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Why it’s a bad idea to mix alcohol with some medications

<p><em><a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jasmine-lee-1507733">Jasmine Lee</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/kellie-charles-1309061">Kellie Charles</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>Anyone who has drunk alcohol will be familiar with how easily it can lower your social inhibitions and let you do things you wouldn’t normally do.</p> <p>But you may not be aware that mixing certain medicines with alcohol can increase the effects and put you at risk.</p> <p>When you mix alcohol with medicines, whether prescription or over-the-counter, the medicines can increase the effects of the alcohol or the alcohol can increase the side-effects of the drug. Sometimes it can also result in all new side-effects.</p> <h2>How alcohol and medicines interact</h2> <p>The chemicals in your brain maintain a delicate balance between excitation and inhibition. Too much excitation can lead to <a href="https://www.medicalnewstoday.com/articles/324330">convulsions</a>. Too much inhibition and you will experience effects like sedation and depression.</p> <p><iframe id="JCh01" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/JCh01/1/" width="100%" height="400px" frameborder="0"></iframe></p> <p>Alcohol works by increasing the amount of inhibition in the brain. You might recognise this as a sense of relaxation and a lowering of social inhibitions when you’ve had a couple of alcoholic drinks.</p> <p>With even more alcohol, you will notice you can’t coordinate your muscles as well, you might slur your speech, become dizzy, forget things that have happened, and even fall asleep.</p> <p>Medications can interact with alcohol to <a href="https://awspntest.apa.org/record/2022-33281-033">produce different or increased effects</a>. Alcohol can interfere with the way a medicine works in the body, or it can interfere with the way a medicine is absorbed from the stomach. If your medicine has similar side-effects as being drunk, those <a href="https://www.drugs.com/article/medications-and-alcohol.html#:%7E:text=Additive%20effects%20of%20alcohol%20and,of%20drug%20in%20the%20bloodstream.">effects can be compounded</a>.</p> <p>Not all the side-effects need to be alcohol-like. Mixing alcohol with the ADHD medicine ritalin, for example, can <a href="https://www.healthline.com/health/adhd/ritalin-and-alcohol#side-effects">increase the drug’s effect on the heart</a>, increasing your heart rate and the risk of a heart attack.</p> <p>Combining alcohol with ibuprofen can lead to a higher risk of stomach upsets and stomach bleeds.</p> <p>Alcohol can increase the break-down of certain medicines, such as <a href="https://www.sciencedirect.com/science/article/abs/pii/S0149763421005121?via%3Dihub">opioids, cannabis, seizures, and even ritalin</a>. This can make the medicine less effective. Alcohol can also alter the pathway of how a medicine is broken down, potentially creating toxic chemicals that can cause serious liver complications. This is a particular problem with <a href="https://australianprescriber.tg.org.au/articles/alcohol-and-paracetamol.html">paracetamol</a>.</p> <p>At its worst, the consequences of mixing alcohol and medicines can be fatal. Combining a medicine that acts on the brain with alcohol may make driving a car or operating heavy machinery difficult and lead to a serious accident.</p> <h2>Who is at most risk?</h2> <p>The effects of mixing alcohol and medicine are not the same for everyone. Those most at risk of an interaction are older people, women and people with a smaller body size.</p> <p>Older people do not break down medicines as quickly as younger people, and are often on <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/medicines-use-older-people/61-polypharmacy-75-years-and-over#:%7E:text=is%20this%20important%3F-,Polypharmacy%20is%20when%20people%20are%20using%20five%20or%20more%20medicines,take%20five%20or%20more%20medicines.">more than one medication</a>.</p> <p>Older people also are more sensitive to the effects of medications acting on the brain and will experience more side-effects, such as dizziness and falls.</p> <p>Women and people with smaller body size tend to have a higher blood alcohol concentration when they consume the same amount of alcohol as someone larger. This is because there is less water in their bodies that can mix with the alcohol.</p> <h2>What drugs can’t you mix with alcohol?</h2> <p>You’ll know if you can’t take alcohol because there will be a prominent warning on the box. Your pharmacist should also counsel you on your medicine when you pick up your script.</p> <p>The most common <a href="https://adf.org.au/insights/prescription-meds-alcohol/">alcohol-interacting prescription medicines</a> are benzodiazepines (for anxiety, insomnia, or seizures), opioids for pain, antidepressants, antipsychotics, and some antibiotics, like metronidazole and tinidazole.</p> <p>It’s not just prescription medicines that shouldn’t be mixed with alcohol. Some over-the-counter medicines that you shouldn’t combine with alcohol include medicines for sleeping, travel sickness, cold and flu, allergy, and pain.</p> <p>Next time you pick up a medicine from your pharmacist or buy one from the local supermarket, check the packaging and ask for advice about whether you can consume alcohol while taking it.</p> <p>If you do want to drink alcohol while being on medication, discuss it with your doctor or pharmacist first.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223293/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/nial-wheate-96839"><em>Nial Wheate</em></a><em>, Associate Professor of the School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jasmine-lee-1507733">Jasmine Lee</a>, Pharmacist and PhD Candidate, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/kellie-charles-1309061">Kellie Charles</a>, Associate Professor in Pharmacology, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, Associate Professor of Pharmacology, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-its-a-bad-idea-to-mix-alcohol-with-some-medications-223293">original article</a>.</em></p>

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Drinking alcohol this Christmas and New Year? These medicines really don’t mix

<p><em><a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>A glass or two of champagne with Christmas lunch. A cool crisp beer at the beach. Some cheeky cocktails with friends to see in the New Year. There seem to be so many occasions to unwind with an alcoholic drink this summer.</p> <p>But if you’re taking certain medications while drinking alcohol, this can affect your body in a number of ways. Drinking alcohol with some medicines means they may not work so well. With others, you risk a life-threatening overdose.</p> <p>Here’s what you need to know if you’re taking medication over summer and plan to drink.</p> <h2>Why is this a big deal?</h2> <p>After you take a medicine, it travels to the stomach. From there, your body shuttles it to the liver where the drug is metabolised and broken down before it goes into your blood stream. Every medicine you take is provided at a dose that takes into account the amount of metabolism that occurs in the liver.</p> <p>When you drink alcohol, this is also broken down in the liver, and it can affect how much of the drug is metabolised.</p> <p>Some medicines are metabolised <em>more</em>, which can mean not enough reaches your blood stream to be effective.</p> <p>Some medicines are metabolised <em>less</em>. This means you get a much higher dose than intended, which could lead to an overdose. The effects of alcohol (such as sleepiness) can act in addition to similar effects of a medicine.</p> <p>Whether or not you will have an interaction, and what interaction you have, depends on many factors. These include the medicine you are taking, the dose, how much alcohol you drink, your age, genes, sex and overall health.</p> <p>Women, older people and people with liver issues are more likely to have a drug interaction with alcohol.</p> <h2>Which medicines don’t mix well with alcohol?</h2> <p>Many medicines interact with alcohol regardless of whether they are prescribed by your doctor or bought over the counter, such as <a href="https://www.drugs.com/article/herbal-supplements-alcohol.html">herbal medicines</a>.</p> <p><strong>1. Medicines + alcohol = drowsiness, coma, death</strong></p> <p>Drinking alcohol and taking a medicine that depresses the <a href="https://adf.org.au/drug-facts/depressants/">central nervous system</a> to reduce arousal and stimulation can have additive effects. Together, these can make you extra drowsy, slow your breathing and heart rate and, in extreme cases, lead to coma and death. These effects are more likely if you use more than one of this type of medicine.</p> <p>Medicines to look out for include those for depression, anxiety, schizophrenia, pain (except <a href="https://www.nps.org.au/australian-prescriber/articles/alcohol-and-paracetamol">paracetamol</a>), sleep disturbances (such as insomnia), allergies, and colds and flu. It’s best not to drink alcohol with these medicines, or to keep your alcohol intake to a minimum.</p> <p><strong>2. Medicines + alcohol = more effects</strong></p> <p>Mixing alcohol with some medicines increases the effect of those medicines.</p> <p>One example is with the sleeping tablet zolpidem, which is <a href="https://www.tga.gov.au/news/product-recalls/zolpidem-stilnox">not to be taken with alcohol</a>. Rare, but serious, side effects are strange behaviour while asleep, such as sleep-eating, sleep-driving or sleep-walking, which are more likely with alcohol.</p> <p><strong>3. Medicines + craft beer or home brew = high blood pressure</strong></p> <p>Some types of medicines only interact with some types of alcohol.</p> <p>Examples include some medicines for depression, such as phenelzine, tranylcypromine and moclobemide, the antibiotic linezolid, the Parkinson’s drug selegiline, and the cancer drug procarbazine.</p> <p>These so-called <a href="https://www.mydr.com.au/medicine/monoamine-oxidase-inhibitors-maois-for-depression/">monoamine oxidase inhibitors</a> <a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0020/145802/oncol_maoi.pdf">only interact with</a> some types of boutique and artisan beers, beers with visible sediment, Belgian, Korean, European and African beers, and home-made beers and wine.</p> <p>These types of alcohol contain high levels of tyramine, a naturally occurring substance usually broken down by your body that doesn’t ordinarily cause any harm.</p> <p>However, monoamine oxidase inhibitors prevent your body from breaking down tyramine. This increases levels in your body and can cause your blood pressure to rise to dangerous levels.</p> <p><strong>4. Medicines + alcohol = effects even after you stop drinking</strong></p> <p>Other medicines interact because they affect the way your body breaks down alcohol.</p> <p>If you drink alcohol while using such medicines you may you feel nauseous, vomit, become flushed in the face and neck, feel breathless or dizzy, your heart may beat faster than usual, or your blood pressure may drop.</p> <p>This can occur even after you stop treatment, then drink alcohol. For example, if you are taking metronidazole you should avoid alcohol both while using the medicine and for at least 24 hours after you stop taking it.</p> <p>An example of where alcohol changes the amount of the medicine or related substances in the body is acitretin. This medication is used to treat skin conditions such as severe psoriasis and to prevent skin cancer in people who have had an organ transplant.</p> <p>When you take acitretin, it changes into another substance – <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&amp;id=CP-2017-CMI-02034-1&amp;d=20221221172310101">etretinate</a> – before it is removed from your body. Alcohol increases the amount of etretinate in your body.</p> <p>This is especially important as etretinate can cause birth defects. To prevent this, if you are a woman of child-bearing age you should avoid alcohol while using the medicine and for two months after you stop taking it.</p> <h2>Myths about alcohol and medicines</h2> <p><strong>Alcohol and birth control</strong></p> <p>One of the most common myths about medicines and alcohol is that you can’t drink while using <a href="https://youly.com.au/blog/sexual-reproductive-health/does-alcohol-make-the-pill-less-effective/">the contraceptive pill</a>.</p> <p>It is generally safe to use alcohol with the pill as it <a href="https://www.healthline.com/health/womens-health/birth-control-and-alcohol#:%7E:text=There's%20a%20bit%20of%20good,a%20less%20effective%20birth%20control.">doesn’t directly affect</a> how well birth control works.</p> <p>But the pill is most effective when taken at the same time each day. If you’re drinking heavily, you’re more likely to forget to do this the next day.</p> <p>Alcohol can also make some people nauseous and vomit. If you vomit within three hours of taking the pill, it will not work. This increases your risk of pregnancy.</p> <p>Contraceptive pills can also affect your response to alcohol as the hormones they contain can change the way your body <a href="https://americanaddictioncenters.org/alcoholism-treatment/birth-control">removes alcohol</a>. This means you can get drunk faster, and stay drunk for longer, than you normally would.</p> <p><strong>Alcohol and antibiotics</strong></p> <p>Then there’s the myth about not mixing alcohol with any <a href="https://theconversation.com/mondays-medical-myth-you-cant-mix-antibiotics-with-alcohol-4407">antibiotics</a>. This only applies to <a href="https://www.healthdirect.gov.au/medicines/medicinal-product/aht,21161/metronidazole">metronidazole</a> and <a href="https://www.healthdirect.gov.au/medicines/brand/amt,1011571000168100/linezolid-apo">linezolid</a>.</p> <p>Otherwise, it is generally safe to use alcohol with antibiotics, as alcohol does not affect how well they work.</p> <p>But if you can, it is best to avoid alcohol while taking antibiotics. Antibiotics and alcohol have similar side effects, such as an upset stomach, dizziness and drowsiness. Using the two together means you are more likely to have these side effects. Alcohol can also reduce your energy and increase how long it takes for you to recover.</p> <h2>Where can I go for advice?</h2> <p>If you plan on drinking alcohol these holidays and are concerned about any interaction with your medicines, don’t just stop taking your medicines.</p> <p>Your pharmacist can advise you on whether it is safe for you to drink based on the medicines you are taking, and if not, provide advice on alternatives.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/196646/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/nial-wheate-96839"><em>Nial Wheate</em></a><em>, Associate Professor of the Sydney Pharmacy School, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, Associate Lecturer, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drinking-alcohol-this-christmas-and-new-year-these-medicines-really-dont-mix-196646">original article</a>.</em></p>

