Hormonal Birthcontrol and You, period

Hormonal Birthcontrol and You, period

Hormonal birthcontrol is almost 50 years old and has developed in many ways. A myriad of hormones, combinations and dosaging has become available to suit a variety of needs. PMS, PCOS, Anemia, Migraine are some of the ailments possibly benefitting from oral anti-conceptives. Let’s have an update:

The Menstrual Cycle

Every month, one egg leaves one of the ovaries on its way to the uterus via the fallopian tubes. Meanwhile, in preparation for the egg, the uterus starts to develop a thicker lining and it’s walls become cushiony (the endometrial lining). If the egg reaches the uterus and is fertilized by a sperm cell, it attaches to this cushiony wall.

Most of the time the egg just passes right through without fertilization. Since the uterus no longer needs the extra blood and tissue which made up the walls thick, it sheds them by way of the vagina. This cycle will happen nearly every month until the ovaries stop releasing eggs, usually several decades later.(menopause). In the Ovarian Cycle diagram is clearly visible how the estrogen and progesterone are peaking during the regular cycle.

How it works

The most important mechanism of action of the pill is suppression of ovulation.
This effect is brought about by the sex hormones estrogen and progesterone in the pill. The hormones  signal the brain that no further hormone production is necessary. The brain consequently steps down production of FSH (follicle-stimulating hormone). This largely inhibits the growth of the follicles and the production of estrogen by the body. As a result of the constant estrogen levels in the blood provided by the pill, the brain does not receive its mid-cycle signal to secrete large amounts of LH, the hormone which triggers ovulation. Without ovulation there is no mature egg available for fertilization and conception cannot take place. The pill has two further effects which help to prevent conception:
It suppresses the development of the endometrium. This remains thin and has a texture that does not allow an ovum to implant. In addition, the progestin in the pill causes the cervical mucus to remain thick and impervious to sperm.

The Pill and ‘Periods’

The pill tricks the body into believing it is pregnant. When the pill was being developed, however, it was felt that women would find the lack of a normal menstrual cycle disconcerting. Many women rely on their regular menstrual period for reassurance of not being pregnant. Consequently, it was decided to have the pill consist of 21 days of active pills followed by a pill-free interval of seven days (either no pills or sugar pills for the 28 pack). The rapid decline in the hormone level results in a ‘withdrawal bleed’, which somewhat resembles a menstrual period and is often still referred to as a ‘period’ for simplicity. It is important to understand that the bleeding which occurs during the pill free interval is not a menstrual period.

The pill free interval is the ‘Achilles heel’ of the pill’s efficacy as it can contribute to pill failure. To stop ovulation from occurring a woman needs to take seven consecutive active pills.  The lengthening of the pill free interval is one of the most common causes of pill failure and is often associated with a woman starting her new pill packet late or neglecting the last days since “the period” is about to come anyway.  This may also occur if some of the active pills near the end of the previous packet or active pills near the start of the new packet are not absorbed properly (due to vomiting, diarrhoea, use of antibiotics) this can also mean that there has not been enough pills taken overall to prevent ovulation, especially with the lower dose pills that have become more common.

So why have a pill free interval? As discussed above, the pill free interval was devised in the early days of the pill because it was felt that women would find having a ‘period’ more acceptable. For a range of reasons, however, women may choose to tricycle their pill (taking three packets together without a pill free interval), thus reducing the number of withdrawal bleeds a year from 12 to four. The pill Seasonale is marketed for this reason while it in fact consists of  4 strips of microgynon 21. A shortened pill free interval could mean the hormones in the pill could be lower, therefore, reducing risks and side effects. pills consisting of 24 days of active pills and a four day pill-free interval are currently available (mircelle, yaz). They contain only 15 micrograms of estrogen, this dosage is also used for the first full  year pill.

Answers to other common myths surrounding the pill

The pill makes you fat
Not necessarily: When the pill was first introduced it contained much higher levels of hormones than what is available in the formulations today (100-175 micrograms of estrogen compared to 20-50 micrograms today). While weight gain was associated with these older high dose pills, the pill formulations used today do not always result in weight gain. It is estimated that in the first year of use:
20-25% of women gain more than 2kg
60% of women experience no change or have a weight change within 2kg (both up and down)
15-20% of women actually lose more than 2kg weight .
The progestogen in the pill can increase appetite which may result in weight gain. Some women may also experience water retention but this can often be reduced by switching to a lower dose pill. The low-dose pill, Yasmin, is effective at reducing the symptoms of water retention.

You need to have regular breaks from the pill
False: This is one of the most commonly held beliefs about the pill, even by some health professionals. The idea of taking a break from the pill may have its origins in the fact that the older pills consisted of high hormone doses. Some people also think it is necessary to have a break from the pill to maintain fertility levels. Repeated restarting  might be more harmful than the relatively steady-state situation that is maintained during sustained use. In addition, as side effects usually occur in the first few months of the pill’s use, often subsiding after a time, women restarting the pill may experience these side effects again. It may be useful for women to remember that they are actually ‘taking a break’ during the pill free period.

The most dangerous time to miss a pill is in the middle of the packet?
False: This myth seems to have come from the idea that ovulation occurs in the middle of a woman’s menstrual cycle. When a woman has been taking active pills her ovaries will be in a resting state (ovulation cannot occur). She can miss seven active pills without the risk of ovulation (which is what occurs in the pill free interval). Therefore, the least dangerous time for a woman to miss pills is in the middle of the packet and the most dangerous time is at the beginning or end of a packet.

