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New research raises questions about the pills that millions of older women take for bone health

New research is prompting questions about the safety of the calcium supplements that so many women age 50 and older take to strengthen their bones. One recent study suggests these pills raise a person’s risk for a heart attack, and another new study—scheduled to be presented next month—is expected to raise more safety questions, continuing the debate that erupted this summer.

The controversy began in July when the British Medical Journal published a study that raised troubling questions about the calcium supplements taken by millions of Americans to ward off the bone thinning that comes as we age.

Ian R. Reid, M.D., of New Zealand, led a team that examined data from 15 clinical trials involving calcium supplements, and reported a roughly 30 percent increase in heart attacks among those taking the pills. The team also found, however, that the supplements had no significant effect on strokes or on the risk of death from a heart attack.

“We think that the evidence is fairly compelling that calcium supplementation is causing heart attacks,” says Reid, a professor of medicine and endocrinology at the University of Auckland. In his own practice, he says, “we almost never prescribe calcium supplements these days.” He advises people “to change their diet so they get what they need from eating conventional foods.”

Calcium in food no risk

This latest research may call into question the popular practice of getting calcium from pills, but it has not suggested any heart risk from calcium in the diet. Researchers say that may be because food doesn’t cause the same temporary, short-term boost in blood calcium as supplements. The authors say this boost produces calcium deposits that may harden the blood vessels or make the blood more likely to clot.

But U.S. doctors widely recommend calcium supplements, especially to postmenopausal women at risk for osteoporosis—thinning and fractured bones—and some say the evidence linking the pills to heart risk is not yet persuasive enough to change that policy.

“I don’t think it’s enough to tell our patients to stop using calcium,” says Lynne Braun, a researcher and nurse practitioner who counsels patients on cardiovascular risk at the Heart Center for Women at Rush University Medical Center in Chicago. “I personally use calcium supplementation. Would I stop based on this [study]? The answer is no.”

Braun says the new study suffers from the usual shortcomings of meta-analysis, a statistical method that pools data from a variety of studies that haven’t necessarily gathered information on the same questions or in the same ways.

Robert R. Recker, M.D., director of the Osteoporosis Research Center at Creighton University in Omaha, Neb., points out that when the New Zealand team looked at trials where specific patient information was available on more than 8,000 people, their analysis found 143 heart attacks among those who took calcium pills and 111 in the comparison group—a spread he calls “underwhelming.”

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Are You Taking Too Many Pain Meds?

An unclear diagnosis can result in being overtreated

Q: I’ve been diagnosed with stenosis or moderate to severe osteoarthritis. I have severe back pain at times, along with neck and shoulder discomfort and pain in my left knee and right ankle.

My rheumatologist has me on tramadol 50 mg (one pill three times daily as needed), naproxin 500 mg (one pill twice daily) and omeprazole 40 mg (one pill twice daily). I have been on these medications for about a year and a half.

Besides my vitamin regimen and low-dose aspirin, I take no other medications. I walk about three miles a day and ride a bicycle about five miles every day. The exercise does not seem to make my symptoms worse. I’m a 5’11″, 220 pound 60-year-old white male. Do I seem to be overmedicated?

A: First, you need to know which of the two conditions you have. If you have spinal stenosis, then an orthopedist can give you an epidural steroid injection in the affected area that could provide relief for several months. If you have osteoarthritis, you may not need all the medications you are currently taking.

Let’s consider the medications one at a time.

Unless you are being treated for Zollinger-Ellison syndrome (a rare digestive disorder), the current dosing of the omeprazole (Prilosec), a proton pump inhibitor (PPI), is twice what is recommended. Studies show that people over 50 years of age who take PPIs for a year or more increase their risk of bone fractures, as the drug inhibits the body’s absorption of calcium.
If you are taking the naproxen, a nonsteroidal anti-inflammatory drug (NSAID), in extended-release form, there’s an additional problem: It’s designed to work in a normal stomach-acid environment (a gastric pH of about 6), and the 80 mg of the PPI you’re taking is, in all likelihood, pushing your gastric pH to at least a constant 9. That’s one of the reasons your pain may not be going away. NSAIDs also can expose older people to an unacceptably high risk of gastrointestinal bleeding, which can be fatal, and the risk goes up with the dosage and duration of treatment.
The tramadol, a nonnarcotic painkiller, is a good choice for you. You might want to consult with your doctor about supplementing each dose with a 325 mg tablet of acetaminophen (Tylenol) for pain relief and gradually phasing out the naproxen. Please be aware that you cannot just stop taking the naproxen; it needs to be tapered off over several weeks.

