Ouch! That hurts!
There is an old orthopedic surgeon’s
joke about the painful Go-Go dancer’s knee, which goes, “What’s a nice joint
like you doing in a girl like this?” However, our joints certainly give us
lots of problems, especially as we get older.
The joints to give us the most worries are knees, ankles, fingers, shoulders
and hips in around that order. All of them are joints you use and need
For many of the joints it is a simple case of wearing them out. This is
especially so with the weight bearing joints such as the knees, ankles and
hips. In the perfect body scenario, your joints are designed to last you
about 80 years, hold your bottom off the ground for 80 years and move
smoothly for 80 years. Overload these joints and they wear out quicker.
Consequently, if they have become knackered by the time you are 55 then you
have another 25 years of aching joints to look forward to. Of course, the
quickest way to wear out your poor old joints is to be overweight.
In the past week I have had a couple of people come to see me to ask about
their pains. However, this is not surprising, as pain is often the
presenting symptom for many illnesses and physical conditions. For example,
the symptom of a fractured rib is pain on deep breathing, coughing or sudden
In fact, our skeletons are responsible for many of our pains. Fractures and
degenerative conditions such as osteoarthritis are certainly high in the
list of likely suspects. Gout, which produces an arthritis in the joint in
the big toe gives exquisite pain - just ask anyone who has had it!
Is it not possible to be pain-free, in today’s Blue Tooth world?
Unfortunately, the chemicals that are strong enough to mask the pain are
also strong enough to render your brain inoperative when taken over a long
I do also realize that there are times when you want “temporary” respite
from pain. The footballer with a fractured finger can have local anesthetic
injected into the fracture so that he can do the two 45 minutes halves plus
injury time and penalty shootout. That’s it. Not tablets for the next three
So why do we have “pain”? Pain is actually inbuilt into our systems for an
important purpose. Damage control! Pain is what stops us damaging our bodies
even further than they are damaged already. Let’s go back to the broken rib
scenario. Most fractured ribs are “cracks” along the long axis of the bone,
not a complete break right through, so that the ends are flapping around in
the breeze. The pain stops the unfortunate person from doing too much and
breaking it totally right through. Pain has a protective influence. With the
person who has joint pains or gout, the purpose of the pain is to stop
further damage to an already “crumbling” joint or one filled with sharp
crystals. Pain makes you rest it, so that it can heal. When you stop to
think about it, pain is good for us.
However, there are also chronic pain situations, and these are harder to
deal with. Particularly when the pain is coming from a permanently damaged
skeleton, or from a condition we cannot “cure”. This is where pain
management comes in, and it is a fairly skillful region of medicine, let me
assure you. Practitioners in this have to really understand what the patient
is going through. What happens is that we (or you) have to maximize an
ability of the body’s nervous system known as “attenuation”. This is where
the nervous system receives so much pain stimuli that eventually the pain
receptors “give up” through the overuse. However, getting to that stage is a
long and painful road itself.
Chemical assistance is needed, but it is not just a case of taking big dose
analgesics. In actual fact, much of the work in this area is with taking
agents to slow down nerve transmission and other agents such as
anti-inflammatories, which work with pain killers to make them more potent
at a lower dose (so the brain doesn’t get mussed up)! It’s not easy.
Psst! Want some cheap blue diamonds?
There has been much finger pointing at
private hospitals in the past couple of weeks regarding pharmacy prices,
from people who, quite frankly, do not take a wide enough view.
Pharmaceuticals cost millions of dollars before they are passed for human
consumption. Laboratory research is costly, and testing is even more costly.
And sometimes that testing shows that this new drug should not be released.
It may do the job asked of it, but the side effect profile is too dangerous.
Back to square one and start again! More expense.
However, “copy” drugs are really the result of stealing. The chemical in the
drug is reproduced by chemical laboratories, and sold in the open market. No
research costs, no testing costs. If copy drugs become the norm, then why
should an original research company bother manufacturing new (and better)
On another tack, how many pharmacies on your street? With so many
pharmacies, the only way they can compete with each other is on price. So
where do they get cheaper drugs in the first place?
