Perception of Telemedicine Trade

Improvements in communication and information technologies have allowed for the globalization of health services, especially the provision of health services from other countries, such as the use of telemedicine. This has led countries to evaluate their position on whether and to what extent they should open their health systems to trade.

This often takes place from the context of multi-lateral trade agreements (under the auspices of the World Trade Organization), which is misplaced as a significant amount of trade takes place regionally or bi-laterally. We report here the results of a qualitative study assessing stakeholders ‘views on the potential for a bi-lateral trade relationship between India  Continue reading

Aids – Like Symptoms from Contagious Mystery Virus Spreading Throughout China

A new mystery virus with symptoms similar to those of AIDS and HIV is turning up all over China, according to a recent report in The Epoch Times. Patients with the highly transmissible disease are experiencing dramatic weight loss, night sweats, numb limbs, severe body aches, joint problems, severe vomiting, and the obvious decrease in white blood cell count and subsequent deterioration of the immune system.

A translated report from the Chinese news source New Express Daily explains that people who contract the new AIDS-like virus — which spreads through any bodily fluid, including saliva and sweat, by the way — experience nearly all the same symptoms as AIDS patients do, but routinely test negative for the disease. And experts are allegedly unable to authoritatively identify the disease, or the source from which it came.

A reporter from New Express Daily recently interviewed 30 different patients with the disease, most of which were believed to have contracted it  Continue reading

Study Claims Junk Food Cravings Trigger the Same as Drug Addict Cravings for Hit

The brain’s response to the tempting appeal of a sugary, fatty milkshake or to a bag of salty, greasy snack chips appears to be the same response a drug addicts brain exhibits when anticipating the next “hit,” suggests a new study published in the journal Archives of General Psychiatry. Ashley Gearhardt of Yale University and her colleagues found that the addictive nature of many junk foods is literally the same as the addictive nature of drugs.

The team analyzed the brains of a group of 48 young women, who were tempted with either a chocolate milkshake or a tasteless beverage solution. Based on data gathered using functional magnetic resonance imaging (fMRI), the team discovered that the women’s anterior cingulated cortex and the medial orbit frontal cortex — two areas of the brain known to respond to drug addiction — both responded to sensory cravings for the milkshake, regardless of the women’s weight.

“If certain foods are addictive, this may partially explain  Continue reading

This Devastating Mistake Can Wreck Your Immune System…

Vaccines can contain live or killed lab altered microorganisms, and also carcinogens, heavy metals, and mutated proteins. Recent news can give you an indication of the unsuspected results that can occur when you inject such a cocktail into your body.

Results from a Swedish study found a roughly 400 percent increased risk of narcolepsy in children and adolescents vaccinated with Pandemrix. The results are similar to those found in a Finnish study.

According to the Swedish Lakemedelsverket:

“An ongoing case inventory study … is expected  Continue reading

Traditional Chinese Medicine for Depression

Today, it is estimated that five million Americans are taking Prozac. Unfortunately, over the last seven years there have been 31,000 reports of adverse reactions to this powerful drug. More and more people struggling with depression are beginning to ask, “Is there any safe, effective treatment that I can use regularly without worrying about side effects? What is the natural way to deal with depression?”

We are often asked the same question by patients, psychologists, psychiatrists, and other health professionals: “How do Chinese, Japanese, and other people from Asia deal with depression?” Prozac is not familiar to most Chinese, not even the health professionals in China. Many popular anti-depression drugs are not available in hospitals in China.  Continue reading

Stop Liver Disease with Coffee

Researchers have found another good reason to go to the local espresso bar: Several cups of coffee a day could halt the progression of liver disease, a study showed Wednesday.

Sufferers of chronic hepatitis C and advanced liver disease who drank three or more cups of coffee per day slashed their risk of the disease progressing by 53 percent compared to patients who drank no coffee, according to the study, led by Neal Freedman of the U.S. National Cancer Institute.

For the study, 766 participants enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial  all of whom had hepatitis C which had not responded to treatment with anti-viral drugs  were asked to report how many cups of coffee they drank every day.

The patients were seen every three months during the 3.8-year study, and liver biopsies were taken periodically to determine the progression of liver disease.

“We observed an inverse association between coffee intake and liver disease progression,” meaning patients who drank three or more cups of java were less likely to see their liver disease worsen than non-drinkers, wrote the authors of the study, which will be published in the November issue of Hepatology.

The researchers put forward several ways in which coffee intake might protect against liver disease, including reducing the risk of Type 2 diabetes, which has been associated with liver illness; or by reducing inflammation, which is thought to cause fibrosis and cirrhosis of the liver.

Even caffeine, the chemical that gives a cup of coffee its oomph, came under the spotlight, having been found in previous studies to inhibit liver cancer in rats.

But drinking black or green tea, which also contain caffeine, had little impact on the progression of liver disease, although there were few tea drinkers in the study.

According to the World Health Organization, 3 million to 4 million people contract hepatitis C each year.

Seventy percent of cases become chronic and can cause cirrhosis or liver cancer.

Heart Risk possibilities for those with Touching Toes

In addition to measuring flexibility, touching your toes may indicate your risk of cardiovascular disease.

Performance on sit-and-reach tests can be a sign of the risk of an early death heart attack or stroke among people 40 years old and older, according to a study in the American Journal of Physiology.

Since arterial stiffness often heralds cardiovascular disease, a test of how far you can reach beyond your toes from a sitting position could be a quick, easy, inexpensive indicator of how stiff your arteries are.

“Our findings have potentially important clinical implications because trunk flexibility can be easily evaluated,” said one of the authors, Kenta Yamamoto. “This simple test might help to prevent age-related arterial stiffening.”

Although it isn’t known why flexibility of the body in middle age and older would be related to arterial flexibility, the authors speculate that stretching exercises may trigger physiological reactions that slow the stiffening of arteries connected with aging.

Healthy blood vessels are elastic, and elasticity helps maintain healthy blood pressure. Arteries stiffen with age, and stiff arteries are a risk factor for cardiovascular disease and death. Previous studies have shown that physical fitness can delay arterial stiffness and the authors of this study theorize that a flexible body could be a quick way to determine arterial flexibility.

The researchers divided 526 healthy, non-smoking adults ages 20 to 83 into three age groups: young (20-39), middle aged (40-59), and older (60-83), to perform a sit-and-reach test. They sat on the floor with their backs against the wall and their legs straight. They slowly bent forward and reached out with their arms. They were classified as either poor or high flexibility, depending on how far they could reach.

The study found that trunk flexibility was a good predictor of artery stiffness among middle age and older volunteers but not among the younger group. They also found that systolic blood pressure (the highest pressure that occurs when the heart contracts) was higher in poor flexibility than in high flexibility groups.

