Grapefruit Warning

Maybe all you Lipitor-takers are aware of this, but this was news to me.

Patients taking many common medications should be weary of consuming grapefruit. Grapefruit (and grapefruit juice and grapefruit supplements) interact with these medications preventing (as I understand it) a liver enzyme from metabolizing the medication and thereby creating unsafe levels of the drug in the body.

Medications that may be affected include

• Anxiety: Xanax, Buspar, Versed, Halcion
  
• Depression: Luvox, Zoloft
  
• Allergies: Allegra
  
• Abnormal heart rhythm: Cordarone, quinidine
  
• Heart disease/stroke/blood clots: Coumadin
  
• Epilepsy: Tegretol
  
• Cancer: Cyclophosphamide, etoposide, ifosfamide, tamoxifen, vinblastine, vincristine
  
• Cough: Dextromethorphan (found in many over-the-counter cold medicines)
  
• HIV: Agenerase, Crixivan, Viracept, Norvir, Fortovase
  
• Prostate enlargement: Proscar
  
• Heart disease/High blood pressure: Coreg, Cardizem, Plendil, Cardene, Adalat, Procardia,
• Nimotop, Sular, Covera, Calan, Verelan
  
• Erectile dysfunction: Viagra, Cialis
  
• Asthma/Emphysema: Theophylline
  
• High cholesterol: Lipitor, Lescol, Mevacor, Zocor
  
• Pain: Alfenta, Duragesic, Actiq, Sufenta
  
• Infection: Biaxin, Sporanox, erythromycin, troleandomycin

Often, a patient can be switched to another drug in the same class that will not interact. (For instance, Pravachol is less likely to interact with grapefruit.) There is some evidence that adjusting the time you eat grapefruit and the time you take your meds may be effective. (This is inconsistently supported in the research.)

As always, ask your doctor and/or pharmacist. Make sure he's aware of all supplements, etc., you are taking. Make sure YOU understand any warnings, precautions, etc., that may accompany your medications.

For more information check out the following links (provided by my dietician cousin!)

• http://cholesterol.emedtv.com/lipitor/lipitor-and-grapefruit.html
• http://www.cbsnews.com/stories/2005/01/20/health/webmd/main668105.shtml

Advocacy: YOU are your only friend.

OK, so I exaggerated a little in the title, but I want to make a long-overdue point on here. Many of you have learned the hard way. Some of you may not have learned this yet, and in that case, you probably think I'm overreacting. I can assure you that the point I make is valid.

YOU are your best advocate. While there are people who advocate for the patients in a hospital, no one in that hospital has the sole responsibility of being YOUR advocate. I see people every day who are consenting to procedures, being prescribed medication, attending therapy, etc., who don't truly understand why they are doing what they are doing. I have even seen very bad examples of this. I have seen patients who consented to procedures only to regret that decision when they come out of surgery and realize the extent to which they've committed.

Hospitals are here to care for patients. They are here to make money while they care for patients. They are here to make more money than last year by caring for lots of patients. They are going to make mistakes at times and cut corners at times. You can't fix that. You can, however, do everything in your power to make sure that someone is fighting for YOU.

I'm not trying to "dog" the hospitals. A hospital pays my salary. I enjoy my job. Please do not misconstrue my comments. I simply urge YOU to fight for what's best for you. This means making sure you understand what the doctor diagnoses you with, what he/she proposes to do, and what that means for you (rehab time, deficits expected, cost, changes to your level of independence, how it affects the rest of your health/other diagnoses, etc.). Too few patients take the time to talk, and I mean truly converse, with their health care professionals. While the doctor is a busy man (or woman), YOU (and your insurance company) are paying him for a service. You wouldn't let the painter change paint colors without telling you why, would you? If the doctor honestly doesn't have time or can not explain it to you in a way you can understand, ask to have someone else come by (e.g., social worker, case management nurse, physical/occupational therapist, speech-language pathologist, etc.). If you have to play the bad guy, do so. I caution you to do so with respect and kindness (if possible), but do so.

