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Wednesday, May 23, 2018
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Even a nurse can fall victim to medical mistakes

Q: Last year, I was hospitalized after lying dehydrated in the ER for 18 hours while waiting for a room. I was admitted with the wrong diagnosis and given the wrong treatment (which included a broad-spectrum antibiotic). Then I was discharged with a C. diff infection.

The drugs to treat the C. diff cost $5,600, and when I received a bill for an unknown “service” beyond what my insurance paid, I asked for an itemized bill. My insurance had been billed fraudulently. Even though I am a nurse, I was a helpless victim while I was ill.

Answer: Hundreds of thousands of patients are harmed or killed each year because of mistakes in hospitals and outpatient surgical centers.

When you are sick, it is hard to protect yourself from errors. That’s why everyone should take an advocate to the hospital, so you have someone to ask key questions. We outline the questions and common mistakes in our book “Top Screwups Doctors Make and How to Avoid Them” (in libraries and online at www.PeoplesPharmacy.com).

Clostridium difficile (C. diff) is a hard-to-treat infection that often causes unremitting diarrhea. Hospitals are breeding grounds for C. diff, which can become life-threatening.

Q: I went through menopause several years ago and have struggled ever since with vaginal dryness and pain. A few years ago I used Premarin cream, but it was messy and smelly, and I was scared that it might promote cancer.

Vitamin E soft gels as vaginal suppositories were not messy. They did help some, but the physician’s assistant at our clinic said I shouldn’t use vitamin E that way.

Replens helps slightly with the dryness but not with the pain. I’ve recently seen TV ads for a pill called Osphena that is supposed to treat this. What can you tell me about that option?

Answer: Osphena (ospemifene) was approved a year ago for postmenopausal women suffering from painful intercourse. Though it is not estrogen, vaginal tissues respond to it as if it were, becoming thicker and less fragile.

You might ask your doctor about trying it for a short time. It is not a long-term solution, because uterine tissues respond to Osphena as if it were estrogen, increasing the risk for endometrial cancer. Any woman who develops vaginal bleeding while on Osphena should see her doctor promptly. Blood clots are another potential side effect.

Q: You have written about the dangers of aluminum, but you have not been keeping up with the evidence. Back in the 1960s, a few studies found high levels of aluminum in the brains of people with Alzheimer’s disease. The research called into question the safety of everyday household items such as aluminum cans, antacids and antiperspirants.

But the findings of these early studies weren’t replicated in later research. Experts have essentially ruled out aluminum as a possible cause of Alzheimer’s. Why won’t you back off?

Answer: We wish that the worries about aluminum had truly been laid to rest by recent research. Unfortunately, epidemiology and experimental data show otherwise.

An aluminum researcher recently published a review titled: “Prolonged exposure to low levels of aluminum leads to changes associated with brain aging and neurodegeneration” (Toxicology, Jan. 6, 2014). Scientists have clearly established that aluminum is toxic to brain cells (Immunology Research, July, 2013). Although the connection between aluminum and Alzheimer’s disease remains controversial, new research has not exonerated this mineral.

Q: I have been working with a nutritionist who trained as a pharmacist. She has been very helpful.

I emailed her a list of my husband’s medications and asked which ones could cause erectile dysfunction. She said it could be enalapril with hydrochlorothiazide.

She recommended L-arginine, an amino acid that increases nitric oxide and boosts blood flow. The instructions are to take 500 milligrams twice a day, preferably on an empty stomach. Can you tell me more?

Answer: L-arginine is a natural compound that is found throughout our bodies and in foods such as nuts, seeds, whole grains, seafood and chocolate. It is an amino acid that is a building block for proteins, and as you have said, it is important for nitric-oxide production.

Nitric oxide relaxes blood vessels and improves circulation. Drugs for erectile dysfunction (ED), such as Cialis and Viagra, work through the release of nitric oxide.

As a dietary supplement, L-arginine has a mixed record of success for ED. In one controlled trial, it worked no better than placebo (Urologia Internationalis, No. 4, January 2000); in another, it only helped men whose own nitric-oxide production was subpar (BJU International, February 1999). Combining L-arginine with other compounds such as Pycnogenol (Journal of Sex and Marital Therapy, May-June 2003), adenosine monophosphate (Andrology, March 2013) or even drugs such as Cialis or Viagra (Journal of Sexual Medicine, January 2013) produced better results.

Side effects are uncommon but may include digestive distress, asthma or allergic reactions. In some people, L-arginine could trigger a cold sore or other herpes-simplex outbreak. Whether it would serve as an antidote to the blood pressure pill is unknown.

Q: After my migraines began flaring up weekly, I started taking riboflavin (vitamin B-2) daily. Ten weeks into this regimen, I have only had two really bad headaches.

I still have Maxalt as a backup, but I haven’t needed to take it in a few months. The only side effect I’ve had from the B-2 is bright-yellow urine. Compared to the migraines, I’ll take it!

Answer: Riboflavin has been used as a way of preventing migraines for many years (Neurology, February 1998). A review of research suggests that it may work even better in combination with Coenzyme Q10 (Headache, Supplement s2, October 2012). While riboflavin will turn urine almost fluorescent yellow, other side effects are rare.

Q: I get plantar warts on the soles of my feet. The doctor scrapes them, applies acid cream and covers them for 48 hours. They go away and then come back a few months later.

Help! How can I get rid of them without going back to the doctor?

Anwer: We have collected several plantar wart remedies through the years. They include:

♦ Taping a banana peel (fleshy side on skin) to warts overnight.

♦ Applying an olive oil and turmeric mixture to the wart.

♦  Taking cimetidine (Tagamet) orally.

♦  Soaking warts in hot water with salt.

Details can be found at www.PeoplesPharmacy.com.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them via their website: www.PeoplesPharmacy.com.

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