Thursday, August 20, 2015

How to Live with AIDS? The Elders Diary 2

How to live with AIDS

PART I

HIV causes AIDS. What are these acronyms?
Advertisements that educate office colleagues, patients afraid of informing family members, spouses denying conjugal rights knowing they are HIV+ or have AIDS, thousands of rupees spent from family income towards treatment- un accounted for, the repeated illnesses, lonely visits to the doctor- what is all this? Being HIV+ is not death. Having AIDS is not death. Do not kill the patient before his time is up. With coming years, HIV+/AIDS is to be ‘downgraded’ to a affliction or condition like Diabetes, which with proper physical care and medication and enable a person to lead a life with dignity and contribute towards society in a meaningful manner.
‘Human Immunodeficiency Virus’ (HIV) is a virus that attacks a category of sub-category of White Blood Cells called CD4+ T Cells. Wide spread destruction of these cells causes a condition called ‘Acquired Immuno Deficiency Syndrome’ (AIDS) where the human body is rendered incapable of defending itself against the simplest of infections.
The three most common ways of transmission of HIV are-
a) Sexual contact with a HIV+ person or someone in the latent period, who could be called a carrier, with yet to be diagnosed as being HIV+.  Semen, blood, sputum and vaginal secretions could all result in the transmission of HIV
b) Blood transfusions, using contaminated needles by accident in hospitals or sharing with other drug abusers. Even simple things like contaminated eye-droppers could help in the transmission of HIV
c) Pregnancy- or later thru lactation from mother to child.
HIV does not have a good life span outside of the human body, hence casual contact, social kissing, or sharing of items that are not contaminated by blood or saliva cannot cause HIV transmission. Toilet seats for example unless contaminated by body fluids- are safe.
The ‘AIDS  = death’ stigma with HIV/AIDS that peaked in the late 90’s and early 2000’ has now sufficiently worn itself out where it has become acceptable to try and psychologically accommodate patients suffering with this ailment into mainstream social life. Doctors now have a bouquet of almost 30+ drugs that combat the spread of HIV (reducing the viral load, as its calculated in the human body) and another 44 more  registered with the USFDA alone, are in various stages of testing.

Heterosexual sex, with multiple partners is like a probability game that one day, a member of the chain  will get infected and then spread it in the ‘network.’ With male homosexuality, the chances of tears to the rectal canal are more during anal sex, and therefore the chances of passing the infection are far more than in unprotected heterosexual encounters. Condoms offer the simplest barrier to reducing the chances of transmission, but human nature, lack of convenience of use, and surprisingly, the lack of knowledge of how to properly use them in rural areas, are among various factors that preclude the use of these- thereby resulting in disastrous outcomes for either individual.
Suspicion of being HIV+ comes mostly from within, the knowledge of a risky lifestyle, or indulging in any of the events mentioned above, in conjunction with multiple subtle medical symptoms- oral infections, swollen lymph nodes, repeated unexplained fevers, repeated diarrhea, oral thrush and a possible dozen other such symptoms. In many cases, this may not happen and routine examination by hospitals before routine surgeries that could be needed, unrelated to AIDS will pop up an alarming result. Paranoia that sets in after a casual sexual encounter with a sex worker is at times enough to ‘cure’ a person from his wayward ways, but ironically the negative result just bolsters him after the intense fear of having contracted AIDS passes away.

SO what  does one do? -
After about 2-3 weeks of the ‘event’ whether a sexual encounter or a suspected wrongly administered blood transfusion, or the wrongful use of a needle has occurred-
1. Get an Antibody test. The Antibody test will show positive for HIV. IT is the cheapest of tests and correspondingly needs a high viral count to create those many antibodies to reflect a positive.  A negative result, unfortunately, could mean nothing and a repeat after 12 weeks will clear the debate to a >98% probability.
2. 1week- 3weeks from date of incident a more expensive Antigen Test will show the results and lastly
3. A Polymerase Chain Reaction Test would show viral load (extend of spread of the HIV) within 2w-3w from date of event.
So what happens when the HIV enters the human body is that it attaches itself to the T Cells and infects it with it DNA/RNA which then helps it replicate itself. These new HIV cells then attack other CD4+ T cells and the reaction continues. The quantum of HIV in the body is referred to as ‘Viral Load.’
On the realization that a high risk event occurring the person in question should get a rapid test done in 3W and then a repeat in 12weeks. If the Antibody and Antigen tests return a positive result then immediate Highly Active Anti Retrovial Drug Therapy (HAART) should begin.

