Woman diagnosed with a rare lung disease

Q: Do you have any information on LAMS disease? My sister-in-law was recently diagnosed. I understand this is a rare disease but don’t really know about it. Any information you may have would be greatly appreciated.

A: LAM is a shortened term for a 24 letter word known as lymphangioleiomyomatosis, a rare lung disease that typically occurs in pre-menopausal women of all races. This may suggest female hormone involvement in the disease pathogenesis. There have been reported cases of post-menopausal women having LAM, as well as rare cases in the male gender. Up to 50,000 women worldwide are believed to have sporadic pulmonary LAM.

Typical symptoms include dyspnea (difficulty breathing) and a cough. Less common symptoms are associated with lymphedema, pneumothorax, hematuria (blood in the urine), enlarged lymph nodes, and swelling of the abdomen. LAM causes destruction throughout the body, with major targeted areas in the lungs, kidneys and lymphatic system. The destruction that occurs is attributed to the clustering of the cysts and clusters of these abnormal cells in the organs involved. With time, patients may experience shortness of breath (particularly following any exercise), chest pain and collapsed lung(s). It is at this stage that permanent full time supplemental oxygen may be required.

Symptoms may mimic those of bronchitis, asthma, or emphysema. Hemoptysis (the coughing up of blood), chest/abdominal/flank pain, and difficulties breathing may occur. Diagnosis can be accomplished with imaging studies through a high resolution CT scan. Following the CT, the next test may be a lung biopsy.

LAM cells resemble those cells in the lungs of patients with a genetic disorder known as tuberous sclerosis complex (TSC). Almost 40% of women with TSC will also have LAM. In fact, 250,000 women worldwide have the LAM form that is linked to TSC. When TSC is not diagnosed in patients with LAM, the TSC is generally treatable. However, serious side effects may still occur, such a and may include kidney disease, seizures, and developmental delays.

The progression of LAM varies from person to person. Some individuals may advance to respiratory failure rather rapidly, while others may not reach that stage for 20 years or more. Almost all women will develop a collapsed lung that may recur, have lymph leak into the chest cavity, and develop growths known as angiomyolipomas in the kidneys so, while the prognosis may appear grim, research remains ongoing. Lung transplant can help some patients. The LAM Treatment Alliance is a non-profit organization with a mission to aggressively find an effective treatment and a larger goal to eradicate the disorder completely.

Does patient suffer from gustatory rhinorrhea?

Q: I am 85 years old. My problem is both frustrating and embarrassing. When eating, my nose runs profusely as though I have a cold. I am on Xanax that I take for anxiety. Do you think it’s my medication or is there another cause?

A: Believe it or not, this is a common occurrence. The condition may be gustatory rhinorrhea or vasomotor rhinorrhea. Common causes may include consuming hot or spicy foods, a food allergy, or even hay fever. Or, you may have vasomotor rhinorrhea, a condition in which the nasal membranes respond to specific stimuli by producing watery mucus.

Some individuals with an allergy may experience a runny nose, excessive sneezing, or nasal congestion. A nose will run because of irritation and inflammation within the sinus cavity from elevated levels of histamine. Histamine is a part of the body’s natural allergic response to specific substances such as pollen. The eyes may become watery and itch or burn. The sinuses may become congested. The stomach may have cramps and diarrhea may occur. And, the nose may itch and produce mucus. When a person consumes something he or she is allergic to, the body produces antibodies and histamines to protect itself from bacteria and infection. Interestingly, histamines are in a number of the foods we eat, including sour cream, dried fruits, anchovies, beer, wine, yogurt, mayonnaise, pickles, and a whole lot more. Medications that may cause or exacerbate a runny nose include antidepressants, alpha blockers and beta blockers for high blood pressure, birth control pills and some medications for prostatic enlargement.