The pill makes you infertile
False: This myth may stem from the fact that women using the pill as a form of contraception may delay childbearing until their late 30s, a time when their natural fertility has declined. It may take a few months for cycles to return to normal for women who were on the pill. It could actually be argued that being on the pill actually contributes to the preservation of women’s fertility as it reduces the incidence of a number of conditions which impact on fertility (eg. ectopic pregnancies, endometriosis, fibroids).

The pill causes cancer
Not necessarily: The pill actually provides a protective effect from cancer of the ovaries and cancer of the endometrium (the lining of the uterus). Women who take the combined oral contraceptive pill show an increased risk of cervical cancer. It has been suggested that women who use the oral contraceptive pill may be less likely to use condoms with new sexual partners and, therefore, can be more at risk of being exposed to STD’s specifically the HP virus (which is considered to be the main contributing factor to cervical cancer). A review of data on the pill’s use and breast cancer found there was a small increased risk of breast cancer in pill users, but this increased risk decreased after stopping use and after 10 years of discontinuation it had disappeared altogether.

The Morning After Pill.

Recently the USA has followed the example of most European Countries by accepting the sale of the morning after pill without prescription. This is valid for the progesterone only pill containing of 1.5mg levonorgestrel in 1 or 2 pills. It has the suitable name Plan B in the US, referring to the fact it should not be used as regular birth control. It is only effective if taken within 72 hours of the unprotected intercourse. It is not effective when you are pregnant. It decreases the chance of getting pregnant by 89% — from 25% without,  to 3% with the MAP if taken around time of ovulation. It is locally available under the name Postinor by prescription or discretion of the pharmacist.

Pharmacy on Wheels Home Delivery

Philipsburg Pharmacy offers a Pharmacy on Wheels service to Philipsburg and surroundings to our customers. (Philipsburg is Free, surroundings $3.00)

No more driving in heavy traffic in St Maarten, no more waiting at the pharmacy, convenient to all that have no transportation readily available.

philipsburg pharmacy delivery serviceThe service is simple and straight forward.

  1. Fax, phone or e-mail us your prescription, your St Maarten address and phone number and if applicable your insurance details and we’ll deliver for free your drug medications right to your doorstep.
  2. Notify us with above details by or before 11:30am and we deliver by or before 2:00pm
  3. Notify us with above details by or before 4:30pm and we deliver by or before 7:00pm

How can you contact us ?

By phone: 542-3001
by fax: 542-3053

by e-mail: pharmacy@caribserve.net

What does it cost?

It’s FREE to Philipsburg St Maarten locations and only $3.00 to the Philipsburg surroundings!

Questions?

If you have any questions, do not hesitate to call us or e-mail us. We are happy to be of assistance.

Philispburg Pharmacy is the BEST St Maarten Pharmacy.

Managing Migraine Headaches

Migraine Management on PhilipsburgPharmacy.com

Almost 10% of the population and three times more women than men suffer from migraine headaches. Although any head pain can be miserable, a migraine headache is often disabling. It is believed that even 50% of migraines are not diagnosed or mislabeled as tension or sinus-headache (which is rare according to experts).  In some cases, migraines are preceded or accompanied by a sensory warning sign (aura), such as flashes of light, blind spots or tingling in your arm or leg. A migraine headache is also often accompanied by other signs and symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. Migraine pain can be excruciating and may incapacitate you for hours or even days.  When left untreated, a migraine headache typically lasts from four to 72 hours, but the frequency with which they occur can vary from person to person. You may have migraines several times a month or just once a year.

Fortunately, management of migraine headache pain has improved dramatically in the last decade. If you’ve seen a doctor in the past and had no success, it’s time to make another appointment. Although there’s still no cure, specific life style adjustments and medications can help reduce the frequency of migraine headaches and stop the pain once it has started.  Most important: You are the manager of your life and need to communicate with your doctor how to keep the migraine under control.  If you ask your doctor about help with migraine and his answer is handing over a prescription, please look for another doctor. Initially medications may help, but without the right knowledge in using them they could quickly become counter effective.

Migraine headache symptoms in children

Migraines typically begin in childhood, adolescence or early adulthood and may become less frequent and intense as you grow older. Children as young as age 1 can have these headaches. In addition to physical suffering, severe headaches often mean missed school days and trips to the emergency room, as well as lost work time for anxious parents.
Children’s migraines tend to last for a shorter time. But the pain can be disabling and can be accompanied by nausea, vomiting, lightheadedness and increased sensitivity to light. A migraine headache tends to occur on both sides of the head in children, and visual auras are rare. However, children often have premonition signs and symptoms, such as:
·    Yawning
·    Sleepiness or listlessness
·    A craving for foods such as chocolate, hot dogs, sugary snacks, yogurt and bananas

Migraine headache triggers.
Migraine is a genetic neurological disease affecting the bloodvessels in the brain. Whatever the exact mechanism of migraines is, a number of things may trigger them. Common migraine headache triggers include:
·    Hormonal changes. Fluctuations in estrogen and progesterone seem to trigger headaches in many women with migraine headaches. Women with a history of migraines often have reported headaches immediately before or during their periods.  Hormonal medications, such as contraceptives and hormone replacement therapy, also may worsen migraines but sometimes also give relief.
·    Foods. Certain foods appear to trigger headaches in some people. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; fermented, pickled or marinated foods; aspartame; caffeine; monosodium glutamate — a key ingredient in some Asian foods. Skipping meals or fasting also can trigger migraines.
·    Stress. A period of hard work followed by relaxation may lead to a weekend migraine headache. Stress at work or home also can instigate migraines.
·    Sensory stimulus. Bright lights and sun glare can produce head pain. So can unusual smells — including pleasant scents, such as perfume and flowers, and unpleasant odors, such as paint thinner, secondhand smoke and my co-workers armpit.
·    Physical factors. Intense physical exertion, including sexual activity, may provoke migraines. Changes in sleep patterns — including too much or too little sleep — often  initiate a migraine headache.  It is important for migraineurs to keep a steady daily rhythm
Triggers may not inevitably lead to migraine, often more triggers are needed to offset the brain i.e. lack of sleep, dehydration and alcohol. Although sensitive people might get migraine every time they drink a glass of red wine .Migraine Food Triggers on Philipsburg Pharmacy

