Is Low Dose Naltrexone Helpful?

I always try to present the facts to anyone who reads this blog. I try not to stretch the truth. Maybe I haven’t been super successful in that regard, but I try to present accurate information without blowing it out of proportion. That’s what I want to do today, present some information and put it into context. For the record, I personally think naltrexone has promise for certain disease states.

Naltrexone is a drug that is specifically for narcotic overdose. It blocks receptors that normallyendongenous endorphins (and narcotics) will bind to create a sense of well being, euphoria, or analgesia (pain relief). Runners will often talk about the runner’s high they get after a good run. That’s endorphins. Mmm, endorphins (think Homer Simpson).

Homer trying to get that endorphin high

Homer trying to get that endorphin high

Naltrexone is wicked awesome, I used awesome not only as a superlative, but as in it’s crazy amazing to watch someone who should probably be dead because of no breathing from narcotic overdose, at reversing it completely. It’s bad to give the full dose all at once too because a person can go from not breathing to full withdrawal within a few seconds. It’s almost like watching someone raise the dead. ER docs will usually give it bits at a time and wait for response to avoid withdrawal.

So why use a revival agent for narcotics in something like rheumatoid arthritis or multiple sclerosis?

It has to do with what naltrexone actually does. You can think of it as an immune modulator. In autoimmune disorders like rheumatoid arthritis, the immune system is literally attacking the host body. Your immune cells are targeting you. No bueno. The only cases where we want this happening is when a cancer cell forms or a virus has infiltrated a cell.

For those that don’t want more nitty-gritty on the mechanism, you can skip this next part, but you should read it anyway and learn something new.

Naltrexone is known to bind the opiate receptors on cells. [1] This of course is how it helps prevent narcotics from doing their job, because they can’t do anything but float around aimlessly in the blood.

At a standard dose of 50mg, naltrexone causes blockade of opiates and if you were to take your Vicodin or Percocet, they wouldn’t do anything, other than the acetaminophen of course. What scientist have found is that when the dose is cut down to about 1/10 or so, blockade still occurs, but because there is little drug in the system, the body is able to clear it quickly and more endorphins are created to overcome the blockade.[2,3] In a normal dose or even a slightly higher dose, the naltrexone is present in enough quantities to stop the transient rise.

In the low dose, this rise creates the possibility of greater analgesia (pain relief) as well as immune modulation. These factors MAY increase quality of life, mood, and/or disease resilience. [4] It’s important to remember that word “may” because large trials haven’t been conducted in a placebo controlled, double-blind manner, which means we only have preliminary data to draw from.

It has been shown that naloxone can reduce inflammation cytokines (chemical messengers that incite inflammation from immune cells) in macrophages in the periphery.[5] This may help explain some of the immune modulation thought to produce effects in things like arthritis or Crohn’s disease. It should be noted that this was done with naloxone and not naltrexone. While similar, you can’t always transfer effects of one drug to another, even though while in the same class.

In the nervous system, naltrexone has been shown to affect microglia, which are immune cells. By reducing inflammatory cytokines, they may help in neurodegenerative disease brought on by inflammation. Indeed, both naloxone and naltrexone, seem to have a neuroprotective effect, at least in mice. [6]

So what about actual studies looking at disease?

Fibormylagia have you feeling fatigued? Maybe naltrexone could help.

Fibormylagia have you feeling fatigued? Maybe naltrexone could help.

In one looking at fibromyalgia, one study looked at 10 women with the disease and found that 6 out of 10 received relief to some degree over placebo, and showed that mechanical and heat thresholds were improved. [7]

In another of fibromyalgia, 30 women were treated with placebo or naltrexone and there was a significant reduction in pain for the naltrexone group over the placebo group. [8]

Another fibromyalgia study with a 50mg dose showed no difference in groups. [9] As discussed above, this could be do the dose, rather than the drug. Remember that at higher doses, the blockade of opiate receptors happens for a longer period and the increased endorphins can’t do their job.

In another study with 60 participants with multiple sclerosis, naltrexone was found to improve mental health quality over placebo. [10] The authors did point out this study did not assess the drug as a disease modifying agent, such as Copaxone. They did state there did seem to be no interactions with typical MS drugs.

