The Nation Newspaper

Category: Family Health

  • Odd Hypnic behaviour: Bruxism

    Bruxism is the act of teeth grinding or gnashing during sleep at night.  Teeth grinding can be voluntary or involuntary. Dogs can do it.  Humans can do it.  In some cultures (possibly more in past civilizations), it may be routinely used to manifest anger.  This means it could also be a learned behaviour and cultural expression. In the Middle East, it might have been routinely used to show anger or distress.  The famous words of Jesus about the damned: “…there will be weeping and grinding of teeth” indicates that people of those days were familiar with the act of grinding of teeth and the act connoted a feeling of anger or distress. It possibly would take extreme emotion such as when damned for any human being to grind teeth, physical or spiritual teeth (God forbid bad ting, as Nigerians say).  However some people more readily grind their teeth physically with life’s common stressors. The reasons for this could be genetic, biological, mental, or spiritual.  It is not well understood scientifically or in any other specialty. However some believe that teeth grinding is a primitive reflex.  How the reflex is triggered is unknown, especially the night time occurrences. Bruxism as a hypnic behaviour may be manifested involuntarily during sleep when one is saint or when one is sinner.  Some recreational drugs such as stimulant ecstasy, cocaine, methamphetamine and heroine all increase bruxism.  Severe bruxism can be caused as a side effect by selective serotonin reuptake inhibitors used clinically as antidepressants.  Broxomania refers to daytime teeth grinding expressed during intense emotion.

    Nowadays, teeth clenching is perhaps the more common expression of anger, hostility, frustration, distress, hatred, etc. in healthy persons.

    Wikipedia tells us that “In the beginning of the twentieth century, Moritz Karolyi, a Viennese dentist, described bruxism as “traumatic neuralgia” and stated “it was the cause of a periodontal condition called pyorrhea (periodontitis).””  Bruxism and bruxomania wear off the hard enamel cover of the teeth, make the teeth sensitive and decay fast because the inner dentine and nerves become exposed and also cause jaw  joint or neuromuscular pain (temporomadibular joint (TMJ) discomfort).

    A feature of bruxism is unconscious repetitive contraction of the masseter muscle. Botulinum toxin (Botox) injected into the masseter muscle weakens the muscle spasms but does not prevent normal utilization of the muscle.  Botox has been successfully used to relieve the symptoms of bruxism.

    Magnesium deficiency is thought to contribute to muscle spasms of bruxism.  Calcium disorders are also suspect.  Magnesium and calcium are both important for proper nerve and muscle functions.

    Examples of devices that can been worn on the teeth during sleep at night are the generic  bite guard or teeth grinding night guard, they limit the erosion of the teeth when a person in bruxing.  To get a comfortable one, one needs to visit the dentist to mold a custom fitted guard. 

    For severe cases a pharmacist may give a sufferer a supplement such as Magnesium and Rhodiola.  A dentist may provide a biofeedback device which includes having an electronic device near one’s face while sleeping. Migraine Relief|NTI-tss Plus™ by Keller Laboratories helps reduces muscle contractions and prevents migraines and has been found to also reduce bruxism. Physiological dentists specialize in various treatments involving facial muscle and orthodontics that may eventually stop a patient bruxing. 

    A psychologist, religious counsellor, career or professional counsellor, social counsellor, certified hypnotist and other behaviour modulators can help one reduce one’s emotional stress or change one’s experience of stressors.  Acupuncture techniques have also been used for bruxism and TMJ discomfort.

    A person on social drugs such as ecstacy and amphetamine should do what is necessary to cease the habit.  Exercise is important for relieving stress as it can be a mental distractor from stressful thoughts, it stimulates the circulatory and immune systems and bodily fitness. Cognitive behavioural techniques, relaxation techniques, daily meditation, quiet focussed prayer at the end of each day or beginning of each day or both, relaxing shower or bath at bedtime  –  all help to normalize our emotions and our processing of stress and may help prevent bruxism.

    One suffering TMJ discomfort and cannot get clinical assistance may try such remedies as applying ice or a towel heated in hot water to the sore jaw muscles, avoid eating hard foods or chewing gum, massage facial, neck, and shoulder muscles.  Massage helps to increase circulation of blood in the area which brings nourishment as well as removes both metabolic waste product s and inflammatory mediators.

    Doctors prescribe inhibiting drugs such as hypnotic-sedatives such as benzodiazepines, anticonvulsants that reduce neuromotor function, muscle relaxants, beta-blockers, dopamine agents, and serotonin agents such as buspirone.  Some of these drugs are addictive and cannot be given long term. They alter the emotions, brain firing, autonomic transmission, and other nerve functions. Examples of drugs prescribed by doctors are gabapentin, pergolide, clonazepam, tiagabine propranolol and clonidine.  Herbs and essential oils that reduce anxiety and promote deep sleep are also used for bruxism.  Examples are hops, valerian, skullcap, chamomile and the oils of lavender and chamomile.

    Teeth grinding is only a health problem if it is severe enough to erode the teeth and cause decay or if it precipitates painful jaw problems.  For most people experiencing it is an inconsequential natural phenomenon.

    Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis.  For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 08160944635

     

     

  • Hypnic headaches

    Headaches are almost a “normal” part of life as most people experience a headache, here and there and once in a while.  One might not feel sorry for someone with a headache in the way we feel sorry for someone who is bleeding.  But head ache is a medical problem that needs attention. Headaches tell us that something is wrong inside our bodies: the composition of blood or other body fluids is unbalanced, the nervous system has gone haywire, there is tension in some muscles, the hormones are disturbed, some minute creatures, poison, or abnormal cells have invaded our body, we need to rest, we need to sleep, we need to eat, we need to drink, etc. Head ache may be simply a body alarm that tells us to take care or it may be a component of disease, or an actual disease.

    We need to be concerned about certain types of headaches and headache issues such as a change in the pattern of headaches, headache that is progressively worsening, severe headache, headaches starting after in midlife, headache that is aggravated by coughing or movement, headaches that affect our mental function or daily activities, headache with painful red eye, headache with pain near the temples, headache after an accident or a blow in the head, headache with fever, stiff-neck, confusion, loss of memory, visual disturbances or other symptoms, and headache associated with cancer and other diseases.  All such headaches require careful clinical attention.

    The hypnic headache is mysterious, as mysterious as the darkness of night, when it happens.

    Your doctor can determine if your headache is hypnic headache or headache associated with a disease.  The history of your night time habits, sleep habits, sleep patterns, including snoring and restlessness.  The doctor needs to exclude secondary causes of headache such as brain tumors, inflammation of blood vessels in the head, and sleep apnoea (lack of oxygen during sleep).  If you have been taking a drug and you stopped the drug recently, the headache may be a withdrawal symptom and the doctor can help to deduce such matters.

    A person may already have headaches during the day such as migraine and cluster headaches and these can continue at night to wake the person up.

    Headache may be derived from the way we sleep: sleep posture, type of pillow, and other factors that cause tension around the head. Have as many pillows as you need for comfort.  Examine the form of your mattress.

    Environmental factors may also be a cause of headaches at night, especially if the environmental factors are peculiar to the night time. You must check your bed or sleeping environment. Many pests and parasites that bite release toxins into the human body which are carried around in our blood.  Bed bugs, ticks, spiders, scorpions, flying biting insects are all guilty and most of them parade around us and feed on human blood at night when we are sleeping.  Periodic cleansing of the sleep environment is necessary.  There are sprays and powders used for bed bugs.  You can deal with flying insects by keeping an electronic fly catcher on in your environment.  There are some simple and cheap products that most people can afford.  However this remedy depends on the availability of electricity that these devices require to work.

    One very important environmental factor is the air we breathe. If the air in our sleeping environment is highly polluted, we are bound to suffer some symptoms.  Some homes are mouldy.  Coming home from work to dwell in mouldy air and sleeping in mouldy air may lead to symptoms at night. Some landlords will not budge to solve such problems.  If you unavoidably have to live in such a condition, you must keep your windows open for fresh air and screened against biting insects.

    Hypnic headaches (not due to environment or other disease conditions) occur only at night.  They wake the sufferer from sleep usually at the same time (such as between 1-3 am) and are thus called alarm clock headaches.  It is most common in people older than 50 years.  More women than men have it. A person should be able to go back to sleep after the pain of an attack subsides.

    Hypnic headache must be clearly distinguished from any other form of headache before embarking on treatment.  Doctors may recommend that patients with hypnic headache use caffeine.  Drinking coffee at bedtime or taking the pain reliever indomethacin at night may be helpful.  If you have hypnic headaches and have had a history of peptic ulcer, you should avoid indomethacin as this drug can cause recrudescence of the ulcer.

    An alternative treatment for hypnic headaches is lithium carbonate which is a prescription drug. Some patients may find this drug intolerable and it should not be used by older adults. Patients on lithium have to be clinically managed with blood tests to keep level of lithium in the blood in safe limits. For those who cannot tolerate lithium, the prescription drug flunarizine may be used at bedtime.

    Hypnic headaches can be stopped or controlled if we study and change our life habits and environments and have a regular medical check-up.

     

    Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis.  For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 08160944635

     

  • SFH, Novartis Social School Business partner to fight diseases

    Society for Family Heath (SFH), a Non-Government Organisation (NGO) and Novartis Social School Business has partnered to fight cardiovascular diseases, type 2 diabetes, respiratory illnesses and breast cancer.

    The collaboration which took place in Abuja last week permits SFH to distribute Novartis Access medicines to patients in some of its partnering health facilities and it would take place in eight states of Nigeria.

    As first treatments will start reaching patients in the upcoming months at a final cost of up to 2.21 dollar per month, SFH expects to possibly reach more than five million patients.

    Beyond distribution of medicines, SFH would also train healthcare professionals on NCD screening, diagnosis and treatment, quality assurance, provide community education and awareness.

    The Managing Director of SFH, Sir Bright Ekweremadu said that Nigeria is increasingly affected by the burden of non-communicable diseases as lifestyles and habits become more sedentary,  “We have been working  for more than 30 years to help Nigerians, particularly the  poor and most  vulnerable, to leave healthier lives including by improving  access to essential  health services. This collaboration with Novartis Social Business is part of the solution to the challenges of the poor who are most at risk of NCDs,” he said.

    According to the statement signed by Media Relations, SFH, Mr Donald Etim, cardiovascular diseases are the deadliest set of NCDs in Nigeria responsible for seven percent of deaths.

