Monthly Archives: July, 2009

The French President & Jogging – What Went Wrong

In France, jogging is a running joke. But more of that later..

Mr Sarkozy, the French President , collapsed on Sunday after 45 minutes of jogging in a typical hot summer’s day  in Versailles. Initial fears had it that he might have got a heart attack. However, as the clearer picture emerged, it became obvious that the real culprit was a vaso-vagal attack, which was precipitated by dehydration in the hot weather and also the fact that he was on a new strict diet & exercise regime.


Sarkozy (in white) with wife Carla Bruni making the rounds in Paris

What exactly is a vaso-vagal attack?

This is a nerve stimulation of one of the 2  involuntary nervous systems that we all have, called the parasympathetic system( the other being the sympathetic system). This stimulation is the one that enables us to pee and poo but it also causes the heart to slow down (bradycardia) and that, at the same time, affects the nerves to the blood vessels in the legs permitting those vessels to dilate (widen). As a result the heart puts out less blood, the blood pressure drops, and what blood is circulating tends to go into the legs rather than to the head. The brain is deprived of oxygen momentarily and a faint episode occurs. TV fans who rush to the washroom to pee quickly during the commercial break are liable to experience similar symptoms. Read more here.


Jessica Simpson jogging - even celebrities can get the Big Five(see text)

This incident illustrates the importance of preventing dehydration, rather than waiting for thirst to appear before starting to drink. Just watch the Tour de France or the marathon events and you will see what I mean.

The other thing to do to prevent a vaso-vagal attack is to warm down properly afterwards so that the heart rate, blood supply and the muscles can return to normal gradually.

Personally, I do not recommend road-running as this can be bad for the joints. The five common complaints of joggers has always been shin splints (sore shins), runner’s knee (also called patellofemoral pain or PFP), plantar fasciitis (foot irritation), iliotibial band syndrome (thigh irritation) and Achilles tendinitis (lower leg irritation). Try the treadmill instead!

And why is jogging a running joke in France? Mr Sarkozy, usually wearing his black NYPD  T-shirt, has been accused of aping certain Western leaders’ penchant for jogging. Besides, athletic coaches say Sarkozy’s arms hang down, he bends too far forward, his stride is bad and his feet strike the ground incorrectly!

Escaping Swine Flu


Typical symptoms: sudden fever (38C or above) and sudden cough 1. Other symptoms include: Tiredness and chills 2. Headache, sore throat, runny nose and sneezing 3. Stomach upset, loss of appetite, diarrhoea 4. Aching muscles, limb or joint pain Source: NHS

Today’s print media highlighted the possible shortage of swine flu vaccine (when it eventually becomes available). The Director-General of WHO, Dr Margaret Chan was even reported to have accused Western nations of hoarding the vaccine and appealed to the big pharmas to divert just 10% of the supplies to developing countries so as not to deprive the less fortunate.

There is also a sense of panic developing as the number of deaths throughout the world rise to 700 (see here). Currently, the only form of possible cure, apart from the vaccine, is by taking Tamiflu or Relenza capsules by mouth. But they don’t come cheap at USD 60 per course. Besides, supplies are scarce and they need to be taken within 48 hours of the onset of the symptoms to be effective.

So where does that leave most of us, especially those who don’t like popping pills?

A comforting fact is that 95% of those who contracted swine-flu recover from it without any complications – this is a reassuring fact that is not emphasized by media hype. Apart from this consolation, an important principle is that the virus attacks those with diminished immunity. That explains why many of those that succumbed are either elderly, the very young, pregnant women, sufferers of chronic disease or thse taking steroids.


How can one increase one’s immunity?

  • Leading a  healthy lifestyle. Hate to repeat it, but regular exercise, no smoking, enough sleep and reducing stress are indispensable pillars.
  • Hygienic measures. Perhaps the most important preventive measure is washing the hands. You need to cough and sneeze safely too, because the tiny droplets expelled can contain the virus.
  • Hydration. Drinking water often and adequately (about 2 litres daily) is an important measure too.
  • Supplements to enhance the immune system. Zinc, selenium and ginseng have these properties.
  • Antioxidants. No need to buy expensive over-the-counter stuff. Taking them naturally is even better – berries,green tea, dark chocolate, coffee and red wine all have antioxidants.
  • Staying away from crowded places. This comes in last in my book as many of us just can’t avoid this, especially public commuters!

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Ban It!..Where There’s A Will, There’s A Way

You can sense the tide of opinion against smoking in the last year or so. It started off with a  ban on smoking in public last October in the world’s third largest market for cigarettes, with up to 250 million smokers, India.

ShahRukh Khan

Shah Rukh Khan - criticised by India's Health Minister for causing a bad example by smoking on-screen

The ban applies to all public places, including restaurants, bars, offices, airports and even bus stops, though there will be exceptions made for larger establishments that set up separate smoking rooms. In an effort to clamp down on a habit that kills an estimated 1 million people every year, the government put in action a ban that carries a fine of 200 rupees (USD 3) – more than the average person’s daily wage.

