Online pharmacy weblog

Dr. Andrew Kramer recently looked over the medical history of one of
his patients who had been in the emergency department complaining of
chest pains.

Kramer was surprised by what he read: The patient had been taking
three to four dietary supplements for erectile dysfunction — every day.

“I would have never given him Viagra,” said Kramer, a urologist at the
University of Maryland Medical Center. “He was on the cardiac
transplant list.”

Heart patients are potentially at risk for a heart attack and an early
death when they combine erectile dysfunction drugs, such as Viagra,
with heart medications that contain nitrates, like nitroglycerine.

Both drugs lower blood pressure and together can lower it to deadly
levels.

Normally doctors won’t prescribe Viagra or Levitra to these men, but
they can look elsewhere — specifically, the Internet, where herbal
supplements of all sorts are available for sale.

While some of these supplements may contain harmless ingredients, many
are indeed as potent as the real thing.

A recent Food and Drug Administration study showed that some of these
herbal remedies actually contained the active compound in prescription
brands as Viagra, Levitra and Cialis, making them potentially deadly
compounds.

The FDA issued a health advisory last week against these supplements.

“These products are promoted and sold on Web sites as ‘dietary
supplements’ for treating erectile dysfunction and enhancing sexual
performance, but they are in fact illegal drugs that contain
potentially harmful undeclared ingredients.”

“These companies are promoting medications that we would never give to
men with heart disease,” said Dr. Dragan Djordjevic, an internist
specializing in male sexual health at Rush University Medical Center
in Chicago.

The FDA specifically targeted the herbal supplements Zimaxx, Libidus,
Neophase, Nasutra, Vigor -25, Actra-Rx and 4EVERON, all of which do
not list the prescription ingredients on their labels.

For this reason, a patient may not realize the risks.

Erectile Dysfunction Common Among Older Men

“If they are not eligible for one of the classic drugs, they may go to
the supplements, and for this reason, it’s more poignant to let the
patient know that they can be harmful,” said Dr. Yair Lotan, an
assistant professor of urology at the University of Texas Southwestern
Medical Center in Dallas. “They may buy the supplement and not know
they are in danger.”

Doctors can’t estimate how many men have suffered from this drug
interaction because many patients don’t reveal that they are on
supplements.

In many cases, erectile dysfunction and heart disease are linked. Both
are caused by decreased blood flow due to buildup in the arteries.

“A person can come in with severely low blood pressure and die of a
heart attack, and not know they should have reported taking
supplements,” said Dr. Ira Sharlip, a clinical professor of urology at
the University of California at San Francisco and spokesman for the
American Urological Association.

Given that a large majority of Americans have erectile dysfunction,
however, doctors estimate that there are many who have taken or are
using these supplements.

It affects about 30 million U.S. men, including more than half of men
older than 40, according to Dr. Dominic Carbone, assistant professor
of surgery in urology at Wake Forest University Baptist Medical Center
in North Carolina.

May Help Some Men, However

Carbone estimates that he has at least six to 10 patients per month
ask him about supplements for erectile dysfunction.

They wonder whether the supplements are just as good as Viagra, he said.

He also recalls a patient coming in who had erectile dysfunction for
years without treatment and was taking eight to 10 supplements per day.

“The guy buying the supplements in a gas station is probably not
taking the recommended dose,” Carbone said.

Doctors say that some male patients feel forced to turn to the Internet.

Often they are still shy about bringing up the subject with their
doctors and prefer the anonymity of buying online.

Also, at about $10 a pill, Viagra can be too expensive for some men,
whereas supplements can go for a variety of prices, usually for less
than prescription drugs.

That isn’t always a bad thing, one doctor noted.

“The other side of the coin is we have made these drugs unavailable to
the poor. Medicaid does not cover Viagra. If something is off market
and is cheap, it may meet a need,” said Dr. Robert Davis, professor of
urology at the University of Rochester.

Many doctors agree, however, that the advisory is important to public
health.

“Not everyone on nitrates will see the sky fall when they take [these
supplements], but enough will to warrant an advisory,” Davis said.

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I am instructing a Medical Asepsis class and have come up with great
information and better understanding of pathogens (disease causing
microorganisms) and infectious diseases as well. Anyways here is an
interesting blurp I came across.