“These findings suggest a possibility that improving flexibility induced by the stretching exercise may be capable of modifying age-related arterial stiffening in middle-aged and older adults,” Yamamoto said. “We believe that flexibility exercises, such as stretching, yoga and Pilates, should be integrated as a new recommendation into the known cardiovascular benefits of regular exercise.”

However, there are other possibilities as to why bodily flexibility should be an indicator of arterial stiffness, including the possibility that the amount of collagen and elastin, which makes muscles flexible, also makes arteries flexible.

Definitions of Herbal Properties

adaptogen: a non-toxic substance which helps the body to adapt to stressful situations while also normalizing physiology

alterative: gradually alters the body towards health, also often referred to as a blood cleanser. Alteratives work directly through the metabolism

anodyne: pain relieving

antibacterial: effective against bacteria

anticoagulant: prevents blood from clotting, blood thinner

antidepressant: relieves depression

antifungal: effective against fungal infections

anti-inflammatory: reduces inflammation

antimicrobial: inhibits micro-organisms

antioxidant: prevents free radical or oxidative damage

antiseptic: prevents growth of microbes

antispasmodic: stops spasms

anti-tumor: inhibits growth of tumors

antiviral: inhibits growth of viruses

aphrodisiac: increases libido

aromatic digestant: promotes digestion through aromatic actions of moving energy and relieving stagnation (promoting peristalsis, expelling gas, etc)

astringent: tightens tissues, useful for toning organs, stopping diarrhea and other excessive fluid loss

bitter: a taste that stimulates salivation and the secretion of bile and HCL to promote

carminative: expels gas from the intestines (often an aromatic digestant)

cell proliferant: promotes cell growth

cholagogue: stimulates bile flow from the gall bladder

circulatory stimulant: promotes circulation

demulcent: internally soothing, often times a mucilaginous that coats and protects the

diaphoretic: a relaxing diaphoretic relaxes the exterior to allow for heat to leave the body a stimulating diaphoretic engages the tissues to help push the heat out.

digestant: aids digestion

diuretic: stimulates urination

emetic: promotes vomiting

emmenagogue: promotes menstruation

emollient: soothing and softening to the skin

expectorant: promotes the expulsion of mucous from the lungs

hemostatic: stops bleeding

hepatoprotective: protects the liver

hypotensive: lowers blood pressure

immunomodulator: promotes health in the immune system by modulating extremes in hyper or hypo action

laxative: promotes bowel evacuation

lymphatic: promotes lymphatic movement; an example is reducing enlarged lymph glands

mood elevator: promotes a happier disposition

nervine: can be relaxing or stimulating. A relaxing nervine relaxes constricted or contracted tissues in the nervous system. . A stimulating nervine stimulates stagnant or overly relaxed tissues of the nervous system.

nutritive: contains a high amount of vitamins and minerals

sialagogue; promotes the salivary glands to secrete saliva

styptic: stops bleeding usually through astringent actions

tonic: gradually increases organ tone and is often considered invigorating

trophorestorative: a nourishing herb or food that usually has an affinity to a particular organ or system of the body, it acts on the particular system to bring it into balance and can also restore function

vulnerary: heals wounds

Natural Medicines in the Clinical Management of Heart Failure

Heart failure can be a bit tricky. Early symptoms are often so subtle they go undetected. By the time symptoms are noticed, there can be significant cardiac damage. By the time they are diagnosed, many patients have already lost up to 50% of their cardiac function.12316 As a result, survival time after diagnosis of heart failure is relatively short…an average of 1.7 years for men and 3.2 years for women.12317

The sooner heart failure is detected, the better. Suspect heart failure in patients with poorly-controlled or long-standing hypertension, valvular disease, or coronary artery disease. An echocardiogram can give an early indication of heart failure even in patients who don’t have symptoms. The diagnosis can often be confirmed with further testing, such as an exercise test.12316

Heart failure develops with a snowball effect. Symptoms beget more symptoms. When the heart starts to fail, the body tries to compensate. As cardiac output decreases, the adrenergic system kicks in and norepinephrine levels increase. At first, the increased adrenergic stimulation helps maintain cardiac output. Over time the adrenergic stimulation starts to work against the heart. Norepinephrine increases arterial pressure. Eventually the heart must contract more forcefully to overcome increased arterial pressure. The increased norepinephrine also stimulates production of renin in the kidney. Renin is important in the conversion of angiotensinogen to angiotensin I. And angiotensin I is converted by angiotensin-converting enzyme (ACE) to angiotensin II. Angiotensin II further increases arterial pressure and causes structural changes in the heart. The structural changes are known as “cardiac remodeling.” Ultimately, these effects put additional stress on the heart, increase cardiac cell death, and cause disease progression.12318

Many of the treatments used for heart failure target these processes…and ultimately slow the snowball effect. The goal of treatment is to slow the progression of the disease.

Commonly Used Conventional and Natural Medicines for Heart Failure*
Renin-Angiotensin-Aldosterone System (RAAS) Blockers
Angiotensin-Converting Enzyme (ACE) Inhibitors
Conventional Medicines
Benazepril (Lotensin)
Captopril (Capoten)
Enalapril (Vasotec)
Fosinopril (Monopril)
Lisinopril (Zestril / Prinivil)
Moexipril (Univasc)
Perindopril (Aceon)
Quinapril (Accupril)
Ramipril (Altace)
Trandolapril (Mavik)
Natural Medicines
Pomegranate (Punica granatum)
Angiotensin II Receptor Blockers (ARBs)
Conventional Medicines
Candesartan (Atacand)
Eprosartan (Teveten)
Irbesartan (Avapro)
Losartan (Cozaar)
Olmesartan (Benicar)
Telmisartan (Micardis)
Valsartan (Diovan)
Aldosterone Blockers
Conventional Medicines
Spironolactone (Aldactone)
Adrenergic System Blockers
Conventional Medicines
Atenolol (Tenormin)
Bisoprolol (Zebeta)
Carvedilol (Coreg)
Metoprolol (Toprol XL)
Propranolol (Inderal)
Conventional Medicines
Eplerenone (Inspra)
Furosemide (Lasix)
Hydrochlorothiazide (Microzide)
Spironolactone (Aldactone)
Natural Medicines
Corn silk (Zea mays)
Dandelion (Taraxacum officinale)
Stinging nettle (Urtica dioica)
Cardiac Positive Inotropes
Cardiac Glycosides
Conventional Medicines
Digoxin (Lanoxin)
Natural Medicines
Digitalis (Digitalis purpurea)
Hawthorn (Crataegus monogyna)
Oleander (Nerium oleander)
Pheasant’s eye (Adonis vernalis)
Squill (Urginea indica)
Star of Bethlehem (Ornithogalum umbellatum)
Natural Medicines
Terminalia (Terminalia arjuna)
Conventional Medicines
Hydralazine (Apresoline)
Hydralazine + Isosorbide dinitrate (BiDil)
Isosorbide dinitrate (Isordil)
Natural Medicines
Coenzyme Q-10
Thiamine (Vitamin B1)
*Note: Many natural products are tried for heart failure, but very few have reliable evidence that they work. Inclusion in this list does NOT imply that these products are effective for heart failure.

