Extracellular vesicle-associated procoagulant phospholipid and tissue factor activity in multiple myeloma

Extracellular vesicle-associated procoagulant phospholipid and tissue factor activity in multiple myeloma

Multiple myeloma (MM) patients have increased risk of developing venous thromboembolism, but the underlying mechanisms and the effect on the coagulation system of the disease and the current cancer therapies are not known. It is possible that cancer-associate…

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How Todd Seals Overcame a Prostate Cancer Death Sentence

<h1>How Todd Seals Overcame a Prostate Cancer Death Sentence</h1>

How Todd Seals Overcame a Prostate Cancer Death Sentence

Seals was 42 when his doctor diagnosed him Stage IV prostate cancer. Twelve years later, he is not only still alive but symptom-free—a testimony to both his personal grit and remarkably fast-evolving medical research.

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Celebrex

<h1>Celebrex</h1>

Celebrex

Celebrex: Therapeutic Uses and Dosing Celebrex 351 Reviews 3 Stars
Celebrex is the brand name for the prescription pain reliever celecoxib, the drug’s active ingredient. Doctors prescribe Celebrex to treat pain, swelling, and stiffness of arthritis and some other conditions.
Celebrex is a non-steroidal anti-inflammatory drug, often referred to simply as an NSAID. NSAIDs block swelling, pain, and fever. Celebrex works by stopping the production of COX-2, a natural substance in the body that causes pain and inflammation. Celebrex is an NSAID and a COX-2 inhibitor.
The Food and Drug Administration (FDA) approved celecoxib in 1998 for the drug company G.D. Searle under the brand name Celebrex. In May 2014, the FDA approved the generic version of celecoxib.
The FDA has approved Celebrex to treat:
Also, a study in the May 2014 issue of the journal Human Psychopharmacology suggested that celecoxib holds promise as an add-on treatment for people with depression. The researchers noted, though, that more study needs to be done to determine its safety and effectiveness long-term. What Are the Key Things I Need to Know About Celebrex?
There are two important warnings you should be aware of before taking Celebrex: Celebrex and other NSAIDs can increase the risk of heart attack and stroke that may occur without warning and can be fatal. This risk may increase if you take Celebrex for a long time. You also may be at higher risk if you have a history of heart disease or high blood pressure. Celebrex and other NSAIDs may cause ulcers, stomach perforations, and sudden bleeding in your stomach or intestine. You may be at higher risk for this if you’re elderly, drink a lot of alcohol, smoke, are in poor health, or take any blood-thinning medications. You also may be at higher risk if you have a history of ulcers or gastrointestinal (GI) bleeding.
. Is There Anything Special I Should Discuss With My Doctor Before Taking Celebrex?
Talk to your doctor about Celebrex warnings, especially if you have a history of heart disease, stroke, ulcers, or GI bleeding. Ask how your doctor will monitor you for these conditions and what the warning symptoms are.
Always tell your doctor if you have allergies to any medications. You may not be able to take Celebrex if you have had allergic reactions to other NSAIDs or drugs called sulfonamides. You also may not be able to take Celebrex if you’ve ever had hives or asthma after taking aspirin or another NSAID. You should not take Celebrex in the days before or after some types of heart surgery, including coronary artery bypass graft surgery.
If you’re a woman, let your doctor know if you are or may be pregnant, or if you’re breastfeeding.
Before prescribing Celebrex, your doctor will also want to know if other conditions or situations apply to you, such as: Frequent use of alcohol Swelling of the face or body High blood pressure Celebrex Side Effects What Are the Most Common and Serious Side Effects of Celebrex?
If you have any side effects from Celebrex, let your doctor know. The most common side effects are indigestion and headache. Other side effects may include: Stomach ache Swelling of feet or hands Body aches Upper airway congestion or infection Rash
Serious side effects can occur. If you have any of these side effects, stop taking Celebrex right away. Call your doctor, get emergency help, or call 911. Chest pain Weakness on one side of the body Slurred speech Vomiting blood or something that looks like coffee grounds Bloody diarrhea or tarry stools Unusual bleeding or bruising Severe skin rash or blistering of skin Hives Swelling of the face, throat, tongue, or body Difficulty swallowing or talking Blood-tinged urine, dark urine, or trouble passing urine Fever Extreme tiredness or lack of energy Yellowing of skin or eyes
It’s not safe to take Celebrex during pregnancy. There is some evidence in animals that it may cause heart defects when used late in pregnancy. Tell your doctor if you’re pregnant or may become pregnant before taking Celebrex. If you become pregnant while taking Celebrex, tell your doctor right away. Celebrex is also not a safe drug to take while breastfeeding.
Children with juvenile arthritis may take Celebrex if they’re older than 2. People older than 65 may have an increased risk for GI bleeding and kidney failure. Celebrex Interactions Do Other Drugs Affect the Way Celebrex Works?
Some drugs may affect the way Celebrex works, and Celebrex may affect other drugs you are taking. It’s very important to let your doctor know about all drugs you are taking, including any over-the-counter drugs and any herbs or supplements.
Drugs known to interact with Celebrex include: Should I Avoid Any Food, Drink, or Activity While Taking Celebrex?
You don’t need to change your diet or activities while taking Celebrex, but don’t drink alcohol heavily while you’re taking the drug. Celebrex Dosage What Is a Typical Dose of Celebrex?
Celebrex comes in capsules of 50, 100, 200, and 400 milligrams (mg), and your doctor will try to find the lowest dose of Celebrex that works for you.
You’ll take Celebrex once or twice a day, with or without food. If you’re taking large doses, though, your doctor may ask you to take your dose with some food. Take your medication at the same time every day. For children or adults who have trouble swallowing capsules, it’s okay to open the capsules and sprinkle the medication on a teaspoon of applesauce.
Typical dose schedules for Celebrex are: 200 mg a day for an adult with osteoarthritis or rheumatoid arthritis 200 to 400 mg a day for an adult with ankylosing spondylitis 200 mg twice a day for pain from injury or menstruation 400 mg twice a day, taken with food, for an adult with familial polyposis
Children with rheumatoid arthritis take Celebrex twice a day, and doctors base the dose on the child’s weight. People with liver disease may need to take a reduced dose. What Happens If I Take Too Much Celebrex and Overdose?
An overdose of Celebrex can cause tiredness, weakness, nausea, vomiting, GI bleeding, and abdominal pain. In rare cases, a large overdose can cause kidney failure, high blood pressure, difficulty breathing, and even a coma. If you think you have taken an overdose or if someone else may have overdosed on Celebrex, call a poison control center at 1-800-222-1222 or call 911. What Happens If I Miss a Dose of Celebrex or Don’t Take It as Prescribed?
Take Celebrex exactly as directed by your doctor. Don’t take more or less. If you miss a dose of Celebrex, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and continue your regular dose schedule. Don’t double your dose to make up for the missed one. Celebrex Pictures Celebrex 100 mg, white, capsule, Celebrex 400 mg, white, capsule, Celebrex 200 mg, white, capsule, Celebrex FAQ Q: Does Celebrex cause weight gain?
A: Weight gain is a possible side effect of Celebrex according to the prescribing literature. If you are experiencing excess weight gain, I would discuss this with your health care provider to be sure the weight increase is not being caused by another medical condition rather than from taking Celebrex. Q: If I’m allergic to sulfa drugs, can I take Celebrex?
A: There have been no reports of sulfa-allergic patients reacting to Celebrex. However, since there is a component in Celebrex related to the molecule that causes sulfa allergy reactions, it is a theoretical concern. The recommendation is that sulfa-allergic patients avoid this medication. Q: I’ve been using Celebrex for 4 months because of arthoscopic knee surgery. The pills helped in the beginning and they are not helping now. Could it be because I stand all day on my job? Does it cause weight gain?
A: The pain can be caused by excessive use and standing all day. You might want to try a knee brace to use at work, which might alleviate some of the strain. If that doesn’t help, talk with your physician to see what other solutions you can come up with. Q: I am taking Celebrex for knee inflammation. The bottle says not to take aspirin at the same time, but can I take ibuprophen and acetaminophen along with the Celebrex?
A: According to the package insert, Celebrex should not be taken with aspirin or other non-steroidal anti-inflammatory drugs (NSAIDS) including ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), or piroxicam (Feldene). Acetaminophen is in a different class of pain relievers (not a NSAID), and studies have shown that Celebrex and acetaminophen (Tylenol) can be used together. It is important to take all drugs in the recommended doses and alert your healthcare provider of all prescription and over-the-counter medicines that you are taking. For more information about Celebrex, please visit //www.everydayhealth.com/drugs/celebrexMichelle McDermott, PharmD Q: Can a person who is allergic to sulfa drugs take Celebrex?
A: A sulfa allergy refers to adverse reactions to sulfonamides, a group of drugs that includes antibiotics and nonantibiotics. The antibiotic sulfonamides are different structurally from the nonantibiotic sulfonamides, and they appear to be much more likely to result in allergic reactions. Many of the sulfa nonantibiotics, therefore, do not cause problems in people with sulfa antibiotic allergy. Celebrex (celecoxib), a popular medication used for the treatment of arthritis and for controlling pain, is a sulfonamide nonantibiotic medication. Although there have been no reports of sulfa-allergic patients reacting to Celebrex, it is a theoretical concern, so the recommendation is that sulfa-allergic patients avoid this medication. Here is a link to more information on Celebrex: //www.everydayhealth.com/drugs/celebrex.Lori Poulin, PharmD Q: Is there something effective that can replace Celebrex? Q: What are the side effects of Celebrex?
A: Celebrex (celecoxib) belongs to the group of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs). It is used to treat pain or inflammation caused by conditions such as arthritis. According to the package insert, some of the most common side effects of Celebrex include upset stomach, heartburn, diarrhea, constipation, bloating, dizziness, headache, skin rash, itching, blurred vision, and ringing of the ears. Celebrex can also cause some serious side effects. Chronic use of Celebrex may cause an increased risk of life-threatening heart or circulation problems, which include heart attack and stroke. Celebrex can also cause high blood pressure and serious gastrointestinal events including bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine. To minimize the potential risk for a serious side effect, the lowest effective dose should be used for the shortest period of time consistent with individual patient treatment goals. For more information, please consult with your health care provider and visit //www.everydayhealth.com/drugs/celebrex. Michelle McDermott, PharmD Q: I would like your point of view on Celebrex. My mom was prescribed said medication and I am worried as to the numerous side effects it has.
A: Celebrex (celecoxib) is classified as a nonsteroidal anti inflammatory drug, and is COX-2 selective. It is used for the treatment of osteoarthritis, ankylosing spondylitis, rheumatoid arthritis, acute pain, familial adenomatous polyposis and treatment of dysmenorrhea. The lowest possible dose and shortest possible duration of time should be used in patients taking Celebrex. There are some serious warnings associated with the medication. These include cardiovascular, coronary, and gastrointestinal warnings. NSAIDs (non steroidal anti inflammatory drugs) as a class have been shown to be associated with an increased risk of cardiovascular events such as heart attacks and strokes. There is a theory that the risk may be increased with longer duration of use of this type of medication or if patients have a history of cardiovascular disease or risk factors. The gastrointestinal warnings state that NSAIDs as a class can increase the risk of gastrointestinal irritation, ulceration, bleeding and perforation. Celebrex is contraindicated for treatment of pain after surgery of coronary artery bypass graft surgery due to increased risk of heart attacks and strokes. This is not an inclusive list of all possible side effects of Celebrex. All medications have possible adverse effects associated with them. When deciding on an appropriate medication, the patient and the physician must weigh the benefit of the medication against the risks associated with it. There are many patient specific variables of your mother’s that must be examined to determine if Celebrex is an appropriate treatment for her. These variables include her medical conditions, other medications she is taking, overall health, etc. Her physician is best able to evaluate the possible risks specifically to your mother. Please have your mother or yourself speak with her physician regarding your concerns about the safety profile of Celebrex. Jen Marsico, RPh Q: I take one Celebrex daily for knee arthritis. I am not overweight,exercise daily, and live a moderate lifestyle. Is there any other drug(s) I could take to help with knee stiffness?