PART II

So the patient had HIV/AIDS- now what?
HAART should commence, even on the day of the HIV+ lab test result.  This is usually a cocktail of 3 antiretrovial drugs from two of the five classes of drugs used to attack the mechanisms that HIV uses to replicate itself. The sooner the drug therapy begins the better, so that at all times the HIV load can be kept to a minimum and the stress on the immune system is consequently lower.
The HIV+ individual needs to regularly monitor two variables that affect his condition. The HIV Viral load and the CD4+ density. Viral load can vary from a barely detectable 40-75 copies per ml to over 300,000-500,000 in case of full blown AIDS. In normal humans, CD4+ T Cells are usually between 500-1000 cells/mm3, and if their numbers sink below 200, then the condition can be categorized as the patient suffering from AIDS.
A few years ago, Doctors preferred to wait till the CD4+ count dropped to <350, but no longer so. The current aggressive therapy demands that treatment begin at the soonest. This enables the person to avoid minor infections and lead a proper healthy lifestyle. The HIV has the unique ability to mutate and create strains that are resistant to the current drug cocktail. Therefore repeated tests track the viral load and CD4+ numbers and indicate the efficacy of the current cocktail. These numbers also then indicate the need/necessity to change the constituents of the same.
It usually would take between 8-12 years for the HIV+ persons’ immune system to get overwhelmed and then result in the condition called ‘AIDS.’ This is for an untreated person. With medications that I will discuss later, the period may be prolonged for upto twice that number. Even today Basketball star Magic Johnson enjoys a healthy lifestyle almost 20+ years from going public with this HIV+ status.
The HIV attacks the CD4+ cells, uses them relentlessly to multiply over a decade, and over time overwhelms the immune system leading to a condition where the body cannot defend itself from simple oral infections, vaginal yeast infections, and wounds that refuse to heal and further, if untreated overwhelms the patient leaving him susceptible to dangerous medical conditions like pneumonia and cancers which then eventually lead to his/her death. |

Today, very few cases of cures are mentioned in the press, only two, if memory serves me right- at last count and few cases of patients becoming resistant to HIV. This does not mean that they are HIV-free, its just that they are not in need of drugs to keep the viral load down. Long term outcomes of such people are not known yet. In a few cases, the transition from being HIV+ to AIDs can progress in two to three years inspite of intensive HAART. Unfortunately the mechanism or the reason for such rapid progression of the disease is not known.

PART III

Life with AIDS
Exercise, proper diet, and regular ART will now be the key ingredients to a healthy and productive life. The better care the patient takes with the above, the longer will be the phase of being just HIV+ and not progressing to an AIDS situation.
Knowing to interpret the numbers is very important- for example, if the viral load changes from 20000 to 40000, then has doubled- that’s not good. But an increase from 45,000 to 60,000 may not be really worrisome. Also, for the same CD4+ number, a higher viral load is more dangerous than a lower viral load number. It is very important to maintain strict data and records of ones own health along with notes on ART-cocktail recipes, and parallel alternative medicine therapies that one may try on recommendations.
Currently the 30+ and the 44 new drugs, from five classes that attack different ‘waypoints’ in a HIVs life, are available as a part of the ART. Modern techniques like refining ‘transcriptase blockers’ will attempt to stop the replicating mechanism of the HIV itself. Some of the most brilliant minds in the pharma industry are at work on this- and a few of their areas of interest are as – vaccines that will teach the T cells to give a stronger response to the HIV attacker, anti viral medication that will make the cells more resistant to attacks by HIV and then cell and gene therapy that will alter cell wall composition and essentially try and block the HIV from entering the CD4+ cell itself.
At home, rest, diet and exercise like stated earlier should form a part of daily routine. Attention to small details like the good levels of bacteria in the gut to prevent alimentary canal infections. Proper hygiene prevents pesky fungal infections in the toes, around the neck- almost like diabetes, but just more sensitive.  Learning to care for wounds, bathing the infirm, cleaning up vomit or body fluids, the proper wear of protective gear and the systematic manner to clean the clothes, cloths, utensils to prevent infections is a must. Updated knowledge on the side effects of the drugs being taken- which could have some serious contraindications without warning, like swelling of the oral tissues creating difficulty in breathing or swallowing. Extreme attention and care to personal hygiene, and including visits to the dentist for regular check up and cleanings prevent oral health issues that could have potentially fatal outcomes. As with chronic diseases like cancer or pneumonia, life partners and family members should concentrate on learning about palliative care..
Help and support groups are a valuable source of emotional and mental support. Knowledge of drugs, therapies, success stories are all a part of a HIV+ persons life. 
It should be an endeavor to find like minded people who are bent on defeating this ailment and that effort itself would be a positive contribution from them to society.