Management and Medical  Advice

Migraines are a chronic disorder, but they’re often undiagnosed and untreated, often waived as incidental headaches.  If you experience signs and symptoms of migraine, track and record your attacks and how you treated them including (or especially) the over the counter medication you took. Then make an appointment with your doctor to discuss your migraines and decide on a treatment plan.

·    If you don’t have a treatment plan when a migraine headache strikes, try over-the-counter (OTC) medications such as ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve) or  paracetamol, or other self-care measures for a day or two. Keep in mind that soluble formulations in a high starting dose often work the best and can be combined with i.e. domperidon or metoclopramide to promote absorption if the migraine is accompanied with  nausea . If you don’t get relief, see your doctor.

Complications

Sometimes your efforts to control your pain cause problems. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and aspirin, may cause side effects such as abdominal pain, bleeding and ulcers, especially if taken in large doses or for a long period of time.
In addition, if you take over-the-counter (OTC) or prescription headache medications more than two or three times a week or in excessive amounts, you may be setting yourself up for a serious complication known as rebound headaches. Although these drugs can give you temporary relief, they not only stop relieving pain, but actually begin to cause headaches. You then use more pain medication, which traps you in a vicious cycle. If you’re caught in the rebound headache trap, talk to your doctor.

Treatment

At one time, aspirin was almost the only available treatment for headaches. Now there are drugs specifically designed to treat migraines. Several drugs commonly used to treat other conditions also may help relieve migraines in some people. All of these medications fall into two classes:

·    Pain-relieving medications. These stop pain once it has started.
·    Preventive medications. These reduce or prevent a migraine headache.

Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine headache. It may help if you rest or sleep in a dark room after taking them:

·    Nonsteroidal anti-inflammatory drugs (NSAIDs).  (Ibuprofen, Naproxen, Diclofenac, others) may help relieve mild migraines. Drugs marketed specifically for migraine, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines, but aren’t effective alone for severe migraines.  Combination drugs are suspected to have a higher incidence of initiating medication induced (rebound) headache.

·    Triptans. Sumatriptan (Imigran) was the first drug specifically developed to treat migraines. It mimics the action of serotonin by binding to serotonin receptors and causing blood vessels to constrict. Sumatriptan is available in oral, nasal and injection form. Injected sumatriptan works faster than any other migraine-specific medication — in as little as 15 minutes — and is effective in most cases. A number of similar drugs have become available, including rizatriptan (Maxalt),  zolmitriptan (Zomig) and eletriptan (Relpax). Experience has shown that sometimes people have to try 3-5 different triptans before they find the one that suits them best. A look at the different durations of effect and relative strengths might be helpfull. Dispersable tablets (wafers) do not have a quicker onset of effect or additional advantage with nausea. In fact the highest concentration in the blood is reached even at a later time then with conventional tablets. Taking triptans during the aura has no effect and might reduce the effect due to earlier elimination. Taking them when the pain becomes unbearable has no use either, they will not work anymore.

·    Ergots. Drugs such as ergotamine (cafergot) and dihydroergotamine help relieve pain. Due to the fact they have more side effects than triptans, they are less prescribed and reserved when the patient is resistant to other drug therapies. Most used is DHE as injectable.

·    Medications for nausea. Metoclopramide (Primperan) or domperidon are useful for relieving the nausea and vomiting associated with migraines, not the migraine pain itself. It also improves gastric emptying, which leads to better absorption and more rapid action of many oral drugs. It’s most effective when taken early in the course of your migraine or even during the aura before your headache begins.
Morfine like medications like vicodin, oxycodone etc. are very effective painkillers as long as they last. Due to their highly addictive properties, drug dependency  and weaning of effect they should be avoided for treatment of headaches.

Preventive medications

Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of pain-relieving medicines used during migraine attacks. In most cases, preventive medications don’t eliminate headaches completely, and some can have serious side effects. They are considered an option with more than 2 attacks per month.

·    Cardiovascular drugs. Beta blockers — which are commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. These drugs are considered among first-line treatment agents. Calcium channel blockers and certain RAAS drugs (atacand) are also used. Consider these medication as choice if you suffer from high bloodpressure as well.

·    Antidepressants. Certain antidepressants are good at helping prevent several  types of headaches, including migraines. Most effective are tricyclic antidepressants, such as amitriptyline, taken in low dosage at night) Newer antidepressants (SRNI’s), however, generally aren’t as effective for migraine prevention. Effect has been measured with ie venlafaxine. In some people these drugs may cause headaches.

·    Anti-seizure drugs. Some anti-seizure drugs, such as valproic acid (Depakin) and topiramate (Topamax), which are used to treat epilepsy and bipolar disease, seem to prevent migraines. Gabapentin (Neurontin), another anti-seizure medication, is considered a second-line treatment agent. They might stabilize the nerve cells that trigger migraines.

