Parkinson's Disease -Continuity -Disease Symptoms, Treatment, and Warnings

 Symptoms, Treatment, and Warnings

BASAL GANGLIA (STRIATUM)
(DIAGRAMMATIC)

Parkinson's disease is a degenerative disorder of specific areas of the brain. It is characterized by muscle relaxation (tremor relaxation), increased muscle tone (stiffness), sluggishness of voluntary movements, and difficulty maintaining balance (post-instability). For many people, thinking becomes impaired, or senility develops.

Symptoms: -

The symptoms are rough and rhythmic.

1. Tremor when the hand is at rest (resting tremor)

2. Often the hand moves as it spins small objects (called tablet-rolls).

3. Decreases when the hand is intentionally moved and disappears completely during sleep

4. Emotional awakening may worsen due to stress or fatigue

Eventually next, switch to arms and legs

5. The most obvious symptom is a tremor that occurs when the muscles are relaxed.

6. Muscles become stiff, movements become slow and uncoordinated, balance is easily lost.

Parkinson's disease is the second most degenerative disorder of the central nervous system after Alzheimer's disease

Often the first sign of tremors is hand tremors. These tremors can be classified as follows: -

-Rough and rhythmic

Usually occurs in one hand when the hand is at rest (resting tremor)

-The hand moves as it often spins small objects (called tablet-rolls).

-Decreases when the hand is intentionally moved and disappears completely during sleep

-Emotional aggravation may be due to stress or fatigue

-Finally, this tremor may progress from one side to the arms and legs.

-It can affect the jaws, tongue, forehead, and eyelids, and to a lesser extent, it can affect the voice too.

It often affects the following People:-

1. 1 in 250 people over 40 years of age

2. 1 in 100 people aged 65 or over

3. 1 in 10 people aged 80 or over

Parkinson's disease usually begins between the ages of 50 and 79. Rarely, it occurs in children or adolescents.

Parkinsonism has symptoms similar to Parkinson's disease, but it can be caused by a variety of conditions, such as multiple organ degeneration of the body, progressive neuronal arthritis, stroke, head injury, or certain medications.

Stiffness:

Muscles stiffen and make movement difficult. When a doctor tries to bend or straighten the person's forearm or wrist, the hand resists moving, and when it moves, it starts and stops, as it is squeezed (called a cake wheel stiffness).

Slow movements:

The movements become slower and smaller and harder to start. Thus, people tend to move slowly. When they move slowly, it becomes difficult to move and it is very difficult to move as the joints and muscles weaken.

Difficulty maintaining balance and posture:

The posture is bent and it is difficult to maintain balance. Thus, the patient tends to invert forward or backward. Because the movements are slow, the patient is often unable to move their arms quickly to prevent them from falling down. These problems then develop into diseases.

Walking becomes difficult: -

 The patient will often retreat, especially after starting the first step. So he will take short steps. He bends his arms at the waist or dips his arms a little. While walking, some people have difficulty stopping or turning. As the disease progresses, some people will suddenly stop walking because they will feel like their feet are sticking to the ground (called frostbite). Others will accidentally and gradually accelerate their actions and enter the stumbling block.

Insomnia: -

Sleep problems, including insomnia, are common because people often have to urinate or have difficulty getting back to bed at night as symptoms worsen. Rapid-eye-movement (REM) sleep disorder usually develops. In this disorder, limbs that do not normally move during REM sleep can move suddenly and violently because people express their dreams, sometimes injuring the person lying next to them.

Insomnia can cause depression, weak thinking, and dizziness during the day.

Urinary problem: -

Problems with urination can occur. Urination can be difficult to begin and maintain (called urinary delay). People may have a compelling need to urinate (urgently). Disability is common.

Digestive system

Difficulty in swallowing may develop as the esophagus may move its contents too slowly. As a result, people may inhale oral secretions and/or the food they eat or the fluids they drink into the respiratory tract, which can cause pneumonia.

Constipation: - 

Because the intestine may move its contents slowly. Inactivity and levodopa, the main drug used to treat Parkinson's disease, can worsen constipation.

Orthostatic Hypotension: -

Sudden onset of hypotension when changing the posture from sitting to standing position (orthostatic hypotension)

Scales (seborrheic dermatitis): -

Most often develops on the scalp and face and occasionally on other areas.

Loss of smell (anosmia): - 

It is common, but people may not notice it.

Confusion :-( Dementia)

One-third of people with Parkinson's disease develop dementia, usually later in life. In many more, the thinking is weakened, but people may not recognize it.

Depression: -

 Sometimes people have problems with movements. Depression worsens as Parkinson's disease worsens. Depression can also make movement problems worse.

Hallucination

Hallucinations, delusions, and paranoia can occur, especially if dementia develops. People can see or hear things (illusions) that do not exist or hold firmly (illusions) despite clear evidence that contradicts certain beliefs. They may become hopeless and think that others are harming them (paranoia). These symptoms are considered psychiatric symptoms because they mean losing contact with reality.

