Recently in Pharmacy Q&A Category

Q. I am a singer, so my voice is critical to both my livelihood and my sense of well-being. I was recently diagnosed with mild asthma and my doctor prescribed an inhaler called Flovent.

I am fairly certain that this medicine is affecting the quality of my voice. Is this my imagination or could this be a side effect? Are there any other complications I should know about?

A. Fluticasone (found in Flovent and Advair) is an inhaled steroid. Such cortisone-like drugs calm inflammation in the lungs with fewer systemic side effects than oral steroids. Nevertheless, hoarseness, throat irritation, sinusitis, oral yeast infections and voice problems are not uncommon.

One reader was livid that she was not informed of any fluticasone side effects. After years of regular use, she had developed cataracts, headaches and osteoporosis. Discuss your concerns with your doctor.

Q. My doctor recently prescribed Premarin Vaginal Cream. It has improved my life dramatically, reducing dryness and easing other symptoms of menopause. Are there any negative effects? Is it absorbed into my body?

A. Premarin Vaginal Cream contains conjugated estrogens just like Premarin pills. It has recently been approved by the FDA to correct vaginal dryness that leads to painful intercourse. The estrogen is absorbed into the body, so discuss the benefits and risks with your physician. According to The Medical Letter on Drugs and Therapeutics, the long-term safety of vaginal estrogen creams is unclear (Feb. 23, 2009).

Q. I have been taking Protonix for heartburn for at least six months. After I learned that long-term use might lead to complications, I tried to stop taking it. Big mistake!

After about a week, I had to start taking it again due to severe heartburn--the rebound effect, I suppose. I asked my pharmacist how to discontinue acid-suppressing drugs but she was unable to find out. Do you have any suggestions?

A. Rebound heartburn may make it difficult to stop medications such as Aciphex, Nexium, Prevacid, Prilosec or Protonix. As a result, people sometimes end up taking such drugs for years. The consequences might include an increased risk of pneumonia, hip fractures and vitamin B12 deficiency, which can lead to nerve damage or cognitive problems.

We spoke recently with Tieraona Low Dog, MD, Director of Education for the Arizona Center for Integrative Medicine. She recommends a gradual approach for discontinuing acid-suppressors.

Dr. Low Dog suggests taking ginger capsules and chewing DGL (deglycyrrhizinated licorice) tablets as you phase out Protonix. Probiotics may also be helpful during this time. There is much more information about the pros and cons of acid-suppressing drugs and many non-drug approaches for controlling reflux and heartburn in our book, Best Choices From The People’s Pharmacy. It is available in libraries, bookstores and online at www.peoplespharmacy.com.

Q. I have a problem and I don't know where to turn. My partner and I don't have sex very often anymore. We have been together for over five years.

I became depressed because of work, family and medical issues but worked through it with his help. He is a great man and I love him more than anything. The problem is that we only have sex three times a month if I’m lucky.

He says it’s not me, but rather that he is under stress from work, family and friends. Is there anything a woman can do to slow down her sex drive? I love this man and will do anything for him, even give up sex if I must.

A. It should not be necessary to give up sex. According to Dr. Ruth Westheimer, a difference in sex drive between two partners is not unusual. She suggests that in a loving relationship, one partner can help the other achieve sexual satisfaction even without intercourse.

Couples counseling can be helpful. He may need a medical checkup to rule out problems with low testosterone. If he is heavy, weight loss may help. A new study suggests that overweight men may have hormonal imbalances that diminish sex drive (Journal of Clinical Endocrinology and Metabolism, April, 2009).
No drugs are approved for lowering libido, but many antidepressants have this effect. So does the herb vitex (chaste tree berry).

Q. I had severe leg pain during the night and day for about four months. My doctor did blood work and found that my vitamin D level was 8. She prescribed me 50,000 IUs per week for twelve weeks and now my leg pain is almost non-existent.

A. Doctors are becoming increasingly aware of the importance of checking vitamin D levels. A surprisingly large proportion of the population has less than optimal levels of this important vitamin. Lower than 20 nanograms per milliliter indicates deficiency. Some experts believe that optimal levels should be at least 30.
Replenishing vitamin D stores can reduce muscle pain. It may also lower the risk of such varied problems as depression, diabetes and heart disease (Dowd & Stafford, The Vitamin D Cure).

Many readers are frightened by the idea of 50,000 IU at a time, but since this dose is usually taken just once a week it comes to about 7,000 IU a day. This is a common prescription dose for correcting a severe vitamin D deficiency like yours.

Q. You’ve heard from a lot of people with bad indigestion. I used to be one of them. One day quite by accident I forgot to buy milk. To my surprise the next day the indigestion disappeared. Since I have given up milk, I can literally eat anything, even Mexican food, without difficulty. I now use lactose-free milk and soy yogurt. I hope this helps others.

A. Many adults have difficulty digesting lactose, the sugar in milk. For them, lactose can cause bloating, cramping or diarrhea in addition to indigestion. Thanks for sharing your story.

Q. I have been on so many cholesterol-lowering drugs I have nearly lost count. Crestor, Lipitor, Zetia and Zocor all give me terrible pains in my shoulders, back and arms. I also have had dreadful muscle cramps in my calves, especially at night.

I don’t know how much longer I can stand taking Crestor, but my doctor just says without it I’m a heart attack waiting to happen. Is there any natural way to lower cholesterol? I want to stay healthy, but the pain interferes with my ability to exercise and has affected my quality of life.

A. If your medicine is preventing you from exercising, it could be counterproductive for your health. Many readers have lowered their cholesterol with red yeast rice. Here is one success story: “My cardiologist suggested I try red yeast rice. Within six weeks my LDL level had dropped from 187 to 123.”

Although readers who have written us about their experience with this dietary supplement rarely have troublesome side effects, some susceptible people do develop muscle pain or weakness while taking this product. If you decide to try it, your doctor should monitor your progress and your liver enzymes. Taking Coenzyme Q10 (CoQ10) might reduce the risk of muscle pain from statins or red yeast rice.

We discuss the pros and cons of cholesterol-lowering drugs and CoQ10 along with red yeast rice and other non-drug approaches in our Guide to Cholesterol Control and Heart Health.

 Vitamin D deficiency may make statin-induced muscle pain worse. Consider requesting a vitamin D blood test and taking supplements if your level proves low.

Q. I read in your column that Detrol might have a negative impact on memory. Both my sister and I have been complaining about memory problems since we started taking it for overactive bladder problems.

I phoned my doctor’s office about this issue and was told they have never heard about this reaction at all. Why are doctors not aware of this side effect?

A. Modern medicine is highly compartmentalized. Specialists in one area may not always be aware of developments in another field. That might explain why a urologist could be unaware of the cognitive impact of certain bladder medicines. The FDA has not required drug companies to highlight this complication.

There is increasing evidence, though, that drugs that affect the activity of the brain chemical acetylcholine can impair cognitive function, especially in older people (Neurological Sciences, online, Feb. 20, 2009). Medications like Detrol and Ditropan can cause dry mouth and constipation as well as confusion, disorientation and hallucinations.

Q. What do you know about prescription Lovaza? My eye doctor prescribed it for dry eyes and eye surface damage due to Sjogren’s syndrome.

I have great respect for my doctor, but I would like to know if other forms of omega-3 fats are just as effective. Lovaza is very costly. He also has me taking flax oil.

A. Lovaza is prescription-strength fish oil (omega-3 fatty acids) approved for lowering high triglycerides. A month’s supply may cost over $160.

Sjogren’s syndrome is an autoimmune disorder characterized by arthritis, dry mouth, dry eyes, dry skin and dry, brittle nails and hair. There is some preliminary evidence that omega-3 fatty acids found in both fish and flax oil might be helpful (American Journal of Clinical Nutrition, Oct. 2005). We see no reason why you couldn’t use high-quality OTC fish oil in lieu of Lovaza.

Q. I am not yet 50 but my doctor says I have something called osteopenia, which could put me at risk for osteoporosis. She has suggested Actonel, but says this decision is up to me. She mentioned that there are some side effects and questions about the quality of the bone that results from this type of treatment. Is it possible that treated bone might not be as strong as that which grows naturally? What else can you tell me about these drugs?

A. There is growing controversy about osteoporosis drugs such as Actonel, Boniva, Fosamax and Reclast (Journal of the American Medical Association, Feb. 18, 2009). Rare but serious complications such as jaw problems, severe muscle, bone and joint pain and unusual thigh-bone fractures have been reported.

One reader shared this story: “I had a right femur fracture in May, 2007 and a left femur fracture in February, 2008. I had been taking Fosamax or Actonel for about 10 years. Prior to breaking these bones I had unexplained thigh pain for several years.”

It seems paradoxical that drugs meant to strengthen bones might contribute to unusual fractures. So you can better understand this issue and other pros and cons of osteoporosis treatment, we are sending you our Guide to Osteoporosis.

Q. Commercials that advertise prescription medicines on TV are my pet peeve. How can we STOP them? I would like to see them go the way of cigarette commercials.

Doctors should be prescribing the drugs people need without the rest of the world being subjected to these irritating commercials. I’m sure many others agree with me. How can we make our voice heard?

A. We have taken many informal polls and found very few people enjoy watching prescription drug ads. Doctors aren’t fond of them either, since patients may try to press for brand name drugs they have seen on TV.

The FDA seems disinclined to do anything to curb these commercials. A ban would require an act of Congress.

Q. I have been on Effexor XR for the past seven years for depression. I decided to wean myself off it, since it wasn't a good mix with another drug I started taking.

The third day I was completely off the Effexor my head started spinning. I felt as if I was on a tilt-a-whirl nonstop! After two days of this, I ended up in the ER getting CT scans and MRIs of my brain.

The doctors finally decided all this was from the Effexor withdrawal. They gave me ONE tablet and all the spinning stopped within an hour! This medication is NOT easy to get off.

A. The whirling sensation you experienced has also been described as “head in a blender.” When people suddenly stop taking antidepressants like Celexa (citalopram), Cymbalta (duloxetine), Effexor (venlafaxine), Paxil (paroxetine) or Zoloft (sertraline) they may experience dizziness, nausea, sweating, insomnia, headaches, nervousness and electrical shock-like sensations.

We discuss the pros and cons of such medications, strategies for stopping them and non-drug alternatives in our new Guide to Dealing with Depression. Gradual tapering of the dose over several months may be the best way to minimize the unpleasant symptoms of withdrawal. Careful medical supervision is essential during this time.

Q. Boudreaux’s Butt Paste caught my eye in your column about diaper rash. Our beagle Buddy was bruising his nose, grinding it to the quick as he went about burying treats, small toys and other objects in some hidden nook of the carpet. He pushed and pushed outward with his nose, rubbing it raw.

Our veterinarian suggested Boudreaux’s Butt Paste, and we thought he was putting us on. Almost embarrassed to ask, I went into our drug store and whispered the name of the product. “Sure, right up here,” said the pharmacist as he reached to the top shelf for a tube of it. It worked! It’s heavy enough that even constant licking kept it in place long enough for Buddy’s nose to heal.

A. Boudreaux’s Butt Paste is a diaper rash ointment that contains zinc oxide. Our veterinary consultant confirmed that veterinarians sometimes recommend this type of ointment for a dog with a sore raw nose like Buddy’s. She cautions, however, that a zinc oxide product should be used for a short period of time and not in large quantities. Dogs do lick their noses frequently, and zinc oxide can be toxic if they ingest too much of it.

Q. I need more information about the generic for the epilepsy drug Keppra. I understand that the generic is fairly new.

Is it safe to take, and does it have the same active ingredient as Keppra?

A. Generic drugs are supposed to be identical to their brand name counterparts. We have received a couple of troubling reports about this epilepsy medicine, however. One reader wrote, “I take Keppra and recently I was switched to a generic version. Several days after I began taking the generic pills, I suffered multiple seizures. I had to go back on name-brand Keppra.” When we asked the FDA about this problem, we were told that the generic formulation was unlikely to be responsible for seizures.

Q. I have been taking thyroid hormones (first Synthroid and then Levoxyl) for more than 15 years. My doctor has recently started lowering my dose because he is concerned that the extra thyroid might weaken my bones.

Ever since the dosage was reduced I have had many troubling symptoms. My cholesterol is going up and so is my weight, although I am exercising and eating carefully. I am tired, cold and depressed most of the time. My skin is dry and my fingertips have painful cracks and my nails are splitting. My hair is thinning and my eyebrows are fading away. Along with all that, I have absolutely no interest in sex. What can I do?

A. Although excess thyroid hormone can weaken bones and contribute to osteoporosis, getting the dose just right is essential for good health. All the symptoms you have described could be linked to insufficient thyroid activity.

We are sending you our Guide to Thyroid Hormones with information on how to interpret thyroid lab results as well as treatment options so you can discuss this with your doctor.

Q. My daughter insists you get colds from catching a virus, NOT from being cold, wet, not fully dressed or walking in the rain. Her beautiful 15-year-old son does not use an umbrella and likes to wear just a T-shirt out in chilly weather. I suspect he is trying to get out of school.

She is so sure that ONLY a virus can cause a cold that she never tells him to take an umbrella or a jacket. It makes me frustrated. I went to school for 12 years and was never tardy or absent, so I feel like I know what I’m talking about.

A. Folk wisdom maintains that becoming chilled--especially if clothes, hair or feet get wet--is likely to lead to a cold. Researchers have dismissed this belief as an old wives’ tale. Like your daughter, they see viruses as the only cause of colds.

Scientists have squirted cold viruses into the noses of volunteers and then exposed them to cold temperatures to see if this makes a difference. Studies that were done decades ago did not find an effect.

More recently, though, researchers in Wales had 90 volunteers put their feet in cold water for 20 minutes. Ninety others served as control subjects. Those who were chilled with cold water were more likely to report cold symptoms over the next five days (Family Practice, Dec. 2005). The investigators concluded that the old wives may have been right after all, though they are not quite sure why.

Q. You recently had an article about treating diaper rash. My granddaughter had a very bad one, and I used an over-the-counter cream called Boudreaux’s Butt Paste. It is not expensive and it works really well.

A. Boudreaux’s Butt Paste contains zinc oxide cream, an established treatment for diaper rash. It provides a barrier to protect the skin from moisture.

The product you used also contains inactive ingredients (castor oil, citric acid, mineral oil, paraffin, Peruvian balsam and petrolatum). Peruvian balsam has antibacterial and antifungal activity, but it can also cause contact dermatitis. Parents should be alert to that possibility if the rash starts to get worse despite using the Butt Paste.

Another reader responded to the idea of using Maalox on diaper rash: “When I was a nurse on a surgical unit, one of our surgeons used this for his patients, especially ostomy patients with angry reddened skin. You boil down the Maalox to form a paste, stirring constantly until it thickens. We applied it with a tongue depressor and put a light dressing over it.”

Q. My son is on Tegretol to prevent seizures and one of the things he has to avoid is grapefruit. I have seen that grapefruit must be avoided by people taking other medicines. What could happen if he does eat some? The school system puts grapefruit in the school lunches.

A. Grapefruit increases blood levels of many medications, including Tegretol. That could lead to side effects such as dizziness, drowsiness, lack of coordination or nausea and vomiting.

Grapefruit can also boost the effects of some blood pressure medicines and cholesterol-lowering pills. One reader had this cautionary tale: “One of my healthy, hard-working professional friends took his Lipitor pill with grapefruit juice and had to be hospitalized. At the time, he had no idea that grapefruit juice enhances or multiplies the strength of this medication.”

We are sending you our Guide to Grapefruit Interactions for a more complete discussion and answers to frequently asked grapefruit questions.

Q. A couple weeks ago, my husband saw his endocrinologist and the doctor ordered a test of his vitamin D level. It was very low, so my husband was put on 2000 units per day.

My husband has been having a lot of pain in his shoulder with a limited range of motion. An orthopedic surgeon told him that he had a tear in his rotator cuff, and that the only option is surgery.

In less than a week and a half on the vitamin D supplement, he has NO pain and FULL range of motion. This is like a miracle! I think we need a second opinion on that surgery.

A. A second opinion might be wise. Rheumatologists have been reporting that vitamin D deficiency can result in significant joint pain, stiffness and fatigue. Correcting the deficiency often cures these problems, although it won’t repair a torn rotator cuff.

In many parts of the U.S., low vitamin D levels are common during the winter because of the lack of sun exposure. It doesn’t take much time in the sun for skin to make vitamin D, but in cold weather that is not practical.

Q. When I first met my friend Mike twenty years ago, he was going through bottles of antacids. He’d been doing this for 12 years, far longer than the bottle label recommended.

He had a severe bout of anemia and was told he had an ulcer. More medicine!

Finally, three years ago he learned he had gluten intolerance. Now on a gluten-free diet, he no longer suffers heartburn at all.

A. Gluten intolerance, or celiac disease, can lead to a wide variety of problems, from migraine headaches and itchy skin rashes to acid reflux or osteoporosis. With the correct diagnosis and treatment (a gluten-free diet eliminating wheat, barley and rye), those who suffer from celiac disease can avoid a lot of suffering and unnecessary medication.

Another reader shared her story: “As a child, I had stomachaches almost every night. No one could figure out why. I also was anemic for several years in grade school, again without a clue as to the cause.

“I am now 
in my 50s and have osteoporosis. I recently learned that my chronic abdominal pain, bowel problems, anemia and osteoporosis are all related to gluten sensitivity! I used to eat a piece of toast to calm my bowels down, not realizing that the toast was the culprit. When I modified my diet I was amazed at how much better I felt.”

Q. What are the best sites for financial help with very expensive drugs? I don’t qualify for Medicaid but my drug bills can reach $5,000 a month. I have multiple sclerosis, Crohn’s and atrial fibrillation. I am a retired nurse and scared about how I can afford these medicines.

A. You may qualify for assistance from the pharmaceutical companies that make your drugs. Go to www.helpingpatients.org to find out.

We are sending you our Guide to Saving Money on Medicine for more information about free medications and other tips for saving money such as ordering from legitimate Canadian Web sites.

Q. My 62-year-old husband had a prostatectomy a year ago. It was successful, but he continues to have bladder problems. His urologist put him on Detrol for this.

When he started acting confused and paranoid, I got concerned. At the urologist's appointment I explained this to the doctor and he matter-of-factly muttered that, “yes, a side effect is COGNITIVE DECLINE.”

I was shocked and very upset that this was not in any of the pharmacy inserts we got with the prescription. Why isn’t this information more accessible?

A. It is alarming that the pharmacy inserts did not mention mental impairment as a possible side effect of your husband’s medication. Drugs for overactive bladder or incontinence like Detrol or Ditropan have been linked with memory problems and confusion in some patients (Clinical Therapeutics, Feb. 2005).

Medicines that alter the action of a brain chemical called acetylcholine are notorious for causing side effects such as dry mouth, constipation, blurred vision and cognitive impairment. Many other drugs besides those for bladder problems can trigger such symptoms. They include the antihistamine diphenhydramine, which is used to control allergy symptoms and insomnia. It is found in such popular products as Advil PM, Benadryl and Tylenol PM.

In Praise of Ambien

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Q. After reading all the complaints about Ambien, I would like to put in a good word for this sleeping pill. I’ve had trouble sleeping all my life. When I finally fell asleep, I had a hard time waking up.

A year ago my doctor prescribed Ambien. I only need half a pill to give me solid sleep. I wake up easily, feeling refreshed.

Before this I couldn’t go walking because I wasn’t able to get up early to beat the Florida heat. Now I walk a mile and a half every morning and feel great! I also work in the garden, paint, make quilts and knit. Ambien has changed my life for the better.

A. Like you, many do get a good night’s sleep on Ambien (zolpidem). Others have reported sleep walking or driving, which can be dangerous.

Q. My husband takes Actos, metformin and glyburide for type 2 diabetes, Lipitor for cholesterol and Diovan HCT for high blood pressure.

The doctor prescribed vitamin B12 because my husband’s low in this vitamin. He can’t get up the stairs without me behind him, pushing. He can’t stand up to work on anything for more than half an hour. When he stands still, he gets dizzy and teeters. As a result, he drags a chair around or uses a walker to go anywhere. He has bad cramps in his lower legs. Could any of his drugs cause the vitamin B12 problem?

A. Metformin is useful for treating type 2 diabetes but can lead to vitamin B12 deficiency. Lack of this vitamin can cause fatigue, peripheral neuropathy (numbness or tingling of hands and feet), trouble walking and confusion.

Lipitor may lead to leg cramps and weakness, while the diuretic HCT in Diovan HCT may interfere with good blood sugar control.

Your husband’s doctor may need to evaluate his treatment regimen, given his symptoms. To prepare for his next visit, we would like to send you our book, Best Choices From The People’s Pharmacy, with more information about treating type 2 diabetes, hypertension and high cholesterol. It is available in libraries, bookstores and online (www.peoplespharmacy.com).

Q. My son was prescribed amoxicillin for an ear infection. The prescription was sent electronically to the pharmacist. The pharmacy gave us prednisone with the wrong doctor’s name on the script. Even the address was wrong.

The pharmacy clerk tried to talk me into taking the prednisone. Then she said there were two meds that were prescribed--amoxicillin and prednisone.

The pharmacist finally called the doctor to confirm the prescription (which was for amoxicillin). The pharmacist explained the problem as “computer error.”

Our doctor will not give me a paper prescription any more because the office just transmits it electronically. I think from now on I’ll ask the doctor to write down for me the medicine and the dose. That way I will make sure what I pick up at the pharmacy is what the doctor prescribed.

A. Even the best computer programs rely on humans for input and interpretation, and that unfortunately still leaves room for mistakes. It is unconscionable that the pharmacy tech tried to cover up the mistake and give you the wrong drug.

Your idea of getting the name and dose of the medicine written down for you is excellent. We suggest that everyone who gets a prescription called in, faxed in or electronically transmitted make sure they have all the details on their drug in writing before leaving the doctor’s office.

Q. You ran a story about lisinopril causing cough. I had the same experience.

My regular doctor referred me to an audiologist who diagnosed acid reflux. I then went to an ENT doctor who had no suggestions. Finally I saw an allergist who immediately took me off lisinopril and replaced it with Cozaar. Cough gone!

A. Lisinopril is an ACE inhibitor. Although this type of blood pressure medicine works well, it can cause a relentless cough that does not respond to cough medicine. Cozaar is a different type of blood pressure pill called an ARB (angiotensin-renin blocker). ARBs are much less likely to cause chronic cough.

Q. One of your readers asked for advice regarding constipation caused by Fosamax and Lipitor. I was surprised you did not mention taking Metamucil to help with constipation.

I have had to follow that regimen for over 30 years, taking 3 teaspoonsful daily. Please pass this information on.

A. Psyllium, the active ingredient in Metamucil and similar products, works well to counteract constipation. It can also help lower cholesterol.

Psyllium must not be taken at the same time as Fosamax or Lipitor, however. It might interfere with the absorption and thus the effectiveness of these drugs.

Q. I'm a 26-year-old female in a committed relationship with a man I am deeply in love with and have been for two years. I've always had a healthy sex drive, but now I'm concerned.

In the beginning we had a very active and passionate sex life, but as time goes by he seems less and less interested. For a while I think he had sex with me just to keep me happy, and now he ignores my advances. I know we won’t have sex several times a day like we did in the beginning, but I don't know why we can't do it several times a week.

I used to send him sexy text messages throughout the day so that when he got home he'd be excited. Now if I do that he doesn't respond. I’ve tried to spice things up--toys, videos, you name it, I've tried it all, but nothing works.

Sex is one thing I truly enjoy. Having good sex relaxes me, relieves stress and allows me to sleep through the night, which I can't do on my own.

He’s gained a lot of weight, but he’s a really great guy and I have no desire to look elsewhere. Talking doesn’t work as he ignores my questions. I don’t know what to do.

A. Many people mistakenly believe that men always have stronger sex drives than women. But according to Irwin Goldstein, MD, editor-in-chief of The Journal of Sexual Medicine, up to one fourth of women have more interest in sex than their male partners.

Counseling for the two of you is the best place to start. Even if he is reluctant, you should seek guidance on your own. Your partner should also have his hormone levels checked, since low levels of testosterone are associated with being overweight and can reduce libido.

Sex expert Dr. Ruth Westheimer told us that when couples have different levels of interest, a partner can help the other achieve orgasm, even if he isn’t in the mood for intercourse.

We interviewed both experts on our radio show, The People's Pharmacy. For an hour-long CD on this topic, please order show # 680.

Q. I am a 63-year-old woman who had estrogen-positive breast cancer 10 years ago. I had bilateral mastectomies, no chemo or radiation.

Now I am extremely estrogen deprived and cannot have sex because of the pain from vaginal dryness. My doctor will not prescribe estrogen to help with this problem because it might increase my risk of cancer recurrence. Is there some other way to treat these atrophic changes?

A. Applying a lubricant such as olive oil or coconut oil daily may be helpful. For intercourse, you might want to consider a water-based lubricant such as Sylk. It contains kiwi-fruit vine extract and is available on the Web at www.sylkusa.com or by calling (866) 831-2920.

Q. I was on atenolol for high blood pressure and kept complaining to my doctor about fatigue, tiredness, light-headedness and swelling feet and ankles. I couldn’t breathe or walk up a flight of stairs without stopping to catch my breath every two steps.

As a military dependent I see different physicians. My current doctor switched me to propranolol. I am now noticing that my feet and ankles are beginning to swell with this medication also and I have developed asthma. There are days when I can't do anything but sleep.

Are there better drugs or natural approaches to control my blood pressure? I am convinced that these medications have caused me more harm than good!

A. Atenolol and propranolol are both beta blockers. Such drugs are rarely considered appropriate as the first-line treatment for hypertension. They can trigger fatigue and asthma and are not appropriate for people with breathing difficulties. You should not have to suffer symptoms from your blood pressure medicine.

We are sending you our new Guide to Blood Pressure with many natural approaches, including helpful foods, special juices and breathing exercises, as well as the pros and cons of many medications. We are concerned about your swollen feet and ankles and urge you to see a cardiologist who could evaluate this symptom.

Q. You ran a letter from a forensic crime scene detective who used Vicks VapoRub to mask nasty smells on the job. You should have said, Don’t put Vicks VapoRub in your nose, your horse’s nose or your meerkat’s nose! You idiots shouldn’t be writing a pharmacy column if you don’t know that Vicks will coat the lungs and should never be inhaled.

A. We warn readers not to put Vicks in the nose for fear of triggering chemical pneumonitis (lung inflammation). In fact, the column you are referring to closed with this caution: The manufacturer warns that Vicks VapoRub is “for external use only,” and should not be put in nostrils. Regular use of petroleum jelly in the nose may increase the risk for lung irritation.

This warning is more important than ever, since researchers at Wake Forest University recently reported a case in which an 18-month-old child developed severe breathing problems when her grandparents put Vicks under her nostrils for a cold (Chest, Jan. 2009).

Q. Please tell me if my blood work is good or if I need medicines. My total cholesterol is 156, LDL is 62.9, HDL is 89.5, triglycerides 18 and glucose 105. I am 79 plus years young and active with no problems that I know of.

A. Whatever you are doing, it is right for you! Your numbers are phenomenal and would be the envy of many younger people. We can’t imagine a doctor would want to prescribe cholesterol medicine for you.

Q. Can you please give me more information on the connection between Boniva and osteonecrosis of the jaw? I heard about this on the radio.

I have taken Fosamax and Actonel for osteoporosis but had to discontinue because of digestive problems. Now my doctor is insisting that I try Boniva.

I am skeptical of these drugs, but find that doctors dismiss the dangers of side effects until the damage is done. I want to arm myself with more information about these drugs for my next doctor’s visit.

A. A new study in the Journal of the American Dental Association (Jan. 2009) suggests that jaw bone death (osteonecrosis of the jaw) may be triggered by drugs such as Actonel, Boniva and Fosamax. In this investigation, up to 4 percent of Fosamax patients having a tooth extraction experienced this serious complication.

We are sending you our new Guide to Osteoporosis with an in-depth discussion of the pros and cons of all the drugs used to treat this condition. Other side effects of such drugs have recently come to light in The New England Journal of Medicine. They include unusual thigh-bone fractures (March 20, 2008) and a possible increased risk of esophageal cancer (Jan. 1, 2009).

Q. Please help me. I am 35 years old and have been addicted to Argo Corn Starch for the past four years. How can I stop eating it? It makes my mouth dry and my limbs cramp. I have mood swings and have gained weight. But just knowing I shouldn’t eat starch is not enough.

A. Please see a doctor and ask to be tested for iron or zinc deficiency. Pica, compulsively eating a substance that is not food, is frequently associated with such a mineral deficiency and often goes away when the deficiency is corrected.

Here is another woman’s experience: “I have been eating Argo Corn Starch on and off for about 15 yrs now. I started in my teens and am now 28 years old. The only time I didn't eat any AT ALL is when I was pregnant.
“At one point in time, I was going through 4 boxes a week but I've cut back a lot. I don't even want to eat a full box now. It makes me very tired, but I crave it. I hate the fact I eat starch but I can't help it.

“I went to the doctor once about this and he prescribed prenatal pills. They were helpful until they were all gone!”

The prenatal supplements she found so helpful may have corrected an iron or zinc deficiency. That’s why we urge you to get tested. Psychological help such as cognitive behavioral counseling might be useful, but only after you have corrected any physiological deficiency.

Listerine Fights Flakes

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Q. When I was young I had an ongoing dandruff problem. This was about 45 years ago.

My uncle was a barber, and he told me to use the old brown Listerine. I have used it ever since, every time I wash my hair, and have never had another problem with dandruff. It works.

A. Thanks for the tip. Many other readers agree that old-fashioned Listerine can help fight flakes and itching on the scalp. That may be because the alcohol and herbal oils in Listerine have anti-fungal properties. Since dandruff is caused by yeast (a type of fungus), it is not that surprising that this mouthwash might be beneficial.

Although the makers of Listerine used to advertise it for “infectious” dandruff, the FDA no longer permits this claim. Nevertheless, rinsing with Listerine (or a generic house brand equivalent) seems like a cost-effective tactic for discouraging dandruff.

Q. I was put on Lipitor to control cholesterol and found it shot my blood sugar through the roof. My doctor suggested switching to Crestor. Would this drug also affect blood sugar?

A. You are not the first person to note that some cholesterol-lowering medicines might raise blood sugar levels. Another reader reported that after taking Crestor, his type 2 diabetes numbers also “went through the roof.” In addition, he reported: “my hands, feet and arms tingled so much I could hardly stand it.”

The official prescribing information for both Lipitor and Crestor mention elevated blood sugar as a possible side effect. A large study of over 17,000 patients (the Jupiter Trial) reported a higher incidence of diabetes in the subjects taking Crestor (New England Journal of Medicine, Nov. 20, 2008).

Researchers are not sure whether this is a real complication of statin-type drugs or just a coincidence. In the meantime, it is still important to control cholesterol since both it and diabetes can increase the risk of heart attacks and strokes.

Q. What can you tell me about testosterone to jump start diminished sex drive in women? I used to have a fantastic libido and enjoyed a great sex life with my husband. But ever since menopause I am rarely interested in sex and when we do make love I almost never have an orgasm.

A. The “APHRODITE” study published in the New England Journal of Medicine (Nov. 6, 2008) reported that a patch containing 300 micrograms of testosterone “resulted in a modest but meaningful improvement of sexual function.” During this year-long trial, women on the patch reported “increases in sexual desire, arousal, orgasm and pleasure…”

In the study a few women on testosterone were diagnosed with breast cancer. The researchers could not determine whether this hormone was responsible. Long-term side effects of testosterone have not been studied.

We are sending you our Guides to Female Sexuality and Treating Sexual Dysfunction with more details about testosterone and other approaches for men as well as women.  The FDA has not approved topical testosterone to improve female libido, though some doctors are prescribing it “off-label.”

Q. When I read in your column that a person was surprised that the blood pressure pill lisinopril caused his constant cough, I just shook my head and wondered why people don't know the side effects of the drugs they take. I take lisinopril too, but when my doctor put me on it I read the paperwork that listed adverse reactions.

I have found that you have to be very pro-active with your health. I research what I can or cannot eat with any of my prescribed medicines. I ask my doctor why I am on a medicine and if I have read something negative about it, I ask if something else would be as good. I also know that questioning a pharmacist is often the best way to get a helpful answer about a medication.

A. We applaud your prudent approach and only wish others were as careful.

Q. Ambien made me sleep-walk, -eat, and-drive! I would wake up with food in my bed not remembering anything that happened.

My mother said I would walk into the living room and start talking to her. I had no recollection this had happened.

A year ago I woke in the hospital with a broken femur, ankle, patella, fractured skull and broken finger. I had been sleep-driving!

I never wear pajamas when I drive, EVER! I had my pjs on when they found me so I believe I went sleep-walking to the car, started driving and totaled my car into a tree!

A. We have heard from many others that sleep-driving may be a complication of using Ambien (zolpidem). A police officer shared the following: “I took one Ambien CR after a meal and went to bed. Some time after that I proceeded to get up, get dressed, left my home in my personal vehicle and was involved in a crash. As a result of the accident I was arrested and lost my job.”

Ambien is not the only sleeping pill that may lead to bizarre behavior. According to the ad for Lunesta, “After taking Lunesta, you may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night…Reported activities include: driving a car (‘sleep-driving’), making and eating food, talking on the phone, having sex, sleep-walking.”

We are sending your our Guide to Getting a Good Night’s Sleep in which we discuss the pros and cons of sleeping pills and offer several non-drug approaches.

Healing Split Fingertips

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Q. Every winter, my wife and I are bedeviled by split skin on the tips of our fingers--tiny cuts that are painful. Can you give us suggestions for not getting them?

A. Split fingertips are common. If regular moisturizing is not enough, apply Vicks VapoRub  or Aquaphor before bed and wear cotton photographer’s gloves to protect the sheets. Liquid bandage on the cuts may help them heal faster.

Q. My sister and I were very concerned about my 73-year-old aunt and the tremendous number of medications she was on. She was in a terrible nursing home and was continually strapped in a wheelchair. She was always agitated and often spoke to people who had been dead quite awhile.

The doctors said her hallucinations were caused by a stroke and dementia. Her family was in complete denial. My sister obtained your Guide to Drugs and Older People with the Drug Safety Questionnaire.

We moved her to a different facility. Two weeks after the medicines were stopped or the doses were lowered, she has become herself again. Thanks for helping us get our wonderful aunt back!

A. We are pleased to learn of your success. Overmedication with some common drugs, such as those prescribed for overactive bladder or insomnia, can contribute to confusion, cognitive decline or even hallucinations. Our Guide to Drugs and Older People has a list of drugs that may be inappropriate for seniors along with the Drug Safety Questionnaire.

Q. Turmeric increases the anticoagulant effect of Coumadin. I have been on Coumadin for 15 years because of an artificial aortic valve.

I had read that turmeric was effective in lowering cholesterol and began sprinkling it on broccoli. My INR went up dramatically and my pharmacist said, “STOP!” Have there been any studies on the blood-thinning effect of turmeric?

A. You are not the first person to report this interaction between Coumadin (warfarin) and turmeric. Others have reported a spike in their INR lab values (a measure of blood anticoagulation) and we believe this is a dangerous combination. Our fear is that this could lead to a serious bleeding episode.

Q. I am 76 years old and I take Centrum Silver vitamins, calcium, low-dose aspirin, Crestor for cholesterol, lisinopril for blood pressure, Coenzyme Q10 and Osteo Bi-Flex for arthritis. My doctor has approved all this medication.

My problem: I have had gray hair since I was thirty-five and over the years it has turned white. Now I have black hair growing from the roots and it seems to grow every day. I am very unhappy about this, as I have never had black hair. Could one of my medications be responsible?


A. We have heard from many other readers that cholesterol-lowering drugs like Crestor, Zocor or Zetia can turn gray hair dark. One woman wrote: “My 84-year-old mother let her naturally black hair go silver gray about ten years ago. Several years later she began taking Zocor and after about a year she noticed the roots of the new growth were black! She is not pleased about this because it makes her otherwise lovely silver hair look ‘dirty!’”

There is no information in the medical literature about this side effect, but we suspect that Crestor might be responsible.

Q. My doctors were mystified by my anemia. The puzzle was solved after I read in your column that taking Nexium and other acid-reducing drugs can hinder the absorption of iron and other nutrients. Now I regularly take iron with my other supplements and am no longer anemic. Thank you!

A. Minerals like iron and calcium are absorbed best when there is acid in the stomach. Powerful acid-suppressing drugs like Nexium can interfere with this process, and may also hinder absorption of vitamin B12. Inadequate levels of this vitamin can also cause anemia.

Q. I have been taking lisinopril for seven months to control my high blood pressure. Soon I developed a hacking cough. When it wouldn’t go away I saw an ear, nose and throat specialist. He shrugged and said this comes with age.

When I complained to my regular doctor he gave me a course of antibiotics, but there was no relief. I called back and was given a different antibiotic prescription.

Eventually, my wife mentioned my cough to the pharmacist who pointed out this is a common complaint with lisinopril. When we brought this to my doctor’s attention, he agreed and finally took me off the drug. How could this happen?

A. Lisinopril is an ACE inhibitor. Like other blood pressure drugs in this class (Accupril, Altace, benazepril, captopril, enalapril, ramipril and quinapril), lisinopril can cause cough as an unpleasant and common complication. This kind of hacking cough won’t go away with cough medicine.

We are shocked that neither your lung specialist nor your regular doctor figured this out. Antibiotics are inappropriate for this kind of drug-induced cough.

There are other medications to control blood pressure. ARBs (angiotensin receptor blockers) such as Avapro, Benicar, Cozaar and Diovan are less likely to cause a chronic cough. For more information about pros and cons of hypertension medications and non-drug ways to lower blood pressure we are sending you our Guide to Blood Pressure Treatment.

Q. I read in your column a while back that a person heard music after taking the antidepressant amitriptyline. My urologist prescribed a similar drug (imipramine) for a mild urinary problem. After a few days, I too started hearing music. My music was a wonderful male chorus each evening. After I pinned the music down to that antidepressant drug I quit taking it. I did miss that wonderful male chorus, though!

A. Drug-induced auditory hallucinations are rare but documented in the medical literature. The person you refer to taking amitriptyline reported: “I hear music all day, both classical and rap.” When the drug was discontinued the music faded away.

One person taking an antidepressant heard a full orchestra playing dramatic classical music: “The final straw came when I was riding my motorcycle (not a quiet machine) and couldn't hear the sound of the engine and wind over the orchestra playing in my head! I took myself off the antidepressant, and the hallucinations disappeared.”

Q. A reader recently reported using zinc oxide to treat hemorrhoid symptoms. I just wanted you to know that I have been using zinc oxide for this purpose for years. I thought no one else knew about it!

It’s something I just tried on my own after little or no relief from such ointments as Preparation H. Zinc oxide provides almost instant relief. I told my doctor years ago, but she had never heard of using zinc oxide for hemorrhoids.

A. Zinc oxide appears to be a safe, inexpensive alternative to other external hemorrhoid creams. When we looked for it at the drugstore, we found it sold as a diaper rash cream.

How to Reduce Inflammation

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Q. I have been hearing that something called CRP may be more important than cholesterol when it comes to heart disease. I don’t know much about it. What are normal CRP values?

My doctor says everything’s fine and that he does not have time to “chat.” But there was an opportunity to have blood work done at my college recently and my CRP was 6.7 mg/L. Isn’t that high? Is there any way to lower CRP other than taking Crestor?

A. Recent research showed that the statin-type cholesterol-lowering drug Crestor lowered CRP and reduced cardiovascular events even in people who started with normal cholesterol (New England Journal of Medicine, Nov. 20, 2008). Before this hit the headlines, many people had never heard of CRP or C-reactive protein. This marker of inflammation should ideally be at or below 1, so yours is elevated. Many cardiologists believe that CRP above 2 calls for treatment.

Crestor can lower CRP, but it is expensive and some people experience side effects. You may be able to fight inflammation with exercise and weight loss. Supplements such as fish oil and Coenzyme Q10 may also help. Your doctor should monitor your CRP level to keep track of your progress. We are sending you our new Guide to Cholesterol Control and Heart Health, in which we discuss CRP and offer a list of anti-inflammatory foods and non-drug approaches for heart health.

Q. Does Topamax cause complete lack of sexual desire? And I do mean complete!

A. Topamax (topiramate) is prescribed for epilepsy, but it is also used to prevent migraine headaches. Your short question implies a lot of frustration and sent us hunting for an answer.

“Decreased libido” has been reported as a side effect of Topamax in the prescribing information provided for doctors. It seems not to be very common, though, affecting just a few patients in a hundred.

Doctors have also described cases in which Topamax completely blocked women’s ability to achieve orgasm (Neurology, Oct. 25, 2005). About five days after discontinuing the Topamax under medical supervision, the women were once again able to climax.

Never stop an epilepsy drug suddenly without your doctor’s approval. An unexpected seizure could be devastating.

Q. I'm responding to a column in which a young woman committed suicide after starting Cymbalta. I worry that others will use this tragedy to say that antidepressants are dangerous.

I take the same pills she did: clonazepam and Cymbalta. These drugs allow me to have feelings again, beyond just the agony of despair. With counseling, I was able to step back and survey what had become of my life when I was most depressed: ruined relationships, lost money and jobs.

These drugs can be life saving for many people. I truly feel, though, that medication must be combined with therapy. It is not the doctor's fault for giving out samples of the medication. They usually come with the full information packet.

A. Many people do indeed benefit from antidepressants. Nevertheless, patients and families must be told to contact the prescribing physician if suicidal thoughts occur when starting a new medication.

Q. I had acid-reflux surgery because stomach acid was irritating my throat. After the surgery, the correct diagnosis of celiac disease was finally made. Eating wheat caused the acid in my throat.

People often write you about chronic heartburn. They should be told that surgery and drugs aren't always the answer. If I’d gotten the celiac disease diagnosis sooner, I might have been spared an unnecessary operation.

A. Celiac disease is an inability to tolerate gluten, a protein found in wheat, barley and rye. The immune reaction to this protein begins to destroy the gut and can cause a wide range of symptoms, from heartburn and migraines to fatigue and osteoporosis.

Celiac disease was once thought to be rare, but more recent research shows that it is far more common, perhaps one in 100 people (Proceedings of the Nutrition Society, Nov. 2005). It runs in families, so relatives of patients should definitely be tested. There are no medications to treat celiac disease, but it can be controlled with a gluten-free diet.

To learn more about the symptoms, diagnosis and treatment of celiac disease, we offer an hour-long CD of our radio interview with a leading expert, Peter Green, MD.

Q. I had shingles many years ago. So did my friend. Her doctor gave her a shingles injection so she won't get it again. My doctor said by having shingles I built antibodies to it and don't need the shot. Which doctor is correct?

A. Chickenpox during childhood can lead to shingles later in life. The virus (varicella zoster) can lie dormant in nerves near the spinal cord for decades. The virus can be reactivated and trigger an intensely painful skin reaction.

Zostavax was developed to prevent shingles in people over 60. The company excluded anyone who had previously experienced a shingles attack from the study. Consequently, the FDA does not allow the company to promote the vaccine for anyone who already had shingles.

We’re not surprised that the doctors disagree. Many were taught that shingles only happen once. That is not completely true. Although quite rare, some people can experience another bout with this virus (American Family Physician, April 15, 2000). The Centers for Disease Control and Prevention call for vaccination even for people who already had one attack.

No Saltpeter in Prison Food

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Q. My boyfriend was recently released from prison and believes there was saltpeter put in the food. How do you remove the effects after numerous years?

A. Saltpeter (potassium nitrate) is falsely believed to lower libido. Youngsters in boarding schools and summer camps as well as men in the military or in prison have perpetuated the myth that they are being fed saltpeter.
If time and support don’t overcome your boyfriend’s sexual difficulties, counseling may help. Hormonal assessment may also be needed.

Q. Once there was only one Robitussin cough medicine. Now there are lots. The one with DM almost killed me. I had such a hard time breathing I thought I was going to die.

I reported this to my pharmacist and was told that I might be allergic to the “DM” in Robitussin. He warned me to read all labels on cough medicines from now on. People need to be warned, especially parents who might give this to their children.

A. Dextromethorphan (DM) is the leading ingredient in most OTC cough medicines. Its effectiveness has been controversial, particularly in children. Parents have been warned to avoid cough and cold medicines for kids four and under.

Reviewers for the Cochrane Collaboration (an international organization that evaluates medical treatments) concluded: “There is no good evidence for or against the effectiveness of OTC medicines in acute cough.”
Although allergic reactions to DM seem quite uncommon, there are reports in the medical literature of serious breathing difficulties triggered by this cough medicine (Allergy, Aug. 2004). Follow your pharmacist’s advice to read labels carefully!

Q. As a teenager, I was blessed with relatively few blemishes. Now in my mid-20s, I have developed large deep pimples that heal slowly and have eroded my self-esteem.

I had tried everything from expensive department store skin care regimens to acid peels at the salon. Nothing was wholly effective and I had been considering seeking a dermatologist's help when I heard MoM mentioned on your radio program.

I tried Milk of Magnesia and my skin hasn't looked better in years! I apply a thin layer with a cotton ball 3 to 4 times a week, let it dry and then remove with a warm cloth before applying my normal cosmetics in the morning.

My skin keeps a matte finish longer through the day and I have been developing fewer and less severe blemishes. MoM works better than anything else I've tried and the price is certainly right!

