Questions for Dr. Hibberd
Headlines (Scroll down for complete
stories):
1. Will Supplements Help Alzheimer’s?
2.
Aspirin as a Preventative
3. Easing the Pain of Polymyalgia
Rheumatica
4. Does Goji Juice Work?
5. Low Blood Sugar
1. My husband was diagnosed with early Alzheimer’s last
year at the age of 56. He takes 125 milligrams of Zoloft in the
morning and 10 milligrams ARICEPT in the evening. We also take
omega-3s. Would additional supplements benefit him?
— Deb B.
A simple multi-vitamin with your omega-3s is usually recommended.
Ask your doctor if his cardiac risk warrants a baby aspirin (81
milligrams) daily. Other supplementation will depend on additional
conditions. For instance, those on statins for cholesterol should
take 50-100 milligrams of supplemental Co-Q-10 daily.
Many patients with early dementia have little to lose by trying
ginkgo biloba at a dose of 40 milligrams of standardized extract
three times daily. Some patients report improvement in as soon as
four weeks.
Ginkgo is not FDA approved for any medical conditions, and there
is great variability in preparations available. Get your doctor's
permission, as there have been reports of bleeding from people
taking ginkgo as well as problems with some medications and
conditions. Ginkgo seeds contain a neurotoxin and are not to be
used. Gingko preparations are not advised for those with seizures or
in conjunction with drugs, such as Zyban and Wellbutrin, which may
lower seizure thresholds.
Pay attention to your diet. Stock up with green vegetables and
fruits, and include generous portions of fresh fish. Use chicken as
a protein source and limit beef products to once a week. At
least 10 minutes of sunlight daily and low fat dairy products
are important for bone strength, so supplement with vitamin D and
calcium if he does not get enough sunlight or doesn’t wish to use
dairy.
Stay active and engage his mind. Active minds seem to manage much
better than those left idle. I hope this helps you with this
difficult situation.
Editor's Note:
2. I take an 82 milligram coated aspirin every evening
before bed as a preventative measure. Should I be taking an uncoated
aspirin or a higher dosage instead?
— Bruce F., Raleigh, NC
Uncoated baby aspirin (81milligrams) is best for daily cardiac
and circulatory preventative use. Higher doses of aspirin are
associated with increased side effects that offset the benefits seen
at lower doses, although higher doses seem to have a preventive
effect on colon malignancy at the expense of increased mortality
from bleeding. The use of high doses cannot be justified because as
the daily dose is increased, there is less cardiac and circulatory
benefit, especially with doses over 325 milligrams daily.
During a hospital visit for a suspected heart attack, we treat
different issues and usually prescribe 165 milligrams or even 325
milligrams chewed as an initial treatment.
The enteric coated variety of aspirin seems not to be as
effective, although you may need to use this formulation if you
cannot tolerate the uncoated variety. Please be sure to discuss your
use of aspirin with your doctor before you begin to use it daily.
Editor's Note:
3. My husband was recently diagnosed with polymyalgia
rheumatica, and prescribed prednisone. His primary care physician
also prescribed Diovan (160 milligrams) for high blood pressure. I
am aware that prednisone causes elevated blood pressure, but his was
high before this, and his glucose levels have also been high.
He was taking Advair for asthma, but was told not to use
it while on prednisone. Are there any alternative therapies he can
use to help alleviate the pain from the polymyalgia
rheumatica?
— anonymous
Prednisone is the least toxic and most effective treatment for
polymyalgia rheumatica. This condition is generally managed by a
rheumatologist in conjunction with your primary care physician.
Complications of prednisone therapy include hypertension,
diabetes, premature osteoporosis, electrolyte disorders and cosmetic
changes that affect fat distribution and acne. Despite these clear
problems, the risk/benefit ratio of prescribing prednisone far
outweighs the consequences of not using it.
The pain can be alleviated by an extensive choice of agents
commonly used to treat chronic pain. These include both narcotic and
non-narcotic pain relievers, antidepressants, anticonvulsants,
topical patches and local nerve blocks.
I recommend that you follow the advice of your physicians. Avoid
unproven alternative remedies, and be sure a substitute inhaler for
Advair is provided. You are right to have concerns, and if you are
not able to feel comfortable with your recommended treatment plan,
always feel free to request a second consultation from a
rheumatologist. No doctor worth his/her salt will be offended by
your request.
Editor's Note:
4. My husband has Parkinson's, Type II diabetes, and has
torn a tendon which will not heal, even after surgeries. A friend is
selling goji juice and claims many of these conditions will be
healed by taking this at $40 a bottle. What do you know about this
juice and should he take it?
— Judy J.
Do not be deceived by false claims. Your friend's goji juice will
heal his financial woes at your expense (literally!). Goji juice is
not your solution.
Since tendon surgeries are usually successful unless complicated
by infection and/or poor circulation, obtain a second opinion. Be
sure his circulation and diabetes are sufficiently under control to
permit healing. Poorly controlled diabetes contributes significantly
to poor circulation and is a very common reason for delayed wound
healing.
Editor's Note:
5. I am a 51-year-old woman in good health. I exercise
regularly and am careful about what I eat, but I have had low blood
sugar for about 10 years which keeps getting worse. Is there
something else I can do with my diet or are there supplements I can
take? At times my sugar drops so low I faint or become
incoherent.
— Leslie C.
Episodic low blood sugar levels (referred to as hypoglycemia), is
uncommon in a patient who is not taking insulin or medications known
to cause hypoglycemia. It often heralds the onset of diabetes
several years ahead of its full development. This does not
necessarily mean you are destined to become diabetic, but you
are in a group that is at high risk.
Hypoglycemia is often caused by over-secretion of insulin in
response to a meal, hence its symptoms four to five hours
after eating. The answer is small and more frequent meals. No
supplements have been shown to help prevent hypoglycemia
effectively.
Patients with severe spells of documented hypoglycemia,
especially seemingly unpredictable episodes or in association with
fainting or neurological symptoms, should be evaluated for other
underlying medical conditions such as insulinoma (tumor of insulin
secreting cells that causes dramatic hypoglycemia and is surgically
correctible).
Keep up the exercise and consider consulting an endocrinologist
if your primary doctor does not wish to do the necessary tests.
Editor's Note:
Editor's Notes:
Dr. Peter Hibberd is a doctor of medicine whose
advice is based on over 25 years of outpatient and
hospital-inpatient experience. He is a fellow and active member of
the American Academy of Family Physicians, a career emergency
medicine consultant, and an active member of the American College of
Emergency Physicians. The previous are questions from our readers
and answers from Dr. Hibberd. If you have a question, e-mail the
doctor at askdrhibberd@newsmax.com.
Dr. Hibberd will not reply directly, but look for your questions and
his answers in future e-mails.
IMPORTANT: These
responses are for informational purposes only. Please consult your
primary care physician for a specific diagnosis and treatment
options.