A: If you have osteoarthritis of the knee, you can take advantage of a wide range of treatment options. The effectiveness of different treatments varies from person to person and the choice of treatment should be a joint decision between you and your physician. Exercises can help increase range of motion and flexibility as well as help strengthen the muscles in the leg. Physical therapy and exercise are often effective in reducing pain and improving function. Your physician or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle. Several types of drugs can be used in treating arthritis of the knee. Because every patient is different, and because not all people respond the same to medications, your physician should be consulted on a program for your specific condition. Glucosamine and chondroitin are oral supplements that may relieve the pain of osteoarthritis. These are two large molecules that are naturally found in the cartilage of our joints. These substances can help reduce swelling and tenderness, as well as improve mobility and function. If you decide to take this therapy, be aware that at least two months of continuous use is necessary before the full effect is realized. Although glucosamine and chondroitin sulfate are natural substances, sometimes classified as food additives, they can cause side effects such as headaches, stomach upset, nausea, vomiting, and skin reactions. These supplements can interact with other medications, so keep your doctor informed about your use of them. Lori Mendoza, PharmD Poulin, PharmD Q: I had prostate surgery in November 2009. I also have rheumatoid arthritis. I go to the bathroom very often at night, every 1 1/2 to 2 hrs. Whenever I take Celebrex for pain, it reduces urination frequency. Can you educate me, please. Is it good or bad?
A: Celebrex (celecoxib) is frequently used to reduce pain caused by a variety of conditions. Usually, after prostate surgery the frequency of urination will increase. It is normally not a problem to reduce the frequency of urination with medication. However, with Celebrex, you should notify your health care provider about the decrease in urinary frequency as this is listed as a more serious side effect of Celebrex. Anytime you notice changes in your daily routine, you should let your health care provider know. Sometimes, the changes will not matter and other times they may need to adjust your medication regimen. It is also good to keep a current list of any prescription medication and over-the-counter products you take and review it with your health care providers and your pharmacist. If possible, use one pharmacy for all your prescription medications and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and to advise you about drug interactions and side effects. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Megan Uehara, PharmD Q: My doctor prescribed Celebrex, but I can’t afford it. What over-the-counter drug will relieve inflammation and pain?
A: Celebrex (celecoxib) belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDS work to reduce hormones that cause inflammation and pain in the body. Celebrex is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. It is also used in the treatment of hereditary polyps in the colon. There are NSAIDS available for purchase over-the-counter, including ibuprofen (Motrin, Advil) and naproxen (Aleve). However, they work slightly differently than Celebrex. Talk to your doctor to see if either of those medications would be appropriate for you and what dose you should take. Your doctor is best able to guide your treatment choices based on your specific circumstances. Common side effects of NSAIDS include upset stomach, mild heartburn, diarrhea, constipation, bloating, gas, dizziness, nervousness, skin rash, blurred vision, and ringing in your ears. The use of NSAIDS carries the risk of serious side effects, such as heart attack, stroke, and bleeding from your digestive tract. The risk of heart attack and stroke increases with long-term use of NSAIDS. However, bleeding from the digestive tract can occur anytime during treatment. Seek immediate medical attention if you experience chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance. Contact your doctor at once if you experience signs that you could be bleeding such as black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds. This is not a complete list of side effects that can occur with NSAIDS. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications, particularly before taking any action. Sarah Lewis, RPh, PharmD Q: My doctor prescribed Celebrex and I have GERD and Barrett’s. Is it safe for me to take the Celebrex? What else can I take for the bursitis in my hip?
A: Celebrex (celecoxib) is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDS work by reducing hormones that cause inflammation and pain in the body. Celebrex is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. Celecoxib is also used in the treatment of hereditary polyps in the colon. Common side effects of Celebrex include upset stomach, mild heartburn, diarrhea, constipation, bloating, gas, dizziness, nervousness, headache, skin rash, itching, blurred vision, and ringing in your ears. More serious side effects can occur and this is not a complete list of possible side effects associated with Celebrex. Using Celebrex increases the risk of serious conditions involving the stomach and intestines, including bleeding, ulceration, and perforation (forming a hole in the wall of the stomach or intestines). These conditions can be life-threatening and can occur without warning at any time during treatment with Celebrex. Because of this risk, people with a history of stomach ulcers or bleeding should not use Celebrex. The risk is also increased in elderly patients (over the age of 65) and with longer duration of therapy. There is no specific warning against using Celebrex in patients with GERD and/or Barrett’s contained in the prescribing information for Celebrex. If you are concerned about the safety of Celebrex use, talk to your doctor for information based on your specific circumstances. Contact your doctor right away if you have symptoms of bleeding from your digestive tract. These include black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications. Sarah Lewis, RPh Q: Over the past year, I have gained about 25 lbs, with excess “flab” around the midsection and a stomach I’ve never had to deal with before. I started taking Celebrex daily for over a year thinking it was better for me than taking 600-800 mg of ibuprofen everyday. I’m really struggling with my weight. Has the Celebrex caused “some” of my weight gain?
A: Drugs can cause weight gain in several different ways. Some can increase appetite or make you crave certain types of foods like those high in carbohydrates or fat. Other medications may slow down metabolism or cause fluid retention. However, the effect of prescription drugs on body weight is complex. Some drugs have no effect on weight, while others cause weight gain or weight loss. Also, the same medications can cause weight gain in certain individuals and weight loss in others. There are also drugs that initially cause weight loss and then lead to weight gain with long-term use. Most prescription medications associated with changes in body weight affect the central nervous system. These include antidepressants like monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs). Mood stabilizers (lithium, valproic acid), antipsychotics, and anticonvulsants have also been linked with weight gain. Other drugs that have been reported to cause weight gain include diabetes medications (insulin, sulfonylureas, and thiazolidinediones), antihypertensive drugs, certain hormonal contraceptives, corticosteroids, antihistamines, some chemotherapy regimens, and antiretroviral protease inhibitors. If you think a drug you are taking is causing weight gain, tell your health care provider. Do not stop any medication or change the dose without first talking to your provider. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. According to the manufacturer’s package insert for Celebrex (celecoxib), an increase in weight and edema are potential adverse effects from the use of Celebrex. So yes, it is possible that Celebrex is responsible for your weight gain. Q: Is Celebrex one of the drugs that will make one have bad dreams, because I take it daily, and have bad dreams more than I care to.
A: Celebrex (celecoxib) belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDS work by reducing hormones that cause inflammation and pain in the body. Celebrex is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. It can also be used in the treatment of hereditary polyps in the colon. Common side effects of Celebrex include upset stomach, mild heartburn, diarrhea, constipation, bloating, gas, dizziness, nervousness, skin rash, blurred vision, and ringing in the ears. This is not a complete list of side effects that can occur with Celebrex. A search of a drug database and the prescribing information for Celebrex did not specifically list bad dreams as a side effect of the drug. If bad dreams continue or get worse, consult your doctor for specific recommendations. Your doctor may be able to determine if the dreams are caused by Celebrex or not. Do not stop or change the amount of medication you take without talking to your health care provider first. Tell your health care provider about any negative side effects from prescription drugs. You can also report them to the U.S. Food and Drug Administration by visiting www.fda.gov/medwatch or by calling 1-800-FDA-1088. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications, particularly before taking any action. Sarah Lewis, RPh Q: Can Celebrex be taken only when needed for pain, or does it need to be taken daily?
A: Celebrex (celecoxib) is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by reducing hormones that cause pain and inflammation. Celebrex can be taken every day for pain prevention, or it can be taken on an as needed basis. People who have chronic pain conditions such as arthritis may need to take Celebrex every morning for pain prevention. People who have intermittent pain conditions can take Celebrex on an as needed only basis. You should consult your physician for more information about how often to take Celebrex. The most common side effects of Celebrex are constipation, diarrhea, dizziness, gas, headache, heartburn, nausea, sore throat, and stomach upset. This is not a complete list of side effects. More severe side effects are possible. Celebrex can interact with other medications. Burton Dunaway, PharmD Q: Can Celebrex affect your stomach, and how long can it be used for muscle tendonitis?
A: Celebrex is classified as a COX-II inhibitor that does not usually cause stomach problems. But if you are experiencing stomach pain or stomach bleeding, please consult your physician. Other causes or other medications must be ruled out. Studies suggest different time periods of treatment for muscle tendonitis depending on pain severity, tolerance to medication and physician preference. Studies also show concern regarding cardiovascular health in some patients using Celebrex. Please keep up with doctor’s appointments for your physician to monitor lab results and heart health. For more information, please see //www.everydayhealth.com/drugs/celebrex Q: What are the long-term (5+ years) side effects of taking 200 mg Celebrex daily?
A: our question concerns long-term side effects of Celebrex (celecoxib) //www.everydayhealth.com/drugs/celebrex. Long-term use of Celebrex may cause renal (kidney) toxicity and decreased blood flow to the heart. Kidney damage may also result. In one study, patients on Celebrex for three years had an increased risk of serious cardiovascular events which included heart attacks, strokes, and heart failures. It is always a good idea to check with one’s health care provider in matters like this. Please consult your health care provider for guidance in your specific case. Gregory Latham, MS, RPh Q: My husband just started taking Celebrex for pain in his shoulder, back, and arm. Is there a generic version, or another medication that is similar but less expensive?
A: Celebrex (celecoxib) belongs to a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by reducing hormones that cause inflammation and pain. Currently, there is no generic available in the United States for Celebrex. For cheaper alternatives, consult with your health care provider. For more information on this medication, go to //www.everydayhealth.com/drugs/celebrex. Kimberly Hotz, PharmD Q: Is Celebrex good for gout, or are there over-the-counter aids you could recommend?
