Q: I am super sensitive to anesthesia. I can’t tolerate lorazepam. A colonoscopy can leave me foggy for days. After general anesthesia for sinus surgery, I needed a month to recover from the brain fog.
The last time I had a colonoscopy, I persuaded the anesthetist to use straight propofol, with good results.
I am in good health except for my thyroid. Its numerous large nodules may require surgery. I’m extremely apprehensive. Would genetic testing help identify either drugs I should avoid or those that would be better suited?
A: We were fascinated by your question and quite surprised to discover so little research appears to have been done in this regard. Two decades ago, an expert in the field of personalized medicine shared his vision that all of us would soon carry a card coded with our genetic susceptibility to drugs. It would make tailored prescribing much easier. His dream has yet to be realized.
Research has shown that certain genetic profiles are associated with delayed recovery from general anesthesia (Pharmacogenomics, Sept. 1, 2018). Before your surgery, request a consultation with the anesthesiologist. Your history, as you have outlined it, will be helpful and may inspire a pharmacogenomic test to tailor your anesthesia and recovery.
Q: My HDL has always been high. The latest test showed my HDL at 101, LDL of 123 and total cholesterol 229. My primary care doctor has always thought my numbers were OK.
I saw a cardiologist for palpitations. She thinks high HDL could be dangerous and wants me to take Lipitor.
The drug sheet from the pharmacy says Lipitor can raise HDL. In that case, does it make sense for me to take the drug?
A: For decades, cardiologists have referred to LDL cholesterol as the “bad” cholesterol and HDL cholesterol (HDL-C) as the “good” cholesterol. That’s because higher levels of HDL-C have been associated with lower risk of cardiovascular disease (Journal of Lipid Research, February 2014). HDL-C appears to have beneficial anti-inflammatory, antioxidant and vasodilating effects (Journal of Atherosclerosis and Thrombosis, Oct. 1, 2018).
Perhaps your cardiologist wants to lower your LDL-C and total cholesterol with atorvastatin (Lipitor). It might raise your HDL-C levels, but it’s not clear whether that would be problematic.
To learn more about these and many other risk factors for heart disease along with nondrug approaches for optimizing cardiovascular health, you may want to consult our eGuide to Cholesterol Control & Heart Health. This online resource is available in the Health eGuides section of www.PeoplesPharmacy.com.
Q: Have you ever heard of using the heartburn medicine cimetidine for shingles? According to my European colleagues it is prescribed off-label for this purpose.
A: We searched high and low for research to support this unique strategy. There do not appear to have been randomized controlled trials of cimetidine (Tagamet) for this purpose. We did, however, find an interesting case series in The New England Journal of Medicine (Feb. 2, 1984) suggesting some benefit from this acid suppressor.
Supporting its antiviral action, there are studies showing that cimetidine may help eliminate warts in children. Warts are caused by the human papillomavirus.