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Taking an antidepressant? Mixing it with other medicines – including some cold and flu treatments – can be dangerous

<p><em><a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p>In the depths of winter we are more at risk of succumbing to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522168/">viral respiratory infections</a> – from annoying sore throat, common cold and sinusitis, to the current resurgence of respiratory syncytial virus (RSV), influenza and COVID.</p> <p>Symptoms of upper respiratory tract infection range in severity. They can include fever, chills, muscle or body aches, cough, sore throat, runny or stuffy nose, earache, headache, and fatigue. Most antibiotics target bacteria so are <a href="https://pubmed.ncbi.nlm.nih.gov/32495003/">not effective</a> for viral infections. Many people seek relief with over-the-counter medicines.</p> <p>While evidence varies, guidelines suggest medicines taken by mouth (such as cough syrups or cold and flu tablets) have a <a href="https://pubmed.ncbi.nlm.nih.gov/25420096/">limited but potentially positive</a> short-term role for managing upper respiratory infection symptoms in adults and children older than 12. These include:</p> <ul> <li>paracetamol or ibuprofen for pain or fever</li> <li>decongestants such as phenylephrine or pseudoephedrine</li> <li>expectorants and mucolytics to thin and clear mucus from upper airways</li> <li>dry cough suppressants such as dextromethorphan</li> <li>sedating or non-sedating antihistamines for runny noses or watery eyes.</li> </ul> <p>But what if you have been prescribed an antidepressant? What do you need to know before going to the pharmacy for respiratory relief?</p> <h2>Avoiding harm</h2> <p>An audit of more than 5,000 cough-and-cold consumer enquiries to an Australian national medicine call centre found questions frequently related to drug-drug interactions (29%). An 18-month analysis showed 20% of calls <a href="https://pubmed.ncbi.nlm.nih.gov/26590496/">concerned</a> potentially significant interactions, particularly with antidepressants.</p> <p>Australia remains in the “<a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-%20prescriptions#Prescriptionsbytype">top ten</a>” antidepressant users in the <a href="https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_PHMC">OECD</a>. More than <a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions">32 million</a> antidepressant prescriptions are dispensed on the Pharmaceutical Benefits Scheme each year.</p> <p>Antidepressants are commonly prescribed to manage symptoms of anxiety or depression but are also used in chronic pain and incontinence. They are classified primarily by how they affect chemical messengers in the nervous system.</p> <p>These classes are:</p> <ul> <li><strong>selective serotonin reuptake inhibitors (SSRI)</strong> such as fluoxetine, escitalopram, paroxetine and sertraline</li> <li><strong>serotonin and noradrenaline reuptake inhibitors (SNRI)</strong> such as desvenlafaxine, duloxetine and venlafaxine</li> <li><strong>tricyclic antidepressants (TCA)</strong> such as amitriptyline, doxepin and imipramine</li> <li><strong>monoamine oxidase inhibitors (MAOI)</strong> such as tranylcypromine</li> <li><strong>atypical medicines</strong> such as agomelatine, mianserin, mirtazapine, moclobemide, reboxetine and vortioxetine</li> <li><strong>complementary medicines</strong> including St John’s wort, S-adenosyl methionine (SAMe) and L-tryptophan</li> </ul> <p>Medicines within the same class of antidepressants have similar actions and side-effect profiles. But the molecular differences of individual antidepressants mean they may have different interactions with medicines taken at the same time.</p> <h2>Types of drug interactions</h2> <p>Drug interactions can be:</p> <ul> <li><strong>pharmacokinetic</strong> – what the body does to a drug as it moves into, through and out of the body. When drugs are taken together, one may affect the absorption, distribution, metabolism or elimination of the other</li> <li><strong>pharmacodynamic</strong> – what a drug does to the body. When drugs are taken together, one may affect the action of the other. Two drugs that independently cause sedation, for example, may result in excessive drowsiness if taken together.</li> </ul> <p>There are many <a href="https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/pnp.429">potential interactions</a> between medications and antidepressants. These include interactions between over-the-counter medicines for upper respiratory symptoms and antidepressants, especially those taken orally.</p> <p>Concentrations of nasal sprays or inhaled medicines are generally lower in the blood stream. That means they are less likely to interact with other medicines.</p> <h2>What to watch for</h2> <p>It’s important to get advice from a pharmacist before taking any medications on top of your antidepressant.</p> <p>Two symptoms antidepressant users should monitor for shortly after commencing a cough or cold medicine are central nervous system effects (irritability, insomnia or drowsiness) and effects on blood pressure.</p> <p>For example, taking a selective SSRI antidepressant and an oral decongestant (such as pseudoephedrine or phenylephrine) can cause irritability, insomnia and affect blood pressure.</p> <p>Serotonin is a potent chemical compound produced naturally for brain and nerve function that can also constrict blood vessels. Medicines that affect serotonin are common and include most antidepressant classes, but also decongestants, dextromethorphan, St John’s wort, L-tryptophan, antimigraine agents, diet pills and amphetamines.</p> <p><a href="https://reference.medscape.com/drug-interactionchecker">Combining drugs</a> such as antidepressants and decongestants that both elevate serotonin levels can cause irritability, headache, insomnia, diarrhoea and blood pressure effects – usually increased blood pressure. But some people experience orthostatic hypotension (low blood pressure on standing up) and dizziness.</p> <p>For example, taking both a serotonin and SNRI antidepressant and dextromethorphan (a cough suppressant) can add up to high serotonin levels. This can also occur with a combination of the complementary medicine St John’s Wort and an oral decongestant.</p> <p>Where serotonin levels are too high, <a href="https://pubmed.ncbi.nlm.nih.gov/15666281/">severe symptoms</a> such as confusion, muscle rigidity, fever, seizures and even death have been reported. Such symptoms are rare but if you notice any of these you should stop taking the cold and flu medication straight away and seek medical attention.</p> <h2>Ways to avoid antidepressant drug interactions</h2> <p>There are a few things we can do to prevent potentially dangerous interactions between antidepressants and cold and flu treatments.</p> <p><strong>1. Better information</strong></p> <p>Firstly, there should be more targeted, consumer-friendly, <a href="https://www.webmd.com/interaction-checker/default.htm">online drug interaction information</a> available for antidepressant users.</p> <p><strong>2. Prevent the spread of viral infections as much as possible</strong></p> <p>Use the non-drug strategies that have worked well for COVID: regular hand washing, good personal hygiene, social distancing, and facemasks. Ensure adults and children are up to date with immunisations.</p> <p><strong>3. Avoid potential drug interactions with strategies to safely manage symptoms</strong></p> <p>Consult your pharmacist for strategies most appropriate for you and only use cold and flu medications while symptoms persist:</p> <ul> <li>treat muscle aches, pain, or a raised temperature with analgesics such as paracetamol or ibuprofen</li> <li>relieve congestion with a nasal spray decongestant</li> <li>clear mucus from upper airways with expectorants or mucolytics</li> <li>dry up a runny nose or watery eyes with a non-sedating antihistamine.</li> </ul> <p>Avoid over-the-counter cough suppressants for an irritating dry cough. Use a simple alternative such as honey, steam inhalation with a few drops of eucalyptus oil or a non-medicated lozenge instead.</p> <p><strong>4. Ask whether your symptoms could be more than the common cold</strong></p> <p>Could it be influenza or COVID? Seek medical attention if you are concerned or your symptoms are not improving. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208662/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and as Associate Professor (Clinical), <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/taking-an-antidepressant-mixing-it-with-other-medicines-including-some-cold-and-flu-treatments-can-be-dangerous-208662">original article</a>.</em></p>

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People with long COVID continue to experience medical gaslighting more than 3 years into the pandemic

