IS TYLENOL SAFE? By Sucharu Chris Prakash, MD

Dr. Chris Prakash, eParisExtra columnist

Dr. Chris Prakash, eParisExtra columnist

Tylenol is one of the most commonly used medicines. We reach for it when we are sick, be it for fever, pain, or even the flu. It is easy to buy; it is over the counter, cheap, and available without a prescription. It comes in all shapes and varieties, and easy to consume formulations such as a solution, chewable, and even a suppository. The whole world takes Tylenol. It’s got to be safe, right? Maybe not!

Most of us are aware that acetaminophen (active ingredient in Tylenol) has the potential to cause liver damage. But exactly how much Tylenol can you safely take before you start worrying about it? There is no clear answer to this question. However, the data from NIH (National Institute of Health) is very clear: Tylenol is the leading cause of acute liver failure in our country. The daily recommended dose of Tylenol is 3 gm (recently dropped from 4 gm by the manufacturer). Taking more than that dose, even for a few days can result in major illness. How easy is it to get to the maximum recommended dose? One extra strength Tylenol contains 500 mg of acetaminophen. Taking 2 tabs at a time three times a day gets you to the allowed dose. If you are taking other over the counter products at the same time, such as cough and cold medicines (they often contain Tylenol), you can easily surpass the safe dose of acetaminophen, and could land in serious trouble.

How common is Tylenol overdose?

According to the CDC, acetaminophen overdose is responsible for 7800 emergency room visits a year, 3300 hospitalizations, and almost 450 deaths. It is important to recognize Tylenol poisoning, because prompt medical care can save your life. A person may not show signs of overdose for up to 12 hours. After that, the following symptoms may appear:  nausea, vomiting, poor appetite, abdominal pain and jaundice. You should know that there is an antidote available to acetaminophen overdose (N- acetylcysteine), but it is most effective when given within 8 hours of ingesting acetaminophen. It can prevent liver failure if given early enough. For this reason, it is absolutely necessary that acetaminophen poisoning be recognized, diagnosed, and treated as early as possible.

Other dangers from Tylenol:

It is not just liver failure that you worry about, with Tylenol.

  • Long term use of Tylenol can cause kidney damage.
  • Tylenol can cause gastrointestinal side effects.
  • It has even been shown to have cardiovascular toxicities.
  • A study in UK showed that with Tylenol, there was a 36% increase in risk of gastric ulcers, a 14% increase in risk of heart attack and a 20% increase in renal failure risk.

Lessons to learn:

  • Don’t assume that OTC medicines are safe.
  • Look at labels: Acetaminophens is often combined with cold and cough remedies, and even sleep aids. Know what you are taking.
  • Do not drink alcohol while taking Tylenol. It increases risk of liver damage.
  • Fasting, or being unable to eat, increases toxicity of Tylenol.
  • Remember that Tylenol is an ingredient in several strong pain killers such as: vicodin, lortab, norco, Percocet and darvocet.

It is important to realize that most people can take Tylenol without any problem! Tylenol remains a very effective and important medication available to us over the counter. Tylenol is safe if you follow the precautions and guidelines outlined above.

This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com

 

IS ORGANIC FOOD BETTER? By Sucharu Chris Prakash, MD

Dr. Chris Prakash, eParisExtra columnist

Dr. Chris Prakash, eParisExtra columnist

Common perception dictates that organic produce is healthier. If our products are grown without using pesticides, or injecting antibiotics and hormones, it’s got to be better, right. Maybe not!

Organic products continue to get more popular. Organic food industry is a multibillion dollar enterprise ($24.4 billion to be exact). This popularity has spawned the growth of grocery store chains such as Whole Foods and Trader Joes, all over the country. Most of us are willing to pay a premium for these products. After all, organic foods are often twice as expensive as conventional, and may not be readily available at the local grocery store.

What is organic?

“Organic” is a pretty simple concept. Farmers who grow organic produce don’t use chemical fertilizers, do not use pesticides, and do not give animals growth hormones and antibiotics. Organic produce can be fruits, vegetables, grains, dairy products or meat. Organic farming practices are designed to be “greener” and reduce pollution. Organic products can sometimes be mislabeled and thereby misleading. In order to be certified as organic by the USDA, all foods have to meet strict standards. These standards are based on how these foods are grown and processed. If a product is certified as at least 95% organic, they will display the official USDA “Organic” seal. Some produce may be labeled as “natural”, which is different from organic. The word “natural” on food packaging can mean any number of different things, such as free range or hormone free, but the term “organic” is strictly defined by uniform, federal regulations.

Is organic better?