The answer is a simple one. You may benefit from a nasal or systemic antihistamine or a nasal steroid. Then too, Ipratropium bromide distributed as Atrovent nasal spray used prior to a meal may markedly reduce or completely diminish the habit. This bronchodilator relaxes airway muscles and is used to prevent narrowing of the airways in the lungs in individuals who suffer from COPD, emphysema and bronchitis. This prescription medication has been approved by the FDA for allergic and non-allergic rhinitis. Possible side effects may include blurred vision, pain or burning on urination, a stuffy nose or dry mouth, headache, and more. On the upside, the nasal spray isn’t addictive.

The symptoms of vasomotor rhinorrhea (rhinitis) lack an allergic reaction. Triggers may include stress, changes in the weather, a viral infection, second-hand smoke, perfumes or after shave products, and certain odors or irritants that are inhaled. Medications referred to earlier in my answer that place individuals at higher risk include beta blockers for hypertension, ibuprofen, aspirin, anti-depressants, and sedatives. Symptoms may include a runny nose, sneezing, post nasal drip and a stuffy nose. The symptoms may last for a mere few hours, or they may last for days.

Treatment may be in the form of corticosteroid nasal sprays, antihistamine nasal sprays, decongestants taken by mouth, decongestant nasal sprays, and others. An alternative treatment is intranasal capsaicin.

The place to begin is with your primary care physician who can ask the all-important questions, perform a complete examination, and perhaps order testing to diagnose exactly what it is that causes your unwanted problem. Make an appointment today so you can get to the bottom of this issue and get on with more pleasant things in your life.

Patient doesn’t want to undergo recommended testing

Q: I have suffered from burning urination for a year. Planned Parenthood said if I have an endometriosis test, they will give me something for my problem. I don’t want the test. Can they give me that ultimatum?

A: It might have helped if the physician or health care professional you saw gave you a reason for thinking you might have endometriosis and then explained just what the testing involved, unless you already knew. And no, if you don’t want the testing you don’t have to have it done. However, the facility may take a stand, as apparently they have implied, that they will not treat you without the testing, and for that I cannot fault them.

The causes for dysuria (burning on urination) are many and include a UTI (urinary tract infection), stones in the urinary tract, interstitial cystitis, STDs (sexually transmitted diseases), a side effect of medication taken, urethritis, (including endometriosis since 10% of endometriosis patients have disuria) and more. A UTI is the result of a bacterial infection that can occur in the bladder, kidneys, ureters or urethra. Stones are hard masses of crystallized calcium or other substances that originate in the kidneys but may pass through the urinary tract, causing possible pain, bleeding, and infection. Interstitial cystitis a/k/a painful bladder syndrome, is a chronic inflammatory condition within the layers of the bladder. STDs may present with pain on urination, itching, burning, a vaginal discharge, lower abdominal pain, and more. Urethritis is an infection of the urethra, the tube that carries urine from the bladder. Symptoms may include burning on urination, abdominal pain, and discharge.

In order to diagnose endometriosis, as well as other conditions that cause pelvic pain and burning on urination, a qualified professional will palpate areas in the pelvis for cysts or other abnormalities on your reproductive organs. The testing might be compared with having a Pap test. Your physician if a male, will likely have another female in the room while the brief test takes place and you can bring someone along with you, as well. With luck, this is all that may be required; however, an ultrasound may be ordered if cysts or some other uterine problems are suspected. And there is a chance you may be referred to a surgeon so a laparoscopy can be performed if there are abnormalities. This is a minor surgical procedure which will require general anesthesia which may be more than you are willing to consider at this juncture.

Now a brief coverage of endometriosis, a somewhat painful disorder in which tissue that lines the inside of the uterus (the endometrium) grows outside it. Because the tissue cannot leave the body, it is trapped and surrounding tissue may become irritated. Pain may be present – pain during your menstrual cycle, during and following intercourse, when attempting to have a bowel movement or when trying to urinate. There may be infertility issues, fatigue, diarrhea, and excessive bleeding. Do these signs and symptoms resemble what you are experiencing? If so, perhaps Planned Parenthood is on the right track. If not, you might consider other causes for your dysuria. .