Only a few conventional treatments are actually proven to slow disease progression and improve survival. They fall into two categories: 1.) renin-angiotensin-aldosterone system (RAAS) blockers; and 2.) adrenergic system blockers.

To read more about heart failure guidelines see Pharmacist’s Letter / Prescriber’s Letter Detail-Document #180109.

Renin-Angiotensin-Aldosterone System (RAAS) Blockers return to top
The RAAS blockers include three classes of drugs:

  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Spironolactone and eplerenone (Inspra)

People used to think ACE inhibitors (e.g., Monopril, Vasotec, etc) worked because they cause vasodilation and decrease arterial pressure. We now know that ACE inhibitors do more. They block production of angiotensin II, and that helps prevent cardiac remodeling. Treatment with ACE inhibitors improves symptoms and can decrease death rate by up to 23%.12318

An angiotensin II receptor blocker (e.g., Atacand, Avapro, Cozaar, Diovan, etc) can be substituted for patients who can’t tolerate an ACE inhibitor. There’s growing evidence that these drugs also improve survival.12320

Spironolactone (Aldactone) is a potassium-sparing diuretic. It causes diuresis, but works in a unique way that also seems to interrupt one of the “snowball effects” of heart failure. Spironolactone blocks aldosterone. Aldosterone levels increase in patients with heart failure, which leads to fluid retention, fluid overload, and worsening of symptoms. Adding spironolactone to heart failure patients already on an ACE inhibitor and other diuretics can reduce symptoms and mortality by about 30%.12321

An alternative to spironolactone is the newer drug eplerenone (Inspra). It works like spironolactone, but is more selective for aldosterone receptors…and therefore causes fewer side effects.

To read more about eplerenone see Pharmacist’s Letter / Prescriber’s Letter Detail-Document #191104.

Practice Pearl
Watch for hyperkalemia in patients who get spironolactone or eplerenone…especially when they are combined with an ACE inhibitor, ARB, or another drug that increases potassium. Inappropriate monitoring of patients on spironolactone has been linked to increased hospitalizations and death due to hyperkalemia.12322

Several natural medicines are promoted and used for cardiovascular conditions such as heart failure. Some of these products affect the renin-angiotensin-aldosterone system.

L-arginine is one of the best known natural medicines used for cardiovascular disease. The most common explanation for its cardiovascular benefits has to do with L-arginine’s affect on nitric oxide. L-arginine is a substrate for the enzyme nitric oxide synthase (NOS). The enzyme converts L-arginine to nitric oxide. This leads to vasodilation, improved coronary endothelial function, and increased coronary blood flow.110,116,1362,1363,3330

In addition to increasing nitric oxide, there is some evidence that L-arginine decreases the activity of the angiotensin-converting enzyme (ACE).7820 Theoretically, this could have benefits in interrupting the snowball effect of congestive heart failure.

Despite these promising pharmacological effects, the clinical benefits of L-arginine are limited. When L-arginine is added to conventional treatment, heart failure patients seem to have improved kidney function and increase fluid elimination.3596 Some patients also have improved functional status, exercise tolerance, and quality of life, but these benefits have not been found consistently in clinical trials.3595,6028,7813,8014

L-arginine seems promising, but there’s not much known about it’s long-term benefits…or if L-arginine can improve ultimate outcomes. For now, don’t recommend it for most patients. But if patients decide to try it, don’t worry too much, L-arginine is usually safe for most patients. Advise patients who use L-arginine that high doses are usually needed… 6-20 grams per day. Explain that adding L-arginine might cause a decrease in blood pressure. This could lead to hypotension in some patients, especially if they are taking other antihypertensives.

Pomegranate (Punica granatum) doesn’t sound all that appetizing to many of us. But pomegranate juice is now becoming a popular healthy drink. Products like POM Wonderful are being promoted by the fact that pomegranate juice has lots of polyphenols that work as antioxidants. There are more of these healthy polyphenols in pomegranate juice than in green tea, orange juice, or red wine.

But the evidence for cardiovascular benefits in humans is still just ramping up. There is preliminary evidence that it can decrease angiotensin-converting enzyme (ACE) activity. Some evidence also suggests that drinking pomegranate juice 50 mL/day might help decrease blood pressure by about 5% in patients with hypertension.8310

Since pomegranate juice decreases ACE, there is potential for its use in heart failure. But so far this hasn’t been studied. If heart failure patients want to drink the juice, no problem. There’s no question that it’s a healthy drink. Just advise them not to rely on it for improved heart failure symptoms.

Question #1
ACE inhibitors
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Question #2
Which of the following drugs is L-arginine most likely to interact with? (HINT: click here to go to the L-arginine monograph; then scroll down to the Interactions with Drugs section)
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Green tea
Orange juice
Red wine

Adrenergic System Blockers return to top
The second category of drugs includes those that target the adrenergic system, beta-blockers.

Beta-blockers are now considered essential in heart failure. We used to think beta-blockers would worsen heart failure, so clinicians weren’t using them. Now there’s proof that at least some beta-blockers (Coreg, Toprol XL, Zebeta) can save lives. Beta-blockers block the adrenergic system that revs up in patients with heart failure and can often lead to serious arrhythmias. Adding a beta-blocker can reduce mortality by up to 34%.12318

Most patients should be started on an ACE inhibitor, even when they are asymptomatic. Beta-blockers should be added for improved prevention of disease progression and improved survival benefits.12319 But don’t add beta-blockers in “decompensated” patients…those with pulmonary edema, etc. Beta-blockers can initially worsen these symptoms.

Question #3
Which of the following primarily affects the renin-angiotensin-aldosterone system?

Diuretics return to top
A lot of patients with heart failure need a diuretic to reduce fluid retention…furosemide (Lasix), hydrochlorothiazide (Microzide), etc.

Some patients also turn to natural medicines to help with fluid retention. Several natural medicines are reported to have diuretic effects. Dandelion (Taraxacum officinale) is one of the most common herbal diuretics recommended for edema. Others include corn silk (Zea mays) and stinging nettle (Urtica dioica).

While tradition suggests that these herbs have diuretic properties, there is no reliable evidence that they reduce edema in patients with heart failure. Advise patients not to use them.

Thiamine and magnesium are sometimes recommended for heart failure patients who take conventional diuretics. That’s because diuretics can deplete levels of these nutrients.

Thiamine (vitamin B1) deficiency can worsen heart failure.1284,1285,1286,10507 This deficiency is most common in the elderly.10506 Elderly patients taking loop diuretics who continue to have symptoms despite adequate treatment might benefit from thiamine supplements.1284,1286,10508 Consider adding thiamine in these patients… 50-200 mg per day.

