What is An Unstable Knee Joint?

An unstable knee joint can be the result of an injury or an underlying medical condition that causes the knee joint to give out on occasion (or all the time). Many people refer to this condition as a trick knee. this can be caused by an injured or torn knee ligament, such as a torn anterior cruciate ligament (ACL) in the knee. The condition can be treated either by wearing a knee brace or surgery.

Symptoms of an Unstable Knee Joint:

1.) Knee giving out from under you when walking or standing
2.) Pain or stiffness in the knee
3.) Cracking sound in the knee

These symptoms of the unstable knee joint can also be symptoms of other problems such as osteoarthritis or rheumatoid arthritis, although the knee giving out usually is indicative of an unstable knee joint due to an injured ligament.

How do you get an Unstable Knee Joint?

Trauma, or a sudden turn or twist to the knee can cause a ligament to give out on you. More often than not, a sports injury will do the trick, but average everyday people can also suffer these injuries in a multitude of ways.

What are the Treatment Options?

Treatment options include total rebuilding of the knee ligament or conservative treatment such as using painkillers when needed, as well as using a knee brace.

Debating the Pros and Cons of the Treatment Options

A.) Knee Surgery: Knee surgery to repair the ligament can be done, although this is an expensive operation and is not 100 percent successful. As is the case with any type of surgery, there is an element of risk, especially since the person must undergo a general anesthetic. The surgery is usually followed by rehabilitation and pain killers. Some people who undergo knee surgery develop an addiction to pain killers that are given after the surgery. (Speak with your physician about medications that you may, or will be taking.)

The positive aspect of the knee surgery is that if successful, the knee will be as good or almost as good as new. a person can resume all of their activities once the knee has completely healed. however, there is an indication that many people who have a problem with a torn ligament are more likely to undergo the same problem again.

B.) Conservative Treatment: Conservative treatment for an unstable knee joint includes wearing a knee brace that will keep the joint stable as well as taking medication for swelling. Rest can also be incorporated into the treatment. Some homeopathic doctors recommend an anti-inflammatory diet, supplements and massage for the condition. for the most part, a knee brace will work well to stabilize the joint and help reduce your pain problems this is not costly and non-invasive. with conservative treatment the risks are usually lower.

The majority of people who have an unstable knee joint opt for conservative treatment whenever possible. The pain that is present can be almost always be managed and when wearing a knee brace an unstable knee joint does not adversely impact their daily life. Nevertheless, you must always exercise caution and wear the brace properly.

If you want to take your knee stability to the next level then it is time you considered using a brace for support. they do not have to be super expensive, or awkward either. Check one out today.

• Men with version of the male Y chromosome, 50 per cent more likely to suffer from coronary artery disease
• Effect independent of traditional risk factors

by Sadie Whitelocks

Last updated at 2:14 AM on 9th February 2012

A study found fathers with a common genetic variant are at higher risk of heart disease, a danger which will be passed don to their sons

Fathers with a common genetic variant are at higher risk of heart disease and will pass the danger on to their sons, say scientists.

A study found men with a particular version of the male Y chromosome, were 50 per cent more likely to suffer from coronary artery disease (CAD), which can lead to angina, heart attacks and heart failure.

The effect was independent of traditional heart disease risk factors such as high cholesterol and high blood pressure.

It is hoped the discovery could prompt new treatments, or tests that could indicate those at particularly high risk of a heart attack.

Dr Helene Wilson, from the British Heart Foundation, which helped fund the research from the  University of Leicester applauded the findings.

She said: ‘This study shows that genetic variations on the Y chromosome – the piece of DNA that only men have – can greatly increase a man’s risk of coronary heart disease.

‘Lifestyle choices such as poor diet and smoking are major causes, but inherited factors carried in DNA are also part of the picture.

‘The next step is to identify specifically which genes are responsible and how they might increase heart attack risk.

‘This discovery could help lead to new treatments for heart disease in men, or tests that could tell men ifthey are at particularly high risk of a heart attack.

‘One of the fascinating things about the study is that it might provide a partial explanation why north-western European men have more heart attacks than their counterparts in other parts of the world.’

More than 3,000 men taking part in three heart investigations – the British Heart Foundation Family Heart Study, the West of Scotland Coronary Prevention Study, and the Cardiogenics Study – were involved in the latest study.

A son receives a single Y chromosome from their father, and unless there is a random mutation, the inherited chromosome should be identical

A DNA analysis showed that 90 per cent of the men carried one of two common versions of the Y chromosomes, called haplogroup I and haplogroup R1b1b2.

Men in haplogroup I category, representing around 20 per cent of British men, had a 50 per cent higher risk of coronary artery disease compared with other men.