Diagnosis of PD

-A physician's evaluation

-Sometimes computed tomography (CT scan) or magnetic resonance imaging (MRI) studies.

-Sometimes predicting whether levodopa is working properly.

People are more likely to develop Parkinson's disease if they have the following:

- Less, slower movements

- Tremor with a specific characteristic

- Muscle stiffness

-Clear and long-term (lasting) improvement in the effects of levodopa use

It is difficult for doctors to diagnose a mild, early disease because it usually begins with a technique. Diagnosis is especially difficult for the elderly.

Physical examination: -

During the physical examination, the doctor will ask the patient to perform certain movements, which will help confirm the diagnosis. For example, in people with Parkinson's disease, tremors disappear or subside when doctors ask them to touch the nose with their fingers. 

Also, sufferers find it difficult to make quick alternate movements such as placing their hands on their thighs and then quickly turning their hands back and forth several times.

Tests: -

No tests or imaging procedures can directly confirm the diagnosis. However, computed tomography (CT Scan) and magnetic resonance imaging (MRI Scan) can be done to diagnose a structural disorder that can cause symptoms. Common brain disorders of the disease can be detected by single-photon emission computed tomography (SPECT) and positron emission tomography (PET).

However, SPECT and PET are currently only used at the research level, and they do not distinguish Parkinson's disease from other disorders.

PD Treatments: -

-Common measures for managing symptoms

-Physical and occupational therapy

-Levodopa/carbidopa and other drugs

-Sometimes surgery (including deep brain stimulation)

-Common measures used to treat Parkinson's disease can help patients function better.

Many medications facilitate movement and help patients function effectively for many years to come.

Key features of treatment for Parkinson's disease: -

-Levodopa plus Carbidopa

-Other drugs are generally less effective than levodopa, but they may be beneficial for some people, especially when levodopa is ineffective or inadequate.

-However, no drug can cure the disease.

Two or more medications may be needed. For the elderly, doses are often reduced. Medications that cause or worsen symptoms, especially antipsychotic drugs, are avoided.

Medications used to treat Parkinson's disease can cause troublesome side effects. If people notice any abnormalities (such as difficulty or confusion in controlling the stimuli), they should report them to their doctor. They should not stop taking the medication until the doctor tells them to do so.

Deep Brain Stimulation: -

It is a surgical procedure that is only recommended if the patient has an advanced acute illness, but this treatment is not only ineffective for dementia or psychiatric symptoms and injuries caused by the use of certain psychiatric medications but can also cause serious side effects.

General Activities: -

-A variety of simple measures to help people with Parkinson's disease maintain mobility and independence:

-Continue daily activities as much as possible

-Regular exercise should be done regularly

-Facilitate daily tasks such as using fasteners or zippers in clothing and shoes.

Simple changes around the house can be safe for people with Parkinson's disease:

-Remove rugs to avoid stumble walking

-Install handrails in bathrooms and rails in hallways and other places to reduce the risk of falls.

-For constipation, the following may help:

-Eating high-fiber foods such as prunes and fruit juices

-Exercise

-Drinking plenty of fluids

-Using laxatives (such as senna, psyllium) or stimulant laxatives to keep bowel movements regular (such as oral bisacodyl)

-Difficulty in swallowing, can reduce food intake, so the food should be nutritious.

Doing more deep breathing exercises will improve the ability to smell and increase appetite.

Levodopa / Carbidopa

Traditionally, levodopa, given in combination with carbidopa, was the first drug used to treat Parkinson's disease. These medications, which can be taken orally, are an important part of the treatment for Parkinson's disease.

There is no truth in the claim that chronic levodopa use can exacerbate side effects and reduce its effectiveness. However, over time, Parkinson's disease can worsen in some people beyond levodopa usage.

Other medications that doctors may use include amantadine and dopamine agonists (drugs that stimulate dopamine receptors). Such drugs are used to increase dopamine production as it decreases in Parkinson's disease.

Levodopa reduces muscle stiffness, improves mobility, and significantly reduces tremors. Taking levodopa makes dramatic improvement for people with Parkinson's disease. This drug helps many people with mild illnesses to return to almost normal and some people who have been confined to bed can walk again.

Risk factors:-

-Brain damage caused by trauma in the past

-Injuries to the head from sports may increase the risk of this condition.

-Toxic exposure: Pesticides, solvents, metals, and other contaminants.

-Sex:-

 Men are 50% more likely to develop this condition than women, although a 2016 study suggests that the risk for women may also increase with age.

And this condition often appears from the age of 60s.

ANTI-DEPRESSANTS-AMITRIPTYLINE

AMITRIPTYLINE 

(Disclaimer: - The information included on this site is for educational purposes only and is not intended for medical treatment.)

Fig-1

This drug is available in pharmacies under the names ELIWEL, TRYPTOMER, and many other brands. They can be listed as follows.