A. We’ve heard from many readers that milk of magnesia (MoM) can be helpful for a variety of skin problems. One reader offered this: “MoM controls my seborrheic dermatitis very well and it is much cheaper than prescription Nizoral cream. I am a retired physician who has had seborrheic dermatitis for many years. My sense is that doctors are prescribing highly potent, pricey prescription agents. It is good to learn of cheaper, effective alternatives.”

We have written about many of these inexpensive practical remedies for acne, dry skin, eczema and wrinkles in our new Guide to Skin Care and Treatment.

Where Is Aspirin Made?

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Q. When I buy plain aspirin there is no country of origin listed. When I call the 1-800 number, I'm promised a reply to this concern but the call is not returned.

Is there any aspirin made in the U.S. with American ingredients?

A. An expose in the New York Times Magazine (Nov. 2, 2008) revealed that there are no major generic aspirin manufacturers in Europe or the U.S. Most aspirin is now made in China.

Many over-the-counter medications as well as prescription drugs now come from manufacturers in China, India or other parts of Asia. If country of origin labeling is important for clothing and food, why wouldn’t it be even more critical for medicine?

Q. I have high lipids and a stent in my heart. I have been on Lipitor, Vytorin and now am on Crestor.

While taking Lipitor and Vytorin I always had muscle weakness. Now that I am on Crestor, not only do I have severe muscle weakness, I have cramps in my legs, itching palms and brain fog.

Is there a more natural way to lower lipids? I am getting worried about my liver since I read somewhere that itching palms might signal liver problems.

A. Statin-type drugs lower cholesterol and inflammation that can lead to heart attacks. Since you have a stent, you need to control blood lipids aggressively.

Not everyone tolerates statin medicines like Crestor, Lipitor or Vytorin (which includes simvastatin). Severe muscle pain, weakness or cramping is a red flag. Ask your doctor to test liver enzymes, as itching could be a sign of trouble.

We are sending you our new Guide to Cholesterol Control & Heart Health with more information on the pros and cons of statins as well as many other ways to control blood lipids.

Q. Our 24-year-old daughter was experiencing anxiety. Her doctor prescribed clonazepam (also known as Klonopin). Along with that, he gave her free samples of an antidepressant called Cymbalta.

Our daughter took these medicines beginning on Thursday, but they made her feel bad. By Sunday evening she began talking about losing a desire to live. On Monday morning, she drove her beautiful 4-year-old daughter to school and then drove to her fiance’s home. When she got there, she took a gun and killed herself.

We are at a loss as to what happened. Our daughter might still be here if not for Cymbalta.

A. We are so sorry to learn about your family’s tragedy. The Medication Guide that comes with Cymbalta contains the following caution: “Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.” Patients or family members should contact the prescriber immediately if the patient feels agitated or has thoughts of suicide. We hope your experience will help others.

Q. I was recently traveling in France and ran out of the acetaminophen I brought from home for my painful arthritic knee. When I attempted to buy more acetaminophen from a French pharmacy, the pharmacist said acetaminophen is not sold in France. The pharmacist advised me to take a product named paracetamol. I took the French pharmacist’s advice and bought some, but I have some reservations about it. What is paracetamol and is it safe to use?

A. Acetaminophen (Tylenol, etc) is sold throughout the world as paracetamol. The two are identical.

Q. I struggled for years with hair loss, dry skin and tiredness all the time. I was finally sent to an endocrinologist who discovered I have Hashimoto's disease and prescribed Armour Thyroid.

Now that I take this natural hormone, my hair is not falling out, my fingernails and toenails grow, my skin is not as dry, my monthly cycle is not as heavy and to my amazement I have much better mental clarity. I used to feel like I was in a haze sometimes. I never understood why, but that is one of the symptoms of low thyroid as well.

Hashimoto’s disease is said to be one of the leading causes of thyroid problems. In this autoimmune disease, the body creates antibodies that attack the thyroid gland. I am grateful that my doctor finally listened to me and ran the blood test for this diagnosis.

A. We’re glad you were finally diagnosed correctly. Thyroid disorders are common and your symptoms were classic. Armour thyroid is an old-fashioned treatment for hypothyroidism and many doctors no longer prescribe it. Some readers report, however, that they feel better on this than on synthetic levothyroxine (Synthroid, Levothroid, Levoxyl) that only contains T4. We discuss the use of Armour Thyroid and the importance of balancing T3 and T4 in our Guide to Thyroid Hormones.

Q. I read your column about floating poop. When I experienced this about seven years ago I ignored it because there were no other symptoms. Luckily for me, I ended up in the emergency room with a kidney stone. This is likely the first time ever you have heard anybody say he was lucky to have a kidney stone.

When they performed a CT scan to find the stone, they found the cause of my floating poop--pancreatic cancer.

One of the reasons the survival rate for pancreatic cancer is so low is that it is rarely found early. By the time most people are symptomatic, it has metastasized. The tumor had blocked the bile duct just enough to cause the floating poop symptom.

I had a Whipple procedure and am one of the very few survivors of pancreatic cancer. Please tell the person with floating poop to see a doctor.

A. You are not the only reader who made a connection between “floaters” and pancreatic cancer. Several readers remembered a televised interview with the late Randy Pausch, author of "The Last Lecture," in which he talked about this as a symptom of his pancreatic cancer.

There are other causes of floating poop, and many are not serious. Just the same, it makes sense to discuss this symptom with a physician.

Q. Someone wrote to you about using zinc oxide as a deodorant. I tried it but it didn't work for me.

At the same time my hemorrhoids were burning and itching, and even Preparation H didn't seem to help. Since zinc oxide is used in diaper cream, I thought why not give it a try?

From the first time I used it I have not had any recurrence of the symptoms. At first I applied it every night but now I only use it once a week or less.

A. The person who wrote to us found that zinc oxide cream (commonly used for diaper rash or sunburn protection) was effective as an underarm deodorant. Your experience shows that it may not work for everyone to control body odor.

We could find only one reference to the use of zinc oxide for the itching and burning of hemorrhoids. A German salve (Mirfulan) that contains zinc oxide plus witch hazel, urea and vitamins A and D was reported helpful many years ago (ZFA Stuttgart, Oct. 20, 1979).

Q. Every winter my skin gets awfully dry and itchy. My hands and particularly my fingertips really suffer. At times they crack and bleed. I heard that you have written about solutions for these problems. I would be so grateful if you would send me any information you have.

A. As indoor heating systems come on, humidity drops. That may be why dry skin is worse in the winter. Washing hands frequently to avoid colds or flu also aggravates dry skin.

Readers have suggested a variety of solutions, including O’Keeffe’s Working Hands Cream, TheraSeal Hand Protection and Lotil Cream. Inexpensive farmers’ moisturizers such as Bag Balm, Corn Huskers Lotion or Udder Cream (an underwriter of our radio show) are also popular.

Cracked fingertips can be extremely painful and moisturizing isn’t always enough. Some readers use Chap Stick or liquid bandage on split skin. We are sending you our new Guide To Skin Care and Treatment with many other ways to help heal cracked fingertips, ease eczema and relieve itchy, dry skin.

Q. I am having trouble leveling out my Coumadin. Many foods are not included on the list the dietitian gave me. Cranberries are a puzzle, for instance. The nurse says eat them; the doctor says don’t. Can I eat cranberries or not?

A. Trying to maintain a steady anticoagulant effect from Coumadin (warfarin) can be a little like walking a tightrope. Too much medicine can lead to bleeding, while too little may permit blood clots to form. Coumadin interacts with many foods.

Several cases in Great Britain led the health authorities there to warn against combining cranberries or cranberry juice with the anticoagulant Coumadin (warfarin). Some people who had been on a stable dose of Coumadin had serious bleeding problems after drinking cranberry juice or eating cranberries.

Australian scientists have reported that cranberry significantly increases warfarin’s anticoagulant effect (British Journal of Pharmacology, Aug. 2008). We suggest you follow your doctor’s recommendation and avoid cranberries and cranberry juice while you are taking Coumadin.

Aleve Makes Her Drowsy

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Q. Can Aleve sometimes cause drowsiness? I only take one but later I find myself dozing off. Is there a hidden ingredient that causes this? Am I the only one who experiences this problem?

A. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as OTC ibuprofen (Advil, Motrin IB) and naproxen (Aleve) or prescription products like diclofenac (Cataflam, Voltaren), indomethacin (Indocin) and meloxicam (Mobic) can sometimes cause drowsiness, dizziness or confusion.

You are not the only one who gets sleepy or spacey on medications like Advil or Aleve. A nurse who wrote to us several years ago reported that ibuprofen made her mentally foggy. She feared early-onset Alzheimer’s disease, but found that stopping the NSAID improved her mental status.

We have prepared a Guide to Alternatives for Arthritis with a discussion of the pros and cons of medicines like prednisone and NSAIDs as well as non-drug approaches for easing joint pain.

Annoyed at ED Ads

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Q. I'm so irked about erectile dysfunction ads. I'm a mature adult, married (with adult children), so I’m not ignorant or prudish.

I think, however, that if you have a problem, you know it and should see your doctor. These advertisements are so offensive, considering all the people who end up watching them.

A. Many people are fed up with TV ads for erectile dysfunction drugs. Only the U.S. and New Zealand permit any prescription drug advertising to patients.

The law could be changed to restrict such commercials. Let your Senator or Representative know how you feel.

Q I have read that cold medicines for children continue to be sold even though they have not been thoroughly tested. Sadly, some businesses are quick to put out OTC medications just to turn a profit (and a rather large one at that). After all, if it promises a miracle, what parent of a sick child wouldn’t spend money for it?

Unfortunately I work in a business that uses that trick time and again. I definitely don't like the lack of standards for children’s OTC cold products.

A. For years, millions of young children have been dosed with ineffective and potentially harmful cough and cold remedies. Pediatricians have been lobbying the FDA to crack down on the manufacturers of these medications. Under this pressure, the companies recently agreed not to market these products for children under four.

We’re not confident that older children will benefit either. In lieu of drugstore nostrums, home remedies may offer a safer approach. Some pediatricians are now suggesting chicken soup for colds or honey and lemon for coughs. For an interesting discussion of natural ways to boost the immune system for fighting off colds, you may want to listen to a podcast of our radio show #664 with Tieraona Low Dog, MD, at www.peoplespharmacy.com.

Q. You have saved my sanity! I’ve always enjoyed your column, but never needed your advice until last year.

I had been suffering in silence as my hair changed its texture from wavy to straight. Then my fingernails began to deteriorate. I thought it was another consequence of growing older, until I read in your column that too much selenium in the diet could affect hair and nails adversely.

At the time I was taking a supplement that contained selenium along with the lecithin I wanted. I immediately switched to a lecithin-only supplement. After about six months, the nails began to recover. In another four to six months, my hair had become wavy again, and my nails were much stronger. Thank you!

A. Problems with hair and nails are often difficult to diagnose, so we are glad we gave you the clues you needed. Selenium is an essential mineral, but excess selenium can be toxic. Loss of hair and nails has occurred both among Chinese people whose diets were naturally high in selenium and in Americans taking supplements with too much selenium.

The tolerable upper limit of selenium is around 400 micrograms daily. Brazil nuts are high in selenium and an ounce (roughly half a dozen) provides 800 micrograms. Overindulging regularly could lead to selenium toxicity.

Q. If the price is too good to be real, the drug might be a fake! With Nexium over $4 a pill, I ordered it from an online Canadian drugstore. When the pills came, they were from India and they were generic.

This medicine did not work and now I have my asthma symptoms and cough back. I don't know what I will do, since I can't afford the name brand!

A. Acid-suppressing drugs such as Aciphex, Nexium, Prevacid, Prilosec and Protonix can relieve reflux. Some people with this condition develop other symptoms such as asthma or cough as a result of acid irritation. If your medicine is not working, your condition might be aggravated.

You have discovered one of the pitfalls of using an online pharmacy. Not all “Canadian” pharmacies are located in Canada. Some online drugstores source their medicines from around the world to get a better price. The FDA has no control over the quality of such medicines.

We are sending you our Guide to Saving Money on Medicines with some tips on how to tell if an online Canadian pharmacy is legitimate.

Q. I was watching Oprah and heard a doctor on her show say that poop should NEVER float. Why?
I have not changed my diet at all, but all of a sudden about two months ago, every time I have a bowel movement, my poop floats.

Is there something wrong with my system? I feel fine and have no pain or anything unusual.

A. Health professionals have been debating the causes of “floaters” vs “sinkers” for decades. Some believe floating is caused by excess fat in the stool as a consequence of digestive disease. Others maintain that gas is the culprit.

If you feel well and have no diarrhea or other symptoms, it probably makes little difference. If it persists, tell your doctor at your next visit so she can rule out anything serious.

Chantix Success Story

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Q. I used Chantix to quit smoking on May 30. I don't recall any psychological side effects and have been recommending it to everyone.

After using it successfully, I figured all smokers should try it and wondered why they weren’t. Reading about the depression and rage some people report on your Web site (www.peoplespharmacy.com) answered that question.

A. Chantix is a unique medication that seems quite effective in helping people quit smoking. But there are potential side effects that can be terrible for some people. They include weird dreams, insomnia, depression, suicidal thoughts, irritability, aggression, nausea and headache.

Q. The recent melamine scare from China has me wondering. Due to the fact that supplements have little regulatory control, is there a risk that protein powders sold for dieters and muscle builders could contain melamine to increase the amount of protein when tested? Also, should I worry about my children's melamine dining plates?

A. You raise a fascinating question. Chinese producers have apparently added melamine to milk to cover up the fact that it was diluted. The same chemical was also added to the pet food ingredient gluten to make it appear higher in protein so it would be worth more.

No one has suggested that protein powder has been contaminated with melamine, though we don’t know how carefully the FDA has tested such products. If the raw ingredients in such powders came from China there might be cause for concern.

Melamine is high in nitrogen and is used to make countertops, dry erase boards and unbreakable dishes. We doubt that the dishes pose any risk to your children, since such plastic plates have been used for decades and are unlikely to release melamine into the food.

Q. As a forensic crime scene detective, I have used Vicks in my nose to block the smell of noxious odors for many years. No adverse effects have been apparent. However, I am aware that adverse effects may still present a serious concern over the long term.

A. We can well imagine that a forensic crime scene investigator would have to deal with some pretty stinky situations. The strong aroma of Vicks can mask other smells.

We have heard from readers that horse trainers sometimes utilize this unique property of Vicks:  “My friend raises and shows palomino horses. When she shows the stallions, she puts a little bit of Vicks inside their nostrils so they won't get a sniff of a mare in heat and act like a typical male and show off. If they can not smell the mare, they behave properly.”

A zoo in England has used Vicks to mask the scent of newcomers in a group of meerkats. Without some such intervention, they are likely to fight.

Our Guide to Unique Uses for Vicks offers intriguing applications for nail fungus, dandruff, bug bites and tennis elbow. The manufacturer warns that Vicks VapoRub is “for external use only,” and should not be put in nostrils. Regular use of petroleum jelly in the nose may increase the risk for lung irritation.

Q. My endocrinologist said my vitamin D level is too low and told me to take 2,000 IU daily. I have done that and find that my arthritis pain has disappeared. Is there a connection?

A. It’s possible. There is growing awareness that vitamin D deficiency can contribute to joint and muscle pain.

Q. I’m not a pill taker, but my doctors insist I get my blood pressure down to 120/80. I started on beta blockers (first propranolol, then atenolol and now metoprolol). They make my joints ache and I feel tired, depressed and disappointed. Diovan makes me weak and dizzy. My hair is falling out, my cholesterol is going up and my breathing is bad.

I used to feel great. I stayed active by walking and golfing. Now I can barely drag myself out of a chair. Are there any better medications or natural remedies I could ask my doctor about?

A. As important as it is to control hypertension, you should not have to curtail your activities because of blood pressure pills. Your medicines could well be contributing to your symptoms. Beta blockers are no longer considered the best first treatment for high blood pressure.

Exercise is important. Other natural approaches include pomegranate, grape or beet juice. Magnesium can also be helpful.

You will find more details on these and other natural approaches along with the pros and cons of various anti-hypertensive medicines in our Guide to Blood Pressure Treatment.

Q. I have been taking Prozac for the past five years. I am happily married, but I've definitely noticed a downturn in my ability to achieve a climax.

My doctor recently switched me to Celexa to see if it would offer an improvement in that area. It hasn't worked, although both drugs have been very helpful with my depression.

Are there any anti-depressants that don't cause this particular side effect? Or is there some way to overcome this problem with orgasm?

A. When Prozac-like drugs were first introduced, no one knew how common sexual side effects might be. Pre-market testing suggested that such complications were relatively rare (2 to 16 percent). Now we know that sexual problems may actually range from 30 to 70 percent of patients.

Drugs like Celexa, Effexor, Lexapro, Paxil, Prozac and Zoloft are prescribed for anxiety, bulimia, depression, chronic fatigue syndrome, hot flashes, obsessive-compulsive disorder, PMS and post traumatic stress disorder.

Many people report that such drugs can reduce libido, interfere with arousal, delay or block orgasm and cause erectile dysfunction. Some describe a numbness or lack of sensation as “genital anesthesia.” If they do achieve orgasm they experience little or no pleasure in the act. A recent article suggests that sexual side effects may sometimes persist indefinitely, even after the drugs are discontinued (The Open Psychology Journal, Vol. 1, pp 42-50, 2008).

There are no obvious antidotes for this problem, though some doctors have tried drugs like Viagra. An antidepressant such as bupropion is less likely to cause sexual dysfunction. Discuss your situation with your doctor to see what solution might be appropriate.

Q. A friend of mine just announced that she has genital herpes. She has had it for quite a few years and has never told her husband.

She claims she contracted herpes from a low immune system due to chronic arthritis. I always thought this disease could only be caught through a sexual encounter. Can you bring me up to snuff on the causes of 'genital herpes'?

A. You are correct that genital herpes is a sexually transmitted disease. Your friend is mistaken either about her diagnosis or about the way she acquired it. We are surprised that she has not informed her husband, since he is at risk for catching the disease whenever they make love.

Q. I believe my friend was sleep driving when he was killed in a car accident. A dump truck slammed into his car at an intersection he’d known all his life. It was only two blocks from his house.

I called his wife to get the story and she said he reportedly ran a blatant red light on his way to work. That is certainly not like him, especially because he was applying for a police job. If you’re doing that, you don't go through red lights, for sure.

When I’d talked with him not five days earlier, he had told me he was on Ambien. He said if he didn't get enough sleep he would do strange things. I feel the Ambien caused him, a husband and father of two, to be killed needlessly because he was probably sleep driving under its influence.

A. Ambien has been linked to “sleep driving.” Whether this sleeping pill was responsible for your friend’s accident is impossible to tell. Others have shared stories of bizarre behavior (including sleep driving) under the influence of Ambien (zolpidem).

Many people are able to take Ambien safely, but others need a different approach for dealing with insomnia. Some people wake early in the morning and cannot get back to sleep. For them, a shorter-acting drug like Sonata may be preferable.

We discuss the pros and cons of sleeping pills like Ambien, Sonata, Lunesta and Rozerem as well as non-drug approaches in our Guide to Getting a Good Night’s Sleep.

Q. I am seeing a new guy and the stubble on his face has left a large chapped area on my face that almost feels burned. It’s an unpleasant aftermath of an enjoyable kissing session. I'm putting Vaseline on it. Is there anything else that might help more?

A. We checked with cosmetics expert Stanley B. Levy, MD, of Chapel Hill Dermatology in North Carolina. He said you can use 1 percent hydrocortisone cream for a few days. It is available over the counter.

To prevent or soothe irritation, Aquaphor (made by Beiersdorf) would feel and work better than Vaseline. It too is OTC.

Dr. Levy continued, “Make sure you are not sensitive to his aftershave, moisturizer or lip balm. Although the grizzly look is in, you could also ask him to shave more frequently.”

Q. I am concerned about all the drugs my 81-year-old mother-in-law takes. Her forgetfulness has gotten progressively worse and she is dizzy much of the time.

She is taking: amitriptyline, Aricept, Arthrotec, aspirin, Avapro, Chlor-Trimeton, Levothroid, Lexapro, Lortab, Norvasc, Symbicort and Tylenol Arthritis. Do you see any red flags?

A. You have reason to be concerned. Her medications might be contributing to her dizziness and mental decline. Amitriptyline is prescribed for depression or pain relief. It is rarely appropriate for older people, as it may increase forgetfulness and confusion. The antidepressant Lexapro might push levels of amitriptyline higher than expected.

Both blood pressure medicines (Avapro and Norvasc) can cause dizziness. So can the pain reliever Lortab. If dizziness caused a fall, it could be devastating.

She is getting a double dose of acetaminophen from Lortab and Tylenol Arthritis. This could put a strain on her liver.

We are sending you our Guide to Drugs and Older People with a Drug Safety Questionnaire to encourage her doctors to review side effects and interactions.

Q. You wrote recently about Voltaren Gel for sore joints and said it is a prescription product. I bought a tube over the counter when I was in New Zealand a few years ago.

It works very well. I recently used it on a knee I hurt trying to get into a window seat in an airplane. It helped a lot.

A. Countries have different regulations regarding which drugs require prescriptions and which are available over the counter (OTC). Topical diclofenac (Voltaren) requires a prescription in the U.S., but not in New Zealand. This gel is used to ease the pain in joints, tendons, muscles and ligaments due to arthritis, bursitis, sprains and strains.

Q. Last night my boyfriend became so violent I was afraid he was going to hit my 22-year-old daughter or me.

He threatened to burn down our home and he tried to kick me out. I just realized that he started changing in the last two weeks right after he started taking Chantix to quit smoking.

He has never acted like this before. He was so threatening and said such cruel and hateful things.
I read on your Web site about possible violence and aggression from a combination of Chantix and alcohol. My boyfriend drinks beer. As soon as he gets home from work I’ll tell him to stop taking Chantix. There needs to be a warning about
this drug. If nothing else, this frightening reaction can ruin relationships that were going beautifully.

A. Some people taking Chantix have become violent. We have heard from others that alcohol may aggravate aggression linked to Chantix.

Even without alcohol, this stop-smoking drug may trigger extreme emotions. One woman wrote: “I took Chantix exactly as prescribed, and within two days, I was a changed person: irritable, with wild mood changes, yelling and screaming at everyone. I would even become violent with close family when things didn't go my way.”

Find more stories about psychological reactions to Chantix at www.peoplespharmacy.com.

Q. Can Synthroid and ferrous sulfate be taken at the same time of the day?

A. No. Iron supplements such as ferrous sulfate interfere with the absorption of Synthroid (levothyroxine) taken to treat thyroid problems. Wait at least two hours after Synthroid before taking iron, calcium or other minerals.

Q. My teenage daughter has been taking antibiotics to treat her acne for years, but she’s also had terrible GI problems (stomachaches and diarrhea) for much of that time. I didn’t think of a connection until recently, but now I wonder if the antibiotics might be responsible.

She has taken Prilosec, as per her doctor’s recommendation, but it really hasn’t helped. Is there anything else that might help her overcome these symptoms? Her dermatologist says if she stops the minocycline she is taking her acne will come back bad, and I hate for her to have to deal with that at the start of the school year.

A. It is possible that years of antibiotic treatment have altered the ecology of her digestive tract, contributing to her pain and diarrhea. Antibiotics kill good bacteria as well as the bad ones.

Repopulating the digestive tract with good bacteria can sometimes help reverse that problem. Such probiotic bacteria may be found in yogurt with active live cultures or capsules such as Culturelle, Enzymatic Therapy or Florastor.

Q. I have normal LDL cholesterol but low HDL, as low as 26. With diet and exercise I can get my HDL to the mid-thirties, which is not great. Lipitor lowered my LDL below 80 but sadly my HDL didn’t budge.

After being on Lipitor for a couple of months I woke up one morning and had no idea what day of the week it was or that the company picnic was the day before. At work I could not make simple postings of dollar amounts from hard copy to electronic spreadsheet (I would forget the amounts).

At a meeting, I could not remember names and later at home I kept asking my wife the same question, as I could not remember her answer. She took me to a doctor, who thought I had a mini-stroke. Ultrasound, brain scans and all other tests were normal, so no stroke.

I mentioned Lipitor but the doctor dismissed it (“no way”). At the end of the evaluation I was diagnosed with transient global amnesia.

Not wanting to be a vegetable for the rest of my life, I stopped taking Lipitor. I now take Niaspan (prescription niacin) and my HDL has improved to 43. My LDL is 80 and my memory is better than ever. I hope this story helps others.

A. We received a startlingly similar story from Duane Graveline, MD, a retired astronaut and family physician, in 2001. He too was taking Lipitor when he had a scary experience with transient global amnesia (TGA).

Subsequently we heard from others who also experienced TGA or other kinds of memory problems while taking statin-type cholesterol-lowering drugs. Anyone who would like to hear Dr. Graveline’s story and learn more about this complication and other ways to control cholesterol may be interested in a CD of a radio interview we conducted with him and several other experts.

Q. I’ve had an odd experience. I’m 66 and in good health, but my eyesight has deteriorated. The ophthalmologist says it’s just due to my age.

When I take Lunesta to go to sleep, the next day my eyesight is crystal clear and needs no correction—just as if I were 18 again. Then, the following day if I don’t take the sleeping pill, my eyes are so blurry and out of focus I have a hard time even with my glasses.

I only take the Lunesta twice a week. Has anyone else reported this weird occurrence?

A. We have searched the official label information and the medical literature and could find no reference to beneficial effects of Lunesta on vision. Thank you for your fascinating report.

Have you considered the possibility that getting a good night’s sleep makes the difference? If others have noticed an improvement in vision linked to Lunesta, we invite them to report it to the Web site: www.peoplespharmacy.com.

Q. My nails break, crack, split and peel and grow out very slowly. They’re not strong enough to open a soda can.

I take Synthroid for my thyroid, hydrochlorothiazide for blood pressure control, simvastatin for high cholesterol and Prevacid for heartburn. Could any of these affect my nails? Is there anything natural I could take or use to help my sad nails? Nail hardeners seem to make the problem worse.

A. Many things may affect nail health. The proper balance of thyroid hormone has an impact. Cholesterol-lowering drugs like simvastatin (Zocor) have been linked to nail changes and so has the acid-suppressing drug lansoprazole (Prevacid).

Avoid nail hardeners, since they may aggravate the situation. Some readers report that taking a dietary supplement called MSM (methylsulfonylmethane), commonly used for arthritis, may be helpful. Others tell us that moisturizing the nails with products like Elon, Epilyt or almond oil is the ticket.

For more details on these approaches, we are sending you our new guide to Hair and Nail Care with a discussion of nail problems and many natural approaches for improving nails.

Q. I have a question about Valtrex.

I know this drug is prescribed to treat genital herpes. If someone is exposed to a partner with herpes, will taking Valtrex right away destroy any of the virus that may have been acquired before it has a chance to take hold and become dormant? In other words, can Valtrex be used as sort of a "day after" medication if taken soon enough?

A. We were intrigued by the idea that Valtrex might protect someone against genital herpes, so we asked the manufacturer, GlaxoSmithKline. We learned that GSK has never done a study to investigate this scenario. The company has only done studies in people known to be infected with herpes simplex virus. As a result, there aren’t any clinical data to support the use of Valtrex as a "day after" medication or as a prophylactic drug in uninfected individuals whose sexual partners have genital herpes.

Q. I take Coumadin to prevent blood clots and have paid attention to potential interactions with food and other medicine. I read in a health newsletter that a full adult dose of Pepto-Bismol is the equivalent of eight aspirins. How serious is this interaction?

A. The maximum daily dose of Pepto-Bismol contains 2080 mg of salicylate. This aspirin-like drug could well interact with the blood thinner warfarin (Coumadin). Such a combination could increase the risk for bleeding. Symptoms include bruises, dark stool, nosebleeds or bleeding gums.

People who use arthritis rubs containing methyl salicylate (oil of wintergreen) may also be at risk for this interaction. Products such as Arthritis Formula BenGay, Icy Hot Cream, Mentholatum Deep Heating and Thera-Gesic all contain methyl salicylate. Anyone taking Coumadin must be extremely vigilant to avoid potentially life-threatening interactions.

Voltaren Gel for Sore Joints

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Q. I read about a topical form of diclofenac called Voltaren Gel. It is supposed to be applied to the skin over painful joints like the knee. Is this an over the counter or a prescription product?

A. Americans are familiar with oral nonsteroidal anti-inflammatory drugs like celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), ibuprofen (Advil, Motrin), indomethacin (Indocin), meloxicam (Mobic) and naproxen (Aleve, Anaprox, Naprosyn). Such medicines can relieve arthritis pain but the price can be increased blood pressure, ringing in the ears, blood clots, stomach upset and bleeding ulcers.

Applying the medication right on the painful joint may reduce the dose needed to get relief and reduce the likelihood of serious side effects. Voltaren Gel is new to the U.S. market and requires a prescription.

We offer more details on topical diclofenac (found in Voltaren Gel and Pennsaid) as well as natural treatments in our Guide to Alternatives for Arthritis.

Q. I was alarmed to read in your article on sunscreens that benzophenone-3 (BP-3) could be a hormone disruptor. I looked at my sunscreens and found that they did indeed have the active ingredient benzophenone-3.

What sunscreen does not have BP-3? My 12 year old plays tournament tennis, so we as a family spend a lot of time in the sun and need to be protected! I know a lot of other concerned parents would be interested as well.

A. Most parents don’t want to expose children to a compound that might disrupt hormones. That is why the concern about BP-3 (also known as oxybenzone) got such attention. This compound, found in many sunscreens and lip balms, can mimic estrogen.

The Environmental Working Group, a non-profit organization that raised the alarm on this issue, has made some sunscreen recommendations on its Web site: www.ewg.org. Products that rely primarily on zinc oxide or titanium dioxide as the blocking agents are generally on their approved list, which features brands such as Keys Solar Rx, Trukid Sunny Days Facestick, and oxybenzone-free products from Badger, Blue Lizard, California Baby and CVS.

Q. I heard that eating an Atkins diet could raise good HDL levels. Surely that is not true! Presumably all that saturated fat raises bad cholesterol even more.

A. In a recent study (New England Journal of Medicine, July 17, 2008), a low-carb Atkins-style diet resulted in higher good HDL cholesterol and lower triglycerides than a standard low-fat diet. Bad LDL cholesterol was not significantly different.

Q. I have an underactive thyroid and take Synthroid. After three years I do not feel any better.
I asked my doctor if I could try an alternative to Synthroid like Armour Thyroid. She told me she prefers the synthetic over the natural form. I was surprised at that, because many people seem to do well on it.

I feel that adding T3 from the natural product might help, but I do not think my physician is going to be willing even to try it. Do you have more info on treating thyroid problems if Synthroid is not working well?

A. If you are experiencing symptoms such as fatigue, depression, hair loss, constipation, puffy eyes, dry skin and brittle nails, you may indeed be suffering from too little thyroid hormone. Although the research is controversial, some people report feeling better when they get a mixture of T3 and T4 forms of thyroid hormone. Synthroid contains only T4 (levothyroxine).

We are sending you our Guide to Thyroid Hormones with a discussion of natural vs. synthetic thyroid replacement and how to balance T3 and T4. Dried thyroid glands have been used for more than 100 years, before the FDA existed. Doctors may prescribe Armour or other natural thyroid preparations.

Q. I was prescribed Advair for asthma. It worked well for my breathing problem but my skin became thin and I started bruising badly. Then I experienced horrible damage to my skin with deep gashes from a slight bump. One day I leaned on the bathroom counter and several inches of the skin on my arm peeled off.

My lung specialist insisted Advair was not responsible for thinning skin. One day I asked my pharmacist, “Have you ever seen anything like this?” She looked at my bruises and said, “It could be from taking steroids.”

She checked my meds and told me Advair contains a steroid. I spoke to my doctor but he still said it was not the medication. I switched to another clinic and got a different asthma medicine, Serevent. My health care provider, a nurse practitioner, told me she had seen a few others whose skin reacted as mine did. After several weeks off Advair, my skin returned to normal and I no longer have bruises or serious gashes.

A. We’re surprised the specialist you consulted was unaware that Advair can affect the skin. The official prescribing information lists bruising and wounds as potential adverse reactions.

The steroid in the asthma inhalers Advair and Flovent is fluticasone. Although not as risky as oral prednisone, there can be some systemic side effects with this drug. A higher risk of cataracts, glaucoma and pneumonia has been reported with long-term use.
 

Q. I was given erythromycin for an infection and immediately started having heart palpitations and shortness of breath. My doctor didn't believe that the drug could have caused the problem, so he gave me something generic but still in the same family of erythromycin. I had the same reaction. A couple of years ago I found something on the AMA website stating that erythromycin had been responsible for several cardiac deaths!

A. You may be more susceptible than average to heart rhythm disturbances caused by certain medications. People with “long QT intervals” may react to erythromycin and many other drugs in a dangerous way. The long QT interval shows up on an electrocardiogram, so you may need to be tested. There are lists of drugs that might be dangerous if you do have long QT interval at www.qtdrugs.org.

Q. My mother, a retired nurse, encouraged me to write you regarding my son's acne problem. He is 19 and has been through many rounds of antibiotics with limited success. I don't like his taking antibiotics for such long periods of time. Any suggestions?

A. You will laugh at our suggestion and dermatologists will cringe. We have heard from readers that putting milk of magnesia on the skin can be helpful for acne. One mother recently shared the following story:

“I wrote you several months ago about my son who almost died back in October 2007 from vitamin A poisoning. The dermatologist taking care of him had prescribed Accutane, and that seems to have been the cause.

“He has been using milk of magnesia topically at bedtime for months now. Our pediatrician ran a test to make sure he wasn’t getting too much magnesium, and also retested the vitamin A level to see if it had come back to normal.

“The happy news is that both magnesium and vitamin A levels are normal. My son looks great and feels well.”

 

Q. I am a woman with over-the-top libido. My doctor says I may have PSAS--persistent sexual arousal syndrome. I’ve been dealing with this problem for a year, ever since I turned 40. The anti-depressant Pristiq has helped immensely, but I wonder if there is a more natural approach to this condition.

A. Persistent sexual arousal syndrome can be a serious problem. In this situation, a woman experiences frequent intrusive genital arousal—tingling or other sensations—without sexual desire. The arousal is not always relieved by orgasm.

No single treatment works for everyone, but antidepressants are sometimes helpful. Pristiq (desvenlafaxine) is a relatively new antidepressant that is related to Effexor (venlafaxine). Side effects may include high blood pressure and withdrawal symptoms upon stopping as well as insomnia, nausea, dizziness, excessive sweating and sexual difficulties.

We are glad Pristiq is working for you. Because PSAS is a relatively rare diagnosis, there is very little research to suggest natural approaches might be effective.

Q. My husband takes hydrochlorothiazide and lisinopril for high blood pressure. I suspect that these medicines are responsible for his dizziness and erectile dysfunction. His blood sugar is also up.

Could the medicine be responsible? Are there any natural remedies that might help lower blood pressure? I have heard that beet juice might be helpful.

A. Diuretics like hydrochlorothiazide (HCTZ) can cause dizziness and raise blood sugar. Erectile dysfunction is a fairly common side effect of both hypertension and the medicines used to treat it.

A low-sodium, high-vegetable diet (the DASH diet) has been shown to help control blood pressure. Drinking beet juice may also help.

For more details on natural approaches to lower blood pressure, including beet juice, the DASH diet and breath training, as well as information on various medications, we are sending you our Guide to Blood Pressure Treatment.

Q. My husband took Flomax for a prostate problem. Recently he needed cataract surgery. Who knew that Flomax would cause complications?

Not only was the surgery very painful, but I have heard that some surgeons won’t operate on a man who has taken Flomax. It has been three weeks since the surgery and he still cannot see very well. The doctor said it would be at least five or six weeks before he can judge the success of the cataract procedure. Please alert other men to this problem.

A. Flomax (tamsulosin) relieves prostate problems by helping smooth muscle relax and improving urine flow. In 2005, ophthalmologists reported that patients taking Flomax sometimes developed a complication known as small pupil or intraoperative floppy iris syndrome (IFIS) during cataract surgery. It appears to be caused by excessive smooth muscle relaxation in the iris itself in reaction to Flomax.

In some cases, men were taking Flomax at the time of surgery, but in at least one documented case the man had stopped the drug a year before his cataract operation. Forestalling this complication requires special equipment and surgical techniques. Cataract surgeons should always be notified that a patient has taken Flomax so they can plan accordingly.

Q. In 2001 I had a very strong urge to chew on ice. After reading in your column that this could be a sign of anemia, I told my doctor about it. The blood work showed anemia and I was advised to get a colonoscopy. This test showed cancer in the colon.

I had surgery and received six months of chemo. The operation removed 10 inches of my colon. Testing the lymph nodes showed the cancer had spread to three out of 15 tested.

I wouldn’t have mentioned the craving for ice cubes had I not read about it in your column. I thank you for that timely article. I have been cancer free for these past seven years.

A. Unexplained cravings for ice, laundry starch, cornstarch or other peculiar substances often signal a deficiency of iron or zinc and should be investigated. We are pleased your doctor took your anemia seriously and looked for the cause. The colonoscopy and subsequent treatment of the cancer may have saved your life.

Listerine to Fight Lice

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Q. Here in Hawaii, we call head lice "Ukus." We’ve had quite a problem with them this year and I have found the medication costly and ineffective. I’m glad you wrote about Listerine, because I never would have thought to use it. We tried it and it worked.

A. Many traditional lice treatments have lost effectiveness. The alcohol and other ingredients in Listerine may help kill lice. One mother described saturating the scalp with Listerine and covering the hair with a shower cap for two hours. She then combed out the dead lice.

Q. I seem to recall reading on your web site about a reliable Canadian site from which to get less expensive legitimate prescription drugs. I am in the Part D doughnut hole and a 90-day supply of my Actos is more than $500.00.

Can you direct me to that Canada information once again so I can get some much-needed help with my drug costs?

A. We did some checking and found that in the U.S. the diabetes drug Actos might run you anywhere from $570 to $692 for a three month supply. The same medicine in Canada could cost between $161 and $382. The savings are significant.

When people enter the dreaded “doughnut hole” in their Medicare Part D prescription plan, they have to pay 100 percent of the medication costs. Buying from Canada can be helpful, but caution is necessary. Some Web site that claim to be Canadian are actually based elsewhere.

We are sending you our Guide to Saving Money on Medicine with guidelines for determining which online drugstores are legitimate Canadian pharmacies. Medicare participants who spend more than $4050 out of pocket become eligible for catastrophic coverage. If you think your drug bills will be a lot more than that, you should probably continue buying your medicine in the U.S.

Q. I was on Lipitor for a number of years and have severe muscle and nerve damage to the extent that I am in a power wheelchair. Do you think Lipitor could be to blame?

A. Statin-type cholesterol-lowering drugs such as Crestor (rosuvastatin), Lipitor (atorvastatin), Mevacor (lovastatin) and Zocor (simvastatin) are linked to muscle pain, weakness and nerve damage. Most physicians have assumed that muscle problems are an extremely rare side effect. Many readers have experienced this problem, however. Here is one example:

“I’ve been taking Lipitor for years. Two months ago I stopped, since I suspected it was responsible for the major pain and weakness I am experiencing in the muscles of my arms, shoulders, hands and feet. I felt like a lump of spasmodic pain with extreme fatigue and brain fog.

“My doctors did not think Lipitor was the cause. Stopping the Lipitor banished the brain fog so I can think and remember things again. I am still plagued with pain, muscle spasms and weakness.”

New research (New England Journal of Medicine, online, July 23, 2008) suggests that some people are highly susceptible to muscle-related complications from high-dose statins. This genetic vulnerability may affect up to one-fourth of the population. Others are unlikely to experience such problems.

Q. I was recently diagnosed with shingles and prescribed Valtrex. I had no idea it was used for anything else until I picked up the prescription and read in the flyer that it is used for herpes.

I thought this would be comforting for the woman who wrote to you that she was so ashamed about having herpes she did not want to seek treatment. She was afraid people at the pharmacy would look down on her. These drugs have multiple uses, so who would know?

A. Valtrex (valacyclovir) is indeed used to shorten an attack of shingles as well as to treat genital herpes. You are right that a prescription for Valtrex is no cause for shame.

Q. I want to warn others about taking too much calcium and vitamin D. Apparently I took more than my limit and ended up with soft tissue calcifications.

My doctors doubted that this caused my calamity, but I am certain that it contributed. The calcium in my left arm caused a lot of pain. My mammogram also showed calcification. Calcium and vitamin D are very popular these days, but you can overdo.

A. Thanks for the words of caution. Women have been urged to increase their calcium intake to maintain strong bones, but a study from New Zealand also sounded a warning (British Medical Journal, Feb. 2, 2008).
Postmenopausal women were studied for five years. In addition to calcium in their food (roughly 850 mg daily), they took either 1000 mg calcium or placebo. The women taking extra calcium were more likely to suffer a heart attack during that time. Another study did not confirm this risk, but there is some concern that excess calcium and vitamin D might contribute to calcification.

Q. I am devastated that quinine is no longer available. I have taken it safely for decades to reduce leg cramping, especially at night. Since I ran out and cannot get more I have a terrible time sleeping. I spend most of the night pacing the floor to work out the cramps. Why would the FDA ban quinine when it is the only thing that works?

A. Many people do well with quinine but for some it is extremely dangerous. One reader wrote: “I took quinine for nighttime leg cramps. I was working for a physician who said quinine might help and wrote me a prescription.

“I took one pill and within a couple of hours, I was deathly ill, not knowing what was going on. My doctor sent me immediately for blood work. My liver function results were worse than my husband's when he died from liver cancer. It took more than two weeks to get my body back on track. I would not recommend quinine to anyone.”

The FDA reasoned that since leg cramps are not life threatening but some reactions to quinine are, the benefit/risk balance did not favor the drug. There are, unfortunately, no other approved medications for leg cramps.

People with nighttime leg cramps may benefit from home remedies. Tonic water, which contains some quinine, is one option. Others include yellow mustard, low-sodium V-8 juice or soap under the bottom sheet. More details on these and many other remedies are available in our Guide to Leg Pain.

Q. I have read your articles on licorice raising blood pressure, but you don't state if it is black licorice or both red and black licorice.

I have never suffered from high blood pressure and I enjoy red licorice once in a while. I don't notice any side effects from eating it. Is it safe?

A. Red licorice is totally safe. It doesn’t contain the ingredient (glycyrrhizin) found in black licorice that may raise blood pressure.

Q. Five years ago I developed duodenal ulcers after taking Fosamax for six weeks. I was also taking ibuprofen for headaches at the same time.

Last year, after taking baby aspirin for a few months, an endoscopy revealed more ulcers. I was diagnosed with H. pylori and treated with antibiotics.

I have bad osteoarthritis pain in my right knee and hip and would love to take ibuprofen instead of Tylenol, but I don't want to take omeprazole long-term and don't want to risk another ulcer.

Since the H. pylori is gone, could I risk the ibuprofen? Or is there some other agent I could take that would relieve the pain without causing ulcers?

A. The combination of Fosamax with the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen was a prescription for trouble. Both medications can cause ulcers. A study of Fosamax together with a different NSAID, naproxen, showed that ulcers were more likely in women taking both medicines (Archives of Internal Medicine, Jan. 8, 2001).

Helicobacter pylori (H. pylori) is a stomach infection that increases the risk of ulcers. Even without H. pylori, you might still be susceptible to ulcers if you take aspirin or an NSAID.

We are sending you our Guides to Digestive Disorders and Alternatives for Arthritis, with information on arthritis drugs that are less likely to cause ulcers as well as non-drug approaches to relieve arthritis pain. Ask your doctor about either Disalcid or Trilisate, anti-inflammatory drugs that are less likely to cause stomach irritation.

Q. My brother-in-law sent me an email about how to remove ticks. It was attributed to a school nurse who suggested applying a glob of liquid soap to a cotton ball and covering the tick with the cotton ball for 20 seconds. Presumably when you remove the cotton ball the tick will come out on its own and be stuck to the cotton ball.

Is this really a good way to remove ticks? We are having a bumper crop this year.

A. According to Snopes.com, this email has been circulating on the Internet for more than two years. It sounds credible, but it is not true. Putting liquid soap, petroleum jelly, Vicks VapoRub, fingernail polish or any other goo on a tick will not make it let go faster. Aggravating a tick might cause it to regurgitate saliva into the bite, increasing the risk of infection.

The CDC recommends grasping the tick with tweezers as close to the skin as possible. Use a gentle steady motion to pull the tick straight away from the skin.

Prompt removal reduces the risk of infection. Symptoms such as rash, fatigue, chills, fever, headache, muscle and joint aches could signal either Lyme disease or Rocky Mountain spotted fever. Both require prompt medical attention.

Q. My husband took Lipitor and had a bad reaction with muscle weakness. Now my doctor is recommending that I take it, but I am reluctant. My total cholesterol is 284. My LDL is 156 but my HDL is 114. Doesn’t that count for something?

A. Your good HDL cholesterol is extremely high, which is great for your heart. The ratio of total cholesterol to HDL cholesterol is an important measure of heart risk. Your ratio is 2.5 which is excellent.

Your bad LDL is also high, but you may be able to get it down with natural approaches such as the soluble fiber psyllium, walnuts or fish oil. We offer details on these and other natural approaches as well as medications besides Lipitor in our Guide to Cholesterol & Heart Health.

Q. My wife has a problem with noise in her right ear. The noise is so constant that it affects her ability to sleep. It started several years ago when she was treated for the flu. The doctor prescribed a strong antibiotic and the noise started the same night and has not gone away.