Magnesium deficiency is particularly concerning in heart failure patients who are also taking digoxin. Low magnesium levels can increase the risk of digoxin toxicity.9613,9614 Consider checking magnesium levels in elderly patients who have been taking diuretics chronically. Also, make sure magnesium levels are checked in heart failure patients who have had arrhythmias…low magnesium levels could be a contributing factor. Add a magnesium supplement for patients who are deficient… 20-130 mg daily.6430

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Corn silk
Stinging nettle
Question #4
Thiamine is sometimes recommended for heart failure patients because:

Cardiac Positive Inotropes return to top
Digoxin (Lanoxin) is a good example of a natural medicine that is no longer an “alternative medicine.” Digoxin is a cardiac glycoside derived from the Digitalis purpurea plant…also known as foxglove. Digoxin can increase intracellular calcium in cardiac cells. This increases contractility and cardiac output. Digoxin is typically added as symptoms progress, but it does not reduce mortality.

Practice Pearl
Help make sure patients who get digoxin get an appropriate dose. There is some concern that doses that are too high might INCREASE mortality in women. Usually doses of 0.125 mg/day are adequate. Serum levels should be maintained between 0.5-1.0 ng/mL.

To read more about gender difference related to digoxin see Pharmacist’s Letter / Prescriber’s Letter Detail-Document #181203.

Several other plants contain cardiac glycosides…oleander, pheasant’s eye, squill, star of Bethlehem and others. Anecdotally, they may help,15331,15332 but none of these have been studied in clinical trials…and none are appropriate for self-treatment of heart failure. Due to the lack of stringent manufacturing standards, these herbal products would likely contain an inconsistent amount of the active cardiac glycosides and produce inconsistent results. Fortunately, formulations of these plants are almost never found in supplements sold on store shelves.

Carnitine seems to have a positive inotropic effect, but it’s much different than the cardiac glycosides. Carnitine is an amino acid-like cofactor in skeletal muscles and the heart. It is involved in generating energy within the cells. Carnitine helps move long-chain fatty acids into mitochondria where they are converted to energy.

Patients with heart failure and other cardiovascular conditions seem to have decreased levels of this cofactor in heart tissue.1572 Some researchers think carnitine levels might be a disease marker for heart failure…lower levels usually indicate more severe heart failure.12323

The clinical evidence looks promising. Carnitine seems to improve symptoms, ejection fraction, and exercise tolerance. Carnitine seems to increase ejection fraction by up to 14% and exercise tolerance by as much as 21% in some patients.1575,1582,1583,3626 In some patients carnitine also seems to decrease cardiac remodeling.1575

There’s even some preliminary evidence that carnitine might slow the disease process and improve survival.3625

The body of evidence supporting carnitine is growing, but it’s still fairly preliminary. There’s not enough support to recommend it across the board. But it might be worth a try in patients who are not improving on standard therapy. Some clinicians are using 1.5-2 grams, usually divided and given 2-3 times daily. Two different formulations are being used…L-carnitine and propionyl-L-carnitine. Both have been used in studies, but there’s some speculation that propionyl-L-carnitine might deliver carnitine to the cells more efficiently.1439

Tell patients who take carnitine that it might take 2 weeks to a month for significant symptom improvement. Maximum improvement can take up to 6 months.

Creatine is a very popular sports supplement. Athletes often use it to bulk up or improve athletic performance. Now some people are using it in patients with heart failure…to improve exercise tolerance. There’s some evidence that it can help improve strength and endurance in heart failure patients.4562,4563

But there are safety concerns with creatine and some unanswered questions. Creatine is probably not a good choice for patients with heart failure. Taking creatine requires drinking extra fluids to prevent dehydration and cramping. Fluid overload is a problem with heart failure patients. So increasing fluid intake is usually avoided. Also, people with heart failure are prone to renal disease. There is some concern that creatine might contribute to worsening renal function.184,2118 Advise heart failure patients to avoid creatine.

Hawthorn (Crataegus monogyna) is an herb with a long history of use in Europe. Many clinicians in Europe consider hawthorn a preferred alternative to digoxin. Hawthorn seems to have many of the same benefits as digoxin. It increases cardiac output and exercise tolerance and reduces symptoms. Specific extracts of hawthorn (Crataegutt and Faros 300) seem to be helpful in the early stages of heart failure.8279,8280,10144,11449 But it might not offer much benefit in patients with more severe disease.

Hawthorn contains constituents that increase heart contraction and coronary blood flow, and cause vasodilation.406,10144,11450 Some people claim that hawthorn is actually better than digoxin. They say it’s less likely to induce arrhythmias, safer in renal dysfunction, and better tolerated overall. But there’s no solid evidence this is true.

You can think of hawthorn as a “milder digoxin.” It’s not appropriate for self-treatment. If you consider using it for your patients, hawthorn should only be considered early on in the disease, when symptoms aren’t too severe and BEFORE patients require digoxin. There’s no benefit to adding it in patients already taking digoxin. Doses of hawthorn extract are typically 200-500 mg three times daily. Keep in mind that it can take 6-8 weeks before there is maximal benefit. Tell patients that as symptoms get worse, they’ll eventually need to be switched to digoxin.

You might see patients trying another herb for heart failure…terminalia (Terminalia arjuna), also known as arjuna. There is some evidence it can improve heart function and decrease symptoms.2504 Some researchers think it might increase heart rate and cardiac output. Terminalia looks promising, but don’t recommend it yet. More evidence is needed about long-term safety and effectiveness.


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Pheasant’s eye
Star Of Bethlehem
Question #5
Which of the following is most similar to digoxin?
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Question #6
Which of the following is TRUE regarding carnitine?
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Question #7
Which of the following is TRUE about creatine?
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Vasodilators return to top
The vasodilators hydralazine (Apresoline) and isosorbide dinitrate (Isordil) were commonly used for heart failure many years ago…before we started using ACE inhibitors and beta-blockers. Now they are making a comeback…especially for African Americans. There are concerns that ACE inhibitors and beta-blockers don’t work as well for blacks as for whites. Black patients with moderate to severe heart failure, who get hydralazine plus isosorbide dinitrate (BiDil) along with standard treatment, seem to have improved survival.

To read more about using hydralazine plus isosorbide dinitrate for heart failure see Pharmacist’s Letter / Prescriber’s Letter Detail-Document #210105.

Question #8
A heart failure patient who is taking digoxin wants to use hawthorn. What should you tell him?