Amichlor             Amitrol DS        Amilin

Amichlor-H         Amitrol              Eliwel

Amidon               Amixide             Emotrip

Amitone              Amixide-H         Libotryp

Librodep             Sarotena              Tadamit

                            Tryptomer

                            Tryptomer-SR

This drug is usually given for depression but is also prescribed by doctors as a pain reliever. Further, Although amitriptyline works through serotonin, it also acts through noradrenaline, unlike SSRI drugs (Figure-3). So although it is more powerful than SSRI drugs it has more side effects.

This prevents the reabsorption of not only serotonin but also other hormones between the nerve endings. So this cannot be called SSRI.

As for amitriptyline, it is used for depression but in very small doses it is also recommended by doctors as an analgesic.

Doctors rarely prescribe amitriptyline after the introduction of modern antidepressants such as SSRIs and SNRIs (We will see later about this in the headline SNRI)

USES

1. Depression (use approved by the drug control system)

2. Migraine.

3.Body and back pain

4.Diabetes neuropathy.

5.Nerve pains.

All of the above applications (2 to 5) are not approved by the Drug Administrations.

Side Effects:

1.Anticholinergic reactions.

2.The following α-adrenergic blocking reactions, viz

  Orthostatic Hypotension - A change in blood pressure 

 when the position is changed from a sitting position to a standing position

3. Weight gain

4. Insomnia.-Some doctors also prescribe it as a sleeping pill. But too much amitriptyline can cause insomnia. So focus.

5. Anorexia

6. Fatigue.-Doctors prescribe this medicine to stimulate the mind and body. But at the same time overuse can cause fatigue and tiredness in the body. So beware.

7.Nausea &Vomiting

Warnings

This drug should not be used spontaneously in the following conditions except under the supervision of a doctor.

1.Pregnancy period (especially the first trimester.

2. Breastfeeding period.

3.People with Kidney and Liver Disorder.

4.Patients with heart and blood pressure.

Other drug interactions with this drug: -

1. Do not take this with ulcer medicine like cisapride. Eating like that can damage the heart.

2.Quinidine drugs (heart disease)

3.SSRI Drugs,

(Examples) Fluoxetine (Flunil, Fludac)

             Paroxetine (Paxidep, Pexep)

             Fluvoxamine (Fluvoxin CR, Fluvator)

4.Quinapril (Q-press) -B.P. Drug

5.Chlorpheniramine, Phenylephrine (allergy and cold medicine)

6.Cimetidine-ulcer drug.

7.Zolpidem (Nightrest) -Sleeping.

We should not take amitriptyline with any of the above drugs.

Contraindications

Do not take amitriptyline under any of the following conditions:

1. Heart disease

2. Heart failure

3. Gallbladder disorder.

4. Liver disease

5. Irregular heartbeat

6. Heart attack

7.Kidney cancer

Frequently Asked Questions about Amitriptyline

1. Does this drug cause addiction?

Yes.

2 Is it possible to drive or operate heavy machinery after consuming this medicine?

Definitely not.

ANTI DEPRESSANTS- SSRI TYPE MEDICINES

 SEROTONIN SPECIFIC REUPTAKE INHIBITORS (SSRIs)

(Disclaimer: - The information included on this site is for educational purposes only and is not intended for medical treatment.)

Fig-1

For those who are depressed, the feelings of sadness are more intense. They cause chaos in their daily lives. This will make you unable to engage at home or at work. Feelings of depression can also lead to a variety of physical and emotional problems.

However, depression is one of the most easily cured mental disorders. But be a little mindful.80 to 90% of people benefit from some mental training in his endeavor. The mental exercises you need will depend on your specific situation, but for some, even though the medication may be very helpful, it is best to try as many mental exercises as possible.

Fig-2A

SSRIs for this depressive condition are now more commonly prescribed by doctors than any other type of medication. This is because they are safer than other drugs such as amitriptyline.

And according to a psychiatrist, this is due to chemical changes in the brain. That’s why he places more emphasis on drug therapy than mental training.

Fig-2B

How do SSRIs work?

Fig-3

SSRIs work by improving the function of nerve cells in the brain that control emotion. This serotonin helps in communication with signals between your brain cells. The chemicals that deliver these signals are called neurotransmitters. Serotonin is a type of neurotransmitter.

When these brain cells (called neurons) send signals to each other, they emit a little neurotransmitter to deliver the message. They then retrieve the released neurotransmitter. So that they can send the next message. This process of modifying the neurotransmitter is called "reuptake".

When you are struggling with depression, the areas of your brain that regulate mood, and send messages using serotonin, do not function properly. But these SSRIs make more serotonin available between neurons by inhibiting the "Reuptake Phenomenon Process". So neurons can send messages correctly between themselves. Therefore these drugs are called "Selective Serotonin Reuptake Inhibitors." or SSRIs.

