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Common use The main component of Viagra is Sildenafil Citrate. Sildenafil Citrate affects the response to sexual stimulation. It acts by enhancing smooth muscle relaxation using nitric oxide, a chemical that is normally released in response to sexual stimulation. This smooth muscle relaxation allows increased blood flow into certain areas of the penis, which leads to an erection. Sildenafil Citrate is applied for the treatment of erectile dysfunction (impotence) in men and pulmonary arterial hypertension. Sildenafil Citrate may also be used for other purposes not listed above. 

Dosage and direction Usually the recommended dose is 50 mg. It is taken approximately 0,5-1 hour before sexual activity. Do not take Viagra more then once a day. A high fat meal may delay the time of the effect of this drug. Try not to eat grapefruit or drink grapefruit juice while you are being treated with Sildenafil Citrate . Precautions Before you start taking Sildenafil Citrate , tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. Aged people may be more sensitive to the side effects of the drug.

Contraindications Viagra is contraindicated in patients taking another medicine to treat impotence or using a nitrate drug for chest pain or heart problems. This medicine should not be taken by women and children as well as in patients with a known hypersensitivity to any component of the tablet.

Possible side effect The most common side effects are headache, flushing, heartburn, stomach upset, nasal stuffiness, lightheadedness, dizziness or diarrhea. A serious allergic reaction to this drug is very rare, but seek immediate medical help if it occurs. Many people using this medicine do not have serious side effects. In case you notice any side effects not listed above, contact your doctor or pharmacist.

Drug interaction This drug should not be used with nitrates and recreational drugs called "poppers" containing amyl or butyl nitrite; alpha-blocker medications; other medications for impotence; high blood pressure medicines, etc. Consult your doctor or pharmacist for more details.

Missed dose Viagra is used as needed, so you are unlikely to be on a dosing schedule.

Overdose If you think you have used too much of this medicine seek emergency medical attention right away. The symptoms of overdose usually include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.

Storage Store your medicines at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store the drugs in the bathroom. Keep all drugs away from reach of children and pets.

Disclaimer We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

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What is Insomnia?

Insomnia exist in various forms: many suffers experience difficulty in getting to sleep, others have interrupted sleep, some wake up too early in the morning and a few simply have poor quality sleep and do not feel rested. If insomnia lasts for more than 3-4 weeks, it is termed chronic.

What are the problems associated with Insomnia?

Individuals vary in their need for sleep: we all know of individuals who can ordinarily function well with less sleep than others. However, for people with insomnia, it causes distress and affects their everyday lives. Poor sleep result in daytime drowsiness and can impair attention and motor coordination when driving or operating machinery. This can be dangerous. Poor attention and memory also affect studies and work productivity. A person deprived of sleep will tend to be irritable and this can impair his relationship with others. Hence an individual with a sleep problem may have an impaired quality of life. It is also important to note that in many cases, insomnia can be a symptom of a psychological disorder such as an anxiety disorder or depression, and these disorders should be treated. Some individuals with chronic insomnia attempt to treat themselves by consuming cough syrup or alcohol. Unfortunately, such an abusive pattern of drug use will not only compound the sleep problem but also cause damage to physical health and create addiction problems.

What are the causes of insomnia?

Insomnia is a very common condition, and most people would have experienced it a few times in their lives. Sleep disturbances can happen in normal people simply due to situational influences. For example, excessive noise or an unfamiliar environment can affect sleep. It occurs in jet-lag, when the person travels across different time zones, and also when a person engages in shift work. Correction of these situational influences will usually improve sleep. Certain physical symptoms such as pain and shortness of breath in patients with medical problems can disrupt sleep.

Transient insomnia also occurs in response to stress or worry. It is common to have poor sleep when one is undergoing stress in studies, workplace or relationship. When the stress is overcome, sleep will usually improve.

However many individuals also suffer from chronic insomnia, where sleep problems persist for more than a few weeks, because the stressors are persistent or overwhelming. Insomnia occurs commonly in adjustment disorders, where one’s coping strategies to stress are overwhelmed. Others may have a psychological disorder such as depression, which needs prompt medical treatment.

Insomnia, especially early awakening, occurs commonly in depression. Other accompanying symptoms of depression that one should look out for include depressed mood, loss of appetite, loss of drive or interest, frequent negative thinking, feelings of worthlessness and even suicidal thoughts. Depression is a disorder that can severely affect an individual’s life but effective treatments are available. Another group of disorders commonly associated with insomnia are the anxiety disorders. These disorders are characterized by persistent and excessive anxiety and worry. Some may also have panic attacks, whereas others have persistent bodily complaints. Yet others have compulsive cleaning or checking rituals, which are symptoms of an obsessive-compulsive disorder. Finally, insomnia is also experienced by an individual developing a major mental disorder like schizophrenia. In this disorder, one experience hallucinatory “voices” and has strange behaviors and beliefs.

It is unfortunate that the psychological disorders mentioned above are frequently under-diagnosed and under-treated, as effective treatments are currently available for these conditions.

How do I know if I need assessment and treatment?