This question was researched by a team of scientists at Stanford, and their findings were published in the Annals of Internal Medicine. They concluded that “there is no difference between organic and conventional foods as far as the nutritional value is concerned”. This was the most comprehensive meta-analysis to date of existing studies comparing organic and conventional foods, and included 237 of the most relevant studies to date. The review showed no evidence that conventional foods posed greater health risks than organic products. Organic produce however, had a 30 percent lower risk of pesticide contamination in their study, which would be expected. This analysis stresses the point that organic foods are produced with fewer pesticides and more natural-growing practices, but that doesn’t always translate into a more nutritious or healthier product.

The Dirty Dozen

Some foods are considered high risk due to a higher concentration of pesticides that may be on the surface or even inside the produce. The Environmental Working Group calls these the dirty dozen. It may make sense to buy these organic if possible. The dirty dozen includes: Apples, Celery, Strawberries, Peaches, Spinach, Nectarines, Grapes, Sweet bell peppers, Potatoes, Domestic blueberries, Lettuce, Kale and other collard greens.

Should you buy organic?

Now that you know the scientific data, you can make an educated decision whether you should choose “organic”. Some of the reasons for buying organic foods are:

  • Concerns about the effects of conventional farming practices on the environment and animal welfare.
  • Taste preference.
  • Limit exposure to pesticide residues.
  • Limit intake of food additives such as preservatives, artificial sweeteners, colorings and MSG.
  • NOTE: People should aim for healthier diets overall, and eat fruits and vegetables, however they are grown.

 

This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com

Aspirin a day keeps the doctor away? By Sucharu Chris Prakash, MD

Dr. Chris Prakash, eParisExtra columnist

Dr. Chris Prakash, eParisExtra columnist

Q: I have heard that aspirin can prevent heart attack and stroke. Should I take it every day even if I am healthy?

 A: Aspirin (or acetylsalicylic acid) was developed in 1897 by the German chemist Felix Hoffmann, and since that time, has been invaluable as an analgesic. Aspirin has been a mainstay on pharmacy shelves, for relief of pain and fever. We have also known for some time now, that aspirin can help prevent heart attacks and strokes. There is new evidence that indicates that aspirin can also reduce the risk of some cancers, and may even help protect against Alzheimer’s disease.

So, is it safe to say that aspirin is a wonder drug?

Maybe!

Multiple studies and meta-analyses have confirmed that the use of aspirin substantially reduces the risk of cardiovascular disease, and prevents heart attack and stroke in otherwise healthy individuals. This evidence prompted the United States Preventive Services Task Force to strongly recommend that men ages 45 to 79, and women ages 55 to 79, take a low-dose aspirin pill daily, with the exception of those at risk for gastrointestinal bleeding.

Over the past couple of years, there have been several reports about aspirin’s benefits in cancer prevention. In 2011, British researchers, analyzing data from some 25,000 patients in eight long-term studies, found that a small, 75-milligram dose of aspirin taken daily for at least five years reduced the risk of dying from common cancers by 21 percent.

In 2012, The Lancet published a research paper which reviewed five long-term studies involving more than 17,000 patients. It found that a daily low-dose aspirin lowered the risk of getting adenocarcinoma – a common malignant cancer that develops in the lungs, colon and prostate, by an average of 46 percent (for some folks with a particular genetic mutation, it slashes the risk of colon cancer by 82 percent).

How does Aspirin do it?

Aspirin helps prevent cardiovascular disease through a variety of mechanisms, including being a natural anticoagulant (prevent blood clots). It is a powerful anti-inflammatory agent, and many experts believe it helps prevent cancer, in part, by dampening a person’s immune response to damaging insults in the body.

Is Aspirin safe?

Aspirin can cause irritation of the stomach lining and loss of stomach protection. This may make people more likely to bleed. Taking aspirin in coated or buffered form may help lower this risk but does not eliminate it. People, who take aspirin regularly, will have roughly double the likelihood of having a perforated ulcer or bleeding in the GI tract.

So how do you decide whether aspirin is right for you?

As with all medications, individuals should first speak with their health care provider to discuss using aspirin. The doctor will then discuss the potential benefits and harm of aspirin therapy.

The following individuals may clearly benefit from low dose daily aspirin:

  • Those who have a documented personal or family history of heart disease, including heart attacks, stokes, or angina.
  • Those with diabetes.
  • Those who have high blood pressure or high cholesterol.
  • If you are a smoker, or have obesity.
  • All males 45-79 and all females 55-79 years old, if benefits outweigh the risks.

The recommended dose for prevention is 75 or 81 mg daily.

This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com

 

Do mammograms save lives?

Breast cancer is the leading cause of cancer deaths in women worldwide. Almost a million new cases are diagnosed each year. A number of studies have shown that mammograms save lives by detecting cancers at an earlier stage.

