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A new symptom or lab test often provokes the question, “Should I be worried?” The answer is always, “No!” Worry is a useless, painful thing we humans do. We get anxious without a firm basis for our reactions. A symptom or abnormal lab test often mean nothing, so doesn’t it make more sense to worry AFTER something has been confirmed? And even then, the value of worry is questionable, because anxiety doesn’t solve anything and it often makes matters worse.

HOWEVER, fear, worry and anxiety are normal human responses.  In fact, scientists tell us that the fear reaction is our natural default. We are hard-wired to look for and expect bad stuff.  So, what I wrote in the first paragraph is actually quite unnatural.

For me, knowing that fear is hard-wired in me is enormously liberating. When I feel uneasy, I say to myself, “There, there. You are just having a human moment.“ This allows me to do through it, as if the door to peace is wider. Telling myself to “get over it” or “fear is useless” never helps. It slams the door to peace shut.

Back to the first sentence in this blog, When we ask, “Should I be worried?” after experiencing a new symptom or lab test, what we are really asking is, “Could this be something serious? That is really a different question. Either our problem is or it isn’t serious.  In that case, it may help to postpone any potential anxiety until you have firm results. That way you aren’t worrying over nothing, should the results turn out favorably.

This is easier said than done, and it takes a lot of practice. Mediation helps. You can try tempting yourself into anxiety-free moments by saying, “I’ll worry about this tomorrow.” If that is too much, you can aim to postpone worry for an hour or five minutes.

If that seems unrealistic, than go ahead and worry. Skip the guilt, and just let the anxiety be what it is. It will pass. And if turns out you were worried over nothing, than celebrate the good news.  

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Last week, I wrote in Our Bodies Have More Than One Clock, how some medications may be more effective when taken at times in sync with your various body clocks. This week I’ll explore potential drug interactions. The subject is not as simple as it looks.

Drugs, alcohol, supplements, and food may interact with drugs (and each other). It does not matter whether the drug is prescribed, over-the-counter, or illicit – all have the potential to interact.

There are various types of drug and supplement interactions. For simplicity’s sake, I’ll break them down to three types:

Duplication – When two drugs or supplements with the same effect are taken, thus intensifying their side effects. This occurs if you take two drugs that have the same active ingredient. This may happen if your doctor prescribes something that has the same ingredient that is in another drug, because either the doctor didn’t check what you were taking, or a different doctor prescribed the other drug. It can also occur because you were unaware that the drug was in more than one over-the-counter remedy that you were taking. For example, an allergy pill and a sleep aid might both contain diphenhydramine.

Opposition (antagonism) – When a drug, food, or supplement reduces or blocks the effect of a drug, supplement, or both. For instance, licorice root may interfere with birth control hormones, thus reducing the effectiveness of this contraceptive method.  

Alteration – In this case, a drug alters how the body absorbs, distributes, metabolizes, or excretes another drug. There are varieties of ways in which drugs can do this. A synergistic interaction means that two or more drugs work together against one target, producing an effect that is greater than the individual effect of the two drugs together. Further, drugs can also potentiate or boost effects. Drug A may boost the effects of drug B, but it may also increase the intensity of drug B’s side effects.

Tips to Help You Reduce Your Risk of Drug Interactions

Talk to your medical provider and your pharmacist before taking a new drug. This includes over-the-counter medicines, dietary supplements, herbs, and illicit drugs.

Read the prescribing information that comes with the drug. Check for potential interactions on a drug interaction checker such as Drugs.com.

Keep a list of all drugs and supplements that you take. Share this with your entire healthcare team.

Use a pharmacy that allows you to maintain a record of your medications. If you use multiple pharmacies, be sure you share information with all of them.  

Take drugs per your doctor’s instructions. Be sure you know when to take them, how to take them, and whether they can be taken during the same time as other medicines you take.

Stay current. Even if you took a drug before, find out if there have been new interactions added to that drug’s safety profile.

Never break, crush, or dissolve a pill, tablet, or capsule without making sure this is all right to do. Some medications need to be intact so they are not destroyed by stomach acids. If you have difficulty swallowing pills tell your doctor.

If you pick up a prescription and the medication looks different from the last time you took it, talk to your pharmacist to make sure there has not been an error.

Report to the doctor or pharmacist any symptoms that might be experiencing while taking a drug.

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Many of us are aware of our internal clock that influences when we are awake and alert versus tired or sleeping. This internal clock the circadian rhythm or sleep/wake cycle. It is basically a 24-hour internal clock that cycles between sleepiness and alertness at regular intervals. Larks (morning people) and owls (night people) have different circadian rhythms.

