Timing is important in everything we do, and of course is important to health and how our bodies function. It is a vast subject, and the only thing I can do here is to give you some ideas that might be helpful.
Your body will perform best for you if you have a daily routine; waking up at the same time every morning, and going to bed at the same time every evening keeps your circadian rhythm from getting confused. Of course, getting a good nights sleep is excessively important to your health. If you have trouble going to sleep at night or staying asleep, you can get all kinds of information over the Internet on “sleep hygiene”.
If you are an international traveler, jet lag is very important because the circadian rhythm is disrupted when you change time zones. The Internet is a rich source of information on how you might or rapidly get back into your routines. Timing of bright light and melatonin are involved.
Your metabolism also has a routine, and drugs work by targeting certain receptors, which cycle, depending on when their function is needed. “ Chronopharmacology” is a slowly developing science that will someday-if doctors, perhaps with electronic help, can ever get enough time to properly take care of the patients- be very important. As an example, certain cancer therapies vary significantly in their effects, depending upon the time of day they are given.
When I was a practicing Allergist, I took care of many Asthma patients. In the 60s and 70s there were few drugs to treat asthma, which is predominantly a nighttime disease. Giving medications, such as Theophylline, at the right time was therefore very important.
Finally, if you have any choice, you might arrange for your surgery during the first half of the day. Surgeons make less errors in the morning, when their minds are well rested.
Kidney stones are more common than you think, and over the span of life, afflict 1 out of 10 people, more commonly men. The pain is sharp, spasmodic and severe; it is described as being worse than the pain of childbirth. The pain is breathtaking, and if you have “renal colic”, your world is truly “ in a grain of sand”.
This sand, this tiny rock, forms when certain elements and compounds become too concentrated in the urine as it is formed in your kidneys, and “drop out of solution”, or precipitates. This little pebble, which I’m sure feels like a rock, then begins its long, painful journey down the drainage system of the kidneys, and eventually passes, you hope, out with the urine.
Be sure to save it for analysis if it does. Sometimes it is arrested, causes the urine to “back up”, and you need assistance to get it out. Half of the kidney stone attacks recur, and you will get other attacks.
This is particularly the case if your first attack comes when you are young, or there is a history of kidney stones which runs in your family. It is important for a doctor, such as an internist, to review your case, particularly if you are young.
Your family history, lifestyle including diet, medications, and other problems may give clues which will allow other attacks to be avoided. Sometimes there are serious underlying conditions that should be addressed. Half of people who have kidney stones have a genetic cause, but even here there are lifestyle changes which will help..
Drinking plenty of liquid helps, unless you have kidney failure. Read the Mayo Clinic article referenced below for details. They are interested enough in kidney stones to have consulted a Geologist, the ultimate student of Rocks.
Finasteride is a medication that I was given by my urologist, after my operation for an enlarged prostate with restricted urine flow. It was used to prevent the re-growth of the prostate, and subsequent recurrence of urinary obstruction.
It is also recommended to treat male-pattern baldness. That it is used to treat male problems suggests that it has something to do with testosterone, and indeed it does. Finasteride (proscar) is a 5-alpha reductase inhibitor, preventing testosterone from being converted to dihydrotesterone, the active form, in the prostate and the skin.
Finasteride is well studied, and has been found to decrease PSA in the blood, and is suspected of interfering with the use of PSA as a screening device for Prostatic Cancer. It has also been suspected of increasing severe, high grade cancer. These findings have been refuted in later papers.
It has also been found to decrease sexual function, which it has in my case. I have continued it for several reasons.
First, my urine flow remains fine. Second, the bulk of the data indicates that it hinders prostatic cancer formation; and in a previous posting, I stated that Prostatic cancer in 88 year-olds is almost universal. Third, we are continuing in a Covid 19 pandemic.
One of the markers for severe infection is male-pattern baldness, which finasteride prevents. I did find in my reading about finasteride that there is a 1 mg. dose, and I am taking 5 mg..
When the Covid epidemic slows, I will probably opt for the 1 mg. Dose, which produces a significant effect, though of course less than the 5 mg. Less medication is usually better.