Miscellaneous return to top
Coenzyme Q-10 is one of the most talked about supplements used for heart failure and many other conditions. The theory about how it works makes some sense. Coenzyme Q-10 is a vitamin-like cofactor found mostly in cellular structures called mitochondria. Coenzyme Q-10 has an important role in the biochemical process that results in production of adenosine triphosphate (ATP). ATP is used by cells as a fuel to produce energy. Inhibition of ATP production can cause cell death and tissue damage. Coenzyme Q-10 levels are low in some patients with heart failure. Researchers think that replacing coenzyme Q-10 might improve cellular energy production and prevent cell death in people with heart failure. Coenzyme Q-10 also has antioxidant effects and can prevent oxidative damage.12321

There is a lot of controversy about the effectiveness of coenzyme Q-10. Many cardiologists are skeptical. The reason is that some research findings are inconsistent. Early clinical studies are mostly positive. But recent studies are more negative. Most studies show that coenzyme Q-10 does NOT improve ejection fraction or exercise tolerance.5090,6037,6038

But coenzyme Q-10 does seem to consistently improve SYMPTOMS…dyspnea, edema, etc. There’s even some evidence that coenzyme Q-10 can improve quality of life and reduce hospital admission rates.6407,6408,6409,8909,12170

There isn’t enough strong evidence to recommend coenzyme Q-10 for all heart failure patients. But coenzyme Q-10 might be worth a try in some patients with heart failure, especially those with persistent symptoms. Consider adding it in patients who still have symptoms despite adequate treatment with conventional meds. Most clinicians use 100-200 mg, divided, and given 2-3 times daily.

Practice Pearl
Be careful in patients taking warfarin (Coumadin). Coenzyme Q-10 is chemically similar to vitamin K and might decrease the effectiveness of warfarin.2128,6048,6199

There’s a good chance patients will ask about taurine. Taurine is an amino acid that is actually increased in the left ventricle of heart failure patients.9900 Researchers are finding that giving taurine supplements can help some patients. Taurine can improve cardiac output and decrease symptoms of heart failure when used for up to a year.5248,5271,5306,8221

Researchers are still trying to figure out exactly how taurine works. But it seems to help regulate calcium movement in cardiac muscle cells. There is also evidence that it might have antioxidant effects, lower adrenergic stimulation, and decrease blood pressure.3467,8219,8221,8222 Each of these effects could help heart failure patients.

Most studies have been small and preliminary. As more evidence develops, taurine may become an important option for heart failure patients. But for now, there isn’t enough evidence to recommend it.

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Coenzyme Q-10
Question #9
Which of the following is most appropriate for a heart failure patient who continues to have symptoms despite adequate treatment with conventional medicines?
Question #10
Which of the following has preliminary evidence suggesting that it might improve survival in patients with heart failure?
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The Bottom Line return to top
The thought of using natural medicines for heart failure makes some clinicians cringe. Heart failure is a serious condition. It requires serious, proven therapies.

It’s true; natural medicines are NOT appropriate as primary treatment of heart failure. But some natural medicines may end up with a place in therapy…as adjunctive treatments.

There are a surprising number of beneficial natural medicines for heart failure. Several could be worth considering as add-on therapy in select patients…coenzyme Q-10, carnitine, and L-arginine.

There is growing evidence that some natural medicines may have a real role in therapy. But they are no substitute for standard treatments. Make sure patients are not attempting to self-treat heart failure. Ensure they are getting treatments proven to improve survival…ACE inhibitors, beta-blockers, etc. Patients adding on natural meds as adjunctive treatment should be monitored closely for signs of improvement or deterioration. These patients should also be watched for potential interactions.

Recommendation Chart for Natural Medicines Used for Heart Failure *
Safety/Effective Likely
(for deficiency)
(for deficiency)
Coenzyme Q-10
(but not advised in CHF)
Corn silk
Stinging nettle
Pheasant’s eye
Star Of Bethlehem
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* These proposed recommendations are based solely on the Safety and Effectiveness Ratings contained in Natural Medicines Comprehensive Database. This assumes use of high-quality, uncontaminated products and the use of typical doses. Keep in mind that some products are never appropriate for some patients due to concomitant disease states, potential drug interactions, or other clinical factors. Use your clinical judgment before recommending any product.
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Multi-Drug Resistant TB on the Rise in Australia

MELBOURNE – Showing that the incidences of multi-drug resistant tuberculosis (MDR-TB) are on the rise, a report has stressed the need for an overhaul of Australia’s TB strategy.

Based on a review of Victorian Health Department data, the report points out that 31 persons were diagnosed with MDR-TB, a mutant strain that is resistant to two of the most effective antibiotics used to treat TB, from 1998 to 2007.

It further reveals that most of the cases occurred in the final few years of the 10-year review window, with seven recorded in each of 2004, 2006 and 2007.

“Our study revealed that there was a clear increase in the number of patients diagnosed with MDR-TB,” the Australian quoted Caroline Lavender, a scientist at the Victorian Infectious Diseases Reference Laboratory, as writing.

“New data available since the completion of our study reveal that the increase … appears to have been sustained in 2008,”

According to the review, the cases of MDR-TB have risen five-fold as a proportion of all TB notifications in Victoria.

In a paper published in the Medical Journal of Australia, Lavender says that the upward trend has “significant implications for public health policy and planning”.

MDR-TB is the result of improper use of these antibiotics during treatment of patients with ordinary TB.

People with the resistant strain must be put on alternate, and less effective, TB-fighting drugs that require specialist nurses and a longer hospital stay, treatment in a negative-pressure rooms and more lab tests.

About 29 out of 31 MDR-TB patients were born overseas, with almost two thirds coming from India, Vietnam or China.

Lavender says that new TB control strategies are needed, and the use of molecular tests should be increased for the rapid detection of drug resistance.

“Another measure that might prove useful is providing information to people at high risk of TB on arrival to Australia, so they know to seek medical attention early should they develop a persistent cough or other symptoms suggesting of TB,” she said.

New Radioactive Imaging Agent may Revolutionize Skin Cancer Diagnosis

SYDNEY – An Australian Government funded research group has developed a potential new material that can make early diagnosis of malignant melanoma, the most serious form of skin cancer possible.

Writing about their work in the ACS’ Journal of the Medicinal Chemistry, the Cooperative Research Consortium for Biomedical Imaging Develop has revealed that the novel material is currently being tested in laboratory animals.

Ivan Greguric, a group member, notes that about 130,000 new cases of malignant melanoma occur each year worldwide.

Although patients do best with early diagnosis and prompt treatment, according to the researcher, the positron emission tomography (PET) scans sometimes used for diagnosis sometimes miss small cancers, delaying diagnosis and treatment.

While searching for better ways of diagnosis, the researchers identified a new group of radioactive imaging agents, known as fluoronicotinamides.

Testing it on laboratory mice that had melanoma, the researchers observed that the novel substance revealed skin cancer cells with greater accuracy than imaging agents currently in use.

Consequently, note the researchers, this substance may become a “superior” PET imaging agent for improving the diagnosis and monitoring the effectiveness of treatment of melanoma.

They have revealed that clinical trials with this new agent are scheduled for 2010.

Communicating With Nature Makes You More Caring

ROCHESTER – Paying attention to Mother Nature not only feels good, it also makes you a better person, says a new study.