It is believed that the increased risk may be linked to the chromosome’s influence on the immune system, increasing the likelihood of inflammation, which is known to be linked to artery disease.

It is thought that the increased risk of heart attack is passed on to male offspring, as a son receives a single Y chromosome from their father, and unless there is arandom mutation, the inherited chromosome should be identical.

Meanwhile females receive an X chromosome, from one of their mother’s two X chromosomes and one from their father.

Lead researcher Dr Maciej Tomaszewski, from the University of Leicester said: ‘We are very excited about these findingsas they put the Y chromosome on the map of genetic susceptibility to coronary artery disease.

‘We wish to further analyse the human Y chromosome to find specific genes and variants that drive this association.’

Coronary heart disease, which reduces the delivery of oxygenated blood to the heart muscle, typically affects more men than women and results in around 94,000 deaths in the UK each year.

The findings are published in an early online edition of The Lancet medical journal.

What is Cardiomyopathy? Cardiomyopathy is a serious disease in which the heart muscle becomes inflamed and doesn’t work as well as it should. there may be multiple causes including viral infections.

People used to assume that only the elderly had heart disease or heart attacks. That is not the case as heart disease can strike before birth and any age in life. Heart disease covers a wide range of health conditions relating to the heart and all its systems.

Cardiomyopathy is classified as primary or secondary. Primary cardiomyopathy is not given specific causes, such as high blood pressure, heart valve disease or congenital heart defects. Secondary cardiomyopathy is due to specific causes. It is often associated with diseases involving other organs plus the heart.

Dilated (congestive) Cardiomyopathy is the most common form. the heart cavity is enlarged and stretched (cardiac dilation). the heart is weak and doesn’t pump normally, with many patients developing congestive heart failure. Abnormal heart rhythms and disturbances in the heart’s electrical conduction also may occur.

Blood flows more slowly through an enlarged heart, so blood clots easily form. A blood clot that forms in an artery or the heart is called a thrombus. A clot that breaks free circulates in the bloodstream and blocks a small blood vessel is called an embolus.these clots are dangerous and can cause other systems plus their organs to become sick. for example, blood clots that form in the heart’s left side may become dislodged and carried into the body’s circulation to form cerebral emboli in the brain, renal emboli in the kidney, peripheral emboli or even coronary artery emboli.

Cardiomyopathy literally means “heart muscle disease” (The deterioration of the function of the myocardium (i.e., the actual heart muscle) for any reason). People with Cardiomyopathy are often at risk of arrhythmia and possibly sudden cardiac death (heart attack).***What Is Angina?

Angina is a symptom of Coronary Artery Disease (CAD), the most common type of heart disease. this happens when the plaque builds up in the coronary arteries. this build up of plaque is called atherosclerosis. as the plaque builds up, the coronary arteries become narrower and stiff. Blood flow to the heart is then reduced. this decreases the oxygen supply to the heart muscle.

Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood to it. It may feel like pressure or a squeezing pain in your chest. the pain may also occur in your shoulders, arms, neck, jaw, or back. It can even feel like indigestion.

There are three types of Angina and it is important to know the differences among the different types.

Stable angina is the most common and it happens when the heart is working harder than usual. With stable angina, a regular pattern will occur. after a short time, you will recognize the pattern/s, predicting when an episode can happen. the pain will disappear in a short time after a rest or if you take angina medication. Stable angina is not a heart attack but makes it more likely that you will have a heart attack in the future.

Unstable angina is a very dangerous condition that requires immediate emergency treatment. It is a sign that a heart attack could occur soon! It does not follow a pattern. It can occur without physical exertion and is not relieved by rest or medicine.

Variant angina is rare and usually occurs at rest. the pain can be severe and usually occurs between midnight and early morning. It is relieved by medicine.

Please remember not all chest pain or discomfort is angina. However, all chest pain should be checked by a doctor.

Unstable angina pectoris is a condition of the heart that is considered to be more serious than stable angina however is still less serious than if you were actually having a heart attack. Stable angina is a condition that causes pain to the chest due to a lack of oxygen reaching the heart caused by excessive physical activity and usually resolves itself with rest whereas a heart attack lasts much longer and often results in permanent damage being done to the heart.

Atherosclerosis is the name that is given to the hardening of the arteries that occurs when plaque or fat deposits accumulate inside the walls of the blood vessels. when this happens in the blood vessels that carry blood to and from the heart is known as coronary artery disease. These deposits of fat can prevent or obstruct the amount of blood that travels through these arteries causing the tissues that would ordinarily receive this blood to incur damage because of the lack of blood and thus oxygen. when this happens the heart responds by causing the pain and discomfort that we know as angina.

