Do you have questions about managing your or your partner's health and wellbeing? Ask PillTime’s pharmacist

Reported.

62Granny

My DH 70, is type 1 diabetic and had a stroke 8 years ago.
He is on insulin x 3 short acting, 1 long acting
BP, meds, valsartan 160mg, Amolodpine 10mg
Clopidogrel 75mg
Paracetamol x 3 times
Baclofen 10mg x 3 daily
Stexerol-D3 1, 000 x 1
Atorvastatin 10mg.
He doesn't sleep that well and is continually saying he is tired.
His mobility is impaired due to the stroke and is getting worse.
He goes to a neurological trainer twice a week.
We had blood test a few weeks which have all come day within normal range.
I am not sure where we go from here? He hates my contacting the GP.
Any advise.

Hi @62Granny. This is a difficult case, as many of his conditions or treatments could be contributing to his tiredness. Out of them all, the first thing to try and improve is his sleep. Without understanding the reasons why he isn’t sleeping well, it’s hard for me to give specific advice.

If he speaks to the surgeon, they may be able to refer him to a specialist who can help. Improving his sleep could then have a positive effect on his day-to-day energy levels.

It’s also worth checking whether he’s drinking enough fluids throughout the day, as dehydration can really affect sleep quality. He may find he needs to get up more often at night at first, but once his body adjusts, the sleep he gets in between could be of much better quality.

NotSpaghetti

Thank you @PeterThnoiaPillTime but no, I was specifically referring to the studies showing that some people are better taking BP drugs (such as Perindopril) at night.
Not the generality.
It was more to do with being a "night person" or a "day person" I believe.

Hi @notspaghetti - Understood. I guess it depends on when your normal circadian rhythm kicks in - basically, the time of day when your body naturally feels awake. If this tends to happen in the evening, then that might be the best time for you. Just make sure that during the day, it’s a time when you actually feel alert and not ready to go back to bed.

dogsmother

Please, what is best for osteoarthritis that seems to be affecting all areas. Shoulders, outer wrist are most painful with stiffness being the problem in the more common areas of toes fingers and occasional knee twinges ?

Hi @dogsmother, Osteoarthritis is something that needs to be managed and treated with the help of your GP. There are supplements you can take that may also help, but make sure you check these with your pharmacist, as it’s easy to double up on similar medications if your GP is also prescribing treatment.

Maintaining physical exercise is very important, and if possible, include some weight training (this can be as simple as lifting a one-litre bottle of water), as this helps strengthen your bones and keep the supporting muscles in good shape.

Ask your surgery to refer you to a physiotherapist, as they may give you specific exercises to help. Remember - consistency with exercise is really important.

Grantanow

I was sent to the pharmacist by my GP surgery for sinusitis. The pharmacist interviewed me on the phone and prescribed an antibiotic which I hope does the job.

I wasn't overjoyed to be sent to the pharmacy. I would have preferred a fully qualified GP. I'm asthmatic and at my age I worry about breathing.

Hi @Grantanow, don’t worry about seeing a pharmacist rather than a fully qualified GP. Pharmacists have a lot of experience that can really help you - they often see which products work best. When a medication doesn’t work, patients usually turn to their pharmacist first for advice, especially when the GP surgery is busy. Many pharmacists can also prescribe the same treatments your GP can, so you can save a lot of time and get the care you need faster.

I’m 68 and have been on an Everet conti estradiol low dose patch for 10 years. Over the last year I started getting an increase in hot sweats during the night. I went to doctor as I thought I my symptoms of menopause would lessen as I got older not get worse.
Lots of tests to rule things out, discovery of fatty liver and on statins now. Did try homeopathic alternatives nothing helped.
So now I have been prescribed progesterone and an estradiol patch. This is in the hope that the night sweats will stop.
My question is I’m nervous in my mind I wanted to gradually stop hrt but now I’m prescribed further does to help me. So do I start new meds ? Feel a bit silly as prescribed by doc and don’t know why I’m hesitating 🤷🏽‍♀️

dogsmother

Please, what is best for osteoarthritis that seems to be affecting all areas. Shoulders, outer wrist are most painful with stiffness being the problem in the more common areas of toes fingers and occasional knee twinges ?

Anything for me?