The study has been published in the Personality and Social Psychology Bulletin.

“Stopping to experience our natural surroundings can have social as well as personal benefits,” says Richard Ryan, coauthor and professor of psychology, psychiatry and education at the University of Rochester.

While the salubrious effects of nature are well documented, from increasing happiness and physical health to lowering stress, this study shows that the benefits extend to a person’s values and actions.

Exposure to natural as opposed to man-made environments leads people to value community and close relationships and to be more generous with money, find Ryan and his team of researchers at the University of Rochester.

The paper includes four experiments in which 370 participants were exposed to either natural or man-made settings. Participants were encouraged to attend to their environments by noticing colors and textures and imagining sounds and smells.

In three of the studies, participants were shown a selection of four images on a 19 inch computer screen for two minutes each. Half of the subject viewed buildings, roads, and other cityscapes; the other half observed landscapes, lakes, and deserts. The urban and nature images were matched for color, complexity, layout, and lighting.

In a fourth study, participants were simply assigned at random to work in a lab with or without plants.

Participants then answered a questionnaire assessing the importance of four life aspirations: wealth and fame (”to be financially successful” and “to be admired by many people”) and connectedness and community (”to have deep enduring relationships” and “to work toward the betterment of society”).

Across all four studies, people exposed to natural elements rated close relationships and community higher than they had previously. The questionnaire also measured how immersed viewers were in their environments and found that the more deeply engaged subjects were with natural settings, the more they valued community and closeness. By contrast, the more intensely participants focused on artificial elements, the higher they rated wealth and fame.

To test generosity, two of the studies gave participants a 5-dollar prize with the instructions that the money could be kept or given to a second anonymous participant, who would then be given an additional 5-dollar. The second participant could choose to return the prize money or keep it. Thus, subjects had nothing to gain if they chose to trust the other participant, and risked losing their money.

The result revealed people who were in contact with nature were more willing to open their wallets and share. As with aspirations, the higher the immersion in nature, the more likely subjects were to be generous with their winnings.

Lead author Netta Weinstein says that the findings highlight the importance of creating green spaces in cities and have implication for planners and architects.

HIV Outwits Yet Another Microbicide

LONDON – The largest study ever conducted of a microbicide designed to prevent HIV infection has resulted in yet another case of high hopes being dashed about a promising product. Earlier in the year, a smaller study of the same vaginal gel gave a hint that it might offer modest protection, but the new results put the question to rest. “It doesn’t work,” says clinical epidemiologist Sheena McCormack, who ran the four-country study for the Clinical Trials Unit of the U.K.’s Medical Research Council.

McCormack says the data mark the end of the road not just for this vaginal gel but the whole class of microbicides that use nonspecific compounds to prevent HIV-infection. The placebo-controlled trial in nearly 9500 women tested a gel called PRO 2000, a so-called polyanion that prevented the AIDS virus from entering human cells in test-tube and monkey studies. The 4-year, $44 million study at six sites in sub-Saharan Africa found no difference between the equally sized treatment and placebo arms of the study: There were 130 HIV infections in the women who used PRO 2000 and 123 in those who used a dummy gel.

Researchers in the beleaguered HIV-prevention field often see glimmers of hope even in dispiriting results from clinical trials–witness the recently completed AIDS vaccine study in Thailand. But that is not the case with these findings. “When I first looked at the data with the statistician I said, ‘You’re not going to need any more analysis, are you?’ ” said McCormack, who is based in London. “It’s really clear-cut.”

In February, a similar study of PRO 2000 that only involved about one-third as many women found 30% fewer HIV infections in the treated group , but with a p-value of 0.10–a positive trend that did not reach statistical significance. That $90 million study, financed by the U.S. National Institutes of Health (NIH), startled many in the field who, based on other failures of nonspecific microbicides, had predicted the product would do nothing. But McCormack notes that the new results actually are consistent with the data from the earlier trial, which had a wide confidence interval and included the possibility that the product did not work.

McCormack says there’s one upside of the failure: It informs future clinical trials. Because the findings clearly show that the positive test-tube and monkey studies of PRO 2000 were misleading, researchers now know to use more stringent requirements to deem a product worthy of human trials.

How To Relieve Pain Without Medicine

For some people, pain can be relieved without using medicine. They use relaxation, imagery, distraction, and skin stimulation. You may need the help of health professionals to learn to do these for yourself. Friends or family members can help with some of them. The techniques are also useful along with pain medicines. Information about nondrug treatments for pain also may be available at a local hospice, cancer treatment center, or hospital pain clinic.

How Does Relaxation Work?

Relaxation relieves pain or keeps it from getting worse by reducing tension in the muscles. It can help you fall asleep, give you more energy, make you less tired, reduce your anxiety, and make other pain relief methods work better. Some people, for instance, find that taking a pain medicine or using a cold or hot pack works faster and better when they relax at the same time.

Are There Any Basic Guidelines for Using Relaxation Techniques?

    * Understand that your ability to relax may vary from time to time and that relaxation cannot be forced.

    * Remember that it may take up to 2 weeks of practice to feel the first results of relaxation.

    * Try several relaxation methods until you find one that works for you.

    * Stick with the same method so that it becomes easy and routine for you. Use it regularly for at least 5 to 10 minutes twice a day.

    * Check for tension throughout the day by noticing tightness in each part of your body from head to foot. Relax any tense muscles. You may use a quick technique such as inhale/tense, exhale/relax, described below.

    * If you have any lung problems, check with your doctor before using any relaxation technique that requires deep breathing.

Is There Any Special Position I Should Be in When I Am Doing Relaxation Exercises?

Relaxation may be done sitting up or lying down. Choose a quiet place whenever possible. Close your eyes. Do not cross your arms and legs because that may cut off circulation and cause numbness or tingling. If you are lying down, be sure you are comfortable. Put a small pillow under your neck and under your knees or use a low stool to support your lower legs.

How Do I Use Relaxation?

There are many methods. Here are some for you to try:

Visual concentration and rhythmic massage:

    * Open your eyes and stare at an object, or close your eyes and think of a peaceful, calm scene. With the palm of your hand, massage near the area of pain in a circular, firm manner. Avoid red, raw, swollen, or tender areas. You may wish to ask a family member or friend to do this for you.

Inhale/tense, exhale/relax:

    * Breathe in (inhale) deeply. At the same time, tense your muscles or a group of muscles. For example, you can squeeze your eyes shut, frown, clench your teeth, make a fist, stiffen your arms and legs, or draw up your arms and legs as tightly as you can.

    * Hold your breath and keep your muscles tense for a second or two.

    * Let go! Breathe out (exhale) and let your body go limp.

Slow rhythmic breathing:

    * Stare at an object or close your eyes and concentrate on your breathing or on a peaceful scene.

    * Take a slow, deep breath and, as you breathe in, tense your muscles (such as your arms).

    * As you breathe out, relax your muscles and feel the tension draining.