·    Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
Preventive medications are normally tried when suffering more then 2 x monthly from migraines. It may take 3 month of slowly increasing dosage before the effect can be evaluated.

Prevention

Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you:

·    Avoid triggers. If certain foods seem to have triggered your headaches in the past, eat something else. If certain scents are a problem, try to avoid them. In general, try to establish a daily routine with regular sleep patterns and regular meals. 
To detect triggers it is important to keep a daily diary in which you keep note of daily life events and medications taken and effect on possible migraine as well. Most smartphones have apps for migraine diaries.

·    Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches.

·    Reduce the effects of estrogen. If you’re a woman with migraines and estrogen seems to trigger or make your headaches worse, or if you have a family history of stroke or high blood pressure, you may want to avoid or reduce the amount of medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Women that experience migraines during the stopweek might consider continuous  treatment. Talk with your doctor about the best alternatives or dosages for you.

·    Quit smoking. If you smoke, talk to your doctor about quitting. Smoking can trigger headaches or make headaches worse.

·    Supplements to consider.  Additional Vitamin B2 (riboflavin) Magnesium and CoQ10 , have shown effect in several studies

·    Relaxation techniques, massage, physical therapy, yoga etc. can all have a beneficial effect.

Summarizing.

A Diary is important to evaluate if you use your medication the right way.  The right time, dosage form, rate of effectiveness and if you are not using to much or maybe to less. It is also important to identify possible triggers for the migraine. A 2 month period of recording would give your doctor (and yourself) a good assessment tool.

Lifestyle is important, taking the right medications is also important. Worrying on dietary triggers is less important. 
It will probably take several months to get the combinations right of type and dosage. This may count for preventive and relieve medication.

Keep in mind to limit the amount of painkillers and triptans to 2-3 days per week. If not you might see a tendency of increase in the frequency of headaches and related an increase in medicine consumption and before you know it you are in a vicious circle of medication dependent headaches. You can always improve !  Do not hesitate to ask for help.

Acne

washing face

For teenagers acne is the worst four letter word. I remember looking horrified into the mirror before going to school, or worse a party, noticing a pimple on the chin or nose. Trying to make it go away ended mostly with a doublesized, glazing red one instead.

Acne is caused by inflammation of the oil glands in the skin and at the base of strands of hair. In the teenage years, hormones stimulate the growth of body hair, and the oil glands secrete more oil (sebum).

The skin pores become clogged with shedding cells and bacteria called Propionibacterium acnes (P. acnes ) growing in the clogged pores. When the body works to destroy the bacteria, the resulting inflammation forms whiteheads and blackheads in these areas. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Nearly 17 million people in the United States have acne, making it the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring, permanent scarring, which can be upsetting for people who suffer from the disorder.

The symptoms of acne are:

  • blackheads
  • whiteheads
  • pimples, some filled with puss

Other troublesome acne lesions can develop, including the following:

  • Papules—inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
  • Pustules (pimples) — inflamed, pus-filled lesions that can be red at the base
  • Nodules—large, painful, solid lesions that are lodged deep within the skin
  • Cysts—deep, inflamed, pus-filled lesions that can cause pain and scarring

These skin eruptions may be painful. In severe cases, cysts (fluid-filled bumps larger than pimples) may develop under the skin.

What causes my acne?

Although cleaning the skin is a first step in controlling acne, a dirty skin is not the cause of acne. This is one of many myths blamed for originating acne. Also foods like chocolate, pig meat or French fries are not a cause of acne. You might notice a flare up but the relation is different as it might be a mild allergy to an ingredient or it might be the stress your body gets from a unbalanced diet. Fruits and vegetables are the main components to a healthy diet and thus create a balance in your body and as such will have a positive effect on acne. Other important stress factors can be school (nothing new here) and lack of sleep. Stick to a regular 8 hour sleep a night rhythm and sleep away your acne (or keep it under control).

Sexual frustration is also not a cause of acne, although it seems to be a popular myth.

The main cause is hereditary, if it is in the genes of your mom and dad you already have a 80% chance of getting it as well. Nothing you can change about that but at least: It ain’t your fault !

Because the actual process is hormonal (testosterone) related, boys will have a worse outbreak in their teens than girls. Adult women have relatively more problems in their post teens, related with their menstrual cycle or due to the use of hormonal birthcontrol.

How to treat acne.

First of all you should review the soaps and lotions you are using as well as make-up you might use. Oily makeup will probably aggravate your condition by blocking up the pores more. In a pharmacy or cosmetic center you might get advice which ones not to use. Harsh soaps have usually a negative effect on your skin because they tend to wash away your natural fatty acids who work as your skin’s disinfectant which might cause easier growth of bacteria, contrary to the effect you are expecting!

Use “Non-soap” soaps, preferably with a acidy pH i.e. like sebamed, sanex or dove.

Several products may be used to help prevent pimples or blackheads. Treatment usually begins with putting products containing benzoyl peroxide on the areas of skin with acne. Benzoylperoxide will enter the pore and kill the bacteria inside. It also opens up the pore. The strength is not very important, however starting with the lower 5% will give less irritation to the skin. Pharmacies will have a gel for sale that is economic and can be used either as a wash or left on the skin overnight. If benzoyl peroxide alone is not effective, your doctor may prescribe antibiotics to be taken by mouth or a antibiotic lotion to put on your skin. You may also need to use a skin cream or gel containing tretinoin (Retin-A, Locacid). Tretinoin is a vitamin a derivative that peels off the old skin while stimulating growth of new cells. Their action might cause a worsening of your condition at first making your skin red and irritated. The best way is to start these creams carefully like every other day before using them daily.