If you have poor sleep for more than 2 weeks and it has been affecting your activities and function, a consult with a doctor will be appropriate. This is especially so if you have other symptoms suggestive of a medical or psychiatric disorder such as depression – these will need to be addressed too and remember, they respond well to treatment. The doctor will talk to you to obtain a thorough medical history, followed by a physical examination. This is to identify any medical or psychological factors that might contribute to your insomnia. Physical investigations such as blood tests may or may not be required. The doctor then makes the diagnosis and decides on the treatment.

How is Insomnia treated?


This is achieved using both non-pharmacologic (non-medical) and pharmacologic (medical) approaches.

A. Non – Pharmacologic
 – Firstly anyone who is a light sleeper or has sleep problems should adopt proper sleep hygiene. Hence one should avoid coffee, tea and drinks containing caffeine from late afternoon onwards, avoid prolonged afternoon naps and ensure that the bedroom is quiet (ear plugs can help) and comfortable. Alcohol should be reduced: although it appears to help induce sleep, it actually disrupt sleep later on. Only go to bed when very sleepy and get out of bed to do some quiet reading if still not asleep after 15 minutes. Relaxing activities such as meditation or practicing muscle relaxation before sleep also helps.

B. Pharmacologic – 
For individuals who need it, the doctor may prescribe sleeping pills. Sleeping pills generally belong to a group of sedatives called benzodiazepines. Certain sedatives such as zolpidem and zopiclone have benzodiazepine-like actions. Different sedatives are effective in promoting sleep in various ways, for example the shorter-acting ones (such as lorazepam) promote initiation of sleep without causing much daytime sedation, whereas the longer-acting ones (such as diazepam) helps one to maintain a longer period of uninterrupted sleep. Despite its proven effectiveness, in a small proportion of users, benzodiazepines are associated with dependence (difficulty stopping its use and need for larger doses over time): this risk is much reduced if the users take the pills for short periods, in moderate doses and under medical supervision. As the patient’s condition improves, the doctor will instruct the tapering down of sedative doses. It is important to note that most users of sleeping pills successfully stop its use when their conditions are treated.

Some individuals taking longer acting benzodiazepine sedatives might experience daytime sleepiness and this is of concern when driving or operating machinery. Sometimes, a person with concerns about the addictive potential of benzodiazepine sedatives may instead be prescribed antihistamines (such as certain flu medicines) or antidepressants with sedating properties. These can work equally well.

It is also important to note that in individuals with depression or anxiety, sleeping pills are adjuncts to antidepressants and anti-anxiety medicines, which are main medical treatment. As the individual’s depression lifts, his sleep will also improve. There are guidelines set by the Singapore Medical Council regulating the prescription of sedatives by general practitioners, and patients must understand that if the insomnia persists and more sedatives are required, a referral to a psychiatrist may be needed.

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Looking For Cheap Diazepam, UK Residents Can Safely Look Online

Diazepam, better known by the brand name Valium, is a prescription medication that belongs to a group of medications that are sedative and anxiolytic (anti-anxiety) in nature, known as benzodiazepines. These kinds of medications are used to treat anxiety, insomnia, muscle spasms and seizures. This medication was introduced in 1963 and it gained quick success and popularity with doctors and patients alike. Between 1969 and 1982, Valium was the most prescribed drug in the US, and sales peaked in 1978 with over 2.3 billion pills sold in that year.

What you need to know before taking cheap diazepam, UK buyers should take note

This medication should only be taken as directed and in the recommended dosages. This medication shouldn’t be taken if you are:

-Pregnant or breastfeeding -Have myasthenia gravis -Suffer from sleep apnoea -Have a personality disorder -Suffer from depression -Are allergic or sensitive to diazepam or any of its ingredients -Have breathing problems -Have cerebrovascular problems -Have liver or kidney problems

As the medication can be habit forming if used incorrectly, it is not recommended that you take it continuously for more than 4 weeks at a time. In addition, long term use will reduce its efficiency meaning that you will need to take larger doses for the same results. Simply go online and search “cheap Diazepam UK” for a list of all the e-pharmacies that stock the medication. Their sites should also provide comprehensive information to read up on.

Side effects

The side effects that are experienced are usually mild and manageable and can include drowsiness, feelings of weakness, changes in appetite, dry mouth and shakiness or unsteadiness. As drowsiness is one of the side effects, this medication should not be taken when you are planning to drive or do any other potentially dangerous activities.

Buy diazepam – UK and EU orders delivered discreetly

The medication is available to buy online from one of the many trustworthy e-pharmacies. When you buy cheap Diazepam UK and EU customers will receive free and discreet delivery to their door within 2-7 work days and 10-14 work days respectively. You can buy in the quantity that you require at no extra cost on delivery. Many e-pharmacies have 24/7 customer care available.

Simply browse, visit the website, select product you’ve researched on and order now.

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Treating Anxiety Attacks with 10mg Diazepam: Does it Work?

Since man was once a part of the animal ecosystem, the initiation to any danger nearby and the response comes through an in-inbuilt alarm system. The same trait saves animal from falling prey to their enemies and surviving in the jungle. The first step is feeling anxious that something is not right, the second is concocting an escape plan and the third includes implementing that plan.