    * Now remain relaxed and begin breathing slowly and comfortably, concentrating on your breathing, taking about 9 to 12 breaths a minute. Do not breathe too deeply.

    * To maintain a slow, even rhythm as you breathe out, you can say silently to yourself, “In, one, two; out, one, two.” It may be helpful at first if someone counts out loud for you. If you ever feel out of breath, take a deep breath and then continue the slow breathing exercise. Each time you breathe out, feel yourself relaxing and going limp. If some muscles are not relaxed such as your shoulders, tense them as you breathe in and relax them as you breathe out. You need to do this only once or twice for each specific muscle group.

    * Continue slow, rhythmic breathing for a few seconds up to 10 minutes, depending on your need.

    * To end your slow rhythmic breathing, count silently and slowly from one to three. Open your eyes. Say silently to yourself: “I feel alert and relaxed.” Begin moving about slowly.

Other methods you can add to slow rhythmic breathing:

    * Imagery.

    * Listen to slow, familiar music through an earphone or headset.

    * Progressive relaxation of body parts. Once you are breathing slowly and comfortably, you may relax different body parts, starting with your feet and working up to your head. Think of words such as limp, heavy, light, warm, or floating. Each time you breathe out, you can focus on a particular area of the body and feel it relaxing. Try to imagine that the tension is draining from that area. For example, as you breathe out, feel your feet and ankles relaxing; the next time you breathe out, feel your calves and knees relaxing, and so on up your body.

Relaxation tapes:  We recommend Barry Eisen’s C/D’s (  These recordings provide step-by-step instructions in relaxation techniques.

Will I Have Any Problems With Using Relaxation Techniques

Some people who have used relaxation for pain relief have reported the following problems and solutions to them:

    * Relaxation may be difficult to use with severe pain. If you have this problem, use a quick and easy relaxation method such as visual concentration with rhythmic massage or breathe in/tense, breathe out/relax.

    * You may have a feeling of “suffocation.” If so, take a deep breath.

    * Sometimes breathing too deeply for a while can cause shortness of breath. If this is your problem, take shallow breaths and/or breathe more slowly.

    * You may fall asleep. If you do not wish to fall asleep, sit in a hard chair while doing the relaxation exercise or set a timer or alarm.

    * You might get feelings of depression or withdrawal. Sometimes being relaxed makes you aware of problems you have been worrying about subconsciously. If this happens, talk to someone who can help you sort out your feelings.

If you have trouble using these methods, ask your doctor or nurse to refer you to a therapist who is experienced in relaxation techniques. Do not continue any relaxation technique that increases your pain, makes you feel uneasy, or causes any unpleasant effects.

What Is Biofeedback?

With the help of special machines, people can learn to control certain body functions such as heart rate, blood pressure, and muscle tension. Biofeedback is sometimes used to help people learn to relax. Cancer patients can use biofeedback techniques to reduce anxiety and help them cope with their pain. Biofeedback usually is used with other pain-relief methods.

What Is Imagery, and How Does It Work?

Imagery is using your imagination to create mental pictures or situations. The way imagery relieves pain is not completely understood. Imagery can be thought of as a deliberate daydream that uses all of your senses – sight, touch, hearing, smell, and taste. Some people believe that imagery is a form of self-hypnosis. Certain images may reduce your pain both during imagery and for hours afterward. If you must stay in bed or can’t go out of the house, you may find that imagery helps reduce the closed-in feeling; you can imagine and revisit favorite spots in your mind. Imagery can help you relax, relieve boredom, decrease anxiety, and help you sleep.

How Do I Use the Technique of Imagery?

Usually, imagery for pain relief is done with the eyes closed. A relaxation technique may be used first. The image can be something such as a ball of healing energy or a picture drawn in your mind of yourself as a person without pain (for example, imagine that you are cutting wires that transmit pain signals from each part of your body to your brain). Here is an exercise with the first image – the ball of energy. It is a variation of the technique credited to Dr. David Bresler at the Pain Control Unit, University of California, Los Angeles (UCLA).

    * Close your eyes. Breathe slowly and feel yourself relax.

    * Concentrate on your breathing. Breathe slowly and comfortably from your abdomen.

    * As you breathe in, say silently and slowly to yourself:

      “In, one, two.” As you breathe out, say: “Out, one, two.” Breathe in this slow rhythm for a few minutes.

    * Imagine a ball of healing energy forming in your lungs or on your chest. It may be like a white light. It can be vague. It does not have to be vivid. Imagine this ball forming, taking shape.

    * When you are ready, imagine that the air you breathe in blows this healing ball of energy to the area of your pain. Once there, the ball heals and relaxes you.

    * When you breathe out, imagine the air blows the ball away from your body. As it goes, the ball takes your pain with it. (Be careful: Do not blow as you breathe out; breathe out naturally.)

    * Repeat the last two steps each time you breathe in and out.

    * You may imagine that the ball gets bigger and bigger as it takes more and more discomfort away from your body.

    * To end the imagery, count slowly to three, breathe in deeply, open your eyes, and say silently to yourself: “I feel alert and relaxed.” Begin moving about slowly.

Are There Any Problems With Using Imagery?

The problems are similar to the ones that may occur with relaxation techniques.

What Is Distraction, and How Does It Work?

Distraction means turning your attention to something other than the pain. Many people use this method without realizing it when they watch television or listen to the radio to “take their minds off” the pain. Distraction may work better than medicine if pain is sudden and intense or if it is brief, lasting only 5 to 45 minutes. Distraction is useful when you are waiting for pain medicine to start working. If pain is mild, you may be able to distract yourself for hours. Some people think that a person who can be distracted from pain does not have severe pain. This is not necessarily true. Distraction can be a powerful way of temporarily relieving even the most intense pain.

How Can I Use Distraction?

Any activity that occupies your attention can be used for distraction. If you enjoy working with your hands, crafts such as needlework, model building, or painting may be useful. Losing yourself in a good book might divert your mind from the pain. Going to a movie or watching television are also good distraction methods. Slow, rhythmic breathing can be used for distraction as well as relaxation. You may find it helpful to listen to rather fast music through a headset or earphones. To help keep your attention on the music, tap out the rhythm. You can adjust the volume to match the intensity of pain, making it louder for very severe pain. This technique does not require much energy, so it may be very useful when you are tired.

Are There Any Drawbacks To Using Distraction for Pain Relief?

After using a distraction technique, some people report that they are tired, irritable, and feel more pain. Some also find that other people do not believe they are in pain if distraction provides pain relief. If these are problems for you, you may not wish to use distraction or you may simply be careful about which distraction methods you use and when you use them.

What Is Skin Stimulation, and How Does It Work To Relieve Pain?