<p><em><a href="https://theconversation.com/profiles/simran-purewal-1405366">Simran Purewal</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kaylee-byers-766226">Kaylee Byers</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kayli-jamieson-1431392">Kayli Jamieson</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>, and <a href="https://theconversation.com/profiles/neda-zolfaghari-1431577">Neda Zolfaghari</a>, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a></em></p> <p>It’s increasingly clear that the <a href="https://www.worldometers.info/coronavirus/country/canada/">SARS-CoV-2 virus is not going away</a> any time soon. And for some patients, their symptoms haven’t gone away either.</p> <p>In January 2023, our team of researchers at the <a href="https://pipps.ca/">Pacific Institute on Pathogens, Pandemics and Society</a> published a <a href="https://pipps.cdn.prismic.io/pipps/bd160219-3281-4c5d-b8be-57c301e7f99b_Long+Covid+Brief+Feb+2023.pdf">research brief</a> about how people seek out information about long COVID. The brief was based on a scoping review, a type of study that assesses and summarizes available research. Our interdisciplinary team aims to understand the experiences of people with long COVID in order to identify opportunities to support health care and access to information.</p> <h2>Lingering long COVID</h2> <p>Long COVID (also called <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms/post-covid-19-condition.html">Post COVID-19 condition</a>) is an illness that occurs after infection with COVID-19, lasting weeks to months, and even years. First coined by a <a href="https://doi.org/10.1016%2Fj.socscimed.2020.113426">patient on Twitter</a>, the term also represents a collective movement of people experiencing the long-term effects of COVID-19 and advocating for care. <a href="https://science.gc.ca/site/science/sites/default/files/attachments/2023/Post-Covid-Condition_Report-2022.pdf">Around 15 per cent</a> of adults who have had COVID still have symptoms after three months or more.</p> <p>Long COVID affects systems <a href="https://doi.org/10.1016/j.socscimed.2021.114619">throughout the body</a>. However, symptom fluctuations and limited diagnostic tools make it challenging for health-care providers to diagnose, especially with <a href="https://doi.org/10.1038/s41579-022-00846-2">over 200 symptoms</a> that may present in patients. Perhaps because long COVID presents itself in many different ways, the illness has <a href="https://doi.org/10.1016/j.socscimed.2021.114619">been contested</a> across the medical field.</p> <p>To identify opportunities to reduce barriers to long COVID care, our team has explored how patients and their caregivers access <a href="https://pipps.cdn.prismic.io/pipps/bd160219-3281-4c5d-b8be-57c301e7f99b_Long+Covid+Brief+Feb+2023.pdf">information about long COVID</a>. We have found that one of the most significant barriers faced by patients is <a href="https://doi.org/10.1177/20552076211059649">medical gaslighting</a> by the people they have turned to for help.</p> <h2>Lack of validation leads to stigma</h2> <p><a href="https://doi.org/10.1136/bmj.o1974">Medical gaslighting</a> occurs when health-care practitioners dismiss or falsely blame patients for their symptoms. While new information about long COVID has become more readily available, some patients continue to face gaslighting and feel that their symptoms are <a href="https://doi.org/10.1016%2Fj.ssmqr.2022.100177">treated less seriously</a> by some health-care professionals.</p> <p>This dismissal can <a href="https://doi.org/10.1111/hex.13602">erode trust</a> in the health-care system and can also lead to <a href="https://doi.org/10.1111/hex.13518">stigma and shame</a>.</p> <p>Preliminary findings from our ongoing study with long COVID patients indicate that, when medical practitioners do not validate a patient’s condition, this extends into community networks of family and friends who may also dismiss their symptoms, contributing to further stigmatization at home.</p> <p>Medical gaslighting can present additional barriers to treatment, such as not being referred to specialists or long COVID clinics. This can, in turn, compound other symptoms such as fatigue, and <a href="https://doi.org/10.1192/bjo.2022.38">exacerbate the psychological symptoms of long COVID</a>, such as depression and anxiety.</p> <p>Medical gaslighting isn’t new. It has been documented by patients with other chronic conditions, such as <a href="https://doi.org/10.5772/intechopen.107936">myalgic encephalomyelitis or chronic fatigue syndrome</a>. And while this is common for patients with <a href="https://doi.org/10.1001/amajethics.2021.512">non-visible illnesses</a>, medical gaslighting is more commonly experienced by <a href="https://doi.org/10.1111/1467-9566.13367">women and racialized people</a>.</p> <p>Long COVID patients also note gender biases, as women with prolonged symptoms feel they are not believed. This is particularly worrisome, as studies have found that <a href="https://doi.org/10.1001/jama.2020.17709">women are disproportionately more likely to experience long COVID</a>.</p> <h2>Where do we go from here?</h2> <p>While long COVID information is constantly shifting, it’s clear that patients face many barriers, the first of which is having their illness minimized or disregarded by others. To ensure that patients have access to compassionate care, we suggest:</p> <p><strong>1. Educating physicians on long COVID</strong></p> <p>Because definitions of long COVID, and its presentation, vary widely, primary care physicians need support to recognize and acknowledge the condition. General practitioners (GPs) must also provide patients with information to help manage their symptoms. This requires actively listening to patients, documenting symptoms and <a href="https://doi.org/10.1136/bmj.m3489">paying close attention to symptoms that need further attention</a>.</p> <p>Training physicians on the full range of symptoms and referring patients to available supports would reduce stigma and assist physicians by reducing their need to gather information themselves.</p> <p><strong>2. Raise awareness about long COVID</strong></p> <p>To increase awareness of long COVID and reduce stigma, public health and community-based organizations must work collaboratively. This may include a public awareness and information campaign about long COVID symptoms, and making support available. Doing so has the potential to foster community support for patients and improve the mental health of patients and their caregivers.</p> <p><strong>3. Ensure information is accessible</strong></p> <p>In many health systems, GPs are <a href="https://doi.org/10.1186/s12913-019-4419-0">gatekeepers to specialists</a> and are considered trusted information sources. However, without established diagnostic guidelines, patients are left to <a href="https://doi.org/10.2196/37984">self-advocate</a> and prove their condition exists.</p> <p>Because of negative encounters with health-care professionals, patients turn to social media platforms, including long COVID <a href="https://doi.org/10.7861%2Fclinmed.2020-0962">online communities</a> on Facebook. While these platforms allow patients to validate experiences and discuss management strategies, patients should not rely only on social media given the <a href="https://doi.org/10.3389/fpubh.2022.937100">potential for misinformation</a>. As a result, it is crucial to ensure information about long COVID is multi-lingual and available in a wide range of formats such as videos, online media and physical printouts.</p> <p>The <a href="https://science.gc.ca/site/science/en/office-chief-science-advisor/initiatives-covid-19/post-covid-19-condition-canada-what-we-know-what-we-dont-know-and-framework-action">recent recommendations of the Chief Science Advisor of Canada</a> to establish diagnostic criteria, care pathways and a research framework for long COVID are a positive development, but we know patients need support now. Improving long COVID education and awareness won’t resolve all of the issues faced by patients, but they’re foundational to compassionate and evidence-based care.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/203744/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/simran-purewal-1405366">Simran Purewal</a>, Research Associate, Health Sciences, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kaylee-byers-766226">Kaylee Byers</a>, Regional Deputy Director, BC Node of the Canadian Wildlife Health Cooperative; Senior Scientist, Pacific Institute on Pathogens, Pandemics and Society, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>; <a href="https://theconversation.com/profiles/kayli-jamieson-1431392">Kayli Jamieson</a>, Master's Student in Communication, Research Assistant for Pacific Institute on Pathogens, Pandemics and Society, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a>, and <a href="https://theconversation.com/profiles/neda-zolfaghari-1431577">Neda Zolfaghari</a>, Project Coordinator, Pacific Institute on Pathogens, Pandemics and Society, and the Pandemics &amp; Borders Project, <a href="https://theconversation.com/institutions/simon-fraser-university-1282">Simon Fraser University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/people-with-long-covid-continue-to-experience-medical-gaslighting-more-than-3-years-into-the-pandemic-203744">original article</a>.</em></p>

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9 medical reasons your short-term memory is getting worse

<p><strong>What is short-term memory?</strong></p> <p>Short-term memory is the type of memory you need to accomplish your immediate goals, explains Dr Patrick Lyden, chair of the department of neurology at Cedars-Sinai Hospital. That may be working your way through tasks during the workday, remembering someone’s name, email, or phone number, or recalling where you tossed your keys when you got home.</p> <p><strong>Where is it located in the brain?</strong></p> <p>When someone rattles off their phone number, you file it away in brain circuits that include the hippocampus (your memory centre) and the amygdala (your emotional hub). Depending on how important the short-term memory item may be (your address, someone you call all the time), it can be converted into long-term memory, says Dr Lyden.</p> <p><strong>How does short-term memory work?</strong></p> <p>Short-term memory isn’t just about being able to quickly recall new info; there are three phases. “You have to register the information, store the information, and retrieve the information,” says Dr Lyden. Registering means that you’re paying attention in the first place. Storing the info means you’ve filed it away in your brain. Retrieval is the ability to access the memory again. Any of these steps can break down, he says.</p> <p><strong>Is your memory okay?</strong></p> <p>Many people assume they have a memory problem when the explanation is something else entirely, says Dr Lyden. Maybe you’re not paying attention because you’re gazing at your phone or texting, for example. The first step to figuring out if something is going on is to “pay closer attention,” he says. Repeat the new information three times to commit it to memory.</p> <p><strong>When it may be time to worry</strong></p> <p>If you can’t pass the “pay attention test” despite repeating the information, your next step, advises Dr Lyden, is to determine if your problem is storing new memories or retrieving them. If you’re having a problem remembering a new acquaintance’s name, ask them to give you three choices – like Carrie, Lauren, or Janet. If your problem is storing new memories, you won’t be able to remember. But if your problem is retrieval, you’ll remember that her name is Janet once you hear the correct name.</p> <p>Having trouble with retrieving a short-term memory isn’t as serious as being unable to store them. “The storage problem is a serious problem, and you should see a neurologist,” he says.</p> <p><strong>Inactivity</strong></p> <p>Blood flow is good for your brain – it keeps it young. “Exercising boosts blood flow to your brain. If you stay active, you’ll have a better memory,” says Dr Daniel G. Amen, author of <em>Memory Rescue: Supercharge Your Brain, Reverse Memory Loss, and Remember What Matters Most</em>. Dr Lyden suggests daily exercise and it doesn’t have to be intense. “A one-kilometre run daily is better than a 10-kilometre run one day a week,” he says.</p> <p><strong>Substance abuse</strong></p> <p>According to Dr Amen, marijuana a toxin that impairs memory. “Marijuana lowers every area of the brain and ages it. On average, pot smokers have brains three years older than non-smokers,” he says. Alcohol abuse can also harm your memory.</p> <p><strong>Mental health conditions</strong></p> <p>People tend to miss their own depression. But if you’re suffering from depression, anxiety, or chronic stress, get help or your memory can also pay the price. “These conditions may all hurt the brain,” says Dr Amen. Getting relief will not only improve your life and outlook but save your brain.</p> <p><strong>Lack of sleep</strong></p> <p>When considering short-term memory loss causes, poor sleep is a big one. “If you don’t sleep seven hours a night or more, you’ll be in trouble. Your brain cleans itself at night. When you don’t get enough, it’s like the garbage collectors didn’t come to clean up,” says Dr Amen.</p> <p><strong>Dementia</strong></p> <p>Before you panic, there’s some good news: “The vast majority of people who are healthy will not have a degenerative neurological condition causing short-term memory loss,” says Dr Lyden. But dementia or Alzheimer’s is a possibility in some groups. If you’re over 60 and have risk factors like diabetes, high blood pressure, or obesity, then you may be more prone to problems and need to be evaluated, he says.</p> <p><strong>Medication</strong></p> <p>If you lead a healthy lifestyle, eat right, exercise, and go easy on alcohol and other substances that can harm memory, yet you still feel like your memory if failing, talk to your doctor about your medications – prescription and over-the-counter, advises Dr Lyden. Cholesterol drugs, painkillers, high blood pressure pills, and sleeping pills are among the drugs that can trigger memory issues.</p> <p><strong>Hypothyroidism</strong></p> <p>When you have an under-active thyroid, everything in your body runs slower. Your digestion will slow and you can become constipated; cell growth slows and can lead to hair loss; your metabolism becomes sluggish, triggering weight gain. And you may be plagued by muddied thinking or forgetfulness. Often, medication to restore thyroid hormones can help alleviate symptoms and help you feel better all over.</p> <p><strong>A poor diet</strong></p> <p>Inflammation is bad for your body and your brain. “The higher the inflammation levels in your body, the worse your memory will be,” says Dr Amen. Eating an anti-inflammatory diet, like the Mediterranean diet, and avoiding foods that increase it (highly processed foods, loads of sugar) is key. He also recommends taking fish oil and probiotics.</p> <p><strong>Lyme disease</strong></p> <p>Lyme disease is transmitted through a tick bite, and causes early symptoms like fever, chills, headache, and fatigue, according to the Centers for Disease Control and Prevention (CDC). Later on, without treatment, some people also may notice short-term memory problems. Dr Amen points out this may include trouble with attention, focus, and organisation. Keep in mind that the types of tick that carry the bacteria are not native to Australia and it’s not likely you can catch Lyme disease in Australia.</p> <p><strong>When to seek help</strong></p> <p>Along with the self-test mentioned earlier, think about how you perceive your short-term memory. Ask yourself: Is it getting progressively worse? Is it worse than 10 years ago? Are other people noticing a problem? “Those are things you should take seriously,” says Dr Amen.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/9-medical-reasons-your-short-term-memory-is-getting-worse-2?pages=1" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

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Which medicines don’t go well with flying?