Wondering why so many physicians in the UK prescribe 10mg diazepam to treat anxiety disorders today? It is because despite anxiety being a normal part of our lives today, the many disadvantages and repercussions it can have on one is an indication that it isn’t always right to feel anxious. People living with anxiety disorders not only suffer from irritability or panic attacks, they also increase their risk for developing multiple health conditions such a cancer, hypertension and other cardiovascular diseases.

But how do anxiety pills actually work? Let’s take a look below.

Treating Anxiety with Cheap Diazepam

https://www.learnerslodge.com.sg/class-schedule/a-level-jc-economics-tuition-sg/ – an anti-anxiety pill is a controlled substance that often goes by the name of Valium. It is a generic drug and can also be taken to induce sleep. It is readily-available via prescription and on online stores, due to its ever-increasing demand.

A 10mg diazepam tablet belongs to the class of benzodiazepines. This drug class refers have a chemical structure that treats multiple forms of anxiety disorders especially panic attacks and irritation.

A 10mg Diazepam tablet does so by working on the GABA receptors in the brain. It increases their activity and sends signals throughout the body. A decreased amount of GABA receptors in the body promotes over excitement of nerves which causes a panic attack. As a result of which, you may experience shortness of breath, rising heart palpitation, muscle spasms and nausea. When one takes cheap diazepam  there is an increase in the GABA receptors in the body which helps calm the excited nerves, relaxing your body and mind.

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Evolving cancer treatments may offer smarter, more precise solutions

Cancer cells have a way of surviving and thriving even under harsh conditions. They adapt to their surroundings, search out nutrients to feed their growth and often travel and colonize. "Cancer cells are smart," says Dr. Pamela Crilley, Chair of the Department of Medical Oncology at Cancer Treatment Centers of America® (CTCA). "They can become resistant to certain treatments. They can also develop new mechanisms that help them evade the immune system or hide away. They can also lie dormant for long periods of time and come back later."https://www.economicscafe.com.sg/

As scientists and oncology specialists learn more about these and other behaviors, they have developed a new generation of tools designed to counteract those mechanisms. This burgeoning field is known as precision medicine, or precision cancer treatment, and it involves understanding and attacking cancer on the cellular level, where its behaviors are encoded in its DNA profile.

While the field is growing with every new discovery, precision cancer treatment generally involves three main tools: advanced genomic testing, targeted therapies and immunotherapies. Advanced genomic testing offers doctors a way to expose cancer's weaknesses by identifying certain cellular mutations known to make the cancer behave in certain ways. Using information revealed in advanced genomic tests or other analyses, targeted therapy drugs may be used to attack specific genetic features in cancer cells and stop the behaviors, almost like throwing an off switch. Or, depending on whether the tumor has certain mutations known to help the disease hide from the immune system, immunotherapy drugs may be used to help the body better recognize it and fight it off. "Every day, we get smarter," says Dr. Maurie Markman, President of Medicine and Science at CTCA®. "It sometimes can sound overly simplistic, but the science is moving so quickly. We’re catching up with understanding what the basic science shows, what the molecular data show, and we’re learning every day how to better treat our patients."

For decades, even a century or longer, doctors have fought cancer with a triad of reliable treatments: surgery, to remove the cancer from the body; radiation therapy, to kill cancer cells with beams of high-energy waves; and chemotherapy drugs, which circulate through the bloodstream and kill or slow fast-growing cancer cells. "We cut it out, burn it out, or try to kill it with poisons," says Dr. Shayma Master Kazmi, Medical Oncologist at our hospital in Philadelphia. "That’s essentially hung in for a lot of years." And with good reason. As these treatments have improved over time, so have the outcomes for millions of cancer patients.

According to the American Society of Clinical Oncology, 3 million cancer survivors were living in the United States in 1971. Today, that number has swelled to more than 15.5 million. From 1975 to1977, the five-year survival rate for all cancers was 49 percent. Today, it's nearly 70 percent for all patients and 82 percent for those younger than 45, according to the National Cancer Institute. "What we do is more sophisticated now, and with a lot less toxicity and side effects, but those three premises still hold," Dr. Kazmi says. "We still operate and remove cancer, we still radiate and burn them, and we still use toxic chemotherapy to try to kill them."

Because these treatments may also damage healthy cells and tissue around the tumor, doctors are always looking for new and better ways to treat cancer with fewer impacts. "Chemotherapy targets, in general, fast-growing cells," says Dr. Kazmi. "However, cells in your hair follicles, your bone marrow, your stomach lining also grow fast. So those are the collateral damage of cancer chemotherapy." That's why some patients on chemotherapy may lose their hair or develop immune deficiencies or gastrointestinal issues. Radiation therapy may kill cancer cells, but it may also kill or damage healthy cells and tissue. Surgery, meanwhile, comes with the risk of excessive bleeding or infections. www.myadvocators.com/economics-tutor-singapore/

With precision cancer treatment, doctors are looking for—and increasingly finding—ways to better target cancers and their specific genetic features, while also reducing side effects. "Precision cancer treatment means identifying precisely what makes the cancer grow and spread and attacking it with a very specific agent and a tool so that we have the best outcome available, with the fewest possible side effects," Dr. Kazmi says.