An earlier medical-oriented article is at-
http://therealslimkd.blogspot.in/2015/08/how-to-avoid-diabetes.html
_____________________________________________________________________

NOTE
Do not ever self diagnose your ailments, the numbers here are to prompt you to take a Doctor opinion faster than you usually would.
As regards, ayurvedic or home remedies, you could continue on them as in the least, they will have a palliative effect. These will not replace Allopathic medication.
Do not every self medicate and never stop any allopathic medication based on anything you read. Always consult your Doctor. If in doubt, get a second opinion.









Tuesday, August 18, 2015

Upgrading your Harley

UPGRADES
With the monsoons receding, the long zonal rides are upon us. It is time to get you bikes out of their hiding places and put on some miles.

A few riders on the last ride were asking me about the various upgrades and accessories available to us. I have broken this into four parts for this writing:

a.       Lights.
Upgrades on the main headlight is usually to the preferred Daymakers from HD. A direct fit, and a quick job. The light beam is very powerful and lights up the road pretty well. An added benefit to most of our daytime warriors is that it increases your visibility to oncoming traffic by a thousand times- and also makes you very easy to track, when you are in a group ride. There are afew riders who have complained about the dawn/dusk hours and the effectiveness of the same when its raining. Do not throw out your old headlight, if the rains bother you, then switch to the regular lights for 3/4 months of the year.
Additional Fog or Auxiliary lights are a boon in our kind of traffic allowing for more light to be ‘laid’ on the road making it safe to ride. These can be mounted along side the headlight or on the crashguard. Always make sure that you use these with a relay and get your wiring checked by someone at the workshop. This is the weakest link in the reliability of HDs.
Cheap Chinese made ones are available, and then there are some super gorgeous ones like the Clearwater Simple faults and shorts cause bikes to fail on highways- and your little effort towards saving money can result in a huge loss of riding opportunity and the cost of getting your bike shipped to a nearby service station.

b.      Exhausts
This is a tricky one. Choose an exhaust that you have heard on the same bike as what you own. Do not buy a particular exhaust because it sounds good on a Sportster. The Sportsters are the nicest sounding bikes, in my opinion but on the FatBoy, the same brand could sound just like distant thunder. So do not choose by name/style or recommendation. Choose because you heard it. Slip ons are changed at the far end of the header pipes, while ‘full system’ ones are ones that change from the exhaust port. Make sure that the full system pipes have Oxygen sensor ports drilled in, as if you have to do it, you could drill too close to the exhaust port and you could burn off the sensor filaments.
The usual suspects for an upgrade are V&H’s, Arlen Ness, Cobras to the more exotic SuperTrapp and Covingtons. The pride of Indias HD was a CFR on a Night Rod- which won any exhaust battle, hand down, till the police surrounded the owners house at 4AM on a Sunday- but that’s another story. Unless its radical change in exhausts, the slip on do not usually need a fuel management system.
c.       Air intakes
Stage 1 from SE is the best upgrade to a better breathing air filter element. Also, it comes with a very long life and only needs regular maintenance (as opposed to replacement for the OE air filter.) Various other more aggressive breathers are available like Heavy breather Screamin’ Eagle of HD, VO2/Drake/Duke from V&H, and the Big Sucker from Arlen Ness. These are the ones that protrude out into the oncoming air and feed the engine with more air, almost like ‘forced air induction.’

