I have also been taking phenindione (50 mg), an anticoagulant, for the past four months. The side-effects of this drug include pink-coloured urine, tiredness and lethargy, a worsening of my tinnitus, a loss of taste and swollen, painful joints, especially about the knees. I could change from phenindione to warfarin, but would I be better off? – Christine Harris, Dorset

WDDTY says: Warfarin side-effects include dizziness, breathlessness, tiredness, diarrhoea, fever and skin rash. A wrong dosage can cause haemorrhage somewhere in the body in one out of every 1000 patients – sometimes fatally.

Consult WDDTY vol 15 no 10 for alternative ways to treat atrial fibrillation.

Each of the prescribing errors is down to mistakes or misjudgements by hospital staff due to tiredness or complete ignorance of the drug and its correct dosage.

A research team from the University of London spent several months at a teaching hospital where pharmacists identified 88 prescribing errors that were potentially serious. One junior doctor alone was responsible for 50 of the errors. In all, 46 doctors – including senior and junior house officers, consultants, specialist registrars and a medical student – were responsible for one or more of the mistakes.

In interviews afterwards, the doctors admitted that the most common reason for the errors was because of a lapse in concentration, usually be-cause they were too busy or were interrupted while writing the prescription. Simple miscalculations of dosage were common, or occurred because the doctor was uncertain what the correct dose should be.

In 31 cases, a heavy workload was blamed for the mistake and, in 13 cases, the physical environment – such as noise – was cited; 15 cases were the result of low staffing levels.

Others confessed to an alarming ignorance of drug side-effects, and seemed to be totally unaware of what to do if something went wrong. In one case, a doctor admitted that he didn’t know that a drug was linked to kidney failure, or how to judge the level of kidney impairment in a patient, or even that he needed to reduce the dose of the drug if kidney failure happened.

The Department of Health is committed to reducing the level of prescribing errors by 40 per cent within three years. Judging things from this research, they have some way to go to meet this target (Lancet, 2002; 359: 1373-8).

Elevated temperature isn’t always a sign that something’s wrong. Although 98.6^oF has been considered normal for years, many healthy people walk around with a temperature a degree or so above or below average. A recent study has concluded that normal body temperature may range from 97^oF to 100^oF.

Body temperature even fluctuates throughout the day. It’s usually lowest in the morning and highest in the late afternoon and evening. Where you measure your temperature also makes a difference. Rectal readings are usually more accurate and read a degree higher than oral readings.

Taking your temperature by mouth after you drink a hot liquid like soup or tea can mislead you into thinking you have a fever when you don’t. Other factors that can temporarily affect your temperature include:

• Wearing too much clothing (if you’re over-dressed enough to raise your body temperature).
  
• Exercise.
  
• Hot, humid weather.
  
• Hormones (increased progesterone levels increase body temperature, so women’s basal body temperature increases following ovulation).
  

Typically, in an adult, if having a fever causes no harm or discomfort, it may require no treatment. But if the fever is making you uncomfortable or goes over 104^oF (102^oF in the elderly) you should treat it.

• Drink fruit juice, water, and soft drinks.
  
• Take a sponge bath with warm (about 70^oF) water. (Sponging with alcohol has no advantage and often makes people feel ill, because of alcohol’s pungent odor).
  
• Take the appropriate dose of aspirin or acetaminophen for your age every 3 or 4 hours. [Note: Do not give aspirin or any medication containing salicylates to a child 19 years of age or younger unless directed by a physician, due to its association with Reye’s Syndrome, a potentially fatal condition.]
  
• Get plenty of bed rest.
  
• Don’t wear too many clothes or use too many blankets.
  
• Don’t do heavy exercise.
  

Questions to Ask

Is the fever accompanied by any of the following? Seizure Listlessness Abnormal breathing Stiff neck Excessive irritability Confusion Inability to be comforted
Is the fever accompanied by any of the following? Ear pain Persistent sore throat Vomiting Diarrhea Urinary pain, burning or frequency
Does the fever occur in a child less than 2 months old?
In an adult, does the fever exceed 104oF, (102oF in an elderly person), or has it lasted more than 4 days despite efforts to reduce the fever?
Has the person recently had surgery or does the person have a chronic illness, such as heart disease, lung disease, kidney disease, cancer or diabetes?
Does the fever occur in a baby less than 6 months old?
Has the fever done any of the following? Gone away for more than 24 hours and then come back Come soon after a visit to a foreign country Come after having a DTP or MMR shot and is present with dizziness
In a child, does the fever over 101oF or (102oF rectally) without decreasing in 48 hours despite efforts to reduce the fever?