The place to begin may be with a simple urine dipstick in a physician’s office which may indicate the presence of white blood cells and bacteria. Or, the physician may choose to request a clean catch mid stream urine which can also be accomplished in the office. This is a simple test performed by the patient without the presence of others. You will be instructed on the step by step process involved (which is brief). The urine collected is then cultured for analysis. If bacteria is found, the patient can then be treated with the best antibiotic based on the type of bacteria found.

Bottom line: don’t put endometriosis at the top of the list unless you have specific cause to do so. Start simple and progress from there. Good luck.

Is Mom having real or imaginary fears?

Q: My mom was diagnosed with Lyme disease about three years ago. Due to her diagnosis, she now thinks everything she sees or finds could be a bug or insect. She is constantly rubbing her body looking for “bugs” and if for some reason she finds a little dust or trash, she says it’s a bug.

Could this be a symptom related to her Lyme disease, some kind of paranoia, or an OCD problem? Pleased tell me what I can do to make it stop.

A: Yes to all three counts. No one wants a tick embedded in their skin that they have to take a series of antibiotics for and that causes unpleasant symptoms. Lyme disease is transmitted to humans through the bite of an infected tick. Symptoms may include fatigue, headache, fever, a rash that many times resembles a bull’s eye ring, and more. If left untreated, the infection can spread to the joints, heart and nervous system. On the positive side, most cases of Lyme can be successfully treated with an antibiotic such as docycycline. Diagnosis is made through a patient’s history and lab testing. It is important to understand that not every tick that bites is a Lyme carrier and even ticks that carry the Lyme bacteria do not always transmit the disease when they b ite, so there is no real need for panic each time a tick bites. The key is to do a complete a body check daily so if a tick is on the skin it can be removed early when it is feeding and hopefully before it transmits the disease.

Paranoia is believed influenced by anxiety and fear – sometimes to the point of delusion and being irrational. If your mother was completely undone by her Lyme experience, she could be suffering from paranoia as a result; however, generally speaking, an individual who is paranoid feels threatened, has fears, distrusts others, and more. If your mother now has a phobia of “bugs” invading her body, it certainly could have stemmed from her Lyme disease experience. OCD (obsessive compulsive disorder) is characterized by thoughts of fear, concern, anxiety, uneasiness and obsessions and compulsions. Symptoms of OCD may include such things as repeatedly washing hands to the stage their hands are raw and bleeding. They may take a step into a room, back away, and repeat the process three times prior to physically entering. They may arrange pencils or crayons in a particular pattern again and again and become extremely distressed if they are found out of order. They may appear paranoid and may be potentially psychotic.

I don’t know how long it has been since your mother had a physical examination but it may be in everyone’s best interests to take her to her physician for a complete examination and blood work. If she is fatigued, she may be anemic. If she is hyper-active, she may have a thyroid abnormality. The possibilities are countless. This may appear extreme, yet if all the testing and the exam are normal, her physician and her family should then be able to help her realize there isn’t a problem. If, on the other hand, her physician feels she may require some professional help, perhaps seeing a therapist or psychiatrist might be an appropriate next step. Enlist the help of her health care professional. You may be glad you did.

As with most equipment, progress isn’t always what we want

Q: Can you tell me where I can get a metal truss for a hernia?

A: Let me take a moment to address an inguinal hernia, a protrusion that occurs through a weakened area in the lower abdominal muscles. Some hernias don’t cause any symptoms at all and a patient may not even be aware of having one until a physician performs an examination. Other individuals, however, may see and feel a bulge in the lower abdomen on one side or the other of the pubic bone, an indication of the presence of a hernia. That bulge may cause pain and swelling, a feeling of pressure or weakness in the groin area, or a burning sensation at the site of the bulge. If the bulge cannot be reduced (pushed back into place) this may be an indication an intestinal loop is trapped or incarcerated within the abdominal wall. While a hernia isn’t dangerous, the protrusion can be painful – particularly when a person attempts to lift heavy objects or bends over. And while surgical repair is quite common, some individuals prefer instead to wear a truss to help stabilize the weakened area. Interestingly, some individuals may be able to push the hernia back into the abdominal area when lying down. However, it will protrude once again when standing.