In patients with Crohn’s Disease, 18 naltrexone patients had significantly more reduction in severity score associated with the disease over 16 placebo patients. [11]

A trial with children found that it also may be very effective. [12]

Because of its mechanism, it’s not improbable that it could help with other autoimmune conditions like rheumatoid arthritis because of the inflammatory effects of the disease. Others like lupus might also benefit.

Naltrexone seems to be tolerated well, especially since it is being used at a lower dose. Some nausea has been reported as well as abnormal dreams. People that have liver disease might be cautious, as it has been shown to cause liver problems, but those are in the 50-100mg/day dose range. 4.5, the common dose used in many studies, doesn’t seem to have that effect.

Naltrexone also must be compounded by a compounding pharmacy. The lowest commercial dose available to pharmacies is 50mg/tab, so they have to make it into caps or suspensions, depending on the dose. You can call a compounding pharmacy and ask how much it would be for 30 caps of 4.5mg naltrexone. Most will probably already know or be able to get you a number relatively quick.

It also must be an immediate release formulation, no extended release. One note of caution: if you do choose to use naltrexone and you take narcotics, you’ll want to wean off of them. Naltrexone, even at a small dose, will block the effect of your pain med and cause problems. Talk to your doc about that if that’s a concern.

Because no large studies have been done, it’s hard to gauge just how effective it is. I’ve read several personal anecdotes of people claiming it has done great things for their lives. I have hope for it as I think it has much promise. Hopefully someone will be able to do larger scale trials to give us a better idea of how well it actually works at a more general population level with a given disease.

I’ve read about some people seroconverting with HIV, while others have claimed that their viral load decreased. Again, I haven’t seen clinical data to back that up, but if true, would be a great thing for people battling that horrible virus.

In short, if you’re willing to give naltrexone a try, their probably shouldn’t be much problem, other than maybe convincing your doctor of writing a script.

CIAO

 

 

 

1.Wang D, Sun X, Sadee W. Different effects of opioid antagonists on mu-, delta-, and kappa-opioid receptors with and without agonist pretreatment. J Pharmacol Exp Ther. 2007;321:544–552

2.Tempel A, Gardner EL, Zukin RS. Neurochemical and functional correlates of naltrexone-induced opiate receptor up-regulation. J Pharmacol Exp Ther. 1985;232(2):439–444

3.Zagon IS, McLaughlin PJ. Gene-peptide relationships in the developing rat brain: the response of preproenkephalin mRNA and [Met5]-enkephalin to acute opioid antagonist (naltrexone) exposure. Brain Res Mol Brain Res. 1995;33(1):111–120

4.Brown N, Panksepp J. Low-dose naltrexone for disease prevention and quality of life. Med Hypotheses. 2009;72(3):333–337.

5.Liu SL, Li YH, Shi GY, Chen YH, Huang CW, Hong JS, Wu HL. A novel inhibitory effect of naloxone on macrophage activation and atherosclerosis formation in mice. J Am Coll Cardiol. 2006;48(9):1871–1879

6.Hutchinson MR, et al. Non-stereoselective reversal of neuropathic pain by naloxone and naltrexone: involvement of toll-like receptor 4 (TLR4) Eur J Neurosci. 2008;28(1):20–29.

7.Younger J, Mackey S. Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. Pain Med. 2009;10(4):663–672

8.Younger, Jarred, et al. “Low‐dose naltrexone for the treatment of fibromyalgia: Findings of a small, randomized, double‐blind, placebo‐controlled, counterbalanced, crossover trial assessing daily pain levels.” Arthritis & Rheumatism 65.2 (2013): 529-538.

9.Younger, Jarred W., Alex J. Zautra, and Eric T. Cummins. “Effects of naltrexone on pain sensitivity and mood in fibromyalgia: no evidence for endogenous opioid pathophysiology.” PloS one 4.4 (2009): e5180.

10.Cree, Bruce AC, Elena Kornyeyeva, and Douglas S. Goodin. “Pilot trial of low‐dose naltrexone and quality of life in multiple sclerosis.” Annals of neurology 68.2 (2010): 145-150.

11.Smith, Jill P., et al. “Low-dose naltrexone therapy improves active Crohn’s disease.” The American journal of gastroenterology 102.4 (2007): 820-828.

12.Smith, Jill P., et al. “Safety and tolerability of low dose naltrexone therapy in children with moderate to severe crohn’s disease: a pilot study.” Journal of clinical gastroenterology 47.4 (2013): 339.