The conductor of the endocrine system is the anterior pituitary gland, nestled at the base of the brain. The hypothalamus sends special hormones called releasing factors to the pituitary instructing it how to manage the other endocrine glands. Then with its own set of directive hormones, the anterior pituitary guides your body’s glands. The anterior pituitary also releases prolactin, a breast feeding hormone, and growth hormone.

The posterior pituitary, a neighbor but unrelated to the anterior pituitary, is responsible for two hormones: antidiuretic hormone and oxytocin. ADH helps you maintain arterial blood pressure during, for example, blood loss by resorbing water from your kidneys. Oxytocin contracts the uterus during childbirth and causes milk letdown during breast feeding.

Each endocrine gland plays a distinct role in your body, but these actions overlap and therefore affect one another too. When one gland is overly or under-active, other glands feel the effect. The same goes for you. When part of your endocrine system is sick, you most likely are too. Fatigue is one symptom that many endocrine disorders have in common. If you feel very tired or can’t seem to shake your fatigue, see your doctor. Once you’ve discovered the source of your fatigue–whether it’s endocrine related or not–there are many natural remedies you can try under the guidance of a professional.

Function

Although part of the endocrine system, the pineal gland isn’t a gland per se. This neuroendocrine body translates nerve messages into hormonal output–namely melatonin. This pineal hormone peaks in your body around midnight. Babies are born with scarce amounts of melatonin, perhaps accounting for their erratic sleeping habits. Levels, however, rise with age, top out in childhood and then slowly decline with years.

The pineal gland and melatonin are thought to keep your biological clock ticking. External cues like temperature and light, as well as endogenous messages such as emotions guide the pineal gland. In this way sleep, mood, immunity, seasonal rhythms, menstruation and even aging are regulated.

Melatonin

Synthetic versions of melatonin have recently been touted as nature’s new wonder cure for fatigue, insomnia, depression, jet lag, cancer and old age. During her lecture on melatonin at a recent naturopathic medical convention in Aspen, Colorado, Anna MacIntosh, PhD, ND agrees this hormone appears to be a cure-all. That’s also what frightens her.

Although supplemental melatonin doesn’t seem to have toxic effects, it shouldn’t be used indiscriminately. There’s too much we don’t know about this hormone yet, says MacIntosh. We don’t know its long-term repercussions and whether it exerts subtle, and as yet, unmeasured effects. Because melatonin governs biological rhythms, will overuse or ill-directed use adversely affect you?

Melatonin is probably safe for insomnia and jet lag. If you decide to take melatonin, don’t take it during the day–this will only aggravate your fatigue and sleeping problems. Instead take melatonin one hour before sleep. Better yet, preserve your own melatonin reserves by sleeping in a dark room, not turning lights on if you get up in the middle of the night and don’t take ibuprofen late at night.

Function


Your windpipe is straddled by the two lobes of your thyroid gland. Using two hormones, triiodothyronine and thyroxine, your thyroid regulates various enzymes that dominate energy metabolism. Calcitonin, a blood calcium lowering hormone, is also released by the thyroid. Thyrotrophin from the anterior pituitary keeps thyroid hormones in check.

Snuggled in the thyroid’s under belly are four tiny parathyroid glands that emit parathormone. PTH acts on your gut, bones and kidneys to control phosphate and calcium metabolism. Without this regulation, bone and nerves suffer. Too little PTH and a convulsive, twitching condition called tetany ensues. Too much PTH leads to high blood calcium and eventually a bone softening disease called osteitis fibrosa cystica.

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When thyroid hormones are deficient, hypothyroidism manifests. Because energy control is pivotal to thyroid function, hypothyroidism is a condition of reduced energy–you feel tired and cold, become constipated, have less appetite but gain weight, feel sleepy. Even your thoughts are sluggish.

The first way to combat low thyroid hormones is by avoiding goitrogenic foods like soybeans, peanuts, millet, turnips, cabbage and mustard. These foods block the thyroid from using iodine, an element vital for thyroid hormone production. Zinc, vitamin E and vitamin A are also central to thyroid hormone synthesis.