A: Celebrex (celecoxib) belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDS work by reducing hormones that cause inflammation and pain in the body. Celebrex is used to treat pain and inflammation caused by many conditions, such as arthritis, ankylosing spondylitis, and menstrual pain. It’s also used to treat hereditary polyps in the colon. Gout is a type of arthritis caused when too much of a chemical called uric acid builds up in the blood. Uric acid comes from the breakdown of protein, whether from the turnover of our own cells or from foods and beverages. Usually, the kidneys can get rid of normal levels of uric acid. In gout, it builds up and is not gotten rid of properly. This can lead to the formation of crystals that deposit in joints and cause pain. The treatment of gout focuses on decreasing both the uric acid levels and the pain caused by the crystal deposits. NSAIDS are a good option for treating gout pain because inflammation is part of the problem. Over-the-counter NSAIDS include ibuprofen (Advil, Motrin) and naproxen (Aleve). Discuss their use with your health care provider before taking them. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications, particularly before taking any action. Sarah Lewis, RPh, PharmD Q: I’ve been taking Celebrex, and it isn’t giving me so much relief anymore. Is there another drug besides Celebrex that I might discuss with my doctor?
A: Aleve (naproxen) and Motrin/Advil (ibuprofen) are over-the-counter (OTC) NSAIDs (non-steroid anti-inflammatory drugs) used to treat pain by bringing down swelling. There are also many prescription NSAIDs such as Voltaren (diclofenac), Lodine (etodolac), Indocin (indomethacin), Orudis (ketoprofen), Toradol (ketorolac), Relafen (nabumetone), Daypro (oxaprozin), Feldene (piroxicam), and Clinoril (sulindac). The main concern with these medications is that over time, they can cause bleeding in the gastrointestinal (GI) tract, which includes the esophagus leading into the stomach, the stomach, and the intestines. An alternative is Tylenol (acetaminophen), as it works differently, but it does not reduce inflammation. NSAIDs work by reducing the effects of prostaglandins, which cause inflammation, pain, and fever in the body. Two enzymes, cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2) make the prostaglandins work. COX-1 makes prostaglandins that support platelets and protect the stomach lining. When they are blocked, the platelets cannot cause the blood to clot as easily. COX-2 makes the prostaglandins that cause inflammation, swelling, and as a result, pain. Of the NSAIDs, Mobic (meloxicam) is thought to go down the COX-1 pathway less than most of the NSAIDs. Scientists were able to make COX-2 inhibitors, which did not go down the COX-1 pathway much, but most of them (Vioxx, Bextra, etc.) were removed from the market, as they caused heart problems. Celebrex (celecoxib) is a COX-2 inhibitor that is still on the market and is considered safe, as long as the person taking it does not have any past heart problems or risk factors for them. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Patti Brown, PharmD Q: Do you recommend Celebrex for mild arthritis?
A: The treatment of osteoarthritis typically follows a stepwise approach, and mild arthritis may not require drug treatment. Initially, doctors recommend that patients rest and avoid activities that cause pain, exercise to increase the strength of muscles around the affected joints, and lose weight to decrease pressure on the joints. If medication becomes necessary, it is best to start with those that have the least side effects. The first treatment is usually acetaminophen (Tylenol), which reduces pain, but does not affect inflammation. It is generally well tolerated, but taking more than recommended or having more than three alcoholic drinks per day can increase the risk of liver damage. The next treatments are nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen and naproxen. Some of these drugs are available over the counter without a prescription. They can cause stomach upset, so it is recommended that they be taken with food. Both acetaminophen and NSAIDs can interfere with blood thinners, so it is important to check with your doctor before taking these medications. Celebrex (celecoxib; //www.everydayhealth.com/drugs/celebrex) is a prescription NSAID that is also called a cyclooxygenase-2 inhibitor or COX-2 inhibitor. It causes less stomach upset than other NSAIDs; however, Celebrex and other COX-2 inhibitors may cause kidney damage or increase the risk of heart attack and stroke. COX-2 inhibitors should be taken only at the lowest dose needed to relieve your pain. When your doctor prescribes a new medication, be sure to discuss all your prescription and over-the-counter drugs, including dietary supplements, vitamins, botanicals, minerals, and herbals, as well as the foods you eat. Always keep a current list of the drugs and supplements you take and review it with your health care providers and your pharmacist. If possible, use one pharmacy for all your prescription medications and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and to advise you about drug interactions and side effects. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Michelle McDermott, PharmD Q: Is there another medication that I can take that is equally as good as Celebrex. It’s very good but so expensive!
A: Celebrex (there is no generic but the active ingredient is celecoxib) is an expensive NSAID (non-steroidal-anti-inflammatory-drug), and there are no alternatives exactly like it, but you may be able to try something similar. Most NSAIDS follow two pathways in the body, COX-1 inhibition and COX-2 inhibition. The second one is desirable, as it decreases the inflammation. The first pathway can slowly destroy the stomach lining and over time, cause ulcers or GI bleeding. Celebrex is the only medication that does not go down the COX-1 pathway very much. Others were developed (Vioxx and Bextra), but then recalled due to issues with people having heart problems. So, if you do not have GI bleeding or an ulcer, you may want to ask your doctor about other NSAIDS. Mobic (the generic name is meloxicam) is a great alternative, because it is generic and has less GI/ulcer problems than most of the NSAIDS. Ultimately, you should see what your doctor thinks is best for you. If your doctor insists on Celebrex, you may want to contact the company and see if they have any discount coupons that your pharmacy can process. Many companies do this. The company to contact is Pfizer. For more information on pain management, please visit our link at: //www.everydayhealth.com/pain-management/pain-treatment.aspx Patti Brown, PharmD Brown, PharmD Q: How safe are Geodon and Celebrex? My doctor wants me on Celebrex, but I’ve read it can cause heart attacks.
A: All prescription medications have side effects or common reactions that are patient specific, and therefore difficult to predict. The U.S. Food and Drug Administration is charged with reviewing a drug’s safety profile before approving the drug for sales in the United States. Both Geodon and Celebrex are FDA-approved drugs. Please consult with your physician as to the best prescription medications to treat your health conditions. Lowell Sterler, RPh Q: Does prolonged use of Celebrex hinder your kidneys or liver?
A: Celebrex (celecoxib) is a nonsteroidal anti-inflammatory drug (NSAID) similar to ibuprofen, naproxen, diclofenac, and many others. According to the manufacturer, Celebrex has the advantage of causing fewer stomach and intestinal side effects compared to other NSAIDs. Like other NSAIDs, Celebrex may cause kidney and liver complications after extended use at high dosage. Clinical studies show Celebrex may cause acute renal failure in less than 0.1 percent of patients treated with Celebrex 800 mg per day. The FDA Adverse Event Reporting System reported 122 cases of renal failure associated with the use of Celebrex at the recommended dose. The prescribing information by the manufacturer also states that Celebrex should be used with caution in patients with pre-existing renal impairment. For low-risk patients, it is customary for clinician to order labs for renal function within three months after initiating therapy and repeated every six to 12 months. For those at high risk for renal failure (older than 60 years, pre-existing renal insufficiency), monitoring of renal function should be more frequent. Celebrex has been associated with increasing liver enzymes. According to research data by the manufacturer, elevated liver enzymes were reported in 0.1 percent to 1.9 percent of patients taking Celebrex up to 800 mg per day. Although liver enzymes were elevated, liver failure is rare. For patients at low risk, liver enzymes should be monitored within three months of starting treatment and repeated every six to 12 months. In high risk patients, more frequent monitoring is required. //www.everydayhealth.com/drugs/celebrex, //www.everydayhealth.com/symptom-checker/, and //www.everydayhealth.com/conditions/. Lori Mendoza, PharmD Q: What is Celebrex?
A: Celebrex (celecoxib) is a prescription non-steroidal anti-inflammatory drug (NSAID). Celebrex is indicated for the symptomatic treatment of pain or inflammation caused by osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis in children two years of age and older, ankylosing spondylitis, acute pain, primary dysmenorrhea and as an adjunct to usual care in patients with familial adenomatous polyposis. Celebrex is contraindicated in patients with documented hypersensitivity to the active ingredient, celecoxib, or sulfonamides or in patients with a medical history of asthma, urticaria, or other allergic-type reactions associated with aspirin or other NSAIDs. Treatment is Celebrex is also contraindicated during the perioperative period in patients undergoing coronary artery bypass graft (CABG) surgery. Treatment with Celebrex should be individualized and prescribed at the lowest effective dose and for the shortest duration required to achieve treatment goals for any given indication. Celebrex should be administered with food or milk to decrease stomach upset. Patients are advised to avoid alcohol while being treated with Celebrex as alcohol can increase the risk of stomach bleeding. The most commonly reported adverse reactions during clinical trials, in greater than 2% of patients, included abdominal pain, diarrhea, dyspepsia, flatulence, peripheral edema, accidental injury, dizziness, pharyngitis, rhinitis, sinusitis, upper respiratory tract and rash. During clinical studies, approximately 7% of patients receiving Celebrex discontinued treatment as a result of adverse reactions. The most commonly reported adverse reactions leading to discontinuation of treatment with Celebrex were dyspepsia and abdominal pain. More severe adverse reactions are possible with treatment with Celebrex. Celebrex carries black box warnings regarding the risk of serious cardiovascular and gastrointestinal events associated with treatment. Celebrex may cause an increased risk of serious cardiovascular thrombotic events, heart attack and stroke, which can be fatal. The risk of cardiovascular events may be increased with duration of use and in those patients with documented cardiovascular disease or risk factors for cardiovascular disease. Patients should be instructed to seek emergency medical attention if they develop any signs or symptoms which may indicate the presence of a cardiovascular event including chest pain, weakness, shortness of breath, slurred speech or vision or balance problems. Celebrex, like other NSAIDs, may cause an increased risk of serious gastrointestinal events including bleeding, ulceration and perforation of the stomach or intestines, which also may be fatal. Serious gastrointestinal adverse reactions can occur at any time during treatment and without warning symptoms. The risk of developing serious gastrointestinal events is greater in the elderly population. Contact your health care provider immediately if you experience any signs and symptoms which may indicate the presence of serious gastrointestinal events including black, bloody or tarry stools or coughing up blood or vomit that looks like coffee grinds. When considering treatment with an anti-inflammatory, the patient and health care provider are advised to carefully assess the potential benefits versus risks of Celebrex and other treatment options before deciding upon treatment with Celebrex. Q: How often should you take Celebrex?
A: How often you should take Celebrex (celecoxib) depends upon the reason for treatment. Celebrex is approved for the relief of symptoms caused by pain or inflammation associated with several medical conditions, including osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis in children ages two and older, ankylosing spondylitis, primary dysmenorrhea, acute pain or familial adenomatous polyposis as an adjunct treatment to usual care. When prescribed for the symptomatic relief in patients with osteoarthritis, Celebrex is usually taken once or twice daily. As a treatment option for relief of signs and symptoms of rheumatoid arthritis in the adult population, Celebrex is typically taken twice daily. For the treatment of symptoms of juvenile rheumatoid arthritis in the pediatric population, the usual administration schedule for Celebrex is twice daily. For the relief of signs and symptoms associated with ankylosing spondylitis, Celebrex is typically administered once or twice daily. In adult patients being treated with Celebrex for the management of acute pain or the treatment of primary dysmenorrhea, the usual dose is initially a higher dose, followed by a lower dose if needed on the first day and typically administered twice daily as needed on subsequent days of treatment when required. Lastly, when Celebrex is used as an adjunct to usual care in patients with familial adenomatous polyposis, the dose is usually taken twice daily with food. When deciding upon Celebrex as a treatment option, health care providers are urged to carefully consider the risk versus benefit of treatment with Celebrex and use the lowest effective dose for the shortest duration of treatment possible to achieve positive therapeutic outcomes. Q: What is the usual dosage of Celebrex?