 

 

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Writing and Health: Part Deux

Last weeks post about writing was pretty popular, so I decided to do another post about it and some of its benefits. If you missed last weeks’ post you can click on it here:

https://pharmacybrute.wordpress.com/2015/01/21/writing-your-way-to-health/

writeThis won’t be a comprehensive overview of everything beneficial from writing. It is a fascinating thing and I do agree that writing and command of language is a skill that can only benefit everyone that is involved; writing or reading.

In many of the studies that I’ve looked at, the writing performed has been centered around self-expression and dealing with emotions and experiences rather than mundane and the everyday. I find this interesting, as mentioned in the previous post, as it focuses our brains on things that affect us very deeply, rather than external “things” that really matter very little.

One study found that blood pressure was reduced as an effect of expressive writing. [1] Another study assessed blood pressure only right after the writing, and found that it was elevated and mood was more negative. [2] This might be explained by people either reliving events, or just having stress associated with thinking about them. The interesting part is that during follow-up, people reported fewer health center visits. This might be a result of expressing the emotions and getting them out of the system, so to speak, rather than having to deal with them in a clinic setting.

In a study of women, it was found that those with chronic pelvic pain who wrote about the stressful consequences of their pain reported lower pain intensity ratings than women who only wrote about positive events. [3]

PTSD (post traumatic stress disorder) is a problem among many people, especially members of the military. During a writing period of just 2 weeks, sufferers of PTSD were asked to write about the trauma or a trivial topic. In both groups “everyone reported less severe PTSD symptoms, impact, and dissociation, and fewer health visits, but about the same suicidal ideation and depression” [4] The trauma group got worse right after writing but were better at the 6 week follow-up. The trivial group was better after and continued to be so at the follow-up.

Another study looking at “traumatic events” found that writing also helped with depression and avoidance behavior. No benefit was found in a “waiting list” group who received no instructions, and who effectively didn’t participate in the trial. [5] It is possible that people with traumatic events in their past simply need to write to receive benefit, with content not so important.

In one interesting study of prison inmates, 3 groups; traumatic writing, trivial writing, and no writing, were assessed pre and post writing assignments. No differences were found between groups with the exception of the traumatic writing and sex offenders. They were found to have decreased infirmary visits than others. [6]

I again reiterate what I said in my last post: WRITE! Write and express thoughts and feelings in a journal. Write a short story too while you’re at it. Look at a writing exercise as just that, an exercise. If that is too much stress, because it sounds like a chore, then write for fun. Exercise is always more productive when you’re having fun doing it, so is writing.

So start a writing club. Try your hand at poetry. Maybe divulge your feelings and emotions concerning things that have happened in the past. Share it with the world or keep it to yourself, but write and enjoy the benefits of learning to command your language.

CIAO

1.Davidson, K., Schwartz, A. R., Sheffield, D., et al (2002) Expressive writing and blood pressure. In The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-being (eds S. J. Lepore & J. M. Smyth), pp. 17–30. Washington, DC: American Psychological Association.

2.Pennebaker, J. W. & Beall, S. K. (1986) Confronting a traumatic event. Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274–281.

3.Norman, Sally A., et al. “For whom does it work? Moderators of the effects of written emotional disclosure in a randomized trial among women with chronic pelvic pain.” Psychosomatic Medicine 66.2 (2004): 174-183

4.Deters, Pamela B., and Lillian M. Range. “Does writing reduce posttraumatic stress disorder symptoms?.” Violence and victims 18.5 (2003): 569-580.

5.Schoutrop, Mirjam JA, et al. “Structured writing and processing major stressful events: A controlled trial.” Psychotherapy and psychosomatics 71.3 (2002): 151-157.

6.Richards, Jane M., et al. “Effects of disclosure of traumatic events on illness behavior among psychiatric prison inmates.” Journal of Abnormal Psychology 109.1 (2000): 156.

Writing Your Way to Health

Unleash your mind power with a good ol fashion pen and paper

Unleash your mind power with good ol fashion pen and paper

Writing is something that all of us have done from time to time. Maybe it hasn’t been a novel or a movie script, but even a grocery list counts as writing. Keeping a journal also counts. I’ve heard over the years that writing can be therapeutic in different ways and wanted to discuss just a few of these things today, especially since drugs aren’t always the answer and finding other avenues of treatment for the mind is useful, especially when it’s free.