<p>Every day, <a href="http://www.iata.org/pressroom/pr/Pages/2012-12-06-01.aspx">more than 10 million people</a> take a flight somewhere in the world. While flying is relatively safe, the unique environmental conditions can put passengers at risk if they’re taking certain medications.</p> <p>These include any hormone-based drugs, like the contraceptive pill and some fertility medicines, and drugs used to prevent heart attack and stroke. Antihistamines should also not be used to help passengers sleep during a flight.</p> <h2>What makes flying different from other forms of travel?</h2> <p>While flying is <a href="https://theconversation.com/whats-most-likely-to-kill-you-measuring-how-deadly-our-daily-activities-are-72505">one of the safest forms of travel</a>, there are specific risks that come with air travel, regardless of the length of the flight. </p> <p>Passenger planes are typically pressurised to the same atmospheric conditions that are found at 10,000 feet altitude. <a href="https://www.ncbi.nlm.nih.gov/pubmed/6823572">At that level</a>, <a href="https://www.higherpeak.com/altitudechart.html">the effective oxygen level is only 14.3%</a>, which is much lower than the 20.9% found at ground level.</p> <p>An additional risk is reduced blood flow from a lack of movement and sitting in cramped conditions, unless of course you’re fortunate enough to be in business or first class. And finally, dehydration is also a common side effect of flying due to the lack of humidity in the air.</p> <p>When these conditions are combined, it results in an increased risk of <a href="https://www.healthdirect.gov.au/deep-vein-thrombosis">deep vein thrombosis</a>, which is also known as DVT. This is a type of blood clot that occurs in the veins deep in the body and occurs most often in the legs. The development of a blood clot can result in blocked blood flow to the lungs, heart, or brain, which in turn can cause a heart attack or stroke.</p> <h2>Contraceptive pill and other hormone-based medicines</h2> <p>Given the inherent risk of a blood clot when flying, a passenger should use with caution any medication that can further increase the risk of a clot.</p> <p>Some brands of contraceptive for women (tablet or implant formulation) are <a href="http://www.theaustralian.com.au/national-affairs/health/new-bloodclot-alerts-added-to-diane35-eds-product-information/news-story/eaa0b596541a760e9c6cf89b37900c42">known to increase the chances of a blood clot</a>, although the overall increase in risk is small. While it’s thought the major risk comes from the hormone <a href="http://www.healthywomen.org/condition/estrogen">estrogen</a>, <a href="http://www.cochrane.org/CD010813/FERTILREG_contraceptive-pills-and-venous-thrombosis">a review of all the medical evidence in 2014</a> showed there’s a risk of blood clot from all contraceptive medicines.</p> <p>Likewise, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hormone-replacement-therapy-hrt-and-menopause">hormone replacement therapy</a>, particularly those that include estrogen, or some fertility medicines, such as <a href="https://www.babycenter.com/0_fertility-drug-gonadotropins_6188.bc">gonadotrophins</a>, can increase the risk of a blood clot.</p> <p>If you take one of these medicines, it does not mean you cannot fly, nor that you should necessarily stop taking the drug. Many millions of women fly while taking these medicines and suffer no ill effects.</p> <p>But the risk is also increased if you have an underlying health condition that includes type II diabetes, heart disease, and prior heart attacks or strokes. As such, passengers who also take medications to help prevent heart attacks and strokes should consult their doctor or pharmacist before flying.</p> <p>If you’re at increased risk of a blood clot, then an anti-platelet medication may be suitable for you. These medicines act by stopping the blood cells from sticking together and include prescription medicines such as <a href="http://www.melbournehaematology.com.au/fact-sheets/warfarin.html">warfarin</a> and <a href="https://www.nps.org.au/australian-prescriber/articles/clopidogrel">clopidogrel</a>, and over-the-counter medicines such as <a href="https://www.healthdirect.gov.au/medicines/brand/amt,34661000168102/aspirin-low-dose-pharmacy-action">low dose aspirin</a>.</p> <h2>Antihistamines</h2> <p>Many passengers can have trouble sleeping when flying, especially on long-haul flights. Parents flying with young children can also be concerned about them not sleeping or being unsettled and annoying other passengers.</p> <p>In these instances, many will turn to <a href="https://www.healthdirect.gov.au/antihistamines">sedating antihistamines</a>, like <a href="https://www.healthdirect.gov.au/medicines/brand/amt,22661000168108/phenergan">promethazine</a> to try to induce sleep. But this is a bad option.</p> <p>The Australian Medical Association specifically recommends <a href="http://www.smh.com.au/national/australian-medical-association-warns-against-sedating-children-on-long-journeys-20150405-1mesd0.html">parents do not do this</a>, as sometimes it can have the reverse effect and make children less sleepy and more active. These types of <a href="http://www.medsafe.govt.nz/profs/PUArticles/Mar2013ChildrenAndSedatingAntihistamines.htm">antihistamines are also known to depress breathing</a>, and in the low oxygen environment of the aircraft this can be especially dangerous.</p> <p>If you feel you or another family member will need sedation when flying, don’t use an antihistamine. Consult your doctor or pharmacist for a more suitable medication. Examples include prescription sleeping tablets, such as <a href="https://sleepfoundation.org/sleep-topics/melatonin-and-sleep">melatonin</a>, or natural remedies, such as <a href="https://www.webmd.com/vitamins-supplements/ingredientmono-870-valerian.aspx?activeingredientid=870">valerian</a>.</p> <h2>What to do before and during your flight</h2> <p>Before you fly, if you’re taking any form of medication, it’s recommended you meet with your doctor or pharmacist to discuss the suitability of your medicines. They may advise you there’s little risk for you, or if there is a risk, they may recommend a different medicine for the trip or recommend a new medicine to reduce the risk of blood clots.</p> <p>During your flight, don’t take antihistamines, and reduce your chance of a blood clot by drinking lots of water, stretching in your seat, and moving about the cabin as much as is appropriate.</p> <p>Finally, the effects of alcohol can be increased when flying – so drink in moderation, and try to avoid tea, coffee, and other caffeinated drinks as these can have dehydrating effects and make it harder to sleep.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/which-medicines-dont-go-well-with-flying-90222" target="_blank" rel="noopener">The Conversation</a>. </em></p>

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“Game-changer”: Michael J Fox shares huge medical news

<p dir="ltr">Michael J Fox has shared news of a medical breakthrough into Parkinson’s disease.</p> <p dir="ltr">The 61-year-old – who was diagnosed with the disease in 1991 – was thrilled to share the news, despite suffering a “terrible year”.</p> <p dir="ltr">Fox told <a href="https://www.statnews.com/2023/04/12/michael-j-fox-parkinsons-biomarker/" target="_blank" rel="noopener"><em>Stat News</em></a> that he had broken multiple bones after a fall, including some in his hand and face, but has said that in some ways he is “feeling better”.</p> <p dir="ltr">Despite his own personal battle, the <em>Back to the Future</em> star was overjoyed to share the breakthrough in Parkinson’s research.</p> <p dir="ltr">The study – funded by Fox’s charity organisation that aims to find a cure for Parkinson’s – found that a key Parkinson's pathology can now be identified by examining spinal fluid from living patients, allowing earlier intervention.</p> <p dir="ltr">“It’s all changed. It can be known and treated early on. It’s huge,” he said</p> <p dir="ltr">“This is the thing. This is the big reward. This is the big trophy.”</p> <p dir="ltr">The findings, published in <em>The Lancet Neurology</em>, are the result of a 1,123-person study that Fox’s foundation has put hundreds of millions of dollars into since it began in 2010.</p> <p dir="ltr">An editorial in the medical journal has also called this research “a game-changer in Parkinson’s disease diagnostics, research, and treatment trials”.</p> <p dir="ltr">In late 2022 the actor opened up about his struggle with Parkinson’s in his emotional acceptance speech for the <a href="https://www.oversixty.co.nz/health/caring/michael-j-fox-reveals-more-details-about-his-struggle-with-parkinson-s" target="_blank" rel="noopener">Jean Hershel Humanitarian Award</a>.</p> <p dir="ltr">In the speech he said that the hardest part “was grappling with the certainty of the diagnosis and the uncertainty of the situation,” but has since felt relieved after an “outpouring of support” from the public and his peers.</p> <p><em>Image: Frazer Harrison for Getty Images</em></p>

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Researchers puzzled by results of anti-inflammatory medications for osteoarthritis

<p>Researchers in the US are calling for a re-evaluation of the way some well known painkillers are prescribed after research showed they may actually lead to a worsening of inflammation over time in osteoarthritis-affected knee joints.</p> <p>NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen and naproxen are designed to reduce inflammation for the estimated 2.2 million Australians suffering from the sometimes debilitating effects of osteoarthritis.</p> <p>Osteoarthritis is a degenerative condition affecting joints in the body – most commonly hips, knees, ankles, spine and hands – which results from the degradation of cartilage on the ends of bones within the joints. As the cartilage wears away, the bones rub together resulting in swelling, pain and restricted movement.</p> <p>To combat this pain and swelling, NSAIDs are commonly prescribed, however the long-term impact of this type of medication is unclear, including its effect on the progression of the condition.</p> <p>“To date, no curative therapy has been approved to cure or reduce the progression of knee osteoarthritis,” said the study’s lead author, Johanna Luitjens, from the Department of Radiology and Biomedical Imaging at the University of California, San Francisco. “NSAIDs are frequently used to treat pain, but it is still an open discussion of how NSAID use influences outcomes for osteoarthritis patients.</p> <p>Surprisingly the report says: “…the impact of NSAIDs on synovitis, or the inflammation of the membrane lining the joint, has never been analysed using MRI-based structural biomarkers.”</p> <p>The study compared 793 participants with moderate to severe osteoarthritis of the knee who did not use NSAIDs, with 277 patients who received sustained treatment with NSAIDs for more than a year. Each patient underwent Magnetic Resonance Imaging (MRI) scans of the joint, which were then repeated after four years.</p> <p>The researchers were able to assess the images for indications of inflammation and arthritis progression including cartilage thickness and composition.</p> <p>The data showed the group using NSAIDs, had worse joint inflammation and cartilage quality than those not using NSAIDs, at the time of the initial MRI scan. And the follow-up imaging showed the conditions had worsened for the NSAID group.</p> <p>“In this large group of participants, we were able to show that there were no protective mechanisms from NSAIDs in reducing inflammation or slowing down progression of osteoarthritis of the knee joint,” said Luitjens.</p> <p>According to Luitjens, the common practice of prescribing NSAIDs for osteoarthritis should be revisited as there doesn’t appear to be any evidence they have a positive impact on joint inflammation nor do they slow or prevent synovitis or degenerative changes in the joint.</p> <p>There is also a possibility that NSAIDs simply mask the pain. Despite adjusting the study’s model for individual levels of patient physical activity, “patients who have synovitis and are taking pain-relieving medications may be physically more active due to pain relief, which could potentially lead to worsening of synovitis,” said Luitjens.</p> <p>Luitjens hopes future studies will better characterise NSAIDs and their impact on osteoarthritic inflammation. With one in three people over the age of 75 in Australia suffering from osteoarthritis and an estimated one in 10 women and one in 16 men set to develop it in the future, unlocking treatment options for this crippling condition is an imperative.</p> <p><strong>This article originally appeared on <a href="https://cosmosmagazine.com/science/osteoarthritis-puzzled-antiinflammatory/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Clare Kenyon.</strong></p> <p><em>Image: Shutterstock</em></p>