Our sleep/wake cycle isn’t the only clock in the body. Nearly every tissue and organ we have is governed by its own clock. These clocks control body temperature, blood pressure, hormones, medication metabolism, and much more. We know this courtesy of research done by  Jeffrey C. Hall, Michael Rosbash and Michael W. Young who won the 2017 Nobel Prize in Physiology or Medicine.

As a result, scientists have been studying the ways drugs are affected by our body’s circadian rhythm. This is known as chronotherapy. Chronotherapy  takes in to consideration the body’s natural rhythms and cycles when treating certain medical conditions.

Here are some examples in which chronotherapy may be used:

Hypertension: Blood pressure tends to be higher during the day and lower when we are sleeping. Unfortunately, many people over age 55 don’t experience this nighttime drop. This is called nondipping, and it can lead to stroke, heart attack and kidney disease. This risk is lowered if high blood pressure medicines are taken at night.

Statins: The liver has its own clock, and it produces more cholesterol after midnight. For this reason, statins (cholesterol-lowering drugs) may be more effective if they are taken at bedtime.

The Bottom line: Medication instructions saying, “Take once a day” may not be specific enough. Talk to your doctor and pharmacist about the best time to take your medicine.

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It is not death that a man should fear, but he should fear never beginning to live.” ~Marcus Aurelius

Death is fascinating, frightening, exciting, hideous, and inevitable. It is also unpredictable. Yesterday, I learned about the death of a man I care about deeply. The irony is that he had escaped death many, many times. He had severe liver disease, and it nearly took him down many times. He received a liver transplant, then was diagnosed with liver cancer. Despite the fact that death was constantly hanging over his head, he plunged in to life.

He did not die as a result of liver cancer. A heart attack claimed him. He died while riding his motorcycle, doing what he loved.

Don’t spend time dying before your time. Do what you love. Now.

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Clinical Trials

A disturbing sentence jumped out at me in the January 2019 Scientific American. “Most cancer patients never get into lifesaving drug trials because of barriers at community hospitals,” wrote David H. Freedman in Out of Reach. Freedman reports that people who get their medical care away from big-name, big-city academic medical centers are less likely to enroll in clinical trials.

Drugs that are being tested in studies often are the best hope for good results, especially with serious medical conditions, such as cancer. I participated in a hepatitis C clinical trial in 2013. At that point, I had lived with hep C for 25 years, and it was starting to do significant damage to my liver. Two prior treatments had failed to cure me, and even if I could wait for a few more years for a cure, I had lousy insurance with a high-deductible. I didn’t hesitate. It was worth the 6 hour round trip drive.

The top reason why cancer patients said they did not participate in a clinical trial was that they were not aware of any studies. A fairly large but old (2009) study reported that 81 percent of cancer patients didn’t discuss studies with their medical providers.

Not all clinical trials are appropriate, but they shouldn’t be viewed as last ditch options. A good study can be an wonderful experience. How do you figure out what is right for you? I suggest you start with learning some basic facts about studies. Hepmag.com has excellent information about clinical trials.

If you want to look for a study, talk to your doctor, or visit the U.S. National Library of Medicine’s  Clinical Trials website. (https://clinicaltrials.gov/)

Participating in a clinical trial can be incredibly rewarding. First, you may get to try a new drug sooner than you otherwise would. Second, you are taking part of making history and making a difference. It can be a wonderful experience.

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Tricks of the Mind: Meditation

Image by Bianca Mentil from Pixabay

My mind plays tricks on me. Recently, I saw a title of a research article on the relationship between liver cancer and the often prescribed over-the-counter medicines known as proton pump inhibitors (PPIs). Since I was just finishing up a two-week course of PPIs, my mind leapt to the worst possible conclusions. It turns out that researchers found that PPIs don’t increase risk of liver cancer. I was relieved, until I started thinking about why they studied the relationship in the first place. By the time my mind was done weaving a tall tale, I was exhausted. And I was wrong about all my assumptions.

My thinking is unreliable. It’s the number one reason I meditate. Meditation is like a field trip for excavating how untrustworthy and changing my thoughts are.

And then there are the memory issues. Age is no friend of memory. Fortunately, there may be good news on that front. In a recent issue of Nature Neuroscience, Romain Quentin and Leonardo G. Cohen published research on reversing working memory decline in the elderly. When noninvasive high-definition transcranial alternating current stimulation was applied to the brain, older adults showed short-term improvements in memory.

Interestingly, memory improvement was done by stimulating theta-phase synchronization. Meditation is all about increasing theta waves. In light of this research, meditation is looking really appealing to me; I’m sticking with it. Plus. I am seeing changes in my thinking. If nothing else, it’s like being in a playground, having fun learning how to do new things.

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