For Patients with BPH opting for medical treatment, Finasteride is usually recommended along with an alpha adrenergic agonist to relax the bladder sphincter.
For the men out there, facing an ever-increasing likelihood of BPH, or wanting to slow down baldness, you may eventually be making the decision whether or not to take this effective medication.
Sometimes I wake up in the morning with a feeling of RELAXED ENERGY. My mind is clear, I have no fatigue, and believe once more that the world is wonderful, and it’s great to be alive.
I St-re-tch, exercise my hands (I have Osteoarthritis, and they are stiff), take out my Nite guard ( I grind my teeth at night and would otherwise wear them away), take my beta blocker eye drops ( to lower my intraocular pressure) and wash down my Eliquis ( an anticoagulant to prevent stroke from my Atrial Fibrillation) with 16 oz. of water, while thinking about all of the delights awaiting me.
Yes, my body was in better shape 60 years ago; but I had much more responsibility then, and much less discretionary time. All things considered, I like to believe that I am happier now.
The KEY is to stay in GOOD HEALTH. GOOD SLEEP is critical, but it cannot be had by willpower alone. As I have discussed previously, you need a bedtime routine, good SLEEP HYGIENE.
You also need a…….. GOOD DIET. with lots of fruits, vegetables and whole grains. Fatty, spicy foods will stay in your stomach and bother you at night, particularly if you eat Late. I like to finish eating by 5 PM. Late dinner is also likely to produce GERD, and maybe Sleep Apnea.
GOOD EXERCISE is also critical. If you are not tired at the end of the day, it is hard to get good sleep. I always seem to sleep better on the day when I walk the hills for an hour, which is 3 days a week. Try not to exercise within 2 hours of bedtime. Assuming that you have a good base of SLEEP, DIET and EXERCISE, there are other mechanisms that can foul things up. INFLAMMATORY conditions often cause fatigue.
The most common inflammatory diseases are OBESITY, METABOLIC SYNDROME and DIABETES. OBESITY is the defining disease of our EXCESSIVE SOCIETY, where there is too much of everything, and excessive consumption is relentlessly advertised everywhere.
External correction is probably a pipe dream, since there is no will even to Tax Sugar-containing Beverages, the “low hanging fruit” of dietary excess. Internal correction is all that is left, and that takes WILL POWER, also in short supply.
INFECTIOUS DISEASES are a subset of inflammatory conditions. COVID 19 is the poster child of infection, and FATIGUE is one of the hallmarks of the disease. Interleukins, like TNF-alpha, IL-1, andIL-6 are some of the defense factors which cause the fatigue. AUTOIMMUNE Diseases like Rheumatoid Arthritis and Lupus are also associated with fatigue-producing interleukins.
Fatigue even has its own flagship disease, CHRONIC FATIGUE SYNDROME. Chronic viral disease has been suspected as the cause of this condition, and inflammatory cytokines may be elevated. This condition, and the similar GULF WAR SYNDROME are still poorly understood. Several CFS patients were sent to me when I was in practice, and I had some success in getting them to exercise regularly, which seemed to help. CANCER is another category of diseases where Fatigue is prominent.
Inflammation plays a role in these diseases, which also drain energy substrates from the Patients body; Cancer cells have a high metabolic requirement. MEDICATIONS, Cancer meds especially, but a variety of other Drugs are associated with FATIGUE. I went through MY MEDICATION LIST. Lo and behold, 3 of them are associated with fatigue.
Finasteride is a relic of my prostate operation, recommended to keep it from growing back. It causes fatigue, probably because of its ANTITESTOSTERONE effect. At least I can still pee, and am not bald. I take METFORMIN because of its fame in prolonging life. Its mechanism is that of interacting with the Sirtuin system, and increasing the inefficiency of mitochondria. Isn’t this surprising?
Like many other things in physiology, you place a stress on the body, and the body responds by improving its performance. If you are fatigued, you exercise. Respecting the body works with drugs as well. If you are drinking a ton of coffee and stop it, after a few weeks you will feel less fatigued.