A: The usual dosage of Celebrex is dependent upon the indication for treatment. Celebrex is indicated for the symptomatic relief of pain and inflammation associated with osteoarthritis, juvenile rheumatoid arthritis in patients two years of age and older, rheumatoid arthritis in adults, primary dysmenorrhea, acute pain, ankylosing spondylitis and familial adenomatous polyposis as an adjunctive treatment. The usual dosage of Celebrex recommended for the symptomatic treatment of osteoarthritis is 200 mg daily administered as a single dose or a divided dose of 100 mg administered twice daily. For the relief of the signs and symptoms of juvenile rheumatoid arthritis in the pediatric population, the recommended usual dosage of Celebrex is based on weight. For those patients greater than 10 kg but weighing less than 25 kg, the usual dosage of Celebrex is 50 mg administered twice daily. For patients weighing greater than 25 kg, the usual dosage of Celebrex is 100 mg administered twice daily. According to the prescribing information, Celebrex capsules can be opened and the contents can be added to applesauce for patients who have difficulty swallowing the capsules. Furthermore, patients should be instructed to carefully empty the entire capsule contents onto a level teaspoon of cool or room temperature applesauce and ingest immediately with water. However, the sprinkled capsule contents are stable for up to six hours under proper refrigeration at a temperature between 35 and 45 degrees Fahrenheit. The usual dosage of Celebrex recommended for the symptomatic treatment of rheumatoid arthritis in adults is 100 mg to 200 mg administered twice daily. For treatment of primary dysmenorrhea and management of acute pain, the dosage and administration recommended for Celebrex is the same. The usual dosage of Celebrex recommended for these two indications is an initial dose of 400 mg followed by an additional dose of 200 mg if needed on the first day. The recommended dose is 200 mg administered twice daily as needed on subsequent days of treatment. For the management of the signs and symptoms of ankylosing spondylitis, the usual dosage of Celebrex is 200 mg daily administered as a single dose or the dosage may be administered in divided doses twice per day. According to the prescribing information, if therapeutic effects have not been observed after six weeks of treatment, a trial dosage of Celebrex of 400 mg daily may be beneficial. If a therapeutic response is still not observed after treatment with 400 mg for six weeks, other treatment options should then be considered. Finally, for the adjunctive treatment of familial adenomatous polyposis, to reduce the number of adenomatous colorectal polyps, the usual dosage of Celebrex recommended is 400 mg administered twice daily with food. Patients should continue to receive usual medical care for familial adenomatous polyposis while being treated with Celebrex. For all uses of Celebrex, it is recommended that the lowest effective dosage be administered for the shortest duration of treatment possible in order to achieve the desired therapeutic response. Q: I was told by a doctor that the tendon on the underside of my elbow was slipping off the bone. He gave me a shot of Cortisone that did not help and he gave me Lortab. It is not helping. Would Celebrex help this any or do I need surgery right away?
A: Cortisone (prednisone) is a corticosteroid, used to reduce pain caused from inflammation and swelling, and Celebrex (celecoxib) is a COX-2 (cyclooxygenase-2) inhibitor, and also reduces pain from inflammation and swelling, but is not as strong as a steroid, while Lortab/Vicodin (hydrocodone+acetaminophen) just “masks” the pain by blocking the pain signal from reaching the brain. Only your doctor can determine if you need surgery, but these medications will probably not keep the tendon on the bone, unless the problem is from inflammation. Celebrex (celecoxib) was created because NSAIDs (non-steroidal anti-inflammatory drugs), such as Motrin/Advil (ibuprofen) or Aleve (naproxen), which were invented first, can cause bleeding, over time, in the GI (gastrointestinal) tract which includes the esophagus, leading into the stomach, the stomach, and the intestines, so if you have a history of ulcers or GI bleeding, NSAIDs may not be the right pain relievers for you. An alternative is Tylenol (acetaminophen), as it works differently, but it does not reduce inflammation. NSAIDs work by reducing the effects of prostaglandins, which cause inflammation, pain, and fever in the body. Two enzymes, cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2) make the prostaglandins work. COX-1 makes prostaglandins that support platelets and protect the stomach lining. When they are blocked, the platelets cannot cause the blood to clot as easily. Cox-2 makes the prostaglandins that cause inflammation, swelling, and as a result, pain. Of the NSAIDs, Mobic (meloxicam) is thought to go down the COX-1 pathway less than most of the NSAIDs. Scientists were able to make COX-2 inhibitors, which did not go down the COX-1 pathway much, but most of them (Vioxx, Bextra, etc.) were removed from the market, as they caused heart problems. Celebrex (celecoxib) is a COX-2 inhibitor that is still on the market and is considered safe, as long as the person taking it does not have any past heart problems or risk factors for them. Patti Brown, PharmD Q: What over-the-counter medications should not be taken with Celebrex?
A: Celebrex (celecoxib) belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDS work by reducing hormones that cause inflammation and pain in the body. Celebrex is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. It is also used in the treatment of hereditary polyps in the colon. Many over-the-counter pain medicines, headache medicines, and cold medicines contain aspirin or the NSAIDS ibuprofen (Advil, Motrin) and naproxen (Aleve). People on Celebrex should avoid these products because they contain the same kind of medication. Read labels carefully for the list of ingredients in over-the-counter medicines. Ask your local pharmacist if you have any questions about whether to take a certain over-the-counter product. Always read and follow the complete directions and warnings on over-the-counter medicines and discuss their use with your doctor before taking them. Sarah Lewis, PharmD Q: I have pain in my low back and hip because of a mild degeneration of the spine. I do not need hip replacement surgery yet. My doctor has prescribed Celebrex, but I don’t want to take it every day because of the side effects. I do take 4 ibuprofen a day. Is there something else I should be doing?
A: Celebrex (celecoxib) belongs to a group of drugs called non-steroidal anti-inflammatory drugs (NDAIDs). Celebrex works by reducing hormones that cause inflammation and pain. Common side effects of Celebrex include dizziness, constipation, stomach upset, and headache. Celebrex can be taken any time of the day with food. Advil, Motrin (ibuprofen) is a non-steroidal anti-inflammatory drug (NSAID). Advil works by reducing hormones that cause inflammation. Advil is used for pain treatment and inflammation. Common side effects of Advil include upset stomach, bloating, gas, headache, and diarrhea or constipation. Advil should be taken with food or a glass of milk. Advil can also increase the risk of stomach problems. Also Advil can increase the risk of heart problems such as heart attacks and strokes. This risk increases the longer that Advil is used. Prescribing information suggests that a individual take more than 6 tablets (200mg) of ibuprofen in 24 hours. Celebrex and Ibuprofen should not be taken together. Coadministration of Celebrex and Ibuprofen may increase the potential for serious gastrointestinal toxicity including inflammation, bleeding, ulceration, and perforation. The risk is dependent on both dosage and duration of therapy. If your pain from the degeneration of the spine cannot be controlled with the Celebrex, consult with your healthcare provider. Your doctor may be able to find you an alternative medication to control your pain without causing potential risks and unwanted side effects. Let your doctor know about all the over-the-counter medications you may be taking including herbals, vitamins, and supplements. Some over-the-counter products can interact with prescription medication or make certain medical conditions worse. Kimberly Hotz, PharmD Q: I take Celebrex once a day at bedtime? Could if be making me tired?
A: Celebrex (celecoxib) belongs to a group of drugs called non-steroidal anti-inflammatory drugs (NDAIDs). Celebrex works by reducing hormones that cause inflammation and pain. Common side effects of Celebrex include dizziness, constipation, stomach upset, and headache. According to prescribing information, fatigue was an infrequent side effect reported. This is not a complete list of the side effects associated with Celebrex. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Kimberly Hotz,PharmD Q: Is there a difference between brand name Celebrex and generic? What is the name of the generic form?
A: Celebrex (celecoxib) is classified as a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID). Celebrex is approved for the treatment of osteoarthritis, ankylosing spondylitis, juvenile rheumatoid arthritis, rheumatoid arthritis, treatment of acute pain, primary dysmenorrhea, and for the reduction of intestinal polyps in familial adenomatous polyposis. In the United States, Celebrex is currently only available as a brand name medication. The drug company that makes Celebrex still has patent rights on the medication. In the future, when the generic becomes approved it will be marketed by the chemical name, celecoxib. Generic medications are less expensive alternatives to brand name medications. Generic medications can look differently and can have a few other minor differences from their brand name counterpart. However, their labeling and directions must be virtually the same as that of the brand name product. Generic products must contain the same active ingredient as the brand name products. Both brand name and generic drug manufacturing facilities must meet the United States Food and Drug Administration’s (FDA) specifications. Generics, as well as brand name medications, must follow the same standards of good manufacturing practices. The FDA requires that generic drugs be bioequivalent to the brand name medication. This means that both generic drugs and brand name drugs will work the same way in your body. Generics are considered by the FDA to be identical to brand name drugs in dose, strength, quality, route of administration, safety, efficacy, and intended use. Generic medications do not need to contain the same inactive ingredients as brand name medications. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Jen Marsico, RPh Q: I have been taking Celebrex for 9 months with no side effects. However, I recently have noticed a skin irritation similar to a bad sunburn where my skin is red and flaking off. I do not want to stop taking Celebrex as it has helped my severely arthritic right hip. I do not want to have hip replacement surgery now. Can Celebrex be the cause of the skin irritation?
A: Celebrex (celecoxib) is a COX-2 selective non-steroidal anti-inflammatory drug (NSAID) which is approved for the treatment of osteoarthritis, ankylosing spondylitis, juvenile rheumatoid arthritis, rheumatoid arthritis, management of acute pain, and treatment of primary dysmenorrhea. Celebrex treats pain and inflammation. COX-2 inhibitors, such as Celebrex, are marketed to have less gastrointestinal side effects than traditional NSAIDs. However, they still carry that risk. COX-2 inhibitors may also have an increased risk of heart attack and stroke over traditional NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). The most common side effects associated with Celebrex include hypertension (high blood pressure), headache, and diarrhea. Some potential dermatological side effects, which are listed in the prescribing information for Celebrex, include skin rash, bruising, cellulitis (skin infection), skin itching, dry skin, and sensitivity to the sun. The prescribing information for Celebrex does recommend to stop treatment and to see your healthcare provider if a rash develops. You will want to have your redness evaluated by your health care provider for proper diagnosis of the underlying cause and treatment options, if necessary. You may wish to see a dermatologist to determine what type of skin condition you have. For dry skin, a skin moisturizing cream or lotion can help with redness and flaking. Celebrex can make the skin more sensitive to the sun which could result in a sun burn. It is recommended to wear a sunscreen with at least SPF 15 everyday, even on cloudy days or when not expecting to be in the sun. Celebrex should be taken with food, if stomach upset develops. Celebrex can interact with over-the-counter (OTC) pain medications, so speak with your doctor before taking any OTC pain medications. It is important to discuss any side effects you experience from medications with your doctor. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Video: Celebrex: Stomach and Intestinal Side Effects Celebrex images