d.      Fuel Management Systems
Once you have altered the exhaust profile (mostly making your exhaust a freer flowing one) and given your bike more air than it could handle with its basic ECU, the air intake and exhaust sensors start to keep correcting this imbalance that is beyond their parameters to handle. So what?
SEPST from HD is the factory choice for FMS. The SEPST comes with a orange coloured interface that gets mated to ONE HD. One specific bike, not the owner. So when you sell that bike, you give the SEPST away. Given that its an authorized product, it is used to flash the ECM with no moving parts to ‘hang around under the seat.’ The drawback is not this- the drawback is if you mix components like a V&H exhaust with a Heavy Breather, you are essentially out of depth and you will need a Dyno to tune in your bike. Very very unlikely. Which means you are jammed. Call your workshop advisor for pricing on this item. Or you need to be like this one ‘tech head’ mariner from Pune who could really work wonders with the SEPST.
FP3 from Vance and Hines is a very popular upgrade, relatively cheap, easy to install, and with a huge database of products to mix and match.  This takes the map from a table that will come with your FP3, or if you have some eclectic mix of parts, then you email them, and in about 72-96 hours V&H will email you the new maps, which again- can be done by yourself.
Power Commander would be the more advanced version of a piggy backed system that alters the ECU output and based on preset maps that you key in, the bike runs. A lot of people are happy- globally with this PC-V, which is the current version on sale.In case of any engine issues, or for instant comparison you can just unplug it in literally 5 minutes and get your bike into stock condition again.
Power Vision – is possibly the most vaunted of the lot. It takes your maps from the dealer, and flashes the ECM with its new maps. There are many plus points to this like recording your ridng data and almost everyone who is tech’ interested in fiddling with the bike would have this. IF flashing your ECM worries you, then this is not for you. If you are going to be upgrading your bike on completion of warranty and the likes, then you should probably plonk in the dollars and get this.


What happens if you don’t do this FMS. The ‘out of syllabus’ oxygen intake and ‘freer than free’ exhaust will cause your bike to start running lean and will cause ‘blueing’ of your exhaust headers. This is the first sign that all is not well in your bike. You will continue to ride it hot till one fine day you will burn your exhaust valve.

I write this from various inputs- printed material and fellow riders mainly. I could be off the mark and would welcome questions or corrective feedback. 

Tuesday, August 11, 2015

The Elders Diary

Born to Doctor-teacher parents, I studied in Ruia College, before getting my MS in Marine Science in 1989. I then went on to get another MS in Thyroid Hormone research from Texas A&M in 1994. I work as a Project Manager and have worked with BPOs like Zenta, Retail houses like CK and FCUK, and then with the construction house- Hirco.

I enjoy teaching- and from teaching Freshmen Biology  for three years in the US to conducting ‘Safe Riding Courses’ to Harley Davidson owners- I have decided to write to educate the people who are most affected by health and other topics- the middle aged women and men who are going to land in the health trap, and the elderly who are already there in the affliction bucket- but have no one to educate them- save the visit to the doctor. My writing endeavours to educate the elderly and to influence the middle aged millennia to age gracefully.


All writings to this effort are going to form a part of ‘The Elders Diary.'

Part 1, the article on Diabetes is already published on this blog


http://therealslimkd.blogspot.in/2015/08/how-to-avoid-diabetes.html

Friday, August 7, 2015

How to avoid Diabetes- The Elders Diary 1

How to keep Diabetes away
PART I
Over the past few months, after reading a few interesting research papers and talks with a few friends from the scientific community and from holistic health communes made me pen this learning. Having studied Hormones for my MS- the one most infamous affliction caused by any one hormone, Insulin (actually by the lack of) in my field of study, made Diabetes the easy choice for an essay.
Diabetes mellitus, commonly called ‘Diabetes,’ is the condition that occurs when the body loses its ability to control blood glucose. Uncontrolled sugar due to reduced production or lack of Insulin or increased Insulin Resistance (IR)  causes havoc with every organ in the body, and its damage is permanent. 

This article focuses on Type II Diabetes, which is what happens when young adults to elders get afflicted, and what one can do to spot its signs upto a decade earlier and prevent or delay its onset.
Why Diabetes drew my attention, is because it’s the most destructive ‘condition’ that one could have- heart disease being the first mal-effect, followed by nerve, vascular, ocular and kidney damage, many of which could occur concurrently, apart from recurrent skin infections- everything that takes a toll on the hospitals, your own finances, your overall health with the new research showing that in addition to the above, Arthritis, Alzheimers' and a few other musculo-skeletal diseases could have their genesis with Diabetes- making it possibly the most expensive affliction to treat worldwide.
Approaching the 50’mark, I am quite surprised by the number of friends, acquaintances who suffer from this malady. I try and present a few points on diet, general fitness, and lifestyle modifications that could help keep diabetes away.

