Archive for July, 2011

DRUG THERAPIES FOR HEALTHY BONES: RALOXIFENE (EVISTA)

The newest pharmaceutical option for protecting bone density is raloxifene (brand name Evista). Raloxifene is a selective estrogen receptor modulator (SERM), which, simply stated, means it has a chemical structure similar to estrogen and attaches itself to molecules in the body where estrogen would otherwise attach. It prevents bone loss by reducing breakdown of bone much the way estrogen replacement therapy does. Postmenopausal women can expect about a 3 percent increase in bone density in the first year of taking raloxifene and 1 to 2 percent per year after that. This brings a 40 to 50 percent reduction of risk of fracture in the spine. Less than 60 percent of women will see increases in bone density with raloxifene, a markedly lower response rate than with the options described earlier, including estrogen. Raloxifene is sometimes given with a progesterone, which might improve your chances of benefiting, as well as the magnitude of your results, though there is no hard evidence of that yet.
Since raloxifene blocks estrogen, it is the best choice for postmenopausal women who can’t take estrogen, especially those fearing an increase in breast cancer risk. It is not an option for men. Although it isn’t quite as effective as other prescription options in protecting bone at the hip, and is only about half as effective in the spine, it doesn’t increase the risk of uterine cancer (as estrogen does) and may actually protect against breast cancer. (Raloxifene is very similar to tamoxifen, which has gotten a lot of press as preventing breast cancer.) It doesn’t cause breast soreness or uterine bleeding, as estrogen can.
If you can take estrogen but are hesitant to, and are wondering if this is a better alternative, note that raloxifene does not offer some of the benefits that estrogen does. Raloxifene’s effect on the heart is still unclear. Though it appears to lower cholesterol levels, it is unknown as yet whether that translates into protection against heart disease and heart attacks equivalent to estrogen’s. Raloxifene does not relieve menopausal symptoms, and can even cause or increase hot flashes. No studies have yet been completed on raloxifene’s effect on colon cancer or Alzheimer’s disease, but estrogen is known to offer protection against both. Finally, raloxifene has one of the same potential side effects as estrogen: dangerous blood clots.
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HOW TO FACE GIVING UP THE FOOD: JESUS SUFFERED

Another way that I have been able to endure the pain of change is to know that even Jesus did not escape the suffering, and He was God’s favorite, so to speak. Hebrews 5:7-10 refers to the suffering that Jesus bore. “During the days of Jesus’ life on earth, he offered up prayers and petitions with loud cries and tears to the one who could save him from death, and he was heard because of his reverent submission. Although he was a son, he learned obedience from what he suffered and, once made perfect, he became the source of eternal salvation for all who obey him and was designated by God to be high priest . . ..” So, even Jesus suffered. Isaiah expressed it very well:
Yet it was the Lord’s will to crush him and cause him to suffer and though the Lord makes his life a guilt offering, he will see his offspring and prolong his days, and the will of the Lord will prosper in his hand. After the suffering of his soul, he will see the light of life and be satisfied. (Isaiah 53:10,11a)
The words of Isaiah came true. After the suffering, He saw the light of life and was satisfied. Obviously, acknowledging Jesus’ willingness to suffer helps us swallow this bitter pill.
So, not only do we endure the sufferings sent by God—we offer ourselves to suffering as God calls for it because it says to the world, “I believe and trust that this is a good God with great ability to run the world.” When we endure and allow this outward suffering, others will witness the inside of us being very much alive, beautiful, and valuable. Happiness is something made on the inside of you.
Jesus suffered and voluntarily gave His life because the Father asked this of Him.
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ADJUVANT ANALGESICS: ORAL LOCAL ANAESTHETICS, ANTIBIOTICS AND KETAMEVE

July 6, 2011 - 5:42 am Comments Off
Indication. Neuropathic pain refractory to other therapy.
Action-Probably by neuronal membrane stabilisation.
Drugs-Mexiletine is the preferred drug; flecainide was associated with an increased risk of sudden death in post-myocardial infarction patients. Mexiletine is commenced at a dose of 150 mg/d and increased by the same amount each few days up to a maximum of 750 mg/d. The medication should be taken with food. The side effects include nausea, sedation and tremor. Mexiletine must be given with particular care to patients with ischaemic heart disease or cardiac arrhythmias.
Ketamine-Ketamine, a dissociative anaesthetic used for short surgical procedures, can relieve unresponsive neuropathic pain. It acts as a NMDA receptor antagonist. It is given in subanaesthetic doses by subcutaneous infusion: 0.1-0.5 mg/kg/h and titrated against effect.
Antibiotics-The pain of cellulitis, mucositis and fungating tumours is often compounded by secondary infection. The use of appropriate antibiotic or antifungal agents can improve pain control.
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