Types of SSRIs: -

The following SSRIs are approved by the US FDA to treat depression, anxiety, and other mental disorders: -

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox, Luvox CR)
• Paroxetine (Paxil, Paxil CR)
• Sertraline (Zoloft)

• Vilazodone (Viibryd)

Side effects: -

Each type of medical treatment carries some risks. Possible side effects of these SSRI antidepressant medications include:

-Sleeplessness

-Headache

-Raw

-Blurred vision

-Dizzy

-Dry mouth

-Rebellion or anxiety

-Dizziness

-Pain in the joints or muscles

-Nausea or diarrhea

-Less sexual desire

-Erectile or ejaculation problems

-Some people, especially children, and young people are more likely to have suicidal thoughts when they regularly take SSRIs.

-There are also important security issues to consider about SSRIs. Although this is rare, if too much serotonin accumulates in your body, you may suffer from a condition called SEROTONIN SYNDROME. This often happens when two different serotonin-boosting drugs are taken together.

Warning: -

Some SSRIs can cause dangerous, side effects with other medications you take. They may be prescribed by a doctor or herbal and supplemental medications. Before starting an SSRI type of medicine, be sure to tell your doctor about all types of medications and supplements you are taking.

Because all SSRIs work the same way, the side effects are often the same no matter what type of medication you take. But each SSRI has a different chemical nature, so if one drug you take causes side effects, you can avoid many side effects if you switch to another drug with a doctor's permission.

While some have side effects, others do not. In many cases, the side effects disappear after a few weeks of treatment. You need to work with your doctor to find the right medicine for you.

How long does it take for the SSRI to be beneficial?

Changes are usually noticed 4 to 6 weeks after treatment. It can take months to realize the full effect of the medication.

If after 6 to 8 weeks you have no improvement, talk to your doctor about trying another treatment or adjusting your medication dose.

Termination of treatment: -

These drugs can have dangerous side effects when abruptly stopped or left unattended for several days. This is known as Discontinuation Syndrome or Withdrawal Syndrome.

You may start to feel like you have a fever. The following symptoms may occur too.

Nausea

-Dizziness

-Discomfort

-Fatigue or laziness

That is why, with the help of your doctor, it is important that you slowly reduce the dose he or she prescribes, and gradually discontinue the medication if you are advised that it is time to stop.

THOUGHT DISORDER-OBSESSIVE COMPULSIVE DISORDER

MANIA- OBSESSIVE-COMPULSIVE DISORDER(OCD)

(Disclaimer: - The information included on this site is for educational purposes only and is not intended for medical treatment.)

Fig-1

Are you the one who comes back ten times and pulls the lock to see if the house is locked properly?

Are you the one who comes back again and again when you leave the house locked and checks to see if the box and bureau inside are locked properly?

Do you wash your hands unnecessarily?

Are you repeating the same phrase unnecessarily during the conversation?

Are you unnecessarily disciplined?

Then you may have this thought disorder called OCD. This mental illness

You too will hate everything and everybody else and you too will feel hated by others. It can take you to the brink of despair and leave you with a sense of failure and a sense of suicide.

Many people with OCD know that their actions are unreasonable, but when they try to ignore the urge to do something, their anxiety increases until they are forced to do so.

That is, manic obsessive-compulsive disorder is a condition in which the problems we face at every stage of life and the experiences they cause us to become a disease that gradually penetrates our thoughts. This is called Obsessive-Compulsive Disorder (OCD) in medical parlance.

This can also be explained as follows. That is, a person may feel the urge to repeat certain thoughts ("obsessions" -obsession) or feel the need to repeat certain procedures ("compulsions" - compulsion). These stubborn thoughts and feelings will cause him great suffering or make him forget the most necessary things he has to do and ignore that process.

For example, he would sometimes miss the train in the process of repeatedly hand-washing and repeatedly checking that the box was locked. Also, he may miss his important daily routines too. Rarely does this condition take him to the peak of despair and even prepare him for suicide.

The disease affects not only adults but also young people and children.

In short, it involves people having repetitive, unwanted thoughts, ideas, or feelings (obsessions) that motivate them to do something over and over again (compulsions).

According to the National Institute of Mental Health, OCD affects 1% of adults in the United States alone. OCD does not discriminate and can affect anyone regardless of race, gender or age. It can have a profound effect on a person's quality of life and can affect their emotional health, education, career, and even their social and personal life, as their passions can lead to many hours of empty rituals.

Types of OCD:-

1.Dirt and washing it

2. Suspicion of accidental harm

3. Proper OCD - Symmetry, arrangement, and counting.

4. Unacceptable forbidden thoughts and mental rituals.

5. Mental pollution.

6. Hoarding

7. Rumors.

8.Invasive thoughts

Symptoms:

 The symptoms of OCD can be classified as follows.

- The inability to control one's behavior or thoughts, even when one realizes that his behavior is irrational.

He spends at least an hour every day in vain for such behaviors and thoughts

-He will perform some rituals to get short-term relief from tension (as opposed to desire and satisfaction)

Motor Tics or sudden repetitive movements (e.g.) Blinking, shoulder rolling, facial movement, shoulder or head shaking, moaning, murmuring.

Symptoms may subside or worsen over time. Some OCD sufferers prefer to stay away from things or situations that trigger their disorders. Others choose drugs, alcohol, or both to keep themselves calm.