For instance, inside the nucleus of every normal cell are 23 chromosomes, each one a tightly wrapped strand of DNA that carries an individual's genetic material. In patients with chronic myelogenous leukemia, one of those chromosomes is abnormal—it’s made of genes from two different chromosomes, fused together. This abnormality sometimes triggers the release of an abundance of enzymes called tyrosine kinases. Normally, this enzyme promotes healthy cell growth, but when the body produces too much of it, the cancerous combination may stimulate uncontrolled growth and cell division. To target and neutralize this behavior, a targeted therapy drug called imatinib (Gleevec®)—technically considered a tyrosine kinase inhibitor—was developed to block these enzymes and stop or slow cancer growth. Imatinib, approved by the U.S. Food and Drug Administration (FDA) in 2001, was one of the first targeted therapy drugs ever developed.

One important way for doctors to discover the presence of those abnormally fused chromosomes or other key mutations, and identify potential targeted therapies that may help, is with advanced genomic testing, a sophisticated laboratory analysis. "You’re really looking at an individual person’s tumor itself," says Dr. Ankur Parikh, Hematologist-Oncologist & Medical Oncologist who leads the precision cancer treatment program at our hospital in Philadelphia. "And so, by doing genomic testing, you’re identifying mutations in your tumor and trying to target the right one. The future of cancer care, I think, is really going to change based not just on what type of tumor you have in terms of where it formed in the body, but on that tumor’s genetic makeup."

In fact, the FDA took a breakthrough step in that direction in May, when it approved an immunotherapy drug to treat cancer based not on the tumor's location in the body but on a specific genetic feature found in the cancer’s DNA. The approval cleared the way for the drug pembrolizumab (Keytruda®)—already approved for a number of specific cancer types—to be used on patients with certain metastatic tumors. To qualify for the drug, patients must have inoperable tumors that have genetic features called microsatellite instability-high (MSI-H) or mismatch repair deficiency (dMMR).

The approval was the latest step forward for a class of immunotherapy drugs called checkpoint inhibitors, designed to help immune cells recognize and attack cancer cells. The FDA approved the first checkpoint inhibitor, ipilimumab (Yervoy®), in 2010 for the treatment of metastatic melanoma. In just seven years, the federal agency has approved a total of six checkpoint inhibitors to treat multiple cancers, including lung, kidney and Hodgkin lymphoma. "Immunotherapy is a relatively new treatment that’s come out over the last few years," Dr. Crilley says. "There’s an explosion of information about immunotherapy, and the basic concept is to try to assist patients in using their own immune system to fight the cancer. This had been a dream for many years for medical oncologists to use as a treatment, and we are seeing some very exciting results.”https://www.learnerslodge.com.sg/class-schedule/a-level-jc-economics-tuition-sg/

Advanced genomic testing, targeted therapy and immunotherapy have become important tools in the fight against cancer. In some cases, these new precision weapons are used in combination with traditional standards to fight cancer cells on multiple levels. And through clinical trials and other research, new cancer therapies are being added to the front lines. "There is no magic bullet to cure our cancer or even a particular type of cancer, like breast cancer or lung cancer," Dr. Crilley says. "But the fact is that we are learning what makes cancer start, what makes it grow, what makes it change, and along the way, we will learn enough to positively impact patients."theeconomicstutor.com

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FDA approves immunotherapy drugs to treat more cancer types

The emergence of a new class of immunotherapy drugs has stirred optimism in the fight against cancer—and with good reason. So-called checkpoint inhibitor drugs like pembrolizumab (Keytruda®) have shown promising results in some patients, most notably former President Jimmy Carter, who was diagnosed in August 2015 with metastatic melanoma that spread to his liver and brain. After undergoing immunotherapy treatment, Carter announced that a brain scan revealed no signs of cancer. Now doctors are hoping to continue to expand the use of these drugs to treat more cancers in more patients.

The U.S. Food and Drug Administration approved the first checkpoint inhibitor, ipilimumab (Yervoy®), in 2011 for the treatment of metastatic melanoma. Three years later, pembrolizumabtheeconomicstutor.com/ and nivolumab (Opdivo®) were approved for melanoma. The following year, the FDA approved pembrolizumab and nivolumab to treat lung and kidney cancers. In May, the agency approved nivolumab to treat of Hodgkin lymphoma. And in June, it approved atezolizumab (Tecentriq®), the newest checkpoint inhibitor, to treat urothelial carcinoma, the most common type of bladder cancer.

"I think the big news for 2016 is more and more immunotherapy," says Dr. Walter Quan, Chief of Medical Oncology and Director of Immunotherapy at our hospital near Phoenix. "Checkpoint inhibitors are going to be used in more cancers and they are going to be used earlier in treatment."

Checkpoint inhibitors work by exposing cancer cells that have hidden from the immune system. Cancer cells deceive immune cells by sending signals at certain checkpoints that indicate they are not harmful. If not for these checkpoints, T-cells would attack healthy cells. Immunotherapy drugs disrupt the cancer cells' signals, exposing them to the immune system for attack.

