Shards of a Website
Posts from the archives of a defunct tech website

HEALTH CHRONICLES – Herbal Supplements and Heart Medications: Can they go together?

By the philippine daily idiot


Quick, what do you notice in the following?
“Waiter, I’ll have grapefruit juice. A friend says it’s okay for dieting.” - Aida
“I’m new in this networking business. Our ginseng liquid extract has been fantastic and I’m drinking some.” - Lorna
 “I’ve been on garlic capsules for three weeks now.” - Fe
Those lines are from some of my patients (not their true names) on different occasions. Now you’d say they mentioned herbal products in passing. And you’d say the herbals are natural and innocuous enough. They shouldn’t be a cause for alarm. Or wait, should they?
You see, for all the vogue of hugging trees and going green, organic and natural nowadays (and the multimillion industry arising from such), the clueless layperson can be prone to being exploited by unscrupulous people peddling gooey herbal stuff and all. Therefore, it pays to expose the common dangerous lie once and for all about herbal medicine: anything that is natural is said to be safe for our health. Nonsense.

Consider the case of Aida, Lorna and Fe. All are in their early 50s. The herbals they mentioned seemed harmless until I tell you that Aida and company have high blood pressure, high cholesterol and heart disease. They are taking prescription meds for such. My spidey sense would say Aida should never drink grapefruit while on medication. Grapefruit may help increase the effect of her meds to a dangerous level (for example, very low blood pressure) (Maskalyk 2002).
Second, Lorna should have known that despite claims about ginseng being cure-all, the side effects of some types of ginseng may include palpitations and elevated blood pressure, which may help diminish the effects of her meds (Tachjian A et al 2010).
Meanwhile, Fe is on aspirin for the prevention of heart attack and stroke. It would be prudent to know that both ginseng and garlic may possibly increase the risk of bleeding (Heck et al, 2000), especially in those who are on anti-clotting meds such as aspirin.
As a doctor, I acknowledge the potential of herbal medicines. In fact, many mainstream drugs today started out as herbals. Herbals in themselves do not constitute a magic potion. They're more like an indication of a holistic mindset about healthy lifestyle; a complement to the more mainstream regimens. Now, in the face of the chronic shortage and high cost of healthcare delivery in the country, herbal medicines are tantalizing linchpins in responsible self-care: they are inexpensive. They can be had regardless of a doctor’s prescription. Most if not all don’t require expert consultation. They are easily available everywhere. If you are enterprising enough, you can grow and concoct your own. And lastly, most (read: not all) are actually harmless in many situations – which is way better than hastily generalizing that everything natural is totally okay.
Now, what can be deemed from the advantages? Paradoxically, these advantages lead to disadvantages. Observe: because they’re readily available everywhere and are loosely regulated by the FDA if at all, the problems are legion.
The main problem is it’s difficult to assess their quality. Many entities making and selling herbal meds lack: a) scientific data (on mixing herbs and drugs, uniform dosaging, clinical efficacy, safety, toxicology, heavy metal content, and microbial contamination), b) standardization and quality control in production, and c) marketing techniques that don’t make outrageous claims or fool people. For example, if someone sells you Chinese marine herbal meds, how can you be sure they’re not contaminated with lead or mercury, and not adulterated with starch? Worse, there are no formal tests that can tell apart quality herbs from bogus and inferior ones.
The other related main problem is that many herbals today are taken: a) unevenly; b) in mega doses; c) in illnesses that are worsened by such; d) with mainstream heart and/or non-heart medications; e) long-term; f) and without the supervision of a duly recognized health professional. As such, the resulting interactions with mainstream western heart medicines may prove harmful. The herbals may potentiate the drugs, render them less effective, lead to new side effects, affect medical tests, or impact the disease in themselves.

Recently, a group of doctors in the US (Tachjian et al 2010) did a study on commonly used herbs and how these interact with heart medicines. Below is a table condensed from their study. It tabulates some herbs to avoid if one has heart/cardiovascular disease or is taking meds for such.

