CHAPTER 4: Common Medical Conditions and Medications

Contents

CHAPTER 4: Common Medical Conditions and Medications

This section describes basic ways to manage common life-long (chronic) conditions and avoid problems with medications.

The common chronic conditions and what many thousands of people like you have said about their management is described in the following Tables. The important message in all the Tables is that how confident you are in managing and controlling a chronic condition makes a big difference. Your confidence depends on how well you and your doctors or nurses have worked together and how much you get involved in your care.

The first Table shows how people with high blood pressure, heart disease or stroke, diabetes, arthritis, or breathing diseases (asthma, emphysema or bronchitis) answered in general about their health and health care. (The information in this and all the following Tables is from many many thousands of persons who used HowsYourHealth).

	The Number Who Agreed To The Question Of Every 100 People Who Answered
Questions People Like You Were Asked About Any Chronic Condition (High Blood Pressure, Heart Disease or "Hard Arteries", Diabetes, Arthritis, or Breathing Problems Problems)	If They Are NOT Confident About Controlling and Managing Their Health Problems	If They Are Confident About Controlling and Managing Their Health Problems
Did you receive very good Information about your problems from your doctor or nurse?	60 of 100 Agreed (60%)	80 of 100 Agreed (80%)
Doctors or nurses helped you live with the conditions?	40 of 100 Agreed (40%)	60 of 100 Agreed (60%)
Do you think that pills for the condition might be making you sick?	25 of 100 Agreed (25%)	10 of 100 Agreed (10%)
Have you been in a hospital or visited an emergency room because of these conditions?	15 of 100 Agreed (15%)	5 of 100 Agreed (5%)
Was this hospital or emergency room use NECESSARY?	65 of 100 Agreed (65%)	80 of 100 Agreed (80%)

Common Conditions: Hypertension (High Blood Pressure)

This Table shows the answers of people with High Blood Pressure who used HowsYourHealth.

	The Number Who Agreed To The Question Of Every 100 People Who Answered
Questions People Like You Were Asked About Their High Blood Pressure	If They Are NOT Confident About Controlling and Managing Their Blood Pressure	If They Are Confident About Controlling and Managing Their Blood Pressure
Did your doctor or nurse give you good information about what to do if you miss a dose of your medicine?	50 of 100 Agreed (50%)	65 of 100 Agreed (65%)
Did your doctor or nurse give you good information about the effect of salt and your weight on the blood pressure?	55 of 100 Agreed (55%)	70 of 100 Agreed (70%)
Did your doctor or nurse give you good information about the problems the medicines might cause?	40 of 100 Agreed (40%)	60 of 100 Agreed (60%)
Are you checking your own blood pressure?	55 of 100 Agreed (55%)	60 of 100 Agreed (60%)
Was the last blood pressure high?	10 of 100 Agreed	5 of 100 Agreed

Hypertension is not the same as feeling anxious or "high strung". Hypertension in adults means that three measurements of blood pressure in the arm average more than 140/90. (The first number--systolic pressure--is caused when the heart pumps; the second number--diastolic pressure--is the pressure when the heart is relaxed).

High blood pressure is very common. High blood pressure is made worse by eating too much salt, being overweight, or drinking too much alcohol (more than two cans of beer, two glasses of wine, or two mixed drinks in a day). Smokers with high blood pressure are at the greatest risk for heart disease and hardening of the arteries which is caused by hypertension.

What should you do? First, remember that Hypertension can cause serious heart and kidney disease, as well as stroke. Even slightly elevated blood pressure (130-139/ 85-89) is a risk. So try very hard to change your lifestyle, regularly take prescribed medicines, and check your blood pressure frequently. Second, help your doctor find the treatment that is best for you. Bring to the office blood pressure measurements you have taken at home or in other community settings and tell your doctor about any problems you may be having with the medications.

You can lower your systolic blood pressure by an average of ten points just by changing the way you eat. If you are overweight and regularly exercise and change your diet (to reduce your weight even a little), you can CUT BY ONE-HALF YOUR CHANCE FOR HAVING HIGH BLOOD PRESSURE! Also possibly helpful: reduce salt (sodium) in your diet and eat a diet high in vegetables, low in red meat, saturated fats and low in sugar. When selecting dairy products choose low fat alternatives such as skim, 1%, or 2% milk, and non-fat cream cheese, sour cream and yoghurt.