"People with melanoma who at any time got pembrolizumab and nivolumab have a higher likelihood than ever before of a better outcome," says Dr. Quan. "Some people have no side effects at all, which is extraordinary. Some people have bad side effects, and we can't predict ahead of time who is going to get bad side effects. But other people have nothing happen, and their cancer shrinks for a number of years, or even disappears completely. And that’s the big news."

While new checkpoint inhibitor drugs are being developed and tested, researchers are using clinical trials to determine whether combinations of already-approved drugs may produce better results. Dr. Glen Weiss, Director of Clinical Research and his team at our Phoenix-area hospital, is conducting extensive research in this area, including a trial launched this year on the effects of combining nivolumab with chemotherapydrugs to treat specific types of colorectal cancer and pancreatic cancer. They are also conducting a trial to determine whether combining pembrolizumab with the drug trastuzumab (Herceptin®), a monoclonal antibody, may improve treatment results for patients with breast cancer, gastric cancer and other advanced cancers.

"There are a number of cancers where it is expected that immunotherapy will work," Dr. Weiss says. "And by ‘work,’ I mean leading to dramatic responses and durable responses where those tumors have shrunk or have held stable for months, if not years."

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Adults who use sleeping pills are more than three times more likely to die prematurely compared to matched controls who don’t use sleeping pills, according to a recent study. (1)

I’ve never been a fan of sleeping pills, even the newer, first-line “Z” medications: zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta). I’ve seen all of them cause more harm than good in my patients, but that’s not surprising, since I treat patients with addictions.

These newer sleeping medications are touted by many as being safer and less addictive than older medication like temazepam (Restoril), triazolam (Halcion) or clonazepam (Klonipin). However, all of the “Z” medications are Schedule IV controlled substances, just like their benzodiazepine predecessors. This means they all have roughly the same potential to cause addiction, despite some enthusiastic and misleading marketing done by some drug companies.

But I know many people, without a history of addiction, can take sleeping pills without apparent problems, so I was surprised to read about this recent study. This relatively large study looked at the medical records of over 10,000 patients who were prescribed hypnotics for sleep, and compared their outcomes to over 23,000 matched control patients, similar except the controls weren’t taking sleeping pills.

The sleeping pills, also called “hypnotics” were associated with significant increases in mortality and  significant increases in cancer incidence.

The patients’ average age was 54, and they were followed for an average of 2.5 years. All were members of a large U.S. healthcare system in Pennsylvania. The data from the two groups were adjusted for age, gender, smoking status, prior cancer diagnoses, body mass index, ethnicity, and alcohol use.

Patients in the group taking prescribed hypnotics most frequently, defined as more than 132 doses per year, had  over five times increased risk of dying than patients not taking hypnotics. Even the group of patients taking hypnotics relatively infrequently (up to 18 doses per year) had a three times higher risk of death. These differences were statistically significant. The medications in the study included all of the “Z” medications, as well as temazepam (Restoril), barbiturates, and the sedating antihistamines, such as diphenhydramine (Benadryl).

Of note, eszopiclone (Lunesta) was associated with the highest risk of death. (This pill’s advertisement has a beautiful butterfly wafting in through an open window, and landing gently by a woman in bed, presumably  helping her sleep. I guess the butterfly seemed like a better commercial symbol that the grim reaper.)

The use of hypnotic medications was also associated with an increased risk of cancer, and reached statistical significance in patients taking the most hypnotics. Lung, colon, and prostate cancers were significantly more likely to occur in these hypnotic medication users, as well as lymphoma.

The author estimated that hypnotic medications are associated with 320,000 to 507,000 deaths in the U.S. over the year 2010.

This study raises some important questions, since hypnotic drugs are the most commonly prescribed drugs in the U.S., with an estimated 6 to 10% of the population being prescribed these medications.

This study really intrigued me. It’s the first I’ve read or heard about this association between sleeping pills and death, other than overdoses from mixing such drugs with opioids. After reading this article, my first thought was, “I wonder if more studies will show the same thing.” Then I started looking on the internet and found other studies that show an association between sleeping pills and increased risk of death. Many of these studies had flaws, but the overall impression is that this is a real correlation. The author of this current large study, Dr. Kripke, goes so far as to say the risks of hypnotic medications outweigh their benefits. He also admits his bias against hypnotics. (2)

Sleep medicine doctors say that correlation doesn’t mean causation, and we shouldn’t jump to conclusions. One sleep specialist pointed out that the study didn’t control for psychiatric illness, which could be a significant factor. Additionally, patients who are prescribed sleeping medications may be sicker overall, in ways the study didn’t control, and therefore a generally less healthy group. This could distort study findings.

Other scientists say that sleeping pills could make sleep apnea worse, and cause deaths in that way. Obesity increases the risk of sleep apnea, and with more adults becoming obese, perhaps sleeping pills make apnea worse and these people die in their sleep. Other scientists say sleeping pills slow reflexes, and perhaps patients taking these medications are more likely to be involved in car accidents and other accidents, increasing their death rates.

As for my patients, many of whom are prescribed methadone or buprenorphine, the risk of drug interaction and overdose with the hypnotics usually outweighs all of the benefits, and I recommend that patients do not mix these two types of medications.