[Herbs - Heart (e.g., cardiovascular) medicines - Standalone effect of the herb on heart/cardiovascular system; effect of the herb on the medicine]
______________________________________________________________________
Alfalfa - warfarin - ↑ bleeding
Aloe vera -Digoxin - ↓ blood potassium causing digitalis toxicity and palpitation
Angelica (dong quai) - Warfarin - ↑ bleeding
Bilberry - Warfarin - ↑ bleeding
Butcher's broom - Alpha-blockers - ↓
Danshen - Anticoagulant or antiplatelet agents - ↑ bleeding
             - Digoxin - ↑
Echinacea - Amiodarone or ibutilide - Palpitation
               -  Statins, fibrates, niacin - ↑risk of liver toxic effects
Ephedra - Class IA and class III antiarrhythmics (types of meds for palpiations) - Palpitation
             - Beta-blockers - ↓leading to hypertension and tachycardia
Fenugreek - hypoglycemia
                - Warfarin - ↑bleeding risk
Fumitory - Beta-blockers, calcium-channel blockers, cardiac glycosides (digoxin) - ↑
Garlic - Aspirin, clopidogrel, warfarin, or heparin-like drugs - ↑ bleeding risk
Ginger - Warfarin - ↑ bleeding risk
Ginkgo biloba - Potential risk of seizures
                    - Aspirin; warfarin - ↑ bleeding risk
Ginseng - ↑ blood pressure; palpitation
    - Digoxin - interferes with digoxin blood test, leading to falsely increased levels
    - Warfarin - ↓
Gossypol - diuretics; ↑ diuretic effect; ↓ low blood potassium
Grapefruit juice - statins, irbesartan, calcium-channel blockers; drugs for palpitation, warfarin - ↑
Green tea - Warfarin - ↓ (contains vitamin K)
Hawthorn - Digoxin; calcium-channel blockers or nitrates - ↑
Irish moss- Meds for high blood pressure - ↑
Kelp- Antihypertensive; anticoagulant agents - ↑
Khella - Anticoagulant agents and calcium-channel blockers - ↑
Licorice - ↑ blood pressure; ↓ blood potassium
            - Spironolactone; digoxin - ↑
Lily of the valley - Beta-blockers, calcium-channel blockers, digitalis, quinidine - ↑
Ma-huang (ephedra) - ↑ heart rate and blood pressure
Night-blooming cereus - Angiotensin-converting enzyme inhibitors, antiarrhythmics, beta-blockers,
                                    calcium-channel blockers, cardiac glycosides - ↑; palpitations
Oleander - Heart block; ↓ blood potassium; palpitation; death
Saw palmetto - Anticoagulant or antiplatelet agents - ↑ bleeding
Soy milk -Warfarin -↓
St. John's wort - Digoxin - ↓
      - Clopidogrel - ↑ bleeding
      - Warfarin - ↓
      - Simvastatin - ↓
      - Class IA and III antiarrhythmic agents (types of meds for palpiations) - ↓ (resulting in palpitations)
Storphanthus - Cardiac glycosides (digoxin) - ↑
Yohimbine - Clonidine, Guanabenz - ↓ blood pressure reduction effect of centrally active agents
                - ACE inhibitors (“-april” drugs) - ↓; hypertension
- Beta-blockers ( “-olol”meds) - ↓; hypertension; increases heart rate
______________________________________________________________________
Note that the list of side effects and interactions above is not exhaustive (it doesn't even mention the effects of animal products used in complementary medicine). This may change if new insights and breakthroughs arise in the future. Hence, they are better properly discussed with one’s healthcare provider.
Here are final tips. Always inform your healthcare provider if you are taking both heart medicines and herbals. If you are still in the stage of planning to take both, stop and ask: how would the herbal preparation affect the prescription medicine and my health? Consult. Any unexpected effect that you sense after taking the herbal should be reported to your healthcare provider as soon as possible.
Sources
Heck A M, DeWitt BA & Luke AL. Potential interaction between alternative medicine and Warfarin. Am J Health Syst Pharm 2000; 57:1221-1227.
Maskalyk J. Grapefruit juice: potential drug interactions. Canadian Med Assoc Journ 2002;167(3):279-280.
Tachjian A et al. Use of Herbal Products and Potential Interactions in Patients with Cardiovascular Diseases. JACC 2010;55(6):515–525.