When we spoke with doctors they said this is part of the aging process and nothing can be done. An audiologist suggested putting the radio on between stations to generate “white noise.” It sure would be great if any of your readers told you of a cure.

A. Many things can cause tinnitus (ringing or buzzing in the ears). Exposure to loud noise can damage the tiny hair cells inside the ear and trigger tinnitus. Various medical conditions like high blood pressure and infection can also cause it. Dozens of medications, including aspirin and certain antibiotics can also lead to this problem.

There is no magic bullet to cure ringing in the ears. Some folks benefit from white noise, while others find it annoying. There are “retraining” programs that help some people cope with tinnitus.

Although the FDA has not approved any medications to treat tinnitus, a small study suggested that misoprostol (Cytotec), a drug used to protect the digestive tract from ulcers, reduced symptoms (Otolaryngology—Head & Neck Surgery, May 2004).

Q. You have written about people having a hard time getting off antidepressants without awful side effects. I had a terrible time getting off Xanax, a highly addictive medication. A pill can only be cut into so many pieces. So the doctor told me I could have a local custom pharmacy make up “gummies” (like the kids’ candy). Each week or two they would put in a little less of the drug until it got down to a minute amount. It took weeks but it helped lessen the side effects.

A. We have heard from many readers who have had great difficult withdrawing from anti-anxiety agents such as Xanax (alprazolam). Symptoms may include nervousness, agitation, difficulty concentrating, headache and insomnia.

Getting off antidepressants like Effexor, Paxil and Zoloft can also be challenging. Having the doctor prescribe a gradually decreasing dose for the compounding pharmacist to include in gummy candy is an innovative solution to a thorny problem. Thanks for sharing this approach.

Q. Has anyone else wet the bed while taking Chantix? I had a very vivid dream that I had gotten out of bed, gone into the bathroom, sat down and urinated. Then I woke up and discovered that I had wet the bed.

I knew to expect nausea and weird dreams when I started taking the drug a month ago. Starting the second week, my anxiety and mood swings have gotten bad. The bed-wetting was the last straw. I stopped taking Chantix entirely. I’m not happy about that, because I really want to quit smoking.


A. We could find no scientific reports of bedwetting linked to Chantix. This stop-smoking drug does cause vivid dreams and nightmares, which may contribute to this problem. Anyone who has experienced such a side effect can report it to www.peoplespharmacy.com or to the FDA at www.fda.gov/medwatch/.
Q. I have been taking Toprol XL for about two years for high blood pressure, and my hair is getting so thin you can see through it. Is there any other medication that can replace Toprol XL that would not cause hair loss? Yes I know, vanity thy name is woman, but I do hate losing my hair.

A. Beta blockers such as metoprolol (Lopressor, Toprol XL) and atenolol (Tenormin, Tenoretic) may cause hair loss. Many cardiologists no longer consider beta blockers the best choice for first line treatment of high blood pressure. Ask your doctor whether another medication might be appropriate for you.

Scores of other medications share this side effect. We are sending you our new Guide to Hair and Nail Care with a list of medications that may lead to hair loss.
Q. You have written columns suggesting use of sunscreens with microparticles of zinc or titanium. I read that some scientists are concerned about nanoparticles found in products such as sunscreen. These particles are so tiny they could get into places in our bodies that larger particles can’t.

No one knows how dangerous this might be, but some experts suggest we exercise caution and avoid nanotechnology in products such as sunscreen. Shouldn’t you warn people about the danger?


A. The Environmental Working Group (EWG) is the collaborative group of scientists that first raised a red flag about nanoparticles in sunscreens. These extremely small particles of titanium and zinc compounds provide an effective way of blocking both UVA and UVB rays. Unlike the old white zinc oxide cream lifeguards used to smear on their noses, products containing nanoparticles appear transparent.

The researchers were suspicious about nanoparticles and expected that after reviewing all the safety data they would recommend against using such products. They have now completed their analysis. It includes nearly 400 peer-reviewed studies. The conclusions they reached were quite different from those they anticipated:

“Repeated studies have shown that these ingredients do not penetrate healthy skin, indicating that consumers’ exposures would be minimal.” The scientists are critical of many other sunscreen ingredients and now suggest that consumers look for sunscreens with zinc or titanium to provide broad UV protection.

Cornstarch Cravings

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Q. I have been eating Argo cornstarch since I was 19. It started when I was in my first pregnancy and I've been eating it ever since. I used to eat a box a day and I think it is making me gain weight. I’m trying to cut back but it's hard. I also have a very low blood count. I have tried everything possible to stop but nothing is helping. I'm 33.

A. Your low blood count may provide the explanation. Ask your doctor about correcting the anemia. Low iron or zinc levels can sometimes trigger pica, a craving for non-food substances. Cornstarch and laundry starch are common objects of cravings, but we have also heard from readers who crave ice chips or even foods such as popcorn, carrots or radishes. Usually these cravings disappear once the deficiency is eliminated.

Getting Rid Of Skin Spots

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Q. I have granuloma annulare and would love to find out if you have any information on ways to cure these raised spots on my skin. I have them on my hands, wrists, elbows and shoulder. I know that they sometimes disappear after a year or two; however, I have some spots that are persistent. Is there any remedy that you have come across? I'd love to beat these little guys!

A. Dermatologists don’t know what causes granuloma annulare. Although unsightly, this skin condition is not at all dangerous. It often disappears by itself eventually.

One reader reported that after applying white vinegar to the skin the bumps went away. A listener to our radio show had success using original Vagisil, an over-the-counter treatment for vaginal infections. It contains resorcinol, an old-fashioned antimicrobial ingredient that also has antifungal activity.
Q. What do you know about the sleeping pill Ambien?

A friend of mine has been taking it occasionally for years. The other night she took one and when she awoke the next morning, she saw signs that she had done things during the night but had no recollection of doing them. She was so alarmed that she crushed her pills and threw them out.


A. We have heard from many others who report unusual behavior after taking Ambien. One woman wrote that her husband began sleepwalking after taking this sleep aid:

“He woke me saying there was something terribly wrong with the computer. I got up and found coffee spilled all over the desk and the cords to the keyboard and mouse cut with scissors. He did not remember doing this.

“On another occasion, he thought that someone had kidnapped his brother and put him in the trunk of a neighbor’s car. He’d gone out in his pajamas and jumped up and down on the car, screaming for someone to let his brother out. He had smeared chocolate pudding on his face like a commando. The neighbors called the police and we had to pay the damages, nearly $1,500.”

Many people use Ambien safely, but others don’t tolerate it. Anyone who would like to know more about this sleeping pill and other sleep aids, including non-drug approaches, may want our new Guide to Getting a Good Night’s Sleep.
Q. Can glaucoma eye drops lower heart rate? Ever since I started using timolol I haven’t been able to reach my target heart rate when I exercise.

A. Timolol (Timoptic) is a beta blocker, which means it can slow heart rate whether taken orally or as eye drops.
Q. I have taken thyroid medication for decades. In addition I take amitriptyline, calcium, multivitamins, Prempro and aspirin.

My eyebrows have become so sparse that I need to use an eyebrow pencil to look normal. I have also lost hair on my legs and arms as well on my head.

When I mentioned this to my dermatologist, he suggested I try Rogaine. It hasn’t been very effective.

My TSH level is between 5 and 6 and my cholesterol is over 240. I am a vegetarian and eat a very healthy diet with lots of fruits and vegetables. No matter how much I exercise or watch my diet I can’t seem to lose weight. When I ask my doctor about all this, he dismisses my symptoms as unimportant. I’d be grateful for any advice.


A. Many of your symptoms, such as high cholesterol, sparse eyebrows, hair loss, depression and trouble losing weight, are consistent with too little thyroid hormone. Your TSH (thyroid stimulating hormone) is high, another indication of inadequate thyroid function.

We are sending you our Guide to Thyroid Hormones with more information about symptoms, treatment and lab test interpretation.

Estrogen (found in Prempro) may affect your thyroid test. Taking thyroid with a multivitamin or calcium could interfere with absorption and effectiveness.
Q. I'm a 40-year-old recovering alcoholic who has not had an alcoholic drink in more than four years. Bizarrely enough, that last drink of mine was a store-brand mouthwash resembling Scope.

This last-ditch effort to resort to some form of alcohol that wasn't a "real drink" was what convinced me that I was a hopeless alcoholic. Though I had tried many times to tell myself that I could control my drinking--sometimes going months without a drink--it was that last gulp of generic Scope that finally made something click firmly in my thick skull that I should at all costs avoid drinking anything with alcohol for the rest of my days.

My life is now lovely--and I have Scope to thank, at least in a tiny part. It's pretty darned clear that only an alcoholic would drink mouthwash. If you know somebody who's doing it, you might want to very gently steer him to the nearest AA meeting. There he will meet others who, in their darkest hours, have also gulped mouthwash.


A. Thank you for sharing your story. You were smart to recognize that drinking mouthwash is a serious sign of addiction. Others may not. We heard from one grieving widow: “My husband died in February from drinking store-brand Listerine. He had been on a drinking binge for about four weeks. He walked off a loading dock.

“We're not sure yet if the fall or the mouthwash killed him. All I know is that my heart is breaking. I tried so many times to save him, but I couldn't. Drinking mouthwash is deadly. I advise anyone with this problem to PLEASE get help!”
Q. I have diarrhea regularly. I have read your column with some great suggestions for more natural remedies.

What I have the most success with is Pepto-Bismol. Are there any ingredients in it that would make it harmful to take one or two tablets three or four times a week?


A. Pepto-Bismol has a long history dating back to the early 20th century. It was originally developed to treat severe diarrhea in babies.

The active ingredient is bismuth subsalicylate. It remedies a wide range of digestive problems including heartburn, diarrhea and nausea. Since the label says you can safely take up to 16 tablets in 24 hours, your dose is not unreasonable.

Despite its good safety record, Pepto-Bismol is not meant to treat a chronic condition. Too much bismuth can lead to loss of appetite, canker sores and poor absorption of nutrients. The salicylate component can cause ringing in the ears. You should check with your doctor about the cause of the diarrhea to see if that can be addressed.
Q. You often write about toenail fungus, but I want to know how to get rid of fingernail fungus. I have it in both thumbnails.      

A. There are many inexpensive home remedies that might help. None works for everyone, but readers have sent testimonials like this one:

“My doctor told me I had a bad case of toenail fungus. I got a bowl and a bottle of Listerine and soaked my toes in the Listerine every morning while doing my hair. (That took about 5 minutes.) My nails cleared up in 3 months.

“My husband also used it. He soaked his nails while watching TV. This has been a great cure and does not cost a lot.”

We discuss Listerine, vinegar, cornmeal, hydrogen peroxide and other home remedies for nail fungus in our brand-new Guide to Hair and Nail Care.

If home remedies don’t work, your doctor can prescribe medications such as Lamisil, Sporanox or Penlac.
Q. In the recent past, I took Alli for weight loss. To my amazement, my constant constipation disappeared. I now keep it on hand for constipation.

A. Alli is OTC orlistat. It has been prescribed under the name Xenical. Diarrhea and increased bowel movements are common side effects of orlistat, so it’s not surprising that it might combat constipation.

Q. I've been advised to use diaper rash ointment containing zinc oxide to keep my horse's muzzle from getting sunburned while he's grazing. I've been wondering if this would also work to keep me from developing a "horse-woman's tan." All of the sunscreens I have tried help me avoid sunburn, but I have brown arms from the edge of my gloves to the edge of the short-sleeved shirts.

A. For decades lifeguards have used white zinc oxide to keep their noses from burning. It blocks both UVA and UVB rays and provides excellent protection.

You could try the diaper rash ointment or get a sunscreen that contains both zinc and titanium. New formulations contain microfine particles that don’t leave a distinctive white color. Human sunscreens can also be used on horses to keep pale skin from burning.

Q. You wrote recently about the dangers of carrying germs around on your shoes or bare feet. Because of studies on the germs found on women's purses, I avoid putting my grandchildren's backpacks on the kitchen table.

Who knows where those book bags have been? They've at least probably been on the floor of the school bus, along with germs from school restrooms and goodness knows where else.


A. Your decision is prudent. Dr. Charles Gerba, a professor of microbiology at the University of Arizona in Tucson, did the research showing shoes carry many nasty germs. He told us he now refrains from propping his feet on his desk. It’s smart to keep shoes, purses or backpacks away from any surfaces where you might want to put your hands—or your lunch.
Q. I use sunscreen daily because I have red hair and fair skin, but I love the outdoors. A lab test shows that I am vitamin D deficient. How can I balance my need for sunscreen and the need for sun exposure to make vitamin D?

A. Vitamin D has been getting far more attention in recent years, as scientists realized that it is critical for many other functions in addition to building strong bones. Recent studies show that adequate vitamin D in early childhood reduces the risk of developing type 1 (juvenile) diabetes (Archives of Disease in Childhood, June, 2008; Diabetologia, online, June 5, 2008).

Vitamin D is also important for controlling blood pressure and preventing several types of cancer. In older adults, low levels of vitamin D have been linked to falls as well as muscle and joint pain (Journal of the American Geriatrics Society, May 2008).

With your fair skin, you need to be careful to avoid sunburn. It just takes a few minutes of sun exposure a day without sunscreen for your skin to manufacture the building block for vitamin D.

To learn more about the consequences of low vitamin D and how to replenish vitamin D stores, you may want to listen to the radio show we did focusing on this topic. We interviewed Drs. James Dowd and Michael Holick about the research and clinical evidence regarding vitamin D. Anyone who would like to order this one-hour CD may send $16 to Graedons’ People’s Pharmacy (CD-672); PO Box 52027; Durham, NC 27717-2027. Show #672 is also available as a free podcast at www.peoplespharmacy.com.
Q. I'm 18 now, a male, 5’9”. I began drinking caffeinated sodas in great excess (1 liter or more a day) when I was 10 or 11. By the time I was 13 I had completely stopped growing.

My height isn't that unusually small until you compare me to the rest of my family. My father is 6’8”, my brother 6’10”, and all my male cousins are at least 6’4”. My own mother is 5’11”. I do believe caffeine played a significant role in stunting my growth.


A. A liter of soda a day is a LOT of caffeine for a 10-year-old. Studies such as the Penn State Young Women’s Health Study (Journal of the American College of Nutrition, Oct., 1998) don’t show a connection between caffeine intake and height, but experts often warn that substituting soda instead of milk could lead to suboptimal calcium intake. That, presumably, would have a negative effect on bone development. Perhaps that is why you ended up so much shorter than the rest of your family.
Q. Can you help me? I’ve had a burning sensation on my tongue and the soles of my feet for weeks. I’ve tried Benadryl, OTC hydrocortisone cream and ice packs. Nothing is helping.

My internist has said everything looks all right (though I think the bottoms of my feet look red). I am diabetic and he did a blood test (HbA1c) that showed my blood sugar is under control.

I am presently taking metformin, Crestor, Lexapro, zolpidem and generic Zantac. I’d appreciate any thoughts.


A. Our first thought is to have your doctor check your vitamin B12 status. Burning mouth and burning feet are difficult to diagnose, but both can result from vitamin B12 deficiency. Your diabetes medicine metformin (Glucophage) is associated with an increased risk of vitamin B12 deficiency (Archives of Internal Medicine, Oct. 9, 2006). Acid suppressing drugs like ranitidine (Zantac) may aggravate the problem by making it harder to absorb this nutrient from food.

When vitamin B12 levels fall too low for too long, people may experience irreversible neurological damage. Symptoms to watch out for include fatigue, confusion, loss of appetite, depression, burning tongue, poor memory, weakness or peripheral neuropathy (burning, tingling or numbness in feet or hands).
Q. I'm 52, and since I was a teenager I've had dry skin, or as my dermatologist puts it, “atopic dermatitis.” He tells me it is stress-related and genetic.

Every three months I can get a steroid shot, but it only clears the problem up for a month at most. Then the skin on my hands dries out, peels off, and splits and cracks.

I've tried an assortment of hand creams and ointments, including prescribed creams like Dovonex or steroids. At times I even sleep with greased-up hands in white cotton gloves. Nothing really seems to do the trick. Do you have any suggestions?


A. Atopic dermatitis, or eczema, is often a chronic problem, but here are some approaches that may help. Probiotics, or good bacteria, have shown benefit in some studies. Hemp seed oil, Pycnogenol (maritime pine bark extract) or oolong tea may be helpful. A low-glycemic index diet (no sugar, bread or pasta) eases symptoms for some people.

We are sending you our brand new Guide to Skin Care and Treatment with a range of recommendations for dry skin, eczema and psoriasis.
Q. We gave our 6-year-old daughter a heartburn medicine, cimetidine, for her warts. It's amazing!

After months of visits to the dermatologist, the warts on the back of her hand are gone. She had up to 40 big and tiny warts, and they were starting to spread to her wrist and other hand. Finally, we gave her cimetidine daily for 8 weeks and they just disappeared.


A. The cimetidine (Tagamet) “cure” for warts was first written up in the early 1990s. This was an unusual use; Tagamet was a popular prescription drug for ulcers at that time.

Since then a number of studies have tested such acid-suppressing drugs against warts. Although some research subjects had a good response like your daughter, most of the well-controlled trials showed no benefit over placebo (Annals of Pharmacotherapy, July/Aug., 2007).
Q. I am a healthy 65-year-old woman who's acquired little aches and pains over the years. Recently I had painful bursitis, for which the doctor prescribed 800 mg of ibuprofen three times daily.

The ibuprofen helped with the bursitis over a three-week period and my aches and pains also improved. I hate to quit taking this wonderful stuff. If the ibuprofen makes me feel so great, can I continue with it forever, in smaller doses?


A. Ibuprofen, like other nonsteroidal anti-inflammatory drugs (NSAIDs), can help relieve a variety of painful conditions. The downside of prolonged use (even in lower doses) is stomach upset, ulcers and even kidney problems. Blood pressure control may also become more difficult.

The FDA recently approved a topical product containing a powerful NSAID called diclofenac. It is prescribed as Voltaren Gel. This medication is applied to the skin around the painful joint (knees, wrists, fingers, etc). It is effective and less likely than oral NSAIDs to cause digestive upset (Current Medical Research and Opinion, April, 2008).

 
Q. My wife has a sleeping problem and so do I. She goes to bed and falls asleep about 10 pm, but wakes up around 2 or 3 am and is unable to fall back to sleep after that.

She takes prescription sleeping pills, alternating between Lunesta, Ambien CR, and temazepam. They have not helped her sleep through the night. I too have trouble getting back to sleep.


A. Most prescription drugs for insomnia are better at helping people get to sleep than stay asleep. There is one, however, that is so short acting that it may be taken in the wee hours when your wife awakes. She may want to discuss Sonata with her physician.

We discuss Sonata, Ambien, Lunesta, Rozerem and many non-drug approaches in our new Guide to Getting a Good Night’s Sleep.

If your wife is taking other medicines, they should be reviewed to make sure they are not contributing to her sleep problems. A surprising number of drugs can cause insomnia.
Q. My mother recently had surgery and now is experiencing significant memory loss. The doctor said that anesthesia sometimes affects memory. How long will this last and is there any thing we can do to help her recover?

A. Surgeons and anesthesiologists are aware that surgery may pose risks to mental function, especially in older people. They call this condition post-operative cognitive decline (POCD).

There is controversy as to whether the problem is brought on by anesthesia or by surgery itself. Some commonly used inhaled anesthetics have been linked to dementia in mouse research (Neurobiology of Aging, online March 7, 2007). Gases like isoflurane and halothane lead to accumulation of beta amyloid, a compound that is thought to contribute to Alzheimer’s disease. Injected anesthetics such as propofol and thiopental may be less likely to cause such problems (Neurochemical Research, Aug, 2005).

For many surgical patients, POCD disappears within a year. A small number, however, may have lasting memory problems. We don’t know of any way to reverse such cognitive decline.
Q. I asked my pharmacist what to do with outdated prescription medicines and was shocked when he said “flush.” I didn’t, of course. Instead I put them in a container of water to dissolve, keeping it out of reach of my cat.

Then I spread out several sheets of newspaper and “painted” the resulting sludge all over them. After they dried, I tore them up and put them in the trash. Was this a safe way to dispose of them?


A. Your pharmacist was misguided when he suggested flushing pills down the toilet. There is growing concern about pharmaceutical contamination of the water supply.

There is no coordinated system for proper disposal of unused pills. Some communities accept unwanted medications in their hazardous waste collection.

If that’s not feasible, your suggestion seems reasonable. Another reader suggested adding Elmer’s glue to the container and allowing it to set hard before throwing the container in the trash.
Q. I've begun to take a prescribed drug that is very expensive and not covered by my insurance. I see that it is available at much lower cost from Canada via the Internet.

Are there any safety concerns in buying from Canada? Are the drugs the same as those sold in the US? Thanks for your assistance.


A. If you were traveling to Canada and buying your medicines in person, you would not need to worry about the quality of the medications. Canadian pharmacies are carefully regulated.

On the Internet, however, pharmacies can easily pose as Canadian even if they are not. One reader sent this report:

“I bought $300 of pills from an online pharmacy. I thought it was in Canada but I received an unlabelled plastic bag with the pills this Saturday. The delivery paperwork listed the originating office as Dandong, China--not Canada!

“Worse yet, I tried one of the pills and it had no effect. I suspect they are bogus imitation pills with no active medicine whatsoever. I know this because I have experience buying this prescription in the US and the pills work every time. Please pass the word about this fraud.”

We are sending you our Guide to Saving Money on Medicine with strategies for buying prescription drugs online safely and other ways to save.
Q. I have suspicions that my husband has been messing around. He recently contracted Chlamydia. He said he got it from sitting on the toilet seat at work. Is this possible? He suggested I get tested as well.

A. You should be tested for Chlamydia, a common sexually transmitted disease that is caused by a bacterium (Chlamydia trachomatis). The infection is easily treated with antibiotics, but untreated it can lead to pelvic inflammatory disease and infertility.

According to the American Social Health Association, “Chlamydia is not passed through things like shaking hands or toilet seats.” You and your husband may need counseling to deal with this issue.
Q. Does eating licorice candy interfere with any prescription drugs?

A. Licorice can raise blood pressure and increase potassium loss, so it may interfere with the effectiveness of many blood pressure medications. People taking Lanoxin (digoxin) or Coumadin (warfarin) should probably avoid licorice. Prednisone or diuretics that deplete potassium are also problematic. When in doubt about interactions, check with your pharmacist.
Q. My husband is 61 and vigorous. He insists that his difficulty with erections is due to us having sex less often than three to five times a week. We manage roughly once a week, but that is challenging since he is not even semi-hard. Is it possible that lack of use causes a man to lose his erection?

I'm 50 and believe I'm starting menopause. My sex drive isn't what it used to be. I hope you can answer this question and help us settle the conflict.


A. Your husband is mistaken. According to Irwin Goldstein, MD, editor of the Journal of Sexual Medicine, having sex every day—even if that were feasible—would not restore your husband’s ability to have an erection.

Erectile dysfunction can be a symptom of underlying medical problems and requires a complete checkup. Certain medications might also be responsible. ED can be treated successfully with drugs or devices. Your libido can also be given a boost if your hormones are out of balance.

We are sending you our Guides to Drugs That Affect Sexuality, Treating Sexual Dysfunction and Female Sexuality so both of you can consider options for improving your sex life without blame.
Q. I was put on Cymbalta to stop hot flashes from menopause. When I switched doctors, my new physician was angry that I had been put on an antidepressant for hot flashes and put me on hormones instead.

I am now trying to stop taking Cymbalta. The dosage was reduced for several months. Then I took a pill every other day for months. I have not taken any for over two weeks and my life is a living hell.

I cannot turn around without falling over from dizziness. I cannot go up or down stairs without falling. Running or exercising is out of the question. No one told me that this would happen. How much longer will these dizzy spells continue? Is there anything I can do to stop them?


A. Cymbalta is not the only antidepressant that can cause trouble upon discontinuation. Doctors don’t always warn patients about the possibility of withdrawal symptoms (dizziness, difficulty concentrating, sweating, anxiety, insomnia or electric shock-like sensations) when they prescribe such medicines.

Another reader related this: “I am experiencing the ‘brain shivers’ of Effexor withdrawal. I reduced the dosage from 75 mg to 37.5 mg and had been on that dose for a month. I have been off for about a week and I have constant brain shivers. Is there anything that can help lessen these odd side effects?”

We don’t know of any good way to diminish the uncomfortable side effects resulting from withdrawal except to take it even more slowly.
Q. I take lisinopril for high blood pressure and occasionally have a cough that cough syrup can’t touch. My doctor told me that his patients have had amazing success with benzonatate to address this issue. It works for me, too!

A. Thanks for the tip. Benzonatate (Tessalon) is not appropriate for anyone allergic to local anesthetics like procaine (Novocain).

An iron supplement may also help with this kind of cough (Hypertension, Aug. 2001). Switching to another kind of blood pressure medication can also solve the problem.
Q. After taking Aciphex to treat serious heartburn for four years, I developed a severe vitamin B12 deficiency. I complained to my doctor about being extremely tired all the time. I needed to rest after just a simple task.

I was also diagnosed with hypothyroidism. I had to beg to have my B12 levels tested, because my doctor didn’t think it was a problem, but we found out it was.

When I contacted the manufacturer of Aciphex, the company seemed uninterested in my experience. Vitamin B12 levels drop very slowly, so the problem wouldn’t show up in just one year, but studies don’t last longer.

The companies make tons of money on acid reflux drugs and I’d like to see them take some responsibility in studying the long-term consequences of these medications.


A. Acid-suppressing drugs (PPIs) like Aciphex, Nexium, omeprazole, Prevacid, Prilosec and Protonix relieve symptoms of reflux. There is a down side, however. Stomach acid is essential for absorbing certain nutrients like calcium, vitamin B12 and even thyroid hormone (levothyroxine, Synthroid). People who take acid-suppressing drugs long term may be at increased risk for hip fractures.

Cases of vitamin B12 deficiency have been linked to acid suppressor therapy (Journal of the American Medical Directors Association, March, 2008). Symptoms of this nutritional deficiency include fatigue, confusion and memory problems, peripheral neuropathy, constipation or depression.

We are sending you a copy of our book, Best Choices From The People’s Pharmacy, with more information on treating severe heartburn and tips for discontinuing PPIs. This book is available in libraries, bookstores and online at this web site.

Getting off acid-suppressing drugs can be challenging. Acid rebound can last for months after stopping such medications.
Q. I started taking Chantix and was surprised how quickly it cut my smoking in half. I continued with the Chantix until I finally quit.

Depression was slowly creeping up on me, but nothing prepared me for what happened. One day I woke up feeling as if I'd never be happy again. I have never felt such despair in my life.

I have found it almost impossible to get help. I went to a mental health facility, but they could do nothing unless I was suicidal and committed myself to their locked facility.

They sent me to the emergency room, but all I could get was a mild anti-anxiety drug. Finally, the cardiologist who prescribed the Chantix called in an antidepressant. I hope it helps.


A. Many people find that Chantix is very helpful in quitting smoking, but some report that the drug can trigger depression, thoughts of suicide or bizarre behavior. Some people suffer from withdrawal symptoms, including depression, when they stop taking the medication. We hope the antidepressant is working.
Q. I have a cure for stinky feet. Wash them, dry them well and apply Mitchum unscented solid antiperspirant to the toes and the area between them. I applied it every day for about a month, then every other day, then once every few weeks. I now apply it just once a month and it works very well. I use a separate applicator for my feet instead of the same one I use under my arms.

A. Reducing perspiration on the feet is a good way to discourage bacterial growth. This contributes to foot odor. Other strategies include foot soaks with Epsom salts, baking soda or dilute vinegar.

 
Q. I am 43 years old and have had high blood pressure for 15 years. I have taken atenolol to control it until recently, when my doctor changed me to a water pill, hydrochlorothiazide.

I had a fasting blood sugar test and it was high (150) for the first time ever. Could my new blood pressure pill be causing diabetes?


A. Diuretics like HCTZ (hydrochlorothiazide) can raise blood sugar and trigger diabetes in susceptible people. Such drugs may also raise uric acid levels and bring on a gout attack.

Atenolol is a controversial first-line treatment for high blood pressure because of questions about effectiveness. There are, however, many other options to control blood pressure.

We are sending you our Guide to Blood Pressure Treatment so you can discuss both drug and non-drug approaches with your physician.
Q. As a dermatologist, I am dismayed by your article suggesting that milk of magnesia could treat cystic nodular acne. This is not a recommended treatment, and the false belief that it might be helpful could cause great harm by delaying proper treatment.

Accutane will cure all acne when used properly for eight to ten months. Keeping the dose low can prevent side effects.

I am willing to bet that the person who said milk of magnesia worked better than prescribed treatment was making this up or did not see a dermatologist for appropriate care.


A. The mother who contacted us said that her son had been under a dermatologist’s care for many years and the thousands they had spent had not cleared his condition. She was pleased that milk of magnesia applied to his face at bedtime had been helpful.

This home remedy has not been tested for acne and might not help other people. Nevertheless, it is inexpensive and accessible.

Accutane has been a revolutionary treatment for cystic acne. It is, however, quite expensive (a five-month’s supply could cost over $5,000) and highly controversial.

Some side effects listed in the prescribing information include depression, suicidal thoughts, aggressive behavior, inflammation of the pancreas, hearing loss, inflammatory bowel disease, high triglycerides, hair loss, dry lips and itching.

Physicians are specifically warned not to prescribe Accutane for more than 5 months at any one time: “Long-term use of Accutane, even in low doses, has not been studied, and is not recommended.”
Q. I am alarmed by recent reports that Vytorin and Zetia are associated with plaque build-up in the carotid artery. My doctor tells me that until more is known, I should continue taking the prescribed medicine. Do you agree? Is it harmful to switch abruptly to another cholesterol-lowering medicine such as simvastatin?

A. In the wake of the ENHANCE study that produced such disappointing results with Vytorin, the American College of Cardiology convened an expert panel to advise their colleagues. These thought leaders suggest that doctors should stick with statin-type cholesterol-lowering drugs, which have a proven track record.

Until there is more convincing data about Vytorin or Zetia, the cardiologists recommend using them only as a last resort. There should be no danger switching to simvastatin since it has been shown to be effective.
Q. No one knows I have this problem. I have been using the laxative bisacodyl every day for twenty years and have steadily increased the dosage.

I've stopped taking it for a few days at a time. Not surprisingly, nothing moves.

Are there any studies on this? Might I have done permanent damage to myself?

Is it better to cut back slowly or stop altogether and just see what happens?

I know it's not healthy for waste to back up in my body, so I'm worried about stopping AND I'm worried about continuing.


A. You clearly have developed a laxative habit. Bisacodyl is considered a “stimulant” laxative, which means it triggers intestinal contractions. This can lead to loss of crucial minerals such as magnesium and potassium. Cramping and diarrhea are other possible side effects, along with a “lazy” colon that will not function properly without laxatives.

A gradual phase-off under medical supervision may allow your body to reestablish a more natural rhythm. We are sending you our Guides to Constipation and Digestive Disorders for information on non-drug approaches such as dynamite pumpkin muffins and “Special Constipation Remedy” with bran, applesauce and prune juice.
Q. My wife thinks I have gynecomastia. I may; I do have man boobs, but it could be from being overweight.

If I do have gynecomastia, I guess it could be from some of the medications I take and/or the weight. I realize the only way to be positive is a doctor's exam. I have one scheduled in about two months. Is there anything I can do to test myself and get an idea if I might or might not have gynecomastia?


A. Gynecomastia is the medical term for enlarged male breasts. Some adolescents develop this condition temporarily, but they usually outgrow it within a few years.

Weight can be a contributing factor. So can many medications. Some examples include cimetidine (Tagamet), eszopiclone (Lunesta), leuprolide (Lupron), spironolactone (Aldactone) and finasteride (Proscar).

This condition requires medical diagnosis. Although there is no test you can do yourself for gynecomastia, your doctor will check your hormone levels and rule out various tumors. If a medication is responsible, it may be possible for your doctor to prescribe an alternative less likely to trigger breast enlargement.

Q. I have a history of sleeping problems. I just started taking half an acetaminophen PM tablet (1/4 the adult dose) just before bed. This allows me to sleep through the night. Is this safe?


A. If pain is not an issue, you don’t need the acetaminophen. The PM part of the pill is diphenhydramine (DPH). This is the antihistamine found in Benadryl and it makes people drowsy. At the dose you are using, there should be few, if any, side effects.

Q. I take hormone replacement in the form of bio-identical hormones from a compounding pharmacy. The prescription is a triple-estrogen compound with progesterone. The compounding pharmacist stated that because all three forms of estrogen are used, the risk that accompanies Premarin or Prempro does not exist. Conventional hormone replacement does not contain all three forms of estrogen.

Is this accurate? I have tried conventional hormone replacement in the past and was completely miserable, while I feel great using the bio-identical product.


A. Conventional hormone replacement therapies such as Premarin and Prempro contain a variety of estrogenic compounds. These are, however, estrogens that horses make, so they may be somewhat different from the estrogens your pharmacist used in compounding your prescription.

There are many claims that compounded hormone therapy is safer than conventional HRT. There are no studies to prove that statement, however. The FDA considers claims that bio-identical hormones are safer or better than conventional therapies to be false and misleading.

To better understand the pros and cons of hormones, we are sending you our Guide to Estrogen: Benefits, Risks and Interactions.

Q. I desperately need your help. I was diagnosed with genital herpes three years ago, and this diagnosis has left me full of emotions. I am crying as I write this letter.

For fear of scorn and rejection, I cannot disclose this to anyone. I won’t ask for a prescription because if I got it filled, anyone who works in the store would know, even the kids they hire after school.

Are there any over-the-counter vitamins I can take to help with the discomfort and pain? I feel tremendous pressure to maintain this secret. The only reason I haven’t killed myself is because I have kids. I am afraid I could pass this on to them, so I constantly wash my hands and disinfect the house and car.

A. You are not alone. It is estimated that one in five Americans (45 million) is infected with genital herpes. Counseling can sometimes help overcome the emotional strain of this infection.

There are effective antiviral medications to prevent outbreaks or shorten the duration of an attack (Current Opinion in Infectious Diseases, Feb. 2008). Your doctor could prescribe acyclovir (Zovirax), famciclovir (Famvir) or valacyclovir (Valtrex).

You should not worry about the pharmacy where you purchase the medication. Your privacy is protected. If you prefer, though, you could use an online or mail order pharmacy service. That way you wouldn’t even have to go to a pharmacy.

The virus that causes genital herpes is spread primarily by sexual contact, so you won’t infect your children. Of course, during an outbreak, frequent hand washing is advisable.

Q. Is chewing Aspergum as effective as chewing an aspirin if you think you are having a heart attack?

A. Physicians frequently advise patients who think they may be having a heart attack to dial 911 and chew a baby aspirin while they wait for the ambulance. Aspergum contains 227 mg of aspirin per gum tablet and should work about as well. Another quick way to get aspirin into the system is to dissolve an uncoated tablet in a glass of sparkling water.

Q. My 81-yr-old Mom is currently prescribed allopurinol to prevent gout, enalapril and labetalol for high blood pressure, metformin for diabetes, Plavix to thin her blood, Zocor to control cholesterol plus extra Magnesium and potassium (Klor-Con).

She exhibits confusion, symptoms of dementia, dizziness, and has fallen several times. I think these medications may be excessive and at this stage some may even be counterproductive. Opinion?

A. Your mother’s medicines could be having an impact on her overall health. A physician who specializes in geriatric medicine should review her situation because we have detected some potential problems.

Allopurinol can cause sleepiness, while labetalol and Plavix both may cause dizziness and fatigue. Some readers have reported severe muscle weakness and memory problems with statin-type cholesterol-lowering drugs like Zocor (simvastatin). Metformin can deplete the body of vitamin B-12, which may lead to confusion and forgetfulness.

Far more worrisome is the combination of potassium with enalapril. This could lead to a life-threatening complication.

If your mother were to fall again, she might break a hip. Such an accident could have devastating consequences. We are sending you our Guide to Drugs and Older People with a Drug Safety Questionnaire to encourage her doctors to review side effects and interactions.

Q. I have a much higher sex drive than my partner. He is in his late 30s, while I am in my mid 20s. I would prefer to have sex every couple of days while he is fine with having it once every week and a half.

I find it difficult to deal with this situation because I feel that it's not normal for me, a woman, to have the higher sex drive. I worry that I might make sex seem like a chore to my partner if I ask him to have it with me more often. I often wish that I could take medication that would lower my sex drive so that I could be happier.

A. We consulted two of the country’s leading sex experts about the concerns you raise. Dr. Ruth Westheimer suggested that your partner could help you achieve sexual satisfaction even if he isn’t in the mood for intercourse.

Irwin Goldstein, MD, editor-in-chief of The Journal of Sexual Medicine, pointed out that you are not unusual. In focus groups it was discovered that 25 percent of women often have a higher sex drive than their male partners.

It may be worthwhile for your partner to have a medical workup and have his hormonal levels checked to make sure everything is within normal limits. Dr. Goldstein mentioned that there is an experimental drug that may improve libido for both men and women called flibanserin. The FDA is expected to review it during the next year.

There are no approved drugs to lower libido. However, the herb vitex (chaste tree berry) may reduce sex drive.

Q. I have back problems and have been taking Vicodin daily for pain. The last six months, my breathing has been terrible. I’d have to stop and catch my breath with any little thing.
I’ve been off Vicodin for a week and my breathing is much better. Could the Vicodin be responsible?

A. The prescription pain reliever Vicodin contains acetaminophen and the narcotic hydrocodone. According to the manufacturer, in sensitive people or at high doses, hydrocodone can produce respiratory depression and irregular breathing. We don’t know if that is what you experienced, but you should report it to your physician.

Q. I developed a dry cough soon after my doctor diagnosed me with hypertension and put me on Altace. I would cough and cough until I would gag and throw up at work into my trashcan because the coughing would just come on so suddenly I didn't have time to make it to the ladies room. I even had to carry a small trash bag in my car because I was afraid that I would throw up during my commute to and from work.

I asked my doctor for another medicine. He prescribed lisinopril, and I am still having the same problem. What’s going on?

A. Both of your blood pressure medicines are ACE inhibitors and can cause a persistent cough in susceptible people. We are surprised that your doctor didn’t mention this side effect.

A survey of participants on the iGuard.org Web site revealed that only one patient in four on lisinopril had been told that the drug could cause cough. More than a third of the respondents had a chronic cough.
The iGuard.org Web site offers personalized estimates of drug risk and interaction concerns. To give you more information about other hypertension drugs, including non-drug approaches, we are sending you our newly revised Guide to Blood Pressure Treatment.

Q. Have you heard of using milk of magnesia on severe acne? My son has cystic nodular acne. He is 16 and has been under a dermatologist’s care for many years.

We have spent thousands to no avail. He has recently tried a home remedy: applying milk of magnesia to his face at night before bed. He looks the best he has in four years. Can you tell us why this is working so wonderfully well?

A. Milk of magnesia (aka MoM) is a solution of magnesium hydroxide and is best known for its laxative action.

We don’t know why MoM might combat acne, but we have heard that this laxative can help clear up seborrheic dermatitis. In this condition, yeast on the skin causes redness and flakes, rather like dandruff, but on the forehead and chin as well as scalp and eyebrows. Here is one reader’s report:
“I have been using milk of magnesia on my face for the past two months and my face flakes are gone! I pour it in my hand and massage it on my face (forehead, eyebrows, around the eyes, nose, cheeks and chin) while showering, and rinse it off at the end of the shower. End of problem. It’s a great, cost-effective alternative to expensive Nizoral, and it works better, too.”

Doing Away With Gluten

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Q. I was diagnosed with celiac disease and advised to avoid gluten from wheat, rye and barley. Avoiding gluten in my diet has made a huge difference for me. Are there any resources to help me avoid gluten in pills?

A. In celiac disease, ingesting gluten triggers the immune system to attack the body, especially the small intestine. This interferes with nutrient absorption. FDA does not require manufacturers to list gluten on drug labels, but you can look up your medicines at www.glutenfreedrugs.com.

 
Q. I have heard that an ingredient in plastic called bisphenol A can get into foods and beverages from containers. I was so impressed with the evidence of harm that I thought I would see what food I could buy without plastic wrap, plastic containers or cans.

My options were few! I bought a lot of fresh veggies, but had to put them in plastic bags. We don't drink sodas, but many 'healthy' drinks come in plastic. I searched for glass bottled juices and oils but found very few choices. The meats, eggs, 'smart' margarines--even the organic versions--all came in plastic containers, and were often wrapped in plastic.

My shopping cart was full of interesting new choices, but I wonder: How can I avoid plastic with bisphenol A?


A. There is a raging controversy about the safety of bisphenol A (BPA) found in polycarbonate plastics. This compound mimics estrogen. Water bottles, baby bottles and the lining of metal cans often contain BPA. Plastic containers may be marked with the recycling code 7.

On our radio show, we discussed the health consequences of BPA in great detail with some of the country’s leading experts.
Q. I have read that using decongestant nasal sprays can be addictive. What are your views on using oral OTC cold remedies for more than seven days? Will these cause any symptoms when I stop?

A. There is considerable controversy about the effectiveness of the readily available oral decongestant phenylephrine (Annals of Pharmacotherapy, March, 2007). Such drugs seem less likely to cause rebound nasal congestion, but they may raise blood pressure in susceptible individuals. Since there is doubt about their benefit, we generally don’t recommend them.
Q. As a physician, I have been testing my patients for 25-hydroxy-vitamin D for several months. Many are deficient and some have symptoms of pain and muscle weakness.

I advise patients to take one or two vitamin D supplements of 1000 units daily. Many pharmacists are not aware of the new information, and some have discouraged my patients from buying such supplements if they are taking multivitamins with 400 International Units per daily dose. Please write about this issue.


A. Fatigue, high blood pressure, joint and muscle pain are just a few of the possible symptoms associated with vitamin D deficiency. Researchers are reporting high rates of this condition because few people spend much time outside, especially during the winter. During the summer, conscientious use of sunscreen can block vitamin D formation.

Experts are now recommending daily doses of vitamin D in the 1,000 to 2,000 range. Although pharmacists may worry about the potential for vitamin D toxicity, this appears to occur only at much higher doses.

Q. I have taken both lithium and Wellbutrin for 15 years to control bipolar disease. Recently I have become very thirsty. It is most noticeable when I'm speaking to large groups. (This is part of my job that hasn't changed for more than 25 years.)

My doctor says thirst has always been a possible side effect of both medications. Is there anything I can take to relieve the thirst, even if only for the periodic speaking engagements?

A. The antidepressant Wellbutrin (bupropion) can cause dry mouth. Real thirst, though, is a common side effect of lithium. The fact that you are bothered with thirst now although it has not been a problem for years might suggest you are more susceptible to the drug. Perhaps your kidneys are not coping with it as well. We recommend you see your doctor for a thorough check-up and blood test to make sure the dose of your lithium medication is still right for you.

Q. I have suffered with insomnia for years. My doctor prescribed Ambien, which gives me eight hours of restful sleep. Then the pharmacist switched me to generic zolpidem for under $15. He said it was identical to Ambien.

It wasn’t! I haven’t had a decent night’s sleep since switching. If I do fall asleep I have horrible nightmares. I cannot afford $130 for regular Ambien. What else can I do? I need my sleep to be alert at work.

A. Dozens of other readers have also reported problems with generic Ambien (zolpidem). If your insurance company won’t cover the brand name medicine, you may wish to consider some non-drug options. They include a small high-carb bedtime snack such as milk and graham crackers, dietary supplements such as magnesium, melatonin, passionflower or valerian, a hot bath an hour before retiring and acupressure wristbands.

We describe these approaches and others in greater detail in our newly revised Guide to Getting a Good Night’s Sleep. We also discuss OTC sleeping pills and prescription drugs such as Lunesta, Sonata and Rozerem.

Q. I need your help to solve a horrible problem I have developed since being diagnosed with type 2 diabetes several months ago. My doctor prescribed medicine to help control my blood sugar. I’ve been watching my diet and have lost 30 pounds.

My problem is TERRIBLE gas. I cannot control it. This never happened before. I can hardly move, let alone walk or bend without outbursts that are both loud and long, just like a motorboat.

In addition, my sex life is nonexistent. Because I can’t control the gas my husband is very annoyed.

I try to stay away from people at work, but that is difficult because I am a secretary. Beano just made things worse. Could this be due to my medication? My doctor seems unconcerned.

A. Some pills for type 2 diabetes are notorious for causing digestive distress and flatulence. Be sure to tell your doctor how much this is interfering with your quality of life. There are a number of alternatives for type 2 diabetes, and another medication might be less troublesome for you.

Q. I have read that magnesium is an important supplement but I have no idea how much to take. Can one overdose on this element? Is it really as important as calcium?

A. Magnesium is crucial for heart and bone health and is frequently in short supply in the diet. A safe dose ranges from 300 mg to 500 mg. Too much magnesium can lead to loose stools or diarrhea.
Q. About a month ago my son-in-law started taking one regular Bayer aspirin each morning and one Bayer PM before going to sleep. Two weeks into this regimen he started bleeding from the mouth while he was sleeping. He stopped taking the aspirin and the bleeding stopped as well. Is this a possible side effect?

A. Aspirin can thin the blood by interfering with the sticky part of blood called platelets. Some people are especially susceptible to this effect so even a standard dose might trigger bleeding.
Q. I have had eczema ever since I was a child. I have used many steroid creams over the years, and while they help alleviate it a bit, in bad bouts those creams were not very soothing and just kept away the worst irritations.

