Category Archives: Drugs and Treatments

Rx Drug Take Back Day 4/27

I’d like to publicize the Worcester area’s prescription drug take back day, 4/27 (10-2), sponsored by the Central MA Regional Public Health Alliance. For more info call 508-799-8531. Dropoff locations include the police departments of Holden, Leicester, Millbury, Shrewsbury, West Boylston as well as the Worcester Senior Center. A good opportunity to safely dispose of old or expired medications.

A little help from my (rheum) friends . . .

Some great pieces from my international colleagues lately!

Dr. Irwin Lim discusses the role of methotrexate therapy here and here. Thanks, Irwin, for your insights.

Also check out his recent video which helps me explain to patients why allopurinol may actually cause a gout flare.

Finally, let’s travel over to Ireland and check out the many videos by Dr. Ronan Kavanagh. Great work, Ronan! (Irwin I see you’re on clear.md as well – I think I’m going to leave the videos to you guys and I’ll keep to the written word). So pleased to be able to share and collaborate with rheumatologists all over the globe.

Photo: taken at the Highland Games in New Hampshire

Now I’m just angry!

High on the list of things making me angry is the weather. A foot of snow each week? Really, Mother Nature? Really? Global warming or not, it’s wearing on us. I’ve tried making idle threats against the earth, which go something like this – “Make the snow stop or I swear I’ll never recycle anything ever again! Look at me holding this peanut butter jar! It’s going in the TRASH. That not enough for ya? OK, I can do better. Here’s a laundry detergent bottle! OOOOH all that plastic, bobbing around in your oceans. Gonna stop the snow now???” Yeah, well, I think all the snow is making me loopy. Not to mention that we’ve had so many snow days causing patient cancellations that it’s really fouling up everyone’s schedules.

What else makes me angry? An article with the headline “Docs Don’t Follow OA Guidelines.” Why so accusatory? In my mind that headline assumes there’s a bunch of guys smoking cigars sitting around a table saying, “To hell with guidelines! We don’t care about guidelines! We’re doing what we want!” (I don’t know why it’s like a 1920’s mobster scene, but that’s my vision here).

Here’s the first paragraph:

Physicians are apparently disregarding standard guidelines to manage osteoarthritis — relying on painkillers and surgery rather than on steps like exercise and weight loss that could help reduce morbidity — adding to the soaring costs of treating OA, researchers argued.

Let’s think about that for a minute. A patient comes in with osteoarthritic knee pain. Usually it hurts when getting up after sitting for a while, hurts going up and down stairs. Maybe they’re already active and it hurts when exercising. Maybe it used to respond to an OTC analgesic but isn’t anymore.

I am fairly certain that most doctors almost always if not always counsel patients with OA about diet and exercise. I’ve given the “even a little bit of weight loss would help take some pressure off your knees” talk so many times I wouldn’t be surprised if I say it in my sleep. But here’s the clincher – diet and exercise are the PATIENT’S responsibility. I can’t go home with you and cook your food (though I can help you find some great internet resources for healthy eating) and I can’t take you to the gym. I have enough trouble getting myself out to exercise and to avoid the lure of the office candy bowl! But when patients come to the doctor they expect us to DO something. Dieting and exercise are slow. They’re hard to do. Your knee still hurts when you’re exercising. Painkillers, injections and even surgery can help you feel better as youre working on healthier lifestyle modifications. So please don’t tell me that I’m “disregarding guidelines” by recommending other treatment options. I’m just trying to help.

Does Vitamin C treat a cold?

How should you respond to a friend who, the minute you have a cough or sneeze, shoves a packet of Emergen-C in your face and orders, “Drink up!” Well, if you’re me, the response has always been, “You know, there are really no studies that prove this helps!” And I’m met with a lot of eye rolling and insistence that yes, it does help, and I’d better quit my “Dr. Know-it-all attitude” and push that vitamin C. Well, I kinda like the taste of Emergen-C, and it can’t hurt, right???

AND THEN . . .

Thank you, NYU Clinical Correlations blog for an excellent review of Vitamin C for the prevention and treatment of cold symptoms. I’d suggest reading the whole entry, but here’s the bottom line:

So, at the end of the day, is there any benefit to taking a daily vitamin C supplement, or for chugging down that fizzy shot of mega-dose vitamin C when you feel a cold coming on?  If you are a marathon runner, or if you are planning a winter adventure in the arctic tundra, you should certainly consider a daily dose of vitamin C.  For the rest of us, it doesn’t seem to be worth the hassle and expense of adding one more pill to our daily routine. 

 On the other hand, regarding the effect of vitamin C taken at the onset of cold symptoms, the Cochrane group left a little room for interpretation.  The group was unable to identify a clinically significant benefit of therapeutic dosing based on the majority of currently available research.  However, they pointed to a few interesting trials showing evidence of benefit, yet to be verified, for therapeutic vitamin C preparations containing 4 to 8 grams.  Furthermore, in the general population, vitamin C’s side effect profile appears to be relatively benign. 