Right now the money you spend on vitamins is wasted because, with your stomach at a pH of 9 (from the omeprazole), they’re just passing through your body unabsorbed. After your medications are properly adjusted you could start back with your vitamin regimen, along with a full-strength aspirin (325 mg, enteric-coated) and 1,200 milligrams of fish oil three times a day, which should also help with your joint and arthritis pain.

Above all, keep up all the exercise, which is the real path to great health.

Source: AARP.org

Contact Pure Home Care Services at (586) 293-2457 today!  If you live in Grosse Pointe or the surrounding area, we can help you care for your loved ones.

Pain medications can ease suffering — but they can also be deadly. Here’s how to be safe.

In May 2008, Mable Mosley, then 68, arrived in the emergency room of west Florida’s Brandon Region ­ al Hospital, complaining of neck and shoulder pain. Her husband, Alvie, a retired construction worker, stayed by his wife’s side as a doctor examined her.

On a scale of 0 to 10, Mable’s pain reached a level 8, so the ER doctor prescribed three pain medications: Toradol, morphine sulfate, and Dilaudid. Mable’s pain dropped to a 1, but later that day she was admitted to the hospital by her primary care physician, who ordered a 50-microgram Duragesic fentanyl patch, a powerful, extended-release narcotic absorbed through the skin. This was followed the next day by a higher, 75-microgram fentanyl patch, and then the next day by a 100-microgram patch and Neurontin, a nonnarcotic drug used to treat pain caused by nerve injury. “I’m not saying she wasn’t hurting real bad. She was,” recalls Alvie. “But after getting the first medications in the ER, she felt much better.”

At midnight on her third day in the hospital, Mable Mosley stopped breathing; she was resuscitated but died several days later. To a grief-stricken Alvie, the cause of his wife’s death seemed obvious: An overdose of pain medications killed her. A year and a half after her death, he filed a wrongful-death lawsuit against the hospital, the pharmacists, and the doctors who had treated her.

From 1999 through 2007, the number of unintentional overdose deaths from prescription opioid painkillers — such as oxycodone, hydrocodone, methadone, and the fentanyl patch — more than tripled, according to the Centers for Disease Control and Prevention. In fact, these painkillers have now surpassed heroin and cocaine as the leading cause of fatal overdoses.

That’s not to say every prescription painkiller is bad; quite the opposite. “When prescribed appropriately and taken as directed, these drugs ease great suffering in patients with other ­ wise severe chronic and postoperative pain,” says Robert J. Friedman, M.D., a neurologist and pain specialist at the Palm Beach–based Headache & Pain Center. But take too many painkillers, or combine them with potent sedatives — as actor Heath Ledger did in 2008 — and they can be fatal.

Source: AARP.org

Contact Pure Home Care Services at (586) 293-2457 today!  If you live in Sterling Heights or the surrounding area, we can help you care for your loved ones.

Debate Over Statins Heats Up as Lipitor Heads Toward a Generic Form

Is a statin the answer to everyone’s high cholesterol?

You think of yourself as reasonably healthy, but your doctor has told you that your cholesterol is too high. Should you be taking a cholesterol-lowing drug called a statin to ward off heart disease?

It sounds like a simple question, but getting a straight answer could prove surprisingly elusive.

Doctors usually urge patients to first try to lower their cholesterol by eating better, losing weight andgetting more exercise. But lifestyle changes such as those may not be enough, so statins likeLipitor, Crestor, Zocor andPravachol — proven lifesavers for those who have already suffered a heart attack — are often prescribed for millions of otherwise healthy people with high cholesterol. It’s a practice called primary prevention.

Although a large new British study released yesterday seems to indicate that statins are safe for long-term use, some medical experts question whether the practice really saves lives. And they point out that statins, while generally well tolerated, are not without risks.