They should be applied at night because they are unstable to sunlight. Other modern “peeling” creams are the those that contain alpha hydroxy acids. They are found in most anti-wrinkle creams.

An oral vitamin A derivative called isotretinoin (RoAccutane) is available for severe acne. However, isotretinoin must be used very carefully because it causes birth defects in babies born to mothers who become pregnant while they are taking the drug or who have taken it several months before becoming pregnant. Sometimes a dermatologist might even use corticosteroids to prevent scarring.

Women can also take certain birthcontrol pills that will counteract the effect of testosterone and therefore dimishing acne.

How long will the effects last?

New whiteheads usually stop appearing after 4 to 6 weeks of treatment, but usually you will need to continue the treatment at least 6 to 8 weeks. Controlling treatment might be needed until you “grow over it”.If you are taking antibiotics, at some point your doctor will ask you to stop taking them to see if they are still necessary.

Many factors may make acne worsen temporarily. Thus, even if you are receiving the proper treatment, results may vary over time. Try to discover and change, when possible, the factors in your environment or lifestyle that make the acne worse.

How can I take care of myself?

Follow the full treatment prescribed by your doctor.

In addition you can:

  • Wash your face two times a day with a gentle soap.
  • Wash your hands more frequently and avoid putting your fingers and hands to your face unnecessarily. Don’t squeeze, pick, scratch, or rub your skin. Scars may form if you squeeze pimples, however a beautician may expell blackheads with a special tool to avoid any contamination.
  • Don’t rest your face on your hands while you read, study, or watch TV.
  • Watch out wearing backpacks or headbands for a long time, the pressure on your skin can cause pimples to form, pressing weights while lying on your shoulders may have the same effect.
  • Avoid working in hot kitchens where greasy foods are cooked.
  • Avoid getting sunburned.
  • Avoid extreme stress if possible. Practice stress reduction strategies such as exercise, meditation, and counseling if stress is extreme.
  • Get physical exercise regularly.

Blood Sugar Control

Insulin Schematic

Why your life depends on You!

The key to understanding blood sugar control is to understand the role played by special cells in your pancreas, called Beta-Cells. These tiny cells are scattered throughout your pancreas and their job is to produce insulin, store it, and release it into the blood stream at appropriate times.

The beta-cells of a healthy person who has not eaten in a while release a small amount of insulin into the blood stream throughout the day and night in the form of very small pulses every few minutes. This is called “basal insulin release.

Maintaining this steady supply of insulin is important. It allows the cells of the body to utilize blood sugar even if some time has passed since a meal.

The steady insulin level as another function, too. A dropping insulin level signals the liver that blood sugar is getting low and that it is time to add more glucose. When this happens, the liver converts the carbohydrate it has stored, (known as glycogen) into glucose, and dumps it into the blood stream. This raises the blood sugar back to its normal level.

Regular functioning of insulin

When a healthy person starts to eat a meal, the beta-cells kick into high gear. Their stored insulin is released immediately. Then, if the blood sugar concentration rises over 100 mg/dl, (5.5 mmol/L) the beta-cells start secreting more insulin into the blood stream. This early release of stored insulin after a meal is called “First Phase Insulin Release.” In a healthy person it keeps the blood sugar from rising to very high levels because it is available to meet most of the glucose that comes from the digestion of the current meal.
After completing the first phase insulin release, the beta-cells pause. Then, if blood sugar is still not back under 100 mg/dl (5.5 mmol/L), they push out another, smaller second phase insulin response which takes effect about an hour after the meal and, in a healthy person, brings the blood sugar back down to its starting level, usually by two hours after the start of a meal.

It is this combination of a robust first phase insulin response followed by a functional second phase insulin response that keeps the blood sugar of a normal person from ever rising over 140 mg/dl(7.8 mmol/L) even after a high carbohydrate meal.

When first phase release fails, or when second phase insulin response is sluggish, blood sugars start to rise to higher levels after a meal and take longer to return to normal. This condition is called “impaired glucose tolerance.” If the blood sugar rises over 200 mg/dl (11 mmol/L) after a meal the same condition is called “Diabetes.”

First and second phase insulin release may fail to do their jobs for several reasons. The most common is a condition called insulin resistance in which some receptors in the liver and the muscle cells stop responding properly to insulin. This means that though there is lots of insulin circulating in the body, the muscles and liver (but not, alas, the fat cells) don’t respond until the insulin levels rise much higher.

So when a person’s cells become insulin resistant, it will take a lot more insulin than usual to push circulating glucose into cells. Eventually the body may not be able to produce enough insulin to clear all the dietary carbohydrate from the bloodstream and blood sugars will rise to abnormal levels.

If your beta-cells are normal, and if insulin resistance at the muscles and liver is your only problem, over time you may be able to grow new pancreas islets filled with new beta-cells that can store even more insulin for use in first and second phase insulin response. In this case, though your blood sugar may continue to rise into the impaired range and take longer than normal to go back down to normal levels, your blood sugar response may never deteriorate past the impaired glucose tolerance stage to full-fledged diabetes. This is what happens to most people who have what is called “Metabolic Syndrome.” Unfortunately, if you have impaired glucose tolerance, there is no way of knowing if you fall into this group or if your rising blood sugars are caused by failing or dying beta-cells.

First phase insulin release also fails because beta-cells are dysfunctional or dying. This can happen along with insulin resistance, or without it. Studies have found that some thin, non-insulin resistant relatives of people with Type 2 Diabetes already show signs of beta cell dysfunction.