Function

Squeezed behind your breast bone and just below the thyroid is an irregularly shaped member of both the endocrine and immune systems–the thymus. Relatively large in childhood, the thymus grows until the teen years, then shrinks with age. Fat replaces active lymphatic tissue.

Thymosin, thymopoeitin and serum thymic factor–thymus hormones–oversee several immune operations. Before and shortly after birth, a baby’s thymus gland preprocesses T-lymphocytes, the white blood cells in charge of cellular immunity. This type of immunity, the kind not controlled by antibodies, shields your body from yeast, fungi, parasites, viruses, cancer and allergies. Thymopoeitein also activates circulating T-cells.

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Because the thymus shrivels with age, its importance has been downplayed. Stress, pollution, chronic illness, radiation and AIDS also diminish thymus function. However, low thymic hormone levels are associated with depressed immunity and elevated infection susceptibility. A cardinal symptom of infection is fatigue.

An ideal way to protect your thymus gland is to use antioxidant nutrients like beta-carotene, zinc, selenium, vitamins C and E. A high potency multi vitamin-mineral supplement is a good way to accomplish this. Thymus gland extracts, derived from calf thymus, is another effective way to stimulate your thymus gland. Echinacea angustifolia, a famous immune-stimulating herb, may also work via the thymus gland. At least one Japanese shows licorice, Glycyrrhiza glabra, to have direct thymic effects (Endocrinology Japan, 1967, vol 14).

Function

Perched atop each kidney is a triangular shaped adrenal gland. The adrenals are divided into two distinct parts somewhat like a peach. The outer fleshy fruit of a peach is like the cortex or outer region of the adrenal, while the pit resembles the smaller inner medulla of the adrenal gland. All adrenal hormones are ruled by adrenocorticotrophic hormone (ACTH) from the anterior pituitary.

The adrenal cortex produces and secretes three kinds of steroid hormones. The first type, called mineralocorticoids, includes aldosterone which maintains normal blood pressure by balancing sodium, potassium and fluid levels. Secondly, the adrenal cortex makes small amounts of sex hormones, namely testosterone and estrogen.

The glucocorticoids, cortisol and corticosterone, regulate blood pressure, support normal muscle function, promote protein breakdown, distribute body fat and increase blood sugar as needed. This hormone class is most noted for its anti-inflammatory properties, hence the popularity of artificial cortisone as a medication.

You may also have heard about DHEA, short for dehydroepiandrosterone. This steroid hormone, also from the adrenals, has been familiar to scientists for years but its purpose was hazy. Researchers used to think DHEA acted as a reservoir for your body to produce other hormones, like estrogen and testosterone. It’s becoming apparent that DHEA has it own role. Its functions are still blurry, but according to Alan Gaby, MD, DHEA appears to affect your heart, body weight, nervous system, immunity, bones and other systems (Preventing and Reversing Osteoporosis (Prima Publishing) by Alan Gaby, MD,).

The adrenal medulla acts more like a member of the nervous system. In fact it’s derived from the same primitive tissue as the ganglion cells of the sympathetic nervous system. The medulla’s hormones, epinephrine (also called adrenalin) and norepinephrine, are also controlled by the sympathetic nervous system during fear or stress. Your body reacts to these hormones with a “flight or fight” response: pounding heart, dilated pupils and high blood pressure.

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While your adrenals save you during crises, continual demands on this glands tire you out. Age, stress and even coffee compromises your adrenal glands. Several years ago, Sanford Bolton, PhD from St. John’s University in Jamaica, New York found that habitual coffee drinkers had diminished adrenal function (The Journal of Orthomolecular Psychiatry, vol 13, number 1).

Nutrients required for adrenal hormone function include vitamins C and B6, zinc and magnesium. Some symptoms of adrenal “exhaustion”, like fatigue, headache and sleep disturbances, resolve with pantothenic acid, found in whole grains, salmon and legumes. Korean ginseng, Panax ginseng, also reduces physical and mental fatigue.

While doctors are still pondering all its possible therapeutic effects, DHEA seems to help osteoporosis, cancer, arthritis, diabetes, and chronic fatigue syndrome. Patrick Donovan, ND, a private practitioner in Seattle gives his Crohn’s patients DHEA when laboratory tests indicate their DHEA levels are low. After six weeks, Donovan’s patients are more energetic and their bowel inflammation, the key symptom of Crohn’s disease, diminishes. DHEA is a prescription drug and must be obtained from your doctor.

