Not all meds need blood lev­els to reg­u­late dosage

Cape Breton Post - - IN MEMORIAM / ADVICE / GAMES -

DEAR DR. ROACH: My son was di­ag­nosed with ob­ses­sive com­pul­sive dis­or­der. The doc­tor pre­scribed ser­tra­line (Zoloft). When I in­quired about a blood test to de­ter­mine his sero­tonin lev­els, the doc­tor told me it wasn’t nec­es­sary. How could a med­i­ca­tion be pre­scribed without know­ing what his lev­els are? My wife has her lev­els checked each year for her thy­roid med­i­ca­tion. -- M.M.

AN­SWER: There are some med­i­ca­tions whose ef­fec­tive­ness can be fol­lowed us­ing blood tests, and a few that must be. If a med­i­ca­tion is be­ing used to treat a symp­tom, it usu­ally is more im­por­tant to treat the symp­tom than to treat a num­ber, so some­times ex­pe­ri­enced clin­i­cians will use a dose that causes the blood level to be a bit higher or lower than rec­om­mended. On the other hand, some medicines -- for in­stance, war­farin to pre­vent blood clot­ting -- need to be pre­cisely reg­u­lated us­ing blood test­ing to be sure it is both ef­fec­tive and non­toxic.

In the case of ser­tra­line and other se­lec­tive sero­tonin re­up­take in­hibitors, there isn’t a blood test to be fol­lowed. It’s not sero­tonin in the blood that is af­fected by these med­i­ca­tions, but sero­tonin in the synapses (the con­nec­tions be­tween brain cells). SSRIs block the clear­ing of sero­tonin after it is re­leased, al­low­ing the nerve to in­crease the rate of fir­ing.

The dose of ser­tra­line de­pends on the con­di­tion treated. Smaller doses are needed for anx­i­ety or de­pres­sion than usu­ally are needed for ob­ses­sive com­pul­sive dis­or­der. For­tu­nately, ser­tra­line is fairly safe: Even the higher doses needed for OCD gen­er­ally have few side ef­fects.

DEAR DR. ROACH: Your re­cent col­umn on short­ness of breath hit home. At age 59, I had short­ness of breath, and my doc­tors said I had asthma. That win­ter I got pneu­mo­nia, and a sharp doc­tor saw some­thing on my test re­sults and called in a car­di­ol­o­gist. After talk­ing with and ex­am­in­ing me and re­view­ing my scans, he called it car­diac amy­loi­do­sis. Fur­ther tests proved him right. I have the wild type. Un­for­tu­nately, there is no cure. They are find­ing this dis­ease in younger peo­ple to­day, and of­ten it is missed or mis­di­ag­nosed. -- J.P.

AN­SWER: I am sorry to hear about your di­ag­no­sis. I have seen a few cases of car­diac amy­loi­do­sis. Amy­loid is a fam­ily of re­lated pro­teins, and amy­loi­do­sis is the de­po­si­tion of a type of that pro­tein into var­i­ous or­gans. The de­posited pro­tein in­ter­feres with the func­tion­ing of the or­gan. The kid­neys, skin, liver, mus­cles and nerves all may be af­fected.

Amy­loi­do­sis can oc­cur in com­bi­na­tion with var­i­ous dis­eases, es­pe­cially mul­ti­ple myeloma. Myeloma -- a dis­ease of plasma cells, which make an­ti­bod­ies -- is associated with AL amy­loi­do­sis. These pro­teins are made up of the light chain of an­ti­bod­ies, and this is the type that also oc­curs in peo­ple with no un­der­ly­ing dis­or­der. (This used to be called “pri­mary amy­loi­do­sis”).

There is another type, called ATTR amy­loi­do­sis. A mu­ta­tion of this gene causes fa­mil­ial amy­loi­do­sis, but the “wild type,” a non-mu­tated gene, causes many cases of what used to be called “se­nile sys­temic amy­loi­do­sis” (“se­nile” be­cause it hap­pens in older adults).

In car­diac amy­loi­do­sis, the pro­teins in­ter­fere with the func­tion of the heart, which can lead to the heart be­ing un­able to pump ef­fi­ciently and the clin­i­cal syn­drome of heart fail­ure. It also can af­fect the con­duc­tion sys­tem.

Treat­ment for car­diac amy­loi­do­sis needs to be un­der­taken by an ex­pert, as ther­a­pies for other types of heart fail­ure can be in­ef­fec­tive or even harm­ful in peo­ple with car­diac amy­loi­do­sis. Heart trans­plant some­times is con­sid­ered for very se­vere cases.

You are right that this dis­ease is un­der­diag­nosed, and I ap­pre­ci­ate your writ­ing to help raise aware­ness. More in­for­ma­tion is avail­able at www. amy­loi­do­sis.org.

Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health news­let­ters at 628 Vir­ginia Dr., Or­lando, FL 32803. Health news­let­ters may be or­dered from www.rb­ma­mall.com. (c) 2017 North Amer­ica Syn­di­cate Inc. All Rights Re­served

Keith Roach To Your Good Health

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