For starters- lets just try a few simple tests.
1. Lie down on the floor- on your back, arms by your side- now get up using the least amount of limb support- the lesser the better. If you need to roll over get on your hands and knees to then sit up, you have required the maximum- four points. If  you are able to sit up, by just folding your knees under you- you are amongst the fittest- two point of touch- and for those using a hand to support them while rising- 3 points of contact- well- you need to work on getting up using only two points.
2. Stand straight, close your eyes, hands by your sides, extend one leg forward. With your eyes closed, rotate your ankle clockwise and anti-clock ten times. Repeat with other leg, keeping eyes closed.
You will be surprised to see how many need three to four points of contact to get up and how many lose their balance when completing ten ankle rotations.
3. A quick walk test - normal people can walk a distance of 400–700 meters in 6 minutes. A 6-minute walking distance of less than 300 meter is simple and useful predictor of poor physical health, and often a very big warning towards a cardiac issue as well.

The brief logic to this- these tests are kind of home check to see  your core muscles, and your sense of balance and a quick check of your hearts condition. It’s the fastest check to let you know where you stand on a general physical ‘shape.’ There are hundreds of other exercises and ways to test for this- but these two can be done even while reading this article. Also, the article is to be treated as a ready reckoner, and by no means an alternate to your Doctor.

Research indicates two things- the genetic bias of Type II Diabetes can be generated in a single generation, and that grandparents not having diabetes may not help you, if your parents are binging on fast food, low on exercise- the two main contributors to causing Diabetes along with genetics. So be careful of what you eat, you are also creating a possibility for your progeny to have the predisposition to diabetes.

Given in brief- these three factors- genetics, food quality and exercise (lack of)- everyone scoffs and says ‘Oh, yes. I know what needs to be done.’ But no one does anything.
 I have a brief analogy to give. Smokers, if you tell them to quit, they retort-
‘What will happen? Cancer?’
To quote a friend of my fathers, the late Dr Shree Bhandare, a very popular Ortho Surgeon-
“Lung Cancer happens to the lucky, others get emphysema or chronic bronchitis- where even death will fear to come quickly. How you will suffer is upto God, but suffer you will. Quit while you can.”
The same applies for Diabetes.

The knowledge of what diabetes can do will abound in every household or social circle, with someone or the other suffering from arthritis, further aggravating his diabetes with the ever popular prednisolone,
friends who take off their shoes and keep scratching their socks as the persistent athletes foot wont go away, the injury to the toes that wont heal, and many many such silent irritants that we will choose to ignore.
Do not ignore these signs.

What do you do?
What one does is the following- carry out three tests-
a) Insulin levels (at fasting)- to be under 5 microunits/milliliter
b) an HbA1C  to be less than 5.6
c) Post prandial  Glucose Level (two hours after lunch)-should be around <120 mg/dL, but upto a max of 140 mg/dL.
You cannot cheat on one of these tests, and remember they are for your good health not anyone elses’.

A brief interpretation of results-
a) Insulin levels of >5 will be a sign of hyperinsulinemia, an unnecessary elevated level of Insulin, even when the body was at rest. This means that you are very high probability diabetes event.
b) a HbA1c >5.6-7 means again that you are in that pre-diabetic zone, with a value >8 meaning that you would need American legalese stating ‘additional action needed,’ euphemistically meaning Doctors intervention required and possible medication too.
c) Glucose values are- Normal Fasting 70-100 mg/dL and post prandial 100-140 mg/dL. Glucose levels of >140 mg/dL are almost a sure shot indication that you are a borderline diabetic and your medication (if any), exercise and diet control are not working in sync. Levels in the 190-200 mg/dL  range, or greater are just a indicative of a phenomenal increase in your risk levels for all complications associated with Diabetes and need urgent, if not immediate medical intervention.
You will be surprised to know that nearly 80% of Diabetes cases are detected more by accident than due to actual concern for the same. In the interest of your health ensure that all results are taken with a comprehensive view and not individually as there could be underlying metabolic disorders that could be causing these numbers.