I have been going to a young dermatologist who advised me to use CeraVe Moisturizing Cream (not lotion). I can't rave about it enough.

Immediately after bathing, I put it on and 24 hours later, when I shower, I can feel that the cream is still there. I have only had to use one of the prescription creams a few times since starting with this, over a year ago. Keeping my skin hydrated seems to do the trick for me.


A. CeraVe moisturizer contains no fragrance to irritate the skin, but it does contain ceramides. These are natural fatty compounds found in cell membranes. People with eczema frequently have lower levels of ceramides in their skin. Moisturizing can help keep eczema from itching and may boost the effectiveness of topical steroids when you do need to use them.
Q. I rarely take medicine, but this winter I have had sinusitis and a nasty cough that required several medications. My enlarged prostate gets me up to go to the bathroom a few times a night and I have trouble falling back to sleep.

I am in total shock after a trip to the pharmacy. Here is a list of my medications and the cost. My insurance has a high deductible so this is all out of pocket: Flovent inhaler ($173.52) to ease my cough; Singulair ($126.99) and Nasonex ($102.99) for allergies; Nexium ($180.99) for reflux; Avodart ($124.99) for the prostate and Ambien ($130.99) for insomnia. Total: $840.47.

Is there any way to get these drugs more affordably? Another month like this and I’ll be eating rice and beans.


A. Yikes! Without insurance, prescription drugs can bust a budget. You may want to consider purchasing some of your medicine from a legitimate Canadian online pharmacy. Doing so could save you over $300.

Not all online pharmacies are reliable, however. We are sending you our Guide to Saving Money on Medicine with tips on identifying genuine Canadian online drugstores plus ways to use generic drugs safely and information on accessing free medicine.

Q. Is it safe to sleep in the same room/bed when your spouse has the flu if he is being treated with Tamiflu?

A. Tamiflu is an effective antiviral medication. It can shorten the duration of an influenza attack if taken early enough, but we don’t know how soon the drug can limit the spread of viruses in a household. Tamiflu can be used preventively, so you may want to ask your doctor whether a prescription could protect you from catching your husband’s flu bug.

Q. My mom drinks Slim-Fast and takes levothyroxine for a thyroid condition. She wants to know if it is okay to take them both at once.

A. We suggest she take the levothyroxine at least half an hour, or better an hour, before she drinks her morning Slim-Fast. This diet drink contains minerals that could interfere with the absorption of levothyroxine.
Q. I read in your column that naproxen can cause kidney damage. I want to reinforce that warning. I lost my kidneys as a result of taking prescription strength naproxen in 1995. I took this anti-inflammatory drug off and on for three to six months.

I eventually needed a kidney transplant. I was lucky to get one in time. People must be informed that this kind of medicine can be dangerous. Many doctors prescribe these drugs without warning patients.


A. Over 20 million Americans use nonsteroidal anti-inflammatory drugs (NSAIDs) daily for arthritis and other pain problems. This class of medicine includes OTC ibuprofen and naproxen as well as a range of prescription drugs (celecoxib, diclofenac, etodolac, piroxicam, etc).

Side effects of such drugs include stomach upset, ulcers, high blood pressure, fluid retention, heart failure, skin rash, liver and kidney damage. Anyone with kidney impairment is far more likely to experience kidney toxicity on these drugs.

People in pain are caught in a dilemma. The most frequently prescribed pain medicine, NSAIDs, can cause a lot of damage. We offer a number of other options in our Guide to Alternatives for Arthritis.
Q. Electric shock is used to start hearts that have stopped beating. In a pinch would it be possible to start a heart using a stun gun?

A. Doctors use defibrillators to shock a heart out of a life-threatening rhythm. A stun gun is NO substitute for a defibrillator! We consulted two cardiologists who both said this would not work and is a very bad idea.

If you are concerned about needing a defibrillator “in a pinch,” you can purchase an AED (automated external defibrillator). These home models detect life-threatening heart rhythms and use an electrical shock to restart the heart. They usually cost between $1200 and $1700. AEDs are sometimes found in airports and other public spaces.
Q. I have atrial fibrillation, an abnormal heart rhythm for which I take Tambocor (a heart rhythm drug) and warfarin (a blood thinner). I also have arthritis. I was taking Tylenol for it, but my lab tests went haywire. I think the Tylenol was affecting the warfarin, because after I stopped taking it my bleeding time results came back into balance.

I know warfarin is crucial to prevent a stroke, but I find it very challenging to figure out all the conflicting information about it. I had been told that Tylenol would be fine, but it isn’t. I’ve also heard different advice about cranberry juice and vegetables. Can you send me any information on warfarin and diet?


A. Warfarin, also prescribed by the brand names Coumadin or Jantoven, is a life-saving drug but it can be tricky to use. It interacts with many other medicines and even many foods. While acetaminophen (Tylenol) could be used for occasional pain relief, regular use can raise the INR (a measure of blood coagulation) and increase the risk of dangerous bleeding.

Cranberries may also increase the risk of bleeding, while vegetables rich in vitamin K such as brussels sprouts or kale can counteract warfarin’s action and increase the risk of a blood clot.

We are sending you our Guides to Food, Drug and Coumadin Interactions for more details on this important medication.
Q. I was alarmed to read that a caring, concerned grandmother had stopped her grandson's medication for ADHD abruptly. This could be extremely dangerous.

I stopped taking Adderall myself after having been on it for some time, but only after I asked my physician. With some medications, it may not be okay just to stop.


A. You are right to point out that stopping medication requires medical supervision. It makes sense to ask the doctor about when and how to stop medicine even before beginning to take a prescription.

The grandmother who wrote us described a complicated situation. When we edited out some details for space considerations, we inadvertently implied she had stopped her grandson’s medicine without medical oversight.

Treatments For Crooked Penis

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Q. I told my physician that my penis bends as an erection occurs. He laughed and suggested that this was not uncommon at my age (71) and that only extensive surgery could possibly correct it.

Now I’ve heard that there are medications that might help. My wife says that it’s a bit uncomfortable, but tolerable.


A. Your description fits Peyronie’s disease. Experts estimate that it affects approximately 8 percent of men over 50. Peyronie’s is caused by scarring on one side of the erectile body of the penis.

Urologist Culley Carson, MD, tells us that medications can sometimes be helpful. They include pentoxifylline (a drug that makes platelets flexible and improves blood circulation) and colchicine (a drug used primarily for gout). The calcium channel blocker verapamil is sometimes injected directly into the scar tissue. Such treatments must be supervised by a specialist. You can listen to an interview with Dr. Carson at www.peoplespharmacy.com (show #668).

Calcium Overdose?

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Q. How much calcium is too much? I take 1500 mg/day and my doctor wants me to add another 500 mg for my thinning bones. I drink milk and wonder if I may be overdosing.

A. Too much calcium (2,000 mg/day) can lead to “milk-alkali syndrome.” The extra supplement might make you vulnerable to this complication that increases the risk of bone fractures and kidney stones.
Q. My husband has taken Zocor to lower cholesterol since he was 48. In 2006, he started to notice problems. His feet became numb and he had trouble writing. He believed that he was less sharp mentally. I could see that his muscle strength was waning too. I excused this as growing older, but he was just in his early fifties.

The problems became more obvious starting in January 2007. Now it's February 2008 and he's 55.

He can't communicate with customers in the business he started 30 years ago. His writing can't be read even when he tries his best to print.

He has trouble walking. He loses his balance easily. It is very difficult for him to get up when he falls. He has very little body strength and he can't walk up stairs. He has no feeling in the bottom of his toes.

He has trouble expressing his thoughts and his speech pattern is halting. He has a lot of trouble sleeping.

He's made numerous trips to his internist and a neurologist. They have recommended we see a dementia psychiatrist. I feel I need to look elsewhere for help--but I don't know where to go. Could any of this be related to Zocor?


A. We have heard from hundreds of people who have developed memory, nerve or muscle problems while taking statin-type cholesterol-lowering drugs (Lipitor, lovastatin, simvastatin, Zocor, etc). People frequently complain that they have trouble remembering words and names. In a recent article in the Wall Street Journal (2/12/08) a doctor observed, “This drug [Lipitor] makes women stupid.”

We have discussed this issue in great detail with several experts on our radio show. We are sending you a one-hour CD of “The Dark Side of Statins,” an interview with Beatrice Golomb, MD, PhD, and colleagues.
Q. Can Preparation H raise blood pressure? I have been using Preparation H for a few weeks for a hemorrhoid problem. During that time it seems that my blood pressure has been going up.

My pressure has always been in the normal range of 120/80 or lower but now I'm seeing systolic numbers in the 130 to 140 range. I noticed that in the Prep H warning it mentions to ask your doctor before using it if you have high blood pressure.


A. One of the active ingredients in Preparation H is phenylephrine, a vasoconstrictor. This is the same drug that is used as a decongestant in some nasal sprays and oral cold medicines.

Vasoconstrictors work by contracting blood vessels and shrinking swollen tissues. One possible side effect is increased blood pressure. Anesthesiologists sometimes use phenylephrine to raise blood pressure during surgery if a patient’s blood pressure drops too low.

The rectum is well supplied with blood vessels. That is why suppositories are effective for delivering drugs into the blood stream. When phenylephrine is absorbed from these delicate tissues, it may raise blood pressure. One reader ended up in the ER with a blood pressure of 206/98 after using Preparation H for several days.
Q. A guest on your radio show mentioned an experimental use for a drug that had been used for inflammation and is now being looked at for diabetes prevention. It was “sawcelate” or something like that. What is the correct spelling, please?

A. The drug is salsalate. It is related to aspirin and fights pain and inflammation as aspirin does. It is far less irritating to the digestive tract, however.

Scientists at the Joslin Diabetes Center have found that salsalate can help people with diabetes and pre-diabetes lower their blood sugar and may be useful in preventing diabetes (Diabetes Care, Feb. 2008). Like aspirin, salsalate has been used for more than a century. Unlike aspirin, however, it is available only by prescription.
Q. I've read that people, especially older folks, should be out in the sun for at least 10 minutes per day to get vitamin D. What if the person has had skin cancer? I am conscientious about sunscreen, but someone told me using sunscreen negates the beneficial effects of sun exposure for vitamin D.

A. Everyone needs vitamin D, and most of us don’t get enough, especially in winter. This vitamin is crucial for a healthy immune system as well as strong bones. Older people who get adequate vitamin D are far less susceptible to falls.

Vitamin D is found in a few foods such as oily fish and fortified milk, but the primary source is sunshine. Sunscreen can keep skin from making vitamin D so a supplement of 1,000 to 2,000 International Units daily might be advisable for someone like you who has had skin cancer. This is quite a bit more than the 400 IU in multivitamins, but corresponds to the latest research.

Do NSAIDs Cause Gas?

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Q. I am taking naproxen for pain in my lower back, hands and knees. It seems to do the trick for the pain but I am having lots of flatulence. There is probably no connection but I would like to know for sure if the naproxen is causing it. Also, are there any other complications of naproxen I should be aware of?

A. Naproxen (available as Aleve over the counter and as Anaprox, Naprelan or Naprosyn by prescription) is a nonsteroidal anti-inflammatory drug (NSAID). Like ibuprofen and similar pain relievers, naproxen can cause flatulence. A surprising number of medications can contribute to gassiness.

NSAIDs like naproxen can cause digestive distress including ulcers, high blood pressure, fluid retention, dizziness, drowsiness, ringing in the ears, rashes and kidney damage. You may want to consider some natural approaches to easing pain and inflammation such as boswellia, turmeric or fish oil.

You can find out more about such approaches as well as a number of causes and treatments for flatulence in Best Choices From The People’s Pharmacy. It is available from your local library or bookseller or online at this website.

Listerine Mouthwash Zaps Zits

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Q. I have very sensitive skin that reacts badly to everything. I have used Listerine for years to clear up small blemishes. Apply a dab to the area at night and usually by morning the spot is clear. It doesn't irritate the surrounding skin either. My husband has started using it for shaving bumps too.

A. The herbal extracts and alcohol in Listerine that are supposed to “kill germs by millions on contact” may be useful in helping your blemishes heal. We have heard from other readers who have used Listerine in this way.
Q. My husband had hip replacement surgery in January. For two days after the surgery, he was a bit groggy. By the third day he was hallucinating.

I was trying to prevent him from injuring his new hip while he was seeing bobcats, raccoons, cattle trucks and airplanes, all in his hospital room. He threatened to divorce me because I wouldn’t take him home. We've been through Hell.

We thought he'd had a stroke but that was ruled out. We finally figured out it was probably the OxyContin he was given for pain.

Since this happened I've heard of other people on this drug who have had hallucinations. Why don't they get that drug off the market?


A. OxyContin (timed-release oxycodone) is a very effective pain reliever, but like other narcotics, it may sometimes cause hallucinations. Doctors should alert patients and their families about this possibility so they don’t have to go through the terror you experienced.

 
Q. I have suffered with stomach pain and reflux for a long time. I have tried Zantac and Pepcid without much success. I am now taking Prevacid that my doctor prescribed to control excess acid. Even after an increase in dose I am still experiencing gastrointestinal upset. Any ideas?

I also have a thyroid problem. My endocrinologist started me on Synthroid and recently switched me to Levoxyl. Now I am noticing side effects. It seems as if the drug isn’t working the way it used to. I know these drugs are supposed to be equivalent but my body says something different. Should I ask my doctor to put me back on Synthroid?


A. Substituting one brand of levothyroxine (Levoxyl) for another (Synthroid) may require an adjustment in dose. But first, you and your doctor need to consider your stomach problems.

An article in The New England Journal of Medicine (April 27, 2006) shows that people with low stomach acidity do not absorb levothyroxine well and may need a higher dose. The Prevacid you are taking reduces stomach acid.

People infected with stomach bacteria called Helicobacter pylori also seem to have trouble absorbing thyroid hormone. This bug may also be contributing to your GI problems. We discuss the treatment of this infection in our Guide to Digestive Disorders. Our Guide to Thyroid Hormones has more information on levothyroxine and other drugs that may interact with it.

Mouthwash Turned Feet Blue

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Q. When I needed treatment for toenail fungus, my doctor suggested I soak my toes in Listerine for 30 minutes a night for thirty days. I sent my husband to Costco for a giant jug of Listerine. He returned with the minty one.

It’s blue, but I figured that wouldn’t really make a difference. It did. My feet turned blue and no amount of scrubbing could take the color off. My husband laughed until he cried.

After switching to the regular (amber) Listerine, my toenail fungus did clear up, but the nails themselves were very dry.


A. The herbal oils in Listerine, such as thymol and eucalyptol, have antifungal activity. Many readers have found that it can help fight nail fungus. The alcohol in regular Listerine (26.9 percent) might be the culprit in drying your nails.

Is Your Soap Clean?

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Q. Is bar soap a possible source of bacteria? Is it better to use liquid soap?

A. Soggy bar soap can become contaminated with bacteria. But not all liquid soap is free of germs. Microbiologist Charles Gerba, PhD, has found that refillable liquid soap dispensers (such as those found in many public rest rooms) can become heavily contaminated with fecal bacteria. Facilities that used sealed plastic bags of liquid soap in their dispensers had no contamination.

Thoroughly rinsing your hands after scrubbing them should help get rid of bacteria and viruses, regardless of the type of soap you use.

Untangling The News About Zetia

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Q. There was a lot of hoopla recently about the drug Zetia. I called my doctor, who told me to continue taking it, but if it's not doing anything good for my high cholesterol, why bother?

A pharmacist told me that the FDA hasn't recalled it, so it must be all right. Can you shed any light on this?


A. Zetia (ezetimibe) and Vytorin (ezetimibe and simvastatin) lower cholesterol. The unresolved question is whether they prevent atherosclerosis, heart attacks and strokes.

The study you heard about was called ENHANCE because the company hoped Vytorin would be better than Zocor (simvastatin) alone. Scientists compared the thickness of the lining of the carotid arteries in the neck between people put on Vytorin and those on simvastatin. Vytorin lowered bad LDL cholesterol more than Zocor did but this did not lead to healthier arteries.

Cardiologist Steven Nissen, MD, of the Cleveland Clinic was shocked by the results. He advised his colleagues not to prescribe Zetia except as a last resort.
Q. I just read that grapefruit increases the risk of breast cancer. What gives? I always thought fruits and vegetables prevented cancer.

A. One study showed that grapefruit raises estrogen levels in postmenopausal women. Higher estrogen is associated with greater risk of breast cancer.

Another study reported that women who regularly ate grapefruit were 30 percent more likely to be diagnosed with breast cancer (British Journal of Cancer, July 10, 2007). Other researchers have found no connection between grapefruit consumption and breast cancer (British Journal of Cancer, Jan. 8, 2008).

Grapefruit interacts with hundreds of medications and can increase the risk of side effects. We discuss this in greater detail in our Guide to Grapefruit Interactions. We also discuss the pros and cons of hormone therapy in our Guide to Estrogen.

Dangers of Drinking Listerine

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Q. You had a question from parents concerned about their son using more than three big bottles of mouthwash in a week. Shame on you for soft-pedaling the use of Listerine.

My dad dried out and then restarted on mouthwash. Alcoholics lie and deny. The son is drinking a half-bottle of 50-proof mouthwash a day and your wishy-washy response is not helping the clueless parents.

A. Thanks for your concern. The parents were convinced their son was ingesting mouthwash, since he had already gone through detox once. They wanted to know the consequences of drinking Listerine.

Original formula Listerine contains 26.9 percent alcohol. Clearly, anyone using 5 liters of Listerine in eight days needs professional help.
Q. My orthopedic doctor did not warn me that the anti-inflammatory drug he prescribed might raise my blood pressure. When it spiked to 172/92 I got scared. The doctor did not respond to my complaints and a pharmacist said it was not a side effect of the medicine.

When I stopped the NSAID my blood pressure returned to normal (122/70). Can you relieve pain and inflammation without raising blood pressure?


A. Nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen or prescription drugs such as Celebrex, Mobic or Voltaren can raise blood pressure. Even acetaminophen (found in Tylenol and many other pain relievers) is linked to hypertension (Archives of Internal Medicine, Feb. 26, 2007).

Our Guides to Alternatives for Arthritis and Blood Pressure Treatment offer many ways to control pain and lower blood pressure. Herbs and topical NSAIDs are less likely to cause harm.

Getting Rid Of Nosebleeds

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Q. My daughter has excessive nosebleeds. Do you have any herbal or home remedy suggestions?

A. You may want to start in the pharmacy. There are three products to consider: Nosebleed QR (www.biolife.com and 800-722-7559), NasalCEASE (www.nasalcease.com and 800-650-6673) and Seal-On (www.seal-on.com).

As for home remedies, our favorite would be to put a wad of cold keys down the back under the shirt. We cannot explain why this might work, but we have heard from many readers that it is amazingly effective:

“When I was a little girl in rural North Carolina, my daddy knew to stop nosebleeds when someone in the family had one. He put a bunch of car keys down her back. The nosebleed stopped pronto. He was uneducated but the remedies that he used worked for us.”
Q. I live in the U.K. On Christmas Eve my boyfriend had been been using Champix for some months. He was drinking and went berserk for no reason, assaulted me and destroyed my apartment.

I fled and waited in an ambulance for the police to come. They found him unconscious from taking an overdose of paracetamol [acetaminophen]. He survived but I have ended the relationship and pressed charges.

 As far as I know he has no past mental health problems or history of violence. Could Champix have contributed to his frightening behavior?


A. The stop-smoking drug varenicline is sold in the U.K. as Champix and in the U.S. by the name Chantix. It is impossible to determine whether this medication was responsible for your boyfriend’s behavior, but the FDA has received reports of “suicidal thoughts and aggressive and erratic behavior in patients who have taken Chantix.”

Your story is reminiscent of a tragic event that took place in Dallas, TX, last year. A musician named Carter Albrecht had been taking Chantix to quit smoking. One night he got drunk and assaulted his girlfriend.

She ran away from him and locked him out. When he wasn’t able to kick the door down, he went to a neighbor’s house and started banging on the door. The frightened neighbor fired a gun through the door. One shot hit Albrecht in the head and killed him. No one has determined whether Chantix played a role in this incident.
Q. My doctor recently put me on Fosamax for osteoporosis once a week. A few days later I was in terrible pain with my arthritic thumbs. They hurt so much I wanted to cut them off.

I called my doctor and he put me on Actonel once a day instead. The pain in my thumbs has subsided but now I have pain in my lower back and hip that I never had before.

I am 67 years old and in good health. Is the pain I'm getting caused by either of these drugs? If it does not stop soon, I am just going to quit taking the Actonel and take my chances. Strengthening my bones is not worth this pain.


A. The FDA recently issued an alert about side effects associated with bisphosphonate osteoporosis drugs like Actonel, Boniva, Fosamax and Reclast. The agency says there is a “possibility of severe and sometimes incapacitating bone, joint and/or muscle pain in patients taking bisphosphonates.” Perhaps you are susceptible to this complication.

Not everyone can tolerate this type of osteoporosis medication, but there are other ways to reduce the risk of weak bones or fractures. We discuss several different sorts of medicines and non-drug approaches to osteoporosis prevention in our book, Best Choices From The People’s Pharmacy. It is available in libraries, bookstores and online at this Web site.
Q. I’ve read about the difficulties of disposing of unused drugs and want to share my solution. I poured Elmer’s glue into the pill container to cover the pills and let it set before putting the container in the trash.

A. That sounds like an innovative solution for the problem of drug disposal. Thanks for sharing it.
Q. I was taking phenytoin, an extended release generic form of the anti-seizure drug Dilantin. On September 19, 2007, I had a grand mal seizure and upon admission to a local ER, my lab results indicated my phenytoin level was UNDETECTABLE! It was not just low, it was actually 0.0!

I had been faithfully taking my 200 mg capsule at bedtime every night. In fact, I had just swallowed that evening's dose right before the seizure.

I have reported this event to the FDA and the manufacturer. I have not been able to find out if the capsules were authentic or counterfeit.

I would encourage anyone taking phenytoin to have labs done to ensure you have an adequate level of the drug in your system. I am still taking the generic for seizure control because my insurance company mandates it. I have my phenytoin level checked monthly, however, to ensure that each bottle is actually providing an active ingredient.


A. Several years ago there was an article in the journal Neurology (Oct 26, 2004) documenting that an extended release generic phenytoin provided less active drug than the brand name Dilantin. Patients in Minnesota had been switched to the generic as a condition of their state employees health insurance. Several experienced seizures after the switch.

The FDA tells us that it is investigating this issue, but it has not issued an official report. In the meantime, your advice to monitor blood levels of phenytoin seems very sensible. No one should have to risk a seizure because of a flawed formulation.

Anyone who has had a problem with generic drugs may share the experience online here at www.peoplespharmacy.com and with the FDA at www.fda.gov/medwatch.

Does Caffeine Stunt Growth?

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Q. Is it true that drinking coffee with caffeine from the age of 9 on up will stunt a young girl's growth and keep her short?

A. We could find no research to support this old wives tale. The Penn State Young Women’s Health Study found no connection between caffeine intake and height or bone strength (Journal of the American College of Nutrition, Oct. 1998). Caffeine has other undesirable effects in children, however, and may weaken bones in older people.
Q. I am lucky to have insurance through my employer, but I need more medications as I grow older.

Last month, my doctor and I discussed new drugs for two health problems. Because I have had serious negative reactions to many generics, we opted for name brands.

My insurance company refuses to pay Tier 3 ($70 for 90 day mail supply) for the brand name medications that my doctor and I agreed would be best. As a result, my budget was blown to shreds. I had to pay $420 for 2 drugs last month, and now must determine which other bills not to pay now and next month. What else can I do?


A. Many insurance companies have created a multi-tier payment system to discourage the use of expensive brand-name medicines. This might seem reasonable, but we are concerned. So many people have reported problems with generic drugs on our Web site that we are no longer confident of their quality.

People who need pricey prescriptions may want to shop comparatively using a service such as www.PharmacyChecker.com. Another option might be to buy brand name drugs from reliable Canadian online pharmacies. Be aware, though, that some online drugstores masquerade as Canadian.

We are sending you our Guide to Saving Money on Medicine for guidance on determining which online pharmacies are legitimate.
Q. We are at a stand-off with our son. During his 8-day visit over the holidays, he used 3 1/2 bottles (1.5 liters each) of Listerine. We are concerned because it contains alcohol.

Our son went through detox treatment four years ago. He refuses to attend AA meetings where he lives. His other addiction is nicotine (in snuff).

He tells us he only rinses his mouth with Listerine after he finishes the snuff, but we have seen so many changes in his behavior (abusive language, attitudes, unsteady walk and speech) that we are convinced he must be ingesting the mouthwash.

Please write about repercussions from the misuse of Listerine.


A. No one could use more than 5 liters (5.5 quarts) of Listerine in eight days purely as a mouthwash. If your son followed the directions on the label to rinse with 2/3 of an ounce morning and night, one bottle should have lasted him over a month. The maker of Listerine states unequivocally, “Do not swallow.”

Listerine lists alcohol as an “inactive” ingredient (26.9 percent). It also contains eucalyptol, menthol, thymol and methyl salicylate (oil of wintergreen). Methyl salicylate can be toxic if taken internally. Combined with the alcohol, it might account for the symptoms you observed.

Your son needs professional help. There are several prescription drugs to help overcome alcohol and nicotine addictions (ReVia or Campral for alcohol; Zyban or Chantix for nicotine).
Q. I am looking for a deodorant that is just a deodorant, not an antiperspirant as well. I can’t seem to find one. Your recommendation?

A. Some readers recommend baking soda. One suggested,“Take a wet washcloth and dip it in baking soda, then apply under your arms. It does not stop you from sweating, but it stops you from smelling.” Others prefer milk of magnesia as an underarm deodorant.

Q. My mother-in-law is 86 years old and in reasonably good health. Several months ago, she started complaining about increased pain and seemed very weak and confused. Within a month, she could not walk and was forced to leave her home and move in with her granddaughter.

I looked her medications up and found a drug interaction between simvastatin (40 mg) and verapamil. We brought this to the attention of her doctor who said, "There is no interaction."

On our own, we stopped the simvastatin and within 4 weeks she had improved dramatically. Two months later, she is now walking without a walker and feels pretty good.

She saw the doctor again the other day and her cholesterol was high, so he ordered Vytorin 10/80. I don’t get it: If she could not tolerate 40 mg of simvastatin what makes him think she can take 80 mg as part of a combination? How critical is it to lower cholesterol aggressively in a person her age? She has no history of heart disease.

A. The blood pressure drug verapamil can indeed boost blood levels of simvastatin (Clinical Pharmacology & Therapeutics, Aug.1998). Older people like your mother-in-law may be especially sensitive to the side effects, particularly muscle pain, weakness and mental confusion.

There is no convincing data showing that lowering cholesterol aggressively will extend life in an otherwise healthy person her age. If she can’t walk, the quality of her life and the risk of a fall could easily outweigh the drug benefits.

We’d like to send you our Guides to Drugs and Older People and Cholesterol-Lowering Drugs for an in-depth discussion of the pitfalls of medications for senior citizens.

Can Vinegar Disinfect Counters?

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Q. I have a three-year-old and am expecting a new baby in a few weeks. I hate to use harsh chemicals to clean our house, and usually rely on good old soap and hot water, sometimes with vinegar or baking soda. I use bleach or Bon-Ami sparingly for some things.

I found a recipe for home cleaner spray--a simple mixture of white vinegar, water and a few drops of essential oil for fragrance. I spray this mixture everywhere, confident that I could eat it if I had to. It does a great job on the stainless kitchen sink, microwave, countertops and bathroom sink.

I'm under the impression that vinegar will be enough to kill germs, especially bacteria. Is that true? Do I need to add something more caustic to get the germs?

A. Vinegar is a great cleaner, but we didn’t know how well it could kill germs. We asked germ guru Charles Gerba, PhD, a microbiologist at the University of Arizona, Tucson. He has done field studies on household germs.

Dr. Gerba said that vinegar is useful as a cleaner and has some antimicrobial properties, but it is not considered a sanitizer or disinfectant. For disinfecting, dilute bleach is still best.

Q. What do you know about compounded testosterone cream? I am a 64-year-old woman with a very low libido.

A friend of a friend uses this cream before sex, applying it to the inner thighs. She has great results with desire and orgasms, but my gynecologist says it is not FDA approved and won't prescribe it.

A. Low testosterone levels in men or women are associated with diminished sexual interest, arousal and enjoyment. Some small studies suggest that testosterone therapy may boost libido, even in women (Menopause, May-June, 2006). Too much of this male hormone can cause facial hair growth, acne, deepening of the voice and clitoral enlargement.

Your doctor is correct that the FDA has not approved testosterone for improving women’s sex drive. Nevertheless, a physician who specializes in sexual medicine may be able to assist you.

We are sending you our Guides to Female Sexuality and Treating Sexual Dysfunction for more information on the benefits and risks of testosterone to counter low libido.

Q. I enjoy using my outdoor hot tub in the winter, but I get an itchy rash on my legs. I think it is eczema. How can I continue to enjoy my spa?

A. You may have “hot tub folliculitis.” This rash may be caused by pseudomonas bacteria that grow in hot tubs that are not properly maintained (Journal of the American Academy of Dermatology, Oct. 2007). Check with your dermatologist to see whether you need an antibiotic.

Q. My doctor prescribed Toprol-XL several years ago and it worked well. Last week my pharmacist refilled my prescription with generic metoprolol succinate. Two days later my blood pressure shot sky high to 190/100.

Luckily, I found some leftover pills of the brand name Toprol-XL. My blood pressure came down to 140/90--high but okay.

Is there a problem with this new generic? This has never happened to me before.

A. Toprol-XL (metoprolol) is a slow-release beta blocker prescribed to control high blood pressure and irregular heart rhythms. Many other readers have reported rapid heart rate and higher blood pressure after switching to some generic forms of metoprolol succinate.

One patient experienced pounding headaches with blood pressure of 225/125 after one week on metoprolol. Another wrote, “I have bouts of ultra-fast heart beats, atrial fibrillation, and severe PVCs (premature ventricular contractions) which have been controlled with Toprol-XL for years. On the generic, it is as if I'm not taking anything.”

We urge anyone having a problem with a generic drug to discuss the problem with the prescriber. The FDA insists that all generic drugs are equivalent, but our readers describe varied reactions.

Q. My wife washes her hands like she is going to do surgery. She says it takes 30 seconds to get rid of germs. I wash my hands for about 3 seconds. I don’t see any advantage in wasting a lot more time. What do you think?

A. Your wife is right. It takes about 30 seconds of vigorous scrubbing and rinsing to wash off most germs. If everyone followed your wife’s good example, there’d be fewer colds passed around each year.

Q. Is it important to have a bowel movement at the same time every day? My late mother-in-law used to insist this was the most important health advice.

A. No one wants to be constipated, but not all healthy people need a bowel movement daily. Some people with excellent bowel function go every other day or every third day. Others need more than one daily trip to the bathroom.

The belief in the importance of a daily BM has led many people to use harsh laxatives, such as senna. We offer more natural approaches to achieving regularity in our Guide to Constipation.

 

Q. You have had questions from people with skin cracking on their fingertips. I have another option to add to your suggestions: Acid Mantle from Doak Dermatologics.

I learned about it many years ago from the cook at my children's camp. Her hands cracked and split from being washed and dried so often until she found Acid Mantle.

We initially used it for sunburn relief, but it’s also wonderful for chronic dry skin or the chapped area under your nose when you have a runny nose. Doing home remodeling (sanding, sheetrock) can be very drying because the protective oils of the skin get removed or the natural acid pH is disturbed.

Acid Mantle is expensive (about $44 for a 1-lb jar). But a little goes a long way, so the large jar lasts a year or more.

A. Ten years ago a scrub nurse wrote to us about Acid Mantle: “What a relief! It reversed the burn caused by the base pH in soaps, and returned my skin to normal.” The product contains petrolatum, glycerin and synthetic beeswax as well as other moisturizer ingredients.

Q. A few months ago, I finally yielded to my doctor’s pressure and went on a blood pressure medication, against my better judgment. I am a 63-year-old female. The medication is metoprolol succinate.

If you could tell me some of its side effects, I would be grateful. I am not feeling well and I am guessing this new med is the culprit.

A. Metoprolol, like other beta blocker blood pressure medicines, may cause fatigue, dizziness or diarrhea. Some people develop an itchy rash while taking the medicine, while others may find themselves short of breath. It slows heart rate, sometimes by quite a lot.

Many cardiologists are reassessing beta blockers, though. Such drugs are rarely considered first line treatments for hypertension these days (Lancet, Oct. 29, 2005). Blood pressure control is very important, so don’t stop your medication on your own. (It is dangerous to stop a beta blocker drug suddenly.) Discuss your symptoms with your doctor and ask about other possible treatments.

Perhaps this reader’s experience will help you: “I was told I need to be on blood pressure meds. I don't like to take pills so I tried breathing exercises and going to the gym. I didn't have high blood pressure at my last visit.”

Disposing Of Drugs Safely

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Q. How do you advise people to dispose of their prescription and over the counter drugs safely? I worry about this stuff being flushed down the toilet and contaminating the water supply.

A. Flushing unused or outdated medications down the toilet is a bad idea for that very reason. The government is suggesting that unused drugs, especially potent pain relievers or sleeping pills, be mixed with something nasty before putting them in the trash. Used kitty litter has been proposed to make the pills unpalatable to children, pets and drug addicts.

One veterinarian complained to us, however, that mixing drugs with used kitty litter is dangerous for dogs and some other animals that find used kitty litter appetizing. Ask a pharmacist about other ways to dispose of unused medicines.

Q. I was surprised that you didn't include a reference to plant stanol esters in your answer to a question about lowering cholesterol. Six years ago my husband's cholesterol was at 385. We didn't want him to take statins because of interactions with other health problems.

His cardiologist recommended that he use at least one tablespoon of Benecol at each meal and make some other dietary changes. This brought his cholesterol down to 185 and the balance of HDL versus LDL was restored to a level.


A. The FDA has concluded that stanol esters can lower cholesterol and reduce the risk of heart disease. Spreads such as Benecol, Promise-activ and Take Control contain these plant products. We are delighted to learn that the dietary changes your husband made had such a profound impact on his cholesterol levels.
Q. Over-the-counter ibuprofen was my friend. I thought it was a miracle drug for pain and inflammation. I have osteoarthritis and fibromyalgia, and I took ibuprofen often to relieve pain.

Then I went for a routine physical, which included blood work and urinalysis. Both my internal medicine doctor and I were shocked that my creatinine level was very high—indicating I was close to kidney failure.

After careful consideration of the medications I was using, we determined that ibuprofen was the culprit. I quit taking it immediately on my doctor's orders. My creatinine levels have been normal ever since.

I don't think many people consider kidney damage as a side effect of regular ibuprofen use. I certainly had no idea.

A. Millions of people take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen every day to relieve pain and inflammation. Many assume such OTC medications are risk free.

These pain relievers can be hard on the kidneys, especially when taken for a long time. Other complications may include liver damage, fluid retention, high blood pressure, heart failure and stomach ulcers. No one should take NSAIDs for more than 10 days without careful medical supervision.

Thank you for sharing your story. It may help others avoid a similar problem. We are sending you our Guide to Alternatives for Arthritis with detailed information about the dangers of NSAIDs and prednisone plus many non-drug alternatives for pain relief.

Q. I have tried many statin drugs for high cholesterol but had muscle pain with all of them. Two years ago my doctor prescribed cholestyramine. It is in powder form and I take one packet a day in juice or water. It is terrific and has lowered my cholesterol with no muscle pain.

A. Cholestyramine was a common prescription drug for high cholesterol long before the statins were invented. It binds to bile acids in the digestive tract, which leads to lowering of cholesterol. Side effects may include constipation, flatulence and digestive upset.

Campho-Phenique For Smelly Feet

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Q. I recently read your answer to the person with smelly feet. I’d like to tell you what worked for me for 30 years. I was a waitress and had to wear solid shoes and nylons for long hours. My feet ached and smelled so bad I couldn’t stand them. I tried everything. Finally, Campho-Phenique worked wonders. It may help someone else.

A. Campho-Phenique contains camphor and phenol as main ingredients along with eucalyptus oil. It is primarily used for relieving minor skin irritations, cuts, scrapes and insect bites. Perhaps the antibacterial and antifungal nature of these old-fashioned ingredients helped clear up a lingering infection responsible for foot odor.

Looking Out For Low Thyroid

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Q. I have just begun treatment for hypothyroidism and for the first time in over 20 years I feel like I'm emerging from a fog. I was diagnosed with depression and attention deficit disorder for years. My mental clarity and concentration were terrible.

Since starting on Synthroid, I feel like a new person. My question is about my daughter. She is 17 and has some of the same symptoms. Is she too young to have her thyroid tested? I would hate for her to go through life feeling like I did.

A. Thyroid problems can run in families, so it makes sense to have her thyroid function checked. Depression has many causes and is not always recognized as a symptom of insufficient thyroid hormone.

Lack of concentration and even clumsiness can be symptoms of thyroid disorder, along with more classic symptoms such as fatigue, constipation, hair loss, weight gain and cold intolerance.

We are sending you our Guide to Thyroid Hormones, which describes symptoms of thyroid imbalance and treatment options as well as how to interpret lab results.

Can Girlfriend's Libido Be Tamed?

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Q. I read your article on suppressing sex drive in men. Are the same options effective for women?

My new girlfriend has an extremely high sex drive (yes, I am blessed), but we’d like to hold off until we know that we have a real future together. Your advice will be appreciated.

A. Many prescription drugs lower libido as a side effect. Antidepressants such as Prozac or Zoloft can do this, but such medications carry other risks.

The hormone progesterone is notorious for reducing sexual desire, but it too has numerous side effects including blood clots, breast tenderness, headaches, dizziness and depression. One alternative is chaste tree berry extract (Vitex agnus-castus). This herb has mild progesterone-like effects and is reputed to reduce libido. There is no clinical research to support this claim, however.

Keep Aspirin Away From Kids

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Q. Recently on two separate prime-time TV shows I heard the character playing the parent of a young child suggest giving the youngster a baby aspirin. It has been some time since I worked as a pediatric nurse, so maybe things have changed. We never gave aspirin to children due to its connection with Reye’s syndrome. If this has changed, please set me straight.

A. You are absolutely correct. When children or even teenagers take aspirin for chickenpox or flu, they run an increased risk of Reye’s syndrome, a rare but potentially deadly condition. Parents should not give children aspirin for fevers.

Q. I was interested in a column about a person who developed cough while taking lisinopril. I myself was put on this medicine for high blood pressure and immediately began having violent coughing spells. If they started in a meeting, I’d have to excuse myself. It became extremely embarrassing. Nothing worked, no cough syrup or cough drops.

I never got more than 30 minutes of uninterrupted sleep at a time. Sometimes the coughing was so severe it caused vomiting. My doctor put me on different medicines but never took me off lisinopril.

Then I went to a new doctor who immediately switched me from lisinopril to Benicar. The coughing stopped immediately.

A. Not everyone develops a bad cough while on an ACE inhibitor like lisinopril for high blood pressure. But you are certainly not alone.

Another reader wrote: “My doctor was pleased with the results of the ACE inhibitor, but my cough became so frequent and violent that I could not sleep for weeks. I couldn’t even lie in bed. When coughing, I would involuntarily empty my bladder, so I could barely leave the house. We eventually found another medication (Benicar) that I do not react to, and my blood pressure is even lower than when I was on the ACE inhibitor.”

We discuss the pros and cons of common blood pressure medicines in our Guide to Blood Pressure Treatment.

Q. In your column you said that warm water is no more effective than cold for removing germs. You are way off the mark.

We wash to remove germs, not kill them. Dirty hands are oily and oils are more soluble in warm water. So is soap. Warm water works faster and is more effective than cold water for rinsing off germs. Even my third-grader knows better than you.

A. Several other also readers took us to task for suggesting that warm water is no more effective than cold for removing germs. To try to get a more objective answer, we checked with Charles Gerba, PhD, Professor of Environmental Microbiology at the University of Arizona. He is one of the country’s leading researchers on germ contamination.

Dr. Gerba told us that he has “not seen studies comparing hot vs. cold water for hand washing. Warm water might be somewhat more effective, but the difference is probably so small as not to make much difference. Washing is too quick for the heating to kill much or the soap to dissolve better.”

To wash hands well, wet the hands, apply soap and rub the hands together vigorously for 15 to 20 seconds. Then rinse the lather off thoroughly.

Q. I have been battling statin side effects for years. My doctor has prescribed Lipitor, Crestor, Pravachol, Lescol and Zocor, but I cannot tolerate any of them because of muscle pain and weakness.

It is imperative for me to keep my lipids under control because of coronary artery disease. What can you tell me about niacin and other ways to control LDL cholesterol? I would also like to know how to raise HDL cholesterol.

A. Although statin-type drugs are extremely effective at lowering LDL cholesterol, many people cannot tolerate side effects such as muscle problems, nerve damage (neuropathy) or memory impairment. There are other ways to lower cholesterol, however.

Niacin can be a very effective way to lower LDL and raise HDL cholesterol. It also reduces triglycerides. A doctor must supervise niacin use, since it can cause liver toxicity as well as uncomfortable side effects (flushing and itching).

Other strategies include fish oil and the soluble fiber psyllium. Non-statin prescription drugs that can help control cholesterol include WelChol, Tricor and Zetia.

We are sending you our Guides to Heart Health and Cholesterol-Lowering Drugs with more information about niacin, fish oil and other strategies. They can be downloaded for $2 from this Website. 

Getting Enough Vitamin D?

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Q. My physician recently found that my vitamin D level is very low. I find this hard to believe since I drink nearly a gallon of milk weekly and take a multivitamin and supplement of calcium plus D each day.

I also take prednisone, tramadol, gabapentin, methotrexate and leucovorin. Could one of these drugs interfere with vitamin D absorption?

A. Many Americans have low vitamin D levels, especially in winter when they don’t get regular sun exposure. A glass or two of milk daily combined with vitamin supplementation does not always correct the imbalance for healthy people.

Your medications are likely making the situation much worse. Prednisone, gabapentin and methotrexate can all interfere with vitamin D.

You may need at least 2,000 International Units daily which is much more than you are getting from your supplements and diet. Have your doctor monitor your progress. Vitamin D is crucial for immune function, muscle strength, balance and blood pressure control as well as bone density.

Q. I had a wart surgically removed, but it came back. I then spent a nine-month period seeing a dermatologist and trying many different treatments he recommended. I had finally given up and told him I would not be returning.

Upon hearing this, he suggested I try Tagamet, the heartburn medicine. I began taking generic cimetidine (200 mg per day). The wart went away in less than two weeks and has never returned.

A. This unconventional use of the acid-suppressing drug cimetidine has been known for more than a decade. You may have been exceptionally lucky that your wart responded so well. A recent review of studies of this therapy concluded that “Current data do not support the use of H2-antagonists [cimetidine and ranitidine] for the treatment of common warts” (Annals of Pharmacotherapy, July/Aug. 2007).

Ketroprofen Gel For Joint Pain

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Q. I have a lot of swelling and pain in my joints. A cousin with arthritis recommended a compounded cream called ketoprofen gel. What can you tell me about this medicine, its side effects and interactions with other drugs?

A. Ketoprofen, like ibuprofen, is a nonsteroidal anti-inflammatory drug. You won’t find this on the shelf in a chain store, but some pharmacists can compound this topical treatment without a prescription. Putting the pain reliever right on the joint minimizes side effects such as stomach irritation or elevated blood pressure. Many people find it is helpful in reducing joint pain.

Q. I have gotten conflicting information from my doctor, a couple of pharmacists and patient information inserts about how to avoid interactions between statins and grapefruit:

Don't take the medication with grapefruit juice.

Don't have grapefruit products at the same time of day as a statin.

It’s OK to have grapefruit products after, but not before, a statin.

Don't have more than 1 quart (though one said 8 oz.) of grapefruit products a day.

Don't have any grapefruit products at all while taking statins.

This warning applies to other citrus products beside grapefruit.

I hope you can clarify this. I have been avoiding grapefruit (though not other citrus) completely, and would like to be able to eat it again if it is safe to do so.

A. Certain cholesterol-lowering drugs such as atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor) interact with compounds in grapefruit and its juice. These natural chemicals can slow the rate at which the drugs are processed by the body. This may result in a higher blood level of the drug and consequently a greater risk of side effects.

Only grapefruit and bitter orange (not regular oranges) contain the active compounds. The enzymes that are affected may show changed activity for more than 24 hours after a person drinks a glass of juice, so the idea that one could have grapefruit for breakfast and take a pill before bedtime is mistaken.

Some people are far more susceptible to this effect than others. We are sending you our Guides to Grapefruit Interactions and Cholesterol-Lowering Drugs for lots more information on the interaction and on statin drugs that are not affected by grapefruit.

Q. I want to respond to your reader who wanted to know why you would disagree with using bourbon as an effective cough suppressant for children.

When I was a child, my mother would give me a tablespoon of whiskey when I had a stomachache. Today, at the age of 42, guess what I am? Yep, an alcoholic (in recovery thank my higher power).

Was the remedy the cause of my alcoholism? I can't help but wonder. A child should never be given alcohol. Period.

A. We’ve heard from readers on both sides of this issue. One reminisced: “My grandparents used the same cough remedy in the 1930's--bourbon, honey and freshly squeezed lemon juice. I still use it.”