In a study of college students, researchers looked at how writing would affect depressive symptoms in those students. College, after all, can be a trying time for many a student. The students were instructed to write on their “deepest thoughts and feelings on current and past emotional upheavals” (intervention) or “time management conditions” (control). [1] It was set for three consecutive 20 minute sessions, plus a booster session 5 weeks later. Depressive symptoms were measured just before the first of three session, just before the 5 week booster and 6 months later.

Students in the “feelings” group did report lower depression scores than those in the control group. The 5 week booster seemed to have no effect. It would be interesting to see if this study was repeated, but with more writing sessions instead of 4, and on a more consistent basis.

In a study with cancer patients, subjects were asked to write about their feelings and thoughts of the cancer, or neutral topics, on four different occasions. Patients writing about their feelings exhibited better physical functioning scores and seemed to improve the cancer related symptoms. [2]

In another intervention in marriages, couples who were experiencing discord and disagreements were assigned to a control or writing group. The writing group was asked 3 specific questions and they were given time to write about them. The writing wasn’t started until a year into the study. The couples who wrote had their downward spiral level off, while the couples who didn’t write, continued in decline. [3] It’s not to say that writing fixed all the problems in the relationship, but it did make an environment from which they could come together and not continue to grow apart.

Writing about it may also be an important step. And I mean actually taking out a pen or pencil and paper and writing, rather than just typing on a keyboard. In a study looking at brain scans and writing, good writers showed more activation in areas of “cognition, language, and executive functions, consistent with predictions, and also in working memory, motor planning, and timing”. [4] This may be beneficial when helping a person really use their brain in coping or figuring out emotional problems.

In another look at typing vs longhand, it was found that people who write notes tend to assimilate information and process it to write it down, whereas typers just assimilate and type the facts. In other words, writing notes longhand while learning allow people to understand concepts better than if they were to type. Actual facts are maintained about the same in both groups. [5]

I think this is some good advice in general; to write regularly and to try to write instead of type. I’ve noticed in my own writing, my style changes when I’m brainstorming or just rambling vs when I’m being direct or making a point. When I write a prescription for example, my writing is neat, organized, and very legible. When I’m taking notes in a class or a meeting, it is more sloppy and all over the place, and not just because I’m trying to be quick.

Does this mean anything? I think it is reflective of different parts of my brain being utilized when writing, I think that’s obvious. It probably goes deeper than that, but I’m no neuro-expert. What I am convinced of is that writing can be beneficial for all sorts of things, but you have to do it to get the benefit. It also appears that focusing on your thoughts and feelings, in other words, what is actually being processed by you, is far more important than just writing about what you did or what you’re going to do, say in a schedule.

Maybe this writing doesn’t have to be everyday, but regularly, whatever that is, would probably be best. Maybe that’s a journal once a week or month. Maybe writing is part of work and your sick of writing already. Sometimes a break from the things we do is part of health as well, or at least changing what we write about.

Writing blog posts regularly can sometimes be a bit boring, so I’m writing a novel on the side for fun. It has reinvigorated my love for writing and now the blog doesn’t seem like a chore as sometimes it can.

Being intentional about writing can be useful too. In the studies listed above, postive outcomes were seen when subjects were answering specific questions about what problems they were facing. So write specifically. If you don’t want to, then at least try writing.

So if any of you want to try a different approach to depression, pain, cancer, crazy children, or anything else, I give you this challenge; write about it.

I’d love to hear any experiences anyone has had with this in the comments.

CIAO

 

1.Gortner, Eva-Maria, Stephanie S. Rude, and James W. Pennebaker. “Benefits of expressive writing in lowering rumination and depressive symptoms.” Behavior therapy 37.3 (2006): 292-303.

2.Milbury, Kathrin, et al. “Randomized controlled trial of expressive writing for patients with renal cell carcinoma.” Journal of Clinical Oncology 32.7 (2014): 663-670.

3.Finkel, Eli J., et al. “A brief intervention to promote conflict reappraisal preserves marital quality over time.” Psychological science (2013): 0956797612474938.