A spoonful of honey?

You may have seen the recent story in The New York Times’ Well Blog about honey as a cough remedy. Stuck in the midst of a rather stubborn URI with coughing fits, I thought the timing couldn’t have been better! After trying every OTC cough and cold remedy on the market, I read the article and promptly reached for the honey bear, squeezed out a big spoonful and hoped for the best. And kept coughing. At least it tastes better than cough syrup.

Gout: A bowl of cherries?

Did you know that I write a health blog for the Worcester Telegram and Gazette? The latest one was about patients asking me about cherry juice as a gout treatment. Keep in mind these are short, general purpose blog entries for the newspaper site.  Here is a reprint:

Maybe it is because the grocery stores are fully stocked with beautiful cherries this time of year, but several patients in the last few weeks have come in touting the merits of cherries as a gout treatment. Yes, I’d heard this before and no, I didn’t really know why. Some patients eat cherries, some drink the juice and some take special cherry juice extract pills they purchase through a vitamin store. My first reaction to the patient who claimed eating a pound of cherries a day cured his gout was, “wow, you must spend a lot of time in the bathroom!” But I digress . . .

Why cherries? I searched good old google and found mainly advertisements or websites trying to sell juice or extracts. I turned to google scholar and to PubMed, which is an internet database of the US National Library of Medicine and National Institutes of Health, or a site where you can search for what we call “scholarly articles” or scientific research printed in medical journals. I did find some articles talking more specifically about the chemicals in cherries. Some of them were sports-medicine related and discussed cherry juice for post-workout recovery following intense exercise, like marathons. There is an article loaded with very “science-y” words in a journal called Plant Foods for Human Nutrition called “Improved antioxidant and Anti-Inflammatory Potential in Mice Consuming Sour Cherry Juice.” I wonder how well the mice liked the cherry juice?? (According to the article the food pellets incorporated the juice). An article in the Journal of Nutrition was titled “Consumption of Bing Sweet Cherries Lowers Circulating Concentrations of Inflammation Markers in Healthy Men and Women.”

I did skim a few more articles and overall it seems there are some anti-inflammatory chemicals in cherries that may have a benefit in inflammatory conditions, like gout. Bottom line? If your gout isn’t that bad and you find eating cherries or drinking juice daily prevents attacks, great! If you feel cherries can prevent a gout attack when you feel one coming on, also great! Remember that cherries and especially juices have calories and sugar. Overdoing it can lead to weight gain or high blood sugars for diabetics. Also, we’re talking tart cherries, bing cherries or dark sweet cherries. Stay away from the bright red ones in the jar! Remember that uncontrolled gout can lead to a chronic and deforming arthritis, so be sure to discuss your condition and what you’re doing for it with your doctor. It is possible your condition may require a prescription gout medication.

The Lazy Blogger Award

Is there a Lazy Blogger Award? Well, if not, I am officially giving it to myself. Congratulations, Doctors’ Rheum, you’ve been a really lazy blogger!!

However, I have been reading blogs and trying to comment here and there and really appreciating some new commenters on my older blog entries. Let’s just say we in New England aren’t used to long stretches of hot, humid air and I think my brain is melting like the dark chocolate in my cabinet. However, I can’t put my brain in the fridge to firm it up, so let’s hope the neurons fire better after this cold front, or with the approach of fall.

Anyway, did you see these articles? If not, these are some points of interest I’ve been collecting to share:

The New York Times’ Well blog featured Voices of Scleroderma. Most people I’ve diagnosed with this condition have never heard of it. Fortunately it is rare, but unfortunately the treatment options are limited. I did my fellowship at The University of Pittsburgh, with several outstanding faculty members doing both clinical and basic science research on scleroderma.

Cheers! Could you actually help prevent Rheumatoid Arthritis by drinking alcohol? The very day I saw this article come across my daily email briefing, a patient brought it in and said, “Hey, does this mean I can drink?” Well, if you’re on Methotrexate that answer is still going to be no, no and are you crazy? The article was an observational study that found arthritis was less severe in drinkers compared with nondrinkers. However, the article also notes,

“We would wish to point out that, at the moment, that our findings are preliminary, and would not recommend that patients drink alcohol with the specific purpose of treating their arthritis,” said Dr. James Maxwell, lead author of the study and a consultant rheumatologist at The Rotherham NHS Foundation Trust in England.

Finally, did you see that all those “toning shoes” may not be all that great for you after all? One of my co-workers, a DIE-HARD fan of the shoes, was very disappointed when I mentioned this article to her. If you’re out of shape, strapping on a new pair of shoes won’t magically get you in shape, just as a treadmill that serves mainly as a clothes rack isn’t doing much for your fitness. However, if the promise of extra toning inspires you to walk more, be my guest. I just think they look a little funny, but, then again, I’m not winning any fashion awards.