Inflammation II: The basics

As Dr. Jerome Groopman says in “Inflamed” (New Yorker article), “Inflammation occurs when the body rallies to defend itself against invading microbes or to heal damaged tissue. The walls of the capillaries dilate and grow more porous, enabling white blood cells to flood the damaged site. As blood flows in and fluid leaks out, the region swells, which can put pressure on surrounding nerves, causing pain; inflammatory molecules may also activate pain fibres. The heat most likely results from the increase in blood flow.” As I mentioned in last week’s post, the classic symptoms of inflammation are redness, swelling, heat, and pain.

Inflammation is both good and bad for us. If we have too little inflammation, we fail to heal. With too much inflammation, healthy tissue can be degraded or destroyed. Inflammation needs to turn on at the right moment and also turn off. Unfortunately our standard weapons against inflammation are imprecise. Anti-inflammatory drugs, such as ibuprofen, are, according to Groopman, the equivalent of peashooter, while steroids, are more like cannons, shutting down the immune system, raising the risk of infection, and eroding the bones.

The topic of inflammation is all the rage right now—mostly with regard to “anti-inflammation” diets (next week’s discussion). But it's also all the rage because the National Institutes of Health recently designated inflammation a priority. Several hundred scientists and hundreds of millions of dollars are now devoted to understanding the role of inflammation in health and disease. In this case, the inflammation in question is the “smoldering” type—the kind that simmers quietly in the absence of trauma or infection.

The reason for all the attention is that low-level inflammation seems to be implicated in heart disease, diabetes, Alzheimer’s, depression, and other disorders. In cases such as these, the inflammation is local: confined to the arteries, or brain, or pancreas, for example. But scientists are a long way from knowing the nature of the relationship between the diseases and inflammation. As Michael Gottseman, a director of research at the N.I.H. says, “We really don’t know how much inflammation contributes” to the disorders.  “Because you find an inflammatory protein in a certain disorder, it doesn’t mean that it is causing that disorder. Correlation is not causation.”

So it’s too soon to get all excited. But lots of people are trying an “anti-inflammatory diet,” the subject of next week’s post.

Incidentally, in last week's post, I mentioned that, at the recommendation of a doctor, I started a regimen of taking four Advil twice a day to help with hip pain. After two week of this, I came down with a cold--something I rarely get. Because I was suspicious about this, I did some research and discovered that Advil and other non-steroidal anti-inflammatory drugs inhibit antibody production. Antibodies are our primary immune defense!

Next week: Inflammation III: Anti-inflammatory diets

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Inflammation I: My accident

Inflammation has four classic symptoms: redness, swelling, heat, and pain. That was my leg, about five weeks ago. I did a stupid thing: I stood on a table to adjust light fixtures. To get down, I stepped on a chair, the seat of which sloped slightly toward the back. My foot slipped under the back of the chair and just kept heading downward, scraping the inside of my shin—from knee to ankle—until my foot hit ground. Painful! It immediately started to swell and a huge hematoma appeared (a hematoma is a swelling filled with blood caused by a break in the wall of a blood vessel).

I concluded that nothing was broken and that my body was doing its job. So I carried on as best I could (13 for dinner that night!). As the days wore on, it started looking worse in some ways. It continued swelling, and started looking more bruised. Plus my foot and toes became purple. I figured I broke a million blood vessels (no blood on the outside—all on the inside) and that the blood was seeping down into my feet. I continued my normal activities, including Jazzercise, although mostly I just wanted to lie down. It made me feel sort of sick.

Friends and relatives were horrified that I didn’t seek medical help. But I couldn’t imagine what a doctor would do. Nevertheless, after two weeks had passed and the swelling and discoloration hadn’t gone down much, as shown in this photo, I gave in and made an appointment with an orthopedic guy.

My leg, 16 days after the accident.

As I predicted, the doctor did nothing. (I did have x-rays. Nothing broken.) He was unconcerned and rather uninterested in my plight. I told him that what really bothered me was pain in my hip, which I’m pretty sure is bursitis. He wasn’t interested in that either, but told me to take four Advil in the morning and four at night. Advil is an anti-inflammatory drug. The idea is to keep inflammation at bay.

So that’s what I’ve been doing. Advil’s scientific name is ibuprofen. It is a non-steroidal anti-inflammatory drug (as are aspirin and many other drugs, such as Motrin). It works by blocking the production of prostaglandins, substances our body releases in response to illness and injury and that also cause inflammation. After doing a little research, I learned that Ibuprofen's painkilling effects kick in soon after you take a dose, but its anti-inflammatory effects may take weeks. So I guess I’m going to be doing this for a few weeks.