4.Berninger, Virginia W., et al. “fMRI activation related to nature of ideas generated and differences between good and poor writers during idea generation.” BJEP Monograph Series II, Number 6-Teaching and Learning Writing. Vol. 77. No. 93. British Psychological Society, 2009. 77-93.

5.Mueller, Pam A., and Daniel M. Oppenheimer. “The Pen Is Mightier Than the Keyboard Advantages of Longhand Over Laptop Note Taking.” Psychological science (2014): 0956797614524581.

 

Does Magnesium Help Sleep?

In last week’s post we discussed some of the possible benefit of giving up electronic screens before bed to avoid blue light. Some people may even wear yellow/orange visors to filter out the blue light.

Today I want to talk about something I’ve mentioned before, and something that many people lack; magnesium.

Magnesium is a metal that is required in the body for over 300 different reactions. It is found in many different foods in various quantities and sold in you local drug stores, supermarkets and everywhere else. The substance has been used for numerous ailments, and rightly so, since it has a wide variety of uses in the body.

So does it help in sleep?

In your brain there is a neurotransmitter called GABA  which is responsible for some of the calming actions in the brain. If the brain had an “on” and “off” switch, GABA could be likened to the off. That is a very basic view of it and there is more involved to it, but for the purposes of this talk lets keep it simple. If you’re interested in some heavier reading, or if you want to read it to put you to sleep, you can go here:

http://emedicine.medscape.com/article/1188226-overview#aw2aab6b3

In the evening, in the hypothalamus, GABA is used, as well as another transmitter called galanin, to calm the brain down. It does so by inhibiting the arousal areas of the brain. It’s kind of like when you had a friend spending the night at your house and you’d get a bit loud, then your dad came and banged on the door or wall telling you to pipe down. GABA kind of does the same thing.

Here’s the thing; GABA is potentiated by magnesium [1].

People who have chronically low levels of magnesium may have problems falling asleep and staying asleep. I can’t speak to the number of people who come into the pharmacy for things like zolpidem for sleep, but I’d love to see what their magnesium levels are and if something like a supplemental magnesium would help. I do know we over prescribe sleep agents.

From a personal note, I have had better sleep with magnesium and know people to whom I’ve recommended it get better sleep as well. I know this is anecdotal, but it is strong enough evidence for me to recommend it.

In a small trial in Italy, researchers looked at supplemental magnesium with zinc and melatonin in patients living in long-term care facilities. They found that this combo helped the patients get to sleep faster and it was more restful. [2] The downside is that in this study, because they used 3 supplements together, we can’t extrapolate the benefit just to the magnesium, especially as we know that melatonin can also help people with sleep.

Magnesium can also address issues of restless leg [3], muscle cramping and twitching, and cold hands.

As a side note, here’s a list of drugs that deplete magnesium in the body:

-Birth Control Pills

-sucralfate (Carafate)

-chloroquine

-docusate

-corticosteroids (ie prednisone, dexamethasone, fluticasone)

-divalproex (Depakote)

-phenytoin (Dilantin)

-triamterene/hydrochlorothiazide (Dyazide)

-estrogens

-hydrochlorothiazide (HCTZ)

-levetiracetam (Keppra)

-digoxin

-furosemide, torsemide, bumetanide

-gabapentin (Neurontin)

-amlodipine

-raloxifene

-senna (Ex-Lax)

I’ve said this before but it bears being repeated: Don’t take magnesium oxide! Magnesium oxide just doesn’t get absorbed well. If you want to use it to induce a visit to your nearest commode, then by all means, but if you’re actually looking to get magnesium into your blood there are better options.

There are lots of forms of magnesium. Be sure to get a good one.

There are lots of forms of magnesium. Be sure to get a good one.

Magnesium comes in various forms. Here are a few and some general uses:

1. Mag Oxide: As stated above this is good for getting a great laxative effect. This was the form used in the Italian study. It would have been interesting to see if another form had been used if it would have been even more effective.

2.Mag Glycinate: This one is well absorbed because of glycinate transporters in the gut. Both magnesium and glycinate have calming effects and may make this a good candidate for muscle hypertonicity and chronic pain. It has a small laxative effect compared to others.

3.Mag Malate: This one could be used for fibromyalgia as malate is a substrate for energy production. It is also well absorbed.

4. Mag Citrate: Well absorbed and a good all around option. Can still produce some loose stool though. This is the form I take.