If beta-cells are dying or not working properly. The remaining beta-cells may be working full-time just to keep up with the need for a basal insulin release so they can’t store any excess in those granules for later release.

Scientists have discovered dozens of different genetic defects which cause beta-cells to fail or die in humans and animals. This means that one person’s Type 2 Diabetes can behave quite differently from that of another person, depending on what exactly is broken in their blood sugar control system. This is why drugs that work well for one person may do little for another person.

Whatever the reason for the failing first phase insulin release there’s an ugly feedback mechanism that kicks in when blood sugar levels rise because of that failing first phase insulin release: High levels of circulating glucose themselves are toxic to beta-cells, a phenomenon called “glucose toxicity”. So as blood sugars rise these high blood sugar concentrations further damage and or kill more beta-cells, making insulin release even less able to control blood sugar concentrations.

When first phase insulin release is weak or missing your blood sugar may easily rise over the 200 mg/dl (11 mmol/L) level currently defined as “diabetes.”

At that point, two bad things happen. When the concentration of glucose in your blood reaches 200 mg/dl (11 mmol/L) your cells become insulin resistant even if they weren’t insulin resistant before, so it takes a lot more insulin to lower your blood sugar from that point on.

And, even worse, the lack of a robust insulin response to the rising glucose may erroneously be interpreted by your liver as a sign that blood sugar is too low and that it is time to dump more glucose into the bloodstream. So in addition to the glucose coming in from your recent meal you also have to contend with additional glucose dumped by your poor old confused liver.

As you become more diabetic, and your second phase insulin response grows weaker, it may take four or five hours for your beta-cells to secrete enough insulin to bring your blood sugar level down to its fasting level. And, in fact, during the day your blood sugar may never get back to its fasting level because the glucose coming in from your next meal comes into the bloodstream before the glucose from the previous meal has completely cleared. Only at night, while you are sleeping, may your beta-cells finally secrete enough insulin to get your blood sugar down low enough that you wake up with a normal fasting blood sugar.

However, since it took all the insulin your beta-cells could make to get back to that normal blood sugar and they will have had no chance to store any extra insulin to take care of your breakfast. As soon as you throw that morning bagel down the hatch, blood glucose will rise, and once again your beta-cells will have to spend many hours trying to bring it back down.

Eventually, even the long hours of the night will not be enough time for your beta-cells to produce enough insulin to bring your blood sugar back to normal, and now, perhaps a decade after you achieved diabetic post-meal numbers, you will finally start seeing diabetic fasting blood sugar levels.

image – exploding-diabetes

This process explains why for many people who become diabetic–particularly middle-aged women, the fasting blood sugar level is the very last measurement to become abnormal. Only when a whole night isn’t long enough for your beta-cells to bring your blood sugar back down to normal or near-normal levels will you become diabetic by a fasting blood sugar test. That is why lately more emphasis is put on the measurement and control of post meal sugar control. It has been calculated that less then 40% of the people that have a  fpg <120 and HbA1C of 7 have post meal glucose <200mg/dl. This is a scary statistic considering the amount of diabetics that have worse data and consider themselves under good control!

People whose fasting blood sugar numbers have risen along with their post-meal numbers have generally lost more beta-cell function than those who still maintain normal or near-normal fasting blood sugars. This is why as soon as you discover that your post-meal blood sugars are rising beyond a normal level, it is so important to start controlling those abnormal post-meal blood sugars immediately. By doing so, you may be able to lower any insulin resistance, preserve your remaining beta-cells and keep your fasting blood sugar from ever deteriorating.

Even after you have been diagnosed as having a type 2 diabetic fasting plasma glucose, you may still have a good number of beta-cells left–anywhere from 40 to 60%. If you can reduce your insulin resistance through weight loss, exercise, and the use of drugs that counter insulin resistance, and if you keep your carb intake low to avoid blood sugar spiking, those cells may be able to produce enough insulin to control your blood sugar.

Even more important, if you keep your blood sugar under the damage-limit of 140 mg/dl (7.8 mmol/L) at all times, you may be able to keep glucotoxicity from murdering the rest of those cells.

Some studies mostly in cell-cultures and animal models have demonstrated that giving stressed beta-cells a rest can sometimes restore function. A few studies suggest this can also be done in humans.

One way of “resting” beta-cells is to use injected insulin as soon as type 2 diabetes is diagnosed, particularly if your blood sugars are very high at the time of diagnosis. If you take the burden off your beta-cells by supplementing insulin, there’s some suggestion that they may recover some of their ability to produce insulin later on so that you can go off insulin and retain much better control. You’ll still have to limit carbs and address any problems you have with insulin resistance through weight loss, exercise, and insulin-sensitizing drugs. But you’ll have an easier time doing it.

Every Tuesday and Thursday from 10 a.m. till noon, you can come to the Philipsburg Pharmacy for a free Diabetes and Blood-pressure check-up.

Diabetes and Your Love Life

Erectile Dysfunction Graph

To understand how diabetes leads to Erectile Dysfunction (ED), you first have to understand how erections work. Getting an erection is really a complicated process.

Anatomy of an Erection

In the shaft of the penis there are two side-by-side chambers of spongy tissue called the corpora cavernosa. They’re mainly responsible for erections. Just below them is another chamber called the corpus spongiosum. The urethra, which carries semen and urine, runs through the center of it.

The corpora cavernosa are made of small arteries and veins, smooth muscle fiber, and empty spaces. The chambers are wrapped in a sheath of thin tissue.

When you get an erection, nerve signals from your brain or from the nerve endings in your penis cause the smooth muscle of the chambers to relax and arteries to dilate, or open wider. This allows a rush of blood to fill the empty spaces.

