The Nation Newspaper

Tag: Midlife

  • Midlife drugs you should not combine: Blood thinners and aspirin

    If you ask a doctor who works in a busy public clinic what are the major medical conditions of mid-lifers frequently encountered these days, he or she may say: stroke, kidney failure, heart failure, diabetes and the complications of such conditions. Even though most people would wish: “Not my portion!”, by midlife some force on earth has managed to apportion these deadly diseases to many people as they make their journey through life.

    Thus there are some drugs that are frequently prescribed and we may have them in our homes.    Let us look at anticoagulants.

    Anticoagulants are used to lower the risk of blood clots.  Blood clots blocking the inside of fine blood vessels can lead to stroke and death. A blood clot (or thrombus) is blood that has changed from a liquid form to a gel-like or semisolid state. A clot is formed when there is a breach or injury in a blood vessel wall that can cause blood leakage and blood loss.  When we have a small cut on our skin, blood flows from superficial blood vessels and then stops because of the blood clot that forms at the site of injury.  The clot blocks the breach and allows repair processes to go on.  Within the body, when a clot forms inside a blood vessel (such as a vein that returns blood towards the heart or an artery that carries blood towards body tissues), it can block (or embolize) the vessel.  This decreases the flow of blood through the vessel causing harm at the site of origin or at the destination of the blood flow.

    Blood clots (thrombi) in the heart tissue can starve the heart of blood nutrients including oxygen and stop the work of the heart in pumping life-giving blood to the rest of the body.  Blood clots in the brain tissue can similarly kill part of the brain and upset the work of the brain in directing the well-being of the body. Blood clots in the lung tissue can kill part of the lung and limit the function of the lung in breathing in oxygen and passing out waste gas, carbon dioxide.  Blood clot anywhere in the body including veins in the legs and blood vessels in the kidneys, can cause disaster.  Thus in persons who are prone to having blood clots, physicians may prescribe a ‘blood thinner’, a drug that inhibits the clotting of blood.

    Certain people with conditions such as heart rhythm disturbance, high blood pressure, high cholesterol, diabetes, trauma or local injury, or smokers, or people using oral contraceptives may be prone to developing blood clots.  People who have had a heart valve replacement or some other surgeries have a risk of blood clots developing.  People with pancreatic or lung cancer, multiple myeloma, or hematologic malignancies may develop blood clots due to cancer-specific factors and their treatment regimens. These patients are often given prophylactic (preventive) blood thinners.

    Many mid-lifers settle into sedentary life styles with very little mobility; hours at a desk, hours before the TV, hours with a laptop without getting up to stretch and exercise.  This can promote blood clots.  The contraction of muscles (e.g. in the legs) helps to sustain the cycle of movement of blood between the extremes of the body and the heart.   Blood that is not flowing well or that stagnates is prone to clot formation.  Deep vein thrombosis (DVT) occurs  in a deep vein such as in the leg, arm, or groin. It can break loose and cause disaster, for example in the lung (pulmonary embolism), or heart (heart attack). Many mid-lifers reach top level positions at work that are more cerebral than physical.  Mid-lifers need to exercise well and to be at least minimally physically active. Bosses should not avoid menial tasks for their own good health.

    To avoid stroke, heart attack, or peripheral artery disease, blood thinners have become a group of drugs that doctors prescribe often. Blood thinners (technically called anticoagulants) include heparin (e.g. enoxaparin injection, Lovenox); vitamin K antagonist warfarin (Coumadin, Jantoven), acenocoumarol, and phenindione,; direct oral anticoagulants (DOACs):  apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa); and direct thrombin inhibitor dabigatran (Pradaxa).

    A person using a blood thinner who decides to take pain killer aspirin because of some unbearable pain may be precipitating trouble. Aspirin is also a blood thinner in its own way.  It is an antiplatelet drug which means it prevents blood cells called platelets from clumping together during formation of a clot. Aspirin should not be taken with blood thinners because the combination can lead to serious internal and external bleeding all over the body. The person may become bloody.  Similarly a person taking aspirin who mistakenly swallows rat poison (made of coumadin) can end up bleeding to death.

    Blood thinners may interact with certain foods, medicines, vitamins, and alcohol. If you are on a blood thinner, you should discuss with your doctor which pain killer, cold medicine, stomach medicine, herbal medicine, and vitamin products, are safe for you because some of these drugs are a disastrous combination with blood thinners.  Drugs may increase or decrease the function of blood thinners.  The blood thinner needs to work enough to prevent dangerous blood clots but not too much to cause dangerous bleeding.