Factors: -

1. Children, younger and older generations who are treated cruelly and unjustly.

2. Frequent stressors lead to depression.

3. Twins born in the same image with a genetic disorder.

4. Subject to repetitive fearful situations.

OCD-A PHYSIOLOGICAL DISORDER-A BRAIN DAMAGE

Fig-2A

Studies of OCD and related disorders suggest that OCD is caused by damage to a specific area of ​​the brain. This area is called the Basal Ganglia (Figure-2A).

The two brain structures that interact with the basal ganglia are the most active in OCD patients. Both of these structures are called the ORBITOFRONTAL CORTEX (OFC) and the Anterior Cingulate Gyrus (ACG). (Figure-2B)

Fig-2B

Treatments.-

 Cognitive-behavioral therapy: -

Creating a fearless atmosphere.

Behaving in such a way as to instill loving confidence in the patient.

Thereby dispelling the impulsive and frightening thoughts that arise in his mind, and finally changing the stubborn repetitive thoughts. This treatment cannot be done overnight. It may take many days, many months, and even many years. But this is a much better treatment than prescription pills. No after-effects. Do not need the help of a doctor.

Dangerous drug pill treatments.

In allopathy, what they say about this condition, is this is caused by a deficiency of the hormone serotonin in the central nervous system. 

Hence if we go to a psychiatrist for treatment of this disease, they mostly prescribe SSRI (SEROTONIN SPECIFIC REUPTAKE INHIBITORS) type antidepressants that turn us into permanent drug-addicted patients.

SSRIs and their side effects: -

All of these SSRI medicines damage the central nervous system and brain when eaten continuously. In addition, the autonomic nervous system is severely affected as follows.

1 Anticholinergic effect

2 Alpha-Adrenergic pressure elevation (caution for those with the prostate problem)

3.Increasing heart rate

4.Irregular heartbeat.

Details about SSRI can be found in the next post.

 Click here to continue watching the next post. Next post SSRI - to be continued .....

DRUGS AND THEIR SIDE-EFFECTS

Medications and side effects 

((Disclaimer: - The information included on this site is for educational purposes only and is not intended for medical treatment.)

Fig-1

All medications can cause unwanted side effects. Medications include prescription drugs, over-the-counter medications, and complementary medications (herbal products and vitamins).

The formula ingredients on the drug label may ‘collide’ with each other. Therefore, taking more than one medication at a time may increase the risk of side effects.

About 230,000 Australians are hospitalized each year due to drug problems, including side effects. Most side effects are manageable, some are very serious and can even cause death.

Managing your medications wisely is in your best interests.

Doctor prescription drugs:-

Generally, any medicine should be bought on the recommendation of a doctor. Self-medication is very dangerous. Even so, alcohol users should not take any medication on their own. This is because some antibiotics can cause unwanted side effects with alcohol

Vitamins if not through food, are all toxic when they are available as store-bought medicines,  including herbal medicines. 

Remember,  medications including vitamins available as store-bought drugs are all poisons.

 They are chemicals.

The following medications should not be taken without a doctor's prescription.

1.Antibiotics 

2. Anxiolytics

3. Antidepressants

4. Antipsychotics

For example, some antibiotics cause allergic reactions in up to five percent of the population. Psoriasis is a common reaction. But it is not always easy to tell if it is caused by a reaction, medication, or disease.

In addition, some antibiotics can cause drug-drug interactions between them and other drugs.

For example, 

It is now common to take the antibiotic azithromycin for soar-throat and cough without a doctor's prescription. This azithromycin can cause unwanted side effects with digoxin used for heart disease. Azithromycin itself can rarely cause severe cardiac arrhythmias.

People with potassium and magnesium deficiency and severe diarrhea caused by C.difficile infection should not be given azithromycin without a doctor's prescription.

People taking antibiotics, especially erythromycin or clarithromycin, are generally advised to avoid the following allergy medications.

1. Terfenadine

2.Astemizole

3.Ketazole-an anti-fungal

The reason is that these compositions can cause damages to the heart.

Generally, do not take all fluoroquinolones, such as ciprofloxacin or ofloxacin, without a doctor's prescription. They can affect your kidneys. can cause crystalluria. Do not take the following medications with them.

1. Theophylline, an asthma drug

2. Probenecid a drug for hyperuricemia and gout.

3. Glibenclamide, a diabetic drug

4. NSAID painkillers such as Aspirin, Diclofenac  Aceclofenac, Brufen, and Naproxen.

Sleeping Pills - Drug Interactions with Sleeping Aids:-

Sleeping pills are available without any control as like ubiquitous vitamin pills, and people now buy and eat. It doesn't matter how old the doctor's prescription is. It is freely available at the pharmacy counters without any restrictions.

Attention Alprazolam Sleeping Pill Eaters. These drugs can cause drug interactions if they are taken with the following drugs.

1. Carbamazepine used for epilepsy

2. Cimetidine used for ulcers

3. Clarithromycin

4.Erythromycin

5.Grapefruit and its juice.