And when you ARE FATIGUED, you drink a LITTLE coffee, and it wakes you right up. Caffeine works by displacing ADENOSINE, which causes Fatigue as it increases through the morning, peaking at SIESTA (or tea) time,at about 2 PM. OMEPRAZOLE, which I take to prevent HEARTBURN, also is related to fatigue especially if it blocks MAGNESIUM for long enough. DEPRESSION overlaps with fatigue, as does SLEEPINESS, to increase the complexity of the situation.
Many chronic LUNG, KIDNEY and LIVER diseases are associated with fatigue as a secondary concern. STAY HEALTHY!
Several ideas apply to ALL MEDICINES. Terminology should be clarified. Medicine, Pharmaceutical, and Drug, in my mind are equivalent.
The term “drug” is pejorative, and I try to use it so. The term “Pharmaceutical” is too long, leaving me with “medication”.
There are some Practical points. You should look at your prescription when you first get it, to make sure it is the right one. Yes, pharmacists rarely make some mistakes. They are human.
You should ask the Pharmacist if she knows WHERE the drug was manufactured. Foreign countries, especially China and India, are less reliable, and the USA is safer. The original Brand Name drugs are more often domestically produced, but even these are being “offshored”.
Next, check the prescription date and expiration date.You should get a ” SHELF LIFE” (the difference between the two) of about 2 years, otherwise, you might ask the pharmacist the next time to give you the “best dating” in his stock.
Store your medications in a cool, dark, dry place in order to prolong their life. Light, heat and moisture degrade most compounds. Remember the O.J. Simpson case? Part of the reason he was acquitted is that a critical DNA sample was stored in a plastic bag, which retained moisture, rather than a paper bag, which is recommended because paper is porous, and allows moisture to escape.
You should follow the suggested TIME to take the medication, because there is almost always an optimal time to take a given medication.
CHRONOPHARMACOLOGY is an emerging field, which is finding that more than 50% of medications are TIME SENSITIVE in their effect in the body. This is an unimportant, academic consideration for most Patients, given the high THERAPEUTIC WINDOW (dosage latitude) of most medications, the mild illness of most patients, and the disinclination of most Doctors to add one more detail onto their already heavy load.
In discussing the medicines in my cabinet and a few other important ones, I will be addressing TIMING.
What about OUTDATED MEDICATIONS? As discussed by the following article from Harvard, the dating is not critical except for liquids, and a few others, like Tetracycline.
This is fortunate, given the expense of medications today. What if I drop a pill on the floor, at home. I usually pick it up and take it. if i just dropped it, unless it is very inexpensive.
What if a pill sticks in your throat, like happens to me a lot? I drink water first, to moisten my throat to make it slipperier.
Next, I take a good sip of water, try to swish it back and go back with my head to accelerate the pill backward, and think confidence. Certain sizes of pills are my nemesis and i have to break them in two.
Please follow Dr. Cs Medicine Cabinet in future postings of DWWR.
Eliquis nicely illustrates my contention in the Overview of Metabolism, that the body is a vast collection of pathways, or “supply chains”. Eliquis blocks a critical enzyme in the pathway leading to coagulation, or clotting” as the product.
Why in the world you want to block clotting? The staunching of blood flow, clotting, has saved countless hordes of early, Paleolithic humans, and continued useful through the bloody Roman and Medieval times, right through the violent 20th Century.
Recently, however, wars are becoming somewhat less popular, and eating excessively more popular, leading to a strange situation. Our evolutionarily-preserved CLOTTING mechanism is now leading to MORE problems than it is solving.
Obesity and type 2 Diabetes are leading to the production of so much fat, that it has to be stored in our arterial walls, clogging the blood flow to our Hearts and Brain, among other areas. This, and the somewhat surprising trend towards longer lives has led to an increase in a variety of age-related illnesses.
When I reached 80 years of age I developed Atrial Fibrillation, a condition leading to a tendency to form clots in my quivering atria, the upper chambers of my heart. To decrease the likelihood of clots getting into my blood stream, lodging in my brain and causing STROKE, my cardiologist started me on Eliquis, an anti-coagulant/blood thinner.