[now leaving my podium and stepping off the soapbox]

Why I'm not Jordan (or Beckham, if you prefer)

A member of our local stroke group emailed me this health article. (Read it here.) It details how myelin works in the brain and how it begins to deteriorate as we get older. It speculates that perhaps Michael Jordan has more myelin than the average Joe. (OH! That's why the NBA never called me. . .I don't have enough myelin. . .)



The article has practical tips for improving brain health (although not a lot. . .). It also discusses the importance of omega-3 fatty acids in brain health. (It's at the bottom of the page. For some reason, Michael Jordan is discussed way more than actual health info. . .) You can read more about the health benefits of fish oil HERE (and more importantly, it contains lots of links to other articles/studies/sites, etc.).



I was always kinda skeptical of supplemental fish oils. . .I mean, gross. However, I am now taking them, and they're really no different than other kinds of supplements. They are very important for stroke survivors to consider, but as stated below, check with your doctor. You also want to evaluate your options in regards to the various brands of fish oil.



(I strongly encourage you to discuss your health options with your health professional before beginning any new regimen--supplements included!)

update

Our stroke group met last night. We will be continuing the book next month, because we didn't have enough people who had finished the book.

We've been doing several community outreach projects to educate the community about strokes. What about you guys? What are your ideas for creatively getting the message out about strokes? We've hit the typical: health fairs, doctors, radio, etc.

Book Questions

Ok, you caught me. I haven't finished the book yet. These are the questions I have come up with so far. Please think about these as you read the book.

1. How was Ms. Bolte Taylor's stroke like you own?
2. How was it different?
3. How was your treatment/rehab different from Ms. Bolte Taylor's? Do you think the type of treatment she endorses would have worked for you? Why or why not?
4. Do you think this would be a good book for a recent stroke survivor or their family? Why or why not?
5. What did you learn from this book?
6. What would you like your healthcare/rehab professionals to know from this book? Do you think this is an appropriate book for healthcare workers?
7. Who did you feel was the intended audience of this book?
8. Summarize (or at least think about) the theory behind this book. How do you know? Do you feel this book is scientific/factual or intended as a memoir?
9. If you were to write a book about your experiences, what would you tell people? OR What would you want people to learn from your experience?
10. What would you like to read/watch next? (Movies are ok, too.)

Reflux

I attended a wonderful course this weekend. I won't bore you with the details (i.e., esophageal swallowing function, saliva production, etc.), but I would like to mention some facts on GERD and LPR.

GER or gastroesophageal reflux is when stomach acid and stomach contents move backward and into the esophagus. We all have that at some time, however, when it becomes regular it can become very damaging. This is then called gastroesophageal reflux disease or GERD. It can even cause or exacerbate failure to thrive, anemia, apnea, pneumonia, and even cancer of the esophagus. LPR or laryngopharyngeal reflux is when the backflow of acid travels to the level of the throat (or above).

GERD can become silent, while you battle many of the symptoms wondering why you have such a hoarse voice or difficulty swallowing, etc. If you feel you have reflux, I urge you to contact your doctor. Left untreated, it can create many health problems. Treatment often involves making environmental changes (e.g., diet changes, looser clothing, eating at a different time, etc.) and medications (OTC or prescription).

Before this course, I had no idea how many things could be attributed to reflux symptoms. I was left to wonder if my daughter doesn't have reflux instead of or in addition to the asthma symptoms we've witnessed the last couple of months. Resources mentioned during the course included gastroatlas.com and heartburnalliance.org.

As always, this information is in no way intended to diagnose or point you to any one treatment. Please seek the advice of a medical professional before beginning any type of medication, medical treatment. (How's my lawyer-ese?)

How I met your mother makes blunder

Check out Sara's post on the poor wording of the cbs show How I Met Your Mother. If you want to contact CBS, I've sent a message to Sara and will post that contact info as soon as I get it.