6.Alcohol and heroin

7.All psychiatric medications

Generally, caution should be exercised when taking any benzodiazepine drugs such as Alprazolam, Clonazepam, and Diazepam.

Because of these

1. Closed-Angle Glaucoma may occur

2. Shortness of breath may occur.

3. Epilepsy may occur

4. Liver/kidney may be damage

5. Depression and suicidal thoughts may be produced.

6. Diphenhydramine Diphenhydramine Codeine Phosphate Cough tonics should not be taken with sleeping pills. These compositions can lead to respiratory depression, hypoxia, and eventually death.

Grapefruit: -

Fig-2

This fruit is a very healthy nutritious fruit. It has a lot of vitamin C and is a boon for diabetics. It is very low in sugar. Stimulating tissue use of insulin. Very low in calories.

However, this fruit can cause reactions when taken with most medicines.

Drugs that cause reactions while eating this fruit: -

1. Cholesterol drugs Simvastatin and Atorvastatin.

2. Nifidipin, a heart disease drug

3. Cyclosporin, which is given to prevent the body from rejecting organs when they are transplanted.

4. Sleeping pills especially Buspirone

5. Budanoside, a corticosteroid used by some patients with peptic ulcers, and asthma.

6. Amiodarone, a drug that can be given for heart disease (irregular heartbeat). 

Grapefruit can prevent the above drugs from being properly metabolized. So those drugs can accumulate in large quantities in the body and cause great harm.

7. Fexofenadine is an allergy drug. Even if you take the right amount of this medicine, the grapefruit will prevent it from being absorbed properly by the intestines. This because grapefruit blocks the absorption of the fexofenadine carrier protein by the small intestine (See Fig-2 above)

Finally, your health is in your hands. It can only be partially attributed to doctors and pharmacists. If not, you may fall into the deep hole (see Figure-1)

ANTI-DEPRESSANTS- SEROTONIN SPECIFIC RECEPTOR INHIBITORS- S.S.R.Is

 WHAT ARE SSRIs?

Fig-1
SSR-Serotonin Specific Reuptakereceptor
DSR-Dopamine Specific Reuptakereceptors
NSR-Noradrenaline Specific Reuptakereceptor
SSRIs specifically block the reuptake of serotonin only and make it available in the synapse while other hormones are reuptake by their receptors and disappear from the synapse as shown in the Fig-1 (3)

Serotonin is the key hormone of the central nervous system that stabilizes our mood, feeling of peace, and pleasure. In a single term, it is the 'Hormone of Peace and Pleasure'

Medical science has categorised this hormone as a CNS inhibitory hormone but this hormone bears stimulant effects also to some extend such as regulating communications between the brain cells and other nervous system cells. This hormone helps the body with sleeping, eating and digestion. 

Serotonin helps the body with sleeping is by its CNS inhibitory effects. Serotonin when compared with GABA helps the body to sleep normally with healthy and natural sleep while GABA and GABAergic drugs produce unhealthy and addictive sleep. Most of the sleeping pills belong to the GABAergic category.

Similarly, serotonin helps the mind to relieve depression is by its CNS stimulatory effects. Serotonin when compared with other CNS stimulants like noradrenaline, and dopamine helps the mind to get out of the blues with minimal side effects.

That is why S.S.R.Is are considered to be safer than other tricyclic antidepressants like amitriptyline, nortriptyline and protriptyline.

S.S.R.Is are the most preferred medicines to alleviate Obsessive and Compulsive Disorder (O.C.D).

There are many S.S.R.Is are available and dispensed at the pharmacy on Doctor's Prescription only. They are,

1.Fluoxetine (Prozac); 

2.Sertraline (Zoloft);

3.Paroxetine(Paxil);

4.Fluvoxamine(Luvox)

The following two drugs are newer members included in this group.

1.Citalopram (Feliz)

2.Escitalopram (Nexito)

Many more new chemicals are coming up with attractive names in this category.

It is not the purpose of this article to describe them all in detail.

One thing is very important to note that in English Medical System (Allopathy) 'minimum side effects of drugs are not yet well defined'

These drugs can be mentioned as one of the many examples of this.

Take a look at a miracle that the same Allopathy Medical Science lists below as to what effects these drugs, which are advertised as having minimal side effects, can cause when used incorrectly and over a long period of time.

The followings are the 'minimal side effects when compared ' with other antidepressants:-

1.Anticholinergic effects-blurred vision, constipation, dry mouth, urinary retention.

2.Antihistaminic effects- low B.P, elevated heartbeats, mucus thickening and airway block, difficulty urinating and constipation.

3.α-adrenergic blockade-palpitations, tremor, anxiety and hypertension.

The followings are the actual side effects of SSRIs:-

1.Nausea, diarrhoea

2.Nervousness

3.Difficult to sleep or sleeplessness

4.Dizziness

5.Impotence and decreased desire for sex

PRECAUTION:-More dangerous than all this is 'serotonin syndrome '. Very dangerous. That taking these SSRIs inadvertently with any MAOI antidepressants such as selegiline (Eldepryl, Zelepar), isocarboxazid (Marplan), Phenelzine (Nardil), tranylcypromine (Parnate).

