LIVER- an important organ of our body

Weighing in at around 3 pounds, the liver is the body’s second largest organ; only the skin is larger and heavier. The liver performs many essential functions related to digestion, metabolism, immunity, and the storage of nutrients within the body. These functions make the liver a vital organ without which the tissues of the body would quickly die from lack of energy and nutrients. Fortunately, the liver has an incredible capacity for regeneration of dead or damaged tissues; it is capable of growing as quickly as a cancerous tumor to restore its normal size and function.

What the liver cells actually do

The liver actually performs several hundred functions in the body. I can't cover them all in detail in this newsletter, but to summarize:

• First, and probably foremost, there's protein synthesis. The liver synthesizes proteins from amino acids. It takes amino acids and assembles them as needed into complex proteins. It makes almost all prothrombin and fibrinogen (clotting factors), as well as albumin, the major blood protein. It also converts forms of amino acids from one to the other when needed for specific proteins.
• It converts toxic ammonia (from amino acid conversions) into less toxic urea (which is excreted).
• It uses amino acids and proteins for energy production or storage as fats and carbohydrates.
• It metabolizes carbohydrates (CHO).
• The liver is the storehouse of carbohydrates as glycogen (glycogenesis) and lipids (lipogenesis).
• It can rapidly break down large amounts of CHO (glycogenesis) and release it as glucose into the bloodstream.
• It can create glucose from lactic acid (gluconeogenesis).
• It metabolizes lipids (fat).
• The liver can store fats in various forms.
• It can break down and release stored fat for extraordinary needs.
• It cleanses the blood and discharges waste products.
• The liver also excretes bilirubin, the broken-down pigments from dead red blood cells, by metabolizing it with bile salts and excreting it through the feces. Bilirubin is what makes our feces brown. If for some reason, bilirubin is not excreted (as in obstructive jaundice) the feces will turn clay-colored.
• It neutralizes and destroys poisons and metabolizes alcohol.
• The liver also detoxifies drugs and chemicals and virtually any toxin that enters the body. It excretes those toxins in two ways.
  • It neutralizes them and releases them into the blood, where they make their way to the kidneys and on out through the urine.
  • It dumps the toxins directly into the bile and, thence into the intestines for excretion.
• It aids the digestive process by the production of bile, which is used for the breakdown of fats in the intestinal tract.
• It helps the body resist infections by producing immune factors and by removing bacteria from the bloodstream.
• It converts (conjugates) vitamin isolates as found in your vitamin pills into non-toxic forms your body can actually use -- and can then store some of those vitamins and minerals (iron and copper, for example) to be used as needed. In fact, the liver stores all the fat-soluble vitamins (A, B12, D, E, and K, for example). Water soluble vitamins such as vitamin C, on the other hand, are not stored in the liver and need to be taken daily, as any excess is expelled in the urine.
  • In addition, the liver is responsible for "activating" vitamin D so that your body can utilize it.
• It helps maintain the body's hormonal balance.
• It regenerates its own damaged tissue.
• And it synthesizes cholesterol from fatty acids and removes excess cholesterol from the bloodstream as required.

Anatomy of the Liver

Gross Anatomy
The liver is a roughly triangular organ that extends across the entire abdominal cavity just inferior to the diaphragm. Most of the liver’s mass is located on the right side of the body where it descends inferiorly toward the right kidney. The liver is made of very soft, pinkish-brown tissues encapsulated by a connective tissue capsule. This capsule is further covered and reinforced by the peritoneum of the abdominal cavity, which protects the liver and holds it in place within the abdomen.

The peritoneum connects the liver in 4 locations: the coronary ligament, the left and right triangular ligaments, and the falciform ligament. These connections are not true ligaments in the anatomical sense; rather, they are condensed regions of peritoneal membrane that support the liver.

• The wide coronary ligament connects the central superior portion of the liver to the diaphragm.
• Located on the lateral borders of the left and right lobes, respectively, the left andright triangular ligaments connect the superior ends of the liver to the diaphragm.
• The falciform ligament runs inferiorly from the diaphragm across the anterior edge of the liver to its inferior border. At the inferior end of the liver, the falciform ligament forms the round ligament (ligamentum teres) of the liver and connects the liver to the umbilicus. The round ligament is a remnant of the umbilical vein that carries blood into the body during fetal development.