The pressure of blood flow causes the sheath of tissue around the chambers to press on veins that normally drain blood out of the penis. That traps blood in the penis. As more blood flows in, the penis expands and stiffens, and you have an erection.

When the excitement ends, the smooth muscle contracts again, taking pressure off the veins and allowing blood to flow back out of the penis.

Diabetes: A Perfect Storm for Erectile Dysfunction

Many common problems related to diabetes all come together to cause erectile dysfunction. That’s why various studies show that 35% to 75% of men with diabetes will develop some degree of erectile dysfunction. If you are having difficulty getting erections, there may be a number of things going on in your body.

Nitric oxide is a chemical released into the bloodstream by the lining of blood vessels. It acts as a kind of chemical messenger that tells the smooth muscles and arteries in the penis to relax and let in blood.

High blood sugar, which must be managed carefully if you have diabetes, causes blood vessel and nerve damage that affects many processes in the body. Sexual response is one of them. Damage to the blood vessels blocks the release of nitric oxide. A lack of nitric oxide results in constricted blood vessels and reduces blood flow to the penis.

What’s more, according to the American Diabetes Association, 73% of adults with diabetes have high blood pressure or take blood pressure medication. The combination of high blood pressure and diabetes also increases the risk for blood vessel damage, further reducing blood flow.

High cholesterol is also common in people with diabetes. LDL cholesterol, or what’s called “bad” cholesterol, can interfere with the ability of blood vessels to dilate. High cholesterol levels result in fatty deposits in artery walls. This buildup of fatty deposit can reduce blood flow.

Some of the choices that men with diabetes make also feed into this “perfect storm.” Smoking, especially. Smoking by itself reduces blood flow all through the body.

Last but not least, feeling badly about your health can lead to erectile dysfunction. For most men, erectile dysfunction is mainly a physical problem, but the mind always plays some part in sexual arousal.

Although having diabetes means that you may encounter problems with your sexual functioning, you really can turn it around. By living a healthy lifestyle and working with your doctor, you can get your diabetes under control and treat erectile dysfunction if it becomes a problem for you.

If you have diabetes and it has caused erectile dysfunction (ED), you still have every reason to be optimistic about the future and a healthy sex life. There are many proven treatments you can try.

A doctor’s first choice for treating erectile dysfunction is usually one of the pills called PDE5 inhibitors. First there was Viagra. Now there’s also Levitra and Cialis. All three drugs work in similar ways. They don’t increase sexual desire. They make it physically possible to get an erection when you are aroused.

No one of them has been proven to work better than the others, although there can be a different individual response. But the time they take to start working and the duration of their effects vary. That’s something you may want to consider based on your sexual habits. For example, does spontaneity matter to you, or do you usually plan sex ahead of time?

Viagra starts working in about 15 to 30 minutes and its effects last about four hours. Levitra starts working in about 30 to 60 minutes and lasts four to five hours. Cialis starts working in about 30 to 60 minutes and lasts as long as 36 hours. Take note that Viagra is most affected by slow absorption if you take it after a meal.

These drugs are not good for every man. Men who take nitrate drugs for chest pain or alpha blockers for high blood pressure or prostate problems shouldn’t take Cialis, Levitra or Viagra. Other reasons why you may not be able to take these drugs include:

  • High blood pressure that isn’t under control
  • Very low blood pressure
  • A heart attack or stroke in the past six months
  • Kidney or liver disease
  • Retinitis pigmentosa (an eye disease)

Other Treatments for Erectile Dysfunction

If erectile dysfunction pills are out of the question, or if they haven’t worked for you, don’t worry. There are other good options.

Alprostadil is another drug for erectile dysfunction. However, it’s not a pill. One brand, called MUSE, is an alprostadil pellet that you insert into the tip of your penis with an applicator. It widens blood vessels and relaxes smooth muscle tissue in the penis, allowing blood to fill the spongy tissue that makes the penis erect.

Injections directly into the penis are another way to deliver alprostadil. Phentolamine and papaverine are additional drugs that are injected into the penis to treat erection problems. When injecting these drugs there is some risk that your erection may last too long, a condition that can require medical treatment.

Next, you may want to try a vacuum device, or “penis pump.” This is typically a clear plastic cylinder with a bulb or plunger and a constriction band.

You put your penis in the cylinder and start pumping. The suction creates a vacuum, so blood rushes in to fill the spaces in the spongy tissue of the penis, creating an erection. The erection lasts only as long as the blood stays in, so you slide the band down around the base of your penis, trapping the blood. It’s safe to keep the band on for up to 30 minutes.

Alternative Treatments for Erectile Dysfunction

Currently, no herb or supplements have been proven to help with erectile dysfunction. Herbs and supplements that some people believe are helpful include:

  • Ginseng
  • Horny goat weed
  • Ginkgo biloba
  • Muira puama
  • Pycnogenol
  • L-arginine
  • Damiana

Before trying any alternative treatment, be sure to ask your doctor about it first. Herbs and supplements, whether they help with erectile dysfunction or not, have real effects on the body. They could cause dangerous reactions with other medicines you might be taking.

Every Tuesday and Thursday from 10 a.m. till noon, you can come to the Philipsburg Pharmacy for a free Diabetes and Blood-pressure check-up.

Common Medicine Mistakes

Common Medicine Mistakes
Doctor writing prescription

Common Medicine mistakes and how to prevent them

Prescription drugs are biologically active substances that can do good but also harm if used in the wrong way or on the wrong moment. And then we are not yet talking about using the wrong medication or the wrong dosage.