When these blood vessels narrow severely enough that there is not enough blood flow to keep the heart working properly even when in a resting state unstable angina pectoris is the end result. In some cases these vessels may become completely obstructed and the lack of oxygen can cause serious damage or death to the tissue of the heart.

Some known contributors that may increase the chances of developing this condition include high blood pressure or hypertension, smoking cigarettes or other tobacco products, high cholesterol levels, being of the male sex, progression of age, lack of physical activity and diabetes.

Some of the symptoms or warning signs that may indicate the presence of this condition include but are not limited to discomfort in the chest that may lead to pain that intensifies regardless of rest and is not relieved by the usual methods, nausea, vomiting, shortness of breath or difficulty breathing, sweating profusely, extreme feelings of anxiety or an overwhelming sense of dread.

In order to diagnose this condition it may be necessary for your health care provider to first obtain a complete and detailed history of your symptoms as well as conduct a physical examination.

The diagnosis generally leads to unstable angina pectoris in cases when an individual previously affected by stable angina has an increased number or intensity of pain in the chest suddenly, an individual who has not been previously diagnosed with angina of any kind begins having painful chest episodes while at rest or when an individual begins having extended periods of pain in the chest with or without previous issue of angina and shows no signs of an actual heart attack.

If you think you are showing symptoms relating to this condition you should seek medical attention promptly for a proper diagnosis in order to prevent unnecessary damage to the tissues of the heart muscle. The sooner this condition is diagnosed the better the chances that the condition can be dealt with effectively.

Many people often wonder and ask the question what does angina feel like? this question becomes very important when heart conditions are an issue however in some cases it is very difficult to determine the difference between angina and an actual heart attack.

When plaque builds up in the blood vessels causing them to narrow this causes the flow of the blood to be decreased. this causes the heart to experience a reduction of oxygen which can then lead to serious problems. when this happens it is often referred to as angina.

When an individual has an angina attack it is often described as a presence of extreme pressure in the chest in addition to sharp knife like pains. The muscle tightness caused by this often makes it difficult to breathe. Although chest pain is common during an attack such as this the pain is not always limited to the chest. many individuals also report feeling pain in areas such as the neck and shoulders in addition to that which is felt in the chest. it is also not considered unusual to feel pain in the arms, throat or jaw or even in the mouth when this happens.

When a person asks the question what does angina feel like it may be beneficial to take notice of the presence of any other symptoms that may be associated with the presence of angina. Some of these signs or symptoms may include such issues as fatigue, nausea and heartburn or indigestion.

One of the biggest differences between an angina attack and a heart attack is how long it lasts. in most cases angina attacks last only a short time and the symptoms are gradually relieved over a period of time whereas with a heart attack the symptoms become progressively worse over time.

Because the symptoms of angina attack and heart attack are similar it is very important that any chest pain be reported immediately regardless of the cause. not all chest pain indicates a heart attack but in the event that chest pain is caused by a heart attack it is vital to the outcome that this diagnosis be made as early as possible for effective treatment.

Many people who cannot answer the question what does angina feel like often feel foolish or silly when they go to the emergency room for treatment to find out that while they thought they were experiencing a heart attack it turned out to be a minor case of heartburn or even an angina attack. Any chest pain should be taken seriously and no one should ever feel silly or foolish for seeking medical treatment even if the chest pain turns out to be something minor.

Think about it from the other end of the spectrum, if you feel chest pain and assume it is something minor and don’t seek treatment and it does turn out to be an actual heart attack it could quite easily cost you your life.

Mrs Smith’s family called for an ambulance after she developed severe chest pain. She is 34 years old and has not been seen by a physician for more than 10 years. Today she has been drinking whiskey for the past several hours. when EMS arrives they find her alert and verbally abusive. She is still complaining of substernal pain without radiation. A 12 lead ECG shows ST wave elevation in the lateral leads. after refusing treatment for 20 minutes the paramedics and family finally convince her to allow transport to the local hospital.

During the transport she is given 4 baby aspirin, nitroglycerin 0.4 mg sublingual two times, oxygen via nasal cannula and an intravenous line is started. once in the emergency department another 12 lead ECG is completed, now 50 minutes after the initial 12 lead. The patient presently denies pain and the 12 lead shows normal sinus rhythm without ST wave abnormalities.

Was there an error on the initial 12 lead? Does this patient still need to go directly to a cardiovascular lab? what specific risk factors should you be aware of?