The debate over statins is bound to intensify in the coming months. The biggest-selling statin — Lipitor, made by Pfizer — which has been prescribed to more than 17 million people and made more than $100 billion in sales over the past decade, is scheduled to come off patent Nov. 30. Over the next year prices are expected to drop gradually as generic forms of Lipitor become available, which could encourage many more people to use them.

In fact, Crestor at about $5 a pill, soon will be the only remaining statin still under patent. But even if you take cost out of the picture, says Mark Hlatky, M.D., a cardiologist and professor at Stanford University School of Medicine, “you could still have questions about” the use of statins.

“The first question is, ‘Does it work and how do the risks and benefits balance out for individual people?’ ” he says.

Dangers of high doses

That question was highlighted in June, when the Food and Drug Administration (FDA) warned that no new patients should start taking an80 mg dose of simvastatin — the generic name for Zocor — because it carries a higher risk of serious muscle damage that could lead to kidney failure and death. Meanwhile, a review of five major drug trials showed that high-dose statin users were slightly more likely to develop diabetesthan those on a lower dose.

Still, many researchers see statins, which have other effects besides lowering cholesterol, as miracle drugs. Intriguing studies have linked statins to a lower risk of colorectal cancer, rheumatoid arthritis,cataracts and multiple sclerosis. Statin users see fewer kidney complications after serious surgery and have better recovery from brain injury. They also are 60 percent less likely to develop high-gradeprostate cancer. Overall, their risk of dying is reduced, largely because of fewer deaths from infection and respiratory illness.

How to calculate your risk

A set of guidelines issued by the National Heart, Lung and Blood Institute (NHLBI) helps doctors decide when to prescribe statins, which provide much of their benefit by lowering LDL, the so-called “bad” cholesterol, Hlatky says.

They factor in LDL levels, signs of coronary disease and risk factors such as smoking, diabetes, high blood pressure and too little HDL, the “good” cholesterol. They also use a risk calculator — based on the findings of the huge, multigenerational Framingham Heart Study — to calculate a patient’s likelihood of dying from heart disease within the next 10 years.

Statins should be considered for patients with elevated LDL, two or more risk factors and a heightened 10-year risk of dying, the guidelines say.

Are My Mother’s Meds Making Her Fall?

And if so, which drug — or combination — is at fault?

Q. My 81-year-old mother has been falling at home, and recently fractured her arm from a fall, which has me worried. Her doctors have been doing lots of tests, and now they’ve ordered a CT scan.

I’m concerned that the medications she’s taking could be causing the falls or at least contributing to them.

She takes Lopressor for her high blood pressure, Lasix for edema, calcium for her bones and Tylenol PM, which she gets at the drugstore, to help her sleep. Could these medications be making her unsteady?

A. Your concerns are on target. Two of the drugs that your mother is taking could well be causing her to fall. Her health care providers should have reviewed her medications before ordering the CT scan and other expensive tests.

The first concern is the use of metoprolol (Lopressor), which is in a class of drugs called beta-blockers and typically isn’t the best choice for treating cardiovascular problems in older adults. That’s because nearly half of all people 60 and older don’t produce the liver enzyme (CYP 2D6) that’s needed to properly metabolize the drug. As the drug builds up in a patient’s system, all the adverse effects commonly associated with its use are exacerbated. Chief among the problems: insomnia, dizziness,vertigo and falls.

The second concern: Tylenol PM. I’m guessing that your mother has been taking this non-prescription pain reliever and sleep aid, probably without her doctor’s knowledge, because the beta-blocker makes it difficult for her to sleep.

The problem is the PM part of the Tylenol PM. This over-the-counter product (Excedrin PM is another) combines acetaminophen withdiphenhydramine, which is an antihistamine with very strong sedative effects. Such medications are contraindicated for use in older adults.

Diphenhydramine, which many of us know by the brand name Benadryl, affects all involuntary muscle activity by depressing the central nervous system and can cause constipation, confusion, vertigo, glaucoma, falls and many other problems.

Source: AARP.org

Contact Pure Home Care Services at (586) 293-2457 today!  If you live in Grosse Pointe or the surrounding area, we can help you care for your loved ones.