An inguinal hernia may be the result of heavy lifting, being obese or carrying excess weight, from chronic coughing, from straining frequently during bowel movements, and more. For some individuals, the weakening may occur at birth when the abdominal lining fails to close properly. For others, a hernia may develop later in life when a person ages, coughs strenuously, or indulges in strenuous physical activity. Men are more likely to develop an inguinal hernia than are women because of a weakness along the inguinal canal.

Diagnosis of a potential hernia is commonly accomplished simply by having a physician perform a physical exam to check for the protrusion in the groin area.

A truss is a means of support, a surgical appliance if you will, to help hold a hernia in place. It is worn during waking hours and acts in a similar manner as a girdle would. There are countless types of trusses made from countless varied materials, few of which are metal at this stage. Earlier versions were made from steel and canvas. A truss, no matter what it is made from, should be fitted by a specialist in the field to fit the individual wearing it. As with many products, newer creations are available to take the place of old standbys, so there may not be a lot of metal trusses to choose from. One under the name of TRUFORM advertises a plated steel shank. Click on to herniaproducts.com for their line. Nulifemedical.com offers spring trusses but many are made primarily from elastic supports.
I know of no outlet or durable medical equipment supply house where a metal truss can be purchased. You may have your homework cut out for you. Some physicians today recommend trusses with metal springs that apply pressure to the area of the hernia, while others don’t recommend trusses at all.

Did her contacts cause conjunctivitis?

Q: I will be the first to admit that I don’t always take my contact lenses out before I go to bed. The only allergy I have is to gentamycin which was used to treat pink eye when I was just three years old. In the past four months, however, I’ve had what I think is conjunctivitis twice in the same eye. Should I be worried? It has cleared up within two days both times but I don’t know if this becoming a chronic problem. I am 29 years old and in generally good health. Any thoughts?

A: To begin with, pink eye is conjunctivitis, inflammation of the conjunctiva – the thin tissue that lines the inside of the eyelid and the white portion of the eyeball. It is so named because the inflammation present makes blood vessels easily visible, giving the eye a pink/red color. The primary causes for pink eye include a virus, an irritant such as chlorine from a swimming pool, pet dander, smoke from a cigarette, and bacteria. Signs and symptoms may include an increased sensitivity to light, burning eyes that are red or pink, crusting of the eyelids or lashes from the discharge that occurs, and a gritty feeling that makes a person want to rub their eyes. Keep in mind that there are other very serious causes for a red eye to include keratitis, angle closure glaucoma, or herpes keratitis that should be addressed as an emergency. Self-diagnosis is out of the question and any delays in treatment could be devastating.

Pink eye will commonly improve on its own without treatment if it is from an irritant or allergen. It will not, however, improve if it is caused by a virus or from bacteria. The latter two causes are extremely contagious. The best methods of avoiding the spread is through hand washing and not rubbing or touching the eyes which a person is inclined to do. While irritating, the condition rarely causes any visual changes, yet corneal inflammation does carry the risk and should be watched for and reported promptly to an ophthalmologist. The cornea is the central portion of the eye covering the colored iris and central pupil.

Those at an increased risk for pink eye include individuals who wear contacts, particularly extended-wear lenses. People who wear contacts will likely feel better if they discontinue their use once symptoms are present and until the pink eye clears but when those symptoms fail to diminish quickly, patients should be seen promptly by their eye doctor to rule out any possible eye infection that could be related to their use.

Viral and bacterial conjunctivitis may affect one eye, or it may affect both. If a virus is present, a patient may experience a watery discharge from the eye(s); generally, if it is from a bacteria, a yellow/green discharge may be present. The bacterial form of the condition is much more common in babies and children than it is in adults.

Treatment for a bacterial infection will likely be addressed with antibiotic eye drops. Ointments appear easier to administer to infants and young children than are eye drops. On the downside, the ointment may cause blurred vision for 15 or 20 minutes following the application but should clear following that.

A virus is a virus is a virus and there is no treatment. Thus, viral conjunctivitis will run its course in as long as two to three weeks with improvement following. The exception to this rule may be if the condition is caused by the herpes simplex virus. On the downside, viral conjunctivitis begins in one eye but may spread to the other within a short period of time.

