Lessons Learned from Whitney Houston; Effects of Meds on Liver; Allergy & Blood Pressure; Commercial Disclaimers

This is written in reference to Let's Talk Medical with Doctor Gigi as it was broadcasted live on Friday March 23, 2012. 

Lessons Learned from Whitney Houston:

First let me say that I absolutely loved Whitney Houston!  She was a beautiful person with an unrivaled talent, & I am very saddened by her struggles in life & her untimely death!

Recently the autopsy results were released which showed what many of us expected:  Whitney 's death was at least partially due to drugs.  Though she had water in her lungs which showed that she "drowned," she also tested positive for a cocktail of drugs, both prescribed & illicit.  The report showed she had Xanax, Flexeril, Benadryl, Marijuana, & Cocaine in her system.  Xanax is an anti-anxiety medication which calms a person's "nerves," whereas Flexeril is a muscle-relaxant & Benadryl is a sedating anti-histamine.  The first 2 are prescription meds, whereas Benadryl is over-the-counter (OTC).  All are sedating products which means that they make you sleepy & relaxed... great idea if you're going to bed, but terrible idea if you're going to try to accomplish activities of daily living such as taking a bath or attending a party!  Marijuana also has sedating properties, so you can easily see that Whitney was likely sleepy beyond belief, & in fact possibly nearly comatose which would have allowed her to slip quietly below the bathtub water without awakening, resulting in her breathing in water which resulted in her drowning.  That is of course one possibility, though I propose a more ominous cause for Whitney's death.  The cocaine which was found in her system, was the most deadly drug... not because it is illegal, but because of it's cardiac effects.  You see, cocaine is like speed - it causes the blood pressure to go up & the heart to beat very fast.  If the heart beats very fast, it never relaxes to fill with blood, & as a consequence, though the heart is beating, it is not pumping blood.  After a brief time, the brain gets low on oxygen (we call this hypoxia) & this causes the person to pass out.  Though your brain might not be functioning, the automatic functions such as breathing would continue.  So I propose that Whitney took cocaine which caused a very fast heart beat causing the heart to pump ineffectively... causing her to pass out, at which point she went limp & slipped beneath the water, but she continued to take a few breaths... thus the autopsy showed that she drowned.  For those who wonder why she could not arouse enough to get her head out of the water, I think this is a plausible explanation.  Sadly, I will add that many addicts who "slip" often over-dose because they resume their drug use at the last dose they used... yet after a dose of sobriety they have lost their tolerance & cannot handle that high of a dose.  So in Whitney's defense, perhaps this was a fresh "slip" with cocaine... unfortunately we will never know!

This whole issue brings up the fact that of course we should not be using drugs of abuse, but it also brings to light perhaps a much more rampant problem in our society... a lack of respect for medications as a whole!   Many people every day do just what Whitney Houston did in regards to combining prescription & over-the-counter drugs without regard to the toxic effects of these combinations.  Heath Ledger over-dosed on a combination of sleeping pills & other prescription drugs, but I am certain that he never intended to die.  Michael Jackson was so desperate for sleep that he began to use medication that is only used as anesthesia for surgery... strange, but I also doubt he wanted to or expected to die!  How many people, in a search for sleep or relief from pain, take multiple medications at doses higher than prescribed by their doctors?  And how many of us take over-the-counter meds on top of prescription drugs without getting advice from our physicians?  And this is not even addressing the sharing of drugs with our friends & family, much less the parties where teens each bring a pill from home & then take them just for fun!  So, before we pass judgement on Whitney, perhaps we need to look at ourselves... & certainly we need to realize that medication is wonderful when used appropriately, but deadly when used inappropriatly!  Always speak with your physician before you change doses of meds, add OTC meds, or "share" your meds!  Be respectful, as it is not just illegal drugs that kill!

Effects of Medications on the Liver:

Dawn had a question regarding the effect of multiple medications on the liver.  First, not every medication is metabolized by the liver, as many are degraded by the kidneys, & some by other metabolic processes.  The problem occurs when a person takes multiple medicines that use the same pathway for metabolism, thus the liver might have a problem if you take several of the following:  cholesterol medications (such as statins), diabetic medications (such as Metformin), rheumatologic meds (such as Methotrexate), anti-seizure meds (such as Tegretol or Depakote), or even Tylenol, as they are all "digested" by the liver.  As you can see, these are very common meds, & often people take several of these at once.  You should not worry about combining them, but you should speak with your doctor to insure that you get proper monitoring, which generally involves blood tests such as an AST or ALT (previously known as an SGOT or SGPT respectively).  If these are elevated, your liver is showing signs of being irritated, & your doctor will probably first do further labwork to rule out viral hepatitis as a cause... & he might even do an ultrasound of your liver & gallbladder if you have abdominal pain or other symptoms.  If there is no other explanation for the increased liver tests, he will likely try to decrease or stop one of the medications that requires the liver to metabolize it.  Generally the damage is not permanent, & getting rid of the offending agent or agents usually results in the liver healing quickly.  Of course, if you have a sick liver due to Hepatitis or cirrhosis, you have to be even more careful with medications.  As a last thought, remember that Tylenol & alcohol are both metabolized by the liver, so be sure to limit these products if you take prescription drugs that go through the liver.  Similarly, anti-inflamatory meds (such as AspirinIbuprofen=Advil, Naproxen=Aleve, & Meloxicam=Mobic) are degraded by the kidneys, so they should be used with caution if you have renal impairment or lots of meds that use the kidneys for degradation.

