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Medical Forum / Diseases and Disorders / Arthritis / December 2005

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Article from Firechief that he wanted me to post.

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Squirrely - 10 Dec 2005 20:46 GMT
Here is one of the articles Firechief wanted me to post. I tried to find
urls for the other three articles I have but couldn't so guess I will type
us some stuff from the article.

It is called:

Pain relief often comes at a price.

By Jane E. Brody

This is about pain control medications.

She says: There's not one without a potentially serious risk. Yet, far too
many people use them carelessly, without adequate attention to dosage and
warnings about risks.

She says: If aspirin had to go through the Food and Drug Administration's
approval process today, it would never make it to market.

Nsaids, can equal or outdo aspirin's action against painful inflammation but
at less risk of bleeding.

But they, too can have serious side effects: They can irritate the
gastrointestinal tract and cause ulcers. People who use Nsaids chronically
are often told to take an anti-acid drug to protect their stomachs.

This problem opened up a market for a new kind of drug called a cox-2
inhibitor, sold as Celebrex, Vioxx, Bextra and Mobic. These drugs are as
good or better than ibuprofen for pain, although as patented prescription
medications, they greatly multiplied the cost of pain relief.

Alas, these, too have come under serious fire as evidence emerged linking
them to heart attacks and strokes among users already at risk for these
problems. With many multimillion-dollar lawsuits looming, Vioxx was the
first to be withdrawn from the market, recently followed by Bextra. Both
drugs may come back, accompanied by more stringent warnings. Or their cox-2
cousins, Celebrex and Mobic, may join the ranks as drugs gone by.

But now acetaminophen is being hailed as an excellent first choice for
chronic pain.

If consumers are unaware of its presence in different medications, or if
they fail to adhere to cautionary statements about dosages, it is possible
to take too much acetaminophen inadvertently.

Taking more than 4,000 milligrams a day of acetaminophen on a chronic basis
can damage the liver of an adult.

It is easier than you may think to take more than 4.000 milligrams a day.
With the higher-dose tablets (650 milligrams each) now sold to treat
arthritis, you can exceed the safety limit if you do not follow the
instructions to take two tablets every 8 hours, for a maximum daily does of
six tablets in 24 hours, adding up to 3,900 milligrams a day.

Even if you follow these directions, you can exceed the recommended daily
dose if you also take another medication - say, an over-the-counter cold or
flu remedy - that contains acetaminophen.

A second warning on acetaminophen says: If you drink three or more alcoholic
drinks every day, ask your doctor whether you should take acetaminophen or
other pain relievers/fever reducers. Acetaminophen may cause liver damage.

So, if your liver is already under attack from alcohol, acetaminophen can be
that last straw, resulting in liver failure.

This year, the journal Emergency Medicine warned physicians about the
hazards of overdoses of acetaminophen. Dr. Shirley Jung and Dr. Kennon Heard
wrote that acetaminophen poisoning could often be much worse than it seemed
at first.

Nausea and vomiting can progress to complete liver failure in as little as
24 hours unless the problem is promptly recognized and the proper antidote
given within 24 hours of a toxic dose. To prevent liver injury, the antidote
should be given within eight hours.

New York Times News Service

This is not the entire article. I just typed out the important parts of it.
Diane - 10 Dec 2005 21:57 GMT
well, that was cheery. :-(

diane
Norman - 11 Dec 2005 03:05 GMT
A couple of things to keep in mind:

For most of us, NSAIDs are not "pain meds" but "anti inflammatory meds".
The pain relief is from the reduction in inflammation. The pain, while
often debilitating, is not the worst part of the inflammation. The
inflammation in arthritis often cause irreversible damage to the body,
the joints erode, etc. Some of the anti-inflammatories won't reduce any
pain that is not caused by the inflammation. Quite a few of us take
separate pain meds to handle that aspect of our problems.

The other thing is that use of medicines should probably considered as a
"lesser of two evils" kind of thing. Will the benefit from taking the
medicine be greater than the possible side effects, which is determined
by just how bad the side effects are.

You need a good doctor who informs you of the side effects, tells you
what to do if they occur and prefers to prescribe the lowest dosage
which will do the job. It took me a couple of tries to find a RD I can
work with (he considers the patient as 'part of the team') but I'm glad
I see him.
Nann Bell - 11 Dec 2005 04:51 GMT
> But now acetaminophen is being hailed as an excellent first choice for
> chronic pain.
[quoted text clipped - 5 lines]
> Taking more than 4,000 milligrams a day of acetaminophen on a chronic basis
> can damage the liver of an adult.

But...... acetaminophen has NO anti-inflammatory action.  If you are taking
it merely for pain that is not inflammation related, or as part of a cocktail
to treat the pain from your inflammation, that's ok, but it is not
appropriate to take only acetaminophen for an inflammatory condition - or to
be prescribed only that by a doc.

and..... it also is the med of choice for bringing down a fever.  If you have
a virus, you may well need to let the fever rage some to kill off the virus
rather than killing the fever with this med.  I finally decided to drop my
acetaminophen for a while when I was running fevers with this virus I've got
and my PCP told me to stay off it at least until the fevers went away.

Signature

Nann
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Simply the thing I am shall make me live --- William Shakespeare

Diane - 11 Dec 2005 17:16 GMT
by the way, nann, how are you feeling? fever gone?

diane
Squirrely - 11 Dec 2005 23:19 GMT
diane,

I sent your post to firechief too so he knows he is getting responses to his
articles. I forgot to mention it when I posted to Norman and Nann. Dah, if I
had a brain I might be dangerous.

Signature

Love and hugs to all
Good thoughts coming your way too.