PeterThnoiaPillTime

Retread

Mine is a question on general health and wellbeing - I have read that an Omega 3 is really beneficial for heart, brain and bone health. I'm not keen on salmon (too rich) - is it advisable to take a daily supplement of Omega 3 to ensure I get enough of it?

Hi @Retread, Omega 3 fatty acids are healthy fats which have lots of health benefits. As you don't like oily fish too often, it's probably best to take 500–1,000 mg (combined EPA+DHA) from a good quality brand daily.

At PillTime, we enable premium customers on our app to add supplements like these into your daily pouches, so you don't forget to take them.

Thank you! Very useful to have specific info.

My DH 70, is type 1 diabetic and had a stroke 8 years ago.
He is on insulin x 3 short acting, 1 long acting
BP, meds, valsartan 160mg, Amolodpine 10mg
Clopidogrel 75mg
Paracetamol x 3 times
Baclofen 10mg x 3 daily
Stexerol-D3 1, 000 x 1
Atorvastatin 10mg.
He doesn't sleep that well and is continually saying he is tired.
His mobility is impaired due to the stroke and is getting worse.
He goes to a neurological trainer twice a week.
We had blood test a few weeks which have all come day within normal range.
I am not sure where we go from here? He hates my contacting the GP.
Any advise.

Thank you @PeterThnoiaPillTime but no, I was specifically referring to the studies showing that some people are better taking BP drugs (such as Perindopril) at night.
Not the generality.
It was more to do with being a "night person" or a "day person" I believe.

NotSpaghetti

^There is some evidence that when to take blood pressure medications (such as Perindopril) - morning or night, might vary according to ones own body clock.^

This question is actually asking about the new evidence and research papers that have looked at circadian rhythms and optimum time to take BP drugs.
I know that they are traditionally taken in the morning but was told that this is only because there is better compliance in the morning than at night.
(There are studies about compliance).

Please can you take a look again at this as I hoped you would be able to more easily digest the academic evidence.
As I said, I want to take them at the optimum time for me.
Thank you

Hi @Notspaghetti, in terms of the circadian rhythms, these are essentially caused by a release of hormones in the morning by the hypothalamus (a region of the brain) . These then trigger the feeling of waking and help you feel ready for the day. The rhythm that studies refer to is when that release occurs naturally, a bit like your own internal body clock. This rhythm can be changed, but it takes a few days, hence the term Jet Lag.

For some medications, it is best to try and time them with this phase of hormone release so that the effect of the medication is occurring as the normal release of Hormones starts to take effect. For Perindopril, as long as its taken at some point in the morning, it will be okay, as the time of action is quite long, so it will help throughout the waking part of the day.

Hope this helps .

AGAA4

I have arthritis in my hip. I love to go for walks but find it painful and tiring. The only time I had any relief was from taking ibuprofen before the walk. Paracetamol doesn't help.
Is it safe to take ibuprofen occasionally? The only other medication I take is lansoprozole twice a week.

Hi @AGAA4, Yes it is safe to take ibuprofen in this way and taking it occasionally like you have described is best. Make sure you eat beforehand and keep an eye out for any indigestion that may occur. If it does cause indigestion, stop taking the ibuprofen. As you are already on Lansoprzole this will help. But its important to never have the ibuprofen on an empty stomach.

Bea65

Hi Peter, would appreciate your advice re anxiety medication before a long haul flight in December…🙏

Hi @Bea65, the best medication for this is one that can only be received through a prescription from your GP Surgery. The type of drug means you can only get this via a prescription. It's likely to be strong enough so that you can still function (which is always a benefit on a flight) and not so strong that you sleep too deeply. Make an appointment and they can give you some to try beforehand to just check you wont have any issues when you plan to fly.

Retread

Mine is a question on general health and wellbeing - I have read that an Omega 3 is really beneficial for heart, brain and bone health. I'm not keen on salmon (too rich) - is it advisable to take a daily supplement of Omega 3 to ensure I get enough of it?

Hi @Retread, Omega 3 fatty acids are healthy fats which have lots of health benefits. As you don't like oily fish too often, it's probably best to take 500–1,000 mg (combined EPA+DHA) from a good quality brand daily.

At PillTime, we enable premium customers on our app to add supplements like these into your daily pouches, so you don't forget to take them.

