"St John's Wort is a weak monoamine oxidase inhibitor (MAOI) and serotonin agonist. Concern has been raised regarding initiation of hyperadrenergic MAOI-reactions by mixing adrenergic preparations, such as ephedra and ephedrine- containing preparations, with St John's Wort; however, no cases of serotonin syndrome or MAOI crisis have been linked to the use of St John's Wort. Strychnine has been found in imported herbal patent medicines and can cause abdominal distress. Although frequently formulated in homeopathic doses, toxic amounts of strychnine cause profound metabolic acidosis, rhabdomyolysis, and generalized "spinal seizures" in fully alert patients. Cardiovascular system- Cardiac glycosides and other cardioactive steroid contaminants may cause toxicity. Digitalis can cause severe cardiotoxicity (eg, complete heart block). An outbreak of digoxinlike deaths occurred in New York City when a Chinese aphrodisiac called Chan-Su was sold. The labeling was in Chinese and stated that the product was meant to be applied topically, but several people ingested it. This product contained an extract from the venom of Bufo toads, which caused the deaths. Ephedra and ephedrine containing products (eg, Ma Huang) may produce cardiac stimulation, hypertension, peripheral vasoconstriction, chest pain, myocardial infarctions, and intracerebral hemorrhage. Ma Huang (ephedra) may produce hypersensitivity myocarditis (case report) and vasculitis. Data collected on adverse effects have enabled the FDA to ban ephedra products from the United States. Hepatic system- Hepatic toxicity with Budd-Chiari syndrome has been reported with pyrrolizidine alkaloids, which are metabolized to alkylating agents that produce hepatic veno-occlusive disease, hepatomegaly, and cirrhosis. These herbal products include heliotrope, gordolobo, and comfrey, and are used to make teas. Toxicity can affect the fetus as well. Pennyroyal oil teas have been mistaken for other mint teas. These teas contain the hepatotoxin, pulegone, which causes hepatocellular necrosis. Pulegone toxicity can result in multisystem organ failure. Germander and Kava can cause centrilobular necrosis. In France, germander was marketed as a slimming agent in the 1990s; fatalities were reported. Chaparral (ie, creosote bush, greasewood, hediondillo) can produce periportal injury, inflammatory changes, scarring, cholangitis, and cholestasis. Renal system- Birthwort, heartwort, and fangji can cause interstitial renal fibrosis due to aristolochic acid, a known nephrotoxin. Licorice root may cause profound renal potassium loss. Hematologic system- Ginkgo biloba has been reported to increase bleeding times and may have contributed to intracranial hemorrhages. Yohimbine use has been associated with agranulocytosis. L-tryptophan has been contaminated with a by-product and associated with 38 deaths. Numerous chronic pulmonary effects are known collectively as eosinophilia-myalgia syndrome. Elevated eosinophils are characteristic of the syndrome. Other systems- Echinacea and chamomile tea can cause anaphylaxis. Royal jelly and yohimbine can cause allergic reactions. Shiitake mushrooms can cause severe dermatitis. Garlic, chamomile tea, and capsicum may produce contact dermatitis. Some herbal products contain high concentrations of heavy metals, such as lead, mercury, and arsenic (also found in kelp); they can cause heavy metal toxicity. (Use of ayurvedic medications should arouse suspicion of heavy metal contamination). Medical-Legal Concerns: The two most common pitfalls are failure to ask patients about use of herbs and herbal products and failure to report drug interactions or any herbal poisonings to the FDA for further investigation. Also, delay in diagnosis and management can lead to irreversible catastrophic conditions." Source:  American Medical Forensic Specialists

Pesticide Linked to Testicular Cancer Risk "Males exposed to a byproduct of the pesticide DDT may have an increased risk of testicular cancer, according to research published online in the Journal of the National Cancer Institute April 29. Blood levels of DDE, the main persistent metabolic product of DDT, were higher in a sample of American men with testicular germ cell tumors (TGCT) than in other men. This relatively rare cancer is often treatable, especially when detected early. The U.S. banned DDT in 1973, but the pesticide continues to be used elsewhere. The chemical and its metabolites are stored in fat tissue and can accumulate, for instance, in humans and in fish. "While levels have declined in the population since the 1970s, DDE remains detectable in the majority of Americans," said lead investigator Dr. Katherine A. McGlynn of NCI's Division of Cancer Epidemiology and Genetics. "This study suggests that chemicals that persist in the environment may have effects years after their usage ceases. A link between pesticides and testicular cancer was proposed decades ago, but testing the hypothesis has been a challenge because the disease is rare. The researchers studied 739 U.S. servicemen with TGCT and 915 healthy men who had provided blood samples to the Department of Defense, on average, 14 years before the current analysis. The men in the group with the highest blood levels of DDE were 1.7 times more likely to develop TGCT than men with the lowest concentrations. If the risk estimates are correct, then DDT exposure could account for 15 percent of TGCT cases in the study. DDT