Medications will generally be prescribed for patients whose blood pressure remains high despite changes in diet if:

your blood pressure remains more than 150/90.
you are black or African-American.
you have diabetes or "hardening of the arteries."
you continue to smoke.
you are in your sixties or older, because blood pressure treatment will have even more benefit than in younger persons.

In some people, certain medications for hypertension can cause tiredness, dizziness when standing up, feelings of depression, being less alert, or decreased interest in sex. ONCE IN A WHILE YOU SHOULD HAVE YOUR BLOOD PRESSURE TAKEN WHILE YOU ARE STANDING TO MAKE SURE IT IS NOT TOO LOW; A LOW STANDING SYSTOLIC BLOOD PRESSURE (LESS THAN 110) INCREASES YOUR RISK OF FAINTING. Health care providers work with you to find the most affordable medicine that controls your blood pressure and causes the least problems for you.

The most effective and least expensive medication to treat hypertension will contain thiazide or a thiazide-like diuretic. It is important to remember that many of the older drug treatments are lower in cost and just as effective as many of the newer drugs.

Heart Disease and Hardening of the Arteries

This Table shows the answers of people with Heart Disease and Hardening of the Arteries who used HowsYourHealth.

	The Number Who Agreed To The Question Of Every 100 People Who Answered
Questions People Like You Were Asked About Heart or Hard Artery Problems	If They Are NOT Confident About Controlling and Managing Their Heart/Artery Problem	If They Are Confident About Controlling and Managing Their Heart/Artery Problem
If you have congestive heart failure did your doctor or nurse give your good information about the effect of weight and salt on your heart failure?	50 of 100 Agreed (50%)	85 of 100 Agreed (85%)
If you have congestive heart failure did your doctor or nurse give your good information about how to adjust your medication for your weight, shortness of breath or leg swelling?	35 of 100 Agreed (35%)	75 of 100 Agreed (75%)
If you had a heart attack are you are your taking a beta blocker? a medicine usually ending in "lol"?	70 of 100 Agreed (70%)	80 of 100 Agreed (80%)
If you had a stroke, paralysis or "shock" are you taking blood thinners?	60 of 100 Agreed (60%)	85 of 100 Agreed (85%)
If you have angina are you mostly satisfied that everything is being done for your chest pain or chest tightness?	30 of 100 Agreed (30%)	70 of 100 Agreed (70%)
Was the last cholesterol too high?	20 of 100 Agreed	10 of 100 Agreed

We know that future problems from heart disease and hardening of the arteries can be reduced when you:

do not smoke.
exercise regularly.
keep weight, blood pressure, and cholesterol near normal. LDL cholesterol should be no higher than 115(US) 2.9(Canada and Europe), if possible.
take a medicine called a “statin”
keep blood pressure less than 150/90, preferably less than 140/90.
take low dose aspirin (or warfarin or newer anti-coagulants if you have a condition called atrial fibrillation).
take a "beta blocker" if you have had a heart attack.
take "converting enzyme inhibitors" if you have heart failure; low dose beta-blockers may also be helpful.

A doctor should also spend time teaching people with angina heart pains and heart failure how to adjust medications so they are as effective as possible. Medication education always stresses that:

Beta blocker medications should never be stopped suddenly.
Nitroglycerin for angina heart pains should be taken before beginning an activity that usually causes pain.
Educated patients can safely adjust diuretics ("water pills") for heart failure. You must keep track of your weight, feelings of shortness of breath, and swelling of your legs (edema). Easy "tricks" for controlling heart failure include lying down for 45 minutes after taking furosemide and using a combination of low dosage spironolactone or hydrochlorthiazide with furosemide.

Patients should always contact their doctor if they notice worsening of pain, shortness of breath, new pains, or pain that is lasting longer.

What about surgery, special tests or other methods for "cleaning" blocked blood vessels? What about "blood thinners" to prevent stroke? Please read Health Habits and Health Decisions before you talk about these choices with your doctor or nurse.

(Sugar) Diabetes

This Table shows the answers of people with Diabetes who used HowsYourHealth.

