Health News. Lots of resources and information

Methadone is a synthetic opioid analgesic which is indicated for the treatment of severe pain in patients unable to take morphine. It is effective orally, rectally and by injection. Methadone is contraindicated (or should be used with great caution) in patients who are frail, elderly or confused and in those with significant hepatic or renal impairment, as the risk of toxicity is higher. The side effects of methadone are similar to morphine except that cumulative toxicity may occur, usually heralded by sedation and confusion.     Administration of methadone is complicated by the drug’s complex pharmacokinetics. After a single dose, the half-life is about 15 hours but the duration of action is only 4-6 hours. With continued therapy, the half-life increases to 2-3 days and it is usually necessary to reduce both the dose and frequency of administration.• Failure to reduce the frequency of administration after the first few days -will predispose to cumulative toxicity with sedation and narcosis.     Pethidine is a synthetic opioid drug used for the treatment of severe acute pain. It has a therapeutic ceiling related to CNS toxicity and should not be used in the management of chronic cancer-related pain.     Accumulation of norpethidine occurs in patients given high or frequent doses and those with significant renal impairment, causing CNS excitation with agitation, tremor, myoclonus and seizures. The myoclonus and seizures are unresponsive to naloxone and are treated with benzodiazepines and anticonvulsants.• Pethidine given in high dose or in the presence of renal impairment leads to CNS irritation and seizures and it should not be used for chronic cancer-related pain.*57\55\2*

Going ‘Cold Turkey’ or Cutting Down Slowly?It is worth noting that if you cut down by any more than a third of the daily amount of cigarettes you could have a full-blown withdrawal syndrome even though you are still smoking. Maybe this is why total abstinence is usually encouraged. On the other hand if you could gradually cut down without lapsing when you had a night out or a bad day, and look after your diet and so on, it could make the final bid easier. It is to be hoped that you will take heart from these stories and remember at the time these people gave up they knew nothing about diet or supplements – you are going to find it much easier!Smoking and CaffeineThe British Medical Journal published some material which shows that caffeine metabolism slows down within days of giving up smoking. Smokers often tend to be quite heavy coffee drinkers, possibly because they metabolize caffeine faster. If they continue with the same amount after the caffeine metabolism slows down, their blood levels of caffeine may go up by 250 per cent. This can continue for several months after stopping smoking. It would seem sensible to change to decaffeinated coffee and even to cut down on that before stopping smoking. Caffeine poisoning could be a large part of the unpleasantness of withdrawal for some people.*44\326\8*

The relationship between a doctor and a patient is an important factor in the treatment of illness. Both the doctor and the patient share a responsibility in the management of asthma. Except for those living in sparsely populated rural areas, most people are able to choose their doctor, particularly their general practitioner.The GP is usually the primary care medical professional in the treatment and management of asthma. It is common for a GP to refer patients to a specialist for specific tests and further assessment, but it is normally the GP with whom the patient has the most contact.Choosing your GP is an important decision. If possible, it is best to have a doctor whom you respect and trust professionally as well as like personally. A mutually respectful and trusting relationship between a doctor and patient makes communication easier, helping the patient feel comfortable in discussing personal health problems and helping the doctor diagnose problems more readily.As the severity and symptoms of asthma can vary from person to person, it is important to have a doctor who is able to recognize and diagnose asthma, is cognizant and up to date with available medications, and who will spend the necessary time working out a management plan for each patient. A patient should also ask for an action plan that can be implemented in the event of an acute attack.Unfortunately the ideal is not always the reality. You may not live in an area where there are enough available doctors to choose from. This can be a particular problem for asthmatics living in rural communities. It is particularly important for such people to have a good management plan and know how to self-medicate.While asthma education for both doctors and patients is improving, asthma is still poorly treated in the community and the information given to patients by doctors is often inadequate and incomplete. This was certainly true for Sonia, 58, when she sought a new GP:I don’t have a car, so I went to the doctor nearest my home. I began to realize that he did not know much about asthma after he prescribed ten courses of antibiotics for my wheezing over a four-month period. I also had Ventolin, but my asthma got worse. Finally I went to the out-patients clinic at a hospital, saw a specialist and my treatment was changed. I am now on Becotide as well as Ventolin and am much better. The specialist advised me to get a peak flow meter and I use it twice a day to monitor my breathing. I also go back to the hospital for regular reviews. The specialist at the hospital said he has written to my GP, but so far I have not been back to see him. Now that I am feeling better, I feel more confident, so perhaps I can discuss my medication with the GP without feeling I am telling him what to do.There is still a serious communication gap between many doctors and their patients. This can be the fault of either. Doctors have a responsibility — but so do patients. Doctors are not trained communicators or educators and some have to deal with difficult and obtuse patients who don’t reveal all their symptoms, take their medication erratically and often take more notice of what unqualified people tell them than the advice given by their doctors. Most doctors have a few horror stories to tell about self-treatment.Many doctors do not appear to allow sufficient time to explain the disease and the management of asthma to the patient. A competent doctor should be able to give the patient and their family a thorough and realistic explanation of asthma and how to manage it effectively.The National Asthma Campaign has produced The Asthma Management Plan, a booklet which has been distributed to doctors and medical students. The publication provides doctors with:•An endorsed asthma management plan in a form that can be used both as a reference and as a teaching tool;•A consistent terminology for both doctor and patient to use;•Check points to help ensure comprehensive management. The National Asthma Campaign’s Management Plan provides a framework within which doctors and patients can work together. It engenders a new and better doctor/patient relationship and encourages patients to take more responsibility for their health and asthma management. Initiatives such as this booklet are addressing many of the perceived problems in asthma treatment and doctor/patient relationships.Most State Asthma Foundations offer a telephone service to help the public with questions and problems about asthma treatment, medication and management.QUESTIONS TO CONSIDER WHEN CHOOSING YOUR DOCTOR:Are you comfortable and at ease with your doctor, and can you discuss your health problems openly?Does your doctor respect your views and your confidentiality?Does your doctor adequately explain what is happening and what treatment to expect?4- Does your doctor spend enough time with you?Does your doctor prepare you for possible side effects of the prescribed medication?Do you feel that you are participating in your general health care and asthma management plan?Does your doctor show displeasure if you suggest a second opinion? (A patient has a right at all times to obtain a second opinion from another doctor regarding any aspect of health.)A visit to your doctor is often more productive if you write down all your questions and observations of symptoms beforehand.*46\148\2*