Monthly Archives: October, 2010

A Very Dangerous Fruit Juice

Two decades ago it was widely known that ingesting this fruit juice with medications could cause dangerous side-effects, sometimes fatal. So, it is rather timely for me to refresh ourselves with this fact, especially when there are new reasons to avoid this fruit when combined with medications.

Grapefruit,  a member of the Citrus family, has been shown to carry many health benefits: it is a rich source of Vitamin C and also contains bioflavonoids which have anti-cancer properties. However, when consumed with  a large variety of medications, it has the ability to make the dosages taken, albeit correct, multiply to several times the usual amount in the bloodstream. Cases have been reported of a person on Lipitor or Cordarone dying due to an accumulation of this drug in the bloodstream.

The reason for this is that grapefruit gets metabolised in the liver by  cytochrome P-450 3A4 enzyme , the same enzyme which also metabolises about half of the drugs consumed today. So when grapefruit keeps this enzyme busy, it is unable to metabolise drugs, causing its accumulation in the bloodstream. Depending on the drug, the person will experience a variety of side-effects due to the “overdose”.

The list of drugs which can be affected is numerous and includes anti-cholesterol medications as well as Viagra. See the list here.

Don't take medications with orange juice, if you can help it

Recently, it has also been discovered that consuming grape juice or even orange juice can affect the absorption of some drugs when taken by mouth, which is why I have always maintained that medications should be taken with just plain water. These drugs include popular ones like beta-blockers (like atenolol), antibiotics( like ciprofloxacin) and anti-cancer drugs (like etoposide). Read more here.

Staying Alive – To Stay Alive!

New guidelines have been introduced for CPR (cardiopulmonary resuscitation)  which make them more user-friendly. Now everyone can apply!

The new guidelines introduced by the AHA this month essentially place more emphasis on chest compressions being the most important component of the triad (Airway, Breathing, Compression). For untrained bystanders, they need no longer hesitate about giving the ‘kiss of life’; they need only concentrate on the ‘C‘ until the medics arrive. Take a look at how its done:

Again, there’s mention of that Bee Gees hit Staying Alive because the tempo of the song (103 beats per minute) is similar to the speed of the chest compressions that the bystander needs to do on the collapsed person. (I know, try humming this song when chances are you are in a state of stress). In case 70s music is not your cup of tea, try Queen’s “Another One Bites The Dust” although this song has a rather inappropriate title!

Just one word of warning – not all people who collapse on the street have a heart attack. There’s a lot of other causes, ranging from a simple faint to an epileptic fit to a drunk stupor. Then what? I too am waiting for the AHA to issue guidelines on this..

Medical Credit Cards Can Harm Your Health

Enter a new phenomenon – the growth of medical credit cards designed for consumers to help them pay their medical bills. With such enticements as a discount on their medical bills, they have proven attractive for those not covered by health insurance or for those who have lost their jobs or faced with declining employer benefits in healthcare.

But really, the consumer has to be on top of the game; otherwise these credit cards can really hurt your financial health by crippling you with the  payment of the hospital bills at the end of the month plus the potentially high finance charges, should you defer paying completely. These medical cards are designed  to cover only health-related spending, but for all intents and purposes, behave like ordinary credit cards. That means enormously high interest rates on balances, late payment charges and other fees that you would find in any credit card.

Already, in New York, some of these cards have come under fire. Some of the reasons:

-claiming to charge no interest when in reality carrying interest rates as high as 25%.

-retrograde charges if the balance was not paid in full.

-‘kickbacks’ received by hospitals or doctors  for every card issued to patients.

-abuse by clinics and hospitals, like charging on these cards for non-existent services.

Consumers need to be informed on what getting a medical credit card entails. Here are some useful tips:

  • A medical card is essentially a credit card and behaves like one.
  • Its important to understand the terms and conditions, often buried in small print. Look for the pitfall of a low introductory interest rate which can skyrocket upon a single late payment. Some card issuers have been known to shorten payment cycles without warning, causing the card-holder to be caught unawares.
  • Do not pay for services in advance by allowing the provider to swipe your card before receiving the service. Often, its a big hill to climb to get the charges reversed should the service be annulled for whatever reason.
  • Avoid signing up when under duress. Notice how medical card companies set up counters in hospitals aiming to prey on those suddenly in need of emergency medical services for which they would normally not be able to afford.
  • Sometimes, despite the hassle of filling innumerable claim forms to claim health insurance, they are usually more cost-effective than simply swiping a medical card. Better still, pay cash if you can and ask for a discount or deferred payment plan from the hospital or clinic.

Embarrassing Health Questions

This morning I had to see a male patient who had been put on cholesterol-lowering medications. After the mandatory checks were over, he seemed reluctant to leave and appeared to have a question over his head. After some coaxing, he admitted to having impotence after commencing the medications.

This problem was easily sorted out, but it got me thinking …were there other ailments that people wanted to ask their doctors but were too shy to ask?  A look on  AOL Search yielded the answers:

Top Searched Embarrassing Health Concerns:
1. Herpes
2. Irritable Bowel Syndrome (IBS)
3. Yeast Infection
4. Psoriasis
5. Urinary Tract Infection
6. Genital Warts
7. Hemorrhoids
8. Impotence
9. Hyperhidrosis
10. Incontinence



Herpes leads the Most Embarassing Disease To Ask About


Why, impotence wasn’t even in the top 5! I guess its hard bringing up health issues which are deemed private with a relative stranger on issues that make one blush just thinking of them. But the doctor is a trained professional and if you’re comfortable with yours, by all means bring it up. They’ve probably seen scores of patients with similar problems as yours anyway!