belongs to a family of organochlorine pesticides that may disrupt the body's endocrine system. "Because evidence suggests that TGCT is initiated in very early life, it is possible that exposure to these [pesticides] during fetal life or via breast feeding may increase the risk of TGCT in young men," the researchers write." Source:  The National Cancer Institute FDA MedWatch- Enbrel- Prescribing Information Revised To Include A Boxed Warning Regarding The Risk Of Infection, Including Tuberculosis‏ "ENBREL® is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis" Source: The Internet Rx Drug List "Amgen and Wyeth Pharmaceuticals informed healthcare professionals of revisions to prescribing information for Enbrel. The revisions include a BOXED WARNING about infections, including serious infections leading to hospitalization or death that have been observed in patients treated with Enbrel. Infections have included bacterial sepsis and tuberculosis. The ADVERSE REACTIONS section of the label was updated to include information regarding global clinical studies and the rate of occurrence of tuberculosis in patients treated with Enbrel. Healthcare professionals should screen patients for latent tuberculosis infection before beginning Enbrel. Patients should be educated about the symptoms of infection and closely monitored for signs and symptoms of infection during and after treatment with the drug. Patients who develop an infection should be evaluated for appropriate antimicrobial treatment and, in patients who develop a serious infection, Enbrel should be discontinued." Source:  The Food and Drug Administration   Stroke Symptoms in Women: Know the Unique Warning Signs Recognizing stroke symptoms, and getting quick diagnosis and treatment could mean the difference between life and death or permanent disability. But often, a woman's stroke symptoms don't fit the textbook signs causing delays in treatment.

Women having a stroke are more likely to delay seeking treatment than their male counterparts. Classic stroke symptoms: Know the classic stroke symptoms: Sudden numbness, weakness, or paralysis of your face, arm or leg — usually on one side of your body Sudden difficulty speaking or understanding speech (aphasia) Sudden blurred, double or decreased vision Sudden dizziness, loss of balance or loss of coordination A sudden, severe "bolt out of the blue" headache or an unusual headache, which may be accompanied by a stiff neck, facial pain, pain between your eyes, vomiting or altered consciousness Confusion, or problems with memory, spatial orientation or perception Stroke symptoms in women The new research study shows that women may have traditional symptoms less often than men do, and they may be more likely to experience and report an alternative symptom first. This discrepancy may cause women to delay seeking help. A woman coming into the emergency department with facial weakness is quickly sent off for brain imaging, but when the main complaint is shortness of breath or fainting, it may be that neither the woman nor even emergency room personnel immediately suspect a stroke.   In addition to or instead of the traditional stroke signs, a woman may have: Loss of consciousness or fainting Shortness of breath Falls or accidents Sudden pain in the face, chest, arms or legs Seizure Sudden hiccups Sudden nausea Sudden tiredness Sudden pounding or racing heartbeat (palpitations) While this new research is important, the traditional stroke warning signs are still the most common symptoms of stroke. The new findings are a helpful reminder — to both you and your doctor — that women may have different symptoms. Know the warning signs: If you suspect that you or someone else is having a stroke, don't hesitate. Rapid diagnosis and treatment improve your chances of survival and decrease your risk of permanent disability. To help you remember the classic symptoms what to look for, think FAST: face, arms, speech and time. Face — Does one side of the face drop when asked to smile? Arms — When raising both arms, does one arm drift downward? Speech — When trying to repeat a simple sentence, are the words slurred or incorrect? Time — Rush to emergency care immediately to get evaluated and treated. As more research is done on women and stroke, primary care nurses and doctors are becoming more familiar with the stroke symptoms and signs that are unique to women. If you're at risk of a stroke, your best defense is to know both the classic signs and symptoms and those that are unique to women. If you have any symptoms you worry might be a stroke, ask your doctor to evaluate you for a stroke. Source:  The Mayo Clinic How Much Water Do Your Need Daily? "Every day you lose water through your breath, perspiration, urine and bowel movements. For your body to function properly, you must replenish its water supply by consuming beverages and foods that contain water. Several approaches attempt to approximate water needs for the average, healthy adult living in a temperate climate. Replacement approach. The average urine output for adults is about 1.5 liters (6.3 cups) a day. You lose close to an additional liter of water a day through breathing, sweating and bowel movements. Food usually accounts for 20 percent of your total fluid intake, so if you consume 2 liters of water or other beverages a day (a little more than 8 cups) along with your normal diet, you will typically replace the lost fluids."