Allergic conjunctivitis may respond well to antihistamines, decongestants, anti-inflammatory drops and steroids. And, it goes without saying that if the cause of the allergy is known or suspected, it should be avoided if at all possible.

On the home front, a cool compress applied to the eye(s) may lessen the symptoms. Remember, however, that if only one eye is affected, do not use a wash cloth or other material on both eyes because of the cross contamination.

I recommend you make an appointment with your ophthalmologist. Explain the presumed conjunctivitis and work with your specialist to determine if your contacts have contributed to your newest symptoms.

Head to the kitchen cabinet for a toothache remedy

Q: A couple of years ago someone wrote to you about tooth abscesses being cured by taking garlic gel caps every two hours. I can’t find the article on the internet and want to know if there was a brand name and a dosage recommendation. Thank you.

A: There’s little more annoying than a tooth ache, whether it be from a non-infected tooth, an abscess, a lack of proper dental care, or for other reasons. One big issue facing us is that a toothache never occurs at a good time; we awaken with a problem, one occurs over a long holiday weekend or when we are out of town and don’t want to go to a strange dentist. And believe me, a dentist is no more pleased to hear from us at 2 AM than we are in calling in total frustration. Generally speaking, infection that have not abscessed can be treated with antibiotics; however, once it forms an abscess, it must be drained since antibiotics will not cure a pus pocket. s such as an abscess are treated with antibiotics and extensive tooth maintenance, yet, as readers have found over the years, there may be relief found in your kitchen.

Garlic, as one product, has been used for many, many years to treat colds, hypertension, as a cancer preventive, and for tooth pain. The active ingredient in the product is an amino acid known as allicin that gives garlic its strong smell and antimicrobial properties. The product is strongest in its natural form that should have the skin removed and the clove (or slices if you prefer) placed in the mouth at the infection site. If this is offensive to some individuals, garlic is also available in tablet form which can be crushed and placed on the tooth or in capsule form. Some of the name brands that come to mind include Nature’s Bounty, Garlic Plus, Puritan’s Pride, Garlique, and others. Capsules should be readily available in pharmacies, department stores (for those of you old enough to know what an almost all-inclusive store was once called), or in health food facilities. This remedy may also work for those individuals who are having issues with wisdom teeth breaking through and the pain that ensues.

The National Institutes of Health states that garlic contains “broad antiseptic properties” that can pretty much kill germs and bacteria on contact. The agency urges users to discontinue large amounts of garlic about two weeks prior to any planned surgical procedures because of the increased risk of extensive bleeding.

Other possible home remedies include clove oil that contains anti-fungal, bacterial and analgesic properties. Clove oil can be applied by massaging it gently on the gum area near the pain site. As an alternative and one that I often recommend is to place two or three whole cloves in a small gauze square. Place the gauze/clove packet in the mouth between the inside of the mouth and against the painful tooth area for about 30 minutes.

Then there is also peppermint oil that can be massaged with your fingers directly on the infected gum/tooth area. Again, peppermint oil contains agents that will help relieve or at least greatly reduce the amount of pain. No peppermint oil in the house, you say? Try applying crushed peppermint leaves from your garden onto the site.

Lastly, don’t forget warm salt water gargles that are an old standby.

Garlic and other home remedies are a great way of getting past the pain temporarily. Remember, however, that an abscess is generally caused by poor dental hygiene. The abscess will not go away without treatment by a professional. Bacteria from an infected tooth can enter the bloodstream and wreak havoc so be sure to follow up with a visit to your dentist for a more permanent fix.

Woman with blood disorder wants to donate blood

Q: Up until 20 years ago, I donated blood regularly and had no problems doing that. At that same time, I was diagnosed with an acute case of idiopathic thrombocytopenia purpura. Well, I spent time in the hospital, was on prednisone, and a few mild episodes followed. At that time my hematologist advised that I should not give blood but that was a long time ago. Now when I see pleas for blood donors, I wonder if I can donate once again. I know it won’t bother me, but I don’t want to go through the donation process if they won’t use my blood based on the fact that I’ve had a blood disorder in the past.