There’s mounting evidence that regular use is risky for older people

Most of us don’t think twice about taking a nonprescription pain reliever to ease a headache or soreness that might follow a game of tennis, but there is growing evidence that commonly used painkillers such as Advil can trigger heart attacks or strokes in some people.

These nonsteroidal anti-inflammatory drugs (NSAIDs), a diverse group that also includes Motrin and prescription varieties like Celebrex and Voltaren, have been used for decades.

Common NSAIDs

Brand name / Generic

• Advil / ibuprofen
• Celebrex / celecoxib
• Voltaren / diclofenac
• Aleve / naproxen*

* In the recent Danish study, naproxen (Aleve) was found to be safer than the others.

Now there is strong evidence that many of them raise risks of heart problems, says Elliott Antman, M.D., a cardiologist and professor at Harvard Medical School.

Several new studies underscore a growing awareness of the problem.

In Denmark, a team led by Anne-Marie Schjerning Olsen, M.D., a research cardiologist at Copenhagen University Hospital, reviewed medical records for nearly 84,000 heart attack survivors, 42 percent of whom reported using NSAIDs.

According to a paper published last May in Circulation, the journal of the American Heart Association, the team found more cases of second heart attacks and strokes among the NSAID users — except for those taking naproxen (Aleve) after as little as a week. Researchers reported last year that NSAIDs raised the general risk for heart attacks even in apparently healthy people. The painkillers have also been linked with stomach bleeding and kidney failure.

Although many doctors endorse the short-term use of the common painkillers when there are no other pain-relief alternatives, the study authors decided there is no safe amount of time to take NSAIDs, according to Olsen.

In July, American and other Danish researchers reported in the British Medical Journal that new NSAID users faced an increased risk of a dangerous heart rhythm called atrial fibrillation. The risk was higher among older patients, those usingcelecoxib (Celebrex) and people with chronic kidney problems.

At the University of Florida College of Medicine, doctors who studied the records of older patients enrolled in a trial of competing blood pressure drugs found that longtime regular NSAID users faced a nearly 50 percent higher chance of death, heart attack or stroke.

Source: AARP.org

Contact Pure Home Care Services at (586) 293-2457 today!  If you live in Macomb County or the surrounding area, we can help you care for your loved ones.

Can an Aspirin a Day Do More Harm Than Good?

Experts are re-evaluating who should take a daily dose

Some 43 million Americans do it every day: take a tiny aspirin to help prevent heart attacks and strokes. In fact, doctors have been routinely recommending the practice to older adults for years.

But recently, experts have been questioning the aspirin-a-day regimen, concerned that this everyday miracle drug can pose serious risks, including bleeding in the brain and stomach.

The aspirin-a-day controversy erupted publicly in March when a 10-year study of nearly 30,000 adults ages 50 to 75 without known heart disease found that a daily aspirin didn’t offer any discernible protection.

The group taking aspirin had cardiovascular disease at the same rate as those taking a placebo. Moreover, the study—published in the Journal of the American Medical Association—reported thattaking a daily aspirin (100 mg) almost doubled the risk of dangerous internal bleeding.

And last year the U.S. Preventive Services Task Force — a panel of medical experts — issued new guidelines for patients, recommending only those at risk for heart attacks or strokes should take a daily aspirin. Risk factors include having high blood pressure, high cholesterol and diabetes, as well as being overweight.

The panel also recommended that people over 80 not take aspirin at all because of bleeding risk.

For the first time, the panel also broke down its advice by gender, recommending against daily aspirin use in women under 55 and men under 45.

So, should you take a daily aspirin or not? The answer is not quite as simple as doctors previously thought. Aspirin, they say, can still be a lifesaving drug, but it’s not for everyone.

Source: AARP.org

Contact Pure Home Care Services at (586) 293-2457 today!  If you live in Macomb County or the surrounding area, we can help you care for your loved ones.

It’s easy to take medicines for granted. When we’re sick, we may take a drug a few times a day to relieve our symptoms. Then, when we’re feeling better, we go back to our daily routine.

But some medicines, such as blood thinner pills, require lifestyle changes. You need to take them at the same time each day, for example, and you need to avoid injuries. These changes are important for you to stay safe and healthy.