"Eight 8-ounce glasses of water a day. Another approach to water intake is the "8 x 8 rule" — drink eight 8-ounce glasses of water a day (about 1.9 liters). The rule could also be stated, "drink eight 8-ounce glasses of fluid a day," as all fluids count toward the daily total. Though the approach isn't supported by scientific evidence, many people use this basic rule as a guideline for how much water and other fluids to drink. Dietary recommendations. The Institute of Medicine advises that men consume roughly 3 liters (about 13 cups) of total beverages a day and women consume 2.2 liters (about 9 cups) of total beverages a day. Even apart from the above approaches, if you drink enough fluid so that you rarely feel thirsty and produce 1.5 liters (6.3 cups) or more of colorless or slightly yellow urine a day, your fluid intake is probably adequate. Factors that influence water needs: You may need to modify your total fluid intake depending on how active you are, the climate you live in, your health status, and if you're pregnant or breast-feeding. Exercise. If you exercise or engage in any activity that makes you sweat, you need to drink extra water to compensate for the fluid loss. An extra 400 to 600 milliliters (about 1.5 to 2.5 cups) of water should suffice for short bouts of exercise, but intense exercise lasting more than an hour (for example, running a marathon) requires more fluid intake. How much additional fluid you need depends on how much you sweat during exercise, the duration of your exercise and the type of activity you're engaged in. During long bouts of intense exercise, it's best to use a sports drink that contains sodium, as this will help replace sodium lost in sweat and reduce the chances of developing hyponatremia, which can be life-threatening. Also, continue to replace fluids after you're finished exercising. Environment. Hot or humid weather can make you sweat and requires additional intake of fluid. Heated indoor air also can cause your skin to lose moisture during wintertime. Further, altitudes greater than 8,200 feet (2,500 meters) may trigger increased urination and more rapid breathing, which use up more of your fluid reserves. Illnesses or health conditions. Signs of illnesses, such as fever, vomiting and diarrhea, cause your body to lose additional fluids. In these cases you should drink more water and may even need oral rehydration solutions, such as Gatorade, Powerade or CeraLyte. Also, you may need increased fluid intake if you develop certain conditions, including bladder infections or urinary tract stones. On the other hand, some conditions such as heart failure and some types of kidney, liver and adrenal diseases may impair excretion of water and even require that you limit your fluid intake. Pregnancy or breast-feeding. Women who are expecting or breast-feeding need additional fluids to stay hydrated. Large amounts of fluid are used especially when nursing. The Institute of Medicine recommends that pregnant women drink 2.3 liters (about 10 cups) of fluids daily and women who breast-feed consume 3.1 liters (about 13 cups) of fluids a day. Beyond the tap: Other sources of water Although it's a great idea to keep water within reach at all times, you don't need to rely only on what you drink to satisfy your fluid needs. What you eat also provides a significant portion of your fluid needs. On average, food provides about 20 percent of total water intake, while the remaining 80 percent comes from water and beverages of all kinds. For example, many fruits and vegetables, such as watermelon and tomatoes, are 90 percent to 100 percent water by weight. Beverages such as milk and juice also are composed mostly of water. Even beer, wine and caffeinated beverages — such as coffee, tea or soda — can contribute, but these should not be a major portion of your daily total fluid intake. Water is one of your best bets because it's calorie-free, inexpensive and readily available. Staying safely hydrated It's generally not a good idea to use thirst alone as a guide for when to drink. By the time you become thirsty, it's possible to already be slightly dehydrated. Further, be aware that as you get older your body is less able to sense dehydration and send your brain signals of thirst. Excessive thirst and increased urination can be signs of a more serious medical condition. Talk to your doctor if you experience either. To ward off dehydration and make sure your body has the fluids it needs, make water your beverage of choice. Nearly every healthy adult can consider the following: Drink a glass of water with each meal and between each meal. Hydrate before, during and after exercise. Substitute sparkling water for alcoholic drinks at social gatherings. If you drink water from a bottle, thoroughly clean or replace the bottle often. Though uncommon, it is possible to drink too much water. When your kidneys are unable to excrete the excess water, the electrolyte (mineral) content of the blood is diluted, resulting in low sodium levels in the blood, a condition called hyponatremia. Endurance athletes, such as marathon runners, who drink large amounts of water are at higher risk of hyponatremia. In general, though, drinking too much water is rare in healthy adults who consume an average American diet. If you're concerned about your fluid intake, check with your doctor or a registered dietitian. He or she can help you determine the amount of water that's best for you." Source:  The Mayo Clinic