Cheap pills for Erectile Dysfunction (ED) that seem too good to be true, are
usually just that - too good to be true! The chances are very high that they
One of the patients showed me a box purporting to be genuine brand name
Cialis tablets, which were not having the desired effect. I was immediately
suspicious as the box was not all that well printed. I was quite sure they
were counterfeit when I read the Patient Information slip. The English
grammar was incorrect, and there were spelling mistakes. Eli Lilly, the
‘real’ manufacturer does not send out mis-spelled literature with their
Eli Lilly’s website on Cialis confirms that there is fake Cialis in the
marketplace. The website suggests you ask yourself these three questions;
any “yes” answer could mean that the Cialis being sold may be fake:
1. Is the price so much lower than the price at the hospital pharmacy that
it seems too good to be true?
2. Does the pharmacy offer “soft tab” or “fast dissolve” Cialis? (Cialis
only comes in tablets. There is no such thing as “soft tab” or “fast
3. Does your local pharmacy offer “generic Cialis” or a drug with a name
that is similar to Cialis? (Such products have not have been evaluated by
the FDA for safety and effectiveness - they could be harmful.)
The World Health Organization puts the annual amount of counterfeit drugs
sales at something like $35-40 billion per year. No wonder I (and you) get
so many offers of drugs through the internet. That’s a very large pie.
The World Health Organization also estimates that one in three drugs on the
worldwide market today is counterfeit. Sometimes the fake drugs contain
toxic substances from which you can die.
Pfizer’s laboratories analyze the fakes and a representative stated, “We’ve
seen boric acid, we’ve seen heavy metals, we’ve seen road paint, we’ve also
seen floor wax to coat the pills and give them a shine. Obviously, they are
detrimental to anyone’s health.”
It is not just Eli Lilly that is targeted. Pharmaceutical giant Pfizer (yes
chaps, the makers of the Blue Diamonds of happiness) estimates its annual
losses to counterfeit drug sales at $2 billion.
However, this is actually a serious situation. The American Food and Drug
Administration (FDA) says, “Patients who buy prescription drugs from
websites operating outside the law are at increased risk of suffering
life-threatening adverse events, such as side effects from inappropriately
prescribed medications, dangerous drug interactions, contaminated drugs, and
impure or unknown ingredients found in unapproved drugs.”
According to WHO, drugs commonly counterfeited include antibiotics,
antimalarials, hormones, anti-diabetic medications and steroids.
Increasingly, anticancer and antiviral drugs are also faked. And you can add
to that, the ‘Blue Diamonds’ and all of the Indian knock-offs. Never forget
the phrase “Caveat emptor” (Let the buyer beware).
If your local pharmacies will offer you ‘name brand’ medication that is
supposedly prescription only at a very cheap price, that should ring alarm
bells in your head too.
Get your medications on a doctor’s prescription from a pharmacy you can
trust. Or suffer the consequences.
Do you wear secondhand clothes? Do you breathe secondhand air?
This week’s column is aimed at parents,
and in particular parents who smoke. In the research by the Royal College of
Pediatrics and Child Health, where their president Dr Hilary Cass said,
“Levels of tobacco smoke in a car can be even higher than in a smoky bar and
the effect on children can be serious, with second-hand smoke strongly
linked to chest infections, asthma, ear problems and cot deaths. The
(British) Government’s recent advertising campaign has tried to expose just
how damaging smoke in a confined space is for children. But we’ve long
campaigned on this issue and are calling on Government to go the extra mile
and make it illegal. You can’t smoke in public places anymore. It’s illegal
to inflict your smoke on colleagues at work. So why should you be allowed to
inflict it on children?”
I think most of the readers of this column know my position on smoking, as I
am very much against it, but being a pragmatist, I do not try and push the
message too hard with adult smokers. They have heard all the statistics and
have made up their own minds. I am not going to do a Joan of Arc over it.
However, it has been known for many years that children in smoking
households suffer from more respiratory problems than the children from
non-smoking households. “Thorax” the International Journal of Respiratory
Medicine stated 14 years ago that “Previous reviews in this series have
shown that parental smoking is associated with an increased incidence of
acute lower respiratory illnesses, including wheezing illnesses, in the
first one or two years of life, but does not increase the risk of
sensitization to common aero-allergens, an important risk factor for asthma
of later onset. Prevalence surveys of school children suggest that wheeze
and diagnosed asthma are more common among children of smoking parents, with
a greater increase in risk for more severe definitions of wheeze.”
