Heart Beat:On waking this morning, I found the world had disappeared. A dense mist blanketed the whole area, reducing visibility to a few yards around the house. It hovered above the glistening grass in the meadow and probed smoky tendrils around the hedgerows, writes Maurice Neligan.
Muffled sounds of traffic carried across the water from the Ring of Kerry; otherwise you could imagine you were alone in the world. However, it was not so and despite my identification with Dr Johnson's words quoted by Boswell, "we would all be idle if we could", I returned from my contemplation to reality.
There was work to be done. I have graduated in retirement to being allowed prepare the breakfast. The Highest Authority reckons that I am able to pour juice and that making toast is within my limited capabilities.
She is still a little dubious about my tea- making and frequently asks in an accusatory tone, "Are you sure you warmed the pot before you added the tea?" Invariably my answer is "yes", sometimes a little too quickly. A previous inquiry from me, as to how a tea leaf would know in any case, was treated with contemptuous silence.
A man of many skills, I laid the table on the patio and watched this wonder of nature unfold. The summit of Seefin opposite broke free into the sunshine of a clear blue sky and shapes of distant houses and walls peered through the fog.
The lifting of the mist was not a continuous phenomenon. It waxed and waned and as I write it has closed once more over Rossbeigh and Glenbeigh to the west. My immediate world has been restored, however, and a beautiful sunny morning is full of birdsong. The meadow grasses sway sinuously and the swallows swoop above them, acquiring breakfast for their young.
Around us the foxgloves (digitalis purpurea) are in full bloom. This plant has great medical associations, being the original parent of the cardiac drug, digitalis. William Withering, a doctor from Shropshire, is credited with introducing this drug to the world for the treatment of heart conditions in the 1770s.
It was without doubt the most valuable cardiac drug ever discovered. It was to prove revolutionary in the treatment of "dropsy", really end-stage cardiac failure in which the patient retains large quantities of fluid with which a failing heart cannot deal.
This heart failure was often caused by cardiac valve malfunction due to previous rheumatic fever. Before Withering and his empirical use of digitalis, there was no real treatment other than bleeding and the patient often literally drowned in his own secretions. Together with the infectious diseases including tuberculosis, it was one principal cause of death at the time. Ironically Withering, who introduced the little green leaf for cardiac sufferers, died himself of tuberculosis in 1799.
It would be a long time before the active principle was isolated and the drug purified; but his initial observations that it slowed and strengthened the action of the heart was a huge step forward. The advent of diuretic drugs and their addition to a regime of digitalis led to "dropsy" being no longer a recognised condition in the developed world.
It has also proved to be one of the safest drugs ever produced. That being said, however, like almost every drug, it can have side effects ranging from the trivial to the lethal.
This line of thought developed in relation to the withdrawal from sale in Ireland of the drug nimesulide, more commonly known as Aulin. This followed several reported incidents of liver damage leading to liver transplant, and also drug-related deaths. I myself have taken Aulin and indeed prescribed it and I found it to be extremely effective and largely free of the gastric side effects of similar drugs.
It clearly states in the literature about the drug that liver toxicity is a known side effect and that it should not be prescribed in the presence of abnormal liver function and that it should be withdrawn if such dysfunction develops.
The Irish Medicines Board (IMB) has concluded that, at this time, the risk-to-benefit ratio is unacceptable and has ordered the drugs withdrawal from the market. A similar story concerned a similar drug, Vioxx, which was withdrawn by manufacturer Merck Pharma- ceuticals, because of an increased incidence of heart problems documented among users, especially those with known cardiac risk factors.
Since then committees of the FDA in America and Canadian authorities have recommended its reintroduction on a restricted basis. Many patients taking Vioxx were prepared to take the attendant risks, so effective had they found its pain-relieving qualities. I know of Irish patients who contend that they feel the same way about Aulin, having found it is more effective for them in treating the pain of arthritis.
One wonders if there could not be a regime in place to strictly monitor liver and or cardiac and renal function, in order to lessen the risks and allow them to enjoy the benefits? Such is in place for the anticoagulant Warfarin, an integral part of cardiac therapeutics, which requires regular blood tests to regulate dosage.
The IMB has a difficult task in ensuring that the medications available to us are as safe as possible, knowing full well that such safety is relative. William Withering's digitalis have killed a few patients over the years and such-like events will always happen.
Maurice Neligan is a cardiac surgeon.