Each year, nearly 2 million Americans start taking a blood thinner pill to prevent blood clots from forming in their bloodstream. Blood clots can lead to strokes, heart attacks or other serious health conditions.

If your doctor thinks you are at risk for a blood clot because you can’t move around easily or you’ve had recent surgery or an injury, he may put you on a blood thinner.

How blood thinners work

When taken correctly, blood thinners, also called anticoagulants, help your blood flow more easily to lower your risk of developing dangerous blood clots.

But blood thinners also increase your chance of bleeding. When taking a blood thinner, you need to be careful when going about your daily routine. For example, you should take extra care to avoid getting cuts from sharp instruments, such as knives, tools or other sharp objects. You must also carefully follow your doctor’s instructions about your diet and how much of and how often to take your blood thinner.

A consumer guide

Like learning to drive a car, taking blood thinners will require you to learn and practice several important steps until they become habits. To help patients remember these steps, my agency, the Agency for Healthcare Research and Quality, recently made a video and produced a consumer guide. These tools will help you get the best results from your blood thinner.

The video describes the “BEST” way for you to remember important tips about blood thinners. BEST stands for:

Be careful. Use caution during activities that put you at risk for getting a cut or bruise. Even a small cut can bleed more than usual. Wear work gloves when working with tools, for example. Avoid high-risk sports or other dangerous activities. And if you do injure yourself, from a fall or hard bump to the head, call your doctor immediately.

Eat right. Your diet can affect how your blood thinner works. Do not eat or drink anything your doctor has told you to avoid. For example, your doctor may advise against foods or drinks high in vitamin K (including leafy green vegetables, vitamins and herbal supplements) because they can interfere with some blood thinners. Most important, keep your diet consistent, both in the type and amount of foods you eat.

Stick to a routine. Take your blood thinner pills at the same time every day. You can have family members remind you, use a pill box or set the alarm on your watch. It’s also important to talk to all of your doctors about all other medicines or supplements you take and to tell your doctors about any changes in your medicines. Remember to talk to your doctor before taking aspirin because it also acts like a blood thinner.

Test regularly. Blood tests let your doctor know if you are getting too much or too little medicine. Your doctor may order an INR blood test. That stands for International Normalized Ratio, which measures the amount of time it takes for your blood to clot. Based on the results, your doctor may need to adjust your dose. It is very important that you have your blood checked regularly if your doctor tells you it’s necessary. Home testing kits are available and covered by Medicare.

Taking a blood thinner does require you to make adjustments in your lifestyle. But just a few changes, followed each day, will ensure you’re getting the benefits you need from this medicine. By following the BEST way and talking with your doctor, you’ll help your blood thinner work well and safely for you.

Source: AARP.org

Contact Pure Home Care Services at (586) 293-2457 today!  If you live in Macomb County or the surrounding area, we can help you care for your loved ones.

9 Types of Medication Older Adults Should Use With Caution

If you’re over 65, think twice before taking these drugs

As you grow older, you’re more likely to develop long-term health conditions that require taking multiple medications. You’re also more sensitive to many common medications, including over-the-counter (OTC) drugs.

As a result, it’s not uncommon for older adults to be overmedicated and to experience adverse reactions to the ever-lengthening list of medications they take.

Ask Questions

When taking a new medication, ask your doctor or pharmacist these important questions:

1. When and how should I use this new drug?

2. What is the purpose of the medication?

3. What should I do if I miss a dose?

4. Will the drug interact with other medications, vitamins or supplements I’m taking?

5. Is a generic or lower-cost brand name medication available?

6. What side effects, reactions or warning signs should I watch for?

To lower the chances of overmedication and dangerous drug reactions, the American Geriatrics Society Foundation for Health in Aging recommends that people age 65 and over be cautious about using the following types of drugs:

Important: If you are taking any of these medications, talk to your doctor or health care provider before stopping their use.

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Be cautious of: long-lastingNSAIDS such as piroxicam(sold under the brand-name Feldene) and indomethacin(Indocin).

The concern: NSAIDs are used to reduce pain and inflammation, but in older adults these medications can increase the risk ofindigestion, ulcers and bleeding in the stomach or colon; they can also increaseblood pressure, affect your kidneys and make heart failure worse. If NSAIDS are needed, better choices include the shorter-acting ibuprofen (Motrin) and salsalate (Disalcid).