	The Number Who Agreed To The Question Of Every 100 People Who Answered
Questions People Like You Were Asked About Diabetes	If They Are NOT Confident About Controlling and Managing Their Diabetes	If They Are Confident About Controlling and Managing Their Diabetes
Did your doctor or nurse give you good information about the importance of having eyes checked?	60 of 100 Agreed (60%)	80 of 100 Agreed (80%)
Did your doctor or nurse give you good information about how to check your feet and choose proper shoes?	50 of 100 Agreed (50%)	65 of 100 Agreed (65%)
Did your doctor or nurse give you good information about how to adjust your medicines for diabetes and when to call a doctor for help?	50 of 100 Agreed (45%)	65 of 100 Agreed (65%)
Was the last blood sugar too high?	40 of 100 Agreed	15 of 100 Agreed

Diabetes describes several conditions that cause sugar in the blood to be higher than normal. People who have high blood sugar are more likely to develop hardening of the arteries, loss of vision, and kidney problems than persons who do not have high blood sugar. Kidney problems can lead to kidney failure. If blood sugar levels are kept as normal as possible, many problems can be reduced—particularly in people with diabetes who need insulin. If you are more than 15% overweight or have a lot of fat around your waist, your chances for diabetes goes up a lot. If you are overweight and regularly exercise and change you diet, you can CUT BY ONE-HALF YOUR CHANCE FOR HAVING (SUGAR) DIABETES.

The best blood sugar goals are:

Fasting -- 75(US) 4.0(Canada and Europe)-120(US) 6.5(Canada and Europe).
Before meal -- lower than 150(US) 8.0(Canada and Europe).
At 3 am -- higher than 75(US) 4.0(Canada and Europe).

A special blood test (glycosolated hemoglobin) should be as close as possible to the average for non-diabetics.

Health care professionals find that many people have difficulty reaching these goals. Your doctor should be able to help you come as close to these goals as possible. People who need insulin should be careful to avoid too much sugar and fat in their diet and should exercise regularly. For others with diabetes, the same exercise and diet rules should be followed; weight should be as close to normal as possible; and medicines may be tried to lower the blood sugar. Sometimes several medicines and insulin may be needed. A daytime pill and nighttime insulin can be very effective in some patients. Metformin seems useful for overweight diabetics who do not need insulin.

Remember, after you have had diabetes for more than five years, you may have difficulty feeling when your blood sugar is too low. This is an important thing to remember and a good reason for regularly checking your blood sugar levels when you are taking insulin or pills for diabetes.

One’s vision can be severely affected by diabetes. You should have your eyes checked every two years even if you think that you do not have a problem. The younger you are, or the less controlled your blood sugar levels, may also be considered in determining how often you may need your eyes checked.

Higher risk eyes should be checked every year - preferably using medicine to dilate the pupil. You should consider your eyes at higher risk if it has been found to have changes in the past, you are below age 50, or your glycosolated hemoglobin is more than 9.

The following treatments are effective for health problems associated with diabetes:

Regular exercise will reduce the average blood sugar even if you do not lose weight.
Eye problems -- laser and surgery treatments.
Blood pressure should be less than 130/80 if possible, and "angiotensin" drugs seem to be the best choice.
Hardening of the arteries -- blood pressure control and cessation of smoking.
You will want to keep your LDL fat in the blood below 115(US) 2.9(Canada and Europe), if possible.
Nerve pains -- antidepressant drugs, capsaicin.
Stomach and bowel problems -- metoclopromide (short term only) and occasionally erythromycin.
Foot problems -- carefully check for any sores twice a day. Be particularly careful if you have poor feeling in your feet and they are badly misshapen; the chance of having a non-healing sore (an ulcer) is more than 1 in 10 in a year.

Arthritis

This Table shows the answers of people with Arthritis who used HowsYourHealth.

	The Number Who Agreed To The Question Of Every 100 People Who Answered
Questions People Like You Were Asked About Arthritis	If They Are NOT Confident About Controlling and Managing Their Arthritis	If They Are Confident About Controlling and Managing Their Arthritis
Are you often or always bothered by joint pain?	45 of 100 Agreed (45%)	40 of 100 Agreed (40%)
Is your doctor or nurse aware of your bothersome pain?	70 of 100 Agreed (70%)	80 of 100 Agreed (80%)
Did the doctor or nurse give a good explanation about the pain?	55 of 100 Agreed (55%)	75 of 100 Agreed (75%)

"Wear and tear" (degenerative) arthritis is very common as we grow older. Arthritis, or pain in the joints, will usually be most noticeable in an area that has been injured or is used a lot in everyday work. The distant finger joints, knees, hips, neck, and low back are commonly affected. Pain is seldom felt when resting except in severe cases.

Degenerative arthritis pain in the knees can be helped by strengthening the muscles in the thigh (see exercises lower leg exercises in Eating Well and Exercising). For every pound (kilogram) of excess weight lost, 3 pounds (kilograms) of stress are taken off the knee.

Degenerative arthritis usually does not cause warm, swollen joints, or pain in many joints at the same time. Please contact your health care professional if this happens.