The liver consists of 4 distinct lobes – the left, right, caudate, and quadrate lobes.

• The left and right lobes are the largest lobes and are separated by the falciform ligament. The right lobe is about 5 to 6 times larger than the tapered left lobe.
• The small caudate lobe extends from the posterior side of the right lobe and wraps around the inferior vena cava.
• The small quadrate lobe is inferior to the caudate lobe and extends from the posterior side of the right lobe and wraps around the gallbladder.

Bile Ducts
The tubes that carry bile through the liver and gallbladder are known as bile ducts and form a branched structure known as the biliary tree. Bile produced by liver cells drains into microscopic canals known as bile canaliculi. The countless bile canaliculi join together into many larger bile ducts found throughout the liver.

These bile ducts next join to form the larger left and right hepatic ducts, which carry bile from the left and right lobes of the liver. Those two hepatic ducts join to form the common hepatic duct that drains all bile away from the liver. The common hepatic duct finally joins with the cystic duct from the gallbladder to form the common bile duct, carrying bile to the duodenum of the small intestine. Most of the bile produced by the liver is pushed back up the cystic duct by peristalsis to arrive in the gallbladder for storage, until it is needed for digestion.

Blood Vessels
The blood supply of the liver is unique among all organs of the body due to the hepatic portal vein system. Blood traveling to the spleen, stomach, pancreas, gallbladder, andintestines passes through capillaries in these organs and is collected into the hepatic portal vein. The hepatic portal vein then delivers this blood to the tissues of the liver where the contents of the blood are divided up into smaller vessels and processed before being passed on to the rest of the body. Blood leaving the tissues of the liver collects into the hepatic veins that lead to the vena cava and return to the heart. The liver also has its own system of arteries and arterioles that provide oxygenated blood to its tissues just like any other organ.

Lobules
The internal structure of the liver is made of around 100,000 small hexagonal functional units known as lobules. Each lobule consists of a central vein surrounded by 6 hepatic portal veins and 6 hepatic arteries. These blood vessels are connected by many capillary-like tubes called sinusoids, which extend from the portal veins and arteries to meet the central vein like spokes on a wheel.

Each sinusoid passes through liver tissue containing 2 main cell types: Kupffer cells and hepatocytes.

• Kupffer cells are a type of macrophage that capture and break down old, worn out red blood cells passing through the sinusoids.
• Hepatocytes are cuboidal epithelial cells that line the sinusoids and make up the majority of cells in the liver. Hepatocytes perform most of the liver’s functions – metabolism, storage, digestion, and bile production. Tiny bile collection vessels known as bile canaliculi run parallel to the sinusoids on the other side of the hepatocytes and drain into the bile ducts of the liver.

Physiology of the Liver

Digestion
The liver plays an active role in the process of digestion through the production of bile. Bile is a mixture of water, bile salts, cholesterol, and the pigment bilirubin. Hepatocytes in the liver produce bile, which then passes through the bile ducts to be stored in the gallbladder. When food containing fats reaches the duodenum, the cells of the duodenum release the hormone cholecystokinin to stimulate the gallbladder to release bile. Bile travels through the bile ducts and is released into the duodenum where it emulsifies large masses of fat. The emulsification of fats by bile turns the large clumps of fat into smaller pieces that have more surface area and are therefore easier for the body to digest.

Bilirubin present in bile is a product of the liver’s digestion of worn out red blood cells. Kupffer cells in the liver catch and destroy old, worn out red blood cells and pass their components on to hepatocytes. Hepatocytes metabolize hemoglobin, the red oxygen-carrying pigment of red blood cells, into the components heme and globin. Globin protein is further broken down and used as an energy source for the body. The iron-containing heme group cannot be recycled by the body and is converted into the pigment bilirubin and added to bile to be excreted from the body. Bilirubin gives bile its distinctive greenish color. Intestinal bacteria further convert bilirubin into the brown pigment stercobilin, which gives feces their brown color.

Metabolism
The hepatocytes of the liver are tasked with many of the important metabolic jobs that support the cells of the body. Because all of the blood leaving the digestive system passes through the hepatic portal vein, the liver is responsible for metabolizing carbohydrate, lipids, and proteins into biologically useful materials.