5.Mag Orotate: This may be good for heart health as orotates get into the cell membranes easier and may benefit in cellular repair and energy production. [4,5] This may be good for people with cardiovascular disease

6. Mag Sulfate: This one is usually injected intravenously. It is also found in Epsom Salt baths.

These are just a few and there are more but if you stick to the above listed, minus the oxide, you’ll probably be just fine. 200-400 mg/day is likely what most people would need. You’ll have to titrate the dose depending on if you have really loose stool or not. Try some a couple of times a day without food.

If anybody has had any experience with magnesium and sleep please let me know about it. I’d love to hear what has worked for you.

CIAO

 

1.  Uusi-Oukari M, Heikkila J, Lovinger DM, Luddens H, Korpi ER. Magnesium potentiation of the function of native and recombinant GABA(A) receptors. Moykkynen T, . Neuroreport. 2001 Jul 20;12(10):2175-9

2.Rondanelli, Mariangela, et al. “The Effect of Melatonin, Magnesium, and Zinc on Primary Insomnia in Long‐Term Care Facility Residents in Italy: A Double‐Blind, Placebo‐Controlled Clinical Trial.” Journal of the American Geriatrics Society 59.1 (2011): 82-90.

3.Hornyak, Magdolna, et al. “Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study.” Sleep 21.5 (1998): 501-505.

4.Stepura OB, Tomaeva FE, Zvereva TV. Orotic acid as a metabolic agent. Vestn Ross Akad Med Nauk. 2002; (2): 39-41.

5.Geiss, K-R., et al. “Effects of magnesium orotate on exercise tolerance in patients with coronary heart disease.” Cardiovascular drugs and therapy 12.2 (1998): 153-156.

 

Blood Pressure Apps

Happy New Year everyone!

I hope all is well in this new year and that any resolutions that have been made are realistic and being accomplished. This year I’m writing a book. It’s to be done by Christmas. I think it will be with time to spare. My hopes are to get it published one day.  Enough about me…

I wanted to start the new year by talking about something that interests me from a professional perspective, as well as personal; Apps.

Apps are on most everyone’s phone and tablet and even on your computer, depending on the browser you use. With Microsoft recently releasing Office for free for use on Android and iOS, I find myself writing my book on my iPad just as much as my computer and laptop. Dropbox and Google Drive are indispensable as my need for a thumb drive is all but vanished. My kids play Angry Birds, any assortment of Disney games and some interesting human body apps that teach about how the body works to kids. I even like going outside on a starry night with my Starry Night app and looking at the stars, learning names, and even following the paths of satellites as they cross into my field of view. Too much screen time is problematic of course, but we’ll save that for another post.

Apps seem to be as plentiful as bad ideas about health

Apps seem to be as plentiful as bad ideas about health

Health apps have been popular too. I’ve used MyFitnessPal to track calories and workouts. I just received a FitBit from my company as a Christmas gift. It measures steps taken, sleep, etc. It syncs with my phone and I can make alarms for multiple things, track calories eaten, and even has caller id which is nice so I don’t have to fish my phone out of my pocket, I can just look on my wrist. I don’t have the model that measures pulse, but I’m thinking about springing for one, who knows?

Some docs are using medical apps in their practice, at least for things like atrial fibrillation. AlliveCor is one such app, and will only set you back $200. It can read certain rhythms in the heart and show them on your phones screen. These apps can quite read if you’re having a heart attack and can’t replace a 12 lead scan, but they seem to be gaining popularity and could be a huge help in the future for a more tech savvy generation as it ages.

One very common app, the one I want to focus on a bit more, is one that measures blood pressure. Actually there are several. One of them is called “Instant Blood Pressure — Monitor Blood Pressure Using Only Your iPhone” and you only have to shell out $3.99 for it. You apparently put your finger over the camera and it is able to read your pulse, and then you put the mic to your chest. The combination of the two can then spit out a number. Not convinced? Yeah, me neither.

There are several others, several. Many of them have very favorable ratings. The problem I run into is I can’t find any information on comparisons that have been done to cuff readings. That’s a bit problematic in any event because if the app is giving you false data, what good is it? It’s not good, that’s the only correct answer, especially since blood pressure is a crucial part of living. Too low = bad, too high = bad. Like everything else there is a happy medium.