The Chapter on Pain describes general treatment approaches for degenerative arthritis and many other types of pains.

Breathing Problems: Bronchitis, Emphysema, and Asthma

This Table shows the answers of people with chronic Breathing Problems who used HowsYourHealth.

	The Number Who Agreed To The Question Of Every 100 People Who Answered
Questions People Like You Were Asked About Their Breathing Problems	If They Are NOT Confident About Controlling and Managing Their Breathing Problems	If They Are Confident About Controlling and Managing Their Breathing Problems
Did your doctor or nurse give you good information about how to adjust your medications for shortness of breath?	45 of 100 Agreed (45%)	70 of 100 Agreed (70%)
Did your doctor or nurse give you good information about how to use inhaled medications?	55 of 100 Agreed (55%)	75 of 100 Agreed (75%)

A "cold" can cause a cough or shortness of breath. However a "cold" lasts only several weeks at most. If you have felt short of breath or had a cough lasting more than a few weeks, you should contact your doctor.

Everyone now knows that chronic bronchitis (a cough with sputum lasting for at least six weeks) and emphysema (destruction of the lung) are caused by smoking. When you quit smoking, some of the damage reverses: shortness of breath and sputum production will decrease. Most of the treatments listed below are also tried in bronchitis and emphysema.

Asthma is a problem that can also make people feel short of breath and cough a lot. Asthma can be present with emphysema or bronchitis or it may occur on its own.

During an asthma attack:

The lining of the airways in the lungs become swollen.
The airways produce a thick mucus.
The muscles around the airways tighten and make the airways narrower.

These changes block the flow of air, making it hard to breathe. It is important to treat even mild asthma so that you can keep it from getting worse.

Certain things can trigger your asthma or allergy and make it worse. If you stay away from these triggers, your asthma will bother you less. Common triggers are: dust, mold, pollen from trees and grasses, cold air, smoke, cats, dogs, some chemicals, and exercise.

There are a lot of ways to treat asthma so that you can be active without having asthma bother you. With asthma you can exercise and play sports and sleep through the night without coughing. Your asthma attacks can be managed and your asthma medicines need not make you sick. But to keep your asthma from bothering you, you have to know what you are doing.

Know what your asthma triggers are and plan ways to avoid them. Many people with asthma have breathing trouble when they start to exercise. These people can take some of their medicine just before they start. If you can't avoid a trigger, treat it before it causes problems.
Develop a medicine plan with your care provider that keeps you from having problems. Many people wait too long before beginning their treatment and the asthma gets out of control.
Know what to take when you have asthma problems.

Some medicines are taken as a pill and some are inhaled into the lungs directly. If you are already getting treatment for asthma, you should bring your medicines to the office, so that your doctor can explain the type you are taking.

There are two types of asthma medicines:

Relaxers (bronchodilators) are medicines that relax muscles in the airways, making it easier for you to breathe. Beta 2-agonists, theophylline, and ipratropium are bronchodilators. (Ventolin, Theo-Dur, and Proventil are brand names for these bronchodilators.)
Anti-inflammatory medicines reduce the swelling in your airways that cause asthma symptoms. They also prevent swelling in the future, which keeps asthma symptoms from starting. Cromolyn, nedocromil (Intal, Tilade), inhaled corticosteroids (Azmacort, Vanceril), and oral corticosteroids (Prednisone) are anti-inflammatory medicines.

Most doctors will tell you to take your inhaled relaxer (bronchodilator) medicine at the earliest sign that your asthma is getting worse. Watch out for early signs so that you can start the asthma medicine right away. An asthma attack is easier to stop if you take your medicine as soon as your symptoms start. Then you won't have to take as much medicine. Keep taking the medicine for several days after a bad attack so that it does not rebound (come back).

Remember: Relaxers (bronchodilators) relieve symptoms, but they cannot reduce or prevent the swelling that causes the symptoms. When you have to use a bronchodilator a lot, or if you use it more than 3 or 4 times in a single day, your asthma may be getting much worse. You probably need another kind of medicine and should talk to a doctor right away.

Take your anti-inflammatory medicines exactly the way your doctor recommends, even if you are feeling well. This will reduce airway swelling and keep asthma attacks from starting. This medicine must be taken regularly for it to work well. This medicine does not work as quickly as the bronchodilators, but don't be fooled. The anti-inflammatory medicines work slowly, over time. But they are very powerful.