Our digestive system breaks down carbohydrates into the monosaccharide glucose, which cells use as a primary energy source. Blood entering the liver through the hepatic portal vein is extremely rich in glucose from digested food. Hepatocytes absorb much of this glucose and store it as the macromolecule glycogen, a branched polysaccharide that allows the hepatocytes to pack away large amounts of glucose and quickly release glucose between meals. The absorption and release of glucose by the hepatocytes helps to maintain homeostasis and protects the rest of the body from dangerous spikes and drops in the blood glucose level. (See more about glucose in the body.)

Fatty acids in the blood passing through the liver are absorbed by hepatocytes and metabolized to produce energy in the form of ATP. Glycerol, another lipid component, is converted into glucose by hepatocytes through the process of gluconeogenesis. Hepatocytes can also produce lipids like cholesterol, phospholipids, and lipoproteins that are used by other cells throughout the body. Much of the cholesterol produced by hepatocytes gets excreted from the body as a component of bile.

Dietary proteins are broken down into their component amino acids by the digestive system before being passed on to the hepatic portal vein. Amino acids entering the liver require metabolic processing before they can be used as an energy source. Hepatocytes first remove the amine groups of the amino acids and convert them into ammonia and eventually urea. Urea is less toxic than ammonia and can be excreted in urine as a waste product of digestion. The remaining parts of the amino acids can be broken down into ATP or converted into new glucose molecules through the process of gluconeogenesis.

Detoxification
As blood from the digestive organs passes through the hepatic portal circulation, the hepatocytes of the liver monitor the contents of the blood and remove many potentially toxic substances before they can reach the rest of the body. Enzymes in hepatocytes metabolize many of these toxins such as alcohol and drugs into their inactive metabolites. And in order to keep hormone levels within homeostatic limits, the liver also metabolizes and removes from circulation hormones produced by the body’s own glands.

Storage
The liver provides storage of many essential nutrients, vitamins, and minerals obtained from blood passing through the hepatic portal system. Glucose is transported into hepatocytes under the influence of the hormone insulin and stored as the polysaccharide glycogen. Hepatocytes also absorb and store fatty acids from digested triglycerides. The storage of these nutrients allows the liver to maintain the homeostasis of blood glucose. Our liver also stores vitamins and minerals - such as vitamins A, D, E, K, and B12, and the minerals iron and copper - in order to provide a constant supply of these essential substances to the tissues of the body.

Production
The liver is responsible for the production of several vital protein components of blood plasma: prothrombin, fibrinogen, and albumins. Prothrombin and fibrinogen proteins are coagulation factors involved in the formation of blood clots. Albumins are proteins that maintain the isotonic environment of the blood so that cells of the body do not gain or lose water in the presence of body fluids.

Immunity
The liver functions as an organ of the immune system through the function of the Kupffer cells that line the sinusoids. Kupffer cells are a type of fixed macrophage that form part of the mononuclear phagocyte system along with macrophages in the spleen and lymph nodes. Kupffer cells play an important role by capturing and digesting bacteria, fungi, parasites, worn-out blood cells, and cellular debris. The large volume of blood passing through the hepatic portal system and the liver allows Kupffer cells to clean large volumes of blood very quickly.

Parents & Children Relationships

Dear parents, please give quality time to your children before it’s too late. Value your child’s innocent and crucial phase of childhood because your time is the backbone of your child’s successful future and nature. Researches put a stamp on this- ‘The first five years are significantly crucial for the development of the brain of the child. The first three years play the most critical role in shaping the brain architecture of the child. As a matter of fact, early experiences constitute the base for the organizational development of his brain and its functioning throughout life. They cast a direct impact on how children develop learning skills and also on their social as well as emotional abilities. It has been found that babies and young children grow, learn and develop rapidly when they are brought up in an environment characterized with love, affection, along with nutritious meals and good health care.’

O Grown Ups! Realize the importance of your parent’s ‘OLDAGE PHASE’ before it’s too late…….

Think about your parents. All through their life, they support you in each and every manner, irrespective of their health or wealth and that too with big smiles on their faces!

But, what we do? We are least bothered about them when they need us in their old age. Their presences frustrate us! We behave just like this child-

A child once made a phone call to some online account system with a strange complaint. He said, "Sir, when I am typing my password, it shows only stars and stars."

From the other side, a reply came- "Well, these stars protect your account from getting hacked."
Child: Uh! Sir, I understand. But, my problem is that they come even when I am alone.