The characters of serotonin syndrome are,

1.Hyperthermia-Elevated body temperature

2.Muscle rigidity-Paralysis

3.Myoclonic seizures

4.Disturbances of mental status.

Natural Healthyway to improve serotonin

Tryptophan is one of the nine essential amino acids

needed by the body through foods. 

Serotonin is nothing but 5-hydroxytryptophan.

Any food that is rich in tryptophan can improve the availability of sufficient serotonin at the CNS nerve synapses.

Foods that are rich in tryptophan are,

1.Chocolates

2.Oats

3.Dried dates

4.Milk and dairy products

5.Mutton, beef and eggs

6.Fish

to see further click here

But if you desire to take foods that are high in tryptophan then you should first stop taking the SSRIs, MAOIs and Tricyclic antidepressant drugs completely with your doctor's guidance

Conclusively do not go to psychiatric medication to get out of your mental blues instead go to s clinical psychologist and get good counselling from him.

DO SLEEPING PILLS DAMAGE KIDNEYS?

 RHABDOMYOLYSIS AND KIDNEY DAMAGE

Fig-1
To have a clear look please click on the figure

Rhabdomyolysis is a rare but potentially life-threatening disease resulting from the disintegration of skeletal muscle cells (myocytes) with the leakage of toxic muscle cell contents into the extracellular space and blood circulation.

The major causes for this condition are direct muscle injuries by accidents, chronic myalgia, myopathies and indirect muscle injuries by immobilization in a place for a long time during a flight journey, or in a car, overexertion, heavy exercises, and drug abuse like HMG Co-A Reductase Inhibitors (...statins), narcotics, sleeping medicines, antihistamines, anticholinergics, amphetamine, alcohol and cocaine.

Narcotics and sedatives like sleeping pills cause indirect heavy pressure into the striated muscles to cause muscle damages.

Common OTC antihistamines such as doxylamine and diphenhydramine are available freely at the pharmacy counters. Prolonged use can cause myopathies.

Diet supplements or weight loss supplements that contain creatine and ephedra a plant that contains non-selective adrenergic agonist ephedrine (Anticholinergic) can cause this deadly disease.

Anticholinergics, antihistamines anxiolytics and sedatives cause heavy pressure on the striated skeletal muscles in the body in some parts or as a whole that may lead to muscle fibre damages.

Prolonged use of statins like simvastatin and rosuvastatin can cause rhabdomyolysis, especially with low serum vitamin D (<10ng/ml). Anybody take statin medicines for a long time must include vitamin -D in their prescription.

Heatstroke and overexertion cause muscular cell damages that lead to rhabdo.

Hypothermia in which the body temperature drop can produce many complications such as cardiovascular and neuronal defects that may exert heavy injury in the skeletal muscles. Avoid prolonged exposure of your body in extremely cold weather, and do not immerse your body in ice-cold water for a long time.

Viral and bacterial blood infections that are injurious to your muscle fibres.

Electrolytes such as potassium and calcium irregularities.

Hypothyroidism and hyperthyroidism

Kidney disorders elevate myoglobin in the blood.

Surgery that causes prolonged bed rest and immobilization that causes skeletal muscle disintegration.

Sickle cell anaemia

prolonged muscle inflammations.

Among all the above-mentioned causes for rhabdomyolysis, some are non-traumatic drug-induced indirect skeletal muscle injuries.

In rhabdomyolysis, there are elevations of serum myoglobin and creatine phosphokinase (CPK) in the blood followed by myoglobinuria in the urine.

Elevated CK cause hypotension and low blood supply to various organs like the kidney and the liver that leads to multiple organ failure.

Elevated CK also causes Compartment Syndrome.

SUMMARY OF CAUSES IN BRIEF

1.Muscle injury by accidents

2.Pressure on the muscles due to long time immobilization such as prolonged bed rest, long journey, coma.

3.Abusive drugs, such as narcotics, sedatives, antipsychotics, and antidepressants.

4.Prolonged and untreated burn injures.

5.Vitamin -D deficiency

6.Prolonged untreated microbial infections, skin cancers, psoriasis which damage skeletal muscles can precipitate rhabdomyolysis.

7.Prolonged body exposure to ultraviolet rays, harmful chemicals can cause rhabdomyolysis.

8.Overdosage and prolonged use of ...statin drugs like simvastatin, atorvastatin and pravastatin.

If you have acute or chronic pain in your lower back or neck and you are using narcotics, sedatives such as sleeping pills or any other psycho drugs and passing urine by dark red or brown colour, that confirms rhabdomyolysis. (See Fig.2)

Fig-2

Blood Profile in Rhabdo

1.Elevated muscle enzymes such as creatine phosphokinase (CPK), SGOT, SGPT, and LDH.

CPK level rise in the blood above 1000 U/L. That is 5 times the upper limit normally indicate rhabdomyolysis.