 
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Bucket Lists in the Time of Armageddon

By the philippine daily idiot

It’s supposedly the Armageddon, sortof, in America right now. Or Day 1, Year 1, AA* around here. :)

No other time could be more perfect to talk about bucket lists. Japan's recent apocalyptic triple whammy means that thinking up our ideal top ten must-do's must be vogueish.

Ah, bucket lists, missions, and goals. They give meaning to our existence, not just a clear straight line to the grave.

And yet, most missions are never complete. Nor every bucket list item is ever ticked.

That’s because keeping up with the Joneses (now reincarnated as Facebook envy) and the barrage of ads (power of suggestion) render such lists seemingly incomplete (“I want that, too.”), impractical, and a source of disillusionment. 

Moreover, the forces of nature might just torpedo them all in one go.

Listen. Vacation plans can get totaled by an Ondoy. Grand designs can be imploded by an Al Qaeda jet. A view of the Boracay sunset can get inundated by a tsunami. 

The dream/dream car shattered by an oncoming truck in the headlights. The booty call ruined by a patient’s call. The next one exploded by a meteor on impact.

Then, the mass extinction of happiness can ensue.

So what lists are we talking about when every moment is Armageddon material? Haha!

The urge to list needs to be cured by our appreciation of things as they are and as they come. I.e., seeing the sunnier side to the epic fail, and the poetry in the mundane. 

Heck, I can channel Boracay vibes in the disgusting heat of the concrete jungle. I can eat isaw and bihod and call them offal and caviar.

Call them what you may -- defense mechanisms or rationalizations or what-have-you. 

To me, it’s just going Zen on your asses.

Now compile them and voila, you have a retrospective spur-of-the-moment top ten. 

One time, my white shirt caught a nasty stain, a stain not unlike some sort of end-of-days rust.

I said holy s#!+ but I was fine, noting it’s nothing compared with losing one’s wallet to pickpockets.

I still went on to pay courtesy call on some medical society bigwig.

Then, five days ago, kaboom, my wallet got stolen. That wallet was a gift from my brother.

Now I have to say oh that’s nothing. People die of hunger in Africa. (Argh.)

See? Events torpedo epic lists. _____________________________________________________*A*AA = After Armageddon

 
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LARGE HADRON COLLIDER vs. METRO RAIL TRANSIT: A COMPARATIVE STUDY

By the philippine daily idiot



LARGE HADRON COLLIDER (LHC) a
METRO RAIL TRANSIT (MRT) b

What is it?
Particle accelerator1
People accelerator
What does it do?
Smashes atoms at near light speed.

Then we can pick up the resulting smithereens, and hope to gain new insights into the hadron, the dimensions beyond 3D, the slowing of time.
Mashes people into tight spaces, sends them to their destinations.

Gives lazy people the false sense that it's ok to wake up late because with the MRT, the workplace is just a heartbeat away; that, yes, therefore, time indeed slows down.
Shape
Circle
Semi-circle (shape of EDSA2)
Path length
27 kilometers (circumference)
16.95 kilometers
Speed
99.999999% of the speed of light
Far below light speed but it will do.
Location
French-Swiss border
Great and Glorious Nation
Unwanted side effect
Creation of a black hole
Same
Risk of instigating a black hole
Low
High (warning alert: level-A evidence)
Level of evidence for the above
According to Stephen Hawking at Newsweek:2

“[I]t is absolutely safe… But if the collisions in the LHC produced a micro black hole, and this is unlikely, it would just evaporate away again, producing a characteristic pattern of particles. Collisions at these and greater energies occur millions of times a day in the Earth's atmosphere, and nothing terrible happens.”
An exclusive research by the Philippine Daily Idiotreveals:

On October 6, 2008, I felt what it likes being packed tight inside the train.On my way to Makati, the packed mass of people, assorted in their levels of Rexona use, was so dense it reached critical mass and could collapse unto itself any time, resulting in a black hole.
Scary incident
So far, none yet.
On that day, when the packed mass of commuters was on the verge of imploding into a black hole, the train -- all of a sudden, in an anti-climax -- stopped, and the participants let go and dropped off at the Ayala Station. Bummer.
Other claim to fame
Creation of the Grid,3forerunner of the Matrix.
Cheap fare.
Ranks, along with the black market and the blogosphere, as a great social equalizer.
a Blah blah blah
b Blah blah blah
1 Blah blah blah
2 Blah blah blah
3 Blah blah blah
 

 
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Great Social Equalizers in the Time of Subprime (last part of 3 parts)

By the philippine daily idiot



IN SPITE of the present world financial crisis that threatens to swallow us whole, hope springs eternal if we keep on discovering the great social equalizers of the world. 

The idea of a great social equalizer gets starker, e.g. its importance becomes more emphasized in interesting times like the time that we are now in.

BUT FIRST, what the heck is a great social equalizer, anyway? My lazy Googling skills didn't bring me anywhere.

Perhaps, a great social equalizer is: any instrument, device, institution, thinking, movement, thought, invention, cause, organization, paradigm shift, fad or fetish that tries to bridge the gap in terms of fun and coolness between the rich and the poor, and between the powerful and the powerless. That is, to attempt to somehow equally distribute/democratize fun among people or groups of people. :-)

As long as there is poor and there is rich, great social equalizers are here to stay. 

No great social equalizer is really that great or perfect but any attempt is more welcome than nothingness in the face of disparity in the distribution of wealth and fun and power and coolness and Serendra properties and Rolexes across nations. Calling great social equalizers as great is only for rhetorical purposes.

History is littered with great social equalizers:

1. the Industrial Revolution
2. Karl Marx, literally
3. the pre-paid phone sim card
4. the United Nations and its agencies
5. The violence/armed struggle resorted to by marginalized groups. If there are no legal avenues to successfully advance a just cause, history teaches us that violence, acceptable or not, is a sensible instrument for leveling the playing field. Most nations of the world were born out of violence.
6. The Metro Rail Transit. Body to body, the rich and the poor ride the train.
7. the Internet and its spawn, the blogosphere
8. Democracy, of course
9. the rule of law
10. The snarling traffic on the non-express South Expressway. Whether it's a Jaguar or a kariton, the speed is the same: crawling speed. Hehehe.
11. the Department of Agrarian Reform, in theory
12. fighting words
13. They said heaven is a great social equalizer. I'm really an agnostic.
14. You name it! Our digestive system is one great social equalizer. You know, whether you eat caviar or galunggung, they all end up as the same thing -- shit. I think there is not much difference between the poor and the rich in terms of turning food into feces.

15. Come to think about it. The financial crisis today is one heckuva great social equalizer. Quick, look at the profiles of those friends at Friendster that proudly state that they work for companies such as AIG, Meryl Lynch, Lehman Brothers. Or that they live in Iceland. Hehehe. Profile updated: Worked for.

As a resident of the Third World, I am nonplussed by the fall of the much vaunted Wall Street and how it streams into our unsheltered personal asses.

I am nonplussed on two levels.

I am nonplussed because, from what I know, it's regrettable that the great American invention and great social equalizer called the American Dream, tantalizing to most of us, is inherently tied to the credit crunch. 

Notice that we are surprised how fast the average hard-working Juan could get a home with an SUV in the garage in America. His car is all over Friendster. This is because the American Dream is reachable when Juan opens a credit line or a credit card. You know, a sort of DREAM NOW! HAVE THEM EVEN NOW! PAY LATER! This reflects the so-called ownership society envisioned by the US Republicans. 

Problem is, credit becoming over-credit is what befalls Walls Street. Does this ultimately mean to our nursing graduates, “Hello to local call center jobs”?