Caleo

problem with capsules in bubble packs. Particularly Ramipril caps. They too often break and spill the Ramipril before I get it into my mouth.

I fear the prescribing person at the GP's will cavil at supplying extra capsules.

Hi, apologies the previous answer I posted was to @Caleo's question

Retread

Mine is a question on general health and wellbeing - I have read that an Omega 3 is really beneficial for heart, brain and bone health. I'm not keen on salmon (too rich) - is it advisable to take a daily supplement of Omega 3 to ensure I get enough of it?

Hi @Retread hi, yes for some reason Ramipril capsules seem to be very brittle. We have patients who have reported the same issue. What we do to help with this is score the back of the foil on the blister card with a sharp knife, which reduces the pressure needed when pushing the capsule through.
In terms of ordering an extra pack, just request an extra pack to cover the broken capsules from the surgery. They should be okay as long as you explain why.

gillyknits

I was diagnosed with acid reflex after an endoscopy.and was prescibed 20mg omeprazol .I have read of long term side effects and tried to reduce my intake but the reflux returns. What are your thoughts on long term use of omeprazol?

Hi @gillyknits, for short term use, omeprazol has an excellent safety record. Over longer periods, months to years, there are heightened risks. The first step is to have the following tests to make sure everything is okay. B12, magnesium and Renal checks should be completed and you should be assessed for fracture risk, which is especially important as you get older.

Grannynannywanny

How important is it not to take levothyroxine within 30 mins of drinking coffee?

I only read this recently. After years of washing it down with my morning cuppa 🙈

Hi @Grannynannywanny, If you have been washing Levothyroxine down with coffee regularly and this is your usual routine, then actually, it's best to keep this up. As your Thyroid blood tests have been taken whilst you are doing this, the level of Levothyroxine that you get with your coffee is your baseline. If you change this habit, you may actually see a fluctuation and the effects of the thyroxine increase and change how you feel. If you do decide to change how you take Levothyroxine, then make sure you book in another blood test after a few months to check you are still within range for your current dose.

AmeliaLW

Do I need to be on statins at age 75?
Total cholesterol 5.8
HDL 2.4
Triglycerides 0.9
My understanding is that HDL and triglyceride numbers are more important than total cholesterol?

Hi @AmeliaLW Great work on having such a good cholesterol result at your age. Having a HDL ( the GOOD Guys ) of 2.4 is excellent. Your ratio of good-to-total is really good at 2.4. Anywhere below 4 is regarded as good. It's best to have a discussion with your prescriber at your next visit, as there may be other risks involved which may mean you could benefit from one.

Please, what is best for osteoarthritis that seems to be affecting all areas. Shoulders, outer wrist are most painful with stiffness being the problem in the more common areas of toes fingers and occasional knee twinges ?

I was sent to the pharmacist by my GP surgery for sinusitis. The pharmacist interviewed me on the phone and prescribed an antibiotic which I hope does the job.

I wasn't overjoyed to be sent to the pharmacy. I would have preferred a fully qualified GP. I'm asthmatic and at my age I worry about breathing.

There is some evidence that when to take blood pressure medications (such as Perindopril) - morning or night, might vary according to ones own body clock.

This question is actually asking about the new evidence and research papers that have looked at circadian rhythms and optimum time to take BP drugs.
I know that they are traditionally taken in the morning but was told that this is only because there is better compliance in the morning than at night.
(There are studies about compliance).

Please can you take a look again at this as I hoped you would be able to more easily digest the academic evidence.
As I said, I want to take them at the optimum time for me.
Thank you

Mollygo

Oh and when Peter gets here, I want to know whether the tablets DH has been prescribed are responsible for his increasingly weakened muscles and tendency to fall more frequently.

Hi again @Mollygo, it's really difficult to answer this as if he has muscle weakening, its likely he will fall more often. I still think the best course of action is to change the statin if possible, for a trial period, and see if it improves. It doesn't look like the evidence that it's being caused by the medication is very comprehensive, so it's best to look at what else you can do to reduce the risk alongside trialling a different statin. Increasing weight bearing exercise (non-cardio) is the most effective, alongside increasing protein intake. Adequate calorie intake is super important too, and a thorough check on his blood and hormone levels may help here as well.