Squirrely Jo

Nann Bell - 13 Dec 2005 03:58 GMT
> by the way, nann, how are you feeling? fever gone?
>
> diane

fever's gone, stomach is still strange.  For now I'm dealing with it by
taking bean-o before I eat.  I'm scared to restart the Enbrel and mtx though
with the stomach still being strange.  I'll check in with the doctor tomorrow
- I think I'm improved enough that I won't have to go back in this week, but
if the stomach stuff doesn't clear up, we'll have to deal with it.  I can
live forever taking bean-o every time I eat something with a trace of fiber.

We got the last official piece of paper for Mike's ordination today.  All is
set for him to become a priest on Saturday.

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Nann
remove the Gator cheer to email me
Simply the thing I am shall make me live --- William Shakespeare

Squirrely - 14 Dec 2005 11:12 GMT
Nann,

Can I use a few of your comments in this post, and I will ask in the other
post also over on my email group. There are alot of the girls over there
having the same symptoms of the virus. I have been telling it is a problem
with the virus. But I don't think they believe me. But if I could use what
you said and what your dr told you, I might be able to get them to see that
is what it is.

I will be letting Joe know about Mike, he has been asking about him.

Signature

Love and hugs to all
Good thoughts coming your way too.

Squirrely Jo

>> by the way, nann, how are you feeling? fever gone?
>>
[quoted text clipped - 14 lines]
> is
> set for him to become a priest on Saturday.
Nann Bell - 14 Dec 2005 13:29 GMT
> Nann,
>
[quoted text clipped - 6 lines]
>
> I will be letting Joe know about Mike, he has been asking about him.

Sure, Jo - use what you want.  BTW, my doctor also had me start taking
probiotic pills from GNC, though he really wanted me eating yogurt to get the
probiotics until I reminded him about my milk allergy. The probiotics help
the stomach and intestines normalize themselves again.

Yesterday I made it without any stomach meds!  Maybe happier days really are
coming, heehee.

Signature

Nann
remove the Gator cheer to email me
Simply the thing I am shall make me live --- William Shakespeare

Squirrely - 11 Dec 2005 21:29 GMT
Nann and Norman,

both your posts brought up good points.

I use tylenol like three times a day just to try to keep the chest pain
somewhat under control. but if I do anything, then the chest pain and back
pain are not controlled with tylenol. It does help me if I take tylenol for
the fms achies, if I get it right away. If not then it doesn't help with
that either.

I know I am probably going to kill off my liver. But what can you do when
you can't take many meds, and the drs won't try to give you anything else.

I did like you Nann, when my fever started going high and not backing down
with the tylenol. I stopped it for a couple of days and it was ok then.

I am seeing where arthritis and treatment of it is a gamble with meds. But
if you don't do the meds there are more serious issues. So  you have to do
something. I agree with you Norman on the meds and being the lesser of two
evils.

Good posts, I am going to mail them off to firechief so he can see there
were responses to the articles.

Any others that come in I will keep for him when they get here to visit on
the 23rd.
I am mailing these because I have to send him the update for the christmas
card list.

It will be good to see them again.

Signature

Love and hugs to all
Good thoughts coming your way too.

Squirrely Jo

>> But now acetaminophen is being hailed as an excellent first choice for
>> chronic pain.
[quoted text clipped - 25 lines]
> got
> and my PCP told me to stay off it at least until the fevers went away.
Nann Bell - 13 Dec 2005 03:58 GMT
> I use tylenol like three times a day just to try to keep the chest pain
> somewhat under control. but if I do anything, then the chest pain and back
> pain are not controlled with tylenol. It does help me if I take tylenol for
> the fms achies, if I get it right away. If not then it doesn't help with
> that either.

yeah - I take tramadol and tylenol.  I did ok with just the tramadol, but am
so much better now that I can take the tylenol with it again.  If only I felt
safe to restart mtx and Enbrel.......

> I know I am probably going to kill off my liver. But what can you do when
> you can't take many meds, and the drs won't try to give you anything else.

that's why we are pincushions...... you know, I'm not even sure how many
times I've had my blood drawn this year!  LOL  I even tried to get efficient
and combine labs for two docs in one trip and they forgot to draw one tube!  
with it being 25-30 miles away for my docs/blood draws (when it's not 80
miles away), I'm tracking it all on the calendar.  All that medical mileage
may be important come tax time.

i sure miss seeing firechief here though.......  even had trouble remembering
his first name the other day, I'm so used to thinking of him as "chief"

Signature

Nann
remove the Gator cheer to email me
Simply the thing I am shall make me live --- William Shakespeare

Harvey R. Stone - 13 Dec 2005 14:30 GMT
> i sure miss seeing firechief here though.......  even had trouble
> remembering
> his first name the other day, I'm so used to thinking of him as "chief"

What,,,, what his name is not Chief?????  LOLOL  A person could always get
whats going around the internet with Joe,,,,Chief,,, that was funny or a
stick in the eye type stuff....  We can thank his good wife for turning Joe
into someone we can get along with....only a few of us could in the old
days.  LOL  So it goes.
Harv
Nann Bell - 14 Dec 2005 13:29 GMT
> What,,,, what his name is not Chief?????  LOLOL  A person could always get
> whats going around the internet with Joe,,,,Chief,,, that was funny or a
> stick in the eye type stuff....  We can thank his good wife for turning Joe
> into someone we can get along with....only a few of us could in the old
> days.  LOL  So it goes.
> Harv

heh, a sure sign that he found the right person!  I always say you can tell
how a good a match is for someone by what kind of person they become through
their partner's influence in their life.  It's great to have him so happy.

Signature

Nann
remove the Gator cheer to email me
Simply the thing I am shall make me live --- William Shakespeare

 
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