    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

  • Midlife crisis or midlife transition

    Continued from last week

     

    There are underlying mechanisms of the midlife crisis: physical, mental, spiritual, environmental, and social mechanisms.  To know them helps the mid-lifer to undergo mid-life transition rather than midlife-crisis.

    Spiritual:   Spiritual matters contributing to midlife crises are typically individualistic and may be above intellectual scrutiny therefore we will not attempt to analyze them too much here. It is important to know that having a good soul mate in marriage and/or suitable life companions, living according to one’s predestination which is often inscribed in our genetic makeup and talents, and having a proper relationship to one’s origin and end (widely understood as God) are important contributors to life fulfilment and satisfaction which are partially attained by midlife. Uneven yokes are risky and may become counterproductive. At midlife one may become aware of what has become one’s predominant contribution (good or evil) to one’s family, society, or the world: progress or backwardness, love or hate, mediocrity or greatness, order or chaos, justice or strife -temporary or permanent.  Positive outcomes of awareness of one’s contributions may be satisfaction, contentment, joy, peace, freedom, optimism, drive, momentum, etc.  Negative outcomes may be dissatisfaction, rebellion, unhappiness, viciousness, paralysis, pessimism, discouragement, despondency, etc. Crises are playgrounds of evil.  Transition is to gain spiritual power to overcome various evils.

    Environmental: A midlife entrepreneur in Nigeria at this point in early 2016 that has no personal solutions to problems of electricity, petroleum, and forex shortages experienced in the country may be bound for crisis.  Many parts of the world are hit by overpowering wars, floods, catastrophes, accidents, epidemics, etc. that devastate people’s lives instantly. No matter how matured and successful the mid-lifer was before such happenings, crisis is generally inevitable.  To see the gains of ones efforts in life destroyed suddenly and possibly irrecoverably is bad for one’s ego and emotions.  There can be lasting wounds: physical, mental, spiritual. People of power, influence, and affluence should be quick is assisting victims who suffer such disasters.  The quicker and the better the aid, the better the transition the victims can make.

    Societal: Some people at midlife find themselves with the double responsibilities of taking care of their children, especially costs of education, and taking care of their parents, especially cost of health care. Both can be financially draining, time consuming, and can limit one’s other interests or capabilities.  This can become a source of crisis.  On the other hand, the Empty Nest may be a source of midlife crises. The children have gone to live their own lives and single parents or couples are left alone in their homes. The initial adjustments may be difficult.  Mid-lifers may also grow tired of or sever longtime associates possibly through such factors as: change of occupation, review of religious beliefs, change of political affiliations, awareness of cultural identities, emergence of differential social statuses between oneself and one’s associates, limitation by illnesses, and relocation.   Loss of friendships, acquaintances, and relationshipsare telling in lack of social support when needed.  The wisdom of Ecclesiastes 4: 10 (NAB) puts it: “Woe to the solitary man!  For if he should fall, he has no one to lift him up.” Transition is to reposition oneself correctly in society and this may be in different aspects for different persons.

    Factors That Can Lead To Male Midlife Crisis

    Popular gossip says “men have huge egos”.  Has anyone been able to disprove it?  A man needs to feel that he is a man and if he does not feel so, there may be crisis. A crisis is expressed in active or passive behavior.   Actively, a man in midlife crisis would most likely do anything to make him feel bigger or better such as: having a new girlfriend that is twenty years younger or far more good-looking than his wife, marrying more wives that he has no time or money for; buying a new posh car that only creates a fleet in his yard; scrambling to the top of the professional ladder recklessly; embezzling a huge some; breaking laws with audacity; oppressing someone; doing outrageous things, etc.  Passively, one may escape from reality through drink, drugs, sex, abandonment of job or family, etc.

    Factors That Can Lead To Female Midlife Crisis

    A woman’s emotions are a treasure for her children and husband and when emotions are empty there may be crisis.  Celibate women who have lost the fervor of their celibacy may experience crisis due to unfulfilled emotions.  Single women may also be strongly disposed towards midlife crisis for lack of a spouse or children.  Widows, divorced women, and single mothers may also be strongly disposed to midlife emptiness.  The premenopausal, menopausal, and postmenopausal stages that women pass through may vary individually and may turn to crisis depending on whether the woman is celibate, single, a widow, or divorced and depending on whether she is a mother or childless.  Talking is a good outlet of one’s feelings but it can also bond one with the listener which may be good or bad, depending on the listener.  Emotional substitutions may be by anything including adopting a child, keeping any company including bad or unfit dates, attachment to groups and teams including faith groups, and using sex toys.