Pediatricians caution parents not to use cough medicines for young children (under 6) because there is no evidence that they work. That is especially true of alcohol-containing cough medicines, home-made or over the counter.

Dealing With The Quinine Ban

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Q. Do you know any doctors who will write prescriptions for quinine sulfate to prevent leg cramps? I am desperate to find one. I have taken quinine for this for 20 years with miraculous results and no problems. Now with only a two-week supply left, I’ve been told the FDA has banned it for leg cramps and my doctor will not write me a script.

Before I started taking quinine, my leg cramps were so terrible I had to call the paramedics or scream for my husband to knead them out. The next day I could not walk. That was 20 years ago. I know I could not withstand it today. It would kill me.

A. The FDA banned quinine for preventing leg cramps because the drug can cause potentially lethal reactions. It may result in heart rhythm disturbances, serious allergic reactions or a dangerous blood disorder.

We can’t steer you to a doctor who would be willing to prescribe quinine sulfate for your leg cramps, but we can make some other suggestions. Tonic water still contains quinine and some people find it is helpful for preventing leg cramps.

We have many other suggestions in our Guide to Leg Pain, including magnesium supplements, low sodium V-8 juice, pickle juice or B vitamin complex.

Dangers Of Potassium

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Q. Be careful taking over-the-counter potassium! It can build up in your body and eventually stop your heart. Consult your doctor about the proper dosage before starting. I nearly killed myself taking potassium on my own a few years ago.

A. Potassium is one of those “Goldilocks” minerals—both too little and too much can be deadly. A physician should use a blood test to monitor anyone who takes a potassium supplement, whether it is prescription or over the counter.

Washing Hands Doesn't Kill Germs

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Q. With flu season and MRSA staph infection upon us, we are urged to wash our hands frequently, usually “with warm soapy water.” My memories of Bacteriology 101 some 50 years ago aren’t crystal clear, but I can’t recall that “warm” water kills anything. Soapsuds, on the other hand, do carry nasty things away. Is there any science behind the “warm water” suggestion?

A. You are absolutely right that warm water is no more effective than cold for removing germs. Soap and water don’t kill germs but only wash them off the surface of the skin.

If we had to guess, we would venture that it is far more pleasant to stick your hands in warm water than ice-cold water. The longer you wash and rinse, the more effective the process. Sing the alphabet song as you wash to get the timing right.

As it is, few people wash their hands as often as they should (after using the bathroom, before eating, after coughing or sneezing and so on).

This is a particularly serious problem in hospitals, where it is often difficult to get health care workers of all kinds to wash hands between patients. A worker who fails to wash can take germs from one patient and give them to the next.

Annoyances Of Drug Advertising

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Q. I find many prescription drug commercials to be totally inappropriate. My kids and I are watching TV when suddenly we see a commercial for Cialis for erectile dysfunction.

I am also fed up with all these intials! ED, RLS? Who on earth ever heard of restless leg syndrome? Are they for real? What’s next--AIW for age induced wrinkles?

A. People have been complaining about restless legs for decades, but “RLS” didn’t become a familiar abbreviation until a drug was developed to treat it. We agree with you that prescription drug commercials are annoying. Only one other industrialized nation (New Zealand) permits prescription drug advertising directly to consumers.

Statins And Lou Gehrig's Disease?

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Q. My mother was on Lipitor for less than two years when she developed muscle weakness and started having trouble speaking. She was initially diagnosed with primary lateral sclerosis and told to continue on her Lipitor.

Her condition deteriorated rapidly and she ended up confined to a wheelchair and unable to speak. She passed away in July at the age of 57 from ALS, Lou Gehrig’s disease.

I truly believe this was brought on by Lipitor and was fascinated to read of a connection in your column. She was in vibrant good health until she started the Lipitor and it was the only drug she ever took.

A. We are indeed sorry to learn of your mother’s death. Scientists have not yet determined whether cholesterol-lowering drugs such as Lipitor, Crestor or Zocor can actually trigger motor neuron diseases like primary lateral sclerosis (PLS) or amyotrophic lateral sclerosis (ALS).

In a previous column, we reported that the World Health Organization drug-monitoring center had found an unexpected association between statins and ALS-like syndrome (Drug Safety, June 2007). Since that time, we have received dozens of heartbreaking stories similar to yours. Many people were diagnosed with PLS after developing severe muscle weakness or cramping on cholesterol-lowering drugs. This condition is not considered fatal but it can be incapacitating.

Others report symptoms such as stumbling, falling, slurring speech or having difficulty swallowing after taking the statin-type cholesterol-lowering medicines. In many instances, the condition was diagnosed as ALS. There is no cure for this disease that causes degeneration of muscles and nerves.

Such reactions may be reported on this website, where more details are available. We will forward case reports to researchers and the FDA for further review.

Q. I am a physician who treats many patients in chronic pain. I am convinced that generic oxycodone is only about half as effective as the brand name OxyContin. This is a huge problem for my patients. How can we get someone to investigate?

A. As a physician, you can report therapeutic failure to the FDA MedWatch program and to the generic manufacturer. Patients taking a narcotic drug of this sort are unfortunately regarded with suspicion, so your voice on your patients’ behalf is especially important.

Despite FDA reassurance about the equality of generic drugs, we have now heard from hundreds of patients who have had difficulties. For more information go to www.peoplespharmacy.com and www.ConsumerLab.com.

Q. I've just learned that many people over 50 are vitamin D deficient. My doctor called with my test results: I have about 7 percent of the recommended amount of vitamin D in my body.

I've got all the symptoms but attributed them to arthritis and age. For years I've taken a multivitamin and two calcium + 400 units of vitamin D daily, so my low levels came as a surprise. My doctor said he's begun testing all women over 50 for D deficiency. He prescribed 50,000 units of vitamin D to be taken once weekly. Is this much vitamin D dangerous?


A. If you were taking that much vitamin D daily, you might well get into the toxic range. Your doctor will be monitoring to make sure your vitamin D levels stabilize with treatment.

Research evidence is mounting that 400 international units of vitamin D daily, the currently recommended intake, is inadequate for many people. Vitamin D is essential not only for preventing rickets and building strong bones, but also for a healthy immune system that can fight off infections and cancer.
Q. I read in your column that putting petroleum jelly in the nose could cause chemical pneumonia. I have been putting Vaseline in my nose every day for years to prevent nosebleeds.

Now I'm worried. I do have a chronic cough that I always attributed to allergies.


A. Petroleum jelly is “for external use only,” according to the label. The makers of Vicks VapoRub go so far as to say, “Do not use in nostrils.”

We found one case in the medical literature of “exogenous lipoid pneumonia” caused by habitually putting petroleum jelly in the nose (Chest, March, 1994). Although this condition is considered rare, we would encourage you to stop this practice and discuss your chronic cough with a lung expert.
Q. I need information about flatulence. I am 92 years old and usually there is no odor when I pass gas. It is loud enough to be heard, though, and I cannot hold it back. This is very embarrassing! Are there any solutions? My daughter says I need a cork!

A. There are a great many medications that can contribute to flatulence. So can many foods and not just beans. The first thing to consider is whether your diet or drugs could be contributing to the problem.

Some ways to fight flatulence include fennel seed tea, Angostura bitters and herbs such as ginger or turmeric. We are sending you our newest book, Best Choices From The People’s Pharmacy, with a list of foods and medicines that can cause gas and more details on ways to overcome flatulence. Anyone who would like a copy may find it in the library, local bookstore or on this website.
Q. What kind of diet should a person adopt if they wish to avoid potassium build-up? During a recent stay in the hospital my husband’s test for potassium revealed a reading of 7. The medications enalapril and Aldactone were eliminated and amiloride was substituted.

A. Potassium levels should normally range from about 3.5 to 5. When potassium climbs above 6, life-threatening heart rhythm abnormalities can occur.

Taking blood pressure pills such as an ACE inhibitor like enalapril (Vasotec) together with the diuretic spironolactone (Aldactone) could have contributed to your husband’s dangerously high potassium levels. His potassium levels should be measured regularly because amiloride also preserves potassium.

We are sending you our Guide to Blood Pressure Treatment, which lists high potassium foods you may want to have him avoid. It also describes other ways to control blood pressure.
Q. Zoloft was prescribed for me after I complained to my gynecologist of feelings of great despair. He recommended Zoloft because he heard positive things about it for menopausal symptoms and believed there were few side effects.

Zoloft did take away my feeling of despair. It also obliterated my sense of humor and caused constant forgetfulness. After six years my husband convinced me to get off Zoloft.

I bought a pill cutter and started to reduce the dose very slowly. My brain retaliated. I became extremely dizzy, to the point of being bedridden. I thought I would not be able to withstand the withdrawal symptoms. Then I remembered having similar vertigo on a cruise ship. Although the Zoloft vertigo was much worse than sea sickness, the acupressure wristbands worked!

I'm now Zoloft-free and have discovered that caffeine contributed to my emotional ups and downs.


A. We are glad the wristbands helped conquer your dizziness. This side effect can be troublesome when people stop antidepressants like Effexor, Paxil or Zoloft. Gradual tapering of the dose may help ease other symptoms such as sweating, nausea, chills, insomnia or headache.
Q. I recently took my husband for a consultation before his colonoscopy. He wants to get the drink now to clean his colon and then take it again the day before the procedure. Is there any danger to this?

I understand he wants the doctor to get a good view of his colon and is afraid taking the drink the day before is not going to be enough. He also thinks he would possibly feel better if he took this.

A. Your husband may be watching too much cable television, where they talk about detoxification and colon cleansing. After he does this once, he may not be so enthusiastic about repeating the procedure right away. It is unlikely to make him feel better.

If your husband follows the doctor’s instructions carefully, his colon will be clean for the procedure. Side effects may include nausea, bloating, cramping and anal irritation.

Cetaphil For Head Lice

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Q. Is there a safe and easy improvement on the method of removing head lice? My wife is a kindergarten teacher and this annual ritual is wearing us both out. Her students bring lice from home, and they spread to the teachers and other students. Please help!

A. There is one novel approach that is both easy and safe. Dampen the hair, coat it with the facial cleanser Cetaphil and then use the blow-dryer. The Cetaphil hardens and forms a barrier that suffocates lice. Leave it on overnight, then shampoo it out in the morning (Pediatrics, Sept. 2004).

Q. I have had anxiety attacks several times in the past 15 years. Always before I have been given Xanax and in several days I would be okay. Then I would take the pills as needed occasionally.

Last week when I went to the doctor and told him I was having anxiety attacks again, he prescribed the blood pressure pill atenolol. Have you ever known atenolol to be given for anxiety? When I tried it I developed an upset stomach and lost my appetite.

A. Atenolol has not been approved for anxiety. Such beta blockers are primarily prescribed for blood pressure and heart problems. Doctors sometimes prescribe propranolol or atenolol for the physical symptoms associated with stage fright, but these drugs are not appropriate for general anxiety (Journal of Clinical Psychiatry, Aug. 2006 Suppl.). Alprazolam (Xanax) is approved for anxiety and short-term use is often quite effective.

Q. I have a problem with bad breath though I brush my teeth three times a day and use mouthwash. My dentist said, “It’s not your mouth, which is very clean.”

I have read that a stomach infection with H. pylori bacteria could cause bad breath. What can I do about this?

A. Bad breath may result from gum disease, but there are other causes. Many years ago we spoke with Nobel Prize laureate Barry Marshall, MD. He discovered that the bacterium Helicobacter pylori could cause stomach ulcers. He told us that these germs are behind some cases of hard-to-treat bad breath.

Over the years we have heard from readers who reported success after curing the infection: “When I read about a blood test for a germ in the stomach that causes bad breath and gastritis, I saw my doctor. He hadn’t heard of this but he gave me the blood test. It turned up positive. Now I am fine, after years of bad breath.”

Treating H. pylori requires medical supervision, so you will need to see your doctor. Multiple medications are often required to rid the stomach of this bug.

For more details about this infection and its treatment, we are sending you our Guide to Digestive Disorders.

Q. I have reached the donut hole in my Medicare Part D plan and my medications are costing me a fortune. I would like to know what online pharmacies could help me with the cost so I can afford my medications. At this point, I have had to quit taking three of my medications. Can you help me locate a reliable online pharmacy?

A. Not taking prescribed medicines could be dangerous to your health, so we suggest you discuss this problem with your doctor. Ask if your state or county provides assistance for senior citizens who can't afford their drugs.

Another possible option is to ask your doctor to help you apply for financial assistance from the drug manufacturer. You can find out more about these pharmaceutical industry programs at www.helpingpatients.org.

We are sending you our Guide to Saving Money on Medicine, which describes these and other approaches, including guidelines for buying less expensive medicines online.

Q. The story about the person who became depressed on Chantix caught my eye. My husband and I were both on Chantix to quit smoking back in June. Neither of us has a history of depression, but after he was on it he tried (with no warning) to take his own life.

I tell everyone thinking about taking Chantix to make sure they talk to the doctor about ALL of the possible side effects. In rare instances, suicidal ideation and psychotic episodes may happen. That is stated in the prescribing information, which also says that depression and anxiety are frequent side effects.

A. Chantix (varenicline) is a relatively new oral prescription medicine to help people quit smoking. Separating drug side effects from nicotine withdrawal can be tricky.

When people quit smoking it is not unusual to feel angry and irritable. Other symptoms may include anxiety, depression, impatience, and problems concentrating.

Some readers have noted similar experiences to yours, though. One person reported: "Two weeks after being on Chantix my emotions have been off the scale: from crying to yelling to feeling totally helpless. I have, twice before, quit smoking cold turkey and NEVER felt so depressed.

"After 48 hours without Chantix I am full of energy and ready to fulfill my responsibilities. I think, for me, that the depression must be a side effect and not just the nicotine withdrawal, based on my cold-turkey experiences."

Q. I was rubbing some Vicks VapoRub on my daughter and by accident I touched my nose after sneezing. A miniscule amount of it went into my nostril. Will this be harmful to me? For a few hours I could taste it even though I rinsed my mouth out immediately.

A. We have warned in the past about keeping Vicks VapoRub out of the nostrils where it could be inhaled. The petrolatum base might then accumulate in the lungs and cause inflammation called chemical pneumonitis.

This caution is directed at the practice of deliberately daubing Vicks in the nose as some people do. We doubt the miniscule amount that got into your nostril will cause you any harm.

Q. Do you have any suggestions for relieving constipation? I have tried many different things but nothing really seems to work for long.

A. For controlling constipation, the basics are fluid and fiber. If you can’t get enough fiber from your diet, you might consider a product such as Metamucil, Citrucel or Unifiber with lots of water.

Some people find that simmering two tablespoons of flax seeds in three quarts of water for a quarter of an hour makes about two quarts of solution. Two ounces a day in juice is reported to move everything along. Sugar-free gum containing mannitol or sorbitol can also be useful.

We are sending you our Guide to Constipation, with a list of high-fiber foods, and recipes for Power Pudding and Pumpkin-Bran Muffins to banish constipation.

 

Q. There seems to be conflicting information on the relationship between consuming shellfish and cholesterol. What does the latest research show? If shellfish is a high-cholesterol food, how much is too much?

A. For years dietitians counseled people to avoid foods high in cholesterol. The theory was that eating cholesterol would raise cholesterol in the blood. As a result, many avoided eggs and shellfish, even though there was little, if any, data to suggest that such foods posed a problem.

There was a flaw with this advice, however. The old tests that were used to determine that shellfish was high in cholesterol were inaccurate. Clams, lobster, mussels and crab contain relatively little cholesterol. Even shrimp is not considered worrisome any more.

Eating cholesterol-rich foods, such as eggs, does not necessarily raise cholesterol (Journal of Nutrition, Oct. 2006). In one study people ate lots of red meat and eggs with almost no starch. Their bad LDL cholesterol did not go up and their triglycerides actually came down (Mayo Clinic Proceedings, Nov. 2003).

Q. You recently wrote about using sugar for slow-healing wounds and bedsores. As a nurse, I learned years ago that the best way to use this home remedy is to make a thick paste of antibiotic ointment and sugar and pack the wound with it.

Old wives’ tale or not, it works. The antibiotic ointment helps to prevent infections.

A. We heard from other nurses and even a vet who have not forgotten this old-fashioned treatment. One wrote: “As a nursing student in 1961, I worked at a small hospital that routinely used a mixture of milk of magnesia and sugar to cure bedsores. It seemed to be successful in many cases.”

Another objected to our terminology: “Using sugar for bedsores is not a wives’ tale. I have been a registered nurse for 45 years. When I was a student, it was very common practice to use sugar packs.”

The veterinarian said: “Many wounds have been shown to heal 3 times faster with the use of sugar granules on a saline wet-to-dry bandage. The sugar helps to pull the bacteria from the wound and the saline feeds the tissue to promote rapid healing of the skin beneath.”

Q. I have had a violent cough for several months and have been treated with four different medications, a chest x-ray and blood test, all to no avail. I started taking lisinopril about the time this all began and noted that a cough was one of the side effects. When I asked my doctor, though, I was told that the drug was not the cause.

I have not been able to get restful sleep because of the constant coughing. Have you ever heard of such a reaction to this medication?

A. ACE inhibitors (benazepril, captopril, enalapril, fosinopril, lisinopril, quinapril and ramipril) are prescribed to lower blood pressure. They’re very effective and usually well tolerated.

A persistent cough that doesn’t respond to cough medicine is a common complication, however. One study from South Korea found that a daily iron supplement, ferrous sulfate, may help ease this symptom (Hypertension, Aug. 2001). If not, your doctor might consider a different blood pressure drug.

Q. Is there a solution for menopausal women who have lost their desire for sex? I am 54 and have talked to my OB/GYN about this. Over-the-counter DHEA prohormone tablets were suggested, but they didn't work.

I could go to bed every night and not even think about sex, but my 60-year-old husband could happily have sex every night. Is this the way the golden years of my life will remain?


A. There is no single solution for this very common problem, but in many cases it can be alleviated. A prescription for testosterone may be helpful if there is a deficiency. Easing vaginal dryness with a small amount of estrogen from Estring, for example, may also help.

We are sending you our Guides to Female Sexuality and Treating Sexual Dysfunction for more details on low libido.
Q. A friend who is an internist recommended a mixture of milk of magnesia (MoM) and Lotrimin AF to combat seborrheic dermatitis on my face and the backs of my ears. She suggested mixing roughly half a 12-oz bottle of MoM with a whole tube of the Lotrimin AF cream.

The first application certainly had a positive effect on my skin. I did not follow through as I should have, so I don’t know how well it works long term. Have you ever heard of this remedy?

A. We could find no research on this intriguing remedy for seborrheic dermatitis. This skin condition is characterized by itching, flaking, scales and redness. It frequently occurs on the scalp as super dandruff or even on the eyebrows, forehead, around the nose or on the chin. It appears to be an inflammatory response to yeast on the skin called Malassezia.

Dermatologists frequently treat this problem with anti-fungal creams (such as clotrimazole, the active ingredient in Lotrimin AF). Topical steroid creams such as hydrocortisone are also used. Dandruff shampoos containing ketoconazole, selenium sulfide, or zinc pyrithione can be helpful.

Readers claim that applying milk of magnesia to the armpits is a gentle and effective way to reduce sweating and odor. Perhaps the drying effect and alkalinity of MoM together with the antifungal activity of Lotrimin AF discourage Malassezia yeast.

Q. How much ibuprofen can a person take and for how long before needing to talk to a doctor? I have read that stomach upset may indicate problems. I can’t really take any NSAID or aspirin unless I eat a 'mini-meal' at the same time. Otherwise, my stomach hurts.

I was taking 1600 to 2400 mg/day of ibuprofen for weeks before surgery, and I expect to need some medicine to help with pain relief throughout my physical therapy.

As long as I eat with each dose, my stomach feels OK, but I'm trying to lose weight. I am also concerned about what the medicine could be doing to my insides. Any information you can provide on other approaches to pain relief would be greatly appreciated.

A. Ibuprofen, like all NSAIDs, can be irritating to the digestive tract. Stomach ulcers are always a risk. Other complications include high blood pressure, kidney damage, fluid retention, heart failure and toxic skin rash. The high doses you are using require medical supervision.

Topical NSAIDs may be a safer alternative. Canadian pharmacies sell Pennsaid (diclofenac and DMSO) if you have a prescription. You may also find fish oil or herbs like boswellia, ginger or turmeric beneficial.

We are sending you our Guide to Alternatives for Arthritis in which we discuss the complications of NSAIDs and options like Pennsaid and non-drug approaches.

Fighting Fear of Flying

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Q. I experience overwhelming anxiety and have problems flying and riding in elevators. This problem has gotten worse lately. My doctor prescribes an anti-anxiety drug when I occasionally fly. Is there an alternative to taking prescription drugs to get relief from the anxiety?

A. You may want to consult a therapist who uses cognitive-behavioral therapy to treat fear of flying. This approach can be very effective.

Anti-anxiety medicine can be helpful. However, if you take it on a regular basis to help you ride the elevator to your office, beware of stopping the medicine suddenly. Some people report withdrawal difficulties from medicines like Ativan (lorazepam) or Xanax (alprazolam).

Patients Pay For Doctors' Lunches

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Q. I sat in the waiting room at a local doctors’ office for hours while a relative was having tests. An amazing number of pharmaceutical reps waltzed in all day pushing dollies of samples. They waved to the front desk as they went back to restock the samples.

I also noticed a lot of food being delivered while I was there. The nurse said that pharmaceutical reps keep the staff well fed with cookies, brownies, pizza, BBQ, chicken, and the like. It seems to me there is something wrong with this picture.

A. The pharmaceutical industry spends an extraordinary amount of money promoting medications to physicians. One way to get in good with the office staff is to provide lunch. We hear that in some doctors’ offices the staff expects lunch to be provided for everyone and complains if the food doesn’t meet certain standards. These “Lunch and Learn” sessions are one way sales reps get face time with busy doctors, but the free lunches will ultimately be paid for at the pharmacy when patients pick up their prescriptions.

Treating Giardia

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Q. A friend of mine traveled in Costa Rica and now doctors think she has something called “jardia.” What can be done to cure it?

A. Giardia lamblia is a single-celled intestinal parasite that is a common hazard for travelers. Drinking untreated water from ponds, lakes, rivers or streams in the U.S. can also cause infection.

Giardia may lead to digestive distress, including diarrhea, nausea, cramps and flatulence. Doctors usually treat the infection with a prescription antimicrobial drug called metronidazole or a similar medicine called tinidazole. People taking such drugs must avoid alcohol during the five days of treatment for Giardia. Pregnant women should not take either medication.

Can Chantix Cause Depression?

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Q. I am taking Chantix to quit smoking.  I have had no urge to smoke, but I am seriously depressed.

In the past I was diagnosed with depression and anxiety. I attempted suicide 10 years ago and was hospitalized for depression.

I am concerned that my recent bout of severe depression may be a result of taking Chantix.  Has this topic been researched? I want to stop smoking but I don't want to be this depressed. I am still seeing a therapist. Should I tell him about this?

A. Chantix is a relatively new oral prescription medication to help people stop smoking. It works in a completely different way from nicotine replacement gum, lozenges and patches.

In clinical studies Chantix was somewhat more effective than another oral medication, Zyban (bupropion SR), in helping people stay off cigarettes.

The most common side effects of Chantix are nausea, headache, sleep problems and strange dreams. Although depression is not listed as a common side effect, it was frequently reported among people who participated in the clinical trials.

Please contact your therapist about your depression. Your doctor may consider whether Zyban, which also has antidepressant activity, might be more appropriate for you.

Q. My sister is highly allergic to cats. I have an indoor cat, so when my sister comes to visit she is miserable. I vacuum before and during her visit but she still suffers.

Is there anything she could take before she comes that would help make her stay more enjoyable? How can I make it more comfortable for us all?

A. This sounds counter-intuitive, but vacuuming during your sister’s visit may actually make her symptoms worse. Some vacuum cleaners actually spew small particles into the air and make the environment more allergenic.

The next time you shop for a vacuum cleaner, why not consult Consumer Reports (Oct. 2007)? The magazine’s experts chose the following upright machines as good values for picking up tiny allergy-causing particles: Kenmore (Sears) Progressive 35922, Eureka Boss Smart Vac Ultra 4870, Hoover Tempo Widepath U5140-900. In canister-style vacuums, they chose Kenmore Progressive 27514.

An over-the-counter allergy nasal spray that can be helpful is NasalCrom. If your sister starts using it a few days before her visit it may prevent some of the symptoms that make her miserable.

We discuss many other strategies against allergies in our book, Best Choices From The People’s Pharmacy. It is available from libraries, bookstores and online.

Inhalers To Rise In Cost

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Q. I'm surprised you haven’t mentioned an important issue facing asthmatics. The FDA has decided that generic albuterol inhalers should be taken off the market. The result is that these stalwarts of asthma relief will no longer be available.

Instead, the generic inhalers are being replaced by the exact same medicine with a different delivery system. That means it will cost substantially more. How could a generic magically turn into a more expensive brand name drug?

A. The FDA has determined that asthma inhalers may no longer contain CFCs (chlorofluorocarbons). These propellant gases damage ozone and the U.S. agreed years ago to eliminate them from spray cans, air conditioning units and refrigerators.

This means that lower-cost generic albuterol inhalers will disappear. People with asthma may have trouble finding such products even before the 2008 deadline.

They are being replaced by alternatives that use HFA (hydrofluoroalkane). Brand names like ProAir HFA, Proventil HFA and Ventolin HFA all contain albuterol, but they do cost more than the old generic CFC powered inhalers.

 

Q. My doctor insists I must take statins to lower my cholesterol even though I experience pain with all of them. Sometimes the pain gets so bad that I struggle not to cry when I walk down the hall of my child’s school.

My doctor says I should accept what he calls “a little discomfort” because studies show statins reduce heart disease. He gets angry if I refuse to take them.

Who is ultimately responsible for my health, me or my doctor? He says this pain is rare but I know a lot of people who have had the same severe muscle pain.

A. We too have heard from many patients who experience debilitating muscle pain as a side effect of statin-type cholesterol-lowering drugs. One reader wrote: “I have had problems with Lipitor and Vytorin. I had severe muscle and nerve pain. My doctor said he didn't believe it was from Vytorin. I stopped the medication and slowly got better. It took 7 weeks.”

Some doctors don’t believe that statins can cause side effects such as muscle or joint pain or memory problems. Others have seen so many cases they have developed different strategies for lowering cholesterol. If your doctor isn’t taking your complaint seriously, you may need to see another doctor.

We are sending you a CD of a radio interview we conducted with several physicians who have studied such issues.

Sugarless Gum May Harm Dogs

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Q. I am a veterinarian and read your advice about the benefits of using sugarless gum containing xylitol for dental health. I have seen several canine patients with toxicity from this sweetener. Your astute readers should be very cautious with its use around pets.

In dogs, xylitol can lead to a precipitous drop in blood sugar, as well as liver disease and seizures.

A. Thanks for the warning. It is important to keep candy, chewing gum and other products that may contain xylitol out of the reach of dogs. Other food items that can be toxic to dogs include avocado, chocolate, garlic, grapes, macadamia nuts, onions and raisins.

Fiber One To Fight Constipation

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Q. I've been troubled with irregularity most of my life until I discovered Fiber One cereal. I take it with me everywhere, on cruises, to Europe, even to the hospital. Fiber One bars come in handy when there's no milk supply available.

It's the only remedy that's ever worked for me. I can't stand liquid Metamucil, so I tried their capsules with no results. Benefiber also did nothing for me, so I'm a Fiber One fan forever.

A. Thanks for sharing your constipation solution.

Q. Is there a link between acid-suppressing drugs and forgetfulness? My mother has been on Tagamet, Zantac and now Prilosec for many years, and her forgetfulness seems unusual.

A. A recent study reported an association between the use of acid-suppressing drugs such as Pepcid (famotidine), Tagamet (cimetidine) and Zantac (ranitidine) and declining mental function. The subjects were older African Americans in Indianapolis (Journal of the American Geriatrics Society, Aug. 2007).

One possible explanation for such problems might be depletion of vitamin B12. This nutrient is essential for normal mental functioning. Vitamin B12 is absorbed best when there is acid in the stomach. Long-term use of acid-suppressors may make it harder to maintain adequate B12 levels.

Q. I had my thyroid removed due to cancer more than a decade ago. Since then I have been on Synthroid. The past few years I was switched to Levoxyl.

My doctor has lowered my dosage twice in the last six months. Since then I have noticed the following changes: from reduced libido to NO libido, elevated cholesterol, fatigue and brittle nails splitting down the middle. I’ve lost the outer third of my eyebrows. Is there any way to reverse these symptoms?


A. Talk with your doctor about your symptoms immediately. They suggest you may be getting too little thyroid hormone. Perhaps the dose of your medicine was lowered too much. Other readers report that when they are switched from one thyroid formulation to another the dose must be adjusted carefully.

We are sending you our Guide to Thyroid Hormones, with discussions of diagnostic difficulties and tests as well as various thyroid hormones.

 

Q. A few months ago, I sprayed insect repellent containing DEET on my legs to keep mosquitoes away. Then I lay down on the grass on my stomach to pull weeds out of my pond. Two days later the grass where my legs had been was dead. None of the other grass was.

If this product kills grass, what does it do to skin?

A. DEET was developed for the U.S. Army and has been used by the public for more than 50 years. Skin irritation has been reported as the most common side effect. There have been some reports of neurological side effects, including seizures, particularly at high concentrations.

DEET is the most effective mosquito repellent on the market. There are some effective alternatives, however. They include picaridin (Avon Skin So Soft Bug Guard, Cutter Advanced, Off Family Care Clean Feel) and oil of lemon eucalyptus (Repel Lemon Eucalyptus).

Digging Out Of The Donut Hole

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Q. I am about to fall into the Medicare Part D “donut hole” and would like to buy my drugs from Canada to save money for the remainder of this year. How do I know which online pharmacy to select?

A. Many senior citizens who signed up for the prescription drug benefit from Medicare are shocked when they hit the so-called donut hole. When drug expenses come to a total of $2400, patients must pay 100 percent of their medication bill. If drug expenses eventually exceed $5,451, Part D kicks in again with catastrophic coverage until the end of the year.

If you don’t think your drug expenses will get that high, you may want to consider purchasing your medicines from Canada. (These do not qualify to get you out of the donut hole, though.) Be sure that you are shopping from a legitimate Canadian online pharmacy. Fraudulent pharmacies may be doing business from other countries without the quality control we expect from Canada.

To help you evaluate your options we are sending you our Guide to Saving Money on Medicine with guidelines for buying medicines from Canada and pros and cons of generic drugs.

Estring For Vaginal Dryness

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Q. I am a 58 year-old woman, and I suffered from severe vaginal dryness after menopause. I have found great relief from Estring. It has stopped the everyday irritation I was experiencing.

My libido is still a problem but I find that once foreplay is underway, I am able to enjoy sex. I feel the ring has played an important part in this. Perhaps my experience will help others.

A. Estrogen has long been used to relieve menopausal symptoms such as vaginal dryness. Concerns about side effects such as blood clots or an increased risk of cancer has left many women in a quandary.

Estring is a vaginal estrogen delivery system that releases 2 mg of estradiol gradually over three months. It has been available in this country since 1996. Women whose main menopausal symptom is vaginal dryness often find Estring helpful.

Although the amount of hormone in this vaginal ring is small, it is not appropriate for women with estrogen-sensitive cancers or for those who may be pregnant.

Q. My 86-year-old father was taking Avandia for diabetes. When concerns began to appear in the news, I did my own research and asked his doctor to take him off the drug because of fluid retention.

The difference is amazing. While he was on Avandia, he had two liters of fluid removed from around his lungs twice. His pants waist size had increased several times during that time. All of the fluid is gone now that he has been off Avandia for a while.

The doctors could not determine what had caused the fluid build-up, but I was relieved that I figured it out. Avandia should be reconsidered as a treatment for diabetes.

A. The maker of Avandia warns that this drug can cause fluid retention and congestive heart failure. Patients are cautioned that swelling, rapid weight gain, breathing problems or unusual tiredness may be serious and deserve immediate medical attention. It’s a shame your father’s physicians did not identify Avandia earlier as the cause of his fluid retention.

Q. Is there anyone collecting and disseminating information on personal experiences with Achilles tendonitis caused by the antibiotic Levaquin? I have had this problem in both legs for several weeks after receiving the medication.  My doctor seems not to have heard of this complication until now.

As a consumer I have found considerable information on the Internet, but nothing regarding the time frame for relief from this painful condition.

A. Unfortunately, inflammation and in rare cases even rupture of tendons, including the Achilles tendon at the back of the ankle, are possible side effects of Levaquin and similar antibiotics. We have heard from other readers with similar problems. One person’s experience suggests the time frame for recovery may be months rather than weeks: “I took 750 mg of Levaquin for a sinus infection for 9 days. I got rid of the sinus infection but have been dealing with tendinopathy in my legs and one shoulder for the past three months.”

Lipitor May Lower Libido

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Q. What can I do about a flagging libido? I'm 66 years old and in very good health, with no bad habits. My only medication is Lipitor to lower cholesterol.

My much younger wife and I used to have a vigorous and inventive sex life, but my interest in sex has practically disappeared. The only time I get aroused is around 4 am, which is impractical to say the least. What do you suggest?

A. We suggest you talk with your physician. Lipitor (atorvastatin), Zocor (simvastatin) and other statin-type cholesterol-lowering drugs may interfere with sexual desire and performance. The authors of a Dutch study propose that lowering cholesterol with these drugs may alter testosterone production (British Journal of Clinical Pharmacology, Sept. 2004). That is because cholesterol is a building block for hormones like testosterone.

Rather than stopping the drug on your own, please get your doctor’s guidance about how to lower your cholesterol without ruining your love life. We are sending you our Guides to Sexual Dysfunction and Cholesterol Lowering Drugs. If testosterone levels are low, a prescription for testosterone may restore your lost libido.


Q. I have had pierced ears for over 25 years, yet I still can’t wear most of my earrings. After about an hour my earlobes itch and become red and swollen with certain pairs, even expensive ones.

A few weeks ago I purchased a generic form of liquid bandage for paper cuts and decided to try it on my earlobes. I applied the product to the back and front of my earlobes, let it dry, then inserted the earrings. I was able to wear them for 10 hours without itching, and when I removed them, my earlobes were not red.

I've tried this with pairs I always reacted to and gotten the same good results. The product flakes off easily after I take out the earrings.

A. Many people are sensitive to nickel, which is present in a lot of jewelry. Even expensive earrings may contain traces of nickel.

Another way to protect your ears from contact with the metal in your earrings is to coat the posts or wires with clear nail polish. This can also be done with rings.

Q. I have read about how people experience muscle pain with Zetia and statin-type cholesterol drugs. That happened to me as well.

My doctor prescribed TriCor instead and it has lowered my cholesterol and triglycerides. Maybe this will help someone else.

A. TriCor (fenofibrate) works differently from statins and Zetia. It can be an effective cholesterol-lowering drug that rarely causes muscle pain.

As with many other cholesterol medications, liver enzymes should be monitored. Gallstones are another possible complication. TriCor is pricey, though, and can cost over $100 a month.

Q. I have been using an applesauce-fiber mixture I learned about from you. It works well to combat constipation.

Now I have to go abroad for two weeks. Do you have any suggestions on how to take this mixture with me? Constipation while traveling is a big problem, starting with the long flight.

A. Dehydration is a frequent result of air travel. It complicates constipation, so make sure you get lots of liquids. Sugarless gum can also help.

The mixture of applesauce, bran and prune juice you have found helpful needs refrigeration and will be too difficult to take with you. Instead, try something like psyllium cookies (Metamucil brand for example). Magnesium supplements are also easy to carry and should help with regularity.

We are sending you our Guide with Ten Tips to Controlling Constipation. It also includes the recipes for Power Pudding made of bran, applesauce and prune juice and dynamite pumpkin-bran muffins.

Q. On my last visit to the dentist our hygienist recommended we chew gum containing xylitol. She raved about its potential to stop the formation of cavities. Is this true? Is xylitol safe?

A. Xylitol is a natural sweetener derived from birch trees and other plants. It is used in sugar-free gum and candy, especially in Europe where significant research has been conducted on its benefits. In a review published last year, dental researchers concluded that “Sufficient evidence exists to support the use of xylitol to reduce caries [cavities]” (Pediatric Dentistry, March-April 2006).

If you chew too much xylitol-containing gum, you may develop diarrhea. Other than that, xylitol appears to be safe.

Q. During sleep I am awakened five or six times a night by erections. I'm 53 years old and take Flomax, venlafaxine, fosinopril, trazodone and vitamin B12. Can any of these medications cause this problem?

A. Men frequently experience erections during rapid eye movement (REM) sleep. This is normally when dreams occur. The erections have nothing to do with the content of the dreams but are a physiological reaction to this stage of sleep.

The antidepressant trazodone (Desyrel) has been linked to prolonged painful erections (priapism). This can occur during sleep or even during the daytime.

Flomax can also trigger this reaction. Both drugs together might make matters worse. A prolonged erection can be damaging and requires medical intervention.

Q. My husband has excessive gas. We eat a very healthy diet and he drinks no soda or carbonated beverages, not even beer. He takes medicine to lower his cholesterol.

We eat lots of vegetables but we have eliminated the ones that bother him most. Milk was a real problem so now he uses lactose-free milk.

Despite these changes, he still gets gas with some foods. We cannot eliminate all fruits and vegetables. How can we deal with this to make him feel more comfortable?

A. Some medications can contribute to flatulence, including several drugs to control cholesterol. Your husband should check this out with his physician.

Taking Beano (alpha-galactosidase) with troublesome vegetables can be helpful. An adequate dose is necessary to get the benefits.

Other options include probiotics, fennel tea and Angostura bitters. We have listed common drugs that cause gas and provided details on many natural approaches for flatulence in our book, Best Choices From The People’s Pharmacy. It is available in libraries, bookstores and online (www.peoplespharmacy.com).

Q. After reading about the difficulties people have getting off certain antidepressant medications, I want to tell you about my success. I planned a weekend at home with no distractions or plans and took Dramamine all weekend to stay somewhat sedated.

By the time Monday rolled around, I was free of the sweating, the shock-like sensations in my brain and all the rest. My neurologist had told me I might just have to stay on the medication because of the withdrawal issues. Glad I didn’t!

A. Thanks for sharing your strategy. There is no data on the usefulness of Dramamine in withdrawing from an antidepressant.

For many people, a weekend is not long enough for phasing off an antidepressant like Paxil or Effexor. They may need to lower the dose gradually over weeks to reduce the risk of side effects such as electric shock-like sensations or a feeling of sloshing inside the head (also described as head-in-a-blender).
Symptoms such as nausea, sweating, shakiness, dizziness and insomnia can also be disconcerting. With careful medical supervision, however, most people can discontinue antidepressants successfully.

Q. I have been fascinated with letters from people reporting that Lipitor weakened their muscles. I believe Lipitor triggered my ALS. Until last month, my doctors wouldn’t listen to me, but then a report from the World Health Organization (WHO) showed a link. Please warn others.

A. The article authored by WHO researchers was published in Drug Safety (June 2007). It points out that an unexpectedly high number of people developed Lou Gehrig’s disease while on a statin-type cholesterol-lowering drug. Lou Gehrig’s disease is also known as amyotrophic lateral sclerosis, or ALS. There is no cure for this degenerative disease of muscles and nerves.

The connection between ALS and statins is controversial. The FDA is not convinced there is a link.
The WHO report advises doctors to discontinue statin therapy if patients develop “serious neuromuscular disease such as the ALS-like syndrome.” People who believe they have experienced such an effect may report it to us at www.peoplespharmacy.com. We will forward such cases to researchers and the FDA for further review.

Q. I have tried many statin drugs for cholesterol, but all gave me muscle pain and cramps. My doctor put me on Zetia and insists it can't cause muscle pain since it is not absorbed into the blood stream. I still have muscle pain, cramps and tingling in my legs and feet. Can Zetia cause this?

A. Although Zetia works differently from statin cholesterol-lowering drugs such as Lipitor or Zocor, it is absorbed into the bloodstream. Muscle side effects seem to be less common with Zetia than with the statin drugs, but they can happen. Ask about another approach for cholesterol control.

Q. I have been diagnosed with celiac disease.  One of the early symptoms was leg and foot cramps, often screamers, early in the morning. The tonic water was by my bed at all times, just in case, as it would provide quick relief. Mustard helps too, if nothing else is available.

I started taking extra calcium, magnesium and zinc to prevent the cramps. That helped, but it wasn't until I went on the gluten-free diet that I found reliable relief.

I was diagnosed with celiac disease by finally becoming anemic due to improper absorption of iron. The person who wrote to you about terrible leg cramps should be checked for this possibility. Celiac disease reduces normal absorption of a lot of necessary minerals.

A. Thanks for sharing your story. Doctors are discovering that celiac disease is not nearly as rare as they once thought. It occurs in almost 1 percent of the population, which means millions of people are affected.
Celiac disease is an inability to digest gluten, a protein found in barley, rye and wheat. When people with celiac disease eat foods with gluten, their bodies react and cause damage to the lining of the small intestine. This can interfere with the absorption of many crucial nutrients.

To learn more about the subtle symptoms, diagnosis and treatment of celiac disease, readers can request a CD of our radio show on the topic. It is an hour-long interview with one of the country’s leading experts.

Q. I read that Proscar and Avodart both cause impotence. My boyfriend is on Proscar and recently said he would rather have a backrub than sex! He used to worship me and now we are just pen pals. He still seems to like me but there is no sexual component.

According to his doctor, my friend has the smallest prostate he’s ever seen. Why do the doctors want to shrink it to nothing? Is it sex or death? If I had a choice like that to make, I’d go for sex. I’m only 74 and he is younger.

I have heard that it is possible for healthy people to have sex for life. Maybe some men are too embarrassed to discuss this subject with their doctor. I still think there should be a way to get around this side effect. Would it help if he didn’t take the pill for the weekend?

A. Drugs like Avodart and Proscar shrink the prostate by altering testosterone metabolism. This can lead to reduced libido and erectile dysfunction. Although impotence may be treated with medications like Viagra or Cialis, there is no approved remedy for low libido.

It is not clear that a “drug holiday” on weekends would restore his sex drive. He might ask his doctor whether a lower dose might solve the libido problem and still protect his prostate.

Q. I have battled toenail fungus off and on for the past 25 years. I have been on Lamisil three times and tried all sorts of OTC and prescription topical medicines.

I decided to try two of the remedies I read about in your articles. I apply hydrogen peroxide with a cotton ball to my toenails after I bathe daily. Then I apply VapoRub to my feet and toenails and put on socks to sleep in.

Within a month, I had no more toenail fungus. I have the most beautiful toenails I have ever had in 25 years. I also like the fact that I can polish my toenails and still use these remedies. Thank you!

A. Toenail fungus can be tough to treat. Prescription medicines like Lamisil are expensive and require medical monitoring for liver problems and other potential side effects.

Success with home remedies like the ones you are using requires patience and persistence. Not everyone will benefit, but we are pleased that the remedies are working for you.

Q. I have been on thyroid hormone replacement for more than 20 years. Now I have been diagnosed with osteoporosis.

My doctor prescribed Fosamax and then Actonel. I have heard that such drugs can cause jaw bone deterioration. This happened to a friend of mine and I am quite concerned.

What other options are available for treating osteoporosis?

A. Too much thyroid hormone can weaken bones. Although medications like Fosamax and Actonel are popular treatments for osteoporosis, they have been linked to osteonecrosis of the jaw. Jaw bone death does not seem to be common, but it is a frightening side effect and extremely difficult to treat. It appears to be triggered by dental extractions or other invasive procedures. People with known dental problems should have them taken care of before starting such medication.

There are a number of other medicines that can strengthen the bones. Ask your doctor to discuss Menostar, Evista, Miacalcin and Forteo as possible alternatives. Each of these works differently from Fosamax and all are used to treat osteoporosis.

There is lots more information about treatments for osteoporosis and hypothyroidism in our new book, Best Choices From The People’s Pharmacy. You can find it in your library, local bookstore or online (www.peoplespharmacy.com).

People with low bone density should be sure to get adequate vitamin D along with calcium and magnesium. That would be at least 1,000 IU vitamin D a day.

Q. I read your column about a person concerned about a prescription that was a couple of months past its use-by date. Whenever I receive a prescription from a pharmacy, I ask for the date on the bottle the medication was dispensed from so I can record that date on my prescription bottle and prescription documents. That way, I'm not constrained by the 1-year time frame most pharmacists put on the bottle.

I also save money because I'm not throwing away perfectly good medication and getting new prescriptions filled. I hope others find this helpful.

A. Thank you for the suggestion. If you make your request at the time you give in your prescription, the pharmacist can allow for the extra time it takes to note the manufacturer’s expiration date. In some states, pharmacists are legally required to display a one-year use-by date, but they are not forbidden to give you the additional information you request.

Q. Months ago I heard about a new prescription drug for weight loss that also lowered cholesterol and blood sugar levels. It was awaiting approval. Has it become available?

A. The drug is rimonabant. Although it is now available in Europe, a panel of experts recommended to the FDA that it not be approved due to an increased risk of depression or suicidal thoughts.

Q. I have just been through detox hell after stopping the antidepressant Cymbalta. After a week of dizziness, nausea, diarrhea, sweats, chills, itching, disorientation, mood swings and headaches, I am angry! My doctor did not tell me that this might happen.

I had been on the drug for about a year and was weaned off it by gradually dropping the dosage. I expected some emotional repercussions, but I didn’t expect to be unable to function for over a week, a prisoner in my own home.