    Cancer accounts for three percent of deaths, diabetes accounts for two percent of deaths, chronic respiratory diseases account for one percent of deaths and other NCDs account for eleven percent.

    Dr. Omokhudu Idogho, Deputy Managing Director, Social Business Enterprise, said that since inception, SFH have conducted hundreds of programmes throughout the country in collaboration with both public and private partners in areas such as family planning, HIVmand AIDS, malaria,  tuberculosis, maternal and children health, “As part of our strong commitment  to achieve Universal Health Coverage (UHC) in Nigeria, we  are working to  promote disease prevention, facilitate access to basic  healthcare and life-saving medicines in both urban and rural areas, conduct  health education  and awareness, and strengthen service capacity with key  focus on health care  facilities and workers. The partnership with Novartis Social  Business will help  us put our expertise and experience behind a programme that  will help poor populations get diagnosis and access to key medicines to treat chronic diseases in Nigeria, which are often responsible for catastrophic health expenditure,’’ he added.

    Dr. Parfait Touré, Head of the West and Central African cluster for Novartis Social Business said the company is pleased to help Nigerian patients manage their chronic conditions,  “We believe new approaches such as our Novartis Access portfolio that bring governments, the  private sector and social sector together are needed to  expand access to  medicines and healthcare delivery in our countries,’ he said.

    This collaboration places Nigeria in the fifth position as one of the countries in Africa after Kenya, Ethiopia, Uganda and Cameroon to sign an agreement to distribute Novartis Access treatments against chronic diseases.

  • Possible drug-drug and drug- food interactions in every day life

    When we take a drug we expect it to cause an effect.  This effect can be altered by the presence of another drug.  This is called drug-drug interaction.

    Drug effect can also be altered by the presence of food substances.  This is called drug-food interaction. The interaction of another drug or food can increase of decrease the effect of a drug.

    Interactions must be avoided for a drug that has a narrow therapeutic index.  This means that the effective dose of the drug is close to the toxic dose of the drug and the presence of another drug or food substance that causes an increase of the drug in the body easily leads to toxicity reactions.  For example, at the therapeutic dose, warfarin prevents blood clots and stroke but at a slightly higher dose, it will cause excessive internal bleeding.  The toxic dose is close to the therapeutic dose and its therapeutic effectiveness can be disturbed by various drugs resulting in either increased clotting or increased bleeding.

    Interactions should also be avoided for drugs that are life sustaining or important for sustaining an important biologic function.  For such drugs, if their effects are eliminated by drug-drug or drug-food interactions, there can be serious consequence, life threatening crises, or even sudden death. For example if the effect of blood thinner warfarin should fail, a person who is prone to blood clots may end up with a stroke.  If the effects of an antiepileptic drug should fail a person may end up with a seizure while driving or while operating a dangerous machine.  If the effect of an oral contraceptive should fail, a person may end up having an abortion. Various foods, vitamins and dietary supplements, herbs in foods and herbal medicines, alcohol, and tobacco have a potential for interacting with our common drugs but more often than not, this is of no consequence. Some interactions, however,  should not be overlooked.  For example, the antibiotics called fluoroquinolones, such as ciprofloxacin, bind to calcium and iron in food or multivitamin products. This can prevent the antibiotic from being well absorbed. If the effect of an antibiotic should fail, an infection can overwhelm the body.

    Some foods are noteworthy. For example, grapefruit juice inhibits the activity of the liver enzyme called cytochrome P450 3A4 (CYP3A4).  This enzyme is important for the processing (metabolism) of certain drugs and toxins.  Thus the target drugs will not be adequately metabolized for excretion and may become toxic in the body.

    Pharmacologists study the effects of drugs on the body and this is called pharmacodynamics.  When a drug relieves a headache, this is a pharmacodynamic effect. Pharmacologists also study the effects of the body on the drug and this is called pharmacokinetics. When the body destroys the drug and eliminates it in urine, these are pharmacokinetic effects.  Drug-drug interactions can be at the level of pharmacodynamics or at the level of pharmacokinetics.  The presence of a second drug or food can change the pharmacodynamics or the pharmacokinetics of a first drug.

    Pharmacokinetic drug-drug or drug-food interactions can be at the level of drug absorption from the stomach or intestines, distribution of the drug around the body, or at the level of processing of the drug by liver enzymes and elimination of the end products by the kidney which forms urine.  Thus the normal destination of the drug within the body can be changed by another drug or by a food substance.

    Mid-lifers who have chronic non-curable illnesses or medical conditions such as diabetes and hypertension have to take a drug for a long time or for life and are often given multiple drugs.  They have a continual chance of drug-drug and drug-food interactions if they liberally take other drugs, especially non-prescription drugs. Many adults buy over the counter drugs and may use several different drugs at once in self-medication.  This entails a risk of drug-drug and drug-food interactions.

    Elders tend to have altered liver and kidney functions that affect the way drugs are processed and eliminated from the body.  Hence, drug-drug and drug-food interactions may affect an elder specially.

    Serious consequences of drug-drug and drug-food interactions include sickness and absence from work, life threatening conditions, hospitalization, disability, and death.

    Doctors know how to deal with possible drug-drug interactions. For example, they may adjust the dose a drug, adjust the dosing times of different drugs, and monitor various parameters of a patient.  However drug-drug interactions and drug-food interactions that may occur from non-clinical self-medication is something we should all watch out for.  We were taught to give thanks and pray before meals.  Indeed, now we know we should pray with everything we consume, including drugs.  Next, we consider specific examples of interactions.

    Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis.  For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 08160944635

  • Drugs you should not combine: Benzodiazepines

    Modern life is demanding on our physical, mental, and spiritual framework.  Many of our lives are naturally full of cares.  Professional cares, family cares, home cares, social cares, financial cares, as well as heath concerns. Professional cares can keep us awake at night burning the midnight oil.  Financial cares are perhaps primary for many people until they become stable in midlife.

    Family cares are complex and none is exempt.  Taking care of property, paying rent, keeping up with taxes and licenses, and registrations and school fees, and those factors that give us good social standing are endless cares. Then there are unexpected cares.  From repair of shoes and clothing to repairs of the car, generator, pump, electronics, it seems there is always some extra work, extra expense, extra demand on our time and life from unexpected sources.  No wonder drugs used for anxiety are commonly used in today’s world.

    Anxiolytic, antianxiety, sedatives drugs (that calm) and hypnotics drugs (that induce sleep) can be found in most homes today.  A very popular group of anxiolytics/hypnotics is the benzodiazepines.  Benzodiazepines such as diazepam and lorazepam are used to calm oneself when one has been worked up into a stat of anxiety.  Benzodiazepines such as temazepam, lormetazepam, nitrazepam are used to force oneself to sleep when sleep just won’t come.

    Benzodiazepines, though they are controlled substances, have become a  widely utilized group of drugs.   In general, the different drugs in the group benzodiazepines are respectively used for different conditions.  Some aresedative-hypnotics for sleep, some are adjuncts to anesthesia to induce relaxation and amnesia (procedural memory loss), some are anxiolytic, some are used for panic disorders, some are used to treat  seizures, some are used in the process of  alcohol withdrawal, and some are muscle relaxants.

    Because these drugs are ubiquitous, we need to educate our households about them.  Youths tend to experiment socially with these drugs.  Apart from the fact that some of them are used nefariously as date rape drugs, for mind control, and for other crimes, when mistakenly used by innocent members of the household, deaths can occur.

    Some of the well utilized benzodiazepine medications are Restoril (temazepam), Halcion (triazolam), Dalmane (flurazepam), ProSom (estazolam), – all used for insomnia to promote sleep; Serax (oxazepam); Versed (midazolam); Tranxene T-Tab (clorazepate), Niravam, Xanax (alprazolam) used for anxiety and Valium (diazepam); Ativan (lorazepam) used for both anxiety and insomnia.  Others such as Klonopin (clonazepam).are used for seizures and may not readily be found in households.

    As much as possible, benzodiazepines should not be used in conjunction with any other drug.  In particular, they should never be used with other commonly used drugs: barbiturates, pain killer opioids, or alcohol -all of which also depress the central nervous system (brain and spinal cord).  Benzodiazepines should not be combined with drugs that have central nervous system actions such as tricyclic antidepressants.  If these drugs are to be combined, it should be under careful clinical care.

    A member of the household should not just take a “sleeping pill” or a sedative just because he or she thinks he or she needs it.  Some benzodiazepines (diazepam, chlordiazepoxide) are converted to active metabolites in the body and these metabolites remain in the system making these drugs long acting.

    READ ALSO: The scourge of drugs: at what cost?

    Temazepam may be more toxic than most benzo diazepines if given in high doses, for too long, or in conjunction with other drugs.  The symptoms of a benzodiazepine overdose or drug-drug interaction toxicity may include; drowsiness, slurred speech, nystagmus, hypotension, impaired motor coordination, coma, suppressed breathing, and cardiorespiratory arrest which is fatal.

    Impaired motor coordination or lack of voluntary coordination of muscle movements (ataxia) is a dangerous effect of overdose or toxicity due to drug-drug interaction with benzodiazepines.  A person who losses control can have a car crash (or trailer crash or bus crash or train crash), machinery accident, fire accident, explosion accident, etc., and  can affects not only the person but other victims and property.

    Many drugs, including oral contraceptives, some antibiotics, antidepressants, and antifungal agents, inhibit liver enzymes. They reduce the rate of elimination of the benzodiazepines by liver enzymes and thus potentially can cause benzodiazepine toxicity and increase risk of benzodiazepine induced accidents and deaths.  These are commonly used drugs which a person may forget that he or she is using when embarking on taking a benzodiazepine.

    Benzodiazepines are a  widely used and popular group of drugs but they must be kept out of reach of children and out of reach of other members of the household for whom they were not prescribed and must not be used with other drugs by those for whom they were prescribed.

    Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis.  For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 08160944635

  • Drugs you should not combine: midlife

    Before we discuss midlife drugs that we should not combine, we take a look at some of the factors responsible for drugs in midlife and which drugs are most likely being taken by mid-lifers.

    Most people are born healthy, normal, and fit.  However, we all pass through a complex world which leaves its marks on us, in our bodies, minds, and spirits, as we live and age.  With age, depending on such factors as diet, lifestyle, and environment, people may develop health problems such as chronic inflammatory conditions, heart and blood pressure problems, metabolic conditions such as high cholesterol and diabetes, physical or functional deformities, mental aberrations, etc.  By the time many people reach midlife (45-60 years of age) they may have to take a drug or some drugs continually or for a long time.  By the time many people become elders (60 plus) they are on drugs for life.  For many midlife and senior people in today’s complex world, polypharmacy is a mainstay part of life.