    Even though men may have huge egos and women may have huge emotions, the role of the ego or emotions in a crisis is individualistic and midlife crisis may have emotional or egoistic preponderance in either males or females alike.

    Dr. ‘Bola John is a biomedical scientist based in Nigeria and in the USA.   For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 08160944635

  • Midlife crisis or midlife transition

    Continued from last week

    There are underlying mechanisms of the midlife crisis: physical, mental, spiritual, environmental, and social mechanisms.  To know them helps the mid-lifer to undergo mid-life transition rather than midlife-crisis.

    Spiritual:   Spiritual matters contributing to midlife crises are typically individualistic and may be above intellectual scrutiny therefore we will not attempt to analyze them too much here. It is important to know that having a good soul mate in marriage and/or suitable life companions, living according to one’s predestination which is often inscribed in our genetic makeup and talents, and having a proper relationship to one’s origin and end (widely understood as God) are important contributors to life fulfilment and satisfaction which are partially attained by midlife. Uneven yokes are risky and may become counterproductive. At midlife one may become aware of what has become one’s predominant contribution (good or evil) to one’s family, society, or the world: progress or backwardness, love or hate, mediocrity or greatness, order or chaos, justice or strife -temporary or permanent.  Positive outcomes of awareness of one’s contributions may be satisfaction, contentment, joy, peace, freedom, optimism, drive, momentum, etc.  Negative outcomes may be dissatisfaction, rebellion, unhappiness, viciousness, paralysis, pessimism, discouragement, despondency, etc. Crises are playgrounds of evil.  Transition is to gain spiritual power to overcome various evils.

    Environmental: A midlife entrepreneur in Nigeria at this point in early 2016 that has no personal solutions to problems of electricity, petroleum, and forex shortages experienced in the country may be bound for crisis.  Many parts of the world are hit by overpowering wars, floods, catastrophes, accidents, epidemics, etc. that devastate people’s lives instantly. No matter how matured and successful the mid-lifer was before such happenings, crisis is generally inevitable.  To see the gains of ones efforts in life destroyed suddenly and possibly irrecoverably is bad for one’s ego and emotions.  There can be lasting wounds: physical, mental, spiritual. People of power, influence, and affluence should be quick is assisting victims who suffer such disasters.  The quicker and the better the aid, the better the transition the victims can make.

    Societal: Some people at midlife find themselves with the double responsibilities of taking care of their children, especially costs of education, and taking care of their parents, especially cost of health care. Both can be financially draining, time consuming, and can limit one’s other interests or capabilities.  This can become a source of crisis.  On the other hand, the Empty Nest may be a source of midlife crises. The children have gone to live their own lives and single parents or couples are left alone in their homes. The initial adjustments may be difficult.  Mid-lifers may also grow tired of or sever longtime associates possibly through such factors as: change of occupation, review of religious beliefs, change of political affiliations, awareness of cultural identities, emergence of differential social statuses between oneself and one’s associates, limitation by illnesses, and relocation.   Loss of friendships, acquaintances, and relationshipsare telling in lack of social support when needed.  The wisdom of Ecclesiastes 4: 10 (NAB) puts it: “Woe to the solitary man!  For if he should fall, he has no one to lift him up.” Transition is to reposition oneself correctly in society and this may be in different aspects for different persons.

    Factors That Can Lead To Male Midlife Crisis

    Popular gossip says “men have huge egos”.  Has anyone been able to disprove it?  A man needs to feel that he is a man and if he does not feel so, there may be crisis. A crisis is expressed in active or passive behavior.   Actively, a man in midlife crisis would most likely do anything to make him feel bigger or better such as: having a new girlfriend that is twenty years younger or far more good-looking than his wife, marrying more wives that he has no time or money for; buying a new posh car that only creates a fleet in his yard; scrambling to the top of the professional ladder recklessly; embezzling a huge some; breaking laws with audacity; oppressing someone; doing outrageous things, etc.  Passively, one may escape from reality through drink, drugs, sex, abandonment of job or family, etc.

