Integrative therapies Archive

Q. My doctor recently put me on Tenormin because my blood pressure was getting high. Now, when I run or row, I can't get my heart rate much above 115 beats per minute even though my peak heart rate should be 136. Is the beta blocker keeping me from getting the full benefit of exercise?

A. Although your heart now beats more slowly when you run and row, rest assured that your heart, arteries, lungs, muscles, and the rest of you are getting the full benefit of exercise.

Q. I took a low dose of the antidepressant desipramine for more than two years for chronic pain. Once I started physical therapy, my pain improved so much that I quickly tapered off the medication. I have been off of it for a month now, but am still experiencing "discontinuation symptoms." I can't sleep well and feel a little dizzy. What can I do for this?

A. It can be liberating to realize that you no longer need to take a medication. However, sometimes you can't just throw your pills away. There are many medications (both psychoactive and otherwise) that require you to taper off slowly when it's time to stop them. Stopping such a medication too quickly will cause what are called rebound side effects. Desipramine (Norpramin) is a tricyclic antidepressant, one of the drug categories that require a slow taper.

For anyone who has been constipated, the promise of relief through medication is clouded by the possibility of developing a "laxative habit." However, a study published online Nov. 18, 2014, by the Journal of General Internal Medicine offers a drug-free approach to the problem: applying pressure to the perineum (the area between the genitals and the anus).

Researchers from the University of California, Los Angeles, studied 100 women and men with chronic constipation. Half were randomly assigned to receive handouts describing conventional approaches to relieving constipation, such as increasing fluid and fiber intake, getting regular exercise, and using laxatives and other medications. The other half got the same handouts, and were also instructed to use their index and middle fingers to press on the perineum at the first urge to defecate and continue until the stool passed easily.

Be mindful of risks for fracture, low B12, and a spike in stomach acid.

Proton-pump inhibitors (PPIs) help treat symptoms of heartburn, but these powerful medications also carry their share of risks. "The risks are for long-term use," says Dr. Jacqueline Wolf, a Harvard Medical School associate professor. "Three months of use should be okay, but if someone needs a PPI longer than that, a doctor should be supervising use."

Don't let misconceptions about these medications prevent you from taking them. 

Q. I had a heart attack several years ago and have been taking low-dose aspirin ever since to prevent a second one. But I keep hearing about the bleeding risks caused by aspirin. What should I be watching for? 

A. Aspirin prevents tiny cell fragments in the blood called platelets from clumping together and forming clots. But it also increases the risk of minor bleeding. You may notice that cuts bleed a little longer than usual. Bruises, which happen when blood leaks out of small vessels (capillaries) after an injury, may also be more noticeable.