By the way, about the impotence (nowadays called erectile dysfunction) caused by cholesterol medications, especially statins – its quite common but the good news is that everything returns to normal a few days after stopping the pills. Then talk with your doctor to discuss about using a substitute..

Where Have All The Slimming Pills Gone?

Looking for slimming pills? Don’t look too far, because virtually all the known slimming pills introduced over the last few decades have  all been banned or for restricted usage only. Whether its phentermine (Duromine, Adipex), ephedrine (Ephedra), rimonobant (Accomplia) or sibutramine (Reductil,Meridia) they’ve all fallen by the wayside due to their dangerous side-effects.


Impressive weight-loss ads often detract the consumer from the dangers of diet-pills



Duromine, one of the earliest slimming pills, is now indicated for short-term use only (I take it to mean less than 3 months) and can only be used in those who do not have a long list of medical conditions (see here). Since it is related to amphetamines (speed), it is very much a controlled substance and available only on doctors’ prescription.

Accomplia practically did not see the light of day, after it was banned within 2 years of use, after a significant percentage showed suicidal behaviour . I had written in an earlier posting here.

Latest to be banned in the US this month is sibutramine because of the high incidence of heart attacks and stroke. As I’ve said before, the Europeans seem to be more responsive and alert, having put this drug in cold storage since January this year.

However, the more worrying issue is that sibutramine has been found in several so-called herbal preparations. Examples include:

  • a Chinese herbal medicine, called “LiDa Dai Dai Hua Jiao Nang”, available on the Internet.
  • a Canadian product “The Slimming Coffee”.
  • In Malaysia, “Slimway Herbs” has been banned after earlier obtaining official approval.


Many Drinks and Herbal products contain sibutramine



So what drugs can be used safely?  Orlistat (sold as Xenical in prescription form and as Alli over the counter) is now the only prescription weight-loss drug approved for long-term use. The drawback of using this drug, as users will tell you, is that it “leaks” and stains trousers and clothing and wherever you sit down. The reason is that it works by preventing absorption of foods containing oil and fats, which then come out the other way (read “leaks out the other passage”!).

I guess the message is loud and clear – to lose weight, you have to fall back to good old diet and exercise!

Forget About Road Rage..Here Comes Desk Rage

You have heard about road rage. Now, its time to face desk rage, as stress problems in the office boil over and cause abusive and violent behaviour. According to a recent REUTERS article, workplace violence is on the rise. And to find the reason why, one need look no further than the world economy. Job cutbacks, home foreclosures and high food and fuel prices are putting a strain on families. Unfortunately, that strain is not staying in the home. It’s traveling to work with many employees right into the office.

Desk rage is a sign of stress: on-the-job anger that increasingly is triggered by the pressures and tensions of the workplace. Furthermore, electronic devices like laptops, PDAs, mobile phones, and e-mail have created an ever-widening gap between the amount of information people are expected to keep up with and the amount they can reasonably process, and this adds on to the stress. No one is spared, including doctors, as in the case of a cardiac surgeon who was sued by his staff for ‘workplace bullying’.

Anger in the workplace – employees who are grumpy, cynical, hostile, short-tempered or insulting – may lead to extreme abusive behaviour, as seen in this video:

Are you stressed and at risk of a ‘burnout’? Take this quick test.

So what can you do if you are put in a situation with a boss or a colleague who’s ranting and raving at you? Here are some pointers:

1. Do not react. Count to 10, take a few deep breaths and tell yourself the rage is about him, not you. Note your own emotion but do not let it control you. So, keep cool, calm and collected.

2. Listen and keep listening till he’s finished, before you talk.

3. Seek to understand the situation and provide empathy. There is a difference between undertanding and agreeing.

4. If that doesn’t work, you can quote Harry Truman, “If you can’t stand the heat, get out of the kitchen!”.

Share this Post

60 is the New 40

Looking at the attractive middle-aged lady patient sitting in front of me has prompted me to write about the way some people age gracefully –  her fine facial features did not make her look 60 at all! But really,cosmetic overhauls aside, it takes more than maintaining a good physical appearance to age well.

Basically, ageing successfully involves a trio of low incidence of disease, good mental & physical shape and actively engaging with life itself. I’m sure you’ve heard of some friend or other  who have got stricken by various diseases soon after retirement – the result of downgrading from an active working life to that of a passive boring life, devoid any positive activity.

Raquel Welch - now 69, compared with when she was in her 20s

Looking at Raquel Welch, Sigourney Weaver, Robert de Niro and Bill Clinton, one can see why the term “elderly” is now replaced with “senior citizens” or “seniors”. But its not just celebrities that benefit. Just look at some of  the perks of being a senior:

  • Things are cheaper – concessions for plane tickets, bus-rides, movies, theatre tickets and so on.
  • No more rushing around – no rush-hour travel, Saturday grocery queues or peak-hour queues to see the dentist or doctor, once retired.
  • More time for relationships and hobbies.

The fact remains that the 60 year old today is in better shape than a generation ago. A culmination of factors has made this possible: better nutrition, better healthcare and a greater awareness to healthy living.  To age well, some tips that are recommended include:

  1. Planning long-term housing & financial needs and activities before retiring (retirement planning).
  2. Regular exercise – including the right type. Besides cardio, strength-enhancing and balancing activities are a must,eg jogging has to be combined with tai-chi.
  3. Eating well – not the same as over-eating!
  4. Keeping the mind active – reading, sudoku, music, even computer games.
  5. Maintaining contact with family and friends plus staying active, socially and productively engaged, including volunteering.
  6. Keeping tabs with the annual medical check-up, a real must.

If you’re over 50 and want to know whether you are ageing well and correctly, I recommend the taking the NARI Healthy Ageing Quiz.

Share this Post

%d bloggers like this: