether enough was known about the risk/benefit ratio of this vaccine and criticized the aggressive marketing campaign by Merck. There is concern that lowering the HPV virus incidence might not prevent cancer. It is not known how long the vaccine effect lasts, and significant side effects are possible.

See JAMA(click here,subscription required) 2009;302:795-6, 781-6.

Seasonal Flu Shot Recommendations for Children

If you agree with the CDC’s recommendation that all children receive flu shots, you should note that the H1N1 virus, whose epidemic scare that never materialized last year, has been mixed in with regular flu shots this fall. If your child got two doses of the seasonal flu vaccine the first year plus one shot of the H1N1 vaccine last year, then he or she would only need one regular flu shot this year. If not, two shots will be required. We recommend one dissolvable tablet of muco coccinium every two weeks to help prevent or lesson the effects of all kinds of flu. Anecdotally, this homeopathic preparation has worked very well for our patients in the past. A recent JAMA study showed that the risk of serious complications was no more for H1N1 infections than for seasonal flu.

See the CDC Advisory Committee on Immunization Practices (click here), June 24, 2010 Guidelines and JAMA 2010 June 8 issue;304:1091-8 (subscription required).