    Factors That Can Lead To Female Midlife Crisis

    A woman’s emotions are a treasure for her children and husband and when emotions are empty there may be crisis.  Celibate women who have lost the fervor of their celibacy may experience crisis due to unfulfilled emotions.  Single women may also be strongly disposed towards midlife crisis for lack of a spouse or children.  Widows, divorced women, and single mothers may also be strongly disposed to midlife emptiness.  The premenopausal, menopausal, and postmenopausal stages that women pass through may vary individually and may turn to crisis depending on whether the woman is celibate, single, a widow, or divorced and depending on whether she is a mother or childless.  Talking is a good outlet of one’s feelings but it can also bond one with the listener which may be good or bad, depending on the listener.  Emotional substitutions may be by anything including adopting a child, keeping any company including bad or unfit dates, attachment to groups and teams including faith groups, and using sex toys.

    Even though men may have huge egos and women may have huge emotions, the role of the ego or emotions in a crisis is individualistic and midlife crisis may have emotional or egoistic preponderance in either males or females alike.

    Dr. ‘Bola John is a biomedical scientist based in Nigeria and in the USA.   For any comments or questions on this column, please email bolajohnwritings@yahoo.com or call 08160944635

  • Midlife peace or midlife crisis

    Everyone who is not yet 40 should pray that they spend their midlife (above forty till early sixties) as healthy and contributing members of society.  In any society, the young (below forty years of age) are typically takers.  They need to be provided for, fed, accommodated, taught, trained, supported, inspired, motivated, directed, sponsored, etc.  On the contrary, mid-lifers are expected to be givers.  They have already got.  They are supposedly settled.  They have landed somewhere good for them and they are poised to be their best and give their best, or so society expects.  The elders are the people who spend more time relaxing and the rest of us pet them.  Thus one expects the good life to progress as: you take, you give, you relax.  Unfortunately, this kind of peace evades many individuals and many societies and mid-lifers too commonly pass through the well talked about mid-life crisis.

    A husband comes home one evening and says he is not returning to that job even if they quadruple his income;Mummy abandons the kids at home and disappears for days or forever;  a  guy buys a posh car with all the money he had been saving for the kids’ education;Daddy decides to sleep with his teenage daughter; a wife turns the family’s sitting room into a chapel;  a woman collects numerous phone numbers of doctors and lawyers; a couple has regular physical fights; an administrator embezzles an outrageous amount of money; a boss fires somebody over trifles; a careerist kills a rival – these are common examples indicating midlife mishaps within human beings.   The midlife crisis is a syndrome of physical, emotional, psychological, and spiritual personal experiences.  There are underlying mechanisms of the midlife crisis: physical, mental, spiritual, environmental, and social mechanisms.  To know them helps the mid-lifer to undergo mid-life transition rather than midlife-crisis.

    Generally for both men and women, a crisis may center within one or more groups of life issues:

    • Looks, appearance, image, status, possessions…..
    • Job, livelihood, career, achievements, contributions…..
    • Health, capabilities, freedoms, powers……
    • Marriage, relationships, friendships, culture….
    • Beliefs, religion, hopes, fears, experiences…….

    The major driving force of a crisis may come from the ego or the emotions, and men may be more prone to forces of ego and women more prone to forces of emotions but none is immune to either.  The major remedy for any crisis may similarly be guided by the ego or the emotions.  A new and better life emerges when the head and the heart become the two polished sides of the precious coin of life.  Then there is a peaceful balance.

    A midlife crisis may be an individual experience or it may be a social experience.  A couple, a marriage, or an entire family including a mid-lifer may enter into a crisis.  If a mother walks away from her marriage or a father walks away from his job, a resultant crisis evolved in their children may become worse than their own personal crises.

    In order to arrive at a balance and peace, one has to deal with or peel off certain layers of a midlife crisis (peel off the P’s).  Chief of them are:

    • Perceptions: shock, confusion, doubt, anger, denial, remorse……obsessions, compulsions, risky behavior, rebellion……
      • Paralysis: boredom, indecision, unhappiness, cynicism, hopelessness, depression…..

      Change towards improvement is not always easy, quick, or strait forward.  Generally, people go through periods of ups and downs before arriving at a balance.

      Always, from a midlife crisis, a better or a worse person emerges, a richer or a poorer person emerges, a healthier or a sicker person emerges, a weaker or a stronger person emerges, a sane or a manic person emerges, a normal citizen or a criminal emerges, and a sinner or a saint emerges.

      Midlife is a necessary and normal stage in life.  Crisis is not necessary but it may be normal in today’s world and, if it comes, we can choose to aim for victory rather than succumb to defeat.