Something to think about when you are making those IV’s

Joe Medina, CPhT

———–
Disgusted by Port-A-Potties? Freaked out by fast-food restrooms?
Believe it or not, picnic tables and ATMs may harbor more germs.

A new report puts our germ fears into perspective. In a nationwide
telephone survey of 1,000 adults, each adult was asked to rate the
surfaces they considered germy. Those answers were then compared with
real studies of bacteria on various surfaces.

You guessed it: The bulk of germs are hiding where you least suspect
– playground equipment, the phone receiver, ATMs, and elevator buttons.

“This survey shows that people have a false sense of security when it
comes to germs,” says Charles Gerba, a.k.a. “Dr. Germ,” a professor of
environmental microbiology at the University of Arizona, in a news
release.

It’s a real health problem, because 80% of infections are spread by
hand, Gerba says. The solution is proper hand hygiene with soap and
water or an alcohol-based sanitizer, he says.

Among his survey’s findings:

* 64% think public restroom doorknobs have more germs than a
typical ATM but a typical ATM has been proven to have more germs
because of the number of dirty hands that touch each of these items.
* 75% think the toilet seats in fast food restaurants have the
most germs — but airplane toilet seats are worse.
* 76% assumed that Port-A-Potties were off-the-chart germ wise –
but picnic tables actually have more germs.

The germ facts:

* At home, the kitchen sink is one of the places with the most
germs — harboring more germs than the bathroom. The most contaminated
sites are those that tend to remain moist. The dishcloth, toilet bowl,
garbage can, refrigerator, and bathroom doorknob are also high on the
list.
* At work, phone receivers harbor more germs than any surface –
even more than the toilet seats. Desktops, keyboards, and elevator
buttons are also on the workplace top germ-covered list.
* In public places, playground equipment, escalator handrails,
shopping cart handles, picnic tables, and Port-A-Potties are top germ
carriers.

Also, only 17% of Americans wash their hands after shaking hands –
yet 51% wash them after sneezing or coughing. It’s part of the
misconception that germs are spread in the air rather than by hand
contact.

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You can’t see it, smell it or taste it. But food or water tainted with
E. coli O157:H7 can leave you fighting for your life, especially if
your immune system is compromised or you’re very young or very old.

Seven people died and more than 2,300 others fell ill in Walkerton,
Ont., in May 2000, in Canada’s worst-ever E. coli outbreak after the
bacteria got into the town’s water supply. The source of the
contamination was manure spread on a farmer’s field near one of the
town’s wells.

While the Walkerton case was unusual, health authorities across the
country normally deal with a few thousand cases of E. coli illness a
year. In the U.S., it’s estimated that 73,000 people are sickened by
the bacteria every year and 61 people die.

While the vast majority of people fully recover from a bout of E. coli
within a week to 10 days, some people will spend the rest of their
lives dealing with the after-effects of the illness.
What is E. coli and where does it come from?

E. coli, short for Escherichia coli, is a type of bacteria commonly
found in the intestines of animals and humans. There are hundreds of
strains of the bacterium, but E. coli O157:H7 has been identified as
the most dangerous to people, producing a powerful toxin that can
cause severe illness.

It was first recognized in the United States in 1982, when an outbreak
of severe, bloody diarrhea was traced to contaminated hamburgers,
leading to the illness to be dubbed as “hamburger disease.”

E. coli O157:H7 can contaminate ground beef during the butchering
process. If it is present in the intestines of the slaughtered animal,
it can get into the meat as it is ground into hamburger.
How does E. coli spread?

While E. coli is most often found in meat, it is not limited to it.
The bacteria is also found in unpasteurized milk and apple cider, ham,
turkey, chicken, roast beef, sandwich meats, raw vegetables, cheese
and contaminated water. In September 2006, an E. coli outbreak that
killed three people and made more than 200 ill was traced to spinach
grown in California. Bean and alfalfa sprouts have also been recalled
due to E. coli contamination.

Fruits and vegetables that grow close to the ground are susceptible to
E. coli contamination if, for example, improperly composted cattle
manure is used as a fertilizer.

E. coli, salmonella and cryptosporidium can also be found in
unpasteurized juice. Children, the elderly and people with compromised
immune systems are encouraged to drink pasteurized juice or boil
unpasteurized juice before consuming it.