These stars can be very well related to the protection shield provided by the parents to their children. The child deemed the stars as essential when sitting with others; similarly, when we are young and dependent, we find the unconditional care and concern of the parents to be important. We take the maximum benefit of this protection cover. But it's really sad that when we grow up and become capable of living life on our own terms, we just find the their care and concern unnecessary, as the child found the stars unwanted when he was alone. The same protection shield turns into a problem, a burden for us, i.e. their presence becomes irritating and troublesome for us! Like that child, we also fail to realize that the protection provided by the  parents is all-time necessary, in whatever phase of life we may be!

Thus, O Grown-ups! Don't forget that our loving and caring parents are, in reality, a very precious gift given to us by God. Their blessings make us successful in life. Therefore, realize their importance and respect their old age before it's too late..... 

Twelve Good Things About Arjuna Medicine

Arjuna Ayurvedic Energetics:
Rasa (taste) - Astringent, bitter
Virya (action)- Cooling
Vipaka (post-digestive effect)- Pungent
Guna (quality) - Light, dry
Dosha effect - Tridoshic, KP-
Dhatu (tissue)- Plasma, blood, bone, reproductive
Srota (channel) - Circulatory, reproductive

Forms used: Stem Bark, Powder, Extract


Arjuna tree bark (Latin Name: Terminalia arjuna Wight & Arn.) is a cardioprotective botanical used in Ayurveda (East Indian traditional medicine) since 2500 B.C. It has remarkable cardioprotective, heart muscle strengthening properties. Here are good reasons to take 250 mgs of Arjuna with meals once or twice daily.

1. Arjuna bark powder is rich in saponnins, natural anti-oxidants (flavonoids) gallic acid, ellagic acid, oligomeric proanthocyanidins, phytosterols, and minerals including calcium, magnesium, zinc and copper.

2. Regular use of T.arjuna improves the pumping activity of heart, which makes it very useful for heart weakness and congestive heart failure.

3. Arjuna improves cardiac muscle strength

4. It decrease in LDL cholesterol levels. Arjuna’s ability to suppress the blood’s absorption of lipids indicates that it has cholesterol-regulating properties. Its principle constituents are §-sitosterol, ellagic acid and arjunic acid.

5. Arjuna bark is rich in Co-enzyme Q-10 which prevents incident of heart attacks.

6. Arjuna also has a tonic and diuretic effects that benefit cirrhosis of the liver.

7. It induces a drug-dependent decrease in blood pressure and heart rate.

8. The bark of Arjuna is useful as an anti-ischemic and cardioprotective agent in hypertension and in ischemic heart disease, especially in disturbed cardiac rhythm, angina or myocardial infarction.

9. Arjuna helps maintain a healthy heart and reduces the effects of stress and nervousness.

10. Arjuna enhances prostaglandins and lowers risk of coronary heart trouble.

11. Arjuna can relieve symptomatic complaints of essential hypertension such as giddiness, insomnia, lassitude, headache and the inability to concentrate.

12. In a study on the efficacy of the bark powder in treating congestive cardiac failure (CCF), over 40% of the cases showed marked improvement. CCF due to congenital anomaly of heart and valve disease was also brought under control. 4 out of 9 cases of CCF due to chronic bronchitis were also relieved by the treatment.

Choosing blood pressure medications

Choosing blood pressure medications

Choosing the right high blood pressure medication can be tricky. Find out which of the various drug options is appropriate for you.By Mayo Clinic Staff

http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure-medication/art-20046280

Heart-Healthy Living

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Dozens of high blood pressure medications (antihypertensives) are available, each with pros and cons. Depending on how high your blood pressure is, your doctor may prescribe one or more high blood pressure medications to treat your condition. For everyone who has high blood pressure or is at risk of developing high blood pressure, lifestyle changes can help keep your numbers under control. Before beginning blood pressure treatment, it's a good idea to understand the options available to you.

Lifestyle changes

Whether you're on the road to developing high blood pressure (prehypertension) or you already have high blood pressure (hypertension), you can benefit from lifestyle changes that can lower your blood pressure. People who have prehypertension have a systolic pressure (top number) ranging from 120 to 139 millimeters of mercury (mm Hg) or a diastolic pressure (bottom number) ranging from 80 to 89 mm Hg.