It is estimated that close to 10% of patients in Hospitals are admitted for medication related problems. With the amount of drugs being marketed nowadays it is difficult for a doctor and a pharmacist to keep track on everything. Computers do help a lot for the cross checking of  interactions of medication but then again, if you visit different pharmacies all the time your Rx history might not be up to date. And even worse, visiting different doctors within 3 days because the flusymptoms did not go away within 2 days (Duh- Real flu can last for 3 weeks of misery and the only thing we can do is symptom relieve) might give you prescriptions with mismatching antibiotics and double dosage.

Here are some tips that you can use to safeguard your health.

Mistake #1.

You can not read your doctors handwriting. If you can’t there is a chance your pharmacist can not either. Some doctors use even abbreviations which may be common in Holland or the US, but is your pharmacist used to the shorthand? A quarter of mistakes is misreading, quickly written names like losec, lasix or lamisil and lamictal can be easily mixed up especially with strengths that might be the same.

Safest Rx: Ask your doctor to spell out the name or even write the intended treatment like water pill or acid reflux (in some countries this is going to be mandatory).

Mistake #2

You have a miserable cold and pop 2 tablets of  a cold medication and some paracetamol every 4-6 hours to keep going. Warning: If that cold medication is one of many containing acetaminophen a.k.a as paracetamol you might be getting close to a toxic dose by the end of the day. 20 tablets Tylenol extra strength in a day will do damage to your liver, add 3 alcoholic drinks and it will double the damage.

Safest Rx: Stay clear from OTC multidosage products and compare the ingredients with prescribed medication you might be taking as well.

Mistake #3

You leave the pharmacy without confirming that this X drug for Y condition.

2% of pharmacy dispensing contains mistakes according to studies. Provide the pharmacy with the right data to process the prescription as good as possible, including birthdate and full name of the intended recipient Make sure the pharmacist verifies the medication and use with you when handing you the medication.

Safest Rx:
choose your pharmacist as careful as you choose your doctor and stick with them. Your history records will give a safety net when the computer checks for interactions or wrong dosages.

Mistake #4

Scared to tell your doctor about herbal products you are taking? In that case you belong to the majority, but do not conceive natural as being without side effects or interactions, St Johns worth (found effective for depression) can interact with the Pill. If you are using bloodthinners, hypertensive or diabetic drugs you should consult with your doctor or pharmacist.

Safest Rx: bring bottles of anything else you use whether natural or not to your doctor when having a check up.

Mistake #5

You self treat with someone else’s medication

You break out in a rash, so you use something the doctor has prescribed for your husbands skin problem. You commited a big health sin! Even if it looks the same it might be a different problem. If your husbands problem was allergy related and yours viral, chances are you made your problems worse. Your neighbours waterpill that helped her swollen ankles may give you a wrong reaction, especially if you are using a bloodpressure drug like and ACE inhibitor.

Safest Rx: eliminate the temptation, never safe leftover medication and never take something from a good samaritan to try help your problem as well.

Mistake #6

You ignore the warnings on the label.

Does it really matter you take your antibiotic with or without food? Certain antibiotics absorb poorly into the body with food, others give discomfort when taking them on an empty stomach. Taking Cipro or tetracycline with Mylanta? You might as well take a sugarpill because little will be absorbed. How about taking your medication after dinner or before breakfast? Fosamax absorbs appr for 2% in your body and that is under the condition you take it with plain water at least half a hour before eating anything, if you take it with milk you might as well throw it in the toilet straight away because that is where it will end up. Some drugs really work best at night due to your body’s rhythm.

Safest Rx: Ask for a patient leaflet at the pharmacy or take the 10 seconds to read the labeling on your packaging. And if you are not sure if a milkshake is a dairy product, ask the pharmacist.

Mistake #7

Take your medication only when you feel sick.

Are you also one of those people taking diabetic of pressure medication when you need it? Join a circus, it means you are superhuman having sensory abilities not known by medical science. A headache does not mean you pressure is to high, 99% it is unrelated and if so, it means the pressure has been bad for a long period and REALLY bad.

Unfortunately these chronic diseases are called chronic because they will not go away anymore. True, drastic changes in lifestyle can improve your condition but you only “sense” being ill from ie diabetes if your numbers are way off. Regular testing and your daily tablet will keep your long term risk on sudden death or illness low. It is very important that the balance created by the medication stays as constant as possible. Even worse; suddenly withdrawing the medication might give a worsening of the disease ie with antidepressants or bloodpressure medication.

Safest Rx: Take your medication as prescribed, if you feel there is a reason to stop discuss it with your doctor first. If you have difficulty remembering to take the medication try using pillboxes and leave your medication in places where you have a daily routine like with the toothbrush (make sure the environment is suitable)

Mistake #8

Take alcohol with your medication, or worse not taking the medication because you want to consume alcohol.

First you have the old time believe that alcohol and antibiotics do not mix. The only one that gives problems is Flagyl and its relatives. For most antibiotics the interference is linked with the fact that your immunesystem might suffer from taking alcohol while fighting an infection, so you do not help the antibiotic doing its work optimal.

SSRI antidepressants (Zoloft, Paxil, Prozac) are more stimulating than sedating so they shouldn’t interact with alcohol. However alcohol is a depressant so confer with your doctor before drinking. Alcohol and the common antihistamines like benadryl and chlorpheniramin are a sure recipe for sedation, the reason why Nyquil works so good at night and should be taken cautiously. Non sedating antihistamines like Allegra, Claritine and Zyrtec are not likely to cause sleepiness.