    In the USA, for example, “people age 65 and older make up 12 percent of the U.S. population, but account for 34 percent of all prescription medication use and 30 percent of all over-the-counter medication use”. https://www.medscape.com/viewarticle/501879.  In a survey of the average number of different prescription drugs taken daily by people age 50plus, it was found that people 50-64 years old took an average of 3.31, people 65-74 years old took an average of 4.45 medications, and people 75 years plus took an average of 4.42 different prescription medications daily (https://assets.aarp.org/rgcenter/health/rx_midlife_plus.pdf).  This did not include use of over the counter drugs that they may be using including supplements and herbal products.  It is now recognized that overmedication of older adults has been an issue in the USA.

    What are the most commonly prescribed drugs irrespective of age groups?  Many countries do not have good records but we can get a glimpse from the 2017 GoodRx (https://www.goodrx.com/) list of the ten most-dispensed prescriptions in the USA as of May 2017.  Some of the trade names of these medications are very popular.  These medications are as follows: 1.Vicodin, Norco, Xodol (a combination of the drugs hydrocodone (opioid painkiller) and acetaminophen (painkiller)); 2. Synthroid, Levoxyl, Unithroid (made of the drug levothyroxine used for thyroid deficiency); 3. Delasone, Sterapred (made of the drug prednisone, a corticosteroid used for arthritis and for some cancer symptoms); 4. Amoxil (made of the drug amoxicillin, a penicillin antibiotic used for bacterial infections); 5. Neurontin (made of the drug gabapentin, an anti-epileptics used for seizures and nerve pain); 6. Prinivil, Zestril (made of the drug lisinopril, an angiotensin converting enzyme Inhibitor that is used to combat high blood pressure and heart failure); 7. Lipitor (made of the drug atorvastatin a statin drug used for high cholesterol); 8. Glucophage (made of the drug metformin a biguanide drug used for type 2 diabetes); 9. Zofran (made of the drug ondansetron a serotonin antagonist used for nausea); and 10. Motrin (made of the drug ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) used for pain, fever, and inflammation).

    Another record keeper, IMS Health, indicates that levothyroxine (Synthroid, AbbVie) used for thyroid deficiency continues to be the USA’s most prescribed drug, and aripiprazole (Abilify, Otsuka Pharmaceutical) used to treat psychosis continues to have the highest sales, at nearly $6.9 billion.

    Many mid-lifers and elders may be on 3-5 of such popularly prescribed drugs.  Not enough research is done in most countries on “why polypharmacy for mid-lifers and elders?”  Factors involved may be real clinical needs of a disease prone age group, big business driven prescription habits, abuse of health insurance systems, following the money of mid-lifers and elders (an assumed financially comfortable population),  or simply bad or lazy prescription habits. Mid-lifers and elders themselves should watch that the drugs they take are really needed.

    Let us look at the ten most highly sold drugs and the income they are bringing in to stake holders so that we may examine if we are necessarily or unnecessarily using them. 1. Humira (adalimumab) used for chronic inflammatory conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, and juvenile idiopathic arthritis has made $8.2 billion.  2. Abilify (aripiprazole) used to treat schizophrenia and bipolar disorder and major depressive disorder has made $7.9 billion.  3. Sovaldi (sofosbuvir) used to treat chronic hepatitis C has sold $6.9 billion. 4. Crestor (rosuvastatin) a statin drug used used for high cholesterol has sold $5.9 billion.  5. Enbrel (etanercept), used to treat moderate to severe rheumatoid arthritis, moderate to severe plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, and moderate to severe polyarticular juvenile idiopathic arthritis (JIA) has sold $5.9 billion. 6. Harvoni (ledipasvir and sofosbuvir) is a combination pill used to treat hepatitis C and has made $5.3 billion. 7.  Nexium (esomeprazole) used to treat acid reflux and stomach ulcers has made $5.3 billion. 8. Advair Diskus (fluticasone and salmeterol) oral inhaler, a combination of a corticosteroid and a beta2-adrenergic bronchodilator, used to treat asthma and chronic bronchitis has sold $4.7 billion.  9. Lantus Solostar (insulin glargine),   a long-acting insulin, used to treat diabetes mellitus to control high blood sugar has sold $4.7 billion.  10.  Remicade (infliximab) used to treat rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, Crohn’s disease, and ankylosing spondylitis has sold $4.6 billion.  Most probably, mid-lifers and elders contribute to much, if not most, of these sales. To be continued.

    Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis.  For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 08160944635

  • Drugs you should not combine: Pain killers and Alcohol

    Many of us are responsible drug users.  We see a doctor when necessary.  We buy prescribed drugs from a pharmacy and we take the drugs as directed by the doctor or pharmacist.  Many of our homes have over-the-counter and prescription drugs, in use or left overs, or even just stocked as handy drugs.  They are regarded as safe.  They cure or at least relieve symptoms when we are sick.  We call them good drugs because they are not like those bad drugs that are used socially and can cause a lot of trouble.

    In this article, we consider how such good drugs can become disastrous.