Even if your doctor prescribes medications to control your blood pressure, he or she will likely recommend you make lifestyle changes as well. Lifestyle changes can reduce or eliminate your need for medications to control your blood pressure. To make these changes:

• Don't smoke
• Eat a healthy diet, focusing on fruits, vegetables and low-fat dairy products, and especially, control the salt in your diet
• Maintain a healthy weight
• Exercise by getting 30 minutes of moderate activity — even if you need to break up your activity into three 10-minute sessions — on most days of the week
• Limit the amount of alcohol you drink — For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

You probably won't need to take high blood pressure medications if you have prehypertension and are otherwise healthy. However, if you have prehypertension and diabetes, kidney disease or heart disease, your doctor might prescribe medications to lower your blood pressure to a more desirable level.

Medication options for stage 1 high blood pressure (140/90 to 159/99 mm Hg)

If you have stage 1 high blood pressure, you have a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg. If both numbers are in this range, you also have stage 1 high blood pressure. The first change you can make is to adopt healthy lifestyle changes to help decrease your numbers. Your doctor will likely prescribe medications, as well. Your choices include:

• Diuretics (water pills). Your doctor may first suggest diuretics — also called water pills. Diuretics work by flushing excess water and sodium from the body, thus lowering blood pressure, which may be enough along with lifestyle changes to control your blood pressure.
  Although three types of diuretics are available, the first choice is usually a thiazide diuretic. Thiazide diuretics typically have fewer side effects than do other types of diuretics. They also offer strong protection against conditions that high blood pressure can cause, such as stroke and heart failure. A diuretic may be the only high blood pressure medication you need. But under some circumstances, your doctor may recommend a different first line medication or may add another medication.
• Angiotensin-converting enzyme (ACE) inhibitors. These allow blood vessels to widen by preventing the formation of a hormone called angiotensin. Frequently prescribed ACE inhibitors include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and ramipril (Altace).
• Angiotensin II receptor blockers. These help blood vessels relax by blocking the action of angiotensin. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), candesartan (Atacand) and valsartan (Diovan).
• Beta blockers. These work by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and atenolol (Tenormin).
• Calcium channel blockers. These prevent calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat CC, Procardia).
• Renin inhibitors. Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the production of renin, reducing its ability to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren along with ACE inhibitors or angiotensin II receptor blockers if you have diabetes or kidney disease.

Adding one of these medications may lower your blood pressure more effectively than if you take only a diuretic. This may reduce the risk of developing complications from high blood pressure. Combining two medications of different classes may allow you to take a smaller dose of each, which can reduce side effects and perhaps be less expensive. The choice of medications in combination depends on your individual circumstances.

Medication options for stage 2 high blood pressure (higher than 160/100 mm Hg)

If you have stage 2 high blood pressure, you have a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher or both. In this case, you'll likely need to take at least two high blood pressure medications when you start treatment.

As with stage 1 hypertension, your doctor will likely prescribe a thiazide diuretic. Diuretics work by flushing excess water and sodium from the body, thus lowering your blood pressure. Along with a diuretic, your doctor will generally recommend that you start an additional drug.

For high blood pressure, diuretics, commonly known as "water pills," help your body get rid of unneeded water and salt through the urine. Getting rid of excess salt and fluid helps lower blood pressure and can make it easier for your heart to pump. Diuretics may be used to treat a number of heart-related conditions, including high blood pressure, heart failure, kidney and liver problems, and glaucoma.

Thiazide diuretics, such as Esidrix or Zaroxolyn, can be used to lower blood pressure, or to treat edema in heart failure.

Loop diuretics (Lasix, Bumex) are often used when people havecongestive heart failure symptoms and are especially useful in emergencies. However, they do not significantly lower blood pressure.

Potassium-sparing diuretics (like Aldactone, Dyrenium) help your body retain potassium and are used more often in congestive heart failure patients. They are often prescribed in conjunction with the other two types of diuretics, but also do not significantly lower blood pressure.

What Are the Side Effects of Diuretics?