Function

Hiding behind the stomach is the long slender pancreas. Its acini, rosette-looking cells, make and pour 2 1/2 pints of digestive enzyme-containing juice each day–amylase for starch, lipase for fat and protease for protein–into the small intestine.

The Islets of Langerhans rule the pancreas’s better known hormones, insulin and glucagon. These opposing hormones work together keeping your blood sugar in check. Glucagon works together with epinephrine, growth hormone and glucocorticoids to stop your blood glucose from dipping too low by promoting glycogen breakdown. Insulin controls high blood sugar by enhancing the uptake and utilization of glucose by your muscles and body fat.

Diabetes mellitus is the worse case scenario of a pancreas gone wrong. In this disease, the seventh most common cause of death in the United States, insulin is ineffective or absent causing very high blood sugar. Resulting signs and symptoms include glucose in the urine, extreme thirst and hunger, frequent urination, weight loss and fatigue. A blood glucose test can confirm or dismiss a diabetes diagnosis.

Like all body parts, the pancreas requires its share of vitamins and minerals to function properly. At the 1994 American Diabetes Association Meeting, information was presented on the value of various nutrients. Magnesium deficiency in common in diabetes. Production of free radicals, the molecules that damage healthy tissue, increases in diabetes. Antioxidant nutrients like vitamin E and C, and beta-carotene dampen free radical harm (Diabetes Care, 1994, vol 17).

A diet low in fat and high in fiber is central to diabetic treatment, however, many herbs help too. French researcher Oliver Bever and his Swiss colleague G.R. Zahnd reported on several plants that naturally lower blood sugar like onion, garlic, bilberry and fenugreek (Quarterly Journal of Crude Drug Research, 1979, vol 17).

Function

Two testes, housed in a man’s scrotum, produce sperm and testosterone. Without this male sex hormone, men wouldn’t have deep voices, beards or be muscular. Testosterone, also responsible for sex organ development, is produced in the testes under the direction of gonadotrophins from the anterior pituitary. Testosterone also enhances libido in both sexes.

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One of the most common problems to strike older men is benign prostatic hypertrophy or BPH. Testosterone naturally declines with age, while other hormones like prolactin, estradiol, luteinizing hormone and follicle stimulating hormone all increase. The net result is a boost in dihydrotestosterone, a powerful male hormone, that causes prostate enlargement.

An enlarged prostate presses down on a man’s urinary tract causing frequent and hesitant urination. Urine may dribble out rather than flow in a steady, strong stream. Nighttime wakings to urinate disrupt sleep and create fatigue.

Luckily natural remedies are very successful at treating BPH. Cutting out coffee and drinking more water are first steps. Supplemental doses of zinc, vitamin B6 and essential fatty acids like evening primrose oil or sunflower oil also help. The herb saw palmetto is an excellent remedy for BPH.

Function

On the female side, two ovaries, linked to the uterus via fallopian tubes, produce a woman’s eggs as well as estrogen and progesterone. These female hormones endow a women with her feminine traits: large breasts and hips, soft skin and a menstrual cycle. During pregnancy, the placenta also produces progesterone, taking over from the ovaries. This arrangement allows pregnancy to proceed normally, as well as prepare a woman’s breasts for nursing her baby.

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One of the most common endocrine-related problems that plague women is premenstrual syndrome. Half of premenopausal women complain of fatigue, tender breasts, depression, irritability, food cravings and any number of the 150 symptoms association with this syndrome one to two weeks before their periods.

Like most endocrine disorders, PMS involves the disruption of more than just one hormone. True, estrogen tends to be higher in women with PMS, especially during the second half of her menstrual cycle. However, progesterone is also lower than usual, FSH overshoots on some days, aldosterone increases prior to menses and hypothyroidism is more common in women suffering from PMS.

Because of the complexity and individuality of this condition, therapies vary from woman to woman. Vitamin E helps reduce fatigue, insomnia and headaches. B-complex, especially B6, ameliorates PMS symptoms in general. Because magnesium deficiency affects the adrenals and aldosterone levels (and thus bloating), this mineral may be beneficial. Unicorn root, Aletris farinosa, historically known as an herb for “poor ovarian function”, has estrogen-like qualities so may be helpful.