    Sometimes we swallow our drugs with just any drink that is handy.  This is risky.  Drugs should be swallowed with water. Drugs are chemicals.  Drinks are also chemicals.  Chemicals tend to react with one another and generate new products which changes the ability of the drug to affect the ailment it is being used for.  It also produces other risks such as a wrong end product chemical that may be anything from inert to toxic, causing undesired and unexpected effects in the body.

    Acetaminophen or paracetamol (Panadol®) is our common household pain killer.  It is a useful and helpful drug for relieving pain and fever but one should not use it habitually.  Taken according to the manufacturer’s  indication, it is safe enough.  Any harmful effect of the drug is not lasting because the drug is soon enough transformed and excreted from the body and the body repair system mends any side effects.  However, this drug taken in excess, routinely and chronically, or just a large dose once, causes acute or long term liver damage and death.

    When drinking alcohol and one develops a headache, one may try to kill the pain with paracetamol.  Paracetamol taken by alcoholics can cause deadly liver damage, especially in people who already have a compromised liver.

    Other pain killers such as aspirin, ibuprofen, or naproxen taken with alcohol increase the risk of stomach irritation and bleeding.  Damage to the stomach and ulceration may seem like a small ailment.

    Just this morning, I was asking about a man that just died and was told he had pain in his “stomach” a few days ago and his autopsy revealed he had ulcer and hernia.  When  the gastrointestinal (stomach and intestine) wall is damaged to the extent that there is a hole through the wall, the contents which have food, bacteria and other microorganism, that were normally safely  heading towards the anus,  leak into the abdomen and cause sepsis and death.  The massive invasion of the clean abdomen by bacteria is a shock to the body.  Thus perforated gastrointestinal ulcers are disastrous.

    Many over the counter pain killers that we buy regularly without prescription can damage the gastrointestinal wall leading to ulcer especially in people who, for economic or other reasons, skip meals.  The group of drugs called non-steroidal anti-inflammatory drugs or NSAIDs are notorious for this.  Aspirin, ibuprofen, naproxen, and indomethacin are all NSAIDs.  They should  not be taken on an empty stomach and they should not be taken with alcohol.

    When we skip meals, the stomach becomes empty.  If the stomach wall protective mechanisms are weak, the stomach is open to the action of the acid and enzyme secreted for the digestion of food.  The acid and enzyme are free to digest the stomach rather than food (which is not available), causing ulcer.  Add an NSAID pain killer, and this may be a recipe for disaster and death.

    Prescription painkillers should not be used with alcohol because the combination worsens the NSAIDs’ ability to cause ulcers.  Alcohol itself has damaging effect on an empty stomach, especially if the stomach lacks strong protection of mucus and other protective mechanisms.

    A second group of painkillers, opioids, are use through prescription unlike NSAIDS that we buy freely.   Opioid pain killers such as oxycodone are central nervous system depressants. Central nervous system depressants depress a part of the brain called the respiratory centre that controls respiration (breathing).  The dose of any opioid that we use for medication does not depress the respiration to a harmful level.   Alcohols also depresses the central nervous system therefor both opioid and alcohol taken together can depress the nervous system to the point of sudden death.

    We need pain killers and when we use them correctly we can enjoy their benefits.  However, if we use NSAIDs when fasting or when skipping meals, or when on a poor diet, we run the risk of gastrointestinal damage and ulcer which can be fatal. Low income level people who tend to skip meals and also use pain killers for headaches are at risk of unexpected fatality from ulcers. High income people who enjoy alcohol and also take NSAIDs for headaches run the risk of ulcer and those who take alcohol and also take an opioid pain killer run the risk of sudden death from respiratory depression and sudden cessation of breathing.

    Many people take these drugs on an empty stomach or with alcohol and the combination does not result in serious problems but we must understand the risk.  Pain killers should not end up killing more than the pain.

    Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis.  For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 08160944635

  • Zinc

    In human living and industry, zinc is ubiquitous.

    Zinc is more reactive than iron or steel and is sacrificially utilized to coat iron or steel (galvanization) for protection.  Many structures in our environment may be galvanized e.g.  fencing material and rails, light posts, metal roofs, and car bodies.

    Zinc oxide is used as a white pigment in paint.  Zinc sulfate is used to make dyes and pigments.  Zinc chloride is added to wood as a fire retardant or wood preservative. Zinc sulphide is used in the luminescent pigments of hand clocks, x-ray and television screens and luminous paints.  Zinc sulphide crystals are used in infra- red lasers. Zinc dithiocarbamate complexes are used as fungicides in agriculture.  Zinc is added to engine oil.

    Powdered zinc is used as anode material in alkaline batteries.  Zinc is molten with various metals to form alloys such as brass (used in communication equipment, hardware, musical instruments, water valves, etc.).  Other zinc alloys are nickel silver, soft aluminium solder, commercial bronze.  Zinc is used in the manufacture of rubber and photocopying products, to make some coins, sheet metal and various industrial and manufacturing materials.    Zinc oxide is used in nuclear reactors and potentially can be used to make nuclear weapons.

    In food, zinc is found in minute amounts.  Zinc is an essential dietary trace element. It is involved in the functioning of more than 100 enzymes in our body.  In the processes of DNA synthesis and cell division, zinc is involved with more than 1000 transcription factors without which no end products can be generated. Many proteins bind, and carry zinc. This includes in the brain (where zinc is stored in glutaminergic nerve cells), muscle, bones, kidney, liver, the eye, the prostate, and in semen. Zinc is important in the immune system.