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What Are Corticosteroids?

What Are Corticosteroids?

Corticosteroids are synthetic drugs that are similar to cortisol, a hormone the body naturally produces. They’re used to treat a wide variety of disorders, including asthma, arthritis, skin conditions and autoimmune diseases.

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Originally Posted by DancingJohari That was beautiful! I have a condition called sinus arythmia, which is dr talk for “irregular heartbeat”
I also have asthma. It used to be really mild, but lately, It’s gotten alot worse. If my heart rate goes too high, I run the risk of passing out. This means that exercise is hard for me. I have figured out over the years where my danger zone is. My asthma is currently being treated with an emergency inhaler, nebulizer treatment and a steroid called Prednisone. In a week, I’ll be switched over from prednisone to symbicort.
Bcc ecause of all this, I am very prone to head colds, respuratory infe tions, bronchitis, pneumonia, sinus infections and anything else that decides to attack my respiratory system, including flu and flu like viruses.
Right now, I am javing round 3 of respiratory illnes which started around thanksgiving. Because I am alkergic to certain antibiotics, and because weaker ones no longer work for me, I’m very limited on what I can take for an infection. I’m 41 years okd, married with 3 kids who are special needs. What’s a day off? lol.
Thank you, Raina, for sharing your story. It helped me to realize that I am not alone.
Sent from my [device_name] using MerNetwork mobile app I’m sorry to hear that someone else deals with these issues too but glad to not feel so alone! Although i stopped my powder inhaler because i had a weird tongue swelling reaction to it now i just keep my emergency inhalers on hand and avoid the cold! Or extreme heat:/ basically I’m the youngest person at all my dr visits lol. But mermaiding with these issues seems to be challenging because it’s a full body activity and holding my breath isssnnttt easy anymore:/….
Sent from my iPhone using Tapatalk

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IL-1 Blocker Succeeds in Real-World Vasculitis

<h1>IL-1 Blocker Succeeds in Real-World Vasculitis</h1>

IL-1 Blocker Succeeds in Real-World Vasculitis

IL-6 Blocker Succeeds in Real-World Vasculitis Clinical and laboratory improvements seen with tocilizumab in refractory giant cell arteritis MedpageToday by Nancy Walsh Senior Staff Writer, MedPage Today January 13, 2019
Tocilizumab (Actemra) was effective for refractory giant cell arteritis (GCA) in real-world practice, although serious infections occurred relatively frequently, Spanish investigators reported.
Among a cohort of 134 patients treated in an open-label study, clinical improvements were seen in 93.9% after 1 month of treatment, according to Miguel A. González-Gay, MD, PhD, of Hospital Universitario Marqués de Valdecilla in Santander, and colleagues.
However, serious infections developed at a rate of 10.6/100 patient-years but were most common among patients receiving high doses of prednisone, the researchers reported online in Seminars in Arthritis & Rheumatism .
Conventional treatment for GCA, a large-vessel vasculitis that usually afflicts individuals over 50, is glucocorticoids, but adverse effects are common and relapses occur frequently following prednisone taper. The aorta and its major branches are most often affected, and blindness, stroke, and aneurysms can occur.
The cause of the disease is unknown, but proinflammatory cytokines such as tumor necrosis factor (TNF)-α and interleukin (IL)-6 have been implicated.
Multiple immunosuppressive agents as well as TNF inhibitors have been tried, but have shown little or no efficacy. However, two recent clinical trials reported beneficial results with tocilizumab and led to approval of this IL-6 receptor inhibitor for GCA in Europe and the U.S.
But in those trials, as is typical for randomized studies, many patients with comorbidities were excluded, patients with recent-onset disease were included, and follow-up was relatively brief.
Therefore, to evaluate the treatment in a real-life setting that included patients with refractory disease and comorbidities — the patient population most likely to receive this treatment — the investigators conducted an observational, retrospective study that included patients from 40 referral centers. All had previously received high-dose prednisone and almost three-quarters had also been given conventional or biologic immunosuppressives such as cyclophosphamide, hydroxychloroquine, abatacept (Orencia), infliximab (Remicade), or rituximab (Rituxan).
The diagnosis of GCA was confirmed with a positive biopsy of the temporal artery or using imaging techniques such as F-fluorodeoxyglucose PET scanning, MRI angiography, or CT angiography. For acute phase reactants, serum C-reactive protein (CRP) levels above 0.5 mg/dL and erythrocyte sedimentation rates (ESR) above 20 mm/hour in men and 25 mm/hour in women were considered abnormal.
Tocilizumab was given either intravenously, in dosages of 8 mg/kg every 4 weeks, or subcutaneously in a dosage of 162 mg/week, generally with background prednisone (40 to 60 mg/day), which was tapered gradually.
The study included 101 women and 33 men whose mean age was 73. Median disease duration was 13.5 months, and symptoms included headaches, constitutional symptoms such as anorexia and weight loss, jaw claudication, and visual abnormalities.
At month 1, median levels of CRP had declined from 1.7 to 0.11 mg/dL, ESR had fallen from 33 to 6 mm/hour, the percentage of patients with anemia had decreased from 16.4% to 3.8%, and mean hemoglobin levels had risen from 12.3 to 13.1 g/dL ( P <0.0001 for all).
In addition, the median dosage of prednisone had already decreased from 15 to 13.75 mg/day ( P <0.0001).
Clinical and laboratory improvements persisted throughout follow-up, which extended for up to 4 years, and among those followed for at least 2 years, persistent remission was seen in 39 patients (69.2%), with normal acute phase reactants and prednisone doses ranging from 0 to 5 mg/day.
Of those 39 patients, seven had mild relapses that were treated with small increases in the dose of prednisone.
After a median 12 months of follow-up, 32 patients (23.9%) reported an adverse event, with 17 necessitating discontinuation of treatment. The serious infection rate of 10.6/100 patient-years was higher than the 4.7/100 patient-years seen in a study of patients with rheumatoid arthritis treated with tocilizumab, González-Gay and co-authors noted.
Patients who had serious infections were somewhat older and had longer disease duration. Among patients receiving more than 15 mg/day of prednisone, the rate of serious infections was 16.3/100 patient-years compared with 4.2/100 patient-years among those with dosages below 15 mg/day.
"Taken together, our findings and the results of the randomized controlled trials [suggest that] tocilizumab seems to be an excellent therapeutic option in GCA" and "improves clinical manifestations, acute phase reactants, and imaging findings."
Limitations of the study, the researchers said, included its retrospective and observational design.
The authors reported financial relationships with AbbVie, Merck Sharp & Dohme, Roche, Pfizer, Eli Lilly, Sanofi, Bristol-Myers Squibb, and Janssen. 1969-12-31T19:00:00-0500

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Turinabol Usage
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Testosterone Enanthate All Year
Take into account buying an aura purifier to help you cover up the sound of your tinnitus. It would both nice and clean air you inhale and create white-noise that can mix with the audio in your mind but not cover it completely. This will help become accustomed to your ringing in the ears after which far better cope with it.
Prednisone Oral 60 Mg

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Seattle Genetics Announces Publication of North American Subgroup Data from ECHELON-1 Phase 3 Clinical Trial of ADCETRIS® (Brentuximab Vedotin) in Newly Diagnosed Advanced Hodgkin Lymphoma

<h1>Seattle Genetics Announces Publication of North American Subgroup Data from ECHELON-1 Phase 3 Clinical Trial of ADCETRIS® (Brentuximab Vedotin) in Newly Diagnosed Advanced Hodgkin Lymphoma</h1>

Seattle Genetics Announces Publication of North American Subgroup Data from ECHELON-1 Phase 3 Clinical Trial of ADCETRIS® (Brentuximab Vedotin) in Newly Diagnosed Advanced Hodgkin Lymphoma

BOTHELL, Wash.–(BUSINESS WIRE)–Seattle Genetics, Inc. (Nasdaq:SGEN) today announced the publication of data from the ECHELON-1 phase 3 clinical trial online in the journal Clinical Cancer Research. The publication, titled “Brentuximab Vedotin Plus Chemother…

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Irritable Bowel Syndrome: How to Avoid an Incorrect Diagnosis