PART II.
So what does one do- 

A. Simple basic exercise-
This is the least effort for the most effective results- Do the following every day.
1. Squats 4 sets of 20
2. Crunches- 2 sets of 20
3. Push ups 4 sets of 20 and
4. Sit-ups 2 sets of 20.
5. Plank exercises for your core- two or three reps till you total about 2 minutes of plank time.
You could take about 4 weeks to work up to this quantum by increasing the load every week. This should not take you more than 20-25 minutes and you are on your way. Encourage your child, sibling, friend to do this with you. Maintain a slow and steady rhythm. Once you are able to do this daily, you should replicate it in the evening before dinner as well. IF you are on any medication, consult your Doctor before starting on any exercise routine.
Any more exercise is a bonus. Swimming, walking, running, jogging- any.

These kind of exercises causes micro-tears in muscle fibers have two beneficial effects to the body- the need for ATP to be generated for energy to repair is the most easy to quantify and for those knowing that the glycolytic pathway and its associated Krebs Cycle keeps utilizing the Glucose in the body. This continual use of Glucose then reduces the stress on the Pancreatic beta cells to produce Insulin which would be needed to convert the surplus Glucose to fat. Apart from this, a little known effect seen almost within 48-72 hours of beginning exercise is the jump in the production of the hormone Follistatin- a glycosylated protein hormone, that plays an important role in muscle mass increase.

B. Simple lifestyle changes-
Park your car in the farthest parking lot, climb the last 5 floors to your house/office, descend the first five floors, keep a chart of stretching exercises that you can indulge in at your desk, cubicle- and do that every so often to keep the muscles in use. The increased activity helps your motor function, keeps your senses alert- sight, smell, balance, hearing and keeps your cognitive function in a learning mode- just like playing chess or solving crosswords and puzzles are believed to delay age-related dementia.

C. Starve.
Jokes apart.  This is serious work. Skip a meal a day, replace it with a fruit, do two days of the week on a 500-700 Calorie/day diet- like the 5:2 diet advises, eat before 7 or 8 in the evening to maximize starvation time. It may sound difficult, but salads, lentil soups and fruits will keep you in that range. The holistic believe that every religion from Islam to Hinduism preaches this- dieting and starvation in one form or the other. Few follow this advise of ‘fasting’ in other words- so I try and simplify this- by asking you to cut down on the meals in a little more ‘easy’ manner. Science is working on huge topic called ‘calorie restriction’ in primates and humans and Google will be glad to give you additional reading on how oxidative stress and chronic inflammation are reduced.
This basically means- that you proportion your food, across the week, and though binging has its mal-effects, and if you cannot avoid the ‘weekend whisky warrior’ or  ‘lounge lizard’ phenomena- then on  Sunday- just eat fruit all day long, and give your system literal ‘rest.’ A proper menu is required to ensure that you do not starve yourself off essential nutrients and create a whole other problem.

D. Remember.
One of the simplest ways to get to a better lifestyle is to start remembering what is it that you did, like climb the stairs when you came home, when was the last time you downed  pegs of a single malt, ro simpler things like, are you purple in the face when you are done tying your shoe laces. Sitting in your sofa, sagging with old age, is it a teeth gritting effort to propel yourself out of the bucket of softness that your backside is stuck in? Three pages into a novel at night, as you asleep that you cannot remember the last word you read- or if the page number was 253 or 337. These simple day-to-day activities that will serve as a barometer for your own fitness. Along with a reduction of a ‘point of contact’ as mentioned in the start of this article, you would be well on your way to avoiding diabetes, or if not- delaying it for a fruitful life for atleast another decade, free of worry.

In addition to this, as if the damage by Diabetes itself was not enough- Diabetes is now believed to be among the precursors for two diseases- Alzheimers and Prostate Gland Cancer due to its effects on levels of IGF-1 and Estradiol. There is a lot of technical data and stuff on this topic, but I have tried to keep it simple.
You don’t want to get old, and not remember how to pee.
And if you remember, not be able to.

 Stand up and exercise.

NOTE
Do not ever self diagnose your ailments, the numbers here are to prompt you to take a Doctor opinion faster than you usually would.
As regards, ayurvedic or home remedies, you could continue on them as in the least, they will have a palliative effect. These will not replace Allopathic medication.
Do not ever self medicate and never stop any allopathic medication based on anything you read. Always consult your Doctor. If in doubt, get a second opinion.