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Clinical pharmacologist from USA advice:
 

While on medication avoid coffee and strong drinks
 

Many drugs interact with alcohol even if taken hours apart, so are some commonly used beverages like coffee and even milk to some extent. These could sometimes reduce the effectiveness of the medications, escalate the action, or could even contribute to the side effects of the medications.

It is in the best interests of the persons on medication to keep out of alcohol and coffee especially while on medication. This advice to the public is given by Dr. Rukmalee Wijesinghe a clinical pharmacologist in USA.

Writing exclusively to this page (Health Watch) on the subject 'Taking your medications the correct way', she says:

Do you sometimes forget to take a medication or take an additional dose by mistake? According to the Institute for Safe Medication Practices (ISMP) of the United States, 50% of patients take the wrong medications, in the wrong doses, at the wrong times or in the wrong way.

Seniors and those with chronic illnesses may be the most frequent victims of home medication errors. Take the following steps to ensure that your medicine heals rather than harms.

Know what you are taking and why

Write a list of all your medicines both by the brand and the generic name and the reasons you are taking them. Include all over-the counter medications, vitamins, nutritional supplements and herbal products. Write the dose and how often you take them.

Ensure your family members are aware of your illness, medications you are taking and the doctor who prescribed them, in case of an emergency.

Take a copy of this list every time you visit your general practitioner and your specialist so that all are aware of the medications that have been prescribed. This will avoid potential `duplication of drug therapy, interactions and adverse effects.'

Follow directions

Medicines should be taken regularly to provide a steady supply in the blood stream. Some should only be taken at certain times - before, with or after meals. Be informed and ask your doctor how long before or after a meal should you take your medicine.

Take with a 'full glass' of water generally means eight fluid ounces. Once a day dosing should be taken at the same time every day. A diuretic such as Lasix is best taken in the morning to avoid having to get up at night to go to the bathroom.

Most cholesterol lowering medications are prescribed to be taken at bedtime to help curb the cholesterol production in your body which occurs early in the morning. Keep a daily checklist or a calendar and cross off each dose as you take it.

Don't invent

Penny wise/pound foolish? Breaking tablets to save money may be dangerous. Don't cut, crush, or chew a tablet and never open a capsule without asking your doctor.

Some medications should not be split because they are specially coated to be long-acting or to protect the stomach. Still some are designed for gradual release and could be harmful if absorbed too quickly.

Furthermore, if the tablet is not split evenly you may not be getting the exact dose. When taking liquid medicines, don't use a household spoon to measure the dose. They vary in size. Use a marked measuring device or a calibrated medicine dropper.

Beware of side effects and drug interactions

Know what adverse effects should you expect and what to do if they happen. Norvasc (amlodipine) given for hypertension (high blood pressure) may cause lightheadedness if you stand up suddenly from a prone or a sitting position. Many drugs interact with alcohol even if taken hours apart.

Alcohol and some commonly used beverages such as coffee and milk may sometimes reduce the effectiveness of the medication, escalate the action, or may contribute to the side effects of the medication.

A commonly prescribed blood thinner Coumadin (warfarin) should not be taken with Dispirin (aspirin) without consulting your doctor. These medications taken concomitantly may thin your blood too much and contribute to bleeding problems. If you are taking any ayurvedic products be sure to tell your doctor.

Even though you can buy these without a prescription, these products are no different from other medications. They can interact with medications you take or cause side effects. 'Natural' does not mean it's safe!

Proper storage and expiration

Don't keep medications in the car or in direct sunlight for long periods. Humidity, heat, light and oxidation can affect the potency and efficacy. Nitroglycerin (TNT) for angina attacks (chest pain) should be dispensed in a dark glass bottle to avoid the breakdown of the product.

Keeping a tablet wrapped in a piece of paper in your purse or the shirt pocket causes rapid disintegration and will not be effective in an emergency.

Unused nitroglycerin tablets should be discarded after 6 months. Look for expiration dates on the bottle or the package. If you are getting loose tablets of any medication ask the pharmacist to write down the expiration date.