<h1>Irritable Bowel Syndrome: How to Avoid an Incorrect Diagnosis</h1>

Irritable Bowel Syndrome: How to Avoid an Incorrect Diagnosis

8 Foods to Avoid with IBS Irritable Bowel Syndrome: How to Avoid an Incorrect Diagnosis Sign Up for Our Digestive Health Newsletter Thanks for signing up! You might also like these other newsletters:
Did you know that the symptoms of irritable bowel syndrome, Crohn’s disease and ulcerative colitis can be so similar that misdiagnoses and incorrect treatment occur all too often?
Join us as we speak with top gastroenterologists about the symptoms unique to each of these bowel diseases, the best tests to accurately diagnose your condition, and why a correct diagnosis is so important for getting the right treatment. You’ll find out which symptoms you should be sure to mention to your doctor, and how to go about getting a second opinion and further testing if you’re not satisfied with your diagnosis.
As always, our expert guests answer questions from the audience.
Announcer:
Welcome to this HealthTalk webcast. Before we begin, we remind you that the opinions expressed on this webcast are solely the views of our guests. They are not necessarily the views of HealthTalk, our sponsors or any outside organization. And, as always, please consult your own physician for the medical advice most appropriate for you.
Now here’s your host.
Rick Turner:
The symptoms of irritable bowel syndrome, IBS, can be very similar to inflammatory bowel disease, IBD. So how do doctors tell the difference between the two when making a diagnosis? Hello and welcome to this HealthTalk webcast, Irritable Bowel Syndrome: How to Avoid an Incorrect Diagnosis. I’m Rick Turner. And in this hour, our guests will clarify the differences between IBS and IBD, walk us through the diagnostic process, and discuss treatment for IBS, Crohn’s disease and ulcerative colitis.
With us on the phone from Seattle, Washington is Dr. Stephen Wangen, a naturopathic doctor and medical director and founder of the IBS Treatment Center in Seattle. Welcome to HealthTalk, Dr. Wangen.
Dr. Stephen Wangen:
Thank you, Rick. It’s a pleasure being here.
Rick:
And before we move on, can you tell us what is a naturopathic doctor?
Dr. Wangen:
Well, a naturopathic doctor is, certainly in the state of Washington and in many other states, a licensed and board-certified physician, and the difference really being often in the types of treatments that are selected. I could certainly prescribe many drugs and medications, although I often choose not to. I have a real emphasis on trying to find the root cause of the problem so that we don’t need to resort to medications. And it’s a really fascinating field, and I am sure we could spend the whole hour just talking about that, but I will try not to.
Rick:
I am sure. Good. Well, it’s nice to have you with us today.
Dr. Wangen:
Thank you.
Rick:
Also joining us from Milwaukee is Dr. Lilani P. Perera, assistant professor of medicine in the division of gastroenterology and hepatology at the Medical College of Wisconsin. Dr. Perera, welcome to you.
Dr. Lilani P. Perera:
Oh, Rick, thanks for inviting me.
Rick:
So, Dr. Perera, beginning with you, the question we posed at the outset, what is the difference between inflammatory bowel disease and irritable bowel syndrome?
Dr. Perera:
Inflammatory bowel disease, or IBD, is a chronic, relapsing inflammation of the gastrointestinal tract. It can both be broadly classified into Crohn’s disease and ulcerative colitis. Usually, IBD develops due to genetically susceptible individuals being exposed to environmental triggers resulting in disregulation of the immune response in the gut, which leads to chronic inflammation. Due to chronic inflammation in both Crohn’s disease and ulcerative colitis, there can be blood loss from the intestine, diarrhea and changes in the intestinal wall. Some of the abnormal blood tests include low hemoglobin, high inflammatory markers and abnormal electrolytes due to diarrhea. The abnormalities in the intestinal wall usually can be seen during endoscopy, X-rays or CT scan.
On the other hand, the irritable bowel disease, or IBS, is a common, chronic, functional bowel disorder. This means there is a disordered functioning of the bowel in relation to functions of the intestines. These include movement or motility of the intestine, the sensitivity of the nerves of the intestine. They seem to be hypersensitive, or they seem to feel at a lower threshold of a stimulus compared to a normal person. And the way in which the brain controls some of these functions can also be altered in IBS patients.
Rick:
So I hear a couple of distinctions between IBD and IBS. I didn’t hear you say that irritable bowel syndrome happens in people who are genetically predisposed to that. Is that correct?
Dr. Perera:
Yes. As far as we know, there is no hereditary or genetic susceptibility in patients who develop IBS, unlike in IBD.
Rick:
All right. And the other part I picked up on is that it’s more of a sensitivity issue. It’s not that there is inflammation going on with someone with IBS, but somehow they are feeling their gut more sensitively than the rest of us. Is that right?
Dr. Perera:
Yes. So it seems that they are more responsive to any stimulus, including even natural stimulus. If there is a rigorous contraction, or trying to push through after the meal, they can feel it much more, or actually they can feel it when it comes to a person who does not have IBS would not even realize that it’s happening inside the body.
Rick:
That’s interesting. So, Dr. Perera, how tough is it to distinguish between the two, IBS and IBD, when you make that initial diagnosis?
Dr. Perera:
Usually, it’s not difficult because in IBS there are no structural abnormalities that can be seen in X-rays or endoscopy or lab tests, so we usually diagnose IBS using constellation of symptoms. And IBD, usually the main diagnostic gold standard is doing an endoscopy and taking biopsies and looking under a microscope at these tissue pieces and looking for a particular kind of inflammation and cell type.
Rick:
Is it any more difficult to diagnose children?
Dr. Perera:
You mean the children with IBS?
Rick:
Or IBD and making sure you get the correct diagnosis with a child?
Dr. Perera:
It can be difficult in children simply because sometimes you might not be able to get a detailed history.
Rick:
Right.
Dr. Perera:
So the initial presentation could be a similar presentation. They both can have diarrhea. They can have abdominal pain. And then if you do not suspect and they do not have alarm symptoms and signs, those can attribute as IBS.
Rick:
And, Dr. Perera, what about the demographic distribution of IBS, is it more common in men or women, for example, or a particular age group?
Dr. Perera:
I believe it affects about 25 to 45 million people in the United States. Approximately 60 to 65 percent of this group is female.
Rick:
Okay.
Dr. Perera:
And 35 to 40 percent is male. And IBS can affect people of all age groups, including children, but it’s more commonly seen in middle-aged females.
Rick:
And is it possible for both to exist in the same patient, IBS and IBD?
Dr. Perera:
I think it’s unclear because there are some studies in the early ‘90s that suggested that IBS co-exists in IBD patients. But in that area, to support the IBS-like symptoms seen in patients with IBD, who are in remission may be actually due to changes that occurred in the intestinal nerves during the periods of active inflammation. And this notion is actually supported by the fact that sometimes IBS can develop after an acute viral or bacterial infection of the intestine.
Rick:
Interesting. Dr. Wangen, I want to bring you back into the conversation because you were diagnosed with IBS back in 1994. Tell us how that came about.
Dr. Wangen:
Well, I suffered from, for a few year from primarily it would be best described as really embarrassing gas, although I would get abdominal pains or get loose stools and diarrhea that wasn’t really life-altering. It was just kind of one of those things.
Rick:
A nuisance.
Dr. Wangen:
Yes. Just a hassle. And well, here it is, and I wouldn’t really have such an urgency usually that there would be a problem. But I just knew that my digestion wasn’t functioning appropriately and that things were not working right in that area and wasn’t really getting any answers anywhere either.
Rick:
So how did the diagnosis of IBS come about?
Dr. Wangen:
Well, essentially going to the doctor before I was a doctor and saying, “Well, I have these symptoms,” and basically ruling out any other more significant problems, and then essentially you are left with this syndrome that doesn’t really offer you much explanation for why you are having these symptoms but gives you a classification that puts you with these 45 million Americans, which is a huge percentage of people that are suffering from these digestive problems that get lumped into this syndrome.
Rick:
Yes. At least it gives a name to it.
Dr. Wangen:
Yes.
Rick:
And it’s interesting, though, I have read that you said your diagnosis had no impact on your health. What did you mean by that?
Dr. Wangen:
Well, I don’t know. I guess that probably came around just from me saying that it was only somewhat embarrassing, but it wasn’t exactly causing me to not be able to live my life the way I wanted to, which will happen with many patients I will see that actually they cannot do the social activities they want to do. They can’t take part in the things they want to take part in. Or oftentimes, I have had many patients who have even lost their jobs because of their IBS.
Rick:
Really? And a bit off topic for a second, but you specialize in IBS.
Dr. Wangen:
And can you define what makes IBS a syndrome and not a disease?
Dr. Wangen:
Well, I think we use those words rather loosely, syndrome versus disease. But I think the syndrome part of it is just that what we’ve done is taken a whole bunch of different symptoms, whether it’s constipation or diarrhea or just loose stools or gas or bloating or abdominal pain, and we have created this category really, this artificial area to place these people, and then given that name a syndrome just called it irritable bowel syndrome. But we don’t always use those two words. There is no real good standard definition for that.
Rick:
Okay. And, Dr. Perera, listening to Dr. Wangen describe his personal experience, does that sound typical to you?
Dr. Perera:
Yes. I mean, some patients can function normally with IBS symptoms, but it depends on how severe are their symptoms. Sometimes actually IBS symptoms can be so serious, and it can have a great impact on their overall well-being.
Rick:
Oh, good to say. So we don’t want to downplay those symptoms.
Dr. Perera:
Yes.
Rick:
Now, Dr. Perera, I spoke with a GI doctor who said that sometimes people go to the emergency room complaining of abdominal pain, and they are told that they have IBS, not to worry, but then their symptoms persist, and it eventually turns out that in fact they have IBD. How commonly does that happen?
Dr. Perera:
There is often a timeline between the onset of IBD symptoms and the actual diagnosis, but there are no large studies that I am aware of addressing the specific issue that you raise right now. But there may well be a time when the patients initially present not only to the ER but actually to their primary physician. Sometimes they just think it may be some transient thing and wait and see.
Rick:
So then for someone who is in that situation who goes to the ER, what sort of follow-up should they pursue if they want to make sure that they have been correctly diagnosed?
Dr. Perera:
Well, I think it’s important for them to follow-up with their primary care physician or a gastroenterologist if they continue to have abdominal pain or they develop alarming symptoms like weight loss or symptoms at nighttime of blood in their stool, of fever, or they have a family history of IBD. So during this follow-up, it’s important that they have the results of the investigations that were performed in the ER. That way, you can prevent unnecessary repetitions at the labs. You can compare.
Rick:
Right. And yes. Go ahead. Finish that thought. You can compare those records from the ER.
Dr. Perera:
Yes.
Rick:
Exactly. And is it possible, Dr. Perera, that IBS could ever morph or turn into either colitis or Crohn’s disease?
Dr. Perera:
The short answer is no. There is no evidence that IBS can turn into IBD, and there is no known increase of developing IBD in IBS patients. So the only scenario, a patient who is diagnosed with IBS can be found to have IBD later in life would be initial misdiagnosis.
Rick:
So you are saying that IBD is just not a more severe case of IBS?
Dr. Perera:
So there are different disease processes going on?
Dr. Perera:
Yes.
Rick:
Okay. We get e-mails from listeners who say they have been misdiagnosed with Crohn’s disease when, in fact, they had ulcerative colitis and vice versa. How common is that, to distinguish between those two types of IBD?
Dr. Perera:
Well, in about 10 percent of patients with IBD, the distinction between Crohn’s disease and ulcerative colitis cannot be made as there are overlapping findings. So these patients are usually said to have indeterminate colitis. Similarly, some patients may initially have diagnosis of UC or Crohn’s disease because the initial presentations and findings during the colonoscopy favors one or the other. But with time, they might evolve or manifest symptoms and signs of the opposite diagnosis.
Rick:
And what is it about those 10 percent of cases that make it difficult to distinguish between the two?
Dr. Perera:
So when, especially when the Crohn’s disease involves only the colon, it’s difficult to diagnose it from or differentiate it from ulcerative colitis. So there are several findings that are suggestive of Crohn’s disease in this setting. They include either involvement of the small bowel, involvement of the rectum, absence of gross bleeding, a characteristic finding during colonoscopy, the presence of granulomas, which is only seen in about 30 percent of Crohn’s disease patients. Granulomas are certain types of collection of cells that we would see during biopsies when they are checked under the microscope or if the patient has any fistula or draining sinus tracks near the anal region.
Rick:
And similar to the question I asked earlier, is it possible for colitis to evolve into Crohn’s or vice versa?
Dr. Perera:
So as I mentioned a few minutes ago, first of all, we must be clear that the differentiation of ulcerative colitis and Crohn’s is not always clear-cut.
Rick:
Right.