Skin stimulation is the use of pressure, friction, temperature change, or chemical substances to excite the nerve endings in the skin. Scientists believe that the same nerve pathways transmit the sensations of pain, heat, cold, and pressure to the brain. When the skin is stimulated so that pressure, warmth, or cold is felt, pain sensation is lessened or blocked. Skin stimulation also alters the flow of blood to the affected area. Sometimes skin stimulation will get rid of the pain, or the pain will be less during the stimulation and for hours after it is finished. Note: If you are having radiation therapy, check with your doctor or nurse before using skin stimulation. You should not apply ointments, salves, or liniments to the treatment area, and you should not use heat or extreme cold on treated areas.

Where Is Skin Stimulation Done?

Skin stimulation is done either on or near the area of pain. You also can use skin stimulation on the side of the body opposite to the pain. For example, you might stimulate the left knee to decrease pain in the right knee. Stimulating the skin in areas away from the pain can be used to increase relaxation and may relieve pain.

What Is Used To Stimulate the Skin?

Massage, pressure, vibration, heat, cold, and menthol preparations are used for skin stimulation.

How Do I Use Massage for Pain Relief?

For pain relief, massage is most effective when using slow, steady, circular motions. You can massage over or near the area of pain with just your bare hand or with any substance that feels good such as talcum powder, warm oil, or hand lotion. Depending upon where your pain is located, you may do it yourself or ask a family member or friend to give you a massage. Remember, having someone give you a foot rub, back rub, or hand rub can be very relaxing and may relieve pain. Some people find brushing or stroking lightly more comforting than deep massage. Use whatever works best for you. Note: If you are having radiation therapy, avoid massage in the treatment area.

How Do I Use Pressure?

Pressure can be applied with the entire hand, the heel of the hand, the fingertip or the knuckle, the ball of the thumb, or by using one or both hands to encircle your arm or leg. You can experiment by applying pressure for about 10 seconds to various areas over or near your pain to see if it helps. You can also feel around your pain and outward to see if you can find “trigger points,” small areas under the skin that are especially sensitive or that trigger pain. Pressure is usually most effective if it is applied as firmly as possible without causing pain. You can use pressure for up to about 1 minute. This often will relieve pain for several minutes to several hours after the pressure is released.

How Do I Use Vibration?

Vibration over or near the area of pain may bring temporary relief. For example, the scalp attachment of a handheld vibrator often relieves a headache. For low back pain, a long, slender battery operated vibrator placed at the small of the back may be helpful. You may use a vibrating device such as a small battery operated vibrator, a handheld electric vibrator, a large heat-massage electric pad, or a bed vibrator.

Which Is Better for Relieving Pain – Cold Or Heat?

As for any of the techniques described, you should use what works best for you. Heat often relieves sore muscles; cold lessens pain sensations by numbing the affected area. Many people with prolonged pain use only heat and have never given cold a try. Some people find that cold relieves pain faster, and relief may last longer.

What Are Some Comfortable and Convenient Ways To Use Cold or Heat?

For cold, try gel packs that are sealed in plastic and remain soft and flexible even at freezing temperatures. Gel packs are available at drugstores and medical supply stores. They are reusable and can be kept in the freezer when not in use. Wrap the pack with a layer of towels so that it is comfortable for you. An ice pack or ice cubes wrapped in a towel can be just as effective. To use heat for pain relief, a heating pad that generates its own moisture (Hydrocolater) is convenient. Gel packs heated in hot water, hot water bottles, a hot, moist towel, a regular heating pad, or a hot bath or shower can also be used to apply heat. For aching joints such as elbows and knees, you can wrap the joint in lightweight plastic wrap (tape the plastic to itself). This retains body heat and moisture. Note: Do not use heat or cold over any area receiving radiation therapy.

What Are Menthol Preparations?

Many menthol preparations are available for pain relief. There are creams, lotions, liniments, or gels that contain menthol. Brands include Ben Gay, Icy Hot, Mineral Ice, and Heet. When they are rubbed into the skin, they increase blood circulation to the affected area and produce a warm (sometimes cool) soothing feeling that lasts for several hours.

How Do I Use Menthol Preparations?

First, test your skin by rubbing a small amount of the menthol preparation in a circle about 1 inch in diameter in the area of pain (or the area to be stimulated). This will let you know whether the menthol is uncomfortable to you or irritates your skin. If the menthol does not create a problem, rub some more into the area. The sensation caused by the menthol gradually increases and remains up to several hours. To increase the intensity and duration of the menthol sensation you can open your skin pores with heat (e.g., shower, sun) or wrap a plastic sheet over the area after the menthol application. (Don’t use a heating pad because it may cause a burn.) If you’re afraid others will find the odor offensive, you can use the menthol product when you are alone, or perhaps in the evening or through the night. Note: Many menthol preparations contain an ingredient similar to aspirin. A small amount of this aspirin-like substance is absorbed through the skin. If you have been told not to take aspirin, do not use these preparations until you check with your doctor.

What Precautions Should I Take if I Use Skin Stimulation?

Heat and cold can easily damage your skin. It is easy to burn the skin with hot water from the tap or with settings too high on the heating pad. Extreme cold can also burn your skin.

    * Never use a heating pad on bare skin.

    * Never go to sleep for the night with the heating pad on.

    * Be very careful while using a heating pad if you are taking drugs or medicines that make you sleepy or if you do not have much feeling in the area.

    * Limit heat or cold application to 5 to 10 minutes.

    * Do not use heat or cold over any area where your circulation or sensation is poor.

    * If you start to shiver when using cold, stop using it right away.

    * Do not use cold so intense or for so long that the cold itself causes pain.

    * Do not use heat over a new injury because heat can increase bleeding. Wait at least 24 hours.

    * Do not rub menthol preparations over broken skin, a skin rash, or mucous membranes (such as inside your mouth or around your rectum). Make sure you do not get the menthol in your eyes.

    * Avoid massage and vibration over red, raw, tender, or swollen areas.

    * If skin stimulation increases your pain, stop using it.

    * As noted earlier, if you are undergoing (or have undergone) radiation treatments, do not use any skin stimulation method without first checking with your doctor or nurse.

Introducing – Bilberry

Bilberry fruit is a close relative to the American blueberry. It’s a common ingredient in pies, cakes and jams. The active constituents are thought to be antioxidants called anthocyanins.

Why Do People Use Bilberry

Bilberry is primarily used for eye conditions and to strengthen blood vessels. During World War II, British Royal Air Force pilots reportedly found that eating bilberry jam just before a mission improved their night vision which prompted researchers to investigate bilberry’s properties.

Bilberry is also used for glaucoma, macular degeneration, diabetic retinopathy and cataracts.

The anthocyanins in bilberry may strengthen the walls of blood vessels, reduce inflammation and stabilize tissues containing collagen, such as cartilage, tendons and ligaments. Grape seed contains similar substances, however, bilberry’s anthocyanins are thought to have particular benefits for the eye.

Because bilberry is thought to strengthen blood vessels, it’s sometimes taken orally for varicose veins and hemorrhoids.