I would have assumed I was dying of a strange flu, but I found accounts of similar withdrawal problems on the Internet. My doctor was out of town and his fill-in confirmed that these were typical symptoms of stopping Cymbalta.

I just don’t understand why I wasn't warned. Why hadn’t I had been told up front, before starting the drug, about the possibility of severe withdrawal?

Is it up to the consumer to read every line of the insert to determine the safety of a medicine before taking it?

It terrifies me to think about other patients going off this drug with no idea of what may happen to them! The withdrawal hell should be explained so the patient can know what to expect and prepare himself for the possibilities.

A. It often comes as a rude shock when patients discover that stopping antidepressant medications can cause distressing withdrawal symptoms. We have heard from folks who stopped Effexor, Paxil or Zoloft who felt disoriented and dizzy. Many report distressing shock-like sensations in their heads.

We are sending you our Guides to Antidepressant Pros and Cons and Psychological Side Effects that discuss these problems in greater detail and offer some withdrawal strategies.

 Q. I have an embarrassing question. What are your suggestions regarding penile fracture?
I admit to being too wild and crazy one night. I bent a fully erect penis about 90 degrees. It was very painful and turned purple, black and blue. It no longer hurts but has a tendency to veer to the left.

Urination and ejaculation work painlessly. Should I look into surgery or will the tissue repair itself?

A. From your description it seems as if you are suffering from Peyronie’s disease. A penile “fracture” that occurs during overly vigorous intercourse is actually a tear in the tissue. This leads to bruising which can cause scar tissue. During an erection, this fibrous area cannot expand normally which leads to the kind of curvature you have observed.

Physicians frequently recommend prompt surgical repair to reduce painful symptoms and prevent complications such as erectile dysfunction. Although Peyronie’s disease sometimes disappears all by itself, you should consult a urological surgeon for an assessment. For more details you may wish to search our Web site for Peyronie’s (www.peoplespharmacy.com).

Q. I had constipation for five years. I was using Citrucel and extra bran on my cereal. I drank lots of water but still had very hard rabbit-like stools.

At water aerobics a friend told me about taking magnesium. It has worked wonders for me.

I take 500 mg before going to bed and have a good response, usually before noon the next day. I asked my internist and cardiologist if it was safe to take and they both said no problem. The cardiologist even said it is good for the heart as well. I thought you might want to pass this along.

A. Magnesium has long been used to counter constipation. Milk of magnesia, for example, is a well-known laxative. Too much of this mineral can cause diarrhea, though. Most people tolerate 300 mg with no problems, but those with kidney problems must avoid extra magnesium.

Q. You had a letter from a woman worried about her husband’s lack of energy. He was on atenolol, Norvasc and furosemide for high blood pressure. She asked about his low potassium.

As I read her letter, I became concerned that he may have heart failure. I’ve been a cardiology nurse for 14 years. Fatigue is one of the hallmark first complaints of heart failure, which is common in people with hypertension.

Norvasc can worsen undiagnosed heart failure. I hope he will see his doctor for evaluation of his "no energy" complaint. Heart failure is the number one reason for admission into the hospital today and there are safer blood pressure medications.

A. Heart failure is extremely dangerous and is increasing at an alarming rate. Symptoms may include shortness of breath, nighttime cough, fatigue and swollen ankles.

The current controversy over the diabetes drug Avandia involves an increased risk of heart failure. Norvasc also seems to increase this risk (American Heart Journal, Jan. 2007). Atenolol can also contribute to fatigue.

Our Guide to Blood Pressure Treatment discusses the pros and cons of various types of blood pressure medication and lists high-potassium foods for those on diuretics such as furosemide or hydrochlorothiazide.

Q. I suffer from chronic leg pain. My doctors have tested me and all they can say is that it might be due to nerve damage. They suggest support hose.

I bought some medical support hose but they are very expensive. I thought I could save money with regular support pantyhose.

It feels strange to wear them but they really help my legs feel much better. Is it a problem to wear women’s pantyhose? My wife bought them for me but she worries someone might think I am gay for wearing them. Is there anything else I could use or is she worried over nothing?

A. Pantyhose don’t provide as much support as medical support hose. On the other hand, if they relieve your leg pain, we see no reason to spend money on more expensive stockings. As long as you are not parading around in shorts, you shouldn’t attract undue attention.

If you are trying to start a family, pantyhose might be troublesome. They could raise testicular temperature and reduce sperm count. If that’s not an issue, your wife can relax.

Q. My husband and I are 63. I am on nine prescriptions and my husband is on four prescriptions for his asthma. Our insurance does not cover prescriptions.

We estimate our prescription cost this year is approximately $11,000. Do you have any suggestions where we can buy our prescriptions to save money?

A. Without drug insurance or Medicare coverage you are vulnerable. You get charged full price at the pharmacy, whereas insurance companies and the government negotiate discounts.

Buying brand name prescription drugs from Canada can save you money. Be careful, though. Not all online pharmacies that claim to be Canadian are legitimate. Look for the Provincial pharmacy license number on the Web site.

Generic drugs can also result in substantial savings, but we worry about lax FDA oversight. Readers of this column have reported some problems with generic drugs.

We are sending you our Guide to Saving Money on Medicine with tips for using generic drugs safely and guidelines for buying medicines from Canada. It can  be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. When I was a child, my sister and I used to compete for first dibs on licking the bowl and beaters when Mother baked. It was a part of growing up.

Recently, I was baking with my grandchildren and asked which of them wanted to lick the bowl. Their mother, my daughter, swooped between them and me with the bowl, and said, "No! No! Don't put that in your mouth! It has raw eggs in it!" Do raw eggs--especially this minute amount--really hurt you? Or is my daughter just an especially picky mother? Why were my sister and I not damaged as kids by our bowl-licking habits?

A. You may think that your daughter is being especially picky, but she is actually following accepted recommendations for food safety. Back when you were little, nobody worried much about salmonella in raw eggs. Perhaps that was because eggs were less likely to be contaminated.

Food safety scientists might not have realized then that licking the bowl did make some children sick. It makes sense to be careful even though it means one of childhood's pleasures--licking the beaters--is taken away.

Pasteurized egg whites in liquid or powdered form are available. Your daughter shouldn’t object to the children licking the beaters if the eggs are pasteurized.

Q. I am currently taking amoxicillin for a sinus infection but my wife is allergic to penicillin. Is there any possibility that she would have a bad reaction if we had unprotected sex?

A. There are reports in the medical literature of women reacting to a medicine in their husband’s semen. The concentration is usually very low, but for sensitive people, even a little exposure can be risky. Over 20 years ago we heard from a reader who reported the following reaction:

"I know this sounds bizarre, but I’m convinced I have been reacting to the penicillin my husband has been taking for a strep throat. When I was 10 I had an allergic reaction to penicillin. Last week I experienced hives and wheezing soon after we made love.”

Men may also react to medicines their wives are taking. It would be prudent to use a condom.

Q. The expiration date on all my medicine is one year after the prescription is filled. Does this mean the Percocet I have on hand for a bad back becomes toxic after that time or is it just ineffective?

A. If your pain medicine is only a few months out of date it is unlikely to be ineffective or toxic. The one-year discard date is for the convenience of the pharmacist and does not necessarily reflect the manufacturer’s actual expiration date.

Q. A few weeks ago I could not get out of my chair to go to bed. I was telling my body "stand up" but my back and legs just wouldn’t respond.

I eventually managed to lever myself up with my arms but I had considerable difficulty getting to bed. This was odd because I am in pretty good physical shape.

About a week before this event I had bought two gallons of grapefruit juice because it was on sale and had been consuming quite a large quantity daily. I have been on Lipitor for about 18 months. Could my back pain and muscle weakness be explained by Lipitor plus grapefruit juice?

A. Grapefruit interacts with dozens of drugs, raising blood levels. This may increase the risk of side effects.
Cholesterol-lowering drugs like atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor) are all affected by grapefruit. Since muscle weakness and pain are possible side effects, it is conceivable that your experience was triggered by a grapefruit interaction that resulted in an overdose. Other drugs that are affected by grapefruit include some anti-seizure medicine, estrogen hormones, heart and blood pressure pills and sleeping pills.

We discuss this issue in far greater depth in our Guides to Grapefruit Interactions and Cholesterol Lowering Drugs. They can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. I’ve been using Rogaine (minoxidil) for more than 12 years to slow hair loss. I started taking the oral medicine Proscar when I heard that this drug could also help grow hair. (Proscar was cheaper and stronger than Propecia.)

It worked well to give me denser hair, even better than Rogaine, but it had negative side effects. The climax during intercourse was less than climactic.

To get around this, I tried splitting the 5 mg Proscar tablets into five chunks of 1 mg each. That’s hard, so I ground up five 5 mg tablets and put them into a one-month supply of Rogaine liquid. I mixed the drugs together and put the solution on my scalp. It works like a charm and I have no more sexual side effects.

I tried not using the Proscar and my hair began falling out again immediately, so the mixture is better than Rogaine alone. I warm the solution before I put it on my scalp and it soaks in quickly. I’ve checked the bottle at the end of the month and there’s not a speck of residue.

A. Finasteride is the active ingredient in both Proscar (for prostate enlargement) and Propecia (for male pattern baldness). It blocks the conversion of testosterone to dihydrotestosterone (DHT), which causes both problems.

Oral finasteride has been linked to sexual side effects. Your experiment may have sidestepped this problem. We could find no scientific study of this combination.

One caution: finasteride in any form must be kept away from pregnant women. DHT is essential for a male fetus to develop masculine characteristics.

Q. Does aspartame affect bleeding if you are taking a blood thinner like Coumadin? I know that cranberry juice poses a potential problem with this drug. How can I keep up with Coumadin interactions?

A. Coumadin (warfarin) is a life-saving drug but it can be tricky to use. This medicine reduces the risk of blood clots that can lead to strokes or heart attacks. Getting the dose right, however, poses a significant challenge. Too much or too little drug can be dangerous.

Many foods and other medications can interact with Coumadin. When a person taking Coumadin drinks a lot of cranberry juice, the risk of dangerous bleeding may rise. Several cases have been reported, but scientists are still debating the clinical significance of the interaction.

Aspartame (Equal, Nutrasweet) is an artificial sweetener that may increase bleeding time (Clinical Pharmacology and Therapeutics, Feb. and May, 1998). Although this interaction is controversial, we would encourage anyone consuming aspartame and taking Coumadin to monitor the impact on bleeding very carefully.

Sorting out all the dangerous food and drug combinations with warfarin is complicated. Our free Guide to Coumadin Interactions is available at www.peoplespharmacy.com.

Q. I have taken Lipitor for several years. I’ve begun to notice numbness in my feet along with sporadic memory loss and difficulty balancing my checkbook and using the computer. I have a PhD, so this is alarming.

My doctor says Lipitor is not to blame. He says that my cholesterol is great (below 160) and not to stop. Is there any evidence that Lipitor could be connected to symptoms like depressed mood and trouble with balance or memory?

A. Statin-type cholesterol-lowering drugs like Crestor, Lipitor or Zocor reduce the risk of heart disease. Most people tolerate these drugs quite well, but some develop debilitating muscle pain. Others report mood, memory or nerve (neuropathy) problems.

Many doctors don’t believe that statins can cause such side effects. Others, however, have seen too many cases to disregard. We are sending you a CD of a radio interview we conducted with several physicians who have studied such issues. To order a CD of this one-hour conversation on “The Dark Side of Statins,” please send $16 to: People’s Pharmacy (CD-523), P. O. Box 52027, Durham, NC 27717-2027. It is also available at www.peoplespharmacy.com. Look for radio show No. 523.

Q. I 
have read that aluminum seems to be associated with Alzheimer’s 
disease. Could the aluminum in antiperspirants increase the risk? What else can you use to reduce underarm sweating and odor?

A. The aluminum-Alzheimer’s connection has been debated for decades. Although there is no definitive proof, scientists have linked elevated levels of aluminum to the development of dementia (Journal of Alzheimer’s Disease, May, 2007).

It is not clear whether enough aluminum is absorbed from antiperspirants to pose a problem. There are options without aluminum, however. Some readers find that milk of magnesia applied to the underarm makes a safe and effective deodorant.

One person reports: “I am allergic to every kind of antiperspirant and commercial deodorant. I heard about milk of magnesia and have been using it very successfully for about six years. There is no smell or residue on clothing.”

Q. Since quinine sulfate is no longer available for leg cramps, I wonder if there is any danger in drinking "tonic water" just for the flavor. Quinine is an ingredient, I believe.

A. Although the FDA has banned the use of prescription quinine pills to treat leg cramps, the agency has not proposed eliminating tonic water from the market. If it did, a lot of people who enjoy gin and tonic might revolt.

Readers aware of the quinine in tonic water have put it to use: “I have been drinking tonic water with quinine for about two months now, and my leg and foot cramps have disappeared completely.”

FDA banned quinine from use against leg cramps because sensitive people may develop a potentially deadly blood disorder in reaction to quinine. Although this complication is rare, it is extremely serious. One reader reported being hospitalized after drinking a 5-ounce glass of tonic water. She developed a terrible skin reaction and her blood platelets plummeted. She was told that in her case even a drop could be lethal.

Q. My husband takes Coreg, Lanoxin, amiodarone, Lasix, metolazone, Lipitor, aspirin, Uroxatral, Renagel, potassium and insulin. He also gets a shot of Procrit weekly for severe anemia caused by kidney problems.

He takes so many pills it gets very confusing. Even though he uses a pill container to help him keep things straight, I discovered amiodarone in with his Lasix, so he was taking double doses of this heart medicine some days. If he thinks he forgot a pill, he takes an extra. Does he really need all this medicine?

A. Only your husband’s doctors can determine if there are medications he may not need. He does need someone to review all his drugs, however. We have detected a number of potentially dangerous interactions among the drugs on this long list.

We are sending you our Guide to Drugs and Older People with a Drug Safety Questionnaire to help his doctors and pharmacist evaluate his medications. It can be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. I recently read that some sunscreens contain hormones that might affect young children. I am an avid user of sunscreen. I’m concerned about any adverse effects on my children, especially my 9-year-old daughter.

What specific ingredient should I be avoiding? When I called the company they said they never heard of hormones in sunscreen. I do not want hormones absorbing through my skin or especially the skin of my 9 year old.

A. As far as we can tell there are no hormones added to sunscreens. There are, however, chemicals in some sunscreens that may have estrogenic activity, particularly when they are combined (Toxicology and Applied Pharmacology, Nov. 2006).

No one knows if this poses a risk for you or your children. If you wish to avoid such compounds in sunscreen, look for brands that contain physical blockers such as zinc oxide or titanium dioxide. According to research published in The Lancet (online May 3, 2007), such ingredients are safe for children and highly effective at preventing sun damage from both UVA and UVB radiation.

Q. I have had great trouble stopping the antidepressant Effexor. I tapered off this medicine as instructed, but I still have a feeling like electrical shocks going through my brain.

Getting off this drug has been a nightmare. If for some reason a person had to stop suddenly, he might go crazy with the withdrawal. Before stopping, I forgot to take my medicine with me on a short trip and the symptoms were excruciating!

A. Many readers report difficulty stopping antidepressants like Effexor or Paxil suddenly. The electric shock sensation is a common symptom. Discontinuing such drugs requires medical supervision.

Q. I have suffered with constipation for more than a year and have had little success finding relief. Someone suggested that I eat an entire red pepper daily. This certainly does not appeal to me, but I am feeling desperate and would try it if you say it would help. I take Bentyl, digoxin, Norpace, Tegretol, Coumadin and prochlorperazine. Is there any way to alleviate this problem?


A. Some of the medicines you are taking could be contributing to your constipation woes. Although your doctor may not be able to substitute alternatives, you should discuss this problem with her before trying to counteract this drug-induced complication.


It is unlikely that a red pepper would solve your constipation problems. Chewing sugarless gum may help. You might also try “Power Pudding.” Mix 1 cup coarse bran, 1 cup applesauce and 3/4 cup prune juice. Take one or two tablespoons daily with plenty of water. Refrigerate the remainder. Do not take this within two hours of digoxin, however, since the extra fiber could interfere with proper absorption of your heart medicine.


For more details about this special remedy, our dynamite pumpkin bran muffin recipe, 10 tips to combat constipation and a list of drugs that can cause it we are sending you our Guide to Constipation. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped, self-addressed envelope: Graedons' People's Pharmacy, No. GG-30, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. Some time ago I read in your column about someone who had success removing skin tags with a liquid bandage. I would appreciate hearing about this remedy.


I have several of these growths around my neck where the chain of my necklace rests. I have been considering having them removed by a dermatologist, but would like to try this remedy first.


A. We have heard from many readers who tell us New-Skin Liquid Bandage works: “I used it twice a day for three days and the skin tags came off!” Others tell us it may take a few weeks.


Another approach some readers have tried involves a wart remedy: “I found Compound W works just as well for getting rid of skin tags.”


There is also an old-fashioned approach to skin tag removal: “I had a rather large one on the side of my neck. My dermatologist said to just ignore it. Soon after, I mentioned to a friend (an orthopedic doctor) how much I hated it, and he promptly tied and knotted a piece of thread around it and cut the ends off real close. You couldn't even see it. He said that would shut off the blood supply to the tag and it would fall off very quickly. It was gone in three days.”

Q. You have written about allergies but I think you may have missed the next great allergy drug. I was having problems last winter and tried Claritin, Allegra and Zyrtec in succession, but all had lost their effectiveness.

The nurse practitioner had noticed that the specialists were prescribing Astelin nasal spray (nasal antihistamine) and it was working like magic. She wrote me a prescription and I had it filled. It works instantly and lasts all day. The only drawback is that it makes me sneeze once or twice when I first spray it. It doesn’t make me sleepy or dopey, which is good since we all have to stay sharp at our jobs.

A. We’re delighted you’ve had such good results. Astelin nasal spray is a topical antihistamine, but not everyone benefits as much as you. It is normally used twice daily and is about as effective as oral antihistamines.

Side effects of Astelin may include a bitter taste in the mouth, drowsiness, headache, nasal burning, sneezing, sore throat, dry mouth and fatigue. A one-ounce bottle can cost as much as $90.

Q. I was diagnosed with chronic fatigue syndrome and fibromyalgia. I was taking Synthroid for an underactive thyroid, but I just didn't feel well. I found a doctor who prescribed Armour Thyroid instead and now I feel great!

A. An underactive thyroid can result in debilitating fatigue until the problem is corrected. Inadequate levels of thyroid hormone can also cause a curious collection of other symptoms, including common ones like weakness and constipation and odd ones like carpal tunnel syndrome, clumsiness or depression.

For most people, the proper dose of Synthroid can correct the deficit and eliminate symptoms. But some people do better with Armour Thyroid, an extract of pig thyroid. Synthroid, Levoxyl, Levothroid and Unithroid all contain levothyroxine or T4. But thyroid glands actually make T3 as well as T4, and Armour contains both.

You can learn more about this issue as well as interpreting thyroid tests and symptoms of thyroid problems in our Guide to Thyroid Hormones. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (58 cents), self-addressed envelope: Graedons' People's Pharmacy, No. T-4, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. My 5-year-old granddaughter sucks her thumb.  Is there something that tastes bitter or unpleasant I can buy to put on her thumb to remind her to not suck it?


A. Most children give up on thumb sucking before they are 5. The American Dental Association says that thumb sucking does not cause problems until after this age.

You may be more successful distracting her with activities that require two hands. If your granddaughter wants to stop sucking her thumb, painting something yucky on it may help remind her to stop. Some parents have used pickle juice or vinegar.

Others use commercial products. Thum contains cayenne pepper extract and citric acid. Control-It has denatonium. These preparations taste bad and remind the child not to suck. Search online or ask your pharmacist to order one. There is also a Lycra glove-like device that covers the thumb. It is called Thumbusters.

Nagging is counterproductive. Most children will stop when they experience peer pressure.

Q. My wife suffers from debilitating leg cramps. For years she has relied on quinine. It works like a charm and she has never experienced any side effects.

She has just discovered that she can no longer get her prescription filled at the pharmacy and is feeling desperate. We’ve heard that quinine is available in Canada and only costs about $35 for 100 pills. How can we locate a reliable Canadian pharmacy?

A. The FDA has made it almost impossible to get quinine for leg cramps. Although many people have used quinine safely for years, others are so vulnerable to its toxic effects that the FDA has determined the drug is too dangerous except to treat malaria.

Although quinine is still available in Canada with a doctor’s prescription, you could run afoul of U.S. Customs and the FDA. We have prepared a Guide to Saving Money on Medicine that discusses Canadian online drugstores, but your wife may want to consider non-drug approaches listed in our Guide to Leg Pain. To order both, please send $4 to in check or money order with a long (no. 10) stamped (58 cents), self-addressed envelope: Graedons' People's Pharmacy, No. RLCA-59, P. O. Box 52027, Durham, NC 27717-2027. They can also be purchased from our Web site at www.peoplespharmacy.com.

Q. I have discovered another use for Listerine. For the last year I have had problems with whitehead blemishes on my face that wouldn't go away. I tried many things, including non-oily soaps and a range of topical treatments.

One day a couple of weeks ago I started putting Citrus Listerine on each blemish at night. About a week later, one blemish started breaking down and others began to do so in the next few days. They are all smaller and several have completely disappeared!

A. Blemishes have a tendency to come and go. Hormones, stress and possibly even diet may have an impact. Citrus Listerine contains components of orange, tangerine, lemon and grapefruit in addition to eucalyptol, menthol, methyl salicylate, thymol and alcohol. Your positive response may be coincidental, or you may have found a new use for Listerine.

Q. I am a breast cancer survivor. I play tennis and golf five days a week and smear a high SPF sunscreen all over my body. I also wear protective clothing to block the sun.

I have heard that some sunscreens may have estrogenic activity. I’m supposed to avoid estrogen, so I wonder if you can tell me more about sunscreens and estrogen.

A. Several common ingredients in sunscreens have been shown to act like estrogen. One test-tube study showed that breast cancer cells grew faster in the presence of such compounds.

Another study showed that sunscreen ingredients are absorbed through the skin and can be measured in the urine (Journal of Investigative Dermatology, July 2004). The significance of this finding for adults remains controversial, but the authors warn that young children may be vulnerable to hormonal disruption from such sunscreens.

Until this issue has been resolved it might be prudent to stick with protective clothing. (Check www.sundayafternoons.com or www.coolibar.com.) Sunscreens that contain physical blockers such as zinc oxide or titanium dioxide don’t have hormonal effects and are safe for young children and people with sensitive skin (The Lancet online, May 3, 2007).

Q. My blood pressure is slightly elevated. I take a water pill to control it, and my doctor suggested that I restrict salt.

My adult-ed science teacher claims that only half the adult population is sensitive to salt so that it makes their blood pressure rise.

I went on an extremely salt-restricted diet for a month and had no change in my blood pressure. My doctor now says I can eat normally.

Please tell people that they should run this experiment themselves before spending the rest of their lives hunting for low-salt foods. Life is complicated on a restricted diet, and it would be a shame to do this if it isn’t needed.

A. The link between salt (sodium chloride) and high blood pressure has been controversial for decades. Studies suggest that cutting back on salt can lower blood pressure modestly. A carefully run, long-term trial found that substantial sodium reduction only lowers blood pressure two or thee points (Journal of Human Hypertension, Jan. 2005).

Some people are especially salt sensitive and benefit from a sodium-restricted diet. Others, like you, don’t see any improvement.

A comprehensive new study in the British Medical Journal (April 28, 2007) found that sodium restriction led to a 25 percent decline in heart attacks and strokes. Even though cutting back on salt may not make a big difference for everyone, it clearly can help some people delay death from cardiovascular disease.


 

Q. Both my niece and I have to take anti-seizure medications. Are there any food interactions with Dilantin, Mysoline or Tegretol?

A. This is a crucial question that is often overlooked. Many drugs are affected by food. In some instances, food interferes with proper absorption. For example, yogurt, milk or even calcium supplements can prevent the absorption of certain antibiotics and thyroid hormone. Fiber (bran or psyllium) may reduce absorption of the heart medicine Lanoxin (digoxin).

The anti-seizure medicines you mention are best taken with food to maximize effectiveness. Avoid grapefruit, however, as it can raise blood levels of Tegretol (carbamazepine) and increase the risk of side effects.

We are sending you our Guides to Food, Drug and Grapefruit Interactions for more information about these issues.

Q. I heard that people on acid-reflux drugs like Prilosec may need extra vitamin B12. How much vitamin B12 do you need when taking Prilosec on a daily basis? Some days I take two pills of Prilosec if my acid reflux is acting up.

A. Acid-suppressing drugs (Aciphex, Nexium, Prilosec, Protonix) can make it much harder to absorb vitamin B12 from food. This can eventually lead to a deficiency of this crucial nutrient. Symptoms may be subtle and include loss of appetite, constipation, depressed mood, confusion and weakness in arms and legs.
People who take these strong acid-blocking drugs for four years or more should have their vitamin B12 levels monitored. If your doctor finds that your B12 level is low and your homocysteine and methylmalonic acid levels are high, an oral supplement of 1000 micrograms (1 mg) of vitamin B12 daily may correct the problem.

Q. Recently while shopping for two different OTC products for two very different health issues, I discovered to my surprise that they contained exactly the same active ingredient.

Benadryl has 25 mg diphenhydramine.

Nytol and Sominex also have 25 mg diphenhydramine.

The Benadryl package describes this ingredient as an antihistamine. Nytol and Sominex both say it is a nighttime sleep aid.

The generic antihistamine costs about half as much as branded sleep aids. I'm pretty sure diphenhydramine is also the same ingredient in Tylenol PM and similar products, which can be even more expensive. It does pay (or in this case save) to read the labels.

A. It certainly does. The exact amount you can save may vary from one store to the next, but the house-brand generic diphenhydramine is much less expensive than brands that contain it. We found one house brand antihistamine for about 3 cents per pill. A brand name sleeping pill containing the same ingredient cost as much as 22 cents per pill.

Because this antihistamine can also be used as a sleeping pill, it should not be taken before driving, operating machinery or doing other tasks that require alertness.

 

Q. I suffered for years with stomach ulcers. On three occasions I had to be hospitalized because they turned into bleeding ulcers.

Once I was diagnosed with a Helicobacter pylori infection, I was treated with a combination of antibiotics and Pepto-Bismol for a month. This treatment worked for me and I haven’t had any stomach problems since.

I would love to write to the doctors who made the discovery about H. pylori causing ulcers to thank them. If you have their names and addresses please let me know.

A. Dr. Barry Marshall and his colleague, pathologist Dr. J. Robin Warren, received the 2005 Nobel Prize for their discovery that a bacterium (Helicobacter pylori) causes stomach ulcers. The recognition that an infection could cause gastritis and ulcers was an enormous change from earlier theories, which blamed stress and spicy foods.

We are delighted that you got such benefit by treating the infection. You can email your thanks to Dr. Marshall (bmarshall@hpylori.com.au) in Western Australia.

H. pylori infection is associated with a higher risk of stomach cancer. People who would like to know more about treating digestive symptoms and ulcers caused by H. pylori may find our Guide to Digestive Disorders helpful.

Q. My granddaughter is 10 years old and she still wears diapers to bed every night. Can you give me some advice on how we can get her up to go to the bathroom? I remember years ago discussion of an electrical device that sounded an alarm to wake the child. Do they still exist? Is this a good idea?

A. If there is no underlying medical problem, a bedwetting alarm is a good treatment. At first the alarm may wake everyone in the house except the sleeping bed-wetter. Waking the child and getting her to the bathroom to finish urinating should address the problem within a month or two. Devices such as SleepDry or Wet-Stop2 cost $50 to $75.
Q. I take 600 mg to 1200 mg of Motrin every day for headaches. My doctor wants me to take aspirin for my heart. Is there a conflict?

A. The ibuprofen (Motrin) you take may counteract the heart protecting power of aspirin. What’s more, so much ibuprofen can create a vicious headache cycle. Please discuss this with a headache specialist.

Q. I read about the person who ate ice all the time. I too ate ice excessively. When I started taking an iron tablet every day, the craving stopped.

Eating ice can totally ruin your teeth. Several months after I quit eating ice I had two caps come loose. Now I have five teeth that require major dental work and a bridge because of crunching ice.

A. Thanks for the word of warning. We suggest anyone with strange cravings, whether for ice, laundry starch or even popcorn, should be tested for iron or zinc deficiency. Correcting the deficiency may ease the craving.

Q. I am a 35-year-old woman who lives a very active and busy life. I work three jobs and have a family with three teenage boys.

The problem is that within the last two years my sexual drive has dwindled down to NOTHING. I love my man and I used to love having sex at least twice a week. Now it's maybe once or twice a month.

My husband has never once complained to me about it. He too says he has noticed a drop in our sex life but when we do make love our time together is most wonderful and breathtaking.

I’ve been on Wellbutrin XL for two years now for stress and anxiety. I’ve also been taking Adipex (phentermine) to lose weight. It has helped me lose 40 pounds. (I exercise and eat right, too.) So why hasn't my sex drive increased? I wish I could get my libido back.

A. It is possible that your weight loss drug could have affected your sex drive. Changes in libido are reported with phentermine.

We are sending you our Guides to Female Sexuality and Treating Sexual Dysfunction with information about testosterone and other approaches to increasing desire.

Sexual interest may be one of the first casualties of overwork. You and your husband may need to talk about this issue and see if there is some way to carve out a little time to relax together.

Q. A lot of press attention has been given recently to the benefits of dark chocolate for lowering blood pressure. A banner at the bottom of the television screen said that eating chocolate is as good as some blood pressure medicines.

However, in the studies from which this conclusion was drawn, the average systolic pressure was only lowered 5 points and the diastolic pressure by about 3 points.

While this is in the right direction, these numbers are hardly anything to get excited about. Why are people so enthusiastic about such limited results?

A. No one is suggesting that people eat chocolate instead of taking blood pressure medicine. You might be surprised to learn, however, that even standard blood pressure pills don’t lower blood pressure much more. A study in the Journal of the American Medical Association (Nov. 10, 2004) found the popular medications Norvasc (amlopidine) and Vasotec (enalapril) lowered systolic pressure by 5 points and diastolic by about 2.5 points.

 

Q. I try to limit my family's salt intake because high blood pressure runs in my husband's family. I found "Morton's Lite Salt" at the store. The package claims it has "half the sodium of table salt...can be used in all your recipes just like regular salt with the same great results.  It cooks the same, bakes the same..." All of that sounds perfect.

But it also says "For normal healthy people. Not to be used by persons on sodium or potassium restricted diets unless approved by a physician."

I'm a little confused. If we only use this when we would've used salt anyway, is it safe for my family? What if I'm making something for guests and I don't know the medical status of everyone who might consume some?

A. You have found a reasonable way to cut back on sodium when cooking for your family without giving up the taste of salt entirely. Guests who must restrict their intake of sodium more completely should be polite enough to tell you that before they arrive for dinner.

Q. I have taken Wellbutrin XL for two years and it has taken care of my depression beautifully. In January my insurance company switched me to the generic called Budeprion XL. I didn’t think twice about it. I just assumed it was as good as Wellbutrin XL.

After a few months thinking I was losing my mind and that Wellbutrin just wasn't working anymore, it finally dawned on me that I was no longer taking WELLBUTRIN! (I honestly hadn’t even thought about the generic.)

I have been very depressed, crying and irritable with no energy or ambition. While I am not suicidal, it sure doesn’t sound like a bad plan most days. I will stop Budeprion XL immediately even though I will have to pay full price for Wellbutrin XL.

A. More than a dozen people have contacted us regarding experiences strikingly similar to yours. Some of them reported nausea or dizziness as side effects of Budeprion XL; all of them said their symptoms of depression had returned.

We have no scientific evidence that there is a difference between the brand name and the generic. Nevertheless, so many reports convince us that there should be an investigation.

We have arranged with the FDA to analyze any generic pills that readers of The People’s Pharmacy suspect are not equivalent to their branded counterparts. Please describe your experience and send your generic pills with as much information as possible: Name of medication, name of generic drug maker, lot number and date dispensed. (Data may be available from the pharmacy.) Send the parcel to Graedons’ People’s Pharmacy; PO Box 52027; Durham, NC 27717-2027.

Q. I have been taking Ambien for about six months. It really helps me get a decent night’s sleep but now I have heartburn.

Can Ambien cause reflux? I hate to take Nexium to counteract indigestion that might be caused by Ambien.

A. Ambien (zolpidem) can cause indigestion or reflux. Here is another reader’s experience: “Ambien gave me a great night's sleep after years of wakefulness. The cost was disabling digestive problems: bloating, pain and acid reflux.

“After a year of pain, more than $20,000 in uncomfortable testing and drugs for reflux, I took myself off Ambien. Two doctors had insisted that my digestive woes were not related to Ambien but after three nights of sleeplessness, the digestive problems went away.”


Q. I have been taking Ambien for about six months. It really helps me get a decent night’s sleep but now I have heartburn.

Can Ambien cause reflux? I hate to take Nexium to counteract indigestion that might be caused by Ambien.

A. Ambien (zolpidem) can cause indigestion or reflux. Here is another reader’s experience: “Ambien gave me a great night's sleep after years of wakefulness. The cost was disabling digestive problems: bloating, pain and acid reflux.

“After a year of pain, more than $20,000 in uncomfortable testing and drugs for reflux, I took myself off Ambien. Two doctors had insisted that my digestive woes were not related to Ambien but after three nights of sleeplessness, the digestive problems went away.”

Q. I have taken Wellbutrin XL for two years and it has taken care of my depression beautifully. In January my insurance company switched me to the generic called Budeprion XL. I didn’t think twice about it. I just assumed it was as good as Wellbutrin XL.

After a few months thinking I was losing my mind and that Wellbutrin just wasn't working anymore, it finally dawned on me that I was no longer taking WELLBUTRIN! (I honestly hadn’t even thought about the generic.)

I have been very depressed, crying and irritable with no energy or ambition. While I am not suicidal, it sure doesn’t sound like a bad plan most days. I will stop Budeprion XL immediately even though I will have to pay full price for Wellbutrin XL.

A. More than a dozen people have contacted us regarding experiences strikingly similar to yours. Some of them reported nausea or dizziness as side effects of Budeprion XL; all of them said their symptoms of depression had returned.

We have no scientific evidence that there is a difference between the brand name and the generic. Nevertheless, so many reports convince us that there should be an investigation.

We have arranged with the FDA to analyze any generic pills that readers of The People’s Pharmacy suspect are not equivalent to their branded counterparts. Please describe your experience and send your generic pills with as much information as possible: Name of medication, name of generic drug maker, lot number and date dispensed. (Data may be available from the pharmacy.) Send the parcel to Graedons’ People’s Pharmacy; PO Box 52027; Durham, NC 27717-2027.

Q. My doctor said that I should be taking an aspirin every day, but my pharmacist said that aspirin doesn’t protect women the way it does men. Who’s right and what’s the best dose?


A. A new study of almost 80,000 women who were followed for more than 20 years suggests that women do indeed benefit from aspirin (Archives of Internal Medicine, March 26, 2007). The nurses who participated had a lower likelihood of dying of a heart attack if they took aspirin regularly for at least five years. After ten years, they were also less likely to develop cancer.


Doses ranged anywhere from one to 14 standard aspirin tablets a week. Some experts have suggested that the optimal dose to protect against heart attacks is around 160 mg daily—half a regular tablet. No one should take aspirin daily without medical supervision, since it can damage the digestive tract and interact with other medications.

 



Q. I was diagnosed with “depression” and for several years I took a series of different antidepressant drugs. The results were unsatisfactory and I experienced many unpleasant side effects.

Then one year I was hospitalized for an unrelated medical problem. During the tests I was found to be suffering from severe hypothyroidism. I needed Synthroid, not Zoloft!

If any of your readers are being treated for depression and have not had a complete physical exam and a thyroid test, they should ask for this immediately.

A. People with underactive thyroid glands may experience a range of symptoms, including depression, apathy and fatigue as well as weakness, anemia, high cholesterol or mental slowness. Treating such symptoms with an antidepressant instead of thyroid hormone could be counterproductive. Certain antidepressants (particularly lithium, but drugs such as Paxil or Zoloft in rare cases) have been associated with thyroid imbalances.

For more information on testing, interactions and therapy we offer our Guide to Thyroid Hormones. We also discuss psychological issues related to hypothyroidism and creative treatment approaches in an hour-long radio interview with thyroid experts Mary Shomon and Ken Blanchard, MD.

Q. My mother was admitted to the hospital a few weeks ago for dehydration, acute bronchitis and pneumonia. During the admission, they checked her blood level of Coumadin and discovered it was about ten times higher than normal.


The doctors in the emergency room were shocked, as were Mom and I! The doctor said that had Mom fallen, she could have bled to death in a couple of minutes. The ambulance would never have arrived in time.


My mother was taking Cymbalta as well as Coumadin. The doctor who prescribed this new antidepressant for my mother didn't know about this interaction. It is NOT listed in the prescribing information. Please warn others of this drug interaction, as it may save someone's life.


A. Taking the wrong combination of medicines can be lethal. Thank you for alerting us to the potential danger of mixing the blood thinner Coumadin (warfarin) with the antidepressant Cymbalta.

 

Q. I have a comment regarding the lady whose sex drive doesn't match her husband's. Perhaps a better balance in household duties would create a better balance in their sex drives.

She is exhausted from working all week and doing all the cooking, cleaning, and childcare on the weekends. No wonder she doesn't have the energy! Grandpa needs to take a few things off her to-do list if he wants to have himself put on there! Maybe his energy level would match hers a little better that way too.

A. You weren’t the only one to react to the letter from the woman who felt overwhelmed by her husband’s sex drive. Here is another reader’s perspective:

"I read with interest the letter from the woman who wrote about her husband’s high sex drive and her low one. Maybe her sex drive would improve if she came home from work, put her feet up and perhaps took a bath while her husband did the laundry and cooked dinner and then cleaned up the kitchen. But by then her husband would be asleep.

“She should get a checkup as you suggested, but I think the woman is just exhausted. When you are exhausted, the last thing you want is sex.”

Q. My husband is taking a lot of medicines, including Lipitor and niacin for cholesterol control, atenolol for high blood pressure, prednisone for pain and Zoloft for depression.

He is having memory problems as well as a lot of muscle weakness, pain and lack of energy. His balance is not good and his doctor has diagnosed peripheral neuropathy. Could any of these problems be side effects from his medicine?

A. We cannot diagnose your husband’s difficulties. Nevertheless, we have heard from hundreds of readers that statin-type cholesterol-lowering drugs may cause memory loss as well as muscle pain and weakness. Depression and nerve problems like peripheral neuropathy might also be drug related.

We discuss these issues in far greater detail and offer some alternative treatments in our new book, Best Choices From The People’s Pharmacy (Rodale). Information is available at www.peoplespharmacy.com or at your local public library.

The combination of niacin and a statin-type drug such as Lipitor may increase the risk of a serious reaction called rhabdomyolysis. Your husband’s doctor should be informed of his symptoms. Your husband should also ask his doctor about atenolol; its effectiveness as a blood pressure-lowering drug is controversial and it may sometimes cause fatigue and depression.

Q. I am tired of people writing about Ambien and its supposed bad effects. I have been taking this sleeping pill for a long time and I think it is wonderful. When taken properly it should cause no side effects. Not only is it relaxing, it does not produce morning hangovers. I think it is the best sleeping pill I have ever taken.

A. Many people use Ambien with no serious side effects. Like you, they get a great night’s sleep and feel refreshed in the morning.

There are others, however, who have experienced disturbing reactions such as sleepwalking, sleep eating or sleep driving. That is why the FDA has issued a new warning for Ambien and other sleeping pills. Since it is impossible to predict who will experience trouble, everyone needs to be alert for strange behavior.

Q. Why don't they take Ambien off the market? I spoke to a friend who drove 20 miles at 7:30 in the morning and doesn't remember a thing that happened. Another driver saw him weaving around on the road, tried to block him and then called 911.

Fortunately my friend wasn't killed and didn't kill anyone else. Needless to say, he was terrified when he “came to.”

The thing that bothers me is that not one doctor at the hospital asked him if he had taken Ambien.  They did many tests and sent him home saying he had global amnesia (whatever that is).

I'm no doctor, but the first thing I asked him was had he taken Ambien. The answer was "Yes." He just found out about the new warnings that are going to be on the bottle.

A. We have heard from others who have also reported “sleep driving” while under the influence of Ambien. This has finally gotten the attention of the FDA. The agency will require new warnings on prescription sleeping pills like Ambien, Lunesta, Restoril and Rozerem.

According to the FDA, “Sleep driving is defined as driving while not fully awake after ingestion of a sedative-hypnotic product, with no memory of the event.” Many people can take such sleeping pills safely, so the FDA does not plan to ban these drugs. Nevertheless, it is hard to predict who will experience this unusual but scary side effect.

Q. After months of nausea, my mom was diagnosed with a Helicobacter pylori intestinal infection.  She has completed the two-week antibiotic course and is still sick. She had such hope that this would be her cure.  How long does it take to recover from H. pylori?

A. Helicobacter pylori is a bacterium that invades the stomach lining and causes gastritis and ulcers. Symptoms can include nausea, vomiting, bloating, abdominal pain about an hour after eating or at night and bad breath.

Experts aren’t completely sure how people “catch” this infection and curing it can be tricky. Untreated, this infection may increase the risk of certain cancers.

This bug has become resistant to some antibiotics. That is why many doctors treat it with multiple medications and bismuth (Pepto Bismol). For more information on this infection and various treatment options we are sending you our Guide to Digestive Disorders. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. G-3, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. Thank you for telling a reader who wrote about eating ice chips excessively to see a doctor. I also was eating ice but no one detected my problem until it was almost too late. Yes, I was anemic--due to colon cancer which had metastasized to my liver. It has been 19 years and I consider myself very lucky.

A. People who are anemic may develop cravings for ice or even certain foods. We have heard from readers who consumed huge quantities of radishes, carrots, tomatoes, popcorn or orange peels and were later diagnosed with an iron or zinc deficiency. Thanks for sharing your story. It demonstrates how important it is to get to the bottom of such cravings.

Q. I just had to put in my two cents on dry cracked hands. My father and I used to compare how many bandages we would be wearing each week because our hands were in such bad shape.

I finally found something that worked: Surgeon’s Skin Secret. It contains beeswax, lanolin and mineral oil. It lasts a long time. I have had my jar for three years. Since beehives have been found that are 100 years old, I don’t worry about it going rancid.

Please let your readers know about this product. Working in the post office as I do dries skin out even more from the paper. This is great for mail carriers!

A. We found Surgeon’s Skin Secret on the Web at www.jamarklabs.com. According to the manufacturer, it was developed by a plastic surgeon in 1950. Some people are allergic to lanolin, so caution is appropriate.
This moisturizer is not inexpensive (about $29 for 16 oz). More economical alternatives include “barnyard beauty aids” like Bag Balm (www.bagbalm.com) or Udder Cream (www.uddercream.com), which costs about $6 for 12 oz.

Q. Some people have written you to complain that their generic drugs are less effective. That is my experience with generic Prilosec. With my last refill, the sticker said I had saved $169.99. Because I paid $10 for the 60 tablets, I guess they were worth $179.99.

When I found out they didn’t help at all, I bought some OTC Prilosec, at a cost of $24.99 for 42 tablets. The generic tablets were supposedly worth $3 each, though they did nothing, while the OTC pills at $.60 each worked just fine.

My esophagus has been damaged by acid reflux, so I pay attention to heartburn symptoms. I shudder to think what might have happened to a cancer or heart patient who got this generic omeprazole.

A. We have heard from others that generic Prilosec (omeprazole) does not always work as well as the brand name acid suppressor. Despite FDA reassurance that generics are just as good as innovator drugs, many readers of this column have a different perspective. Anyone who wishes to report a problem with generic medicine may do so at our Web site (www.peoplespharmacy.com).

Q. I love grapefruit and have used it to help lower cholesterol, curb my appetite and lose weight. My pharmacist says I must not eat grapefruit while I am taking lovastatin (a generic for Mevacor). Would it be safe if I eat my grapefruit at breakfast and take my pill in the evening?

Would there be a problem with grapefruit if I were to switch to red yeast rice? I have heard that this natural product has fewer side effects and can help lower cholesterol almost as well as lovastatin.

A. Red yeast rice contains lovastatin and other statin-type compounds. We assume that grapefruit might increase these blood levels and therefore raise the risk of side effects such as muscle pain and weakness.
Grapefruit affects dozens of other drugs as well. They include some blood pressure pills, epilepsy medicine, sleeping pills, heart medicine and estrogen. The grapefruit impact can last up to 48 hours.

We are sending you our Guides To Grapefruit Interactions and Cholesterol-Lowering Drugs with answers to frequently asked grapefruit questions. Anyone who would like copies, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. JL-97, P. O. Box 52027, Durham, NC 27717-2027.

Q. I have read about various constipation treatments in your column. I have a different and more enjoyable solution--ice cream with sorbitol (the non-sugar sweetener). It has been working for me for years.

A. Non-sugar sweeteners like sorbitol are not absorbed from the digestive tract and have a laxative effect. Whether found in sugarless gum, candy or ice cream, they can all help relieve constipation. Too much, though, may cause diarrhea.

Is Lip Balm Addicting?

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Q. My lips are constantly dry, so I use ChapStick repeatedly. The relief is short lived, though. I seem to be addicted to ChapStick. Is there a safe alternative?