Any stats you may be able to find on the chances I will have a recurrence of IPT would be appreciated. I am a 48-year-old female Caucasian. My only health issues have been gestational diabetes, high cholesterol for which I take a statin and back surgery seven years ago for a herniated disk.

A: ITP results from low platelet levels, the cells that help blood clot. The condition can lead to easy bleeding and bruising. Individuals of all ages can develop ITP. When it occurs in children, it is often following a viral infection, with the child most commonly recovering completely without treatment. However, when an adult develops ITP, the disorder may be chronic.

Symptoms may include spontaneous nosebleeds, purpura (excessive bruising), gums that bleed following hard brushing or dental work, blood in the stool, fatigue, and more. The treatment provided provided will depend on a person’s age, his or her platelet count, and symptoms that present. Serious cases may respond well to medication, while more extreme cases may require surgery.

While the exact cause for ITP isn’t fully known or understood, it is known to be a malfunction of the immune system that incorrectly attacks platelets. Antibodies are produced by our immune system. They attach to platelets and earmark them for destruction. The spleen recognizes those antibodies and removes the platelets from the system, resulting in a case of mistaken identity . A normal platelet count is commonly higher than 150,000 per microliter of circulating blood. The individual with ITP may have a count lower than 20,000 and when that number falls below 10,000, the risk of internal bleeding is elevated dramatically. In fact, an internal bleed is the greatest problem known – particularly when it occurs into the brain.

Depending on the severity of each case, medications such as corticosteroids should help raise the platelet count. Hopefully the first round will be effective, since the long-term use of steroids comes with its own set of issues. Other treatment might include intravenous immune globulin, thrombopoietin receptor agonists, biologic therapy and ultimately splenectomy which is removal of the spleen.

When it comes to blood donation, because it has been so many years and I am interpreting your platelet count is now normal, and because the problem is idiopathic, meaning there is likely no known cause for the occurrence, you may be able to donate. However, there are differing schools of thought on the subject. Sloan Kettering indicates an individual may donate if he or she had a history of ITP as a child (prior to the age of 11) with no residual effects. Another source, however, indicates you cannot because you may have antibodies that would effect other platelets in the recipient’s blood. I recommend you speak with the Red Cross center nearest you for clarification. Good luck.

Man is referred to rheumatologist for temporal arteritis

Q: I am a 76-year-old male. I was diagnosed with temporal arteritis and was put on prednisone for two years. Since then I have had inflammation in my right thigh and foot. My eye doctor said I have inflammation in both eyes. It’s been recommended I see a rheumatologist. What can I expect and what can I do?

A: Temporal arteritis is inflammation that leads to damage of the blood vessels that supply blood to the head. The condition commonly occurs in the temporal arteries that branch off from the carotid artery which is located in the neck. However, arteritis can also occur in other arteries in other areas of the body. While the cause for it remains unknown, it is believed to be due, at least in part, to an immune response that is faulty, or possibly to severe infections, or because of the use of high doses of antibiotics.

Symptoms may include tenderness of the scalp on palpation, severe headaches on one side of the head or at the back of the head, pain and stiffness of the neck/shoulder/upper arms, fever, jaw pain that exacerbates and dissipates when chewing, and more. There may be issues with the eyes as well, that include blurred or double vision and blindness or reduced vision in one or both eyes. There may be facial pain, hearing loss, and joint stiffness.

While blood tests alone may not provide all the answers a physician requires, a C reactive protein, sedimentation rate, hematocrit and liver function tests may be ordered. The physician in charge may also choose to order imaging studies that include an MRI or ultrasound; however, the diagnosis of choice is a temporal artery biopsy.