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10 items you MUST carry in your travel medical kit

<p>Health concerns are the last thing you want to be dealing with when on holidays, but unfortunately accidents can still happen when we are travelling.</p> <p>This is why a travel medical kit is one of the most important things you will pack.</p> <p>From simple first aid measures to equipment that will help you in instances where something more serious is occurring, a well-stocked travel medical kit is the hallmark of every sensible traveller. Here are 10 items you must include in your travel medical kit.  </p> <p>We’ve also included some additional tips at the bottom of the article.</p> <p><strong>1. Adhesive dressings (Band-Aids)</strong> – When travelling we’re particularly susceptible to minor cuts. Adhesive dressings ensure these nicks and scrapes don’t get infected.</p> <p><strong>2. Antihistamine</strong> – These are essential, especially if you’re someone who suffers from allergies, as they allow you to control allergic reactions in foreign environments.</p> <p><strong>3. Bandages</strong> – Use bandages to create support structures for strained limbs, reduce swellings, hold dressings in place, and even as a makeshift sling.</p> <p><strong>4. Instant cold pack</strong> – These handy devices are especially useful when it comes time to deal with any swelling issues or untoward skin reactions encountered abroad.</p> <p><strong>5. Antibacterial gel</strong> – If you’re in a situation when you need a pair of clean hands, antibacterial gel makes it possible without the need of water access.</p> <p><strong>6. Oral rehydration salts</strong> – Dehydration can quickly turn into a big issues overseas, so having a few oral rehydration salts on hand can get you out of a serious bind. </p> <p><strong>7. Safety pins</strong> – The practicality of safety pins knows no bounds, especially if you find yourself in a situation where you need to keep bandages or slings in place.</p> <p><strong>8. Thermal blanket</strong> – In an emergency situation a thermal blanket can help control body temperature and ultimately avoid the likelihood of someone going into shock.</p> <p><strong>9. Thermometer</strong> – It’s also quite useful to have a thermometer at hand just in case. Go for a digital design that’s easier to read in an emergency situation.</p> <p><strong>10. Tweezers</strong> – If you ever need to remove splinters when you’re overseas or do running repairs to adhesive dressings, a pair of tweezers becomes quite useful.</p> <p><strong>Additional tips and pointers:</strong></p> <ul> <li>Keep you travel medical kit in a dry, cool storage location if possible.</li> <li>Make sure it’s in an easily accessible part of your suitcase or backpack, and make sure everyone you are travelling with knows where to find it.</li> <li>Before you head off, double check the contents of your kit ensuring any creams are up to date, bandages and dressings are properly sealed and all items are working properly.</li> </ul> <p><em>Image: Getty</em></p>

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New medical emergency hits Guy Sebastian trial

<p dir="ltr">Guy Sebastian’s trial against his former manager faces more delays after another medical emergency unfolded just days after the presiding judge suddenly passed away.</p> <p dir="ltr">One of the jurors was rushed to hospital after suffering a severe allergic reaction during the lunch break - prompting the new judge to question whether it is practical for the trial to continue, as reported by <em><a href="https://7news.com.au/entertainment/celebrity/guy-sebastians-ex-manager-trial-resumes-c-6811553" target="_blank" rel="noopener">7News</a></em>.</p> <p dir="ltr">Judge Timothy Gartelmann announced that he would be taking over the trial on Monday, and with several jurors handing him notes raising concerns about future commitments, he said he would deliberate overnight once he found out about the welfare of the ill juror.</p> <p dir="ltr">“I will then make a decision about whether or not it is practical for individual jurors and indeed the trial itself to continue,” he said.</p> <p dir="ltr">Sebastian’s former manager, Titus Emmanuel Day, has pleaded not guilty to 50 charges, including allegedly embezzling money owed to Sebastian through royalties and performance fees, as well as 50 alternative counts of larceny.</p> <p dir="ltr"><a href="https://www.oversixty.com.au/finance/legal/guy-sebastian-fronts-court" target="_blank" rel="noopener">Beginning his testimony</a> on Wednesday, May 4, the <em>Voice </em>judge testified that Day promised him 10 percent equity in his company 6 Degrees - which Day managed him through for nearly a decade - in recognition of his importance as a “foundation client” in the company’s success.</p> <p dir="ltr">Email exchanges tendered in court also showed that Day told Sebastian he would give him 10 percent ownership of Solar D, a sunscreen brand Day created.</p> <p dir="ltr">Sebastian said he then became an informal ambassador for the brand, conducting interviews and participating in a rowing event and photoshoot among other duties.</p> <p dir="ltr">He said he didn’t expect any payment for the work because the emails made it clear he was part-owner of the company.</p> <p dir="ltr">Sebastian said “there were requests for intros”, and when asked about Day’s character in relation to the company, he gave “him a wrap”.</p> <p dir="ltr">“He’s a good bloke, and I’m involved as well. There’s nothing to worry about,” he recalled saying.</p> <p dir="ltr">The trial is expected to continue under Judge Gartelmann on Tuesday.</p> <p dir="ltr">The funeral for Judge Peter Zahra, who presided over the trial until his sudden passing and was a highly respected and senior judge in the NSW District Court, will be held on Friday.</p> <p dir="ltr">In a statement, Judge Zahra’s family said he would be remembered as a “special soul”.</p> <p dir="ltr">“We have received many lovely messages and memories that demonstrate the type of person he was, he had a big heart and wanted to see everyone achieve more than what they ever thought possible,” the statement said.</p> <p dir="ltr">“In honour of our Dad and his life, we encourage everyone to have a hot chocolate and share a dad joke in his honour!”</p> <p><span id="docs-internal-guid-0cdb885f-7fff-00d9-e8aa-0b79dacde790"></span></p> <p dir="ltr"><em>Image: Guy Sebastian (Facebook)</em></p>

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Bruce Willis forced to retire after medical diagnosis

<p>Bruce Willis has announced he will be stepping back from acting after a shocking medical diagnosis. </p> <p>The 67-year-old has been diagnosed with aphasia: a medical condition that can affect a person’s ability to speak, write and understand language, both verbal and written.</p> <p>“To Bruce’s amazing supporters, as a family we wanted to share that our beloved Bruce has been experiencing some health issues and has recently been diagnosed with aphasia, which is impacting his cognitive abilities,” Bruce’s family wrote in a statement shared to each of their Instagram accounts.</p> <p>They added that he will be “stepping away from the career that has meant so much to him”.</p> <p>“This is a really challenging time for our family and we are so appreciative of your continued love, compassion and support,” the family continued. </p> <p>“We are moving through this as a strong family unit, and wanted to bring his fans in because we know how much he means to you, as you do to him."</p> <p>“As Bruce always says, ‘Live it up’ and together we plan to do just that,” concluded the statement, which was signed by his wife Emma Heming, his ex-wife Demi Moore, and his five children, Rumer, 33, Scout, 30, Tallulah, 28, Mabel, 9, and Evelyn, 7.</p> <p>Willis has multiple projects that he has completed that are now in the stage of post-production, including <em>Vendetta</em>, <em>Fortress: Sniper’s Eye</em> and <em>White Elephant</em>.</p> <p>His upcoming project <em>Fortress 3</em> is currently in pre-production, with no announcement on the future of the film. </p> <p>Rumours of Willis' health declining were first pushed by OK! magazine in January 2021, when the actor was kicked out of a Los Angeles chemist for not wearing a mask during Covid-19 restrictions. </p> <p>He later apologised, saying in a statement that it was “an error in judgement”.</p> <p><em>Image credits: Getty Images</em></p>

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Could pain and fever medication affect our reaction to Covid?

<p dir="ltr">New research has made some surprise findings about common pain and fever medication and its impact on infections like COVID-19.</p> <p dir="ltr">A team of Australian pain researchers combed through studies that evaluated the effects of these medications - which include morphine, paracetamol, and aspirin - on the immune system, as well as the effects they have on a person’s risk of infection.</p> <p dir="ltr">Dr Christina Abdel-Shaheed, the lead author on the review and a pain researcher at the University of Sydney, said the team were initially interested in studying the possible impacts of paracetamol during the coronavirus pandemic as people began hoarding the medication during the early months of the pandemic.</p> <p dir="ltr">Instead, they made several findings related to several other conditions, including chicken pox and Covid, and in relation to vaccination.</p> <p dir="ltr">“Our review shows some of the common pain and fever medications may work with the immune system to fight infection, whereas others work against it and increase the risk of contracting or responding badly to infectious diseases,” Dr Abdel-Shaheed <a href="https://www.scimex.org/newsfeed/are-medicines-affecting-our-response-to-infections-like-covid-19">said</a>.</p> <p dir="ltr">For example, they found that aspirin could be an affordable and accessible treatment option for tuberculosis, while morphine increases the risk of infection, particularly after cancer surgery, because it suppresses key cells in the immune system.</p> <p dir="ltr">Dr Justin Beardsley, an infectious disease researcher at Westmead Hospital and the Sydney Institute for Infectious Diseases, said this was an important finding as morphine is one of the most commonly used drugs in post-surgical care.</p> <p dir="ltr">He noted that its effect of increasing the risk of infection is particularly important for cancer patients and immunocompromised patients in general “who are already vulnerable to COVID-19”.</p> <p dir="ltr">“Taking paracetamol or ibuprofen before or immediately after vaccination - for example for COVID-19 - to try and prevent mild fever or headache is not recommended, because this could reduce the body’s desirable immune response to the vaccine,” Dr Abdel-Shaheed explained.</p> <p dir="ltr">“For chickenpox, the use of ibuprofen is not recommended as it might increase the risk of secondary bacterial skin infections.”</p> <p dir="ltr">Professor Ric Day, a co-author from UNSW and St Vincent’s Hospital, said research in this area was still catching up and that investigating these medications could have considerable impacts.</p> <p dir="ltr">“One of the problems is that widely used medicines - such as paracetamol, nonsteroidal and anti-inflammatory drugs like ibuprofen, and corticosteroids such as prednisone - have been around for decades and in the past we didn’t tend to consider their impacts on the immune system because it has been an under-recognised area,” he said.</p> <p dir="ltr">“From community use to hospital and acute care, these classes of pain and fever medications are among the most popular drugs worldwide but we need to consider the significant impact these can have on our immune system and our response to infectious diseases, including COVID-19.”</p> <p dir="ltr">The clinical review was published in the <em><a href="https://doi.org/10.1111/bcp.15281" target="_blank" rel="noopener">British Journal of Clinical Pharmacology</a></em>.</p> <p><span id="docs-internal-guid-b8c0294d-7fff-d7ef-7268-8cf46134c4ea"></span></p> <p dir="ltr"><em>Image: Getty Images</em></p>

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10 medication mistakes that are hurting your health

