Stopping medicine could trigger problems

Q. I am a practicing emergency physician, and I must take issue with your statement that atenolol and other beta blockers should NEVER be stopped abruptly. Stopping such a medicine suddenly is usually unwise, but if a patient is in complete heart block as a reaction to the medication, you bet we stop it immediately. Not to do so would be malpractice.

A. Thank you for the explanation. In an emergency room, under intensive supervision, ordinary guidelines don’t apply. We do want to emphasize, though, that patients should not stop a beta blocker such as atenolol, metoprolol or propranolol suddenly on their own. Doing so might land them in the emergency department with chest pain, an irregular heart rhythm or even a heart attack.

Q. I am desperate for a good night’s sleep, but I hate sleeping pills. They make me too groggy the next day. Benadryl makes me absolutely stupid if I take it in the daytime. If I took it at night, would it leave me feeling hung over? Do you have any other recommendations?

A. Millions of people take the compound in Benadryl, diphenhydramine (DPH), to get to sleep. It is the “PM” in many popular nighttime pain relievers such as Tylenol PM and Advil PM. Some people find such OTC medicines helpful for occasional use, though the benefits may wear off over time. Not everyone gets a morning hangover from DPH, but some people experience confusion, drowsiness and impaired judgment.

We are sending you our Guide to Getting a Good Night’s Sleep. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (64 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. I-70, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

Q. A few weeks ago, you wrote, “You as the patient have the ultimate responsibility for quality control” of your prescription. That’s so wrong! I can’t read the doctor’s scribble. If we can’t read it, we can hardly be responsible for knowing if the drug is correct.

A. If you don’t want to take the wrong medication, you may need to step in at the very beginning of this process. Tell your doctor you want a prescription you can read, and that you need to know how to take it. Write his instructions down, so you can check them against what’s written on the prescription bottle.Medical educators maintain that there’s no excuse for illegible prescriptions. It shouldn’t take more than a minute for a doctor to print a prescription. If it does, perhaps he or she should use a computer instead of a prescription pad.

Q. My wife experiences pain when I ejaculate in her. Sex without my orgasm is painless, but as soon as I ejaculate she feels intense burning and pain.Is there any advice for this condition?

A. Your wife may be experiencing an allergic reaction to your semen (seminal plasma hypersensitivity). The primary treatment is to avoid direct contact by using a condom. An allergist familiar with this condition might be able to provide desensitization shots.

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