So stay tuned. As time goes on, hopefully we’ll learn more about this correlation between sleeping pills and death. This current study is helpful because of its large size, and the author points out that 19 other studies have shown a relationship between hypnotics and increased risk for death.

Let’s also consider that sleeping medications bring in more than a billion dollars a year to the drug companies that sell them. I’ll be looking for more studies that are not funded by drug companies.

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Oral chemotherapy needs to be stored properly

As cancer treatments advance, more patients are taking anti-cancer medications, including oral chemotherapy, at home. Unlike the traditional IV infusion chemotherapy given in a clinic, oral chemotherapy is a drug taken in tablet, capsule, or liquid form. It has the same benefits and risks as chemotherapy given by infusion.

Oral chemotherapy may be easier than taking a trip to the clinic, but the pills are just as strong as intravenous forms of chemotherapy.

Here is some key information to know about oral chemotherapy:

1.    Understanding your drugs is important

Before beginning oral chemotherapy, talk with your doctor or nurse to learn how this medicine will affect your body. You should know:

The name of the medicine (both trade and generic)

How the medicine works

When to take the oral chemotherapy

Dose, frequency, and when the prescription will need to be refilled

Best time of day to take the drug

Whether to take the drug before or after a meal or snack.

Whether any other drugs, supplements, or vitamins you are taking may interfere with the anti-cancer drug.

What to do if you miss a dose

Who to call if you have questions.

Check with your local pharmacy to find out whether your oral chemotherapy can be filled there, or if it must be ordered by mail. Oral chemotherapy can be costly, so it is also important to find out about insurance coverage.

Most oral chemotherapy medicine needs to be stored at room temperature, away from heat or moisture. Avoid storage in a bathroom or near direct light. It must be kept in its original container, away from other medications, and out of the reach of children or pets.

3.    Take extra precautions before and after handling pills

Remember to wash your hands thoroughly before and after taking the pills. If a caregiver is handling the pills, he/she should not have bare hands. Instead, the caregiver can empty the pills into a cap or small plastic cup, or he/she can wear latex gloves. Only the patient should come in contact with the drugs.

It is also important not to crush, break, or chew your pills.

4.    Don’t throw away extra pills

Bring any extra oral chemotherapy pills back to the pharmacy where the prescription was filled. They should not be flushed down the toilet, poured into the sink, or thrown away in the trash.

5.    Take your pills at the right time

It’s important to be consistent with oral chemotherapy treatments; the drugs should be taken at the same time of day and under the same circumstances. You can try programming reminders on your phone or keeping a diary that records the time, date, and any side effects you feel. Watch this video for more tips on remembering to take oral chemotherapy.

Read more:

Tips and Advice for Taking Oral Chemotherapy

Chemotherapy Related Neuropathy: Managing this Nerve-Wracking Problem

Stay in close contact with your cancer care team throughout your oral chemotherapy treatment. Keep phone numbers for doctors or nurses, as well as drug information, in a prominent place.

If you begin to experience any side effects that could be related to your oral chemotherapy medicine, contact your doctor or nurse right away. Early intervention can minimize your symptoms and help you continue to benefit from the treatment.

For more information on oral chemotherapy treatment, handling and side effects visit dana-farber.org/oralchemo.

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Fran's Blog - "The Pill" - Excerpt from CANCER SCHMANCER

I remember Elaine had spend a year complaining about leg pain before being dianosed with a blocked artery by a vascular doctor. Up until that point she'd been told she needed back surgery for a compressed disc.  Her fear of surgery kept her searching for another diagnosis, though, and she eventually found her way to Mind Over Back Pain by Dr. John Sarno.  This doctor's approach sounded nonsurgical to Elaine, so she pursued it.

An associate of Sarno's listened to her symptoms and asked her what no other medical doctor had thought to ask: "Have you had a Doppler flow test?" Wouldn't you know it? That one little test, easily and painlessly performed in a doctor's office, told the whole story of her leg pain. The cause was  a blocked artery in her leg, which required bypass surgery.  At least she was getting operated on for the right thing, and it did fix her. The lesson here is that if you're experienceing pain, numbness, weakness, or weird sensations in any of your limbs, or if you seem sluggish in your head, a bit out of it, just not as sharp as normal, you may have a blocked artery.  I don't know why doctors don't offer this test regularly.

So there I was, describing all my symptoms again to the vascular specialist, Doctor #6, wanting this Doppler flow test, too.  He used a wand that looked like an ultrasound and scanned my arterial system for any blockages.  But once again the test showed nothing.  "You probably have night cramps," he blurted out.

"What are those?" I questioned.

"No one knows why we get them, but they're very common.  I've been told tonic water helps," he said, while cleaning up his tools.

"Tonic water?" I asked, incredulous.

"Yup.  Do you like gin and tonics?" he inquired.

"I never had one," I answered.

"Well, try having one before you go to bed, lemme know if it helps," he said, exiting. Now, I gotta admit, a gin and tonic is a tasty thing at around 11 p.m. with the fireplace goin' and the TV on... it didn't do much for the leg pain, though.