If you are in doubt, ask

Do you know what to do if you miss a dose? Should you take it as soon as you remember or should you take 2 doses the next time? If you take an additional dose by mistake can you skip the next dose?

You should always ask questions to fully understand the treatment you are receiving and to clear up any doubts about any aspects of the therapy. Unfortunately, for various reasons some patients hesitate to question medical professionals.

Some believe it is disrespectful to question their doctors and others are simply uncomfortable talking about anything related to their health or medications. Above all, some health professionals can be intimidating. No matter what, speak up! Learn what questions to ask and expect answers. It's your life, and your health!

Dr. Rukmalee will answer any of your questions on this subject through this Page.

Dr. D. P. Atukorale writing on viral myocarditis:

'First to die of viral myocarditis in Sri Lanka was a lawyer'

Heart operation in progress.

The most senior cardiologist in the country Dr. D.P. Atukorale writing to the Health Watch on the present viral myocarditis, that is spreading fast in the Badulla district causing serious concern to the health authorities here, and even internationally to the extent of the World Health Organisation WHO, to send a team of doctors to investigate it, says that in his career of 35 years in cardiology upto now including the period he headed the Cardiology Unit in the Colombo National Hospital, he had seen about 20 patients with this cardiac condition Viral myocarditis, one of them had been a Judicial Officer who succumbed to the illness at the Cardiology Unit.

Dr. Atukorale writes: "As early as 1806, relationship between infection and chronic heart disease was postulated but it was only in 1970 with the advent of endomyocardial biopsies that diagnosis of this cardiac condition was established.

How this comes about

Many reasons have been attributed for developing this condition, the most common being of viral in origin.

Viral Myocarditis

Myocarditis (myo=muscle; card=heart; it is = inflammation) or heart muscle inflammation, is usually caused by viral infections that attack the heart. Myocarditis is a rare disease.

World Health Organisation (WHO) reports that incidence of cardio-vascular involvement after enteroviral infection is 1-4% depending on causal organism and incidence varies greatly among countries.

Myocarditis is characterised by enlargement of the heart and poor function (i.e. heart contracts badly) leading to heart failure. In some affected persons sudden death occurs and myocarditis causes death in 30-70% of children depending on their age (worst in young children less than one year of age).

In others, heart transplantation is needed. In the remainder of children improvement or normalisation is seen.

Causes, incidence and risk factors

Myocarditis as mentioned earlier is an uncommon disorder caused by viral infection such as coxsackie virus (type A and B) especially coxsackie B3h adenovirus type 2 and 3, echovirus, cytomeglovirus, Epstein - Barr virus, Herpes virus, Human immuno-deficiency virus, influenza and para-influenza virus, measles, mumps and varicella virus.

Myocarditis may be caused by exposure to chemicals or allergic reactions to certain medications and it can be associated with auto-immune diseases.

Coxsackie virus infection

Coxsackie refers to a collection of closely related viruses classified among the enteroviruses namely those that cause infection after being taken in orally with contaminated food or water and then multiply in the intestine (entero-intestinal).

Coxsackie viruses are divided into two major subgroups labelled A and B. There are 23 known coxsackie A viruses that usually cause only enteric diseases and 6 known coxsackie B viruses.

Coxsackie B 3 has been found to be one of the main causes of certain debilitating or life-threatening diseases such as viral myocarditis.

In viral myocarditis heart muscle becomes inflamed and weakened and causing symptoms of heart failure which may mimic a heart attack.

Symptoms of viral myocarditis

These include (a) history of preceding viral illness (b) fever, (c) chest pain that may resemble a heart attack, (d) joint pain or swelling, (e) abnormal heart beats (f) fatigue (g) dyspnoea (shortness of breath), (h) leg oedema (i) orthopnoea (J) irritability (k) lethargy (L) anorexia (loss of appetite) (m) periodic episodes of pallour and (n) lack of energy and general malaise. Absence of symptoms is common.

Additional symptoms that may be associated with acute myocarditis are (a) syncope (fainting), (b) decreased urine output and (c) other symptoms consistent with viral infection such as headache, muscle aches, diarrhoea, sorethroat and rashes.