Think of it this way. Having some nice rib eye steak is good. Not having it ever is bad. Having it every night isn’t good because you’ll get sick of it, swear it off, and then never again enjoy the wonderful creation of rib eye steak, grilled and seasoned to perfection… oh man I think I need a steak.

In other words there is a happy medium. I don’t think anyone is really unaware of this in blood pressure. The problem though is the app. The interesting thing about the above mentioned app is there is a small fine print disclaimer stating that the app is for entertainment purposes only and not FDA approved. In other words the makers are admitting that you shouldn’t use it for actual blood pressure monitoring.

If a person were to base their decision to go see a doctor or to the ER based on an app like this because their readings were “normal” when in fact they aren’t, I’d be very worried about the outcomes for that patient, especially if they have hypertension.

I’m all for technology advancing and especially for the ability of phones and other devices to advance medical care. I think if something is useful and beneficial and if it can fit in your pocket then why not? We need to be careful though because sometimes, when we get into consumer mode (which is especially easy to do on a phone of tablet), we forget to double check what it is we’re actually getting. Health is something you don’t want to take casually like buying an app.

CIAO

 

Late Night Reading and Sleep

Many people enjoy a good book before going to bed. Some enjoy the news, some enjoy a game and some just enjoy a story. With so much available on tablets and laptops, all from the comfort of your own bed or couch, it’s no wonder that many can be found on devices when the sun goes down.

Having a hard time falling asleep or getting good rest from sleeping? Screens might be the problem

Having a hard time falling asleep or getting good rest from sleeping? Screens might be the problem

Is it all that good though?

Researchers at Brigham and Women’s Hospital released a study they conducted with subjects and electronic readers. You can find it here:

http://www.brighamandwomens.org/about_bwh/publicaffairs/news/pressreleases/PressRelease.aspx?sub=0&PageID=1962

During a two week period, subjects read on an iPad for 4 hours before bed. When I initially read this I thought, “Man that is a long time” but then realized that I have been on the computer for several hours before bed and while it doesn’t happen every night, it does happen.

According to the study participants on the iPad, “took longer to fall asleep, were less sleepy in the evening, and spent less time in REM sleep.”

Less REM sleep is no bueno. Also from the study, “Participants who read from the iPad were less sleepy before bedtime, but sleepier and less alert the following morning after eight hours of sleep.” They also stated that this type of light is emitted can come from just about any electronic device including phones, computer screens etc. It is the blue light causing the problem.

Lack of good sleep can increase chance of sickness like the flu and common cold by decreasing the strength of the immune system. It also contributes to cardiovascular disease and just makes life plain miserable if left unchecked.

One software maker, f.lux, has compiled a list of studies that you can visit for yourself if you want to see the effects of blue light on people. You can find it here:

https://justgetflux.com/research.html

f.lux is a program that lowers the amount of blue light coming off a screen and makes everything appear warmer, or with more reds.

Another thing a person could do is snag a pair of orange glasses that filter out the blue light. Here is such a pair:

http://www.amazon.com/gp/product/B000USRG90/ref=as_li_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B000USRG90&linkCode=as2&tag=herbkati-20&linkId=ICGPJMPHTSBXIKE6

The other option is just turn off screens at night. I know personally getting on screens anymore than what I do at work contributes to eye strain and gives me headaches. Some of these headaches can last a few days if I don’t peel my eyes from the screen.

The most common sense answer is stop looking at screens late at night. Reading an actual book seems like a better alternative or dare I say actually go to bed. I know too often I stay up wasting time on things that don’t need time wasted on and if I find myself doing that I try to turn it off and sleep. Falling asleep on the couch or computer chair isn’t as comfortable as my bed anyway.

Merry Christmas

CIAO

What is Your Health Worth?

The answer to the above question really is priceless. Your health is one of the few things that truly affects you directly every single day. No one escapes it. Whether you feel like a million bucks or feel like someone just stomped a hole in you, you get to deal with your health and only you have the power to change it.

That’s right, only you have the power to change it. No one else can.

Sure you can visit a doctor to seek out treatment or advice, but it is you that made the decision to go, not the doctor. It is you that made the decision to take the prescribed medication. It’s you that decided to eat or not to eat something. It’s you that has control.