<p><strong>Taking an OTC remedy without reading the label</strong></p> <p><span>When it comes to over-the-counter drugs, many people have a blasé attitude, thinking, </span><em>They can’t really hurt me, right?</em><span> Wrong. </span></p> <p><span>Plenty of people end up with serious health problems from accidentally taking too much of an over-the-counter drug (such as a painkiller), overusing drugs such as laxatives or acid blockers, or taking something that interferes with another medication they’re on. </span></p> <p><span>No matter how innocuous a drug may seem, it’s always smart to read the label. It might surprise you.</span></p> <p><strong>Taking sedatives if you have heartburn</strong></p> <p><span>People who took prescription drugs called benzodiazepines (Valium, Xanax, Halcion) to fall asleep were 50 per cent more likely to have heartburn at night than those who didn’t in one large survey. </span></p> <p><span>Other research has shown that these prescription anti-anxiety drugs loosen up the lower oesophageal sphincter, the ring of muscle that keeps stomach acid where it belongs.</span></p> <p><strong>Taking an antidiarrhoeal if you have a fever</strong></p> <p><span>Never treat yourself at home with a diarrhoea remedy if you also have a fever or if there’s blood or mucus in your bowel movements. </span></p> <p><span>These are signs of an infection and warrant a visit to your doctor.</span></p> <p><strong>Taking a daily aspirin without asking your doctor</strong></p> <p><span>Some people shouldn’t take aspirin every day, especially since it can cause stomach bleeding. </span><span>Doctors usually recommend it only for people who have an increased risk of heart attack and stroke. </span></p> <p><span>Women may not benefit as much from aspirin therapy as men. And some people appear to be resistant to aspirin’s anti-clotting effects. </span></p> <p><span>(Tests are available to check for aspirin resistance, though some doctors question their accuracy).</span></p> <p><strong>Quitting an anti-anxiety med cold turkey</strong><span></span></p> <p><span>If you’ve been taking an anti-anxiety medicine for a long time, do not quit abruptly. Talk to your doctor about how to gradually taper the dose. </span></p> <p><span>Otherwise, you could experience very serious complications such as seizures.</span></p> <p><strong>Using old antibiotics for a new infection</strong></p> <p><span>First, you should have finished the entire prescription the first time around. Second, many antibiotics are specific to the type of infection you have. </span></p> <p><span>Taking the wrong antibiotic might not work and can lead to antibiotic-resistant bacteria, making treatment for that type of infection more difficult the next time.</span></p> <p><strong>Taking an antipsychotic without asking why you need it </strong></p> <p><span>Don’t accept a prescription for an antipsychotic drug (if you don’t have schizophrenia or other severe mental illnesses like psychosis) without asking your doctor, “Why this drug?” </span></p> <p><span>A study published in the Journal of Clinical Psychiatry and sponsored by the National Institutes of Health found that the majority of people prescribed these drugs didn’t have schizophrenia or other severe mental disorders for which the drugs are approved. </span></p> <p><span>Instead, they had conditions like depression, anxiety or post-traumatic stress disorder that could be managed with safer, less-expensive medications. </span></p> <p><span>Although some antipsychotics are labelled for use in depression, they should be used as a last resort if typical antidepressants don’t work.</span></p> <p><strong>Taking calcium on an empty stomach</strong></p> <p><span>The calcium in most supplements is bound to a form of salt called carbonate. </span></p> <p><span>Your stomach needs plenty of hydrochloric acid to break down calcium carbonate, so always take your supplement with a meal or snack. </span></p> <p><span>Food will cause your stomach to produce the acid.</span></p> <p><strong>Stopping your medication</strong></p> <p><span>Don’t skimp on eczema medicine. In one study, researchers found that about 65 per cent of parents stopped applying prescription ointments to the skin of kids with eczema just 3 days after it was prescribed. </span></p> <p><span>To get the most out of your eczema treatment, use it exactly as your doctor prescribes.</span></p> <p><strong>Diagnosing your own yeast infection</strong></p> <p><span>Yes, the itching and discharge could be a yeast infection – but it might not be. </span></p> <p><span>In one study of 95 women who diagnosed themselves, testing showed that just a third actually had a yeast infection; the rest had various other vaginal infections. </span></p> <p><span>Pay a visit to your doctor for the correct diagnosis.</span></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a rel="noopener" href="https://www.readersdigest.co.nz/healthsmart/tips/drugs-medicine/10-medication-mistakes-that-are-hurting-your-health" target="_blank">Reader's Digest</a>.</em></p>

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Tobacco giant angers medical community

<p><span style="font-weight: 400;">Philip Morris International has made a £1 billion bid to take over a company that makes inhalers used to treat lung disease, sparking outrage in the medical community.</span></p> <p><span style="font-weight: 400;">The tobacco company behind the Marlboro man has made an offer to buy Vectura, a UK company that develops inhaler technology for lung illnesses.</span></p> <p><span style="font-weight: 400;">Medical experts are concerned that the takeover could see Philip Morris profiting from the treatment of smoking-related lung diseases it has helped create.</span></p> <p><span style="font-weight: 400;">“If they buy Vectura, Philip Morris will then be making money not only from selling cigarettes that cause lung disease, but they’ll also be making money from the technologies that treat patients who have lung disease caused by smoking,” respiratory pathologist and chief executive of the Thoracic Society of Australia and New Zealand Graham Hall said.</span></p> <p><strong>Changes to research and treatment </strong></p> <p><span style="font-weight: 400;">As a result, many are concerned that research and the treatments doctors prescribe to patients with lung disease could change to avoid directing funds to the tobacco giant.</span></p> <p><span style="font-weight: 400;">For some of the 200,000 New Zealanders with Chronic Obstructive Pulmonary Disease (COPD) who use Vectura inhalers, this could result in the prescription of different medications by their doctors.</span></p> <p><img style="width: 500px; height: 414.0625px;" src="https://oversixtydev.blob.core.windows.net/media/7844087/copd-diagram_160331_100539.jpg" alt="" data-udi="umb://media/e0a76635bd59443fbe1c71d6f4dcc0f9" /></p> <p><em><span style="font-weight: 400;">Image: healthflexhhs.com</span></em></p> <p><span style="font-weight: 400;">COPD describes a group of diseases that affect the lungs, including emphysema, chronic bronchitis, and chronic asthma, which cause a progressive decline in lung health.</span></p> <p><span style="font-weight: 400;">Up to 50 percent of smokers develop COPD to some level.</span></p> <p><span style="font-weight: 400;">“How can we in good conscience give a treatment to a patient where the funding from that treatment will be going to the company that caused the disease to begin with?” asked Professor Hall.</span></p> <p><span style="font-weight: 400;">“No doctor is going to want to prescribe a treatment to a patient, that they know may be funding a tobacco company.”</span></p> <p><span style="font-weight: 400;">Research into these diseases could also be at risk, as many doctors, health bodies, and journals have policies banning professionals from dealing with tobacco companies.</span></p> <p><span style="font-weight: 400;">“Cutting-edge research would be able to be published in these journals if there was known links to Vectura if it’s acquired by Philip Morris,” Professor Hall said.</span></p> <p><strong>Australia ‘indirectly’ funding tobacco companies</strong></p> <p><span style="font-weight: 400;">Currently, Australians are prescribed any of 10 different dry powder inhalers that use technology made by Vectura.</span></p> <p><span style="font-weight: 400;">In 2020, 2 million scripts for different brands of these inhalers were dispensed and cost about $121 million to taxpayers, according to figures from the federal government’s Pharmaceutical Benefits Scheme (PBS).</span></p> <p><span style="font-weight: 400;">Though most of the profits go directly to the pharmaceutical company, Vectura has licensing and royalty deals with companies that use its technology, meaning it gets some of the funds as well.</span></p> <p><span style="font-weight: 400;">“It could be the situation where the Australian government is paying taxpayers’ funding indirectly to a tobacco company to treat patients who have lung disease caused by tobacco,” Professor Hall said.</span></p> <p><span style="font-weight: 400;">But, the result could put Australia in a breach of a global treaty it signed and ratified on tobacco control.</span></p> <p><span style="font-weight: 400;">Since the inhalers are subsidised under the PBS, the government would indirectly funding Philip Morris, violating the treaty.</span></p> <p><span style="font-weight: 400;">“It’s a UN tobacco control treaty and it’s been signed and ratified by more than 180 countries, including the UK, including Australia,” Melbourne-based GP Dr Bronwyn King said.</span></p> <p><span style="font-weight: 400;">“One of the provisions of the treaty is that it explicitly prohibits engagement between governments and the tobacco industry.”</span></p> <p><span style="font-weight: 400;">A spokesperson for the federal Health Department said the government was closely monitoring tobacco activities, but the </span><span style="font-weight: 400;">ABC </span><span style="font-weight: 400;">reports they were unaware of the 10 products on the PBS which used Vectura technology.</span></p> <p><span style="font-weight: 400;">The takeover bid has already been approved by Vectura’s board, and will go before the company’s shareholders in London.</span></p> <p><em><span style="font-weight: 400;">Image: Getty Images</span></em></p>

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“Medical triumph”: Conjoined twin survivor gives birth

<p><span style="font-weight: 400;">Charity Lincoln Gutierrez-Vazquez, who was born attached to her twin sister from breastbone to pelvis, has had a “full circle” moment with the birth of her own child in the same hospital.</span></p> <p><span style="font-weight: 400;">Charity and her sister Kathleen were separated by a team of nearly 30 doctors, nurses, and support staff in 2000, making national headlines when they were just seven months old.</span></p> <p><span style="font-weight: 400;">Now, she has returned to the University of Washington Medical Centre in Seattle to give birth to her daughter, Alora.</span></p> <p><span style="font-weight: 400;">“It feels like a full circle, since my mom had us here and everything,” Gutierrez-Vazquez said.</span></p> <p><span style="font-weight: 400;">Dr John Waldhausen was involved in the 31-hour surgery to separate the twins, who each had one leg and shared a second, fused leg, as well as sharing several internal organs.</span></p> <p><span style="font-weight: 400;">“This is probably about as complex and as difficult as anything we do or have done,” Dr Waldhausen said at the time.</span></p> <p><span style="font-weight: 400;">Dr Waldhausen’s involvement in saving her and Kathleen’s life has had an impact on Charity, and he was one of the first people she told when she found out she was pregnant.</span></p> <p><span style="font-weight: 400;">“He’s been with me through the lot,” she said.</span></p> <p><span style="font-weight: 400;">“When you’re involved with an operation like that, you’re really hoping you can create a whole lifetime for somebody,” Dr Waldhausen said.</span></p> <p><span style="font-weight: 400;">But, Dr Waldhausen admits he had some concerns.</span></p> <p><span style="font-weight: 400;">“I didn’t know if her uterus was going to allow her to carry a child,” he said.</span></p> <p><span style="font-weight: 400;">“I didn’t know if her abdominal wall reconstruction was going to allow her abdomen to expand in such a way that a baby could grow.”</span></p> <p><span style="font-weight: 400;">To oversee Gutierrez-Vazquez’s pregnancy and delivery, Dr Waldhausen reached out to a colleague, Dr Edith Cheng, for help.</span></p> <p><span style="font-weight: 400;">Alora was born at nearly 34 weeks via C-section before being taken to NICU for supplemental oxygen, with doctors reporting that both the mother and newborn are healthy.</span></p> <p><span style="font-weight: 400;">“I wouldn’t call it a miracle,” Dr Waldhausen said. </span></p> <p><span style="font-weight: 400;">“I would call it a medical triumph.”</span></p> <p><span style="font-weight: 400;">“Charity’s case really is the full obstetrical circle,” Dr Cheng said.</span></p> <p><span style="font-weight: 400;">“This howling girl this morning, at almost 34 weeks, that is a true triumph, to get this baby to almost term.</span></p> <p><span style="font-weight: 400;">“This baby’s healthy.”</span></p> <p><span style="font-weight: 400;">Gutierrez-Vazquez’s twin, Kathleen, met Alora via Facetime.</span></p> <p><span style="font-weight: 400;">“God’s really blessed me with all the doctors in my life and everything,” Gutierrez-Vazquez said.</span></p> <p><span style="font-weight: 400;">“I think it’s important that people see we’re still doing good, and living the best life we can.”</span></p> <p><em><span style="font-weight: 400;">Image: Yahoo news</span></em></p>

