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Daily Column

June 3, 2008 By Dr. Gott

DEAR DR. GOTT:
I am 72 years young, active, and do all my own housework. I recently read your letter concerning hair loss after taking medication. I am on three medications and three over-the-counters. The first drug is lisinopril 20 mg tabs, one and a half pills every day. The second is prednisone 4 mg daily prescribed by a rheumatologist because of rheumatoid arthritis . The third is blood pressure medicine known as metoprolol 50 mg that I’ve been on for over four years. I was taking one in the morning and a half every evening until my doctor increased the medication to two a day.

My over-the-counter drugs are a one-a-day multi-vitamin, calcium 1000 mg plus D daily, and calcium citrate 315 mg with 200 IU of vitamin D.

Years ago I noticed hair loss and attributed it to the metoprolol. The problem keeps increasing and, in fact, if it continues, I will need a wig in another year. I mentioned the problem to my doctor and her reply was that all medicines make people lose hair. Would I be wrong in asking my doctor to take me off the metoprolol and prescribe another medication for my high blood pressure? I showed her the drug information provided by my pharmacy indicating hair loss as a side effect.

I recently changed primary care physicians since my first doctor wasn’t concerned at all about my hair loss. What can I do?

DEAR READER:
Let me begin with some general information. Medications must go through several clinical studies before being approved. This is done by giving thousands of people a drug, while others are given a placebo. During the studies, no participant knows if he or she is taking the real thing or a placebo. An adverse consequence in more than 1% of the people studied in both categories is referred to as a common side effect, while less than that amount is referred to as rare. Once a drug is approved, it is no longer studied.

Now for the bad news. You are on lisinopril, metoprolol and prednisone. Rare side effects of all three drugs list hair loss as a possibility. Steroids are known to precipitate hair loss in men, yet all women have some male hormones. Therefore, of the prescription medications you take, all three share a similar consequence. The good news, according to my resources, is that the hair loss is generally reversible once a drug is discontinued.

It could be difficult in your situation to determine which drug might be causing your hair loss, unless you kept meticulous records indicating when the pattern began. As we age, we suffer wrinkles, heart problems, hypertension, arthritis and more. It’s difficult enough dealing with the problems over which we have little control. We shouldn’t have to deal with balding when it might be preventable. I recommend you speak with your new primary care physician who might be able to prescribe different medications in each instance without such an emotionally devastating side effect, no matter how rare it might be.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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Daily Column

May 30, 2008 By Dr. Gott

DEAR DR. GOTT:
Are generic prescription drugs from India safe to use? Thank you for your input.

DEAR READER:
Outsourcing is all too common today, whether we are talking about a pair of rubber boots or something as critical as cardiac medication. India now has more facilities making drugs and drug ingredients for the American consumer than any other foreign nation today.

The Food and Drug Administration (FDA) is responsible for ensuring the safety of all drugs made for American use regardless of where they were manufactured. However, during the past seven years the FDA has conducted just 200 inspections at plants in both India and China, and many of those inspections were done with prior notice. As a comparison, 1,222 quality assurance inspections were made in US manufacturing plants in 2007. In the US, the FDA performs spot inspections without advance notice. This keeps pharmaceutical companies on their toes more than they would be with advance notice.
The FDA claims they are unaware of any health issues caused by drugs imported from India, but also admits it would be impossible to determine if contamination or poor quality causes some patients to become sicker or remain ill.

India is currently producing both finished drugs and drug ingredients for more than 350 types and strengths of heart medicines, antibiotics and antidepressants. Just ten years ago, they were responsible for only eight. This is largely because of cost. Americans want cheaper drugs and these countries can make them for much less than US based companies. While most of these manufacturers provide high quality products and ensure they meet FDA requirements, some companies are less than honest. No matter where production occurs, counterfeit drugs are a problem. However, in India and China, this risk is increased, simply because someone is out to make a quick buck.

In my opinion, the FDA needs to increase its over-seas inspections (without notice to the plant). This is the only way to be sure that US importers and consumers are receiving high-quality products.

To the best of my knowledge, several organizations in the US and abroad are urging the FDA to increase foreign inspections. If a foreign manufacturer in on the up-and-up, he should have no concerns (and many are asking for more inspections). This will not only provide peace of mind to consumers, it will help weed out the so-called “bad guys”.

I recommend that anyone who wants the US FDA to take greater responsibility write or email the organization to express their opinions. Perhaps if enough Americans come forward, we can achieve change.

If you would like to read more about this topic, I direct you to an article (“FDA Scrutiny Scant In India, China as Drugs Pour Into U.S.”) written June 17, 2007 by Marc Kauffman for www.WashingtonPost.com.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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Daily Column

May 27, 2008 By Dr. Gott

DEAR DR. GOTT:
While driving recently, I listened to a radio program about medical issues. The program hosts indicated that sound nutritional practices can, over time, allow people to eliminate pills and medications they had been told they would have to take all their lives.