Now, Turkey, which has one of the largest number of smokers in terms of percentage of the population( 20 million out of 72) has extended an existing ban to cover all bars, cafes and restaurants. BBC News reported that local authorities have hired thousands of extra staff to track down smokers and impose fines amounting to 69 liras (USD 45).

“We are working to protect our future, to save our youth,” said Health Minister Recep Akdag.

What I fail to understand is why other developing countries cannot do the same, when the big boys have already done so. Lack of political will? If so, newly-elected government leaders should put banning smoking high on their list of priorities because the tide of change has come and its time to act against this public murderer Number One!   (see my previous posting “Smoking..Its Not Cool Anymore”)


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Viagra Coffee, Part 2

2 postings ago, I wrote about innovation being the driving force during recessionary times, in reference to the addition of sildenafil, the active ingredient of Viagra, into coffee powder to give that extra boost.

Its now becoming more apparent that this practice is more prevalent. The US FDA recently issued this statement:

FDA MedWatch Alert

Voluntary Recall of Libipower Plus

July 14, 2009

Audience: Consumers, pharmacists.

Haloteco and FDA notified healthcare professionals and consumers of a nationwide voluntary recall of Libipower Plus. Lab analysis of Libipower Plus samples were found to contain undeclared Tadalafil, an active ingredient of FDA approved drugs for Erectile Dysfunction (ED). Tadalalafil may interact with nitrates found in some prescription drugs such as nitroglycerin, and may lower blood pressure to dangerous levels. Additionally, the product may cause side effects.


Stamina-X contains Cialis..


..just like Libipower

This has resulted in this rather common ‘food supplement’ to be withdrawn from the shelves of big chain supermarts as well as from popular websites like Amazon. By the way, tadalafil is the active ingredient of the prescription drug Cialis, used for treating sexual dysfunction.

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A Rich Man’s Disease Becomes Middle-Class

I was quite bemused recently to see a regular patient hobble in to the clinic in slip-ons,  a typical scene with which most doctors would be able to diagnose immediately an  attack of acute gout. Bemused because a few weeks earlier he had joked about gout being a ‘rich man’s disease’ and he was sure, given the recession and his financial state, that there was no way he was going to get an attack.

Gout, more accurately acute gouty arthritis, has always been referred to as ‘ the rich man’s disease’ because of its association with rich foods and alcohol once available to aristocrats (like King Henry VIII and Sir Isaac Newton). The scenario today has changed as it extends its hold on the older, sedentary and overweight middle-class workers.  Acute gouty arthritis is caused by  excess uric acid ( a by-product of ingested proteins) being deposited to joints, especially the large toe, causing an excruciatingly painful situation which often wakes one up in the middle of the night.


English caricaturist, James Gillray(1757-1815), himself a gout sufferer, aptly illustrated the misery and pain of Gout


Pain relief requires strong  medications like non-steriodal antiinflammatory analgesics(NSAIDs) or colchicine and once the pain subsides, to take medications on a long-term basis to help prevent forming uric acid (like allopurinol) or to help throw away uric acid via the urine (like probenecid). As these have side-effects, many switch to alternative remedies, like apple cider vinegar, celery and other anti-oxidants.

Just to keep you updated, there has been no new medications for treating gout for the past 40 years(!)….until quite recently, when Uloric was introduced in the market. Touted to be safer than existing medications (which cannot be given to people with kidney disease and also carry death-threatening allergic reactions), the US FDA recently approved its general use.

Stuff which you need to reduce to avoid gout include:


Dairy foods (can be problematic for many with gout.)

Fluoridated and chlorinated (tap) water.

Fried Foods .

Junk foods and baked items have saturated and trans fats.

Meats with high protein levels like Steak, Turkey, Duck, Goose, Pheasant, Herring, Anchovies, and Sardines.

Mushrooms and Mushroom Gravy.

Organ Meats like Kidney and Heart (read pate).

Peas and some beans.

Pizza (white flour, cheese and meat for a triple whammy).

Roasted Nuts.

Sugary foods, esp high-fructose corn syrups.

Tangerines and other citrus fruits.

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Viagra Coffee – Keeps You Up All Night?

In times of recession, business entities have got to be innovative, so who can fault those guys responsible for mixing two aphrodisaics (one established and one speculative) and marketing them as a sure-cure for flagging poles! 🙂

Malaysian health authorities had seized several shipments of coffee mixed with viagra and sold in sachets and promising to perk up, in more ways than one, drinkers (see here). The brands that were pulled from store shelves included Kopi Pahlawan, Coffee Hari2-mau Power X2, Jamu Tenaga Lelaki, Bio Trim BTB and Kopi Tenaga Tok Lebai Plus. Just to give an extra fillip to consumers, there were 3 brands which not only contained sildenafil, but also had added tadalafil (Cialis). Talk about great marketing!

