Diplomate, Board Certification of Emergency Medicine
I want you all to know how much I appreciate hearing from
you. I believe I answered the retired doctor from Petach
Tikva on a subject we have discussed previously. The NSAIDs
may be dangerous in older patients. This group of drugs
includes Naproxen (Naxyn, Narocin), Ibuprofen (Artofen,
Advil), and Voltaren as well as newer drugs like Vioxx. All
these drugs can cause bleeding in the stomach, kidney failure
and are at best mild pain relievers no better than
paracetomol. They do reduce fever well and since all these
side effects are rare in children this is a good choice for
them. On the other hand, they are not used in pregnancy.
I received another article from Mrs. W. from a newspaper that
uses an Associated Press medical column. These columns are
generally well-written but they do not consider special
situations in Israel, tend to have some bias, and of course
they cannot have questions sent to them. The article in
question was about PVD or disease of the blood vessels. This
is most often seen in pregnancy with the well-known varicose
veins, and occasional clotted superficial blood vessels which
sometimes get infected. This condition is known as phlebitis.
Worse disease includes discoloration and swollen legs that
develop bulla--fluid-filled blisters. A variant of PVD is
shoshana or erysipelas, the red, painful, hot legs
that we often see in Israel. Support hose and frequent
exercise all help in these conditions.
Diabetic circulatory problems come from poor control of
diabetes, and while fats in the blood may go along with
diabetes, the diseases are not related. Who has diabetes?
Overweight people can develop it but if you are drinking and
urinating a lot, you should think of it. A simple blood test
can tell if you have it and how bad it is. Poor control of
diabetes or poor treatment of non-diabetic PVD can lead to
amputations.
Other common variants are DVT: a clot in the leg which can be
due to cancer, long trips without exercising the leg, surgery
(especially pelvic surgery), and immobilization. A trip to
Israel without walking around in the plane can cause this.
The most feared complication is an arterial clot which causes
a cold, pulseless, painful leg without feeling in it. If the
clot is not opened soon the leg can be lost. Frostbite can
lead to a similar situation.
The best bet to prevent all forms of vascular disease is to
exercise. Write me in care of the Yated.
A message from GlaxoSmithKline, sponsor of this
column. Oxy is Glaxo's treatment for acne. It does work.
A prescription is not needed, and the active ingredient is
the very effective Benzoyl Peroxide. Unlike other treatments
for acne it can be taken in pregnancy and by nursing
mothers.