I had my first physical in over 30 years. I was found to be in good shape, except I was diagnosed with thyroid disease. I take one L-thyroxine 25 mcg pill daily. Periodically I have to have a blood sample drawn to determine if the drug dose is adequate. My question is, do you know of some nutritional practice that can eventually eliminate my dependence on taking synthetic thyroid medication for the rest of my lifetime?

DEAR READER:
There are some home remedies you can take for hypothyroidism; however, the results will likely be less than optimal. Caffeine, alcohol, tobacco and aspartame can all worsen a thyroid condition. Try adding fresh vegetable juices to your diet three days a week. With your doctor’s permission try using products such as Thyroidinium or Tryosine 400 (an amino acid supplement). These are available at health food stores. You may choose to see a naturopathic physician along with your primary care physician. If you choose this route, be sure the two physicians work together to provide you with the best treatments. The naturopath can offer natural remedies while the PCP can provide modern medicines and testing. You must continue to have appropriate testing to ensure your thyroid is within limits.

Having said this, the fact that you have an under active thyroid gland and require medication is an indication to me that you will have to take it for the rest of your life. Your thyroid probably is not going to function properly on its own. Fortunately, L-thyroxine is inexpensive and safe to use. Make some dietary modifications and stick with your doctor‘s recommendation.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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Sunday Column

May 18, 2008 By Dr. Gott

DEAR DR. GOTT:
I was just diagnosed with osteoporosis. Would you please tell me, in your opinion, the best route to go? Everyone is pushing this new IV treatment.

DEAR READER:
As I am sure your doctor mentioned, osteoporosis means “porous bones” and refers to the loss of bone density and bone mass that commonly appears as we age. Mild bone loss is known as osteopenia. Osteoporosis occurs when the loss is so extreme that the bones cannot perform their supportive function. As a result, they can easily break.

The condition is commonly found in postmenopausal women, but can affect men as well. Hunched shoulders and a stooped posture are often attributed to the aging process, but may actually be the result of osteoporosis. Other signs are kidney stone formation, gum recession, tooth plaque, joint pain, thyroid disorders, and lower back pain.

Hormone therapy for women using patches, creams or vaginal rings, was once the gold standard for treatment. Unfortunately, because of safety concerns, this is no longer the case.

Biphosphonates may preserve bone mass and increase bone density in the spine and hips. This treatment can be beneficial for men, younger adults, and those individuals with osteoporosis induced by therapeutic steroid use. Biphosphonates can be taken orally or intravenous infusion. Side effects can include bone, joint and muscle pain (mild to debilitating), severe abdominal pain, nausea and osteonecrosis of the jaw (destruction of the jaw). Those with a history of ulcers or acid reflux should avoid this class of drugs because of the possibility of esophageal inflammation and esophageal ulcers. Common biphosphonates include Fosamax, Actonel and Boniva.

Zoledronic acid (Reclast) is in the bisphonate class and was approved by the FDA in 2007 as the first once-a-year drug for osteoporosis. It is also indicated for the treatment of Paget’s disease (“soft” bone disease) in both men and women. It should be avoided by those with kidney disease. Adverse reactions include bone, joint and muscle pain and osteonecrosis of the jaw. Reclast is given intravenously in a physician’s office.

Raloxifene (Evista) mimics the beneficial effects of estrogen for post-menopausal women only. It is not approved for men or pre-menopausal women. Those with a history of blood clots should not take this drug as there is an increased risk of deep vein and retinal vein thrombosis and pulmonary embolism. Adverse reactions include hot flashes, leg cramps, flu-like symptoms, peripheral edema (leg swelling), and joint pain.

Teriparatide (Forteo) works by stimulating new bone growth. It is an injection given once daily under the skin in the thigh or abdomen. The medication has been found to cause an increased risk of a certain malignant bone cancers in rats and it is not known at this time if it affects humans in the same way. There is a black box warning on this product’s packaging and, in my opinion, the product should be avoided.

There is no practical way to restore bone mass. However numerous treatments to slow the process of deterioration are available. For example, a new emerging therapy without prescription medication shown to significantly reduce back pain and improve posture is known as weighted kypho-orthosis (WKO). It is a harness with attached weights that is worn twice daily for 30 minutes at a time. It is combined with back extension exercises.

Given the drugs now available, it is rather difficult to determine which therapy might be appropriate for every person. Because I am not your personal physician and we have never met, it makes that job even harder. I don’t know your age, current medications, exercise habits, weight, family history, and more. Therefore, I cannot determine the best choice.