At level 2, I am nonplussed in the sense that although our government would say that we may be affected by the credit crunch caused by subprime American homeowners, the truth is, here in the Third World, our asses have been subprime since forever, kindof. Our loans are peanuts by American standards. We don't do loans to buy an SUV or a mansion. I know a lot of friends who loan para lang makapunta sa Boracay. Enough said.

There is so much disconnect between what's happening around here and the great social equalizer called the American Dreamanywhere abroad. Heck, there is even more disconnect between Wall Street and Divisoria. What the government probably is talking about is that the in-flow of remittances, passed off as the trickle-down effect of local good governance to prop up the corrupt government, would likely slow down. (In contrast, Thailand and Indonesia don't even need remittances to progress. That's how worse the Great and Glorious Nation is.)

NOW, our disconnect from the great social equalizer of the American Dream is also due in part to an unheralded great social equalizer: the black market. Hey, I'm not talking here about plutonium or cocaine. The non-credit-based black market is simply the maverick way of making fun accessible to the poor. Maybe the official market is vulnerable to any problems in other parts of the world but the non-taxed black market of pirated CDs, shoes, and everything else in Greenhills and Divisoria is less so or even not at all affected.

Around here, as I have been saying, the black market is the new black, it is de riguer. The black market on steroids is a natural outgrowth of the homogenizing effect of monopolies (e.g., Windows, mp3 format, BluRay, etc.) on IT products. Why?

Ans. Because a lot of products are based on the Windows platform et al and everyone uses Windows. It is feasible/lucrative to pirate products that everyone has already been using. Monopolies are maybe dark and evil and want our souls but thanks to the monopolies and to Bill Gates, they had inadvertently given birth to a more vibrant black market.

This is entirely beside the point. Okey, the ultimate great social equalizer is the appreciation of the simpler things in life. On second thought (maybe I'm just sleepy), that's the essence of the black market. (The selling and enjoyment of the home-made kakanin and halo-halo is essentially black-market; shoe-shining and jeepney-driving and -barking are essentially non-taxed and totally black-market.)

Even if our local asses have been sortof subprime since way, way long before subprime became a hot new word, we are prime in making the best of what we have in here. That's what I do. I don't have a credit line and my phone is a Nokia 8210. I don't eat in fancy restaurants. I'm writing this on an EeePC. I'm online via free Wifi. How crisis-proof I could get?

Meanwhile, they are having a hard time parting with their plasma TVs and SUVs. Good morning.

 
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IN A DOG-EAT-DOG* WORLD, THIS IS WHAT IS MEANT BY “HAS GONE TO THE DOGS”

By the philippine daily idiot




I mean, I'm referring to a certain forwarded message. But later on that.

Of late, I have been ripping off my inbox. Many of these gems of forwarded messages must never be lost in the archives forever.

Why? Sayang eh. The psychology behind forwarded messages is that they are an antidote to destruction or boredom.

OR they are a reminder of the same. They seem so, while we are wasted between 12NN and 1PM in our work stations.

They’re cute, funny, touching, Nirvana-enabling. OR they’re gross, emo, hardcore, soul-freezing.

In the world of messages forwarded (in contrast to the blogosphere), a tribe of creative artists thrive, the kind who will never be acknowledged for unselfishly originating and dishing out coolness in the form of forwarded messages. In my attempts to trace who ultimately forwarded which, the originators get lost.

But cut the over-analysis, will you? It's really beside the point.The forwarded message below is about what my gut feel considers as a true event in Japan/China/wherever – it’s a welcome respite from bland sex and the usual Hippocratic frothing in the mouth -->


Hey, wake up! wake up!

A dog was knocked down by a car and died on the middle of the road. Later, this dog is seen beside the corpse of the dog, he tried to wake his wife up using his leg.


Let's move to the safer side of the road...i will move you to the safer side!

When his attempts to wake his wife failed, he tried to push his wife to the side of the road. But the weight of his wife was proven too heavy for him.



Anyone help, tell me what to do.

Though the traffic is busy and dangerous, he just will not go away from his wife. Just stand beside his wife howling and crying.