    Amongst the important enzymes that cannot work without zinc are carbonic anhydrase and carboxypeptidase.  Carbonic anhydrase is involved in the regulation of the amount of carbon dioxide in the body and maintains the acid base balance of the blood.  Carboxypeptidases are involved in the digestion of proteins in various cells and tissues.  These enzyme are involved in digestion and catabolic modification of proteins, blood clotting, growth factor production, wound healing, reproduction and other processes.  Insulin production requires a carboxypeptidase. Zinc is also needed for the senses of taste and smell.  Daily intake in the diet is necessary as it is not stored in the body.

    Some of the foods that contain zinc are oysters, red meat, dark meat chicken, whole grains, fortified cereals, dairy products, pork, nuts such as cashews and almonds, beans, legumes, and lentils including peas. Adults need 8-12 mg of zinc per day.  Dietary supplement zinc tablets can be obtained over the counter.  Safe limits recommended in supplements are between 25 mg and 40 mg.  Zinc is included in daily vitamin tablets as zinc oxide, zinc acetate, or zinc gluconate.  It is an antioxidant indirectly.

    Zinc is used in the management of diarrheal disorders and gastroenteritis.  Zinc appears to suppress human rhinovirus which causes common cold.   Zinc acetate or zinc gluconate lozenges are used for common cold by administration of up to 75 mg/day at the onset.  Its side effect includes bad taste and nausea. Intranasal sprays containing zinc products can lead to loss of the sense of smell.  Zinc ointments and powders are used on the skin to protect against sunburn or windburn.  Such preparations are also made to protect against baby diaper rash.  Chelated zinc formulated into toothpaste and mouth washes is used to prevent bad breath.   Zinc pyrithione is added to shampoos to prevent dandruff.  Zinc may be protective on the eye limiting age related macula degeneration.

    Zinc is a negative modulator of the a brain inhibitory neurotransmitter GABA  A’s  receptor. Zinc deficiency is linked to major depressive disorders.  Zinc supplements may be helpful in some brain disorders.

    Zinc deficiency symptoms include suppressed growth, diarrhoea, disturbance of reproductive processes and impotence, eye and skin lesions, impaired immunity, hair loss, disturbance of cognition and disturbance of carbohydrate utilization.    Some seeds and cereal bran contain phytate which binds zinc and limit its absorption in the gut and this may be significant in people who do not eat meats and have phytate containing foods in their diet.  Zinc deficiency is common in developing countries, especially amongst children.  Zinc supplements can reduce mortality from malnutrition but other factors may be important in the malnutrition states. Mental disorder may be associated with zinc deficiency in elderly persons.

    Zinc is an element that is handy for life.  Minute amounts of zinc in our diet is responsible for many important biologic processes.

    Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis.  For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call

  • Emerging from disaster: being fully alive on the road to happiness and perfection

    We conclude our series on emergency preparedness by considering a topic that is important as one begins a new year with hope for the best – being fully alive.

    Before the recent holidays, I commented to a student that I had a lot of work to do at home when asked how I would spend the holidays.  After the holidays he asked if I had finished everything.  It was the question of a youth.  I gave a “geriatric” answer that I did some work and others keep coming up but I go on and that is life. As we go older, we realize, we can only finish when we die.  We need to keep fit for life as we need to keep going on with duties and tasks and challenges and interests and goals and possibilities, etc. When we are not fully alive and when we are not fit for them, these activities are finished, so are the benefits, rewards, merits, credits, profits, fruits, and  glories.

    Fitness for life involves well-being in body, mind, and spirit.  Fitness is important for us to be our best and do our best and make a difference in our world, great or small.  We all know about eating a balanced diet and eating regularly and properly (quality, quantity, and suitable for our own body).

    In Nigeria, I feel far away from reality when I discuss eating a good diet and I know many people cannot if they want to.  In a struggling economy that is left to market forces, it may be very hard indeed for salary earners to maintain a good standard of living or to aim for a good standard of living.  As prices go up, stay up, and then climb up again, and again, the quality and quantity we can afford go down and down.  As we look forward to better life in the New Year we need to change to an economic environment that favours better life.

    I was tidying up my office to begin the New Year when I saw the Oct 28 – Nov 3 2012 edition of Castles.  On Page 12, the Property Xtra section gave me food for thought.  Under a bold title on that page, “Continuing lack of electricity and fuel”, I have here a few extracts:   “queues at petrol stations seem to getting longer….. On the back of this is the mystery of persistent powercuts which also seem to be getting worse and worse”; “The average generator using Nigerian spends between N200k-N2m a year on personal use of their generator.  The cost of running personal businesses is a monumental drain on the profits of that business”;   “Generators are being run round the clock, noise and air pollution are major problems that are not even acknowledged”.

    Acute fuel shortage at Christmas time in 2017 came like a customary event.

    Many people took to walking to their destinations.  Initially, there were no buses along certain routes and in other routes, there were buses but they hiked their prices to make up for the difficulties in getting fuel. The Government is trying to drive out the demons of disaster, a task indeed.  For many Nigerians at a time of fuel scarcity, some of the little money budgeted for feeding well is diverted to solving fuel scarcity issues.  People need to get to work so that their bosses do not have excuses to fire them or cut their salaries or wages.  They would rather starve than lose their jobs.