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13 medical reasons you’re tired all the time

<p>You feel like you’re always going to bed early, but when your alarm goes off, it’s hard to open your eyes and you’re in a fog all day. You may feel like no matter how much sleep you’re getting, you’re still tired. But how do you know how much sleep you need?</p> <p>How much sleep you need varies by age. While newborns under three-months-old may need up to 19 hours of sleep and adults over 65 may need as little as five hours, most adults need about seven to nine hours of sleep a night. While not getting enough sleep can hurt your health in these sneaky ways, oversleeping and constantly being tired can be a sign of a problem.</p> <p>What’s best, according to Dr Jacob Teitelbaum, who specialises in sleep, fibromyalgia, and pain, is to sleep the amount of time that leaves you feeling the best. “If you are needing more than 10 hours of sleep to feel restored, however, then that suggests that your sleep quality is poor and needs to be addressed,” he says.</p> <p>If you’re getting enough sleep on a good schedule or are even oversleeping and still feel tired, it could be a sign of health problems.</p> <p><strong>You’re tired because…you’re oversleeping on weekends</strong></p> <p>You may think skimping on sleep during the week and oversleeping during the weekends will help you feel well-rested, but it’s actually hurting your sleep. This habit is called “social jetlag” which is brought on by shifts in your sleeping schedule during the week versus on the weekends. “Your body prefers routine, but still appreciates you making up the sleep, so it’s best to find a steady balance you can stick to,” adds Dr Teitelbaum.</p> <p><strong>You’re tired because…you’re anaemic</strong></p> <p>When you visit your doctor and complain of feeling tired all the time, the first things they’ll often check for is anaemia or thyroid disorder because you can detect those with a blood test, says Dr Amy Shah. “When a patient says ‘I’m tired,’ it’s such a broad term and could be so many things, but if someone says ‘I’m tired and feeling a little more short of breath,’ or, ‘I’m having trouble exercising,’ that tends to be anaemia.” Anaemia is when your blood doesn’t carry enough oxygen to the rest of your body and the most common cause of anaemia is iron deficiency. Anaemics may also experience feeling cold, dizzy, irritable, or have headaches in addition to feeling tired.</p> <p><strong>You’re tired because…you have a condition that causes chronic pain</strong></p> <p>People who suffer from conditions, such as fibromyalgia, rheumatoid arthritis, hypothyroidism, and anaemia, often require sleep. “For fibromyalgia, the person is not able to go into deep restorative sleep because the sleep centre (the hypothalamus) is not working,” explains Dr Teitelbaum. “For rheumatoid arthritis, the pain often disrupts deep sleep, so it takes more sleep to get the same recharging of your battery.” In hypothyroidism and anaemia, extra sleep over nine hours doesn’t really help.</p> <p><strong>You’re tired because…you have a thyroid problem</strong></p> <p>If you have a thyroid issue, like an underactive thyroid (hypothyroidism), in addition to feeling tired, you might also feel like your skin is really dry and you’re constipated a lot, along with the lack of energy, says Dr Shah. Hypothyroidism is a condition that occurs when your thyroid gland doesn’t produce enough of certain important hormones. While women are more likely to have hypothyroidism, thyroid function tests can diagnose hypothyroidism easily and if you have an issue, your doctor may prescribe a synthetic thyroid hormone.</p> <p><strong>You’re tired because you…may have prediabetes or type 2 diabetes</strong></p> <p>Most people who have high blood sugar due to type 2 diabetes have insulin resistance. “Insulin is the key that opens up our cellular energy furnaces called mitochondria and allows sugar to enter to be burned for fuel,” explains Dr Teitelbaum. “Because this key is not working, sugar cannot get into the furnaces to be turned into energy, leaving people tired.”</p> <p><strong>You’re tired because…you’re depressed</strong></p> <p>If you feel like you’re tired all the time, don’t want to get out of bed in the morning, and/or have trouble sleeping, you could be suffering from depression. Your primary care physician should do a depression screening during a regular visit, says Dr Shah. Your doctor can use a screening tool to determine if you’re experiencing an ongoing depressive disorder, or whether a life stressor or alcohol affects your emotional state. “Depression, alcohol abuse, and fatigue are very tightly knit,” says Dr Shah. Sometimes people will treat depression with alcohol and then be tired, she says.</p> <p><strong>You’re tired because…you may have gut issues or food sensitivity</strong></p> <p>Your gut is supposed to be a very closed system of cells where nothing from inside of the gut gets into the outside– like a pathway where the body absorbs what it needs without having things enter the rest of the body, says Dr Shah. “If you’re eating poorly, especially a lot of processed foods, the gut cells can become a looser, net-like structure instead of a tight structure and proteins that aren’t supposed to be in our bloodstream leak into our bloodstream, which creates an inflammatory response,” says Dr Shah. The inflammatory response is thought to possibly manifest as bloating, fatigue, moodiness, headaches, or weight gain. Some people call this leaky gut, although this condition hasn’t been clinically proven. If you have food sensitivities (to foods like wheat and dairy) you can feel fatigued, get rashes, and experience bloating or brain fog. “There’s no real good test for food sensitivities,” says Dr Shah. Following an elimination diet of possible food culprits and then slowly introducing them back in may help you identify what you’re sensitive to. If you remove all wheat from your diet and feel great, and then add it back and feel lethargic, that could be a tell-tale sign of a food sensitivity to wheat, Dr Shah says.</p> <p><strong>You’re tired because…you’re suffering from adrenal fatigue</strong></p> <p>“Adrenal fatigue isn’t a Western medicine term, it’s a functional medicine term, and a lot of Western doctors don’t recognise it as a medical [issue],” says Dr Shah. There’s a disconnect because it’s hard to show with lab testing, she says. These hormone imbalances could be brought on by a stressful situation in your life, like family problems, or it could be constant stress at work, lack of sleep, over-exercising, having a poor diet, or drug or alcohol abuse, says Dr Shah. Those circumstances can push your stress hormones high and then eventually leave you exhausted and depleted, like a bank account that you’re overdrawing on and not putting money back into.</p> <p><strong>You’re tired because…you have an infection</strong></p> <p>Doctors will often check for chronic infection as a cause of fatigue due to such infections as the Epstein-Barr virus (mononucleosis) or Lyme disease. Both of these medical issues can present with extreme fatigue.</p> <p><strong>You’re tired because…you have sleep apnea</strong></p> <p>If you have sleep apnea, your throat starts to close when you’re asleep, which is why people with the condition tend to snore. Not getting enough oxygen sounds scary, but your brain won’t let you suffocate. “Sleep apnea prevents you from going into the deep restorative stages of sleep, so people are unable to get rested and fall asleep frequently during the day,” explains Dr Teitelbaum. “Falling asleep easily during the day with a shirt collar size over 42 centimetres, high blood pressure, being overweight and snoring tell you that you should check for sleep apnea.”</p> <p><strong>You’re tired because…you have heart failure</strong></p> <p>When you have heart failure, your heart can’t keep up with the body’s needs for blood. Your body will start to bring blood away from body tissues so it can keep vital organs fully supplied. With less blood in your leg muscles, even everyday activities can feel exhausting. Plus, fluid gets backed up in your veins leading away from your lungs. This increases pressure and allows fluid to leak into the lungs, making you lose your breath suddenly. When you’re asleep, it could wake you up and make for a restless night.</p> <p><strong>You’re tired because…you have hypersomnia</strong></p> <p>Heneghan says oversleeping may be a sign of hypersomnia, a chronic neurological condition where you’re tired no matter how much sleep you get. According to the US Hypersomnia Foundation, you may have this condition if you’re tired during the day no matter how much sleep you get at night. The condition usually crops up in adolescence or early adulthood and can seriously affect sleep quality, as well as your ability to function during the day.</p> <p><strong>You’re tired because…you have haemochromatosis</strong></p> <p>Nearly 10 per cent of the Caucasian population carries a genetic marker for this condition, which causes the body to store too much iron. In addition to fatigue and weakness, haemochromatosis can also cause joint pain, stomach upset, depression, liver disease, heart trouble, and diabetes. While people are born with the condition, symptoms often don’t become obvious until people reach their 50s and 60s. Doctors can test for the condition using various blood screens; if you have any combination of these signs, talk to your GP about being tested.</p> <p><em>Written by Diana Kelly. This article first appeared on <a href="https://www.readersdigest.co.nz/healthsmart/13-medical-reasons-youre-tired-all-the-time?pages=1">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.co.nz/subscribe"><span class="s1">here’s our best subscription offer</span></a>.</em></p>

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Unsolved medical oddities that still mystify doctors