Allergy Season:

Of course we have all heard about the early Spring & it's high pollen levels, & many of us have been aware of this for several weeks as we have been suffering with allergy symptoms.  These include itchy eyes & nosewatery eyes & nosestuffy nose, & generally the feeling that you have a "cold" which comes & goes for weeks.  There are many choices for treating these symptoms, but many people don't understand those options.  In general, if you have a runny or itchy nose or eyes, try an anti-histamine as this type of medicine will dry things up & decrease the itchiness.  There are great over-the-counter anti-histamines such as:  Claritin (=Loratidine), Allegra (=Fexofenadine), Zyrtec, or even Benadryl.  Claritin & Allegra are not likely to cause sedation, though Zyrtec might & Benadryl almost certainly will (so take them at night!).  Also, note that the first 3 work for 24 hours, whereas Benadryl works for only 4-6 hours, so you will need to take it more than one time per day, & you will likely be very sleepy!  On the other hand, if you have a stuffy nose, you probably want to try a decongestant such as Sudafed (=Pseudoephedrine) or Phenylephrine which are both OTC.  You need to know however that decongestants often cause an increase in blood pressure, heart rate & anxiety, so you might want to ask your doctor if they are safe for you!  If you cannot take decongestants, your doctor can prescribe Astelin (which tastes horrible but will both dry & unstuff your nose), or perhaps a nasal steroid such as Flonase (=Fluticasone), or even Singulair or Accolate which decrease inflamation in the respiratory tract.  As a last thought, remember if a medicine name includes "D," that medication includes a decongestant, so beware that it might increase your blood pressure, make your heart beat fast, &/or cause you to feel anxious!  Such is the case with Claritin DAllegra D, & even Mucinex D (which has a decongestant, whereas Mucinex DM has a cough suppressant called Dextromethorphan).

A cost-saving tip:  Claritin is over-the-counter, but you can buy the generic version (Loratidine) from the Pharmacy with a prescription.  The Loratidine from the Pharmacy should cost only $4 for 30 pills at WalMartKMartSweetbayPublixTargetSam's Club, & Costco.  Thus the prescription med is a lot cheaper than the OTC med, so ask your doctor for a prescription!  This is the case with several meds, so ask your doctor or Pharmacist, or even check the $4 WalMart list!

Medication Side-effects on Commercials:

A listener commented that he doesn't understand how the FDA would ever approve medications given the horrible side-effects listed on commercials.  Well, I certainly understand the comment, but there is some information that lay people need to know.  When a drug is being tested in clinical trials, the patients are told to report any & all changes in their health while enrolled in the study.  Thus headaches & "flu" are frequently reported, as are heartburn & back pain.  Obviously these are common problems in the general population, so it is no wonder why they are frequently reported.  Realize that these reported "adverse events" are then listed on the drug's list of "side-effects" even though cause & effect have not been proven!  Therefore drugs which are studied during the flu season, often list "flu" as a side-effect.  Again, that does not mean that the drug "caused" the flu, though the commercial will not make that distinction as the FDA does not allow that!  If you have concerns, ask your doctor which side-effects are most likely, as we know that information & use it to help us prescribe appropriately. 

Also, remember that some disease processes, rather than the medicines themselves, cause the side-effect.  You might remember the recent concerns involving Zoloft which was accused of causing people, especially teens, to commit suicide.  Though I can't prove it, I would suggest that the failure of Zoloft to fully treat the depression is more likely what caused the person to commit suicide as depression itself is usually the cause for suicide.  In my opinion, the failure of Zoloft to work well or to be appropriately managed is a better explanation for this "side-effect."  Similarly, diabetics are more likely to have heart attacks & strokes than the general public, so it is likely that diabetic meds will show more of these adverse events than meds like antacids which are used in healthy people as well as diabetics.  There is a question in many people's minds as to whether or not statin medications (which are used to treat high cholesterol) cause forgetfulness.  The problem is that once again, high cholesterol itself can cause mini strokes which can cause forgetfulness... so if a person with high cholesterol takes a statin & gets confused or forgetful, do we blame the medicine or the high cholesterol itself?  Obviously, if you stop the statin & the patient's memory returns to normal, I would be convinced that the statin was the culprit, but if nothing changes, I would resume the statin medication to help lower the cholesterol & hopefully decrease the risk of further cardiovascular events, including tiny strokes!

So take the commercial disclaimers with a grain of salt!  Talk to your doctor to get more appropriate information & to make better decisions.  Remember, if you read the side-effects of aspirinTylenolbirth control pills, or even alcohol, you would likely never take any of them!

On that note, I'll end, so here's to our health!

Doctor Gigi

PS  Don't forget to check out the live radio show on WTAN 1340-AM in the Tampa/St. Pete area on Fridays at 1:00PM Eastern time, or on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts.  And I would love to hear from you regarding any medical concerns or comments you might have.  You can reach me via phone during the radio show (866-TAN-1340) or any time via e-mail (DoctorGigi@SkipShow.com).