Aging Begins at 30

Swapping Pills or Diagnosing Yourself Can Be Harmful

We had a fascinating sail down the Bosporus, toasted our wonderful guides goodbye, walked across a park, and boarded the bus to take us to the Istanbul Spice Markets. There was a commotion at the back of the bus. "Dr. Smith, could you give some help here please," the guide said.

Gertrude -- I never learned her other name -- was out of it, eyes gazing askew at the roof of the bus and making little twitchy movements of her arm muscles. To my "Can you hear me?" there was a minimal response. "What is your name?" and faintly I heard "Gertrude." I quickly checked her arms and legs. She could move all four. Her cranial nerves responded. She could eye follow my finger, grin, stick out her tongue, and push my hand with her chin. She denied any chest, shoulder, or jaw pain. I noticed that she was white haired and overweight.

"What happened?" I asked when she returned to the land of the living. "When I was crossing the park I got short of breath and felt strange inside my chest." "Was it pain?" "No it wasn’t." "What happened next?" "Then I took one of my husband’s anginal chest pain nitros." There was the answer! We could not afford to miss anything so off to the hospital she went and lost two days of her vacation.

Nitroglycerin (NTG) in pure form is explosive! Used as a pill in lactose sugar and dissolved under the tongue it relaxes the smooth muscle that works without our voluntary control. NTG relaxes the tone of veins and the coronary blood vessels that nourish the heart by crowning (so corona) and draping the heart. It is absorbed most quickly through mucous membranes under the tongue. Its action reaches a peak within 3 minutes and is mostly gone in 5 to 10 minutes. For angina, rapidity of action is more important than duration.

Nitroglycerin’s fainting effect is produced by a fall in blood pressure by pooling blood in the relaxed veins. People with true anginal pain produce excess "fight or flight" (nor)adrenaline that holds up the blood pressure. She didn’t have angina, so her blood pressure dropped. NTG's effects are made worse by alcohol, (remember we drank a wine toast), by being erect, and by having high blood pressure which all fitted Gertrude to a tee. (75% of obese women over 70 have high blood pressure.) The bad effects can progress to loss of consciousness (fainting). Lowering the head will usually cure it.

Nitroglycerin is used to treat chest pain from coronary heart disease or prevent pain by taking it prior to exertion or stress. Angina patients should contact the doctor or go to the ER if three tablets at five-minute intervals don’t work. There is no virtue in trying to avoid nitroglycerin for anginal chest pain.

Being your own doctor may be attractive but as with Gertrude there can be penalties. Dr. Oliver Wendell Holmes, a famous Boston physician, found one of his patients reading a medical textbook in the library. He whispered in his ear "Prithee sir, be careful -- thou may some day die of a misprint!"

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