Drugs have three names. The proprietary name, Eliquis in this case, is given by the patenting company to be memorable; q,z,and x are popular letters. The second is the FDA drug name, Apixaban. The drug name often gives the doctor a clue as to its type: xaban refers to inhibiting (banning) of factor 10a (Xa). The third name is a chemical name of interest to biochemists and drug researchers.
When I started the Eliquis, at first unknown to me, I started to bleed internally, leading to a drop in my hemoglobin down to 8.6. I will go into this story when I start going through “how to read your laboratory report”.
I found that reducing my Eliquis from 5mg. to 3.75 mg. allowed me stabilize my hemoglobin by taking extra iron, which I will discuss later.
The doseage selected when the drug company markets a drug is fairly arbitrary, and usually involves round numbers. Interestingly, there is a 2.5mg. Eliquis, which is given if you meet 2 out of 3 criteria. I meet only one and am only 5 pounds shy of the second, in case you think (like my cardiologist does) that I’m taking a risk.
I believe that, whenever you are given a medication, you should be educated about the medicine, and the problem it is intended to benefit. Today’s physician often does not have the time to do this. The internet, including this website, offers a corrective.
I am trying my best to be helpful to you as a Patient Advocate. You and I both must have a doctor to rely upon. But to get the most out of our care, WE MUST BE INFORMED.
According to the American Academy of Dermatology, “The technology has reached a point where, in many situations, health care providers can use IT to offer quality health care services remotely,” and they support telemedicine as an additional treatment tool to supplement in-person services.
To get the most from your telemedicine appointment, board-certified dermatologists offer these tips:
Contact your insurance provider to find out if your plan covers telemedicine appointments. Many insurance providers are updating their plans to cover telemedicine visits during the coronavirus pandemic. Find out what type of telemedicine visits are covered by your insurance.
Gather essential information. This is especially important if you have a telemedicine appointment with a dermatologist you haven’t seen before. Knowing your medical history will help your dermatologist make a diagnosis, decide treatment options, and prescribe medicine, if necessary. Ask your dermatologist’s office if they have any forms you need to fill out before your appointment.Before your appointment, make a list of the following:
Medications you take
Major illnesses or surgeries you have had
Previous skin problems
When your current symptoms began
Illnesses that your family members have had, such as cancer, heart disease, or diabetes
Find out how to reach your dermatologist. Talk to your dermatologist’s office to make sure you know what type of telemedicine appointment you will have, and how your dermatologist will reach out to you. Ask when and how to send the pictures and information you gather.
For video visits, you will be sent a website link you can use to connect with your dermatologist at the time of your appointment.
For telephone visits, you may be given instructions on when to expect a call from your dermatologist.
Write down all your questions. Doing this helps you remember everything you plan to talk to your dermatologist about and make the most of your appointment.
Take pictures. To help your dermatologist examine your concern, take clear pictures of the areas you need examined. Follow these tips to make sure the pictures are the highest-possible quality:
Make sure your pictures are well-lit. Take your pictures in natural light, if possible. Use another light source, like a book light or flashlight, if needed. Make sure that there aren’t any shadows or glares on the area you are taking pictures of.
Take multiple pictures, including one of each side of the area you need examined. Make sure to show the entire area around your spot or rash. If your spot is hard to see, you may want circle it or draw an arrow pointing toward it with a marker.
Take pictures to compare. For example, if you have a spot on your hand, take pictures of both hands so your dermatologist can see how that area usually looks. Make sure you also take a close-up and a far-away picture of the areas you are concerned about so your dermatologist can compare.
Just like an in-person dermatologist appointment, do not wear makeup. If you need your nails examined, take off any nail polish you have on before taking any pictures.
Get help. If you live with someone, ask them to take pictures of hard-to-reach areas, such as your back. If you live alone, use a mirror to make sure you are taking pictures of the right spot.
If your picture turns out blurry, delete it and replace it with one that is clearer.
Avoid irritating your skin before your appointment. Try to avoid doing things that could change the appearance of your skin before you begin your telemedicine appointment or take your pictures. Some examples of things to avoid are taking a hot shower, rubbing or picking at your skin, or applying skin care products.
Find a private space. Find a quiet and private space without distractions to have your appointment. Make sure you can connect to the internet in that space and it has the best-possible lighting.