Dr. Perera:
Both disorders can present with inflammation in the colon, which is the colitis, and that’s the meaning of colitis, the inflammation of the colon. So sometimes it is difficult to distinguish the two types, even you are the best gastroenterologist. So the 10 percent of cases can remain undifferentiated.
Rick:
I see.
Dr. Perera:
In addition, with time it can evolve, and we might be able to differentiate if a patient has Crohn’s disease or ulcerative colitis.
Rick:
So it just takes time to make sure you have the correct diagnosis?
Dr. Perera:
Yes. Sometimes the initial presentation might not be very distinct.
Rick:
And then, Dr. Perera, how do gastroenterologists diagnosis IBS? Tell us about that process. Is it largely a process of elimination, making sure it’s not IBD?
Dr. Perera:
Actually, the diagnosis process in IBS usually starts with a detailed history and physical exam. So the presence of certain symptoms typical of the disorder, which includes abdominal pain or cramping, which improve with defecation, the change in bowel habits, either constipation or diarrhea, or the change in the character of the stools. So the symptom-based diagnostic criteria for IBS actually emphasizes positive diagnosis rather than doing numerous tests to exclude other organic causes.
Rick:
I see.
Dr. Perera:
So you want to do tests only on the presence of alarm symptoms or red flags that I mentioned before.
Rick:
Yes.
Dr. Perera:
And usually patients, even they have the typical constellation of symptoms, they may have basic blood work, including blood count or the CBC and basic chemistry. We are looking for anemia, infection with increase of a white cell count, or changes in electrolytes which can be related to diarrhea. And they will look for inflammatory markers, which are known as C-reactive protein and erythrocyte sedimentation rate. There are studies from the U.K. suggesting that patients with sprue can present with symptoms similar to IBS, so usually I do the sprue panel in these patients. And if the age at presentation of the patient is more than 50 years or they have family history of colon cancer, then I will do a colonoscopy.
Rick:
And, Dr. Wangen, listening to that process, you are a naturopathic doctor, as we mentioned before. How different is the process for you when it comes to screening a patient for IBS? Are your methods radically different from those of traditional medicine?
Dr. Wangen:
Well, I would say that I guess the majority of my patients have already been diagnosed as IBS, and screening them is not something that I focus on. I am not so concerned with diagnosing IBS because it has so little meaning. I am mostly concerned on solving their problem, so whether or not they get classified as an IBS patient or not isn’t important to me. Having ruled out IBD is important, and usually that’s already been done. Or if they need to have that done, I can refer them to a gastroenterologist to have that done. But what you find is that a very large percentage of patients who visit gastroenterologists, and the studies have shown that it’s as many as a quarter, nearly 25 percent of patients who visit a gastroenterologist, end up with a diagnosis of IBS, which, of course, leaves them basically still wondering what the cause of the problem is.
Rick:
And that’s where we really start. My specialty is picking up at that point.
Rick:
So they have already been diagnosed?
Dr. Wangen:
Typically. Although not necessarily always. I mean, there are certainly many patients who just haven’t really needed to see a gastroenterologist because the quality of their symptoms haven’t met that severity, or their age or their risk factors or what have you haven’t really lent them to necessarily being referred to a specialist yet, and they refer themselves. And they say, “I have these digestive problems, and I would just like to have an answer,” whether or not they are truly classified as IBS.
Rick:
So how do you go about helping them, Dr. Wangen? I understand you test DNA.
Dr. Wangen:
Well, we do several things. When you really start to look at digestive problems that are not IBD, and they are just falling into this IBS world or just falling into a no diagnosis world, just sort of chronic abdominal pain or constipation or diarrhea, if you start to really look at all the medical literature out there, all the research that explains the various causes of these things, you would find that there are many hundreds of causes of these kinds of symptoms.
And one of the things that you mentioned, DNA, relates to a particular kind of testing we do with stool. The digestive tract is, of course – or maybe not of course – that’s the wrong term to use, but it is this fantastic ecosystem of organisms. And we tend to underappreciate the value of all these organisms. We hear about good bacteria, for example, such as acidophilus.
Rick:
Right.
Dr. Wangen:
And we have many other bacteria, and there are all kinds of bad bacteria, and we hear about some of the really bad ones such as salmonella.
Rick:
Yes.
Dr. Wangen:
Or some of the bad E. colis. And those make the news, but there are many other bacteria. There are yeasts such as candida. There are many good bacteria, and there are all kinds of parasites, even ones that we generally don’t hear about that can be involved in this ecosystem that’s occurring in the digestive tract. The DNA portion of this gets involved when we can actually use DNA testing now to assess that environment. And we can take a stool sample and run a DNA analysis looking for genetic material from all these different organisms.
Rick:
So you are doing a DNA test on the microbes?
Dr. Wangen:
Exactly. That’s the latest in the technology for testing these organisms that are involved in that ecosystem.
Rick:
And do you have evidence from clinical trials, as an example, that shows this is a valid and clinically meaningful bit of information to have?
Dr. Wangen:
Well, certainly there have been many studies over the years involved on detecting these kinds of organisms in the stool sample, and most of those have been done by traditional stool cultures, which are the more common technique for looking for what’s going on in the digestive tract as far as measuring these organisms. We also do microscopic examinations as the traditional way of looking at these organisms as far as parasites go because you can’t culture those.
With DNA testing, of course, it’s been around for many years, but it hasn’t been available as a tool for the public to use to measure these kinds of organisms. It’s been around in research for many years, and we have all heard about DNA testing with regard to whether or not someone in the legal system when somebody left a blood sample.
Rick:
Right. Right.
Dr. Wangen:
So it’s the same concept, and researchers have been using it, only now it’s available to the rest of us because before there were too many patents and controls on things that made it too expensive to offer to the public.
Rick:
So when you test for these, Dr. Wangen, is there a spectrum of microbes, say, bad microbes on one end and good microbes on the other and sort of neutral microbes in the middle, and you find if they have the proper array of microbes in the gut? Is it something along that process?
Dr. Wangen:
There certainly is a balance. That’s a big issue, the balance of all these organisms. You have many different, what we call probiotics, the good guys, and acidophilus is the most commonly understood one, or in the public’s mind that’s the one we hear about the most. There are all kinds of other organisms that, like you say, there are some that are basically neutral. They are not really causing problems. There is no research demonstrating that they cause problems. And then there are others that you never hear of that there are lots of case studies and lots of research that show that they cause digestive problems, but oftentimes they will even get ignored in medical textbooks. So if you crack open the text, and it will say, oh, this organism is non-pathogenic, meaning it’s not causing problems. But when you dig deeper and you actually look at the research studies and all the case studies, you find often many examples of that organism causing the digestive problems. So, of course, anybody who has a digestive problem wants to know everything there is to know, not just to sort of get chalked up as, well, usually this isn’t a problem.
Rick:
And in general, Dr. Wangen, are these tests covered by insurance?
Dr. Wangen:
That will vary from one plan to another, and it’s really hard to say. Sometimes they are, and sometimes our patients are covered 100 percent, and sometimes they are not covered at all. It’s hard to speak for insurance plans.
Rick:
Sure. Now, you have said also that IBS is primarily caused by food. Why do you say that?
Dr. Wangen:
Well, the other thing, and I haven’t mentioned that I find incredibly important when it comes to digestive problems is, of course, the food that we eat. And most people associate their problems with foods, and they find that they feel much better when they don’t eat, but, of course, you have to eat.
Rick:
Eventually.
Dr. Wangen:
And it turns out that there is certainly a profound effect that food has on us, and food allergies are a major aspect of what I look at to assess what’s going on in a person’s digestive tract. And this is an area that gets really overlooked and underestimated by most of the medical community because we tend to think of food allergies as something very traditional, that if you have an allergy, your tongue swells up, or you get hives, or you have an anaphylactic reaction.
Rick:
Yeah, it’s very dramatic.
Dr. Wangen:
Yeah. But it turns out that in most cases it’s not very dramatic or at least not in the classic sense that we think of it. And food allergies are much more complicated areas than just looking for the traditional IgE antibody reactions that allergists typically are looking at. And again in the research we see, many examples of studies on these same areas, it’s hard for doctors to know everything because there are too many things to know, obviously. And so in my area, that’s what I specialize in is focusing on what is it that impacts a person’s digestive tract that’s not IBD, that’s not cancer, that’s not any of these other things, and there are many, many issues. And the food allergies are a huge one, and it can be literally any food, but those will usually show up on a blood test.
Dr. Wangen:
In general, Dr. Wangen, are there certain factors that tend to exacerbate IBS?
Dr. Wangen:
Well, when you run into any information about IBS, of course, you get the same kinds of information. You are told to reduce your stress. You are told to take more fiber. And probably don’t intake caffeine or alcohol, and certainly all those things will exacerbate a digestive problem. So if you have a health issue regardless of what it is, but certainly if it’s a digestive issue, and then you get stressed on top of that, it’s certainly going to make things worse. It’s not going to make them better. And so, and the fiber might help, but it’s not treating the cause of the problem. It’s pretty rare that people are so deficient in fiber that that’s really the key issue that’s going on. And the same thing I find with the alcohol and the caffeine is that they are irritants, and they will exacerbate an underlying digestive problem but aren’t usually the primary factor that’s causing the problem.
Rick:
Dr. Perera, back to you, and talking about treatment now for IBS, how is treating IBS different than treating IBD?
Dr. Perera:
The treatment of IBS I usually start with, as Dr. Wangen said, asking the patient to avoid the food types that can exacerbate their symptoms and then followed by symptomatic treatments. If a patient has diarrhea, treat it with anti-diarrheal medications. If they have constipation, treat with fiber supplements and laxatives or lubiprostone, a medication that inhibits the chloride channels or the channels that absorb water in the stool. And also we use neuromodulating anti-depressant medications. Those include tricyclic anti-depressants and the selective serotonin reuptake inhibitors. These are not used just thinking the patient depressed. These medications have shown to affect the nerve function in the intestine.
Rick:
Really?
Dr. Perera:
So that the pain can be controlled. And there are studies actually showing that probiotics can improve the abdominal discomfort and the overall symptoms in IBS patients.
Rick:
And then for treating IBD, I guess the key is you have the inflammation to deal with, right?
Dr. Perera:
Yes. So in the treatment in IBD, of course, the treatment depends on the location and the severity of the disease. The goal of treatment, there are two goals. The first thing is to control the symptoms or achieve remission, and then is to maintain the remission. So we use mainly four classes of drugs involved in Crohn’s disease and ulcerative colitis. The first one is 5-aminosalicylic acid or 5-ASA products. So these medications work at the lining of the intestines. They do not suppress the immune system. They are usually used to treat mild to moderate ulcerative colitis or Crohn’s disease.
Rick:
Okay.
Dr. Perera:
But studies have shown that the Crohn’s disease may not respond to the 5-ASAs as well as the ulcerative colitis will.
Then if you think that the patient has more active disease, then we use corticosteroids. So there are several types of corticosteroids that we use, depending on the clinical scenario. If a patient has mild to moderate Crohn’s disease involving just the terminal part of the small intestine or the terminal ileum and the right side of the colon, we can use something called budesonide or the Entocort, which is actually a topical steroid. So it does not get absorbed mainly into the bloodstream, so there is minimal toxicity compared to the other steroids that get absorbed into the blood directly.
Rick:
I see.
Dr. Perera:
Well, but we do use those steroids, the hydrocortisone or the prednisone, which are the most commonly used ones, to achieve remission when the patient has serious symptoms. But because of the toxicity, we usually at the same time start another group of medication called immunomodulators. Those include methotrexate, or azathioprine. And then after we achieve remission, then we continue patients on immunomodulators.