I strongly urge you to speak with your physician who knows you and your medical history and can make an appropriate choice. I know this sounds as if I am taking the easy way out, but osteoporosis is an extremely important and complex issue. Were I put on the spot and forced to make a decision, I would probably recommend you take 1200-1500 mg calcium combined with 400 international units (IU) of vitamin D daily. When combined with regular exercise and a nutritious diet high in calcium containing foods, such as yogurt, fat free milk and dark leafy greens, this can be an excellent preventive step and may stop further bone loss if started early in the disease. To determine if it is working, be sure to have a bone density study one year after starting therapy. Bypass all oral and injectable prescription drugs as long as possible or until more time has passed and additional research can be done.
To give you related information, I am sending you copies of my Health Reports “Osteoporosis” and “Consumer Tips on Medicine”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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Daily Column

May 3, 2008 By Dr. Gott

DEAR DR. GOTT:
Your recently wrote a column about a gentleman who was taking 16 medications. My husband, who is 82, is taking 19.

He has survived Hodgkin’s Lymphoma (1988), a 5 way by-pass surgery (1991), stroke (1997), and two carotid artery surgeries (1997 and 1998). He has type two diabetes as a result of his lymphoma chemotherapy. He is in kidney failure, was diagnosed with bladder cancer in 2005 and myelodysplasia.
He regularly sees an oncologist, endocrinologist, nephrologist, urologist and cardiologist. His medications include pain relievers, blood thinners, cholesterol reducers, calcium, vitamins, water pills, and many more.

I would like your opinion. We have insurance which I am very thankful for. I respect his doctors and their opinions as I do yours. I am worried, though, that he is over medicated. I also am worried that if he stops any of these, it would be his end. He leads a fairly normal life other than sleeping a lot, but given the situation, I would expect this. He does not do much, cannot play golf and is no longer sexually active (even though he would like to be). It is just not possible for him to do the things he wants and enjoys the way he used to.

DEAR READER:
Your husband has several serious medical ailments for which he is taking various (and mostly appropriate) medications. In your list, I do see two medications that I believe could be safely stopped. Valtrex is given to individuals with genital herpes as an outbreak preventive or treatment. Because your husband is not sexually active, there is little risk of him passing this condition on to you. You also state that your husband sleeps a lot. I note that he is taking Lunesta which is a sleep aid. If he is getting more than adequate sleep (7-8 hours) I don’t believe he needs this. If he is taking it because he cannot fall asleep at night, perhaps this is a result of him sleeping too much during the day. Try to keep your husband as active as possible during the day and he should have no problem sleeping at night.

Before making any modifications, I suggest you discuss your concerns with his physicians. Perhaps they would be willing to set up a conference call or meeting at which you and your husband can discuss the necessity of his medications and whether or not any can be modified, reduced or stopped. It is important, given his various ailments, that all his physicians agree on medication modifications. Perhaps now is also the time to involve a primary care physician who can help you sort out his medications and treatments. This will also help in the future if his situation becomes worse. At that time he may wish only to have medication to make him comfortable. Your husband’s quality of life should be of the utmost importance and if he is not enjoying his life and is missing out on the things he loves, his is, in my opinion, suffering. This can also lead to depression.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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Sunday Column

April 27, 2008 By Dr. Gott

DEAR DR. GOTT:
I have had toenail fungus for 15 or 20 years. It has spread to all my toes despite my attempts to cure it. I used tea tree oil for about six months with no change, iodine for about four weeks with little change and soaking my nails in Listerine nightly for six or eight weeks with no change. I have used Vicks VapoRub twice now, the first time for six months with change only in one toe but it didn’t last. My most recent experience with it has not shown any results, despite using it twice a day for one year. I put it on liberally and then put on socks.

Can you please advise me about what else I can do? Do I still have non-medication options? Should I now consider using those expensive anti-fungal pills?

I am a 60-year-old female, 50 pounds overweight and take metoprolol, simvastatin, Wellbutrin, L-tryptophan (for my depression, it works great), and several vitamin supplements. I try to eat healthfully and exercise by walking, meditating and doing Tai Chi. I have a stent but a recent stress test and echocardiogram show no blockages. I used to smoke a pack a day for 25 years but quit (which is when the extra weight came on).

I would appreciate any suggestions you can give me.

DEAR READER:
Toenail fungus can be especially difficult to treat. You appear to have unsuccessfully tried several home remedies.

Only one of your medications, simvastatin, lists changes to hair or nails as a side effect but I doubt that this is the cause of your nail problems. Interestingly, both simvastatin and metoprolol list depression as a side effect. With your history, I wonder if these medications are appropriate choices for you. Another fact to consider is that Wellbutrin can cause cardiac problems. Because you have a stent, perhaps this is also not the best choice. L-typtophan is an amino acid that naturally occurs in the body. It is a precursor to serotonin, which may be why you have had success using it for treatment of your depression.