    For a happy New Year, we must eat well.  There is no life without food and no good life without good food.  Michelle Obama was growing her own vegetables in her backyard at the White House.  Many of us own land here and there or have access to land in our villages and home towns.  There are things the authorities should do but there are also things that we can do for ourselves to improve our standard of living. This is food for thought to begin the year with.

    Apart from good food, the body needs exercise.  Exercise that is enjoyable is good for both the body and the mind. Such exercise should be frequent and even regularly planned.   Exercise can be fun with music, with good company, or in a good environment.  Some superrich Nigerians go to the level of bullet proof gym but for most of us, we can get by with a good walk on the beach with a friend, playing with the kids in the park, bicycling in a safe neighbourhood, skipping rope at home, swimming in a hotel or resort, farming in the village, etc.

    And how do we keep our mind fit.  Love is it.  Do what you love and love what you do.  There is nothing better for the mind than love.  Sometimes the things we have to do are difficult but we can do them in a way we love.  For many people, professional work or their means of livelihood may not be loveable.  One may find some loveable activity to do frequently because the mind needs to experience love.  When we love what we do, we easily bear fruit in it.

    Of course, one’s spirit needs to be healthy and fit, therefore we should all learn to walk with God, as King David said: “The LORD is my Shepherd, I shall not want” (Psalm 23).

    Dr. Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis. For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 08160944635

  • Sodium

    Sodium is a nutritional element that is a servant of life but it can also be and is often a servant of death.  This two-faced element is a constituent of common salt, sodium chloride, that we add to most of our foods to enhance taste.  Currently the story of sodium in intrigued with cardiovascular diseases.

    Sodium chloride (common salt) is abundant in sea water and gives sea water its taste. Salt is found abundant in nature because it is essential to animal life.  In animal life, including within human bodies, it is found in fluids around cells, extracellular fluid. Thus in medical clinics, sodium chloride dissolved in water is used in intravenous fluids (drips) to supply the body with fluid.

    Sodium moves in and out of cells.  Other elements that move in and out of cells include chloride and potassium.  These movements create electrical changes in cell membranes leading to nerve transmission and muscle contraction.  Without sodium, the nerves and muscles cannot work.

    Thus sodium is essential for our living processes. “Salt is a necessity of life and was a mineral that was used since ancient times in many cultures as a seasoning, a preservative, a disinfectant, a component of ceremonial offerings, and as a unit of exchange. The Bible contains numerous references to salt. In various contexts, it is used metaphorically to signify permanence, loyalty, durability, fidelity, usefulness, value, and purification” (Wikipedia https://en.wikipedia.org/wiki/Salt_in_the_Bible).

    The 25-day Salt March in 1930, was a protest led by Mohandas Gandhi in colonial India to gain freedom to produce salt from the seawater in the coastal village of Dandi, as was done before the colonial era. All peoples need salt. Salt is a servant of life. One without salt lacks life. Thus metaphorically, Jesus called Christians “salt of the earth,” people who give and enhance life (Matt 5:13) and told them to: “have salt in yourselves and be at peace with one another” (Mark 9:50). “Spiritual salt” is understood by knowing the power of physical salt.

    Sodium in the body is so important that it has to be well regulated and this job is done regularly by the kidneys.  The kidney determine how much sodium to excrete from the body and how much to retain.   Too much sodium in the blood stream osmotically attracts water and increases blood volume and blood pressure. High blood pressure can injure blood vessels, especially disrupting microvessels.  High blood pressure, with time, induces formation of plaque inside blood vessels that hinder blood flow and increases the pumping effort of the heart.  In the past three decades, clinical evidence has been gathered to implicate sodium in hypertension and cardiovascular diseases and patients are generally warned to curtail consumption of salt.

    Many germs cannot survive in salty medium.  They are small and salt draws water from them dehydrating and killing them.  Therefor food producers use salt to keep foods fresh and preserve them.  Foods such as smoked meats or fish and canned foods are well salted for preservation. Salt is also used for developing or controlling the appetizing colour of cheese, bacon, ham, and other processed meat products. Bakers use salt to control the rate of fermentation in dough. Many snacks, junk foods and appetizers are well salted for preservation and for strong taste.  Salt is commonly used as a condiment and food preservative.

    We thus can consume excess salt from foods. People who are more sensitive to excess salt are people who have high blood pressure, diabetes, or kidney problems.  It seems that many people develop elevated blood pressure with age and blacks are thought to be more prone to this, therefore blacks and people over 50 years of age may need to avoid excess salt.

    Excess sodium and hypertension can result in heart disease, heart failure, and stroke.   Sometimes excess salt may destroy the heart blood vessels and kidneys irrespective of blood pressure.  Excessive salt can also affect the bones because the amount of calcium excreted in urine increases with the amount of salt intake.    Too little calcium left circulating in the blood forces the bones to release calcium into the circulation are may result in osteoporosis.

    Thus, much as we need the nutritional element sodium, we must take care not to have excessive intake, especially as we grow older.

    Dr. Theresa Adebola John is a lecturer at Lagos State University College of Medicine (LASUCOM) and an affiliated researcher at the College of Medicine, University of Tennessee, Memphis.  For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 0816094463