QUESTION: Our dog was recently bitten by a copperhead snake. The veterinarian prescribed an antibiotic to keep the wound from becoming infected. She added an NSAID for pain.

To protect his stomach, she recommended omeprazole and a veterinary probiotic. The probiotic arrived by FedEx inside an insulated envelope with a cold pack and a temperature monitoring device. Even though it was hot out, the monitor showed that the medicine had never become too warm.

Why don’t my mail order human medicines have temperature-monitoring devices enclosed so I can verify that they did not become overheated in transit?

ANSWER: You raise a fascinating issue. If some veterinary products are shipped with temperature monitors, why not human medications? We think the Food and Drug Administration should require that all drugs shipped during the summer or winter should have such devices in the packages, even though it might cost a bit more.

QUESTION: You’ve written about the dangers of Lp(a). Doctors should absolutely test for this cardiac risk factor. Patients should insist on it.

My husband was a thin runner with low lipids and triglycerides; yet, he had a heart attack. We learned that his Lp(a) level was high.

Three cardiologists said that wasn’t important. One even said statins lower it. My husband consulted a fourth cardiologist, took niacin and lowered his level.

Lp(a) are sticky lipids, so when there is turbulence in your arteries, for whatever reason, they glue things together and cause blood clots that can block arteries.

ANSWER: There is strong evidence that Lp(a), which is also referred to as lipoprotein(a), can increase the risk for heart attacks and strokes (Biomedicines, July 2021). In addition, high levels of Lp(a) are linked to aortic valve calcification (European Heart Journal, July 23, 2022).

The cardiologist who suggested that statins lower Lp(a) was mistaken. In fact, statins raise this risk factor for heart disease (European Heart Journal, Jan. 1, 2020). This might explain why some people who eat right, exercise and even take statins could still have heart attacks.

QUESTION: In your reply to the person who is using over-the-counter Primatene Mist for asthma, I’m surprised that you didn’t mention the dangers of overuse. As a pulmonary clinical nurse specialist, I cared for several people who landed in the intensive care unit because of cardiac stimulation from this drug. Our practice never recommended its use.

ANSWER: The active ingredient in Primatene is epinephrine (adrenaline). It opens airways but also stimulates the heart.

The over-the-counter label cautions consumers that using more than directed can be dangerous to the cardiovascular system. Thank you for reinforcing that warning.

Prescription bronchodilators containing albuterol also can stimulate the heart and raise blood pressure. The official prescribing information notes that: “Fatalities have been reported with excessive use of inhaled sympathomimetic drugs in patients with asthma.”

In their column, Joe and Teresa Graedon answer letters from readers. You can email them via their website: www.PeoplesPharmacy.com.

©2022 King Features Syndicate Inc.

Care Advantage, headquartered in Richmond, has acquired Herndon-based National Home Healthcare.

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