Signs of viral myocarditis

A physical examination may detect weak pulse, cool extremities, pale and mottled skin, tachycardia (rapid heart beat), abnormal heart sounds (murmurs, extra heart sounds; Heart sounds (murmurs, extra heart sounds; heart sounds may be muffled especially in the presence of pericarditis.)

In myocarditis the patient may get fluid in the lungs and fluid in the skin of legs. In addition, other signs suggestive of an infection such as fever, rashes, red throat, itchy eyes and swollen joints may be present.

Hepatomegaly (enlargement of the liver) may be present in younger children. Neonates may seem irritable or may have respiratory distress and somnolence or hypothermia, oliguria (reduction in urine output) elevated liver enzymes, elevated blood urea and elevated serum creatinine.

In case of infants, myocarditis amy lead to failure to thrive, anorexia (loss of appetite), tachypnoea (rapid respiration), tachycardia (rapid heart beat) wheezing and diaphoresis with feeding.

In severe cases of myocarditis; low cardiac output may progress to acidosis and death.

Tests used the diagnosis of myocarditis

These include (a) electrocardiogram (b) chest x-ray, (c) ultrasound of the heart (echocardiogram) which may show weak heart muscle, enlargement of heart of fluid surrounding the heart. (d) white cell count (e) red cell count (f) blood cultures (g) blood tests for antibodies against heart muscle and body itself and (h) heart muscle biopsy (rarely performed).

Treatment

Treatment of myocarditis includes evaluation of underlying cause. This requires use of antibiotics, reduced level of activity and low salt diet. Steroids and other medications may be used to reduce inflammation. Diuretics (medicine to promote removal of body water via urine) are also given.

Q10 and Taurine are used in the treatment of myocarditis. If the heart muscle is weak, standard medicines to treat heart failure are also used.

Abnormal heart rhythm may require the use of additional medications, a pacemaker or even defibrillation. If a blood clot is present in any of the heart chambers, blood thinning medications such as warfarin sodium are given.

Prognosis (Expectations)

Prognosis depends on the cause and the individual patient. Some may resolve completely while others may have permanent heart failure (dilated cardiomyopathy).

Many researchers believe that dilated cardiomyopathy is a direct result of a previously burnt result of a previously burnt out.

As mentioned earlier, in most of the cases of viral myocarditis patients, the disease is resolved spontaneously without any treatment. In 20 per cent, there can be progressive disease or recurrence of symptoms.

The heart damage can be extensive causing arrhythmia (rhythm disturbances), weakened left ventricular function and in worst cases heart failure requiring heart transplantation. In these severe cases, cardiac disease progression persists after the virus is long one and the immune system continues to damage the heart.

Oxford recognition for Colvin Goonaratna centenarian study:

Fifty per cent of our centenarians are Dementia free

Oxford University has recognised Daily News medical page - HealthWatch collaborated Prof. Colvin Gooneratne Centenarian Study in Sri Lanka which began in 2001.

Following this, the Oxford University's Department of Pharmacology last year chose Sri Lanka to begin one of its studies on the extent to which Dementia and Alzheimer's disease are affecting the centenarian population in the world.

The study in collaboration with the Kelaniya University was done on randomly selected 20 centenarians who were in the Colvin Goonaratna study, thus crediting the Daily News (HealthWatch) collaborated study as the first of its kind in the world.

The Oxford/Kelaniya University study group in their report state that 50 per cent of the centenarians studied had no evidence of Dementia and about 25 per cent had no evidence of Alzheimer's disease.

The report states: "The average age of the study population was 102.1 comprising of 11 men and 9 women. 16 lived with their families and 4 in care homes."

"Ten out of 20 had Dementia and Alzheimers disease accounted for 72.2%."

The Oxford University study is headed by Prof. A. D. Smith, Director, OPTMA and Professor of Pharmacology. The Sri Lanka collaborators in the study were Dr. Asitha de Silva (Senior Lecturer and Head Department of Pharmacology Kelaniya University), Prof. S. B. Gunatilleke (Consultant Neurologist and Head Department of Medicine, Kelaniya University and Prof. Colvin Goonaratna (Emeritus Professor of Psychology Colombo University and Head Centenarian Study).

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