A. Most dermatologists deny that lip balms such as ChapStick pose problems. They suggest that people continue to use lip moisturizers because moist lips feel better. They often blame dry lips on repeated licking.
Some consumers insist, however, that this is a real addiction. There is even a Web site called Lip Balm Anonymous devoted to the controversy.

To cut back on lip licking you might try a moisturizer that tastes bad to you, such as castor oil.
We heard from a woman who found that a lanolin-containing product for breast-feeding mothers works as an alternative: “I started to use it on my lips instead of ChapStick and I have not had dry lips since. A little goes a long way, as it is very thick and does not wear away easily.”

Q. I read about the woman whose mother was diagnosed with dementia while taking Darvocet. My mother was also given Darvocet while hospitalized. Overnight she became disoriented and suffered hallucinations.

The doctors claimed this was because she was depressed, but after three days they took her off the medicine. Almost overnight she was back to her normal lucid self.

A. Propoxyphene is an ingredient in both Darvon and Darvocet. Some people are very sensitive to potential side effects such as hallucinations, dizziness, confusion and drowsiness. Older people are especially susceptible and doctors have been advised to use other pain relievers for them.

Q. I have been taking Effexor for depression for nearly a year. I have noticed that if I miss a day or two, I feel extremely unwell both mentally and physically. It makes me a little worried to think I am so dependent on this prescription.

I have expressed these concerns to my doctor and she basically says I am "married" to this drug because of my chemical imbalance. Should I worry about becoming dependent?

A. Effexor can be an effective antidepressant, but stopping it suddenly (even for just a day) can trigger uncomfortable withdrawal symptoms. Others have reported dizziness, nausea, sweating, chills or anxiety if they stop an antidepressant abruptly.

We discuss the these problems in greater depth in our Guides to Psychological Side Effects and Antidepressant Pros and Cons. Anyone who would like copies, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. MX-23, P. O. Box 52027, Durham, NC 27717-2027.

There is no reason to worry about continuing on an antidepressant that is working. If you have to stop, however, you will need to do this very gradually under medical supervision.

Q. Can eating ice, literally all day long, be harmful to my health? A couple of months ago I suddenly developed an intense craving for ice and now I start eating crushed ice first thing in the morning and do not stop until bedtime. What could have caused this?

A. Check with your doctor and ask to be tested for anemia. Sometimes a deficiency of iron or zinc will lead to a strong craving for ice or other unusual items that aren’t normally in your diet. Correcting the deficiency may banish the craving.

Q. If you are going to zap your kitchen sponges in the microwave to disinfect them, make sure they are wet. If one puts in dry sponges, they could start a fire.

A. Even a wet sponge may not be safe in the microwave. One reader reported: “I just wanted to let you know that we microwaved our WET sponge this morning and it caught on fire. Now our house smells and we're not sure about the microwave. It was pretty scary AND annoying at 6:30 in the morning!”

Another reader added, “I am surprised you advocate disinfecting sponges in the microwave. I read about this in a cooking magazine and tried it, placing my DAMP sponge in the microwave for two minutes on Christmas day, 2005. We then left the house. Upon our return, we noticed a burning smell the minute we walked in the door.  The sponge had ignited, ruining the microwave. We now disinfect our sponges by boiling them in water on the stove.”

Q. This is surely not one of the more important or serious questions you may be asked, but will you PLEASE offer some remedies to help fade spots (age or liver spots) on the hands and elsewhere on the body? I have been told that these are from too much sun years ago. I do hope that something can be done since they continue to get worse.

A. Age or “liver” spots are officially called “solar lentigines.” These brownish spots frequently show up on the face and other places where people have been exposed to excess sunshine.


Dermatologists have traditionally recommended fade creams that contain hydroquinone (found in products like Esoterica and Porcelana). It is highly controversial, however. The FDA is threatening to ban hydroquinone because of animal studies suggesting it may have cancer causing properties. The European Union has already banned hydroquinone from cosmetics.


Many dermatologists maintain that in the low concentrations found in over-the-counter products, hydroquinonone poses no risks. Nevertheless, you may want to consider other options. One is the prescription acne or anti-wrinkle cream tretinoin (Avita, Retin-A, Renova) applied once daily for six months. Dermatologists can also eliminate age spots by freezing them with liquid nitrogen or by using a laser or intense pulsed light (IPL) therapy.


Whatever you do to eliminate age spots, reduce sun exposure from now on. Use a UVA and UVB sunblock that contains zinc and titanium to prevent recurrences.


Q. My father-in-law has completely cut out all green leafy vegetables because he is taking the blood thinner Coumadin (warfarin). Must he really eliminate all these healthy vegetables?


A. Anyone taking Coumadin must be extremely careful about interactions with food and other medicines. Green leafy vegetables contain vitamin K which can counteract the effectiveness of the blood thinner. That doesn’t always require total elimination of such healthy foods. As long as your father-in-law keeps his vitamin K intake constant the doctor can adjust the dose of warfarin accordingly.


We are sending you our Guides to Food, Drug and Coumadin Interactions for more details about vitamin K levels in foods and dangerous drug combinations. Anyone who would like copies, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. FD-195, P. O. Box 52027, Durham, NC 27717-2027.

Q. I recently had dinner at a friend’s home. After dinner, my friend put the dishes on the floor for the dog to lick. Needless to say, I was horrified.

Not only was this dog licking his own back end, he was licking the cats' back ends.
My friend does not have a dishwasher and washes dishes by hand. Now I do not want to eat there again unless I bring my own dishes.

Can humans get germs from dogs this way? (I have a suppressed immune system.)
How would you handle this situation and still keep your friend?

A. Dogs can harbor germs like Bordetella bronchiseptica (kennel cough), which pose a risk for anyone with a suppressed immune system. Other bacteria that can be carried by cats and dogs include Pasteurella multocida, which can trigger a sinus infection.

Invite your friend to your house or to a restaurant. If you must explain, tell her that you are more vulnerable to infections than most people. Ask if you could bring paper plates for your next visit to make cleanup easier and safer.

Q. I use Transderm-Scop patch for motion sickness, but after a couple of hours it starts to itch.  I take it off, but it takes a week or so for the itch to wear off. It works better than Dramamine or wristbands, but I hate the itch!

A pharmacist told me there was a spray. Do you know anything about it?

A. The ingredient in Transderm Scop (scopolamine) has been used for decades to ease symptoms of motion sickness. The patch containing this drug is placed behind the ear and releases the medicine into the bloodstream over three days.

Since you appear to be allergic to the adhesive patch, you may want to try another form of scopolamine. Your doctor could prescribe this drug as pills. Side effects may include blurred vision, dry mouth, difficulty urinating and drowsiness. We could not find scopolamine as a spray in the U.S., though it has been tested in clinical trials.

Q. My mother is 79. Several weeks ago, she came down with the flu. A doctor in the practice put her on erythromycin, but she got worse instead of better.

She landed in the hospital for six nights. I stayed with her the whole time. They gave her Darvocet, and she became very disoriented.

When I took her to see her regular doctor, he was astonished and diagnosed her with dementia. I was startled, as before this episode my mother was doing very well.

The doctor has started her on Namenda and Lexapro. Any information you can share with me will be greatly appreciated.

A. If your mother had the flu (a viral infection), erythromycin would have been ineffective. This antibiotic can sometimes cause disorientation or hearing loss in older people. Experts in geriatric medicine consider Darvocet (propoxyphene) inappropriate. It too could contribute to confusion.

We list many medications that cause problems for the elderly and we discuss drug-induced forgetfulness in our Guide to Drugs and Older People. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. O-85, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Please discuss your mother’s situation with a geriatric specialist. Adjusting her meds might help. Namenda is for dementia and Lexapro is an antidepressant.

Q. My question is about ED. My wife really turns me on, but I always lose my erections.


When I lose it, I have trouble getting another one. Often we do not finish because of my problem and I get frustrated. She has a strong sex drive and gets frustrated, too. At times I give her excuses, like I’m tired or I don’t feel well. She thinks I do not want to be with her, but I do. I’m just afraid of failing.


My wife would never cheat on me but I don’t want to frustrate her more so she considers it. Is there anything over the counter that would help?


A. You and 18 million other American men suffer from erectile dysfunction (ED). It is nothing to be ashamed of.


There are several medications that can help, but none are available without a prescription. When you see your doctor, make sure he checks your hormone and cholesterol levels. Sometimes ED can be a symptom of cardiovascular problems.


Drugs like Viagra, Cialis or Levitra may help but are by no means the only solution. Your physician may prescribe another kind of medicine or even suggest a vacuum device that may help you maintain your erection.


A qualified sex therapist can also provide you and your wife with useful advice. Open communication will help her better understand what you are going through.


Q. Your column about quinine really upset me. I have been taking it for leg cramps for many years and it has helped me incredibly. I have none of the symptoms you described.


My doctor keeps renewing my prescription. I can’t believe she would keep doing that if what you wrote is true. I am very skeptical about your information.


A. The FDA has decided that quinine is too dangerous to be used against leg cramps. Some people are susceptible to a life-threatening blood disorder triggered by quinine. As a result, soon doctors will only be allowed to prescribe it for malaria.


For the vast numbers of people like you who have taken quinine safely, the FDA’s action will be painful. One reader suggested an alternative:


“At one time I used Legatrin, but it is no longer available. Now when I get leg cramps, I drink a small bottle of tonic water. Within a minute the cramps subside.”


We are sending you our Guide to Leg Pain with other suggestions against cramps and restless legs. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. RLS-5, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.


Q. I have been taking Zetia for four months with dramatic results. My cholesterol count went from 240 down to 183.


I am thrilled, but I have noticed pain in my legs. It is difficult to sleep as I massage them to make them feel better. The soreness and tiredness remind me of pain after strenuous exercise like running.


I would not agree to take statin drugs to correct my high LDL and low HDL levels because I know statin drugs can cause leg pain. Isn’t Zetia different?


A. Zetia (ezetimibe) works differently from statin drugs such as Lipitor or Zocor. Instead of blocking the creation of cholesterol, Zetia interferes with absorption of cholesterol from the intestines. Despite this difference, people taking Zetia sometimes report muscle or joint pain. Please let your doctor know about this reaction.

Q. You invited readers who have had trouble with Ambien to write. I had two incidents in 2003 when I drove in my sleep while taking Ambien. Once, I bought a pack of cigarettes while I was out. I did not realize this until I saw them on the kitchen counter the following morning.

In October of 2005 I went on a cruise. I took Ambien to get some sleep, but my roommate reported that I got up in the middle of the night and started walking around. Someone found me and took me to the doctor’s office on board. I slept there all night and remember waking up in a fog. The doctor was sitting in a chair with a notebook, looking after me. I have not taken another Ambien, because I am afraid of what I might do.


A. We keep hearing from people who sleep walk or even sleep drive while taking Ambien. Although this appears to be a rare side effect, it is disconcerting and potentially dangerous.


Q. I have been treated for hypothyroidism for years and I can always tell if I have an imbalance. My hair starts falling out more rapidly than it should and my nails start splitting. Why is this?


A. The thyroid gland produces hormones that control every cell in the body. This includes the tissues responsible for hair and nails. Perhaps that is why low thyroid activity can result in hair loss and brittle nails.

Other signs of hypothyroidism include dry skin, constipation, fatigue, weakness, puffy eyes, reduced libido and elevated cholesterol. An unusual symptom is loss of the outer third of the eyebrow.

We are sending you our Guide to Thyroid Hormones with more information about symptoms, diagnosis and treatment of both under- and overactive thyroid. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. T-4, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. Following my doctor's suggestion, I have been taking magnesium for osteoporosis. I also have rheumatoid arthritis and fibromyalgia. I don't know if it will help my osteoporosis, but my fibromyalgia is much better. I sleep better at night and my appetite is improved.

What bothers me is the loose stool. Is it all right to take one pill (400 mg) every other day?

A. Magnesium can cause diarrhea, especially when the dose gets to 300 mg or more per day. Why not try a dose of 200 or 250 mg daily, and see if you tolerate that?

Q. My neighbor is about 30 years old. She weighs about 98 pounds soaking wet and is less than 5 feet tall.

I am early 50s, 6 feet tall and over 220 pounds. I have significantly more body muscle and (sadly) more body fat. So how can a dosage of a medicine like aspirin or cold medicine be "for adults?"


A. Your point is well taken. Drug dosing (prescription as well as OTC) should be individualized. Offering a single adult dose for everyone would be like trying to get everyone into a size 10 shoe. Sadly, the FDA has not required non-prescription drugs to have more detailed weight-based dosing instructions.

Q. I love to eat hard-boiled eggs, but do not like the yolk. Do I get any type of benefit just eating the white of the egg? The dog gets the yolk!

A. Egg white provides high-quality, low-fat protein. Your dog is getting all the cholesterol, but also the other nutrients such as lutein found in egg yolks.

Lowering Caffeine in Tea

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Q. I've heard that steeping tea for 30 seconds and then pouring off the water and steeping the bag again in new water dramatically reduces the amount of caffeine in the tea. I'm wondering if this is correct. I love tea, but too much caffeine triggers my acid reflux.

A. Much of the caffeine in tea is released within the first half-minute of steeping. Your technique won’t decaffeinate your tea completely, but it should help considerably. It might bring the caffeine level down enough so that tea no longer gives you terrible heartburn.

Q. What is considered LOW when it comes to cholesterol? My levels were always low but now they are back down to 120, just like they were in my mid-twenties. I am almost 49. The highest it has been is 142.

I am very forgetful, especially now with customer’s names. I don’t sleep well and have never been a great communicator because I have trouble remembering all the Movement Disordefacts and have trouble finding the right words (usually technical or specific ones like the name of a place). Is this related to my cholesterol?

A. Many doctors believe that cholesterol can never be too low. New research throws that concept into question.

The importance of cholesterol in neurological conditions like Alzheimer’s or Parkinson’s disease is controversial. A recent study in the Archives of Neurology (Jan. 2007) concluded that, “A decline in serum total cholesterol levels may be associated with early stages in the development of dementia.” Another study (Movement Disorders, Dec. 18, 2006) has linked low LDL cholesterol with a higher occurrence of Parkinson’s disease.

You may want to discuss your lab results with your doctor in light of the new research. We can’t say whether your memory problems are related to your low cholesterol, but we can’t rule it out either.

Q. Is it possible that iron tablets can cause constipation? I have been taking iron to prevent restless legs syndrome and wonder if this supplement could be causing a new issue: constipation.

A. Many medicines cause constipation including antidepressants, blood pressure pills and pain relievers. Iron and calcium supplements are notorious for this problem.

Chewing sugarless gum daily may be enough to solve the problem. Blackstrap molasses dissolved in hot water supplies iron and may ease constipation as well.

We are sending you our Guide to Constipation with Ten Tips to Combat Constipation plus recipes for power pudding and dynamite pumpkin-bran muffins. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. GG-30, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. Are you aware of any side effects after long-term use (10 years) of Prozac? Do the benefits of Prozac decrease over time?

A. Some psychiatrists refer to the diminished effectiveness of Prozac after long-term use as “Prozac poop-out.” If this has happened to you, ask your doctor about other ways to deal with depression.

Canadian researchers recently found that long-term use of antidepressants such as Prozac, Paxil or Zoloft is associated with a higher risk of bone fractures in older people (Archives of Internal Medicine, Jan. 22, 2007).

Q. I know that eating grapefruit can interfere with how the body metabolizes certain medications, so people taking certain drugs should not eat grapefruit. I am wondering whether the tangelo, a cross between a grapefruit and an orange, would have the same effect?

A. One study showed that tangelos don’t contain enough of the compound that causes the grapefruit effect to pose a problem (Journal of Food Science, Aug. 2005).

Q. As a physician I want to offer my perspective on the "sticker shock" problem in the pharmacy. I am very conscious of the fact that my patients may not be able to afford medications I prescribe.

Almost all medications have alternatives, and I wish I knew which would be cheapest when I am writing the prescription. Patients with drug coverage could save a lot of time and money if they brought the list of drugs covered by their insurance to every doctor visit.

I also want to know how much patients pay for drugs. I wish they would call the office if the prescription is too expensive! Most of the time, I’d be able to identify a cheaper alternative to prescribe.

A. We appreciate your thoughtful approach. A recent study showed that many doctors don’t discuss the cost of prescriptions with their patients (American Journal of Managed Care, Nov. 2006). If more patients brought their insurance company’s drug list to their office visits, it would facilitate these discussions.

Q. I am a 65-year-old female and just got back my cholesterol test results: total 235, HDL 109, LDL 118, triglycerides 39. I believe some of the results are good, but I'm concerned about the cholesterol and LDL numbers. Among other supplements I take glucosamine and chondroitin for my stiff joints. I read these may elevate cholesterol. Is that true? How can I get these numbers down?

A. Unless you already have heart disease or other risk factors such as smoking, diabetes, high blood pressure or a family history of heart problems, you may not need to worry about your cholesterol reading. Your ratio of total to good HDL cholesterol is excellent. That may be a better indicator of risk than total cholesterol.

We are sending you our Guide to Cholesterol and Heart Health, so you can learn about interpreting the test results and what steps you can take to maintain good heart health. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. C-8, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Many readers have reported that their cholesterol went up while they were taking glucosamine and chondroitin and went down after they stopped the supplements. There are no studies that indicate these supplements raise cholesterol levels, however.

Q. I read your column about reflux medication and hip fractures. I take three Tums a day and am symptom free with this dosage. Are antacids as likely to affect bones as more powerful acid suppressing drugs such as Aciphex and Prilosec?

A. In the study that raised this concern, less potent acid suppressors like Tagamet or Zantac were not associated with an increase in hip fractures. Antacids like Tums provide calcium and are more likely to be good for bones than to cause problems.

Q. I recently heard that the FDA will no longer allow quinine sulfate to be used for treating leg cramps. My internist prescribes quinine sulfate for me. I use the drug only when I go on 90-mile bike rides. If I do not take quinine, I get leg cramps when I am riding and later that night when I am sleeping.

I have found that if I take three 260 mg tablets the leg cramps do not occur. I take one tablet the night before the ride, one tablet the morning before the ride and one tablet after the ride. This a total of 780 mg of quinine sulfate in a 24-hour period. My internist says this is the maximum amount.

Quinine sulfate is the only thing that prevents these cramps. If this drug is unavailable and I cannot figure out some other remedy, I will have to curtail my cycling.

I understand tonic water also has quinine in it, but I don’t know how much. Is it realistic to expect to get 780 mg of quinine from drinking tonic water?

A. The FDA has virtually banned quinine as a treatment for leg cramps. Serious side effects such as headache, nausea, diarrhea, rash, ringing in the ears, liver damage, irregular heartbeats, birth defects and a life-threatening blood disorder convinced the agency that this drug is too dangerous to use for leg cramps.

Tonic water is flavored with quinine, but the amount varies from brand to brand. Some may contain as much as 80 mg per quart. Even then, you would need nearly ten quarts to get 780 mg. That much tonic water would be hazardous to your health.

In the absence of quinine, our Guide to Leg Pain offers many home remedies for cramps. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. RLS-5, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. I read your column about the problem the man has with his blood pressure pills and his sex life. My cardiologist prescribed Altace and that did the trick.

A. Altace (ramipril) is an ACE inhibitor. Such blood pressure medicines are less likely than many others to cause sexual dysfunction, but not all patients can tolerate these drugs. Thanks for sharing your experience.

Q. My husband is 55 years old, 6 feet tall and 180 pounds. He has been on Lipitor for two years.

His LDL is still above 210. He hasn’t changed his diet of bacon cheeseburgers, steak, French fries, cookies and ice cream, however. He also has two or three drinks a day because he read that this might help lower cholesterol.

I understand that alcohol should be limited for someone who is taking Lipitor, but his physician has mentioned neither diet nor alcohol.

Can you give him some advice as to a healthy diet and recommended alcohol intake?

A. Lipitor is a powerful cholesterol-lowering drug but is no substitute for a sensible diet. The manufacturer clearly states that Lipitor is to be used in addition to a low-fat diet, exactly the opposite of your husband’s eating habits.

As for alcohol and Lipitor, the prescribing information warns: “Atorvastatin should be used with caution in patients who consume substantial quantities of alcohol.” Three drinks daily could be considered “substantial quantities.” The combination could increase the risk of liver damage.

Q. I saw part of a news story on TV that said people who take Nexium (and similar drugs) for a year or more are at greater risk of bone density loss and have more bone fractures.

I have been taking Nexium for almost a year and a half. I have had a knee replacement and a total hip replacement. I did not get the details of who did the study and how. I want to ask my gastroenterologist if I can stop taking Nexium, but I would like to be able to give him some details. Can you supply them?

A. The research was published in the Journal of the American Medical Association (Dec. 27, 2006). The scientists compared more than 13,000 cases of hip fracture to some 135,000 matched control patients in the United Kingdom.

They found that long-term use of drugs such as Aciphex (rabeprazole), Nexium (esomeprazole) or Prilosec (omeprazole) for more than a year increased the likelihood of hip fracture by more than 40 percent. Patients on high-dose heartburn medication were more than twice as likely to break a hip as those not taking such drugs. The investigators hypothesize that reducing stomach acid decreases calcium absorption and increases bone loss.

We understand that having had your surgical joint replacements increases your concern about the strength of your bones. There is no association that we know of between the PPI medicines such as Prilosec and the need for a replacement.

Q. I am a 40-year-old male taking Toprol XL for high blood pressure and Crestor for high cholesterol. Prior to starting on Toprol, I suffered from frequent debilitating and nauseating migraines for 10 years. I noticed that after starting Toprol the frequency of my migraines decreased dramatically. Could the Toprol be responsible for this life saving benefit?

A. Indeed it could. Toprol (metoprolol) is a beta-blocker. This type of medicine is often used to treat heart problems or high blood pressure. It is also prescribed to prevent migraine headaches.

Q. My father is on Coumadin and Plavix to keep blood clots from causing a heart attack. His family doctor prescribed Relafen for arthritis pain but it led to intestinal bleeding. Then she switched him to another pain reliever called Mobic.

Now he is in the hospital with severe rectal bleeding. What can he take for his joint pain that will not put him at risk of a bleeding ulcer?

A. The official prescribing information for Plavix warns that combining this drug with the anticoagulant warfarin (Coumadin) requires caution due to an increased risk of hemorrhage. Doctors are also warned that combining NSAID pain relievers (such as ibuprofen, naproxen, Mobic, Relafen, etc) with Plavix or warfarin can lead to a bleeding ulcer.

Patients with arthritis are caught in a dilemma. The very drugs they need to ease their aching joints may trigger life-threatening reactions like the one your father experienced. We discuss these issues and offer safer options in our Guide to Alternatives for Arthritis. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. AA-2, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

A topical pain reliever might be an option. NSAID gels or lotions such as Pennsaid (diclofenac), Feldene (piroxicam) and Nurofen (ibuprofen) can relieve symptoms without intestinal irritation. Such products are not available in the U.S. but with a prescription from his doctor, your father could import one from another country.

Q. My husband had stents put in his arteries three years ago. At his periodic check-ups, he gets a good report.

Ever since getting them, he has been taking blood pressure medicine. On this medicine he has lost all interest in sex and has no sexual desire.

I read that there is a blood pressure drug that does not have this effect, but his doctor says there is not. He prescribed Viagra, but it did nothing for my husband’s desire. This problem is ruining my marriage.

Is there really a blood pressure medicine that does not reduce libido? If so, what is it called?

A. Many medications can affect sexual interest, satisfaction or performance. Because this is such a personal issue, people are often reluctant to discuss it with their physicians. A urologist or a physician with a special interest in sexuality may be able to advise your husband on the most appropriate blood pressure medication.

To help with this conversation we are sending you our Guides to Drugs That Affect Sexuality, Treating Sexual Dysfunction and Blood Pressure Treatment. Anyone who would like these Guides may send $4 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. YPB-967, P. O. Box 52027, Durham, NC 27717-2027.

Some physicians report that ACE inhibitors (such as enalapril or lisinopril) or ARBs (such as losartan or valsartan) may be less likely to affect sexual function (Drugs, Vol. 65, #6, 2005). Your husband should also have his testosterone levels checked.

Q. I have seen full-page ads for Fosamax Plus D in my local newspaper. Why is Merck spending so much money advertising this osteoporosis drug? Could it be that the company is worried people will quit this medicine after learning that the benefits persist even after stopping it?

I was also intrigued to read that acid-suppressing drugs like Nexium and Prilosec may be linked to hip fractures. Drugs like Fosamax can cause symptoms of heartburn, for which people would take acid suppressors. Could this create a vicious cycle?

A. Two articles in the Journal of the American Medical Association (Dec. 27, 2006) reinforce your perspective. In one study, women who discontinued alendronate (Fosamax) after five years lost some bone density but were no more likely to suffer broken vertebrae than women who stayed on the drug for a decade.

The other article suggests that people who take strong acid-suppressing drugs for more than a year are at increased risk for hip fracture. You are right that drugs for osteoporosis (Actonel, Boniva, Fosamax) can cause symptoms of heartburn, which could easily lead to a prescription for drugs like Aciphex, Nexium, Prilosec or Protonix.

Q. I thought my serious leg cramps were just old age creeping up on me. I handled them with additional calcium and magnesium supplements, and also with tonic water and mustard.

It was only when I was diagnosed with celiac disease (I was so anemic that I had to go to the ER) that I realized I was not absorbing calcium. Since I started the gluten-free diet for celiac, I haven't had any leg cramps at all.

A. People with celiac disease must avoid gluten found in wheat, rye and barley. It triggers a reaction that harms the lining of the small intestine and interferes with the absorption of crucial nutrients, including calcium.

Q. I had a terrible experience with Ambien about a month ago. I took the drug at bedtime, then had hallucinations and got in my car to escape. I don’t remember a thing, but the police stopped me and my boyfriend had to bring me home.

A short time ago, I tried taking Ambien again. This time too I had terrible hallucinations and got in my car and drove. I don’t remember a thing about it, but I was arrested and spent 24 hours in jail. Because of the Ambien, I slept almost the entire time. I had to have an attorney and have lost my job as an RN. Have you heard of other people who have had such serious problems with Ambien?

A. There are reports of hallucinations, sleepwalking and sleep-driving associated with the sleeping pill Ambien. In one case a woman (another nurse) walked out of the house on a cold Colorado night wearing just a thin nightie. She got into the car and drove until she had an accident. When she was being arrested, she became violent with the officers, but later could remember nothing about the event. Sleeping pill-induced amnesia has been reported for years.

Q. About five years ago, I discovered a treatment for hangovers: a few activated charcoal capsules with a lot of water at bedtime and then another few capsules around 7 am with another glass of water. By 9 am, you are not feeling perfect, but much better than if you just drank water.

I have since married and now have two kids, so I rarely have more than two drinks. But when I do, four drinks make me feel like I've had way too much. I only take the charcoal remedy occasionally, but it may help someone else.

A. Activated charcoal is frequently used to adsorb toxins. It is also an important component in water and air purification systems. Activated charcoal capsules are also sold to help relieve flatulence.

There is little evidence that activated charcoal can adsorb alcohol or lower blood levels so we’re not sure how it could possibly help a hangover.

Q. I have been taking statin drugs, including Pravachol, Lipitor and now Zocor, for over ten years to control my cholesterol.

I have always been warned that grapefruit and grapefruit juice inhibit the effectiveness of statin drugs. Every container of a statin drug I've ever been given has a warning on it to avoid grapefruit in any form. I was shocked to read that you said someone could eat grapefruit while taking Lipitor. Where do you get off with this?

A. You and dozens of other people were quite upset by the column in which a reader asked if he could cut his Lipitor in half and take it with grapefruit to save money. We recommended that he check with his doctor and pointed out that grapefruit raises blood levels of statin-type drugs like Lipitor.

The idea that grapefruit interferes with the effectiveness of these cholesterol-lowering drugs is mistaken. It actually boosts concentrations in the blood. This might increase the risk of side effects if the dose is not adjusted properly.

We are sending you our Guides to Cholesterol-Lowering Drugs and Grapefruit Interactions with detailed information on the many medications affected by this fruit. Anyone who would like copies, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. JL-97, P. O. Box 52027, Durham, NC 27717-2027.

Q. I want to let you know that hormone replacement therapy (HRT) can have very serious side effects. Between 1996 and 1998 I took HRT under the advisement of my OB/GYN. She told me that the benefits of taking HRT outweighed the risks and that it would protect my heart. The dose I took was very low.

In May of 1998 I drove myself to the emergency room where I was diagnosed with deep vein thromobosis (blood clots from my calf to my groin) and also a number of blood clots in my lungs. The emergency room doctor said, "The good thing is that you are still with us." That let me know the gravity of the situation. After many tests, I was told that the blood clots in my legs were caused by HRT.

I was hospitalized for a week. I hope you pass this information along to anyone who is taking HRT or birth control pills. They can be very dangerous. They nearly took my life.

A. The hormones in both HRT and birth control pills can increase the risk for blood clots. If the clots break loose, they can lodge in the lungs and cause a potentially life-threatening condition. You were lucky.

Although most women can take hormones with minimal risk, some may experience heart attacks or strokes because of blood clots. The Ortho Evra birth control patch now comes with a warning that it releases more estrogen into the bloodstream than typical birth control pills. This may increase the risk for blood clots.

Q. I have been suffering crippling pain at night from lower leg cramps. I tried all the popular remedies, even prescription quinine. Nothing helped.

Recently I stopped taking Vytorin, a drug my doctor prescribed to control cholesterol. The pain seems to have disappeared. Have others reported such an experience with statin drugs?

A. Muscle pain and cramps have been reported as side effects of statin cholesterol-lowering drugs. We cannot tell you whether your symptoms were caused by the simvastatin ingredient in Vytorin, but you should discuss this with your physician. Discontinuing such medication, however, may increase your risk of experiencing a heart attack.

We are sending you our Guides to Leg Pain and Cholesterol-Lowering Drugs for side effect information and remedies for both restless legs and cramps. Anyone who would like copies, please send $3 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. LR-85, P. O. Box 52027, Durham, NC 27717-2027.

Q. Like the man whose wife complained about him becoming addicted to Nicorette, I also used this gum and became addicted to the nicotine in it. In an effort to break the 'gum' habit, I resorted to the nicotine-containing Commit lozenge and became addicted to that as well. I felt that the craving for the gum and the lozenge was stronger than the craving for cigarettes.

To break this vicious oral cycle, I used a low-nicotine patch for a couple of weeks and chewed regular gum. It worked. I am now nicotine free and have been for many years. My doctor recommended the patch when I asked him how to extricate myself from the gum.

A. Thanks for the helpful tip on overcoming nicotine craving. Research shows that smokers may need to make several attempts to conquer their addiction, but if they continue the efforts they are often successful.

Q. I just read a question about Zicam Cold Remedy. Here is another instance of loss of sense of smell from this zinc nasal gel.

My sister took it recently and immediately lost her sense of smell. Her doctors say she will be lucky to get 30 percent back. After 5 weeks, she has barely any sense of smell. She is a medical practitioner and knew how to follow the directions explicitly.

A. Consumer Reports (Jan. 2007) notes that “studies with animals and case reports suggest that nasal zinc may cause loss of smell, possibly permanent. Last year we [CR] unearthed more than 200 complaints to the Food and Drug Administration about an impaired sense of smell, taste, or both after using zinc nasal products."

People who want to take zinc to fight cold symptoms might want to stick with zinc pills or lozenges so that nasal passages are not directly exposed.

Q. I run at least 30 miles a week, and I do strength training 3 times a week. I maintain a healthy weight of 125 pounds and most of the time my blood pressure is around 110/60.

As you know, blood pressure can vary during the day. Whenever I go to my doctor it skyrockets, but soon afterwards it goes back to normal.

My doctor wants to put me on a diuretic indefinitely, but I disagree. I used to take a prescription antihypertensive, but I would get very dizzy. When I told the doc, he cut my dose of HCTZ in half, but I still got dizzy. Is there anything besides prescription medication that can keep my blood pressure down?

A. You are experiencing “white coat hypertension.” This happens in the doctor’s office when someone wearing a white coat and carrying a stethoscope takes your blood pressure.

A study in Italy several years ago showed that most people (47 out of 48) experienced a boost in blood pressure within two minutes of the doctor walking into the room. For some people, that hike in pressure was enough to qualify them as hypertensive, even if prior blood pressures were within the normal range.

There are a number of ways to lower blood pressure without medications. Releasing stress through relaxation and avoiding situations that bring out hostile feelings are important tactics that are often overlooked. Eating lots of high-potassium, high-fiber vegetables and fruits can also help.

We are sending you our Guide to Blood Pressure Treatment with a discussion of many non-drug options and ways to deal with white coat hypertension. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. B-67, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. An article in the newspaper on menopause quoted an expert (Ob/Gyn) that "virtually everybody can use topical estrogen." How much estrogen is absorbed into the body?

I was diagnosed with estrogen-positive breast cancer and was taken off all estrogens. While the few hot flashes are annoying they are tolerable. The vaginal discomfort is not. Can you confirm that yes, virtually all women can use Premarin cream?

A. The estrogen in Premarin Vaginal Cream is easily absorbed into the body (JAMA, Dec. 14, 1979). Discuss this issue with your oncologist, since this product could be inappropriate for you.

Q. I've been struggling with body odor for years. When someone approaches me, I hear them continuously sniffling or covering up their nose to mask the odor. What is it that irritates so many people on a daily basis?

I've used anti-bacterial soap for years, but it only helps for a short while. There has not been a day without someone sniffling or moving away from me. It's really affecting the way others look at me in my workplace, commute, and outings. I try to avoid enclosed areas like elevators, and try to keep my distance from others if at all possible.

Once I thought this odor was due to a serious nail fungus. After taking oral Lamisil, I no longer have the fungus, but I still smell bad. I've had many sleepless nights worrying about how others would react to me on my commute and at work. Please help!

A. Only a physician can diagnose what’s causing your problem. Some people have a metabolic disorder called trimethylaminuria. A defective enzyme allows a chemical to build up in the body that smells like dead fish.

If this were your problem, a special diet might help. Avoiding eggs, milk, meat, beans, fish and cheese could reduce the odor. Some people report that chlorophyll pills also help. If a different condition is responsible, perhaps your physician will be able to come up with an effective treatment.

Q. I have been on Prevacid for a few years for acid reflux. I am trying to get off of it, but whenever I cut back my symptoms get worse. Are there any other ways to control reflux?

A. Medications that suppress acid formation in the stomach (Aciphex, Nexium, Prevacid, Prilosec, Protonix) are quite good at relieving symptoms of reflux and heartburn. When they are discontinued, however, people experience a phenomenon called drug-induced acid rebound. That means the stomach pumps out even more acid than it did initially. This effect can last for many months.

Gastroenterologists are debating the significance of this rebound hypersecretion of acid (Basic & Clinical Pharmacology and Toxicology, Jan. 2006). Some data suggest that the excess acid production may lead to prolonged heartburn.

We have offered numerous other ways to control heartburn symptoms in our new book, Best Choices From the People’s Pharmacy (Rodale Books). They include cutting back on carbohydrates, chewing sugarless gum after meals to stimulate saliva, sipping ginger tea or swallowing a little yellow mustard. Anyone who would like more details can find them at www.peoplespharmacy.com.

Q. I have a solution for constipation I would like to share with your readers. I take around 500 mg magnesium every night. The result is what "normal” people experience: a regular, comfortable bowel movement. Nothing else I tried in the past helped me so gently.

Is there a problem taking this supplement? I’ve mentioned my approach to two doctors who didn't think it was harmful. Your opinion would be appreciated.

A. Magnesium is in several time-honored laxatives. Some people even tell us that taking this mineral before bedtime helps them sleep. It may also prevent nighttime leg cramps.

People with kidney disease should avoid extra magnesium. Even healthy people can experience diarrhea if they take too much. The normal supplement ranges between 300 mg and 500 mg.

Don't Swallow Save the Baby

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Q. When I was very small (late 1950's) there was a great children's cold salve called "Save the Baby.” It was rubbed on the chest to help clear congestion. Do you know if this product still exists?

A. When we last wrote about Save the Baby several years ago, a reader told us that it is a regional remedy available in Massachusetts. We have not seen it for years, but you might find it on the Internet.

Save the Baby was promoted for coughs, colds and congestion. It contained camphor, which gave it a distinctive aroma. Not only did people rub it on the chest, they were also encouraged to administer it internally. Such advice was dangerous because camphor can be toxic when taken orally.

You can still find products with camphor. Vicks VapoRub is one of the most well known. Heed the warning: “For external use only, avoid contact with eyes. Do not use by mouth, with tight bandages, in nostrils, on wounds or damaged skin.”

Q. I think I read something about skin flaps in your column. Is there anything that will get rid of these annoying and unsightly growths?

A. Skin tags are not dangerous, but as you point out, these fleshy growths can be bothersome. They often appear in skin folds such as under the arms, in the groin area or on the neck.

Several weeks ago a reader recommended applying New-Skin Liquid Bandage to a skin tag or flap to remove it. We have since heard from several readers that this approach worked.

Here’s one testimonial: “I have had five skin tags removed in the past by a dermatologist and was about to call for an appointment to have another removed when I read about the 'liquid bandage' in your column. I bought the spray. WOW, the skin tag was gone in a week.”

Q. I am very concerned about my mom. She has high blood pressure and elevated cholesterol. Her doctor has her on atenolol and clonidine for the blood pressure and Pravachol to control the cholesterol. Her aches and pains are worse than ever and she has no energy. Could her medicine be contributing to her symptoms?

A. Beta blockers like atenolol may make it hard to control cholesterol and can also cause fatigue. There is some question as to whether such drugs prevent heart attacks or strokes, which is the whole point of the exercise. Many European experts now believe beta blockers should not be first choice treatments for hypertension (Lancet, Oct. 29, 2005).

Statin-type cholesterol drugs (Crestor, Lipitor, Pravachol, Zocor) sometimes cause aches and pain in muscles and joints. Your mother should discuss her symptoms with her physician and never discontinue any medication suddenly.

We are sending you our new book, Best Choices From The People’s Pharmacy (Rodale Books) with information on alternative approaches to blood pressure and cholesterol control. Others can find it at a local bookseller or on the Internet.

Q. My husband, a 45-year smoker, is now addicted to Nicorette. He chews this gum constantly and uses it in places he never smoked, such as work, stores, home, etc.

Is this common? What are the long-term health effects? He has high blood pressure.

A. Nicotine is clearly addicting in any form. Others have reported difficulty stopping Nicorette. Side effects may include nausea, throat irritation, indigestion and irregular heart beat. Nicotine may also increase blood pressure.

Q. If grapefruit increases the action of Lipitor, is it OK to drink grapefruit juice and reduce the dosage of Lipitor to save money?

A. This is an intriguing strategy. Researchers have occasionally used grapefruit to boost the power of some expensive medications. Cyclosporine (Sandimmune), used to prevent organ transplant rejection, can cost thousands of dollars a year. Although grapefruit juice may allow transplant patients to lower the dose and save money, investigators find that there is too much variability among patients and also in batches of grapefruit juice for this to be a safe practice.

The dose of Lipitor needed to lower cholesterol is less critical than that of Sandimmune. Check with your doctor before trying this approach. We know one man who breaks his Lipitor in half, takes it with grapefruit juice and gets good results on his cholesterol tests.

Q. What do you make of the cold product called Zicam? Do you have any information about the loss of smell that might result from using Zicam?

A. Zicam is a zinc nasal gel that is promoted as a homeopathic treatment for the common cold. The effectiveness of zinc against cold symptoms remains controversial. Some studies indicate benefit, while others find no advantage over placebo.

There have been reports of people losing their sense of smell following the use of zinc nasal gel (Laryngoscope, Feb. 2006). The company that makes Zicam says such reports are “completely unfounded and misleading.” Despite this reassurance, one reader of our column reported that after using Zicam she now has only 30 percent of her former senses of smell and taste.

Q. Is there anything that can increase a woman’s libido? I am interested much less often than my husband, and it is causing us trouble.

A. A few treatments have been shown to help increase women’s sexual desire (Danish Medical Bulletin, Aug., 2006). Although the FDA has not approved its use, some doctors prescribe testosterone as a patch, a gel or a tablet under the tongue. A prescription-only device, the Eros-CTD, has been shown to improve arousal. We discuss these options and other treatments in our Guides to Female Sexuality and Treating Sexual Dysfunction. Anyone who would like copies, please send $3 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. PZ-9, P. O. Box 52027, Durham, NC 27717-2027.

Q. After being diagnosed with celiac disease, I became extremely frustrated. I knew I wasn't getting gluten from anything I was eating, yet I had a persistent rash on my knees that would not go away.

I did some research and found that even if a brand name drug was not manufactured with wheat starch, the generic might contain it.

Now I ask the pharmacist about wheat starch in my pills and will pay extra for brand name drugs to avoid this substance that makes me sick. Sometimes my doctor has to change to another drug.

Will drug companies ever acknowledge that "inert" ingredients can still cause trouble for some people?

A. People with celiac disease cannot tolerate any gluten from wheat, barley or rye. In addition to monitoring their diets rigorously, they must also monitor their medications. Both your doctor and your pharmacist can help you avoid gluten in your medicines.

Q. I am a 54-year-old woman, with extremely low cholesterol and no risk factors for heart disease. I had a heart attack resulting from an artery spasm two weeks ago after my second dose of Boniva.

The doctors were totally floored. I am so healthy that it made absolutely no sense. They were unable to find any damage or plaque in my arteries in the angiogram.

I noticed an article you wrote about a woman who also suffered a heart attack while taking Boniva. Is there any new information on a connection between this drug and heart attacks?

I am so angry I even took the drug. My bone density wasn’t that bad.

A. We have forwarded your report to the FDA. It is the second report of heart attack on Boniva we have received, but there is no warning about arterial spasm or heart attacks in the official labeling information and the FDA has not confirmed any link. There are reports that this osteoporosis drug can raise blood pressure and cholesterol.

Most people tolerate Boniva well, but some experience serious heartburn and severe irritation of the esophagus. Others complain of incapacitating muscle or joint pain. Rare cases of jawbone death have also made headlines recently.

Q. In a recent column a pharmacist was accused of negligence. I had the reverse situation when I was very ill.

I couldn’t get an appointment with my regular doctor, so I was seen at the emergency service. When I got a prescription, I carefully asked the doctor for the correct dosage to ensure I would be using it properly.

When I took the prescription to the local pharmacy a long delay occurred, even though I was the only customer. The pharmacist returned to tell me that the prescription had been improperly written regarding the dosage.

He located the correct information and gave me my instructions. Had he been less diligent, I might no longer be of this world.

Motto: Not only can a pharmacist make an error, so can a physician.

A. Medication errors are far too common, and they can occur at any step of the process. That’s why it is crucial for every patient to understand what drug has been prescribed, what dose to use, how to use it and what serious effects might result. Our new book, Best Choices From The People’s Pharmacy (Rodale Books), offers this kind of information for a variety of conditions. It is available at bookstores or www.peoplespharmacy.com.

Q. What can you tell me about the interaction of alcohol and drugs? My husband is being treated for depression and has been taking a double dose of Lexapro and also Wellbutrin SR for a few months.

Recently he has been drinking an increasingly large quantity of wine--a bottle or two daily. I have just found out he is taking the diet pill phentermine on top of all this.

His behavior has become hostile and strange. How dangerous is this combination and would it account for his aberrant behavior?

A. The mixture of drugs and alcohol that your husband is consuming is a prescription for disaster. Excessive alcohol together with Wellbutrin increases the risk of seizures.

Phentermine in combination with Lexapro could trigger serotonin syndrome, with symptoms of irritability, lack of coordination, nausea, restlessness, uncontrollable muscle contractions and, in the worst case, loss of consciousness and death.

Q. Is grapefruit juice dangerous with all statins? A pharmacist told me it interacts only with Mevacor, but not with other statin drugs. I take Zocor daily to control my cholesterol.

A. Not all statin cholesterol-lowering drugs interact with grapefruit, but Mevacor (lovastatin) is not the only one that does. Zocor (simvastatin) and Lipitor (atorvastatin) may also be affected.

Grapefruit can boost blood levels of many medicines, potentially increasing the risk of side effects. We are sending you our Guides to Grapefruit Interactions and Cholesterol-Lowering Drugs for more details about the grapefruit effect. Anyone who would like copies, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. JL-97, P. O. Box 52027, Durham, NC 27717-2027.

Q. Can medications cause bad breath? My husband takes pills for heart trouble, high blood pressure and diabetes. His breath is really bad, and mouthwash or breath fresheners don't seem to help.

A. According to a recent review in the British Medical Journal (Sept. 23, 2006), some drugs may indeed contribute to halitosis. Medications that cause dry mouth can create conditions that foster odor-causing germs. Oral infections are often the source of bad breath so he should see his dentist.

If bacteria in the stomach (Helicobacter pylori) are the problem, antibiotic treatment can help. Diabetes that is out of control can create a distinctive breath odor. Heart medicines containing nitrates (nitroglycerin and related drugs) are occasionally linked to bad breath, but such drugs are crucial and must not be discontinued.

Q. My mom has just entered the donut hole. For October, November and December, her prescription drug bill increased to $800 per month.

This has been the biggest boondoggle ever put over on seniors. Even though she got some benefit earlier this year, she has to keep paying the insurance premiums out of her Social Security (only $305 a month).

The cost of drugs has increased by at least 20 percent. Congress should be run out of town for approving such an awful plan.

This month I officially became a senior myself. My health is pretty good, but I worry about the future for her and for myself.