Myoglobin level exceeds 1.5mg/dl  

Too much intake of protein with heavy exercise may elevate CPK level in the blood.

Urine Profile in Rhabdo

Colour =  Dark Pinkish Red or Dark Brown

Creatine Phosphokinase (CPK) = Above 1000U/L

Myoglobin = even traces in the urine can indicate the presence of rhabdo but the colour of the urine changes to dark red or brown when myoglobin exceeds above 100gm/dl.

Fig-3

Any kind of muscular abuse can result in myalgia, myositis and rhabdomyolysis. These abuses are traumatic, or by drug overuses or by infections.

All antipsychotics including sleeping medicines, anticholinergics, antihistamines, are prone to abuse your muscles.

Symptoms of Rhabdo:

1.Muscle pain in the shoulders, thighs, or lower back.

2.Muscle weakness

3.Trouble moving arms and legs

4.Dark brown or red urine.

5.Decreased urination.

6.Abdominal pain

7.Nausea, vomiting

8.Fever, hyperthermia

9.Tachyarrhythmia

10.Confusion, and dehydration.

Sleeping Medicines That Causes Indirect Non-Traumatic Skeletal Muscle Injuries:

1.Alprazolam

2.Diazepam

3.Clonazepam

4.Lorazepam

and many other benzodiazepines.

5.Barbiturates

6.Opioids like heroin, morphine, codeine.

7.Abusive narcotics like cocaine, heroin, LSD, ketamine

8.Alcohol

Diagnosis:-

The most reliable diagnostic test for rhabdomyolysis is the elevated level of creatine phosphokinase(CPK) in the blood that is above 1000mg/dl.

This followed by a myoglobin test in the urine (dark pink coloured) test that confirms rhabdo.

Rhabdo-Treatments at Home:

The following home remedies can be beneficial when the disease is at the beginning stage.

1.Rest and relax conveniently so that muscle can recover from the damage.

2.Take plenty of water, light broth and sports drink to rehydrate your body and to prevent further kidney damages.

3.Withdraw abusive drugs such as sleeping pills step by step under the doctor's supervision.

4.Completely stop taking...statin like cholesterol-lowering drugs. 

5.Stop performing hard and heavy exercises.

6. If you feel tired recline in comfort and relax.

Compartment Syndrome

Fig-4
Lower Extremity Compartment Syndrome

Severe rhabdomyolysis at the extreme stage that may develop after fluid resuscitation produces potential complication like Compartment Syndrome.

Our body skeleton and skeletal muscles are divided into many compartments which are covered and separated by a special thick membrane known as Fascia.

Every compartment is supplied with muscle fibre cells, extra and intracellular fluids and components, neuronal and supplies. Any injuries to the myocytes, directly and indirectly, will disturb this system in a compartment, causes fluid collection inflammation and oedema in that compartment will lead to rhabdomyolysis.

Complications of Rhabdomyolysis:

1.Increased blood clotting

2.Low Pressure

3.Shock

4.Kidney and liver failure due to necrosis and insufficient blood supply.

5.Electrolytic imbalance.

6.Hypoalbuminemia (Blood albumin depletion)

7.Hyperuricemia (Increased uric acid level in the blood)

8.Compartment Syndrome

9.Disseminated Intravascular Coagulation. (DIC)

Disseminated Intravascular Coagulation. (DIC)

DIC is a condition affecting the blood's ability to coagulate to stop bleeding.

In DIC abnormal thick clots form inside blood vessels that consume all clotting factors of the blood. The depletion of the clotting factors causes heavy bleeding in all sites of the body.

The major causes of DIC are inflammations, infections, cancers and rhabdomyolysis.

Medical Counselling To Prevent Rhabdo

1. Avoid continuous use of statins and use them at one or two months interval.

2.Systematically withdraw the use of benzodiazepines, barbiturates and any other anxiolytics and sleeping pills.

3.Withdraw step by step the use of any psych medicines like antipsychotics, antidepressants and narcotics like opioids, cocaine, and LSD and completely stop them.

4.Carefully handle antihistamines, anticholinergics,  adrenergic agonists and any other ANS agonists or antagonists under the doctor's advice.

5.Avoid self medications.

6.Do not take anabolic steroid or any other steroid without a doctor's supervisions.

7.Avoid diet control supplements that contain harmful drugs like ephedrine.

8.Be alert when you are taking any hormone drug especially thyroid hormone, androgenic or contraceptive pill.

Non-Medical Counselling

1.Do not perform heavy exercises

2.Do not subject your body to exertion. Be care the job and recreational games that involves exertion, and heat exposure.

3.Drink more water to avoid dehydration before and after strenuous exercises so that your kidneys can eliminate any toxic myoglobin released by your muscle easily.

4.Avoid taking too many proteins and bodybuilders before and after heavy exercises as it may cause elevation of creatine kinase in the blood.

5.Do not sit or stand in one place for a long time.

Conclusively Rhabdo is a rare condition but life-threatening and can occur to anybody at any time without age difference in case if you abuse your body by any means.