I thought it’d be fun to put some numbers up to look at this question. They won’t be exact, especially since everybody’s situation is different, but it will give an idea of money attached to healthcare.

Without any major hospitalizations here are a few things to consider:

If you have been diagnosed with hypertension at the age of 35 (something that isn’t uncommon) you can expect to be taking something for that, usually lisinopril is one of the first choices. You can get a 90 day supply at your local WalMart for $10. That’s $40/year. At first you’ll have a couple visits to the doc from the time you’re diagnosed as follow up to make sure you’re doing well on the medication. If you have a $35 copay that’s between $70-$105 total visits for the year, at least for the first year and assuming you go to the doctor for nothing else that year.

3 visits = $105

1 year of meds = $40

Total = $145

Subsequent years would look like this:

1-2 follow up visits/year = $35-$70

1 year of meds = $40

Total = $75-$110

Over 20 years ~ $1500-$2300

Now this is assuming a few things. First you don’t ever have problems keeping your blood pressure from going up after the initial diagnoses and treatment, which is rarely the case for most. This also assumes you have no problems with the initial medication and have to get it changed, although this wouldn’t add a whole lot.

If you’re on two blood pressure medications, this jumps to $2300-$3000 over 20 years. This of course is no mortgage but still it adds up. If you happen to be taking a beta blocker like metoprolol as one of those blood pressure medications your cholesterol might go up just enough to trigger a prescription for something like simvastatin. Add another 10 dollars a month for that one.

Simvastatin $120/year

Metoprolol (assuming the cheap immediate release) $40/year

Lisinopril $40/year

2 visits/year $70

Over 20 years ~ $5400/20 years or $270/year

If you become borderline diabetic because of the simvastatin and the metoprolol in combination or were already there and these push you over you might add some metformin into the mix for blood glucose control. Three months of twice daily metformin will run you another $40/year.

Total ~ $6200/20 years or $310/year

We’re still not even close to a mortgage, but we’re increasing.

Now we’ve only discussed the financial part of all of this. Metoprolol is also going to sap some of your energy because it prevents chemicals like epinephrine and norepinephrine from having their full phsyiological effect. What does this mean? Well as I said it will probably sap some of your energy depending on the dose. It won’t necessarily make you drowsy, but it will make you tired easily.

Simvstatin as well as others have the tendency to cause muscle pain and weakness. I’ve had members of my family experience this, and I’ve experienced it myself. Many older folks attribute this to older age. I call nonsense. Yes we do degenerate as time goes on but my own grandmother was able to walk again in her 80’s after stopping simvastatin. It really can be that bad for some.

I’ve talked to others who’ve told me about lisinopril or losartan (angiotensin converting enzyme inhibitor and angiotensin receptor blocker respectively) who describe feeling like people who are on metoprolol do, with a lack of energy. Not enough to keep them from being out and about, but enough to make a few dread having to do anything because they have no energy to do it with.

Instead of medications doing some physical activity 2-3 times per week and backing off on total calories every day will likely achieve what most medications are seeking to achieve. Going on a brisk walk and having only one plate at dinner are two things that go a long way in improving health.

Think about it for just a moment; if you have only 1 plate, or maybe a smaller portion, you save on food and caloric intake. Eating till you have to undo your pants button is ok on Thanksgiving, Christmas and your birthday,…ok and maybe 1-2 other times/year but that’s it. If having to loosen your belt regularly after eating is a habit I can tell you that the belt is only going to get tighter and tighter.

Taking a brisk walk or going on a hike or riding the bike or whatever it is you might find joy in will get your heart pumping and muscles working. Blood pressure will go down as some of the fat comes off and you will feel more energized and not get out of breath while doing things you love.

I personally wish I could go back to Tahiti now that my heart is conditioned better to be able to stay underneath the surface while snorkeling with the fish longer.

Having a plan and sticking to it will pay off dividens in the long run. It’s sad to see people who take their medications exactly as the doctor directs and have been doing so for a long time only to see them deteriorate. Don’t be a statistic. Change now! Plan for the future, however long that may be, and make a difference in your life.

I know the amount of money that we went over above isn’t a lot in the grand scheme of things, but that’s assuming you take the meds and nothing ever happens and you never deteriorate any further than where you are. Not having to deal with the side effects and not having to visit the doctor is worth going biking and feeling awesome at the same time.

CIAO