Dr. Chris Prakash, eParisExtra columnist

Dr. Chris Prakash, eParisExtra columnist

However, a Canadian study published in British Med Journal on february 12th, concluded that mammograms do not lower the risk of dying from breast cancer, while finding tumors that may not need treatment. The study followed 90000 women and compared annual breast exams (by a nurse) plus a mammogram, versus breast exam alone. After 25 years, breast cancer death rates were similar in the two groups.

This study has been reviewed by several experts and some major flaws have come to light. It appears that the equipment used may have been outdated, and poor methods may have been followed that made the mammograms look ineffective.

The precise benefit of mammograms, although widely acceptable in the U.S, remains controversial. Not all organizations agree on the guidelines. The American Cancer Society recommends mammograms every year starting at age 40, while the USP Task Force recommends starting at age 50 and then every other year.

As with most other medical decisions, a personalized approach needs to be adopted, in concert with your doctor. Those who are at the greatest risk of disease, get the most benefitfrom screening.

Mammogram screening is not a perfect science. There is a slight exposure to radiation, and it may lead to overdiagnosis and unnecessary procedures.

But it may also save your life!

By Sucharu Prakash, MD – eParisExtra columnist 


This information is strictly an opinion of Dr. Prakash and is not intended to replace the advice of your doctor. Dr. Chris Prakash is a contributing columnist and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris with his wife and two children and can be reached at (903) 785-0031 or Sucharu.prakash@usoncology.com. 

PARIS SMOKING BAN: A DOCTOR’S PERSPECTIVE by Dr. Sucharu Chris Prakash, MD

Dr. Chris Prakash, eParisExtra columnist

Dr. Chris Prakash, eParisExtra columnist

As a physician who sees the ill effects from smoking every day, I am glad that the proposed city wide smoking ban may become a reality in Paris, TX. We are all well aware of the dangers of smoking. I am not going to waste your time by reiterating the statistics about the toll that smoking takes on peoples’ health. However, I would like to talk about the hazards of second hand smoke, and third hand smoke, as well as discuss the potential effect of such a ban on our local businesses.

Facts about Second hand Smoke

Second hand smoke is the smoke and other airborne products that come from being close to burning tobacco such as from cigarettes.

 Most exposure to secondhand smoke occurs in homes and workplaces, but a significant exposure also occurs in public places such as restaurants and bars.

 Eliminating smoking in indoor spaces is the only way to fully protect nonsmokers from secondhand smoke exposure.

 Separating areas where smokers can smoke (from nonsmokers), opening windows, and ventilating buildings does not eliminate secondhand smoke exposure.

 There is no risk-free level of contact with secondhand smoke. Even brief exposure can be harmful to health.

What is Third hand Smoke?

Third hand smoke is considered to be the residual nicotine and other chemicals left on surfaces such as clothes, furniture, drapes, walls, bedding, carpets, vehicles etc. This residue reacts with indoor pollutants creating a toxic mix. This toxic mix contains carcinogens, posing a potential health hazard to nonsmokers who are exposed to it, especially children. Third hand smoke is a relatively new concept, and all its possible dangers are not known.

Third hand smoke residue builds up on surfaces over time and resists normal cleaning. This smoke cannot be removed by opening windows, using fans or air conditioners, or confining smoking to only certain areas. The only way to protect nonsmokers from third hand smoke is to create a smoke-free environment.

Health Hazards of Second hand Smoke

 Lung Cancer – Secondhand smoke contains more than 4,000 substances, several of which are known to cause lung cancer and other cancers. EPA estimates that exposure to secondhand smoke causes approximately 3,000 lung cancer deaths per year in nonsmokers.

 Second hand smoke increases the risk of heart disease (coronary disease).

 Serious Health Risks to Children – Children are particularly vulnerable to the effects of secondhand smoke for a variety of reasons. These risks include Asthma, increased risk of pneumonia and bronchitis, middle ear infections, and also increased risk for SIDS (Sudden infant death syndrome). Exposure to secondhand smoke can even trigger asthma attacks and make asthma symptoms more severe.

Effect of smoking ban on Hospitality Industry

We all want businesses in Paris to thrive. So, will the public smoking ban adversely affect local restaurants and bars? Evidence says No! Several peer-reviewed studies have examined objective measures such as taxable sales revenue and employment levels across various cities in the US, and have found that smoke-free policies and regulations DO NOT have an adverse economic impact on the hospitality industry.

In fact, a study of hospitality revenues in El Paso, Texas (2002), found that there was no decline in total revenue at restaurants and bars during the first year after the city adopted a smoking ban in all workplaces and public places.

Right to Smoke

Smokers feel that they have the right to smoke anywhere and at any time they want. They feel that they are only hurting themselves. However, as the data above proves, non smokers are at equal or greater risk from their act.

So, I hope that we will all do the right thing and support the city wide smoking ban, not only for our health and our childrens’ well being, but for the long term prosperity of the city.