I think you should just accept that at face value, do your own ‘googling’ if
you like, but undoubtedly cigarette smoke and children is not a good mix.
With the details that levels of cigarette smoke in closed cars is higher
than in smoky bars, this should ring some warning bells.
As I said at the beginning of this article, I do not try and push the
message to adult smokers, so please do not give me a barrage of ‘hate mail’.
However, if this item about kids and smoking has hit a nerve, here is the
truth on stopping smoking. The success rate really hangs on commitment.
Leaving aside hypnosis and acupuncture, about which I know very little, but
the good books tell me do not enjoy high success rates, let’s look at the
other methods. Nicotine Replacement Therapy (NRT) gums and sprays make
Nicotine available for you in measured doses - much like cigarettes do. You
get the craving, you chew the gum. You get the craving, you squirt the
Patches are slightly different. They deliver the Nicotine slowly over a 12
or 24 hour period, supposed to stop the craving before it happens. But often
do not. After stabilizing on the NRT it is time to bring the dosage down,
which is the next hurdle at which many fall. The end result can be cigarette
smoking plus NRT - a potentially fatal combination. In fact, I strongly
believe that NRT should only be done under close medical supervision. Too
much nicotine can kill too!
So what is the best way? It’s called Cold Turkey. The proof is in the
numbers. There has been enough research done and the prime factor is that
the quitter has to be committed to the concept of becoming a non-smoker.
Doing it (quitting) for somebody else, because you lost a bet, because you
are being nagged into it by your wife, girlfriend, boyfriend is doomed to
failure, I am afraid. This is something which requires your total
commitment. 100 percent all the way.
Cold Turkey demands you stop immediately. Go through any withdrawals. Come
out the other side as a non-smoker and you can stay that way for the rest of
your life (and your children’s lives).
Living longer by living well
There are no secrets to long life, and
I can help you live longer - but there are some secrets to getting the
Quality of Life.
Long life without having Quality is not worth it. Nobody wants to end up in
a wheelchair, or even worse being alive but bed-ridden.
Live longer by knowing your own body. There are certain items in your
make-up that you should know. These include your blood pressure, your blood
sugar, your cholesterol, your liver enzymes and your hormone levels.
The key to good health comes in early warnings, but there are silent
conditions which don’t give you a warning.
Blood sugar can go up by 10 percent a year and you will not know it.
Blood pressure can go up 10 percent a year and you will not know it.
In 10 years the levels have doubled and you will be in trouble.
Cholesterol will go up. Liver enzymes go up, but you won’t know about it.
However, hormone levels will fall and you will feel yourself slowing down,
but you will put it down to getting older, when it does not need to be.
So how do you make sure you get the warning? To get the warning - go
looking! Under the age of 40 have a medical every two years (unless you are
a smoker). Over the age of 40 have a medical every year.
Let’s look at what happens as you get older:
Immune system aging
Decreased kidney function
Increased autoimmune diseases
Decrease of Cardiac function
Increase of CV risk
Increase of blood pressure
Loss of calcium from the bones
Loss of elasticity in the skin and ligaments
Changes in hormonal secretion
(Reading that lot could be depressing!)
Your hormones include
Looking at Growth hormone Function
Administration of Growth Hormone in a British study claimed
72 percent Decrease of Body fat mass
81 percent Increase of Activity
71 percent Improved Skin elasticity
68 percent Increase of skin texture
71 percent Improved Fibroblast number
51 percent reduced wrinkle depth
38 percent increased hair growth
(Growth Hormone is looking good, other than the fact there are side effects
like increasing cholesterol and a tendency towards diabetes, all of which
Now Testosterone Function
Deficiencies in the hormone can lead to
Loss of Libido
Increase in upper body and abdominal fat
However, Testosterone should only be used when a deficiency is shown on
blood tests, not as a hoped-for willy stiffener.
Now for Progesterone
Progesterone is a hormone that stimulates and regulates important functions,
playing a role in maintaining pregnancy, preparing the body for conception
and regulating the monthly menstrual cycle.
However, the U.S. Food and Drug Administration (FDA) now advises health care
professionals to prescribe menopausal hormone therapies at the lowest
possible dose and for the shortest possible length of time to achieve
treatment goals. If you are taking hormones, you should re-evaluate your
treatment with your health care professional every six months.
What about obesity? Being overweight puts a great strain on your joints -
hips and knees, and a strain on your heart. Not good for longevity.