Because of the increased risk of bleeding, don’t use NSAIDs together with aspirin, clopidogrel (Plavix), dabigatran (Pradaxa), dipyridamole(Persantine), prasugrel (Effient), ticlopidine (Ticlid) or warfarin(Coumadin).

If you take NSAIDs regularly and have a history of ulcers, or are 75 years of age or older, you may need to protect your stomach against bleeding with a prescription medication such as misoprostol (Cytotec) or a proton pump inhibitor such as omeprazole (Prilosec).

Source: AARP.org

Contact Pure Home Care Services at (586) 293-2457 today!  If you live in Macomb County or the surrounding area, we can help you care for your loved ones.

Aging sometimes means reduced balance, coordination, vision, strength and agility. These factors, along with certain medications and even our home environment, can increase our risk of falling.

Ground-level falls are a major health problem for people 65 and older. An estimated 30% of people in this age group fall each year, resulting in hospitalization, permanent disability, and sometimes death. In fact, injuries related to falls are the sixth leading cause of death for seniors, and annual health care costs associated with falls are approximately $10 billion dollars. Once a person has experienced a fall, a “falls cycle” can begin in which the individual experiences an ongoing fear of falling, which can result in decreased activity, loss of strength and mobility, and an increased risk of falling.

Fall Predictors
Being aware of the common risk factors and taking precautions helps lower the overall risk. One or more of the following factors can place a person at a moderate to high risk for a fall:

• Prior fall history
• Poor, uncorrected vision
• Parkinson’s disease, untreated diabetes, and obesity
• Use of medications that can cause drowsiness, dizziness, low blood pressure and weakness
• Use of multiple medications
• Poorly fitting shoes and slippers
• A cluttered, poorly lit home with multiple levels
• Slick or wet floors, throw rugs, electrical or other cords in walk ways

What You Can Do to Reduce Your Risk of Falling
A simple test called “Get-up and Go” can additionally help predict the risk of a fall by determining one’s mobility. ² It’s easy to perform. All you need is a straight-backed chair with armrests. Make sure the chair has a high seat. Then have the individual complete the following steps:

• Rise to a standing position from the chair, using the armrests
• Stand still momentarily
• Walk 10 feet
• Turn slowly
• Walk back to the chair
• Turn around
• Sit down

A successful test occurs if the person completes this in 20 seconds or less. Those passing this test may be considered at low risk when other risk factors are absent.

Some medications can place a person at risk for having a fall. The following are some of the most common fall-associated medications:     Sleep medications, pain medications, anti-anxiety medications, anti-allergy medications, high blood pressure medications, water retention medications, anti-depressants, overactive bladder medications, and tranquilizer medications.

How can you reduce your risk of having a fall that might be caused by medication?

• Take your time. Stop for a moment before getting up. Stand slowly to be sure that you have your balance and aren’t light-headed — then walk. This allows your blood pressure to normalize and helps prevent orthostatic hypotension (also known as a head rush or a dizzy spell).
• Use the bathroom before bed. If you are taking a diuretic, schedule your last dose a few hours before going to bed. Also, leave a soft light on that illuminates your pathway to bathroom in case you need to get up during the night.
• Avoid alcoholic beverages in excess.
• Exercise regularly. Exercise strengthens important muscle groups and improves your balance and coordination. Ask your health care provider about the best type of exercise for you.
• Make your home safer. Inspect each room of your home for safety hazards such as poor lighting, obstructed walkways, throw rugs, cords and other obstacles that could cause you to trip. Place regularly used items within reach so you don’t require a ladder or stool. Install anti-slip mats and grab bars in showers and bathtubs.
• Have your vision checked regularly. Get an up-to-date prescription and treat physical conditions such as glaucoma or cataracts that can weaken your vision.
• Get checked for osteoporosis. Ask your doctor or pharmacist about the need for calcium and vitamin D.

Pure Home Care Services serves Macomb and the surrounding area.  Our helpful, caring staff is ready to help you and your family.  Give us a call! Our number is (586) 293-2457.

Source:  AARP.org