It was all so crazy.  One doctor told me I had the tits of an eighteen-year-old, one doctor said I was eating too much spinach, and this guy thought I should drink gin and tonics at bedtime.  So there I was with perky breasts, in need of roughage, going to bed sloshed, all in some futile attempt to cure myself.

Excerpted from Cancer Schmancer by Fran Drescher

Available at Amazon.com with a percentage of proceeds donated to Cancer Schmancer.

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My initial reactions to The Pill

I don’t talk about intimate things often and let me assure you, this post will not be intimate in the way you think it could be. There will be no crazy sex stories here, you can go find an erotica section online – this is not it. Today, I wanted to share my experience with birth control. I know most women think about the options but many are afraid to speak about it.

Besides the traditional rubber, I have been a semi-long term user of birth control pills. I have been on a number of different ones ever since I got my first boyfriend at the age of 17. As an overly cautious person, I wanted to be absolutely sure there was no way I could get pregnant. I was willing to pay the couple of dollars a month for the daily pill in order to keep those worries at bay.

My initial reactions to The Pill

I don’t remember the first brand of birth control pill I was on but I know it wasn’t as difficult to keep track of taking it as some women think it is. I set an alarm on my phone for a time that I knew I would always be able to take it, for me it was 4:30pm, and I took it daily. Sometimes I was late by a few hours, but thankfully you don’t have to be super precise about the time for it to work. Also, you can use a scheduler for taking the Pill. This option wasn’t around back then though so I didn’t utilize it at the time.

The time I started taking this particular birth control, I was also nervous about one of the dreaded side effects – weight gain. As an already average/slightly-fluffy girl, there is no way I would be okay with gaining any extra weight. I ensured that the OB-GYN knew this. To be on the safe side, this was also the time I started practicing self-hypnosis for weight loss. The result? I lost 15 pounds after starting birth control without even noticing it. The power of hypnosis, I tell you – it’s amazing. This is why I’m so passionate about it. But anyway, back to my story…

Everything was fine until a few months in when I started getting increasingly more irritable. It didn’t help that I was in a mentally abusive relationship. I found myself getting depressive and wanting to cry at little things. I would think of the most depressing things and cry about them at night. I sometimes cried about stupid things during the day too. None of my friends knew. The only time someone saw what was going on is one night when I was really depressed and bawling my eyes out at night and I asked my mom to sleep with me that night. She said it was probably the birth control that was making me all loopy. I laughed through my tears and I hoped she was right.

I got switched to another birth control pill – Yazmin. This one was supposed to be better. It was supposed to be specifically designed for people with mood issues due to PMS (oh yeah, I also developed an intense attitude problem: everything was irritating to me and I snapped on people numerous times without much reason). The mood issues got better but my boyfriend and I broke up (finally) and I didn’t see a reason in continuing the birth control.

Then I got older…

The next time I went on the pill was when when I went to college. I was prescribed Loestrin Fe 24. I didn’t use it for a long time the first time I was prescribed it but I went back on it my Junior year when I started dating someone more seriously. This pill was supposed to have a minimal amount of side effects – no weight gain and no mood issues. Everything was fine and dandy for the first few months again but this was the time when my relationship with food was very up-and-down which caused a lot of low self-esteem. This, combined with my previous relationship and detachment issues, has lead to some minor depressive spurts. After about 7 months of taking the Pill, my sex drive was completely gone and I was no longer interested nor excited about getting intimate. Additionally, my relationship with food become more disordered and this caused more stress in my life. I went off the pill to get my hormones back in order. My boyfriend and I broke up 2 months after that for reasons unrelated.

The Pill for other reasons

I was off the pill for almost a full year after that, until 2-3 months ago when I went back on another form of birth control pill. For the first time, though, this was not done for the reasons you usually use birth control. For some odd reason, my hormones have been out of whack (which I think might be due to losing + gaining weight) and my period started acting really weird – I would not have it for 2 months, then it would come back, then it would come back 2 weeks after that, then it would be gone again for 2 months. It was extremely unpredictable and very annoying to keep track of. When I went to my OB-GYN she said I should just get back on the pill to get my hormones back in order. I do wish she did a blood test I asked for though, just in case there was something else that was wrong. Best pill Anyway, the new pill she put me on is Lo Loestrin Fe 1-10 which is the lowest dose of hormones you can get in a birth control pill at the moment which also means the least amount of side effects. I haven’t had any issues with it so far and my periods have been regular and a lot lighter. I guess only time will tell how this one affects me in the long run!

I like using birth control because it makes me feel more in control. I like the obvious benefit it provides but I have also saw a benefit of improved complexion from using the birth control pills as well. I think the thing is that each pill works differently for everyone – so it’s mostly all about trial and error. You can find out which form of birth control would work best for you from Bedsider’s Method Explorer. While the only one I have used is the Pill, I have friends who swear by other forms – such as the copper IUD. It’s really up to your lifestyle choices and other factors that determine what birth control is right for you!

Bedsider is having a “What’s in Your Bedside Drawer?” Pinterest contest! Check out the cool prizes you can win here.

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Quiz for Rare Disease Day 2017

Rare Disease Day occurs annually, on the last day of February. It is an awareness day meant to increase cognizance and spark conversation among decision-makers, the public, and patients about rare diseases and the effects they have on lives. Take our quiz to see how much you know about rare diseases and to discover some things you might not know!