Once someone has eaten contaminated food, the infection can be passed
person-to-person, by hand-to-mouth contact. The bacteria are most
often spread from person-to-person.
What are the symptoms of E. coli O157:H7?

Symptoms — characterized by severe abdominal cramping — can appear
within hours, but could also take up to 10 days to show up. Some
people may also be afflicted with bloody diarrhea or non-bloody
diarrhea. Frequently, no fever is present.

Some people may show no symptoms at all, but can still carry the
bacteria and pass it on to people who will become sick.
How is it treated?

In most cases, symptoms clear up on their own within five to 10 days.
The use of antibiotics is not recommended.

But in a small number of cases, E. coli contamination can lead to a
condition called hemolytic uremic syndrome (HUS). This is a
life-threatening condition that is treated in hospital intensive care
units. It kills three to five per cent of people who come down with
it. Some people who recover still have to contend with lifelong
complications that can include blindness, paralysis and kidney failure.
How does E. coli get in the water?

According to the U.S. Environmental Protection Agency, the presence of
E. coli in water is a strong indication of recent sewage or animal
waste contamination.

E. coli comes from human and animal wastes. During precipitation, E.
coli may be washed into creeks, rivers, streams, lakes, or
groundwater. When these are used as sources of drinking water — and
the water is not treated or inadequately treated — E. coli may end up
in drinking water.
What precautions can I take to minimize my risk?

Proper food handling techniques can go a long way towards preventing
exposure to E. coli. All ground meats should be cooked thoroughly so
the center is no longer pink. Other steps you can take include:

* Refrigerate or freeze meat as soon as possible after buying it
and then thaw frozen meat in the refrigerator, not on the counter.
* Place cooked meat on clean plates. Don’t re-use dishes that have
been in contact with raw meat.
* Use a digital food thermometer when cooking ground beef, which
should be cooked to an internal temperature of at least 71 C (160 F).
* Serve cooked meat immediately or keep it hot (60 C or 140 F).
* Clean and sanitize countertops and utensils after contact with
raw meat.
* Don’t store raw and cooked food together.
* If you marinate meat, don’t use the liquid as a dip or to pour
over cooked meat.
* Drink only pasteurized milk or cider.
* Drink water from a supply known to be safe. If you have a
private water supply (well) it should be tested several times a year.

Since most cases of E. coli contamination are passed from person to
person, good personal hygiene is critical to protecting yourself:

* Wash your hands thoroughly and frequently.
* Don’t handle food if you are suffering from diarrhea.
* Wash raw fruits and vegetables thoroughly before cooking or
cutting them.
* Sanitize food preparation surfaces and utensils.

Anyone known to be infected with E. coli, should not share dishes,
cutlery or glasses with anyone else. Their towels, face cloths and
bedding should be washed separately in hot water and bleach.

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Many of you have heard of the critical need for medical people in Honduras for
the planned upcoming medical mission. IHS (International Health Services) is
sending many medical teams in Feb and they will go to remote places where the
only medical care they will get is from our teams.

I am getting several inquirers with several questions. Great! The interest is
good and we have a couple new pharmacists who are signing up to go. Several IHS
veteran pharmacists are planning to go, too. However… with about 10 or 11 sites
where we will need one or two at each, we still have an urgent need for several
more. With about 100 folks needed in all, we certainly are seeking many
medical, dental, and eye care professionals along with support and helper
people, too. Each site has varying pharmacy dispensing needs so many will
qualify to help somewhere. We even have a couple pharmacy students who are
interested in going to help team pharmacists. We are hoping to get a list of
committed names for all the pharmacists, translators, and other medical folks by
1 October so IHS can start buying all the supplies (pharmacy, food, medical
supplies, plus radio and engineering gear). They will send all this in a
container shipment about the end of December.

If you have any questions for info on how to go or how to help out, call John
Kirckof at 320-634-4386 right away. A phone call may be the best. There is a
tiny IHS web site at: www.IHSOFMN.org It does not have a ton of ham info but
it does have some good general info in their “newsletter”.

NOTE – I have attached a couple articles written from the last mission trip IHS
did last Feb. I sure hope you can help !! The very poor of Honduras do need
our help.

John Kirckof
IHS BOD
320-634-4386

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