Over the years, we all grow used to headlines that capture the imagination like, “Sticky Buns kill 31 in China” or “Two British ships collide, one dies”. Somehow the English language is capable of creating dramatic images in just a few words, converting a simple story of food poisoning into an epic movie where killer buns rampage through a crowded mall until brought down by Chinese kung fu warriors. But, every now and then, the story is both extraordinary and literally true. “College girl avoids loss of all her limbs”. Medicine is still a fairly inexact science. We all know the names of the big diseases and that there are treatments for many of them. But whether patients get the right diagnosis in time for the treatment to work. Well, that is a different story. Take meningitis as an example. The bacteria responsible live happily in the throats for weeks and months and nothing happens. Then, without warning, something as yet unknown, can trigger them into activity.
The first signs are what seem to be a cold or flu, sometimes with a headache, then developing with fever, vomiting and a rash. But there is no guarantee that these symptoms will appear or in this order. It is often the case that treatment is too late if the rash appears. This is a sign of meningococcemia, a bacterial infection of the blood stream. In some cases, there can be a loss of blood circulation to the hands and feet. At the beginning, they feel cold and, if treatment is delayed, gangrene can set in and there is no choice but to amputate. It is a little like a horror movie. First, surgeons remove the fingers of the affected hand. If that does not stop the spread of the rot, the hand follows, then the arm below the elbow, continuing until there is no arm left. That just leaves the other arm and two legs to go. Amputations occur in between 10 and 20% of cases.
This brings us to Jamie Schanbaum who is a student at the University of Texas in Austin. Early in February, 2009, she felt ill and quickly realised it was something serious. But, instead of going to hospital, she went to bed hoping to sleep it off. This was a crucial loss of time. When she awoke, the bacteria had spread throughout her body. But she has benefited from a new approach to treatment. Patients are placed in an oxygen chamber and given high doses of viagra. Although this drug is most usually associated with the treatment of erectile dysfunction, it works by dilating arteries in certain key areas through out the body. So it has a general effect in improving blood circulation. Changing the air pressure also improves flow. With these two working together, circulation to the affected areas of the arms and legs can be improved and amputations avoided. Years ago, Jamie would have lost all her limbs. Today, comparatively little needs to be removed. Although this is an extreme example of the effectiveness of viagra, it should remind us that it also represents a dramatic way of restoring circulation to the penis and creating hard erections. Different needs are equally well served by this amazing drug.
Tags: drug
Many people think the Food and Drug Administration’s role is limited to licensing new drugs and medical devices, but it actually has a post-marketing role as well. Doctors and hospitals all round the US are required to report any and all adverse side effects to drugs. It’s not uncommon to find that drugs can pass through clinical trials involving only thousands of participants, but show side effects when millions start taking them. Obviously, many problems come from those who abuse the drugs in one way or another but, every now and again, serious problems emerge over time. Once a pattern emerges, the FDA can either change the labels on the drugs to give stronger warning to patients or, in the worst cases, withdraw the licenses for the drug to be used. Since withdrawal can have a dramatic effect on the manufacturer, the FDA prefers to improve the level of warnings unless the problems are too severe to ignore.
Doctors have been aware of the problems of serotonin syndrome for some years. It’s a potentially serious adverse side effect when people ingest too much serotonin. Perhaps it’s better to think of this as a form of poisoning caused when people take excessive dosages of one drug or mix different drugs together. The effects fall into four main classes:
- a change to metal status – you may become agitated, hallucinate or, in extreme cases, fall into a coma;
- the body may start to function erratically and your blood pressure rises, your heart races and your body suddenly loses or retains heat;
- loss of physical co-ordination; and/or
- nausea, vomiting and diarrhea.
In some cases, the result has been death, e.g. the high-profile case of Libby Zion in 1984 which produced a change in the law of New York limiting the working hours for medical postgraduates and requiring their close supervision by senior physicians at all times. Thus, the FDA is not reacting to a new problem, but merely increasing the visibility of the warning notices as it affects all drugs containing serotonin.
In this instance, the warnings affect tramadol in the following ways. It always has been the case that an overdose of any of the opioid painkillers can cause this syndrome. Fortunately, this particular problem is relatively uncommon. Even those in the most severe pain understand the risks of exceeding the safe dosages are too dangerous to justify. Accidental overdose is almost unknown. So the most common problem arises with interactions between tramadol and other drugs with a serotonin content. The most dangerous combinations come with the classes of antidepressants called serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, and triptans.
The syndrome can arise even though you take the safe prescribed dose of the painkiller. So the warning is not so much about the painkillers themselves, but to alert people not to self-medicate. Since the rise of the online pharmacy industry, too many people have been buying drugs without a prescription – that means without talking through the risks with a doctor. Obviously, a doctor with access to a person’s medical history would immediately identify the dangers and either change the dosages or change the drugs. When people rely on recommendations from friends or the information they glean from the internet to decide what drugs to take, they can be putting themselves at risk. Hopefully, this new warning will prevent problems and keep people safe.
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