Now to your nail fungus, there is a new over-the-counter ointment that you may wish to try called Miranel. It works similarly to Vicks but has the added benefit of being able to penetrate the skin and nails more easily, allowing it to work more effectively. Remember to keep your nails trimmed short for faster results. The kit which contains a nail file for easy nail trimming, a brush for a less messy application and the ointment is available at Wal-Mart and most pharmacies. You can also purchase it online at www.MiranelBrands.com.

In my opinion, however, now is the time to consult a podiatrist. This specialist will be able to take samples of your nail fungus and determine what type it is. This will also then allow him or her to give you treatment options. Not all nail fungus is the same. You may have a particularly resistant or uncommon type. That being said, a pharmacist recently wrote to me saying that those “expensive anti-fungal pills” were available as a generic at Wal-Mart for $4. So while the medication may not be as expensive as it once was (if you live near a Wal-Mart, at least), it still is not my top choice. You must have blood work before starting the treatment to ensure there are no problems with your liver, and both during and after treatment to ensure that your liver was not adversely affected by the pills. Nail fungus is not harmful, it is simply ugly. I recommend you avoid medication until you have exhausted every other option.

To give you related information, I am sending you copies of my Health Reports “Dr. Gott’s Compelling Home Remedies”, “A Strategy for Losing Weight: An Introduction to the No Flour, No Sugar Diet” and “Consumer Tips on Medicine”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

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Daily Column

April 21, 2008 By Dr. Gott

DEAR DR. GOTT:
After using a particular medication for a long period of time, the side effects may increase, especially in older adults. This has happened to me.

How and where do you report these side effects?

DEAR READER:
The problem you experienced is not so much in the medication as it is a function of age. Senior citizens undergo striking metabolic changes as they age. One of these changes is a decreasing ability to detoxify many medications. When this occurs, the patient may need an adjustment in drug dosage, or even a change in the medication itself. I’ve also observed that if a patient has been on more than one medication for an extended period of time with apparent success, metabolic changes occur that can result in adverse effects.

I urge my elderly readers to report any suspected drug reaction to his or her physician. Another option is to review the situation with a pharmacist who can offer further advice.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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Daily Column

March 11, 2008 By Dr. Gott

DEAR DR. GOTT:
I have been diagnosed with iatrogenic secondary adrenal insufficiency. I have searched the internet for information on this but have not been successful.

Can you please explain ways that might help me to get off oral cortisol? I am currently taking 22.5 mg daily. Almost every time I drop the dose, even by as little as 1.25 mg every other day, I get the beginning symptoms of an adrenal crisis (sweating, nausea, vomiting, abdominal pain, diarrhea, extreme fatigue and profound weakness). I take extra cortisol when this happens and I usually start to feel better within 30-45 minutes.

During one of these episodes, I noticed that my skin looked tan even though I had not been out in the sun. What was this from and what does it mean? I want my adrenal glands to work on their own. I have been on oral cortisol for four years.

P.S. I was given large quantities of high dose prednisone for treatment for a back problem. I don’t know if this will help you.

DEAR READER:
The adrenal glands, which are next to the kidneys, produce steroids, notably cortisol, that are vital for normal metabolism. Yours adrenal glands are deficient therefore you need to take supplemental cortisol.

Iatrogenic secondary adrenal insufficiency (reduced function of the adrenal glands caused by medical treatment) is one of the most common forms of adrenal insufficiency. It is caused by excessive or chronic use of glucocorticoid medication (such as prednisone) which essentially reduces adrenal function or shuts down the adrenal glands. I suspect that you are now having issues because of your use (by doctor’s orders) of prednisone. Your doctor should have known and told you about the possible risks of long-term prednisone use and offered ways to reduce the risk of adverse effects.

To the best of my knowledge, your adrenal glands will not likely resume normal function, necessitating supplemental cortisol for the rest of your life. Without normal levels of cortisol, your body cannot function properly (as you know by your symptoms). This can lead to serious consequences, including death if proper amounts of cortisol are not given. Your endocrinologist is the best person to answer your concerns. He or she will know more about the condition, treatment and outcome of your disorder better than I.

As for your tan skin, that is due to the lack of cortisol present in your body. It should have disappeared after taking the extra cortisol. It is one of the symptoms of adrenal insufficiency.

For my other readers, there is some good news. Iatrogenic adrenal insufficiency is somewhat preventable. If you must take glucocorticoid medication such as cortisone or prednisone, use the lowest dosage possible, take it on alternate days or use a topical or inhaled form. Your physicians are the best source for information.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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