This Advil-taking regimen is something I wouldn’t have known about if I hadn’t gone to the doctor. I don’t like the idea of blocking any of my body’s normal functions. But what the heck. It’ll be a scientific experiment. The drugs.com web site says the maximum amount of ibuprofen for adults is 800 milligrams per dose or 3200 mg per day (four maximum doses; I'm taking two). I guess that Ibuprofen can increase the risk of heart trouble and can damage the lining of your stomach. I’ll take my chances. I want to see if this works.

Report: I took those big doses for two weeks and was not impressed. Maybe it helped a little. The day after I stopped taking the twice-daily doses, I had a terrible time sleeping plus I got a cold, something I've not had for many years. I think all that Advil compromised my immune system. I don't recommend that regimen.

Next week: Inflammation II: The basics

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

A final rant about pharmaceutical companies

Sorry—I can’t stop ranting about drug companies. (Look at the Topics menu for more rants on the subject.) Lately, there’s been a brouhaha about the increase in the cost of a Daraprim, a 62-year-old infectious disease drug that was recently acquired by Turing Pharmaceuticals. Turing immediately raised the price from $13.50 a tablet to $750 a tablet. (The CEO, Martin Shkreli, was arrested December 19^th last year on securities fraud charges—essentially for a Ponzi-like scheme.)

Pharmaceutical companies want you to think their prices are high because they spend so much on research and development. That’s hogwash. Their prices are high because they’re trying to make the biggest profits they can get away with. Like Turing, their strategy is to buy companies and/or drugs, after which they jack up the drug prices. Here's another example: Valeant Pharmaceuticals International spends just 3 percent of sales on R and D, which they consider to be “inefficient” and “risky”. Valeant bought the rights to Isuprel, a heart medication, and immediately raised the price of 25 pills from $4,489 to $36,811. Similarly, 100 capsules of Cuprimine, a drug for Wilson’s disease, rose from $888 to $26,189. (In some foreign countries that same drug sells for $1.00 a capsule.) In all, Valeant has raised the prices of its brand-name drugs an average of 66 percent.

Executive pay, by the way, is tied to shareholder returns. Last year, Valeant spent $123 million on the five highest-paid executives. Its president, J. Michael Pearson has become a billionaire. Although Pearson operates out of an office in New Jersey, the company has relocated to Canada for its tax advantages. 

While their profits have generated wealth for shareholders, it’s not been so great for the employees who worked for the companies acquired by Valeant. Many, if not most, have lost their jobs. For example, after acquiring Bausch & Lomb, Valeant fired 3,000 of the original 4,103 workers. 

Valeant and Turing may be extreme examples, but I think many if not most of these companies are immoral, if not downright evil. For my part, I just say no to drugs. I’m glad I can do that.

Next week: Inflammation I: My accident

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Fear not: a summing up of 2015

In his book, Less Medicine, More Health, Dr. Gilbert Welch concludes, “If the American public knew the full story about the benefits, harms, and uncertainties of medical care, many would choose to have less…meaning the interventions of testing, medication, procedures, surgeries, and devices.” This is the position I have taken, as discussed in my years’ worth of posts in 2015. For me, this means—

• Not going to the doctor unless I’m sick; in other words, no annual checkups.
• Not worrying about cholesterol, germs, saturated fat, or most anything else.
• Not getting mammograms or other screening tests.
• Not using prescription medicines (I admit to taking Advil pretty regularly).
• Not getting flu shots.
• Etc.

 My rationale is based on a number of things, most of which I’ve gleaned from my research:

• I don’t get sick (admittedly, this is dumb luck).
• Forty percent of doctors’ treatments have no value.
• Ninety percent of scientific journal articles are flawed.
• Pharmaceutical and device companies drive much of medical practices.
• Accepted medical practices are often discovered—too late—to have been wrong-headed and harmful.

I’m willing to go to the doctor if the situation calls for it. (My last visit was about four years ago, when I had wax removed from my ear and my do-it-yourself efforts using Debrox were unsuccessful). I refuse to worry about some hidden malady that might be lurking in my body just waiting to be discovered by a test. Where my health is concerned, I don’t believe in “better safe than sorry.” I believe in “if it ain’t broke, don’t fix it.”

Next week: Another rant about pharmaceutical companies

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Cartoons for the holidays II

Next week: Fear not: a summing up of 2015

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.