Like any drug, diuretics come with potential side effects. They can include:

• Frequent urination. This may last for several hours after a dose.
• Arrhythmia(abnormal heart rhythm)
• Electrolyte abnormalities -- Blood test monitoring of bloodchemistries or electrolytes, such as potassium, sodium, or kidneyfunction, is important before and during drug use.
• Extreme tiredness or weakness. These effects should decrease as your body adjusts to the medication. Call your doctor if these symptoms persist.
• Muscle cramps or weakness. If you take potassium supplements, be sure that you are taking your potassium supplement correctly, if prescribed. Contact your doctor if these symptoms persist.
• Dizziness, lightheadedness. Try rising more slowly when getting up from a lying or sitting position.
• Blurred vision, confusion, headache, increased perspiration (sweating), and restlessness. If these effects are persistent or severe, contact your doctor.
• Dehydration. Signs include dizziness, extreme thirst, excessive dryness of the mouth, decreased urine output, dark-colored urine, orconstipation. If these symptoms occur, don't assume you need more fluids, call your doctor.
• Fever , sore throat, cough, ringing in the ears, unusual bleeding or bruising, rapid and excessive weight loss. Contact your doctor right away.
• Skin rash. Stop taking the medication and contact your doctor right away.
• Loss of appetite, nausea, vomiting, or muscle cramps. Be sure that you are taking your potassium supplement correctly, if prescribed.

Rarely, potassium-sparing diuretics like Aldactone can cause breast enlargement or tenderness in men and in women it can cause deepening of the voice, decreased hair growth, and irregular menstrual cycles.

In addition, most diuretics are sulfa drugs. If you are allergic to sulfa drugs, tell your doctor.

Uses for calcium channel blockers

Doctors prescribe calcium channel blockers to prevent, treat or improve symptoms in a variety of conditions, such as:

• High blood pressure
• Chest pain (angina)
• Brain aneurysm complications
• Irregular heartbeats (arrhythmia)
• Migraine
• Some circulatory conditions, such as Raynaud's disease
• High blood pressure that affects the arteries in your lungs (pulmonary hypertension)

Calcium channel blockers may not be as effective as diuretics, beta blockers or angiotensin-converting enzyme (ACE) inhibitors at lowering blood pressure. Because of this, calcium channel blockers aren't usually the first medication you'd be prescribed to lower your blood pressure.

However, for blacks, calcium channel blockers may be more effective than other blood pressure medications, such as beta blockers, ACE inhibitors or angiotensin II receptor blockers.

Side effects and cautions

Side effects of calcium channel blockers may include:

• Constipation
• Headache
• Rapid heartbeat (tachycardia)
• Dizziness
• Rash
• Fatigue
• Flushing
• Nausea
• Swelling in the feet and lower legs

Olmesartan medoxomil is a selective angiotensin II type 1 receptor antagonist with proven BP-lowering efficacy. In a number of clinical trials, the agent generally lowered both mean DBP and SBP by at least 10 mmHg after treatment for 8 weeks. Importantly, the majority of patients in clinical trials achieved target DBP of <90 mmHg (Neutel 2001; Puchler et al 2001; Chrysant et al 2003)


Additionally, olmesartan medoxomil has been shown to be at least as effective as the calcium channel blockers amlodipine (Chrysant et al 2003) and felodipine (Stumpe and Ludwig 2002) and the beta-blocker atenolol (Van Mieghem 2001), and significantly more effective than the ACE inhibitor captopril at the doses tested (Williams 2001).

Heart- Cure and care

When the muscle layer of the heart weakens and doesn’t pump effectively (cardiomyopathy),patients may experience fatigue and lethargy, swelling in the legs and feet, cold extremities, digestive problems and other symptoms of poor circulation. Drug treatments available through a cardiologist may enhance heart muscle function. Some patients benefit from a pacemaker, and some may even undergo a heart transplant.

to be continued

HORRIBLE and TRUE

After an angina attack, Mustafa Gunaydin was prescribed cholesterol lowering drugs, which seemed to trigger neuromuscular degeneration, culminating in his death. His story is told by his partner

("Statins" is a class of drugs that lowers the level of cholesterol in the blood by reducing the production of cholesterol by the liver. (The other source of cholesterol in the blood is dietary cholesterol.) Statins block the enzyme in the liver that is responsible for making cholesterol.)