Treatment, as you have already begun, will commonly include corticosteroids that may appear to cause improvement within a few days but which may have to be taken for an extended period of time – between one to two years. This long-term use of steroids can increase a person’s risk of fracturing a bone or bones. Corticosteroids, even in low doses, may cause additional side effects that include weight gain, osteoporosis, cataracts, insomnia, bruising, and more. Therefore, because the osteoporosis may have been caused by prednisone, you should speak with your physician about taking a calcium supplement with vitamin D, avoiding smoking altogether if appropriate, reducing your alcohol intake if appropriate, having periodic bone density scans, and seeing the rheumatologist to which he refers. A rheumatologist is a specialist in joint diseases.

Temporal arteritis/giant cell arteritis (inflammation of the lining of the arteries) may develop with or may follow with polymyalgia rheumatica (PMR), another inflammatory disorder. PMR presents with widespread aches and stiffness in adults over the age of 50. Women appear to be at a slightly greater risk for developing PMR than are men, Caucasians more so than non-Caucasians. Symptoms may appear in the upper arms, neck, buttocks and thighs and be more severe in the morning. Symptoms tend to appear rather quickly with both sides of the body equally affected.

PMR can be diagnosed through lab testing that includes a sedimentation rate and a C-reactive protein (CRP). The condition may be difficult to diagnose, because both lab tests may be extremely elevated in most patients, yet normal to minimally elevated in others.

Wife wins this round on medication trivia

Q: I’ve read that grapefruit juice should not be used when taking medicine and food supplements. Later I read that this applies to orange juice also. My husband said I’m wrong. What’s the truth? Should I worry about V8, tomato juice, beer, wine, other alcohol, or even soda? Please clear up this small family feud and sign me a ‘worry wart’.

A: Grapefruit and other citrus drinks may interfere with some medications (85 in all) prescribed by a physician. The problem is that chemicals in the fruit juice may interfere with the enzymes that metabolize the medication in the digestive system and the way in which it processed by the liver. This translates to the drug remaining in your system for too short or too long a period of time. The medication that breaks down too quickly simply doesn’t have sufficient time to work. Those that remain too long can increase to dangerous levels and cause unwanted side effects.

It would be impossible for me to list all the drugs that can interfere with citrus, but antibiotics for infection, cardiac medications, those taken for high blood pressure, and others taken to lower cholesterol levels are worthy of note. This does not imply if you are on any drugs for these disorders that you can drink your grapefruit juice, take your medication later, or reverse the process and take the medication with water or another drink and follow-up an hour or so later with that beloved grapefruit juice. The product may actually have to be removed from your diet.

For example, statin drugs are prescribed for individuals with high cholesterol levels, or for those with cardiovascular disorders. According to the American Journal of Clinical Nutrition, furanocoumarins, organic chemical compounds in many plants including grapefruit, inhibit the efficacy of an important enzyme that helps the body process the medications we take and balances out how much of it goes into the bloodstream. Because of the furanocoumarins hindering this enzyme, larger amounts remain in the blood and could increase a person’s risk for muscle breakdown, liver damage and kidney failure. Because statins interact differently, you should check with your physician to determine if the one you are taking falls into the ‘no grapefruit’ category. And remember also that this only applies to oral tablets. Injectable drugs and skin patches may be okay.

Grapefruit is also known to interact with drugs used to treat nausea, urinary tract infections, cancer medications, anti-anxiety drugs, and immunosuppresants. The FDA has stated grapefruit might also affect the body adversely if a person is on an antihistamine such as Allegra.

On to orange and other juices. Many medications can interact with orange, apple and cranberry juices. As an example, the drug fact label of over the counter fexofenadine (Allegra) indicates the product should not be consumed with fruit juices. Period. Seville oranges, limes and pomelos can produce drug interactions similar to grapefruit by inhibiting intestinal CYP-34A. Orange, apple and some other juices appear to inhibit OATPs (organic anion-transporting polypeptides) that aid in the absorption of drugs. The OATP inhibition results in reduced absorption and potentially decreased serum levels of drugs transported by OATP. Cranberry juice can have a bearing on warfarin, an anticoagulant. According to some researchers, reduced warfarin metabolism results. Further, it causes an increased bleeding risk.

So, I guess you win this round. Without knowing which medications you are on, I cannot recommend you take or eliminate citrus drinks. That answer is best left to your prescribing physician(s). Good luck.