Archive for December, 2015

How To Deal With Bitter Pills

December 21st, 2015. Filed Under: consumer information, medicines, Taste.

Q:    Since I started a new medicine, my food doesn’t taste right. Is there anything I can do about this?

Our ability to taste foods and drinks enhances our enjoyment of socializing with special foods and savoring favorite flavors, but as we age we start to lose our ability to taste sweet and salt, and that can affect our food choices.

The worse a medicine tasted the more potent they were believed to be, leading to the phrase, “a bitter pill to swallow”. Medicines also have the power to change how our food tastes and smells, with 250 medicines documented to affect how we taste or smell.

There’s also a difference between the taste of something on your tongue, and its characteristic flavor. If you’ve ever had a bad cold or sinus infection which suppressed your sense of smell, you may have noticed that your food and drinks didn’t have their own particular flavor.

Taste is a complex process. We have several different types of cells and nerves inside our mouth and nose receiving signals from foods and drinks that come in contact with them. These signals are then carried to the brain where they are interpreted and identified. This is how we can tell the difference between the heavenly smell of a fresh baked cinnamon roll and the tang of spoiled milk.

Think about your favorite flavor of ice cream. What makes it taste so good?  You have three types of receptors working together to create that taste sensation: your taste buds, some other taste receptors found in your mouth, and smell receptors in your nostrils. Each of these handles a different type of sensation.

Found on your tongue, soft palate, and the back of your mouth where you swallow, your taste buds have 4 different types of taste receptor cells, each picking up only one type of taste: sweet, salty, sour or bitter. The other taste receptors in your mouth are not only on your tongue but all along the lining of your mouth, and these taste receptors can sense stinging, burning, cooling and sharpness. People who wear dentures report that they don’t taste food as well since they started wearing them. This is because the taste receptors on the roof of their mouth are now covered up.

What causes taste disturbance? Medications are a common culprit but they aren’t the only one. Medical conditions such as cancer, or poor oral health such as severe tooth decay, an abscessed tooth, and gingivitis can affect the ability to taste. Either radiation or chemotherapy for cancer can also change taste perception.

Medicines can alter taste in several ways, either by tasting bad or changing how you taste. Liquids come in contact with more of your taste buds than a tablet, creating a more intense taste experience. To give our new doctors-in-training an appreciation of why kids have to be coaxed into taking their medicine, my clinic hosts a Taste Test of several liquid medicines every spring. It’s appalling how awful some of them taste.

Another way medicine can affect your ability to taste is by causing your mouth to be dry. Taste and smell receptor cells need moisture to function; taste buds and other taste receptor cells are continually bathed in saliva, and mucus protects the scent receptors in your nose.

Antibiotics and cancer chemotherapy drugs top the list of drugs that can give you a “bad taste in your mouth”. Unfortunately, the drugs most commonly used to treat breast cancer are some of the worst offenders at changing taste and flavor. These drugs diffuse throughout your body, even into your saliva and mucus. That metallic taste in your mouth? When you notice a “funny” (metallic, bitter or sour) taste in your mouth, it’s because you are actually tasting the drug itself as it contacts your taste buds!

Chemotherapy agents also affect taste by destroying your taste and smell receptor cells. Chemotherapy and radiation treat cancer by attacking any rapidly dividing cells. Taste receptor cells are renewed every 10 days, and smell receptor cells are regenerated every 30 days, making them very susceptible to damage from both chemotherapy and radiation treatment.

What can you do about your funny taste in your mouth? Sugarless gum with xylitol, or sugarless lozenges can help dry mouth symptoms and chase away an unpleasant taste. Sips of water or ice chips can also help mask weird tastes. If this doesn’t help, speak up and let your doctor know about this so that you can discuss other medicine options that you could take instead.

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The Cough That Wouldn’t Quit

Every Monday afternoon I see patients in a small town clinic. Last week it was time to see Elsie, one of my favorites for her monthly check of her blood thinner medicine. She had raised 12 children, was 83 years old and a widow. Ron, one of her 6 sons had driven her to her appointment because he was concerned about her. Every time I see Elsie, I ask her the same questions. Today was no different.

“Any new medicines since I saw you last?” I asked, as I glanced at my laptop with her chart on the screen.
“Why, yes. I saw the heart doctor and he increased one of my medicines. Ron knows which one it is…” as she looked across at her son sitting in the chair to my left in our exam room.
“When was that?” I asked.

“Oh, about 2 weeks ago, now,“ replied Elsie.

“Okay, then. Is it the one that starts with an L? That’s the only other heart medicine I see here on your list of medicines. It shows here that you’ve been taking one tablet of 5mg lisinopril twice a day.”

Ron nodded, and when I asked if he knew what her dose was changed to, he handed me a folded paper that read: “Increase lisinopril 5mg to two tablets twice daily”. He then looked across the room at his mother. “Ask her what you can take for allergies.”

“Dr. Louise, can you recommend something for allergies? I’ve tried the usual stuff but nothing seems to help.”
“What kind of allergy symptoms are you having, Elsie?”
“Just a cough.”
“Are you coughing anything up?”
“Well, no. Just a dry tickle.”
“That cough keeps you up at night, Mom.”
“Well, it may not be allergies after all, Elsie. I’m really glad you said something about it.”

I sent a message to her family doctor about her new cough symptoms since the medication adjustment and it was addressed the very next day with a medication change.

A couple of hours later, I was talking with radio personality Dottie Kaufman. She told me how she had spent 3 months and over $200 seeing an allergy specialist for a dry cough that had caused big problems for her on her radio show. The specialist couldn’t help her, so she continued to put up with it. One day, she was talking to a pharmacist who connected her cough symptoms with a prescription medicine she had started right before the cough showed up. The name of the medicine was lisinopril. Within days of stopping her lisinopril, Dottie’s cough vanished and has never returned.

My father was diagnosed with diabetes at age 78, and his family doctor started him on 3 pills: one for his blood sugar, one for his cholesterol, and one to protect his kidneys. A couple of weeks later while we were talking on the phone, he asked me about them. The medicine he was taking for his kidneys was lisinopril. I asked, “Dad, have you noticed any coughing?”
“No. I feel just fine.” “That’s great, Dad! Be sure to mention it to your doctor if you notice any nagging, tickly type of cough, ok?”

Nine months later my dad had his left knee replaced and I came to stay overnight with him after his surgery so he wouldn’t have to go to a nursing facility. But he wasn’t taking lisinopril any more. Instead, he was on losartan, which is what doctors usually switch to if the lisinopril causes any side effects.

Dad did fine at his starting dose of lisinopril, but, just like Elsie, he developed a nagging cough when his doctor increased the dose. He was changed to the losartan and hasn’t had any further problems.

Lisinopril belongs to a group of drugs called ACE Inhibitors, which are all related to each other and have the word fragment –pril in their generic name, like ramapril and lisinopril. One of the most commonly prescribed drugs in America, lisinopril is given to lower blood pressure, strengthen the heart in congestive heart failure, and to reduce the potential for kidney problems in diabetes. However, it is also notorious for causing a chronic dry cough. One out of every 4 people started on an ACE Inhibitor will develop a cough similar to those described by Elsie and Dottie.

If you have just started a new medicine, speak up if you notice any unusual symptoms. There are lots more strategies for taking your medicine safely in my book, Why Dogs Can’t Eat Chocolate: How Medicine Works and How YOU Can Take it Safely.

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