My partner, Mustafa, a long term smoker, underwent a single vessel angioplasty after an angina attack in September 2005, aged 55. He immediately stopped smoking and, on his doctor’s advice, joined a three month rehabilitation exercise class and began taking statins (40 mg simvastatin to start with, replaced by 40 mg atorvastatin within two months). He continued to eat a healthy Mediterranean diet and take regular exercise (he was a semi-professional dancer in his youth and, having sold his business earlier in 2005 and taken early retirement, now enjoyed long walks exploring London with a friend). Although he had been a moderate drinker, in response to his health scare he cut down on alcohol. He was now free of angina, active, and positive, and said that he had never felt better.

Early signs

The first indications that all was not well came in spring 2006, when Mustafa started complaining of muscle cramps, especially at night, in his calves and thighs, usually after a long walk. By early 2007, he found it an effort to keep his arms aloft to wash his hair in the shower or to walk up even mild slopes. Sitting became uncomfortable, his neck and shoulders ached, and he experienced pain after mild exercise or even just standing for fairly short periods. He started to age visibly: his limbs lost muscle tone, his hair fell out, and he began to look permanently anxious as his confidence eroded. He had been proud of his looks and always dressed well, but now his clothes no longer fitted him and he had little spare energy to expend on his appearance.

He made several visits to his general practitioner over this period, and in August 2007 the statin dose was halved at his request. By October, his serum cholesterol level had risen to 5.4 mmol/L, but, despite the lower statin dose, his creatine kinase level continued to rise and was now at 312 units/L.

Things fall apart

He became depressed about his permanent tiredness and weakness, and obsessed with finding out what was wrong with him, spending most days reading medical reference books. This fixation developed into a loss of trust with all but a few members of the medical profession with whom he came into contact during his illness. He felt that nobody was listening to him and that any discussion he wished to have about the documented side effects of statins and how they might be affecting him was met with a wall of silence. Two memorable remarks that contributed to his frustration were, “If you don’t take the statins, you will die” (his GP) and “Ah, you’re on statins, you will live forever” (a hepatologist).

A welcome turnaround

In April 2008 Mustafa decided to stop taking statins without telling his doctor. By late May, his symptoms had improved dramatically. He was able to walk long distances and up steep hills again, even in hot weather on a holiday in Turkey. The fact that his joie de vivre was returning was a huge boost for me too—it seemed that we could get our life back together again now that he was starting to have the energy to do the things he used to enjoy.

Reversal of fortune

At a check-up some time around the end of June, when his cholesterol level was found to have risen, he admitted that he had stopped taking statins. His GP strongly advised him to go back on them, and within a short time he was complaining of breathlessness, weakness, and backache. His GP switched him to ezetimibe (10 mg), and within 10 days he was complaining of back and leg pain and a hoarse voice. His health continued to deteriorate, and by early November his voice was weak, he was fatigued all the time, and on one memorable night had to get up seven times to urinate. He developed a suffocating sensation when lying down, and his urine became brown and cloudy, but he was told that a urine test showed nothing abnormal. However, in late November his GP told him to stop taking ezetimibe immediately: we later discovered that his creatine kinase level had reached 783 units/L at that point.

Despite stopping all cholesterol lowering drugs, he continued to decline. By early 2009, his appetite had reduced, he had worsening muscle wasting, weakness, and twitching, especially at night, and in February was admitted to hospital. His emotional state at this time was poor; he was convinced he was going to die. While in hospital, he was seen by a neurologist whose notes state that there was “muscle twitching in thighs, which are rather coarse for true fasiculations” and who diagnosed statin induced myopathy. After a week, he was discharged from hospital without any real knowledge of what was likely to happen to him.

Final months

As the year progressed, he developed an itchy rash on the back of his legs, a dry mouth, mouth ulcers, and was often cold (particularly his legs, feet, and right shoulder), especially at night. He had vivid dreams, which he would act out; he was too weak to cough and could sleep only on one side, otherwise he couldn’t breathe. During June, he had increased difficulty breathing and insisted on sitting in a chair all night, as he felt he would stop breathing if he went to sleep lying down. His posture was poor, and his neck became very weak. Eventually his head twisted round to the left, and his right shoulder was permanently raised. Several tests confirmed progressive weakness of his proximal muscles but normal strength in his limbs.

He had an appointment with a neurologist, who agreed with the statin related diagnosis and recommended a muscle biopsy if there was no improvement in his condition over the next three months. As his condition swiftly worsened, we got an emergency appointment at the same hospital, where he saw a different neurologist, who diagnosed, with little preamble and with nine people in the room, motor neurone disease. This came as a shock to us both and a huge blow to his already fragile mental state.