If anything, these coffee merchants, though innovative, were not original in their ideas; as the Simpsons were the first to moot this idea:

Just in case you didn’t know, its dangerous to drink this coffee as sildenafil, the active ingredient of Viagra, can cause low blood pressure and fast heart-beats (which is also caused by the caffeine in coffee), can can lead susceptible persons to a heart-attack.

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The Swine Flu, Fake Tamiflu & Flu Vaccines

As mentioned previously , 3 postings ago here, where there is a threat there’s opportunity! It didn’t take too long after  WHO declared a pandemic of the H1N1 (swine flu) virus that a flood of self-proclaimed remedies came onto the internet, enticing consumers to part with their money in return for dubious cures.

The US FDA were quick to respond to these quack merchants by publishing  a blacklist of internet sites. Many of these sites have since either closed down or retreated into “under construction” modes.


Tamiflu - the most sought-after prescription on the Internet

Not to be outdone, these marketeers have now resorted to fake Tamiflu sales over the Internet, so much so, scam emails on these fake Tamiflu have exceeded that for Viagra! Sir Liam Donaldson, the UK’s Chief Medical Officer, told the BBC that the whole field of counterfeit drugs is becoming a much bigger problem, with fake Tamiflu substituted with sugar and even coumadin (a blood thinner originally used to kill rats).

Even if you managed to get the genuine product, which sells as a course of 10 capsules for about USD 6 each, Tamiflu  has to be taken correctly (within 48 hours of the flu symptoms) to be effective. And if the flu persists, chances are you’ve got H1N1 flu because Tamiflu & Relenza (the other ‘antidote’) do not always knock off this virus!


Prevention Measures Like These Are More Effective than Tamiflu or Flu Vaccines

And the flu vaccines? The ones available in the market are only effective against the previous flu strains over the last few years, but not against swine flu. The swine flu vaccine will only be available end-August but it is doubtful whether there will be enough to go around should the containment phase now being undertaken by most countries moves towards the treatment phase as the pandemic spreads, as it is widely expected to.

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Death of The Stars..Learning From Their Mistakes


In my previous posting, I alluded to the possibility that Michael Jackson’s death could be due to the potentiating effects of several opiate prescription drugs like oxyContin & pethidine. We will know for sure whether this is the case, in a few weeks when the toxicology results are announced.

heathledger2In the case of Heath Ledger, who died at 42, the coroner found six different tranquillisers & opiate pain-killers in his tissues and concluded that accidental overdose was the cause of death. The prescription drugs found included OxyContin, hydrocodone, diazepam (Valium), temazepam (Normison, for sleep), alprezolam (Xanax,for anti-anxiety) and doxylamine (available over-the-counter as Somnil for aiding sleep).

annanicolesmithAnother case in point is that of Anna Nicole Smith, who died aged 39 in early 2007 due to massive doses of a sedative chloral hydrate together with at least 9 other tranquillizers that included Valium, Ativan and Rivotril.

The common denominator in all the three above cases (assuming MJ’s results are confirmed) is that there has been untoward drug interactions where many prescription drugs with similar actions are taken concurrently. The thing to note is that there need not  necessarily be a overdosage of any particular drug – sometimes normal dosages, when taken at the same time, create a cascading effect and  cause these untoward effects aka drug interactions aka drug toxicity.

Here are some common mistakes that can be avoided:

  1. Usage of several painkillers in an attempt to get fast relief –  people with long-term pain like backache may resort to increasingly stronger medications as the body gets used  to them. In MJ’s case, it has been reported that he had been on oxyContin (an addicting painkiller derived from narcotics) for many years and had received pethidine (another narcotic painkiller) at the same time. The false and wrong rationale is usually that the more one takes, the better for fast pain relief.
  2. Taking a cocktail of sleeping pills to ‘knock off’ – expecting a sleeping pill to work immediately can lead some people to erroneously take ‘more of the same or similar’ in an attempt to induce sleep quickly and perhaps get rid of unpleasant memories of the day. This is compounded when alcohol had been taken as it is a brain “downer”, just like sleeping pills. The combined effects of these pills and alcohol will suppress the brain from allowing the lungs to breathe. Never mix sleeping pills, sedatives, tranquillizers or take them with alcohol.
  3. Alcohol does not jive with many medications – apart from sleeping pills and cold medications, even some antibiotics (eg Bactrim, Flagyl) can cause unpleasant reactions.
  4. Using many doctors or pharmacies – when visiting multiple doctors, bring along the list of medications in your possession so that there is no inadvertent cross-reactions. Similarly, using only one pharmacy enables screening with existing medications to prevent harmful drug interactions.

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