A. Your mom’s situation is not unusual. Many senior citizens have fallen into the “donut hole? of Medicare Part D. The assistance offered by the federal government for prescription drugs dries up when the total bill reaches $2,250. Some have seen their monthly drug expense go from under $100 to over $500 per month.

Some people with exceptionally costly medicines will rack up more than $5100 in total for their drugs before the end of the year. They will come out of the donut hole and get significant help with further medication costs.

Others will not emerge from the donut hole before the year ends. Plans start over in January. In the meantime, some may want to consider buying medicines from Canada.

Q. I found some Levaquin 500 mg tabs in the back of my medicine chest. I was looking for something to help with my chronic back pain. What is Levaquin for and how should it be taken? I have forgotten all the information on it.

A. Levaquin is an antibiotic. It will not help your aching back. With antibiotics, all the pills should be taken when they are prescribed. They should not be saved.

Q. I have taken both Viagra and Cialis. They work well, but I do get sinus pressure headaches when I take these drugs. I feel this has contributed to sinus infections that have required lengthy courses of antibiotics. Is this possible?

A. Nasal stuffiness is a relatively common reaction to drugs for erectile dysfunction like Viagra, Cialis and Levitra. People who experience chronic congestion may develop an infection and sinusitis as a consequence.

Please discuss this issue with your physician. There are other ways to treat erectile dysfunction. Q. You have suggested that people should check prescriptions carefully to avoid pharmacy errors. How many people read Latin? Why aren't prescriptions written in English? Start a crusade!

A. We have been campaigning against Latin abbreviations in prescriptions for nearly 30 years. There is no excuse for physicians to use this archaic system in the 21st century.

This idea makes some doctors angry, though. One took us to task after we wrote a column calling for prescriptions to be written in legible English: “You do not have a right to tell us to change the standard format in which pharmacists provide service to physicians by saying that we should change the way prescriptions are written and have been forever. Pharmacists are here to serve, not to instruct.?

Despite this objection, the leading pharmacology textbook used in medical schools is clear: “The directions to the patient should always be written in English. The use of Latin abbreviations serves no useful purpose.?

Q. I have had weakness in my arms and legs, pain in my back, aching arms, loss of memory and fatigue. I have not been able to play golf for more than two years and I totally lost the quality of life I enjoyed prior to undergoing angioplasty and starting on Lipitor.

If there is to be a class action suit, I would like to be included. Your article helped me understand the pain and suffering I have endured.

A. Millions of people are able to take cholesterol-lowering drugs like atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor) without complications. But some experience debilitating muscle, nerve or joint pain, weakness, skin rash or memory problems.

The nutrient Coenzyme Q10 may help counteract some of these side effects. You can learn more about how to use it and alternative ways to control cholesterol in our new book, Best Choices From The People’s Pharmacy (Rodale Books).

We cannot offer legal advice. Several lawsuits have been filed claiming deceptive marketing of statins.

Q. Do nitroglycerin heart tablets lose their potency once the bottle is opened for the first use, or can I go by the expiration date on the bottle? I have gotten conflicting answers from my doctors and my pharmacist. I’m not sure whom I should believe.

A. Nitroglycerin evaporates easily, which is why these pills should never be left out in the open or in a plastic pillbox. Store them in the original amber glass bottle with the cap screwed down tightly.

If there is cotton in the bottle, take it out and throw it away as it can absorb the medicine. If you replace the cap firmly as soon as you remove a pill, you should be able to rely on the expiration date on the label.

Spanish Fly Fights Warts

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Q. My doctor shaved off some skin and put Spanish fly (cantharidin) on my wart. It stung for 24 hours but the wart went away. Forget the bacon grease, duct tape or other home remedies. This works.

A. Spanish fly has an undeserved reputation as an aphrodisiac. It is actually a very irritating substance made by male blister beetles.

Dermatologists have used the active ingredient, cantharidin, to trigger an immune response that helps eliminate warts. This prescription liquid must be applied with care by a physician since it may burn and cause a painful blister.

Q. I took hormones for years and then discontinued them when there was so much negative publicity. Without HRT I have hot flashes, night sweats and poor sleep. My doctor wants me to resume hormones, but I would rather not.

Are there any alternatives that will help with these symptoms? I would like some straight answers.

A. Hormones relieve symptoms such as hot flashes and night sweats, but side effects may include an increased risk of gallstones, migraines, hypertension, asthma, breast cancer, heart attacks or strokes. German researchers tested a combination of the herbs black cohosh and St. John’s wort (Obstetrics and Gynecology, Feb. 2006). This combination was significantly better than placebo in alleviating menopausal symptoms and produced few side effects.

We are sending you our Guides to St. John’s wort and Estrogen: Benefits, Risks and Interactions for more information on various options including herbal treatments. Anyone who would like copies, please send $3 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. WV-82, P. O. Box 52027, Durham, NC 27717-2027.

Q. You recently responded to a person whose pharmacy made a serious error by instructing that the medicine be taken four times a day instead of four times a week. I was very disappointed that you did NOT answer the question that the person asked: "Is there anything else to be done??

You said "mistakes happen." EXCUSE ME! Pharmacies need to ensure that mistakes DON’T happen. They need to make sure that their pharmacists are not overworked. A mistake could kill someone.

The mistake should have been reported to the state attorney general's office. The pharmacy should, at the very least, write an apology to the patient and explain what procedures they will put in place to keep such a mistake from happening again.

A. We’re sorry that we may have seemed callous to this serious error and we agree that a written apology from the pharmacy is in order. Medication errors are far too common in pharmacies and hospitals. An estimated 50 million mistakes are made each year.

Normally, the state Board of Pharmacy regulates pharmacy practice. Since the reader had already notified this agency, we did not think it necessary to alert the attorney general’s office. The patient caught the error before harm was done. Until a system is devised to eliminate all errors, everyone must be vigilant about prescriptions.

Q. Is there anything that works for cold sores? I have a red, itchy, ugly sore on my lip that people stare at.

A. There are several antiviral medicines that help heal cold sores (herpes simplex) more quickly. Ask your doctor whether Famvir, Valtrex or acyclovir would be appropriate for you.

Q. I have noticed quite a few skin tags appearing on my body. I have had one or two of the larger flaps cut off by my doctor. I was fascinated to read in your column that a reader had success getting rid of skin tags by putting special BandAids on them. I tried this but could never get a bandage to stay on long enough.

I was about to give up when I ran across some liquid bandage in my medicine cabinet. I had a large flap growing on my shoulder and put the New Skin Liquid Bandage on it. Within a week the flap fell off. I put it on some smaller skin tags and they shriveled and fell off too. Have you heard of this before or have I discovered an alternate way to get rid of these unsightly skin growths?

A. Skin tags are benign fleshy growths that commonly appear in skin folds such as under the arms, in the groin area or on the neck. They can also show up on the face. They are common and not dangerous. Dermatologists can remove them surgically or with an electric needle.

A few years ago a reader suggested applying BandAid Clear Spots tightly over skin tags to get rid of them in a week or two. Your technique sounds a little easier and we will be interested to learn if it works for others.

Q. My mother recently had emergency surgery (two days after planned hip replacement surgery) to repair an ulcer that had left a hole the size of a half dollar in her stomach. She had been taking Mobic prior to her hip surgery.

Please alert your readers to the dangers of NSAIDS. They must be informed about the risks of these drugs, particularly for the elderly.

A. It has been estimated that over 100,000 people are hospitalized each year because of adverse reactions to NSAIDs (nonsteroidal anti-inflammatory drugs). More than 15,000 people die, often because of complications caused by bleeding or perforated ulcers. Drugs in this class include ibuprofen (Advil, Motrin), diclofenac (Cataflam, Voltaren), meloxicam (Mobic), naproxen (Aleve, Naprosyn) and indomethacin (Indocin).

In addition to digestive tract damage, NSAIDs can raise blood pressure, increase the risk of heart attacks and strokes as well as injure kidneys and liver. We offer more information about such medicines and ways to reduce stomach damage and ease joint pain in our Guides to Alternatives for Arthritis and Digestive Disorders. Anyone who would like copies, please send $4 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. AAG-3, P. O. Box 52027, Durham, NC 27717-2027.

Q. Is there a generic for the depression drug Paxil? I have already fallen into the "donut hole" in Part D (Drug Coverage) of Medicare and would like a substitute for Paxil if one is available.

A. When Medicare patients enter the donut hole they must pay 100 percent of their medication bill. Paxil can cost around $100 a month. The generic paroxetine is available for about a third as much.

Q. Are there any effective treatments for age spots on the hands and face?

A. A compound called hydroquinone (Porcelana, Eldoquin, Esoterica, etc) has been used for decades to bleach brown spots (liver spots) caused by aging and sun exposure. The FDA is considering a ban of this ingredient, however, because of animal data suggesting that it may promote cancer.

Q. I had a gastric bypass 32 months ago. Last year I started craving mint in everything: mint coffee, ice cream, cake, cookies, even mint lip balm.

It has now gotten worse. I am worried because all I want to do is sit down with a tube of mint Chapstick and eat my heart out. I have asked other bypass people if they crave non-food items. Some have said they eat lip balm for the waxiness. I told a doctor but he laughed it off and said mint would not hurt me. Why am I craving mint? I just found out I do have a very low iron level. Could this be the problem?

A. Your very low iron level could indeed be contributing to your craving. Iron or zinc deficiency is sometimes associated with a condition called pica. This is the medical term for craving and eating non-food substances. While mint coffee or cookies qualify as food, mint-flavored lip balm certainly does not! When you correct the iron deficiency, your craving may disappear.

Q. I recently had a prescription filled at my local pharmacy. The dosage was mislabeled big time. The label read “take 4 times a day,? but it was supposed to be 4 times a week.

I caught the error myself before I even left the drugstore. It was lucky that I did.

Other than reporting the pharmacy to my physician, the state Board of Pharmacy and the drugstore chain itself, is there anything else to be done?

In relating this incident to co-workers, friends and family, I've heard many similar horror stories regarding botched prescriptions. How do pharmacies get away with this kind of thing and stay in business?

A. Pharmacists are often overworked, putting in 12-hour shifts with little time to go to the bathroom or eat lunch. When they have to fill hundreds of prescriptions a day, mistakes happen. One study published in the Journal of the American Pharmaceutical Association (March/April, 2003) found roughly four errors a day in an average pharmacy filling 250 prescriptions. That translates to more than 50 million errors a year across the country.

Everyone should follow your good example and check each prescription carefully to verify drug, dose and instructions!

Q. What can you tell me about buying medicine from Canada? I added up our costs for the year and found that my wife and I are paying more than $5,000 between us for drugs to treat high blood pressure, cholesterol, reflux and osteoporosis.

A. Brand-name prescriptions often cost significantly less from a Canadian drugstore. Make sure you deal with a legitimate Canadian pharmacy, one that has a physical address in Canada and a provincial license that can be verified.

These tips and other ways to economize are in our Guide to Saving Money on Medicine. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. CA-99, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Customs officials have been confiscating some drug shipments from Canada. A new law permits Americans to bring a 90-day supply across the border. Mail-order shipments may still be confiscated, though Customs officials say they will start relaxing their enforcement.

Q. I take Xanax to sleep at night. I now understand that you can't eat grapefruit when you use Xanax. I've done that in the past before I learned about the issue. How long do I need to wait after drinking a grapefruit-flavored Shasta soda or a Smirnoff or a mixed drink that has grapefruit?

A. You don’t need to worry about grapefruit interacting with Xanax (alprazolam), but we sure are concerned about the Smirnoff. Mixing an anti-anxiety agent like Xanax with alcohol could cause excessive sedation. If you needed to go to the bathroom in the middle of the night you might become dizzy and fall.

Q. I just wanted to give you a heads-up that Acomplia is available online from the UK without a prescription. The trouble is that you run the risk of having the drug seized by US Customs.

I know because when I ordered my second pack of 28 pills, the package was seized and all I received for my $158 investment was a letter from Customs. I was really disappointed because I had lost 7 pounds in my first month on the drug with only mild side effects.

If I could find a safe way to order Acomplia, I would do it in a heartbeat. I read that this medication might be hazardous during pregnancy. Perhaps that is why the FDA is dragging its feet on approving Acomplia.

A. Acomplia (rimonabant) is a new weight-loss medicine that has recently been approved in Europe. It is available in the UK and several other countries.

Acomplia is completely different from all prior weight loss products. It blocks brain receptors that are activated by marijuana. This “anti-munchy? effect may partially explain the drug’s ability to control appetite. In addition to weight loss, Acomplia increases good HDL cholesterol and improves insulin efficiency.

Side effects include dizziness, nausea, diarrhea, headache, anxiety and depression. The effects during pregnancy are unknown but several investigators are concerned about a potential for harm. It is still so new that some adverse effects may not be known.

While Acomplia is being prescribed in the UK, it is unlikely that a reputable online pharmacy would sell it without a prescription. Taking it without medical supervision would be inadvisable.

Q. We are just getting home after three weeks on the road with our RV. But yesterday I began to sniffle with a head cold and sore throat. It's been years since I've had a head cold. What should I take to shorten it?

A. If you act quickly, a Chinese herb popular in Sweden may help cut a cold short. Andrographis paniculata has been tested in a few clinical trials and was shown to shorten a cold by several days. Zinc is another candidate for treating a cold. The research on zinc has given mixed results, though, and sucking on zinc lozenges can cause nausea.

Vitamin C, garlic, ginger tea and chicken soup may also be useful in easing cold symptoms. Sadly, the herb echinacea has not proven very effective in recent clinical trials.

We are sending you our Guides to Herbal and Cold Remedies with dynamite recipes for chicken soup, hot toddies and ginger tea. Anyone who would like copies, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. EQ-25, P. O. Box 52027, Durham, NC 27717-2027.

Q. What can you tell me about medication used to fight alcoholism? I am getting out of prison soon, and I need all the help I can get. My four kids need it just as much as I do. How would I get it and how much will it cost? I don’t have much money.

A. The prescription medications used to treat alcoholism work best in conjunction with counseling and social support. ReVia (naltrexone) has been available for some time and takes away the pleasurable feelings associated with alcohol. Sadly, the drug is quite expensive (over $200 for a month’s supply) and there is no patient assistance from the manufacturer.

Campral (acamprosate) is relatively new and seems to affect brain chemistry by helping people avoid alcohol once they have quit. It too is expensive (over $115 for a 30 day’s supply). Fortunately, the manufacturer (Forest Labs) does have a patient assistance program. Your doctor will need to fill out an application for you to receive free medicine.

Q. Recently I experienced two rather worrisome events—the total loss of vision for a minute or two and occasional double vision. My MRI and MRA were fine but my doctor concluded that Viagra was causing these visual problems. I have taken it once or twice a week for quite some time. He told me that if I continue using it, I might have a total loss of vision. If this is indeed the case, would Cialis or Levitra be an alternative?

A. The FDA has warned patients that a loss of vision associated with Viagra, Cialis or Levitra could be an early warning sign. Some men taking these drugs have become blind as a result of NAION (non-arteritic anterior ischemic optic neuropathy). This condition occurs when blood can’t flow easily to the optic nerve. You may want to talk to your doctor about alternative approaches to erectile dysfunction. We are sending your our Guides to Treating Sexual Dysfunction and Drugs That Affect Sexuality for more information on other ways to deal with ED. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. YP-96, P. O. Box 52027, Durham, NC 27717-2027.

One possibility may be alprostadil. It can be injected or inserted into the urethra. A cream (Alprox-TD) improved erections for over 50 percent of the men in a clinical trial. This topical form has not yet been approved by the FDA.

Q. I have heard that people with diabetes need to be careful about fish oil supplements. The capsules can raise blood sugar. Please tell me if this is true. My doctor doesn’t know anything about it.

A. Norwegian scientists recently reported the results of a study of type 2 diabetics given high doses of fish oil (6 grams per day) (American Journal of Clinical Nutrition, Sept. 2006). The diabetics on fish oil had lower insulin sensitivity and higher average blood sugar.

Even though fish oil may be beneficial for most people, these findings suggest that high doses pose a problem for diabetics. Lower doses, such as one gram daily, might be fine.

Q. Have you ever heard of using Reglan to enhance breast milk production? Are there any side effects?

A. Reglan (metoclopramide) is prescribed for serious heartburn (reflux). It appears to increase breast milk production, but this is an unofficial (off-label) use. Side effects may include drowsiness, restlessness, fatigue, insomnia and depression. Reglan gets into breast milk.

Q. I’ve heard that ibuprofen will negate the positive effects of aspirin if the two are taken together. I read a report that says ibuprofen blocks aspirin’s effect for only two hours and that it’s safe to take ibuprofen 2 hours after aspirin to circumvent this effect. Any truth to this?

A. Several years ago a report in the New England Journal of Medicine (Dec. 20, 2001) suggested that ibuprofen could counteract the anti-clotting benefits of aspirin. A new study in the journal Clinical Pharmacology and Therapeutics (Sept. 2006) confirms that ibuprofen undermines the effectiveness of aspirin against blood clots.

In this study it did not make any difference whether the aspirin or the ibuprofen was taken first. Waiting two hours won’t solve the problem.

Q. Do you have any information regarding sugar-free gum and diarrhea? My daughter had trouble with weight loss, stomach cramps and diarrhea. Three different doctors could not diagnose the cause. Then she remembered it all started after she began chewing sugar-free gum.

A. Sugar-free gum frequently contains compounds such as maltitol, sorbitol, mannitol and xylitol. These sweeteners are not absorbed well from the digestive tract and attract water. This can lead to watery diarrhea, gas and cramps. Giving up sugar-free gum should ease your daughter’s digestive woes.

Q. My doctor has prescribed Avodart for enlarged prostate. I am interested in any adverse side effects from this new drug.

A. Avodart (dutasteride) blocks the conversion of testosterone to dihydrotestosterone (DHT). DHT stimulates the growth of prostate tissue. Researchers are studying whether this medicine might lower the risk of prostate cancer. Although most men tolerate Avodart very well, a few report reduced libido or impotence.

Q. I am very confused about when to take my medicine. The label on my blood pressure pills says to “take on an empty stomach.? How long after a meal should I wait?

I also take Lipitor for cholesterol control and Cipro for a sinus infection. My doctor warned me about grapefruit juice and coffee but I am unclear what the problem is. Can you help?

A. Many drugs must be taken on an empty stomach to work effectively. Examples are the blood pressure pill Capoten (captopril) and the osteoporosis medicine Fosamax (alendronate). This means at least an hour before eating or two hours after a meal.

Antibiotics like Cipro (ciprofloxacin), Noroxin (norfloxacin) and Penetrex (enoxacin) can slow elimination of caffeine so that a cup of coffee provides a bigger jolt. Grapefruit can also boost the blood levels of Lipitor (atorvastatin), Mevacor (lovastatin) and Zocor (simvastatin). This may increase the risk of side effects.

For more information on how to take medications, we offer our Guides to Food, Drug and Grapefruit Interactions. Anyone who would like copies, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. FJ-19, P. O. Box 52027, Durham, NC 27717-2027.

Q. You advise people to dispose of old mercury thermometers and replace them with electronic models. How should we discard the old ones?

A. Many communities have a household hazardous waste collection facility. If none is available, ask your pharmacist how to dispose of old mercury thermometers safely.

Q. Help! I take bupropion for depression. I was switched to bupropion because of my inability to reach orgasm when taking other antidepressants. Bupropion is a little better, but not much.

I have to take antidepressants or I have no life at all, but I would like to have a sex life. Can you suggest any other drug?

A. Most serotonin-based antidepressants such as Prozac, Paxil and Zoloft can interfere with sexual function. Wellbutrin (bupropion) is less likely to cause this problem, but you may be more susceptible to sexual side effects than most.

Ask your doctor about a different category of antidepressants. There is a new drug called Emsam (selegiline) that comes as a skin patch. It might not interfere with your ability to achieve orgasm. Common side effects may include skin irritation, headache, insomnia, diarrhea or dry mouth.

Q. At the time of its introduction in 1990 or 1991, Prilosec came out under a different brand name. The original name was so similar to an existing drug that the makers changed its name to Prilosec. What was the first brand name?

A. When omeprazole was first introduced, it was called Losec. The FDA worried that this name might be confused with the diuretic Lasix and requested a name change to Prilosec in the U.S. This drug is still sold under the name Losec in other countries, including Canada.

As an aside, Prilosec sometimes has been confused with Prozac. Trying to prevent one mix-up may have resulted in another.

Q. What’s the difference between Armour Thyroid and Synthroid? When I was taking Synthroid, I was diagnosed with fibromyalgia and chronic fatigue syndrome. My TSH was in the normal range, even though my health was a mess.

Then one physician decided to switch me to Armour Thyroid, and I feel so much better! No more chronic pain, bone-weariness or urge incontinence. I wonder if some other people with these problems simply need thyroid treatment too.

A. Doctors often rely on blood tests such as the TSH (thyroid-stimulating hormone) because they are less subjective than patients’ self-reported symptoms. Your experience shows, however, that the clinical picture is also important.

Synthroid contains only one type of thyroid hormone (T4 or levothyroxine), while Armour Thyroid contains several. While many people do well on levothyroxine, some seem to need the mixture in Armour Thyroid.

We discuss the pros and cons of both Synthroid and Armour thyroid in our Guide to Thyroid Hormones. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. T-4, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. My doctor has his patients put pressure on the bridge of the nose after using eye drops. He says otherwise the medicine goes directly into the bloodstream.

Many residents in my senior center say their glaucoma doctor never mentioned that. Is it helpful?

A. Some medicine for glaucoma can cause side effects throughout the body. To prevent absorption, press on the inside corner of your eye for at least 30 seconds (up to two minutes) after placing the drop in the eye. This closes the tear duct off and helps reduce the amount of the drug circulating in the body.

Q. This concern has plagued me for 21 years and I need to know once and for all if I can stop worrying. My son is now 27 years old; when he was about 6 he had a fever and while I was taking his temperature with an old-fashioned mercury thermometer, the bulb tip broke and he ingested the mercury.

He's grown into a fine, normal young man with no obvious problems. Can I assume no damage was done and nothing will surface down the road due to this incident?

A. Stop worrying! Swallowing a small amount of mercury from a broken thermometer does not pose a poisoning problem. Virtually all the mercury passes through the digestive tract and is not absorbed.

Breaking a thermometer and failing to clean up the mercury very carefully is another matter entirely. The gray liquid vaporizes readily. Mercury fumes are absorbed through the lungs and are highly toxic.

People should dispose of old thermometers like toxic waste instead of throwing them out in the trash. Some states now conduct exchange programs so that old-fashioned mercury thermometers can be traded in for newer and safer electronic models.

Q. After several days with a high fever I was diagnosed with Lyme disease and my doctor prescribed doxycycline. This antibiotic worked great at first. The fever subsided and the aches in my joints let up.

After a few days, I came down with a horrendous headache. I couldn’t get out of bed. My doctor told me to go to the ER. He was afraid I might have meningitis. That scared me! A spinal tap came up negative, though, and no one could explain my headache.

The pain got worse. My husband found some information online that suggested such a headache might be a reaction to doxycycline. When we told the doctor that, he gave me a prescription for a different antibiotic and now I am recovering. Why didn’t he warn me about this problem?

A. You may have experienced a rare but dangerous side effect called pseudotumor cerebri. Doxycycline and certain other medications can cause increased pressure inside the skull, leading to severe head pain or visual problems. Your doctor may not have warned you because the condition is so uncommon.

Q. I have suffered with constipation for years. It became so upsetting that I began using a senna laxative every night. Even with that, I sometimes had to resort to a suppository to get relief.

I’ve recently discovered inulin (Fibersure). It helps me stay regular but causes gas and bloating. I am pleased to be done with my laxative habit but this gas is a real problem.

A. Inulin is a type of soluble fiber, made up of simple sugars combined in a way to make them indigestible. It occurs naturally in foods such as Jerusalem artichokes, jicama and chicory root.

We are not surprised that it has caused you gas and bloating. This is not uncommon because the fiber is fermented by bacteria in the colon.

We are sending you our Guide to Constipation with a dynamite bran muffin recipe and our 10 tips for promoting regularity. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. GG-30, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. I was wondering if you could answer a few questions for me about coffee and asthma. I've tried coffee and it certainly works for my asthma!

Does it have to be regular coffee or can it be decaf? Should the coffee be brewed or can it be instant coffee? I am going on vacation this month and it would make me feel better to know these things, in case I run into trouble.

A. Physicians have known about the beneficial effect of coffee for treating asthma since at least 1859 (Edinburgh Medical Journal). Research has shown that caffeine can open airways and improve asthma symptoms (New England Journal of Medicine, March 22, 1984). The dose is around three cups of strong coffee for an average adult.

Caffeine is related to theophylline, an old-fashioned asthma drug. As a result, decaf coffee will not work. Instant coffee contains less caffeine than brewed coffee, so a person might need a few more cups of instant.

You should not rely on caffeine to control asthma symptoms. Although it can be helpful in a pinch, prescribed medication offers more reliable relief.

Q. Often my entire head will just start perspiring a flood. It will drip down my neck and face. Just a minor exertion can trigger my scalp to sweat horribly.

Someone even asked if I’d been swimming. This sweating is so embarrassing I am reluctant to go out socially. Please help. I take Theo-24 and Serevent for a breathing problem and Lexapro as an antidepressant.

A. It is possible that Lexapro is contributing to excessive sweating. Some of the newer antidepressant medications can cause this reaction. Do not stop taking this medicine suddenly, though, since that might trigger unpleasant withdrawal symptoms.

Let your doctor know how much this side effect is bothering you. There may an alternative that does not cause this response.

Q. Can my high blood pressure be treated without drugs? I have been on several drugs that lower it, but I've had side effects with every drug I've tried. I think my doctor is getting a little frustrated. Can you help?

I've heard about breathing techniques and am looking into that. Walking lowered my heart rate but not my blood pressure. I eat a healthy, low-sodium diet and I am not overweight. High blood pressure does not run in my family. Might the Claritin I take for allergies be causing it?

A. We don’t know if you will be able to control your blood pressure without medication, but we can suggest several steps you might take. Regular exercise, a diet rich in potassium, magnesium and fiber, and stress management may help get your blood pressure down.

We have outlined these non-drug options along with dos and don’ts for measuring blood pressure in our Guide to Blood Pressure Treatment, which we are sending you. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. B-67, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Claritin alone is unlikely to raise blood pressure. This might be a side effect of Claritin-D, however. The decongestant can contribute to hypertension.

Q. You’ve had several suggestions about remedies for plantar warts. I had one on each foot when I was a kid in the late 1950's. They were removed with 2 sessions of spot radiation. The radiation was on the same wart each time and a week or so later, the wart cone fell out and the hole shrank. It was totally painless.

A. During the first half of the 20th century, dermatologists used X-rays to treat a wide variety of skin conditions. Not only was radiation used against plantar warts, it was also employed in the treatment of psoriasis, eczema and fungal infections of the skin.

This type of treatment would be considered reckless today. Skin cancers sometimes developed at the site that was irradiated. There are now much safer treatments available against warts.

Q. I have a caution about Effexor, which I took for hot flashes. I had to go out of town suddenly and ran out of pills because I couldn't get the prescription refilled beforehand. On the third day without it, I started to feel bad. Then I began vomiting and shaking.

As soon as I returned home, I took some anti-nausea medicine and restarted the Effexor. The next day I felt fine, so it wasn't the flu. I tapered off the medication over the next several months without any problems. My doctor said she had never heard of this type of reaction, but I know that's what it was.

A. Many people have difficulties with symptoms of withdrawal when they discontinue an antidepressant like Effexor suddenly. It makes no difference whether you intend to stop the drug, or whether you forget your dose; nausea, vomiting, dizziness, sweating, shakiness, shock-like electrical sensations and anxiety are possible symptoms.

Your approach of gradually tapering the dose is sensible. We are always discouraged to learn that a doctor is unfamiliar with this reaction, since it has been known and documented for at least 10 years.

Our Guides to Antidepressant Pros and Cons and Psychological Side Effects provide more insight on such problems and solutions for stopping. Anyone who would like copies, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. MX-23, P. O. Box 52027, Durham, NC 27717-2027.

Q. My doctor recently switched me from the cholesterol-lowering drug Lipitor to Omacor after I had a slightly elevated liver count. What should I know about Omacor?

A. Omacor is highly purified prescription fish oil. FDA approved its use to lower high triglycerides. The most common side effects of Omacor are burping or indigestion, but they are less likely with this prescription product than with everyday fish oil.

Q. I am responding to a question from a person who is going on a cruise and doesn’t want to get seasick. Suggest Bonine. This tiny pink pill is available over the counter.

It should be taken an hour before boarding the ship or you can chew the tablet as soon as you remember. The only side effect is a slightly dry mouth. I went on a cruise to Hawaii and never got sick. Bonine was my miracle tablet.

A. Meclizine is available over the counter as Bonine or by prescription as Antivert. This antihistamine has been used for motion sickness for decades. Some people experience drowsiness dry mouth, constipation, urinary retention or blurred vision.

Q. Some years ago, my mother had surgery and had a very bad reaction to the sedative Versed. The surgeon said she must never get Versed again.

A few years later, she was scheduled for another surgery. There was a NO VERSED message on her record. I insisted on going to the pre-op visit with her. I asked the anesthesiologist what he would give her. You've got it—Versed!

I told him that she could not tolerate it and to consult her chart, but he got angry with me. I finally looked him in the eye and told him that if he insisted on using Versed and something bad happened to my mother during surgery, I would come looking for him. I pulled a notebook out of my purse and wrote his name down. That convinced him.

A. The prestigious Institute of Medicine recently issued a report on the widespread problem of medication mistakes. Such errors harm or kill 1.5 million Americans annually.

The report encourages patients and their families to get involved just as you did. You may have upset the anesthesiologist, but you also may have saved your mother’s life. Others should follow your example.

Q. One of your readers complained about Zocor being left in a hot mailbox for hours. I have a question. Aren't medicines delivered to pharmacies in trucks that can get hot? How can we know if our medicines have been damaged?

A. You have identified a weak link in the drug-supply chain. Manufacturers often ship their products to wholesalers in temperature-controlled trucks. But once the drugs have been delivered, the distributors rarely ship them under such controlled conditions. Medicines may sit in a hot vehicle for hours, and we do not know if this poses a problem.

Q. I am desperate to find something that works against headaches. I have been prescribed at least a dozen different drugs for tension and migraine headaches (Inderal, Neurontin, Depakote, etc). I have also taken OTC pain relievers like Motrin (12 pills a day). Imitrex works, but only for migraines, not for the tension headaches that bother me every single day.

A. Your medications may actually be contributing to your head pain. According to headache expert Joel Saper, MD, if you take pain relievers more than two days a week on a regular basis, you may be experiencing rebound headaches brought on by the medicine. Pain-relieving medications such as Advil, Motrin or Tyelenol, or even narcotics such as Darvocet, can be responsible.

We discussed solutions to drug-induced headaches with Dr. Saper. If you would like to learn more about migraine, tension, sinus and rebound headaches, you may want to listen to this one-hour radio interview on CD. It is available for $16 from the People’s Pharmacy (CD- 572), P. O. Box 52027, Durham, NC 27717-2027 or from www.peoplespharmacy.com.

Q. Nicotine replacement therapies such as Nicorette gum are meant to be used on a temporary basis to help smokers quit. What are the effects of continuing to chew nicotine gum beyond the recommended twelve weeks? (A person I know has been chewing it for years.)

A. It can be hard to give up nicotine, whether in cigarettes or chewing gum. Nicorette gum is fairly safe but can cause side effects such as nausea, indigestion, diarrhea, headache or heart palpitations.

Gradually reducing the amount of Nicorette may ease withdrawal. Using a nicotine patch instead might help.

Q. Now that Mel Gibson’s alcohol problem is out in the open, perhaps there will be more discussion about treating alcoholism. Why don’t rehab centers use naltrexone or acamprosate for this disease?

One of my family members is being treated at such a center. I asked the counselor why they don’t use these medications and he said they make people very sick if they drink. That suggests to me that he hasn’t kept up with the field.

Please tell your readers that the new medications can be helpful. I say this because another family member uses the medication and it is working, we hope forever.

A. Thank you for highlighting the new treatments for alcohol dependence. In the old days, doctors prescribed Antabuse (disulfiram), which did indeed make people extremely ill if they consumed alcohol. Naltrexone (ReVia) works by blocking pleasurable effects associated with alcohol. Eliminating the high removes the reward for drinking.

When acamprosate (Campral) is combined with counseling or social support, it can help people who have stopped drinking avoid alcohol. There is no magic bullet, but these relatively new drugs can be useful for motivated individuals.

Q. I was on prednisone for supposedly "short-term, low-dose" treatment that turned out to be neither. I developed avascular necrosis two years after I stopped taking it, and as a result lost my hip at age 58. The package insert warns that prednisone can cause this horrible condition.

I was in excruciating pain in a wheelchair for two years before I finally gave in and had a hip replacement. Doctors prescribe this medication far too freely for non-life-threatening problems.

A. Prednisone is a valuable drug, but it may also cause serious side effects. Avascular necrosis is tissue death, especially bone, from lack of blood supply.

Prednisone can also cause adverse psychological reactions. Another reader reports: “About two months ago I had shoulder problems and the doc assured me that 5 mg of prednisone couldn't hurt. After three days I had to stop taking it. I was increasingly wired, couldn't sit still, and couldn't even rest, much less sleep.?

We are sending you our Guide to Alternatives for Arthritis with more information about the hazards of prednisone and NSAIDs and suggestions on other ways to ease joint pain. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. AA-2, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. You have suggested tonic water with quinine can help prevent leg cramps in people who are not susceptible to certain blood conditions. You also should warn against quinine for pregnant women.

My wife suffered from leg cramps when she was pregnant, and her internist recommended quinine. I checked with her OB-GYN about this advice. He said it might put the developing fetus at grave risk. P.S. 15 years later, we have a beautiful daughter.

A. Quinine comes from the bark of a South American tree, the cinchona. It was used to treat fevers and was widely used against malaria in the 19th century. High doses of quinine have caused birth defects.

Q. As a person who is both a cat lover and who has eczema and asthma, I was concerned to read the question from a grandmother worried about a cat causing her granddaughter eczema. I fear some people will use that excuse to take their cat to an animal shelter.

I have found a perfect solution. My cat is never allowed outside. Every few months, or more often if needed, I wipe him down with cat wet cloths. No problems with eczema or asthma and no need to get rid of the cat!

A. We don’t know any cat lovers who would take their cat to a shelter for fear of eczema, but we recognize this may be a concern for some families.

A pediatric pulmonologist suggested bathing the cat regularly. Now that you have told us about cat cleaning wipes, this is a much less daunting prospect.

Q. My 22-year-old daughter recently went to the doctor with a sinus infection. She was given the antibiotic Avelox. After a couple days of treatment, she felt dizzy and had heart palpitations. We took her blood pressure and it was 88/56.

We contacted her doctor and the pharmacy, but they were evasive about whether the antibiotic was to blame. She just stopped it. Now we don't know if she can ever take this medicine again.

A. Avelox and similar quinolone antibiotics (Cipro, Floxin, Levaquin) may occasionally affect heart rhythms and cause palpitations. This could lead to dizziness and lowered blood pressure.

Your daughter should be evaluated by a cardiologist to make sure she does not have a heart rhythm anomaly called long QT interval. If she does, she may well have to avoid this class of medicines and many others. Visit the Web site www.torsades.org for more information about this condition.

Q. I read in your column about someone with chronic constipation. My husband had the same problem for decades.

We were already eating a healthy diet. Now for breakfast every morning, I make a smoothie with at least two cups of mixed frozen fruit, eight ounces of yogurt and just enough white soy milk in the blender to make a nice, frothy smoothie. At night, before bed, he has eight ounces of chocolate soy milk.

This really works. All it took was the purchase of a really good blender, a six-pound bag of mixed frozen fruit and a supply of natural yogurt and soy milk.

A. We’ve never heard before that soy milk could help fight constipation. There are many other ways to solve this problem. Adding extra fiber to the diet as you have with the breakfast smoothie, may have accomplished this goal.

We have compiled many other approaches to overcoming constipation, including pumpkin-bran muffins and an applesauce-prune juice-bran remedy in our Guide to Constipation. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. GG-30, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. I just received a shipment of Zocor in the mail and it sat in a hot mailbox, probably 150 degrees, for hours. Would this harm Zocor?

A. The manufacturer (Merck) recommends storing Zocor between 41 and 86 degrees F. Chemical analysis might be needed to tell if the drug was harmed. Your story points out a potential problem with mail-order pharmacies.

Q. For over 25 years I have been using Listerine full strength in a spray bottle for sunburn. An old fisherman told me about it when I got a severe sunburn from sitting in a boat on a lake and got burned so bad that I looked like a lobster.

The people I tell say this remedy works for them too. It stops the pain instantly. I keep it in my travel bag, in a zipper-top plastic bag to avoid spilling.

I don't like Listerine as a mouthwash but it’s great as a sunburn treatment. You don't have to touch the skin and hurt yourself even more while you’re applying it.

A. This is a fascinating use for Listerine we’ve not encountered before. Perhaps the menthol or eucalyptol in the original flavor Listerine have cooling properties. Thanks for sharing your remedy.

We’d be disappointed, however, if you had many opportunities to use it. Dermatologists tell us that multiple sunburns increase the risk of melanoma and other skin cancers. Why not put a bottle of sunscreen in that plastic bag along with the Listerine, so you’ve got prevention as handy as the cure?

Q. I’d like an effective insect repellant without DEET. What can you suggest?

A. Look for new products containing picaridin (Cutter Advanced) or oil of lemon eucalyptus (Repel Lemon Eucalyptus, Off Botanicals).

Q. I have been taking atenolol in the morning and evening to reduce my blood pressure. Now my doctor wants to add additional medications because the atenolol is not doing the job.

I think the medicine is slowing me down. I am tired all the time, short of breath and depressed. My cholesterol used to be low and now it is over 250. Could any of this be caused by the atenolol?

A. There is growing concern within the medical community about the effectiveness of the beta-blocker atenolol (Tenormin) for lowering blood pressure. A review of the scientific literature (Lancet, Nov. 6, 2004) casts doubt on the drug’s role in treating hypertension.

Atenolol can cause fatigue, depression and breathing problems. Atenolol and some other beta-blockers may also raise triglycerides and lower good HDL cholesterol.

We are sending you our Guide to Blood Pressure Treatment with more information on atenolol and other drugs for this condition, side effects, and some non-drug approaches to blood pressure control. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. B-67, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Please discuss your treatment with your doctor and do not stop atenolol suddenly. That might trigger chest pain or even a heart attack. Other medicines used to treat hypertension should not cause the side effects you are experiencing.

Q. I want to thank you for writing about licorice. My husband had open-heart surgery last year. He is on so many medicines, but no one can figure out why his blood pressure won't stay down.

After reading your article, I know. He eats licorice every day. He has all the symptoms you mentioned—muscle cramps, fatigue and irregular heart rhythms. No more licorice in our house.

A. Thanks for sharing your experience. Natural black licorice is a lovely treat, but it must be eaten judiciously by healthy folks and avoided by people with heart problems or high blood pressure.

Q. My daughter's friend is pregnant and eats Vicks VapoRub. I read in one of your articles about people eating something that's not food. Is it caused by some sort of vitamin deficiency?

A. Vicks VapoRub may have many uses, but it should not be eaten! This familiar salve contains camphor, which can be toxic when ingested. Even if it didn't harm the woman herself, there is the baby to consider.

People sometimes feel compelled to eat strange things if they are deficient in minerals, particularly iron or zinc. Your daughter's friend should be tested to see if she is missing one of these essential minerals. Correcting the deficiency should ease her craving for Vicks.

Q. Several years ago, our optometrist prescribed my husband a product called TheraTears Nutrition to relieve dry eyes. The daily dose of three softgels contains omega-3 fatty acids from fish oil (EPA 450 mg, DHA 300 mg), 1000 mg organic flaxseed oil, 183 IU Vitamin E (as d-alpha tocopherol), and 20 mg mixed tocopherol concentrate (including gamma tocopherol).

The last time my husband's cholesterol was checked, it had dropped from around 250 to 150! Could TheraTears Nutrition have contributed to this change?

A. We checked with the scientist who developed this nutritional supplement, Jeffrey Gilbard, M.D. He says there are a number of anecdotal reports that this dietary supplement can lower cholesterol. In addition to relieving dry eyes, there is some data suggesting that TheraTears Nutrition may improve dry mouth symptoms in people with Sjogren's syndrome.

Q. Thank you for highlighting the fact that birth control pills reduce libido in some people. I had this problem and had to figure it out myself. Doctors sent me for psychological counseling when the problem was hormonal.

Libido does not return automatically when you stop the oral contraceptive. A short (2 or 3 weeks) daily dose of bio-identical testosterone will bring desire back. I took 1 mg (sublingual) bio-identical testosterone prescribed by my doctor and prepared by a compounding pharmacy.

Another thing about the Pill: The progesterone has a depressant effect for some people. Doctors may prescribe antidepressants instead of addressing the cause of the problem.

A. According to a study published in the Journal of Sexual Medicine (Jan. 2006), women taking oral contraceptives may have less interest in sex as well as less arousal. This seems to be caused by lower levels of testosterone circulating in the bloodstream.

The therapy that worked for you (stopping the Pill and taking testosterone for a short time) might help other women. A doctor familiar with the effects of birth control pills on sexuality should supervise the treatment. We have prepared Guides to Female Sexuality, Sexual Dysfunction and Estrogen and Progesterone for a more in-depth discussion of these concerns. Anyone who would like copies, please send $4 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' People's Pharmacy, No. WPZ, P. O. Box 52027, Durham, NC 27717-2027.

Q. Why do blood pressure readings vary so much? Mine was 124/72 in the morning and went to 144/85 in the afternoon. I don't take blood pressure pills, just OTC allergy medicine.

A. Blood pressure varies throughout the day, but decongestants in allergy pills may raise it.

Q. I recently tried Lunesta. It helped me get a good night's sleep, but for the next two days I had a horrible metallic taste in my mouth. I'd like to take Lunesta again sometime, but not enough to suffer with that taste! Is there anything I could take to combat that?

A. Nearly a third of the people in clinical trials of Lunesta reported an unpleasant taste as a side effect. We know of no way to counteract this reaction.

Q. I was diagnosed with hyperthyroidism (Graves’ disease) and prescribed Tapazole to treat it. Hyperthyroidism has made me lose a lot of weight. I’m actually pleased, because weight has been a problem all my life.

I have not been taking this medication since I worry that treating Graves’ disease might make me regain the weight. Am I harming myself by not taking Tapazole?

A. Your thyroid gland has gone into overdrive and is producing too much thyroid hormone. Although you feel well now, leaving this condition untreated might result in serious health issues such as heart failure, eye problems, extreme muscle weakness and stroke. Other symptoms include fatigue, insomnia, tremors, palpitations and trouble concentrating.

We are sending you our Guide to Thyroid Hormones for more information about Graves’ disease, Tapazole and both hyper- and hypothyroidism. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons' The People's Pharmacy®, No. T-4, P. O. Box 52027, Durham, NC 27717-2027. It can also be downloaded for $2 from the Website: www.peoplespharmacy.com.

Q. I was having trouble with hot flashes waking me and causing sleep deprivation, but my physician solved the problem. She prescribed 25 mg of Zoloft daily. She said it only works for about half her patients.

I still have an occasional hot flash, but I fall back to sleep immediately so my husband is not disturbed. It’s working for me.

A. Thanks for the success story. Many women have found that drugs such as Zoloft or Prozac can help ease hot flashes during menopause.

Q. In a column you wrote about generic drugs, you urge consumers to be vigilant. How would a consumer know if a generic drug has the proper ingredients? I would be unable to determine this. How do you suggest we exercise vigilance?

A. In many situations, you can tell whether a medicine is having the desired effect. If your blood pressure was well controlled with a brand name drug but not with its generic equivalent, that’s a red flag. The same thing would hold for a pain medicine, blood thinner or sleeping pill.

If you suspect there’s a problem, check with your doctor. Switching back to the brand name may tell if the trouble is with you or with the drug.

Many generic drugs are manufactured under careful controls. But the FDA does not have a system in place for detecting problems if an unscrupulous manufacturer decides to cut corners.

Q. Nothing I have taken for leg cramps has helped. I heard that quinine is a classic cure, but that it is dangerous. When I asked my doctor, he suggested I drink a little tonic water daily. This works, but isn’t it just as risky as taking quinine pills?

A. Some people develop a life-threatening blood disorder when they take quinine, either in tonic water or a pill. For those who are not susceptible, tonic water can be an effective remedy against leg cramps.

Q. My 26-year-old daughter has been on Effexor for a little over one year for anxiety. Recently, she forgot a dose and the following day she experienced what she described as an electrical sensation from her feet to her head. She described it as a "zing."

The sensation went away when she took the required dose that evening. She is on the lowest dose of Effexor and would like to stop taking it prior to getting pregnant. Should she be concerned about stopping this medication?

A. She should discuss her plan to start a family with her doctor, since she might need help getting off Effexor. New data suggests that when pregnant women take some Prozac-like antidepressants, the risk of heart and lung complications in newborns may increase.

The electrical “zing? she experienced is sometimes mentioned when people describe what happens when they stop taking this or similar drugs. Effexor lasts such a short time in the body that even a missed dose may trigger some withdrawal symptoms.

We are sending you our Guides to Antidepressant Pros & Cons and Psychological Side Effects for more information on advers