A lot of people saw this incident and feel very touched.

How even a dog can show his loyalty and love to his wife.

______________

End of forwarded message.

Silence.

(OK, I still have to credit who originally forwarded this message. Those images even have watermarks if you look closely. To the owner, don't request Blogger yet to have them erased. :-) )

Anyway, I must say it’s the highest form of speciesism/antropocentrism when humans insist that animals have no souls. If animals are soul-less, why do they understand death?

I have come to a profound conclusion, thus (naks). And it’s beyond the metaphorical or the figurative (e.g. the soul-less Hitler; the soulful voice of Aritha Franklin). This is it: depending on your viewpoint/mood, animals are either as soulful or as soul-less as the rest of us are in the universe. Especially you. Especially Joc-joc.

Now, if you still have doubts about animals’ capability of genuine compassion, look no farther than another true story – the case of two elephants named Jenny and Shirley – which was featured in Reader's Digest and somewhere else.

So, once upon a time …

 
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THE EFFECTS OF FALLING IN LOVE: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

By the philippine daily idiot



Mel, OK MD, PDI1 and Northrop Jones, MD, PhD2

1 As in yeah, OK!
2 Mukhang Doktor Pero Hindi Doktor


A B S T R A C T



Objectives To determine whether falling in love results in trauma, romance, marriage, pregnancy, or long life.

Design Systematic review of randomized controlled trials.

Data sources Medline, Pubmed, and the Cochrane Library databases.

Study selection Randomized controlled trials showing the free fall effects of falling in love.

Main outcome measures If falling in love is a form of gravitational challenge: Death or major trauma, defined as Glasgow Coma Score of 3. If falling in love results in romance, marriage, pregnancy or long life: Romance, marriage, pregnancy or long life.

Results We were unable to find randomized controlled trials of gravitational challenge posed by falling in love or that of resulting in romance, marriage, pregnancy or long life. (BTW, is it rise in love instead of fall in love?)

Conclusions and Recommendations As with many methods proposed to make life long and worthwhile, falling in love and the efficacy of its use has never been subject to rigorous testing by way of randomized controlled clinical trials. Supporters of evidence-based effects of falling in love have disapproved of the use of studies using only descriptive observational phenomena.

We suggest that everyone participates in a double-blind, randomized, placebo-controlled, crossover trial of falling in love.

Haay. In other words, ganito ang binoblog ng mga taong --you know. Hahaha.

Belated Happy Valentine's Day!

 
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in search of the perfect flash drive

By the philippine daily idiot


By perfect, I mean resistance to violence, war, famine, pestilence, nuclear detonation. (God, no sensible post yet in my busy, busy life.)


And yes, in my busy, busy life (w/c is short of a nuclear detonation area, sortof, right now), I am a recidivist when it comes to misplacing thumb drives. At times, I commit them to accidental total destruction.
Ah what fun! It is not fun.

So the point is, I'm looking for that shock-proof, water-proof drive. Here are the 5 short-listed ones:

1. Super Talent 's pico drives:


Verdict: Pico-sized, duh. Can insert them in tight spots like your wallet. But will easily get lost in many places - not excluding bodily orifices (sometimes a flash drive is just a flash drive, damnit). :D

2. Lacie's iamaKey, itsaKey, and PassKey:


Verdict: Key-sized, duh. Woot.


3. Pretec's i-Disk:





Verdict: Bullet-proof. For the James Bond types.


4. The IronKey:



Verdict: Military-grade hardware encryption. Will self-destruct a la Mission Impossible. Nah, I won't have it self-destruct for just some stolen private videos. :-)


5. And last but not the least, the IronDrive:




Verdict: Get ready for this --> resistant to nuclear explosion. Kaboom. But with that size, I won't schlepp it around. Plus, it's least likely that I will have Dear Leader Kim Jong Il for an enemy.


Hey, WAIT FOR MY OVERALL VERDICT: Got the Lacie iamaKey, man! It has theAdvantage ofBeing locallyAvailable.

 
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