<ol> <li><strong> The girl who never aged</strong></li> </ol> <p>Brooke Greenberg died at the young age of 20 in 2013. But she didn’t look like your average 20-year-old because her body stopped developing at the age of five. Her hair and nails were the only parts of her body that continued to grow year by year. Despite being born premature, doctors remained perplexed as to why she stopped ageing. Numerous DNA studies showed no abnormalities in her genes associated with ageing. Nor did her parents have a history of abnormal development. Plus, all her sisters were normal and healthy. Scientists continued to refer to her condition as Syndrome X, a metabolic syndrome. Yet, her unusual condition remains unexplained by science.</p> <p>On the other hand, <a rel="noopener" href="https://www.readersdigest.co.nz/true-stories-lifestyle/science-technology/13-unsolved-mysteries-easily-explained-by-science" target="_blank">here are 13 unsolved mysteries easily explained by science.</a></p> <ol start="2"> <li><strong> Mermaid syndrome </strong></li> </ol> <p>Sirenomelia is a birth defect that partially or completely fuses the legs together, similar to how a mermaid looks, thus the alternative name “mermaid syndrome.” Most newborns don’t survive for long with this anomaly but some children defy the odds like Shiloh Pepin who lived until she was ten or Tiffany Yorks, the oldest known survivor of the condition, who died at age 27 in 2016. But the exact cause of sirenomelia is still unknown in the medical world because most cases occur randomly for no reason. Due to this randomness, researchers believe a new mutation or environmental factors may play a role in the development of the disorder.</p> <ol start="3"> <li><strong> Highly superior autobiographical memory </strong></li> </ol> <p>If you give Jill Price a date, she can easily tell you what day of the week it fell on and what she did that day. Price was reported as the first known case of highly superior autobiographical memory (HSAM) in 2006. Since then, more adults and even children have been identified as having this ability. People with HSAM can recall almost anything from their memories in minute detail from events in their life to conversations they’ve had. The true mystery is why some people have this superhuman brainpower and others don’t. Brain images of people with HSAM have shown researchers that some parts of their brain structure are different from people who have a typical memory. But it’s not yet known if these brain differences cause HSAM or if they occur because the person uses areas of the brain associated with memory more.</p> <p><a rel="noopener" href="https://www.readersdigest.co.nz/true-stories-lifestyle/thought-provoking/15-scientific-mysteries-boffins-cant-figure-out" target="_blank">Here are 15 more mysteries that have scientists perplexed.</a></p> <ol start="4"> <li><strong> Water allergies </strong></li> </ol> <p>Fewer than 100 people in the world have been diagnosed with aquagenic urticaria, a rare condition where people break out in hives or rashes every time they’re exposed to water. However, researchers have not found an underlying cause for the condition. Some scientific theories suggest that the hives are caused by an allergen in the water or an interaction between the water and a substance found in or on the skin that generates a toxic material, which causes hives. Some doctors recommend patients only bathe in or drink purified water (that is, if the condition is allergen-based), but an effective treatment still has yet to come to fruition due to limited data on this rare condition.</p> <ol start="5"> <li><strong> Stiff person syndrome </strong></li> </ol> <p>This rare, progressive syndrome known as stiff person syndrome (SPS) can cause people to experience extreme stiffness, rigidity and painful spasms in their muscles. Sometimes, these muscle spasms are so strong they can even fracture bones. When the central nervous system, specifically in the brain and spinal cord, has decreased inhibition, it can cause a person’s muscle activity to increase, which can result in SPS. Scientists think the syndrome may have an autoimmune component and research has indicated that it may occur when the immune system mistakenly attacks the brain and spinal cord. Although scientists are on the cusp of discovering what could cause this disabling disorder, they still have yet to understand everything about SPS.</p> <p><a rel="noopener" href="https://www.readersdigest.co.nz/healthsmart/6-myths-about-human-body-quashed" target="_blank">Here are 6 myths about the human body quashed. </a></p> <ol start="6"> <li><strong> Disembarkment syndrome </strong></li> </ol> <p>You know that feeling you get when you feel wobbly after you disembark a boat? You’ve probably heard someone say you’re “getting your land legs back.” For most people, this feeling of being in constant motion usually goes away after a few minutes or hours. But some people suffer from disembarkment syndrome, a condition where their bodies and brains can never shake that feeling of swaying and rocking. Unfortunately, it’s a hard condition to treat and usually goes away within a year. And it’s not just limited to being out on a boat either; riding in planes, trains, cars, even elevators can cause it too. Unfortunately, doctors still aren’t sure what really lies behind disembarkment syndrome. People who get migraines and women ages 30 to 60 are more likely to get it, but experts are uncertain if hormones play a role or how migraines could be linked.</p> <ol start="7"> <li><strong> Morgellons disease </strong></li> </ol> <p>People with this skin condition typically feel like something is stinging or crawling all over their skin. Unfortunately, Morgellons disease is an uncommon skin condition, characterised by small fibres or particles emerging from skin sores, that modern medicine still doesn’t understand. Some doctors think the condition is all in the patient’s head and try to treat them with cognitive behavioural therapy, antidepressants, antipsychotic drugs or counselling, while others in the medical field think the fibres could be caused by an infection from the bacterium Agrobacterium, commonly found to cause tumours in plants. As researchers attempt to study the cause of this mysterious disease, there’s still no official guidelines on diagnosis and treatment.</p> <ol start="8"> <li><strong> The boy who doesn’t feel hungry</strong></li> </ol> <p>In October 2013, Landon Jones, a 12-year-old boy from Iowa, U SA, suddenly woke up without an appetite or thirst. It only took a year for the boy to go from a healthy 47kg to a meagre 30kg. Doctors were baffled by his condition after countless brain scans, psychiatric evaluations and medical evaluations for digestive problems or eating disorders showed nothing. Some doctors wonder if he suffers from a rare brain dysfunction, particularly in the hypothalamus, the part of the brain that controls hunger and thirst. In 2014, his parents reached out to the National Institutes of Health to help evaluate Landon and possibly treat him for this rare disease. But there’s been no news to-date to say if doctors have determined a diagnosis.</p> <p><em>Written by Ashley Lewis. This article first appeared on <a href="https://www.readersdigest.co.nz/culture/8-unsolved-medical-mysteries-that-still-stump-doctors">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.co.nz/subscribe">here’s our best subscription offer</a>.</em></p> <p> </p>

Caring

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Time to end drug company distortion of medical evidence

<p>While there’s much to celebrate in medicine, it’s now beyond doubt that we have <a href="https://www.bmj.com/content/347/bmj.f7141">too much</a> of it. Too many tests, diagnoses, pills and procedures are wasting resources that could be better spent meeting genuine need.</p> <p>As a recent <a href="http://www.oecd.org/health/tackling-wasteful-spending-on-health-9789264266414-en.htm">OECD report</a> concluded, up to one-fifth of health spending may be wasted, and many patients “unnecessarily harmed” by treatments they didn’t need.</p> <p>Antidepressants, for example, can be life-savers for some people. But drug company-funded studies have <a href="https://ebm.bmj.com/content/early/2019/09/24/bmjebm-2019-111238">overplayed their benefits</a> and <a href="https://www.bmj.com/content/351/bmj.h4320">downplayed</a> their harms, contributing to overuse and unnecessary side effects.</p> <p><a href="http://www.nationalacademies.org/hmd/Reports/2009/Conflict-of-Interest-in-Medical-Research-Education-and-Practice.aspx">Widespread industry influence</a> is jeopardising the integrity of research and medical education, and threatening the quality of patient care.</p> <p>Today in <a href="https://www.bmj.com/content/367/bmj.l6576">The BMJ</a> a global group of researchers, doctors, editors, regulators and advocates outline key strategies to reduce the financial entanglement with industry. The first step is ensuring the evaluation of any new tests, treatments and technologies are free from industry influence.</p> <p>Distorted research, education and clinical practice</p> <p>A huge proportion of medical research is currently funded by industry – in the United States <a href="https://jamanetwork.com/journals/jama/article-abstract/2089358">almost 60%</a>. Yet there’s a <a href="https://www.cochrane.org/MR000033/METHOD_industry-sponsorship-and-research-outcome">mountain of evidence</a> that company-sponsored studies tend to overstate product benefits and playdown harms.</p> <p>One example is cholesterol-lowering drugs, or statins. A <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0040184">review</a> analysing almost 200 studies of statins found that company-sponsored studies were much more likely to find results favourable to the sponsors’ drug.</p> <p>There’s similar distortion with devices, like <a href="https://www.bmj.com/content/359/bmj.j5515">pelvic mesh</a>, used to treat pelvic organ prolapse. In this case, poor testing meant many women received the mesh without knowing the risks of horrendous harms, including severe pain, infection, and repeated surgery.</p> <p>Those same companies then <a href="https://bmjopen.bmj.com/content/7/6/e016701">sponsor the “education” of your doctor</a>, often with the evidence they’ve funded, and good food and wine.</p> <p>As a <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2528290">study of 280,000 doctors reveals</a>, accepting just one sponsored meal is associated with higher prescribing of the sponsor’s products: a 20% increase in statins, and a doubling of antidepressants.</p> <p>Industry argues it’s information helps patients, but a <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000352">systematic review</a> found differently. Doctors who accept marketing, including sales representatives, tend to prescribe more, at higher cost, and lower quality, such as prescribing an inappropriate drug, or prescribing that is not in line with guidelines.</p> <p>Just look at the opioid epidemic in the United States. One <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2720914">study</a> found the amount of marketing, including payments to doctors, was associated with small but significant increases in both prescriptions and deaths from overdose.</p> <p>How to end commercial influence</p> <p>Evidence of the dangers of financial relationships with industry has caused many groups to seek more freedom. As we show in today’s <a href="https://www.bmj.com/content/367/bmj.l6576">BMJ Analysis</a>, there are signs of change.</p> <p>In Norway, industry-supported education can no longer be used formally by doctors, and the government funds independent drug information.</p> <p>Some medical journals no longer accept drug company advertising. Citizen groups like the US <a href="https://www.nwhn.org/">National Women’s Health Network</a> accept no funds from companies selling healthcare products.</p> <p>The biggest challenge is working out ways to evaluate tests and treatments, free from the influence of companies developing them. But radical reform is in the wind in many places.</p> <p>In <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2362.2009.02226.x">Italy</a>, the promotional budgets of drug companies are taxed to create a pool for independent research.</p> <p>In Britain, <a href="https://cancerunion.org/wp-content/uploads/2019/09/Medicines-For-The-Many.pdf">Labour</a> is proposing the government funds clinical trials and creates <a href="https://www.theguardian.com/politics/2019/sep/24/labour-pledges-to-break-patents-and-offer-latest-drugs-on-nhs">state-owned pharmaceutical makers</a>.</p> <p>More needs to be done</p> <p>Our <a href="https://www.bmj.com/content/367/bmj.l6576">proposals</a> are from a team with expertise across medicine, law, and philosophy and includes people from The BMJ and the World Organisation of Family Doctors.</p> <p>We argue the pathway to independence includes three key reforms:</p> <ul> <li>government policies ensuring the evaluation of tests, treatments and technologies is free from sponsor influence</li> <li>reforms to ensure medical education is free from industry support and on-going professional accreditation can’t be gained from company-sponsored events</li> <li>new rules to end marketing interactions between industry and prescribing doctors, such as sales representatives’ visits.</li> </ul> <p><em>Written by Roy Moynihan. Republished with permission of <a href="/While%20there’s%20much%20to%20celebrate%20in%20medicine,%20it’s%20now%20beyond%20doubt%20that%20we%20have%20too%20much%20of%20it.%20Too%20many%20tests,%20diagnoses,%20pills%20and%20procedures%20are%20wasting%20resources%20that%20could%20be%20better%20spent%20meeting%20genuine%20need.">The Conversation.</a></em></p>

Legal

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Man awarded $12.5 billion for bizarre side effects to Johnson & Johnson medication

<p>US pharmaceutical giant Johnson &amp; Johnson has been ordered to pay a hefty NZ$12.5 billion in damages after they failed to warn that its drug, Risperdal, could cause bizarre breast growth in men. </p> <p>Nicholas Murray told a court in Philadelphia the psychiatric medication, normally prescribed to treat schizophrenia and bipolar disorder, had made him grow breasts. </p> <p>His attorneys, Tom Kline and Jason Itkine, argued the drug had links to gynecomastia, an incurable condition - and accused Johnson &amp; Johnson of making billions of dollars while illegally marketing and promoting the drug. </p> <p>“(Johnson &amp; Johnson is) a corporation that valued profits over safety and profits over patients,” they said in a<span> </span><a rel="noopener" href="https://www.jnj.com/our-company/johnson-johnson-statement-on-todays-risperdal-verdict" target="_blank">statement.</a></p> <p>However Johnson &amp; Johnson immediately challenged the ruling, explaining the damages as “grossly disproportionate” in a statement. </p> <p>“The company is confident (the ruling) will be overturned,” it said. “We will be immediately moving to set aside this excessive and unfounded verdict.”</p> <p>The company said the courts exclusions of key evidence left it unable to present a meaningful defence, including what they described was on the drug label that “clearly and appropriately outlined the risks associated with the medicine” or Risperdal’s benefits for patients with serious mental illness.</p> <p>“Further, the plaintiff’s attorneys failed to present any evidence that the plaintiff was actually harmed by the alleged conduct,” the company added.</p> <p>Thousands of lawsuits have been filed over the drug, including in Pennsylvania, California and Missouri.</p> <p>Mr Kline and Mr Itkin said this was the first time a jury had made the decision to award punitive damages and had come up with an amount. </p> <p>Risperdal was approved for the treatment of adults by the US Food and Drug Administration in 1993 and brought in about A$1 billion in sales in 2018.</p>

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