How much do you know about rare diseases? To commemorate this year’s edition of Rare Disease Day, Orphanet Journal of Rare Diseases presents the following quiz to see how much you know about them!

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Viagra protects the heart: back to the future for the love pills

New research published today in BMC Medicine shows that Viagra could be used as a safe treatment for heart disease. In this guest post, lead author on the paper, Andrea M. Isidori of Department of Experimental Medicine at Sapienza University of Rome, tells us more about the background to this research and what they found out.

Everybody’s heard of Viagra (sildenafil). It was the first phosphodiesterase type 5 inhibitor (PDE5i) marketed for the treatment of erectile dysfunction. But few people are aware of the other beneficial effects and potential new uses for this class of drugs.

Viagra was originally tested for heart problems – angina pectoris, a chest pain associated with coronary heart disease – on the basis of its vasodilatory effects (in other words it widens the blood vessels). Its results as an anti-angina drug were only modest, but patients reported the unexpected “side effect” of improved erections. The focus of interest in this drug shifted rapidly from the heart to the bedroom.

In the first decade (1998-2008) after its approval, Viagra revolutionized the sex lives of millions and became one of the most commercially successful drugs in the world, with over 1.8 billion pills used by about 35 million people. The number is still growing.

However, the success of the blue pill was accompanied by isolated early reports of cardiovascular events and sudden deaths. Nonetheless, subsequent large surveillance studies merging data from placebo-controlled clinical trials, the prospective observational cohort study and the International Men’s Health Study (IMHS) demonstrated that myocardial infarction and all-cause mortality rates for Viagra were similar to placebo, suggesting that its use was not associated with any greater risk.

So how can we explain the early reports of cardiovascular side effects?

Mainly through its incorrect use alongside nitro compounds (NO-donors). This can produce an acute drop in blood pressure that, combined with the increased oxygen required during sex, can be detrimental in men with heart disease.

Clearly, this is the result of a series of conditions occurring simultaneously. When Viagra is taken correctly, it is no longer a concern. Nevertheless, in the mind of the public, use of the “love pill” was at this time invariably considered dangerous for patients with heart disease.

Now is the time to change public opinion on this type of drug

Today, these drugs can be taken daily to treat other conditions: pulmonary arterial hypertension and lower urinary tract symptoms, for example.

Interest in continuously administered PDE5is is growing in several areas, such as andrology and urology, for rehabilitation of erectile function, relief of the symptoms of benign prostatic hyperplasia and treatment of some bladder disorders; respiratory medicine, for its effects on pulmonary hemodynamics; neurology, to protect the brain against ischemic injury; and rheumatology, for the treatment of Raynaud’s phenomenon.

What about cardiology?

Several animal studies have shown that Viagra attenuates cardiac remodeling, with an anti-hypertrophic and anti-fibrotic effect, and protects the heart against different types of injury.

Some small clinical trials have demonstrated that chronic PDE5 inhibition improves cardiac performance and geometry in various clinical conditions, including heart failure, myocardial infarction and diabetic cardiomyopathy.

In the last sixteen years pre-clinical and clinical research into the extra-urological effects of PDE5i has expanded dramatically, revealing previously unsuspected indications for these drugs. Once more, the blue pill could change the quality of life of millions of people.

But how?

Our meta-analytic research just published in BMC Medicine originated to clarify some controversies emerging from the available human studies. We wanted to analyze if chronic PDE5i administration was cardioprotective and safe, and, if so, where the benefits were mainly seen: cardiac muscle, peripheral vessels, or both.

We showed that continuous administration of Viagra improves cardiac performance and has an anti-remodeling effect without a major impact on vascular parameters, suggesting that it does indeed have a direct effect on the heart.

The novelty of this meta-analysis is the identification of subgroups of patients that may benefit more from PDE5i: patients with cardiac hypertrophy and heart failure, and patients developing a maladaptive remodeling to different injuries, in which the cardiac pump no longer works well.

Our study is the first to show in a large patient cohort that chronic PDE5i administration improves cardiac output and decreases heart rate.This could result in longer survival, increased exercise tolerance and a better quality of life. Surprisingly, the magnitude of effects was similar to that seen with the drugs currently used to treat these clinical conditions, and was obtained in a relatively brief period (3 to 12 months).

Most strikingly, we found that PDE5is are among the very few drugs that are able to improve diastolic relaxation, thus helping the correct refilling of the ventricle after each contraction, a nearly unique feature in drugs used in cardiology, and with incredible potential for future development in the prevention of heart failure.

We also demonstrated their high tolerability and safety in a population that included elderly patients with various stages of cardiac disease and numerous comorbidities who were taking multiple pharmacological treatments. This setting resembles what we normally see in real life, supporting that daily administration is safe and involves no increase in the risk of adverse events compared to on-demand use.

It is now time for a large multicenter study of the effects of PDE5is on cardiac architecture, taking into account the evidence emerging from this meta-analysis. This publication sets the scene for a change in general opinion on PDE5is.

Love pills go back to the future: sex goes back to the heart.

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