And then the last group of medications are the biologics. So those include the proteins, which are called anti-TNF molecules. Those are the first ones that were available. The first medication that was available was infliximab or Remicade, which has been there about for 11 years, and it is usually given intravenously. We give induction treatment, which is followed by every eight weeks intravenous infusions. And then there are another two types of anti-TNF medications which are approved for Crohn’s disease. Those include Humira (adalimumab) and Tysabri (natalizumab).
Rick:
Tysabri. And, Dr. Perera, do you ever treat IBS with surgery?
Dr. Perera:
No, because all the gastroenterology community agrees that the surgery has no place in treatment of IBS.
Rick:
Dr. Wangen, back to you, you talked about treating the cause of IBS rather than the symptoms. How do you folks at your clinic treat IBS?
Dr. Wangen:
At the IBS Treatment Center, what we do is we really focus on trying to resolve the condition altogether. As Dr. Perera mentioned, many of the medications, well, all of the medications that are used in the treatment of IBS, and many of my patients are on them, are designed to treat symptoms, whether they are anti-spasmodic drugs or they are anti-depressant drugs or they are changing the motility of the gut. They are doing something to treat symptoms, but they don’t cure the problem, and there is no pretense that they are going to cure the problem.
So when a patient comes in, a new patient comes in, of course, we need a detailed history. Oftentimes, there are lots of clues involved, when the problem started, what may have been some of the triggers involved, but really what we need are two big broad panels of information. I need to understand exactly what’s going on in that environment, in that ecosystem in the digestive tract of theirs. What are the organisms like? What’s the balance like? Is there something in there that needs to be treated? And there are many examples of things, whether it’s candida, which is a real problem that actually gets sort of overestimated by the public and underestimated by the medical community, but it really exists. You certainly can see yeast overgrowth, and that’s a common problem. You will see other bacteria that have been missed. Certainly, the DNA testing is far superior, and I have used the other testing traditionally in a much broader sense than most physicians because I have always looked for the good bacteria as well as all kinds of indifferent and bad bacteria, but the DNA test is even much better at capturing those organisms than any technology we have had previously. So I want to see that whole picture.
And then the other thing I want to see is how is their immune system reacting to the foods that they are eating, and not just traditional IgE antibodies, but IgG antibodies as well. And I don’t know if we will have time to get into this whole antibody discussion, but the majority of our immune system actually lines the digestive tract and protects us from invaders in that area. And the immune system has, of course, a lot to do with how we react to food because that’s where we are also coming into contact with food is, of course, ingesting it. And then the immune system has to identify whether or not it’s going to be something that’s okay and safe and nutrition or something that needs to be basically attacked, and antibodies are a great way of measuring that reaction or potential reaction that’s going on. And that will tell me does a particular patient have a problem with dairy or a problem with wheat or eggs or you name it. It could be anything. And I will run a panel of about a hundred foods usually on most people to see what is it in this person that’s going on because it’s so different. There are so many different variables in both environments, whether it’s the immune reaction or the ecosystem, that we need to know. I have no idea how I am going to treat a patient until I get lab results back on these two broad-based kinds of panels because I could tell everybody that came in to stop eating whatever it was, alcohol or caffeine or dairy or something like that, but I could be way off.
Rick:
That would be a stab in the dark, right?
Dr. Wangen:
Right. It would just be a guess. And I think that’s what makes us so successful is that we are very specific to each individual patient. And I always try to guess because it’s just kind of interesting, and I am often wrong when I get the lab results back. But it always is different. It’s just different for everybody, and often there are several variables that are occurring at the same time that make it that much more difficult for a patient to figure out.
Rick:
Okay. And in terms of the treatment, are supplements a big part of that, Dr. Wangen, fish oil, probiotics or anything along those lines?
Dr. Wangen:
Not necessarily. I find that supplements are often used in a lot of the same ways that medications are. They are treating the symptoms usually. And supplements can have good properties, and probiotics certainly can be well-warranted. But in many patients, they aren’t necessary or they aren’t effective, and so you take care of other parts of the picture first. And so that will be a problem. Another problem is that people are often taking their probiotics in a dairy form, which if they have a problem with dairy, whether it’s a dairy allergy or lactose intolerance or whatever it is, oftentimes they can’t tolerate the probiotics until we find out that and then actually get them dairy-free probiotics.
And people often confuse this issue of lactose intolerance and dairy allergy, and there are two completely different things. And I thought it was worth mentioning because if you are allergic to dairy, it doesn’t matter if it’s lactose-free or not, you still have a problem with the dairy products. And people will often mistake those and think they are the same. So you have all these other supplements. Like you say fish oil is often recommended or peppermint oils or there are various things that have good properties and that can help the healing process, but until you know what the cause is and deal with that first those things aren’t going to be very effective. They certainly are not going to cure the problem and not work for very long.
Rick:
Okay. We want to get to questions from our listeners in just a moment here, but, Dr. Perera, before we do, what about the issue of diet and diet supplements from your perspective? Is there a safe and effective way to manage IBD through diet? We get that question a lot from our listeners.
Dr. Perera:
Well, unfortunately diet alone will not be enough to manage the inflammatory bowel disease, but that can certainly affect symptoms of these diseases, and it is shown to play some role in the underlying inflammatory process, but diet is not the major cause of the chronic inflammation that we see in IBD. But at the same time, diet is really important in the overall management of the patient. It is very important that they have a well-balanced, healthy diet because the good nutrition is important for your body to fight against any illness. So it is important that they still take all efforts to prevent becoming malnourished.
Rick:
First we get an e-mail from Columbus, Ohio, “What are the chances that someone diagnosed with ulcerative colitis by endoscopies actually has Crohn’s and vice versa? And also, how reliable is the Prometheus test?”
Dr. Perera, how about fielding that one?
Dr. Perera:
As I mentioned earlier, sometimes the symptoms, not only symptoms, but the biopsy can have just chronic inflammation, which is going to be typical in both conditions, especially if the Crohn’s disease only involves the colon.
Rick:
All right. You mentioned that happened maybe 10 percent of the time?
Dr. Perera:
Yes. Ten percent of the patients at this point, and as I mentioned only 30 percent of patients will have granulomas, those special collections of cells which would differentiate Crohn’s disease from ulcerative colitis. So, and in this situation, we can use those serological markers, but they are not 100 percent. But the more serological markers that are present in each patient are going to help us to decide whether they have Crohn’s disease or ulcerative colitis.
Rick:
And how reliable is that Prometheus test?
Dr. Perera:
Those are the serological markers we use.
Rick:
Those are those. Okay. Got it. All right. Next question comes from Pennsylvania, and this person writes, “How can I prevent losing control of my bowels?” This writer does not say if he or she has IBS or IBD.
Dr. Wangen?
Dr. Wangen:
Well, you bring up a good point. It’s a little difficult I guess based on the information that we know on this person, but certainly loss of bowel control and urgency is something that we see in IBS patients, and that falls into the same kinds of issues I have been discussing. Oftentimes, that’s triggered by any number of things, whether it’s a particular reaction to a food or a combination of foods or a bacterial or a yeast or a parasitic problem. But oftentimes there are things that can be done. I mean, I would actually expect that, assuming they don’t have IBD or something else, that there is a very good chance that something can be done for that.
Rick:
And Dr. Perera, in terms of the issue of urgency, how is that typically treated, be it either IBS or IBD?
Dr. Perera:
Usually, in IBD the urgency is related to the inflammation in the rectum, so that can be treated with 5-ASA products that I mentioned earlier.
Rick:
Right.
Dr. Perera:
They do have different forms of 5-ASA products that you can use into that area. There is Rowasa (mesalamine) enema. Then there are the suppositories that they can use, which is Canasa (mesalamine). And then we have steroid enemas. So those can be used to control the inflammation and which should help with urgency and the incontinence that they do develop secondary to the inflammation.
Rick:
Right. Okay. We have a phone caller joining us. Barbara is on the line from Florida. Welcome, Barbara to HealthTalk. What is your question, please?
Barbara:
Thank you for taking my call. I have ulcerative colitis, and I have two questions. I have been on a low residual diet for six weeks, and I have been feeling pretty good. I haven’t had any accidents. Can I start bringing back some regular foods now? I was told no nuts, no salads, no fruits with skin, no potato with skin. Or do you just start trying everything again once you are feeling well?
Rick:
Okay. And the second question?
Barbara:
And my second question is should you be having your blood tested or liver tested every few months when they say you have ulcerative colitis?
Rick:
Blood tests or liver tests, you say?
Barbara:
Yes. I am on Lialda (mesalamine) now, so that was my question. I wanted to know if you should be having any kind of blood tests?
Rick:
Right. Okay. Dr. Perera, first to you?
Dr. Perera:
Well, regarding the first question, the food diet that she mentioned mainly has increased amount of fiber, so we usually recommend that patients to cut down those if they have strictures like in Crohn’s disease because if they have high fiber diets, sometimes they can completely block and develop symptoms suggesting obstruction or blockage of the small intestine. And, of course, fiber is a laxative, so it can give you loose stools, even when you have ulcerative colitis if you are that type of person.
Rick:
I heard her wondering if she can sort of dive back into the fiber world or if she has to try it gradually?
Dr. Perera:
So, yes. Because she has ulcerative colitis, I mean, she should be able to. Maybe she just had so much of diarrhea because her inflammation is uncontrolled.
And for the second question, just because she has ulcerative colitis, we would not be checking blood work unless the medications that she is using, like if she is on immunomodulators or other biologic agents, then we do have to take complete blood count and liver function test and the basic chemistries to make sure that they are not affecting the liver and they are not suppressing the immune system too much, making her more prone to infection.
Rick:
Got it. And, Dr. Wangen, did you want to add anything?
Dr. Wangen:
I would just say that you, obviously you want to proceed cautiously when you are reintroducing foods. One of the things I will see, and I would say that you can see people who have both IBD and IBS, and the reason I say that is because I have had IBD patients where I don’t expect to be able to solve their IBD, but I do oftentimes find that we can improve their overall digestive health and improve their digestive problems because they often have something else going on as well. And if you have an immune reaction to a particular food and then you reintroduce it, you might find that it causes problems. It causes symptoms. And that can happen even with fiber. For example, fiber has obviously got to come from a food, and I have had patients who were actually allergic to things like psyllium so just keeping that in mind when you are reintroducing foods.
Rick:
Okay. Next up, we have an e-mail question from my former home, Flagstaff, Arizona, and this person writes, “I have IBS.” Another question about fiber here. “Should I take soluble fiber supplements to stop the diarrhea? If so, for how long? I have read for just a few days.”
Dr. Wangen, to you first on this one.
Dr. Wangen:
Well, I guess, yeah. I mean, that’s one of the common treatments I suppose for loose stools is fiber, and soluble fiber is often a good choice. I don’t know that it would necessarily need to be for only a few days. If it helps, that’s wonderful, although I find that for a lot of patients it’s not adequate, and they often resort to things like Imodium (loperamide), over-the-counter remedies. So as far as a best answer for that, without really being able to delve deeper, without the proper kind of testing, that would be the best answer I could give.
Rick:
Sure. Dr. Perera, did you want to add anything?
Dr. Perera:
Well, I mean, I agree. If it helps him, he can continue with that. And if it doesn’t help, of course, he can stop it.
Rick:
That’s right. Next question is about colonoscopies, “How often does a person with colitis need to get a colonoscopy?”
Dr. Perera?
Dr. Perera:
So, of course, you will have a colonoscopy with your initial diagnosis. And the usual recommendations is after that if you have involvement of your colon due to ulcerative colitis, your whole colon is inflamed and involved, then eight years after the onset of the disease, then you should have every one to two years of colonoscopy because of the high risk of developing colon cancer compared to the general population. If they have only left-sided disease, the recommendation is that we start surveillance colonoscopies 15 years after the onset of the disease.
Rick:

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