Despite this diagnosis, he had no muscle stiffness, no difficulty swallowing, and he never once fell. His fine dexterity was good: he was able to dress and feed himself until a few days before he died, only eventually needing help with these tasks because he was too weak to manage on his own. Two weeks before he died he threaded a needle, changed a fuse in a plug using a screwdriver, and fastened a small fiddly necklace clasp for me. I encouraged him to do as many of these tasks as possible in an effort to contradict a diagnosis that he found too awful to contemplate.

He died in hospital on 22 August 2009 of type 2 respiratory failure (oxygen level 50% on admission to the emergency department) and two heart attacks over the course of three days.

Listening to the patient

During the last six months of his life, Mustafa came under the care of a different GP at the same practice. Dr Freris was kind and sympathetic and made appointments for him at times when I could be present too. She listened to his fears and concurred with his view that, whatever the final diagnosis, statins had had a serious effect on his health. Although it was clear to us all that he was beyond help, Mustafa always came away from those appointments feeling that he had found a doctor who understood what he was going through.

Are There Side Effects of Statin Drugs?

Most people who take statin drugs tolerate them very well. But some people experience side effects.

The most common statin side effects include:

• Headache
• Difficulty sleeping
• Flushing of the skin
• Muscle aches, tenderness, or weakness (myalgia)
• Drowsiness
• Dizziness
• Nausea or vomiting
• Abdominal cramping or pain
• Bloating or gas
• Diarrhea
• Constipation
• Rash

Statins also carry warnings that memory loss, mental confusion, high blood sugar, and type 2 diabetes are possible side effects. It's important to remember that statins may also interact with other medications you take. 

Which Statin Side Effects Are Serious?

Statins are associated with a few rare, but potentially serious, side effects including:

• Myositis, inflammation of the muscles. The risk of muscle injury increases when certain other medications are taken with statins. For example, if you take a combination of a statin and a fibrate -- another cholesterol-reducing drug -- the risk of muscle damage increases greatly compared to someone who takes a statin alone.
• Elevated levels of CPK, or creatine kinase, a muscle enzyme that when elevated, can cause muscle pain, mild inflammation, and muscle weakness. This condition, though uncommon, can take a long time to resolve.
• Rhabdomyolysis, extreme muscle inflammation and damage. With this condition, muscles all over the body become painful and weak. The severely damaged muscles release proteins into the blood that collect in the kidneys. The kidneys can become damaged trying to eliminate a large amount of muscle breakdown caused by statin use. This can ultimately lead to kidney failure or even death. Fortunately, rhabdomyolysis is extremely rare. It occurs in less than one in 10,000 people taking statins.

Statin Warning Signs

If you experience any unexplained joint or muscle pain, tenderness, or weakness while taking statins, you should call your doctor immediately. Pregnant women or those with active or chronic liver disease should not use statins.

If you take a statin drug, tell your doctor about any over-the-counter or prescription drugs, herbal supplements, and vitamins you are currently taking or plan on taking.

Which Statins Are Approved for Use in the U.S.?

The statin medications that are approved for use in the U.S. include:

• Lipitor
• Livalo
• Mevacor or Altocor
• Zocor
• Pravachol
• Lescol
• Crestor

Since their arrival on the market, statins have been among the most prescribed drugs in the U.S. with about 17 million users.

CHOICE IN LIFE........

1.  Life has 4 letters so does                     Dead

2.  Hate has 4 letters so does                    Love

3.  Enemies has 7 letters so does              Friends

4.  Lying has 5 letters so does                  Truth

5.  Hurt has 4 letters so does                    Heal

6.  Negative has 8 letters so does              Positive

7.  Failure has 7 letters so does                 Success

8.  Below has 5 letters so does                 Above

9.  Cry has 3 letters so does                     Joy

10 Anger has 5 letters so does                  Happy

11. Right has 5 letters so does                  Wrong

12. Rich has 4 letters so does                   Poor

13. Fail has 4 letters so does                     Pass

14. Knowledge has 9 letters so does          Ignorance

      Are they all by coincidence? Life is like a double-edged sword. We should always  choose right and better side of life.

                                                                                       :- Rajesh Dixit