So what is “good” to eat?
Dieticians claim that Boron protects your prostate
Calcium to strengthen the bones
Chromium prevents Diabetes
Co-Enzyme Q10 boosts energy
Creatine boosts muscle and memory
Folic acid lowers the chance of Alzheimer’s Disease
Glucosamine helps the joints
Omega 3 oils protect the heart
Selenium fights cancer
Vitamin E slows the effects of aging
But all this is theory, rather than clinical, but in low dosages probably is
good for you.
The best news is that there is a powerful antioxidant in grapes and red
wine, called Resveratrol, that may help lower your odds of getting cancer,
heart disease, and premature aging.
So what can you do to increase your life span?
Moderation in all things is a start.
Do not smoke
Exercise daily (swimming is best)
Eat a healthy diet
Maintain a ‘healthy’ weight
Look for ‘silent risks’ by having annual check-ups
Correct those risks
Change to a healthy lifestyle - starting today
Drink Red Wine! The Stonefish 2010 Merlot is my favorite.
Take this tablet three times a day
I received notice the other day that
they have found a cure for Alzheimer’s Disease. But reading further, they
haven’t! However I’ll tell you more about that next week.
Read any of the popular press (as opposed to the scientific medical press
such as the Lancet, for example) and you will read about vaccines
being developed to save us all from AIDS, cancer, next year’s elephant flu
Unfortunately, the next generation vaccines and drugs are still in the
testing phases, because they need rigorous testing. Remember that in 1976 a
vaccine was rushed through by order of an American president, and I believe
more people died from the vaccine than died from the flu from which it was
supposed to protect the public. It also left a large number of people with a
nasty condition called the Guillain-Barre syndrome, and about 30 percent of
those with Guillain-Barré still have a residual weakness.
Have you ever wondered just how a new drug finds its way on to the
pharmacist’s shelves? Just how do the pharmaceutical companies manage to
develop newer vaccines and drugs such as ACE inhibitor antihypertensives
when there were already plenty of alternatives? Or the apparently stiff
competition in the drugs for males with Erectile Dysfunction.
However, when any new medication is formulated, there begins a very long
process before the new “wonder drug” is licensed for use by the public. Part
of that process is testing the compound on live beings. Note I did not say
“human” beings. Those live beings are usually convenient test animals, of
which Mr. Rat the rodent is a prime example.
We always need to know how poisonous the new drug is. Mr. Rat is then fed
the new compound in ever increasing quantities until the dose high enough to
kill 50 percent of the rat population is reached. The scientists call this
the LD50 (Lethal Dose for 50 percent) for the new compound - but remember
this is for rats. If it takes 10 mg of compound A to kill 50 percent of the
rats, but only 1 mg of compound B, then B is 10 times stronger than A.
Pregnant Mrs. Rats are also fed the new drug and the offspring are
thoroughly examined to see if there are any abnormalities, greater than the
‘normal’ amount of expected abnormalities. Yes, no animal, including us, is
without a usual percentage of birth abnormalities. Laboratory rats in
particular are well known for being able to develop all sorts of
abnormalities if you even just look at them sideways!
Only after this exhaustive testing is the drug then used in limited test
runs on a very limited human exposure group. And, by and large, that does
not include testing on productive age females.
All this takes an enormous length of time, so next time you read of the new
wonder drug “breakthrough” do not expect that this will appear in the
pharmacy next week. Unfortunately too, many of these new drugs will end up
never being released as further examination and research often turns up
problems that only made themselves apparent after long term usage.
However, even the ones that do get released have to be approached with
caution. Just because rat testing appeared to show that the drug was “safe”,
does not mean that humans will also react the same way. However, man (or
woman) is not a large rat! This is one reason why women in particular must
be very careful with the drugs they take during pregnancy, particularly in
the first three months, that time when the growing fetal structures are
susceptible to toxic chemical damage. In fact, any woman who has to take
regular medication should ask her obstetrician about the relative risks.
However, this does not mean stop taking the tablets as soon as you miss a
period. Letting the maternal problems run unchecked can be an even greater
risk to the baby than the risk from the medication taken by Mum.
Antenatal care is a very specialized branch of medicine and I do recommend
you should ask your obstetrician for advice. You may not be a rat - but you
don’t want to be a guinea pig either!