NOTE: IF YOU REGULARLY USE ASTHMA DRUGS THAT CONTAIN CORTISONE, YOU SHOULD BE TAKING CALCIUM. TALK TO YOUR DOCTOR.

Some people are afraid that if medicine is taken all the time, it will no longer work. This fear is wrong. Asthma medicines do not stop working over time if you take them as prescribed. Asthma medicines are safe, if taken as directed. But, sometimes asthma can change. If this happens, your asthma medicines may also have to be changed.

One of the most important ways to keep your asthma under control is to have a written plan. You take different medicines depending on how well you are breathing each day, or on your peak flow rate if you use a peak flow meter. Most doctors use the Zone System to help you follow your plan. The zones are set up like traffic lights.

GREEN: Great! Keep up the good work!
YELLOW: Not too good, watch out and take the right medicines to get yourself back in the green zone.
RED: Emergency! Call your doctor and take your bronchodilator medicine.

Your medicine plan will tell you what kind of medicine to take every day (when you're feeling well and in the Green Zone). It will also tell you what kind of medicine you need to take when you are feeling badly and you are in the Yellow or Red zone. Your doctor will help you with this plan, but it is up to you to keep track of how you are feeling, and then FOLLOW THE PLAN! As time passes, you will be the best person to manage your asthma.

Medications

Modern countries use a lot of pills; they are using 50% more pills than they did 20 years ago. Medication use has more than a financial cost. It can also be risky. It is now estimated that medications are the third most common cause for health problems in the United States and cause up to 150,000 deaths a year. In the past 25 years, one out of every ten medications newly placed on the market has been withdrawn later because they hurt people more than they helped.

Non-steroidal anti-inflammatory medications (aspirin,"nsaids", ibuprofen, Motrin, Naprosyn, etc,) account for about 8,000 deaths each year and seem to increase the chances for kidney diseases. As many as 40% of these types of prescriptions may be "unnecessary".

Adults who take medications each day often take several different types. Sometimes the medications may cause problems or side effects. Because of their smaller size, women are often at higher risk for problems with medications. The challenge for your doctor and for you is to find and reduce the bother caused by medications. Doctors are often able to reduce the dosage or change to another safe, effective, and inexpensive medication for the one causing the problem. Sometimes stopping the medicine completely is the best choice.

Many drugs leave the body through the kidneys. If you have kidney problems, the dosage or frequency of taking drugs may need to be reduced. Always talk to your doctor before starting a new medication.

What else can you do? First, make yourself a "Medications I Take" list. Make sure you list all medications you take al least three times a week, not just the new ones. An example is shown below. Always bring this list with you when you see any other person who is going to help you manage your medical problems.

Second, tell your doctor when you are having trouble taking your medications because they are either too expensive, too easy to mix up, or too easy to forget. For example, "older drugs" for high blood pressure are lower in cost and as effective as many of the "newer drugs". You should consider buying a "pill holder" if you are taking two or more types of pills each day. (You can also use an egg carton for the same purpose.) Seven-day pill holders are very useful. No matter which holder you choose, make sure each section is labeled with the name of the pill and the time it should be taken. You can obtain electronic devices that remind you when to take pills.

Third, you should have your pharmacist check for drug interactions. You can become sick when one medicine reacts with another.: Be very careful about interactions of heart pills, all aspirin like drugs (including Motrin or ibuprofen), stomach pills, and all types of pills for anxiety and "nerves." Finally, please tell your doctor if you think that your medications are bothering you.

If you are pregnant or planning pregnancy, please discuss any medications being used. Medications of concern are aspirin, ibuprofen, and similar medications during the third trimester. "ACE inhibitors" should also be discontinued whenever possible.

If You are 70 Years of Age or Older, You May Wish to Check with Your Doctor if Taking These Medication. (These Medications May Make You Sick and Should only Be Used at a Low Dose when Used)

Allergy/Cold Pills: chlorpheniramine, diphenhydramine, hydroxyzine, tripleramine, cyproheptidine, promethazine.
Bowel Medications: dicyclomine, hycoscyamine, propantheline, belladona, clinidium.
Depression: amitriptyline, doxepin
Heart/Blood Pressure: disopramine, dipyramidole, methyldopa, reserpine.
Muscle "Relaxers": carispodal, chlorzoxazone, cyclobenzaprine, metoxalone, methocarbamol.
Pain Medications: propoxyphene, meperidine, indomethacin, piroxicam, phenylbutazone.
Sleep/Anxiety: clordiazepoxide, diazepam, flurazepam, barbiturates.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.

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