Background Prinzmetal and colleagues1 described a syndrome of ischemic pain accompanied by ST elevation that occurs at rest that is now referred to as Prinzmetal’s or "variant" angina (PVA). this population typically can tolerate exertion well without inducing chest pain.

The syndrome is generally a result of focal vasospasm in the Caucasian population and more of generalized coronary artery hyperactivity in the Japanese or Korean population2. The site of the spasm can fluctuate from one coronary artery to another3, or several at the same time. The right coronary artery is the most frequently affected vessel, followed by the left coronary artery4. Coronary spasm occurs most often between midnight to around 8 AM. The incidence of PVA is greater in the Japanese5.

PVA patients can be much younger than those with stable or unstable angina secondary to coronary artery disease (CAD). many patients share the risk factor of heavy cigarette smoking.

PVA attacks can precipitate cardiac rhythm disturbances such as AV blocks, asystole, or ventricular tachyarrhythmias. These are more frequent in populations with underlying CAD. Angina associated with CAD or ischemia frequently causes ST depression instead of elevation.

Clinical findings The key to diagnosing PVA is detection of ST segment elevation during episodes of chest pain. The ST segment elevation disappears promptly as chest pain resolves especially if administration of nitroglycerin is responsible for pain resolution. Patients with PVA may have CAD and luminal narrowing or they can have angiographically normal coronary arteries. All patients with variant angina should be examined in a cardiovascular lab (CVL) unless a contraindication is present6.

Treatment Patients should be encouraged to stop smoking. The mainstay of therapy consists of calcium channel blockers (CCB) and some patients also benefit from the addition of long acting nitrates. Acute Myocardial Infarction (AMI) is a frequent consequence for patients that have underlying multivessel disease and evidence suggests CCB therapy may reduce the risk of AMI7.

Nitrates Nitroglycerin relieves symptoms rapidly and should be used as a first line therapy. Long-acting nitrates are effective at preventing attacks, but development of tolerance may limit their long-term utility.

Calcium channel blockers CCBs are effective at preventing attacks6. More than 50 percent of patients treated become completely asymptomatic, but higher than normal doses are frequently required. Diltiazem, verapamil, amlodipine, and nifedipine are equally effective at preventing PVA attacks.

Beta blockers Beta blockers should not be used. they have a tendency of increasing the frequency and duration of attacks 8,9.

Aspirin Aspirin is not indicated for the diagnosis of PVA. Doses of 81 mg to 325 mg have been tolerated without complications, however higher doses have been shown to exacerbate coronary spasm10 (325 mg 4 times daily or greater).

Coronary artery bypass graft and CVL In patients with significant organic stenoses present where bypass surgery is indicated elimination of PVA can be very successful, but only when the anastomosis can be placed distal to the focal spasm site. Patients requiring CVL intervention or CABG may have recurring vasospasm symptoms if calcium channel blockers are not continued as new spasm sites may develop at a different location10. 

Take home points

• Nitroglycerin sublingual or intravenous is a first line medication
• ST elevation rapidly resolves as chest pain subsides
• Exercise is usually well tolerated without symptoms
• Patients with underlying CAD are at high risk for life threatening dysrhythmias

References

1) Prinzmetal M, Kennemer R, Merliss R, et al. Angina pectoris: I. A variant form of angina pectoris. am J Med 1959;27:375-388.

2) Yamagishi M, Miyatake K, Tamai J, et al. Intravascular ultrasound detection of atherosclerosis at the site of focal vasospasm in angiographically normal or minimally narrowed coronary segments. J am Coll Cardiol 1994;23:352-357.

3) Ozaki et al. Fluctuation of spastic location in patients with vasospastic angina: a quantitative angiographic study. J am Coll Cardiol (1995) vol. 26 (7) pp. 1606-14

4) Chevalier et al. Arrhythmic cardiac arrest due to isolated coronary artery spasm: long-term outcome of seven resuscitated patients. J am Coll Cardiol (1998) vol. 31 (1) pp. 57-61.

5) Lilly, L. S. (2008). Braunwald’s heart disease review and assessment. (Vol. 2, pp. 1337-1340). eighth edition, Philadelphia, W B Saunders co.

6) Fuster, V., Alexander, R. W., Hurst, J. W., & O, R. A. (2004). Hurst’s the heart. (pp. 1269-1271). eleventh edition, New York, McGraw-Hill.

7) Waters et al. Spontaneous remission is a frequent outcome of variant angina. J am Coll Cardiol (1983) vol. 2 (2) pp. 195-9.

Walling et al. Long-term prognosis of patients with variant angina. Circulation (1987) vol. 76 (5) pp. 990-7

9) Tilmant et al. Detrimental effect of propranolol in patients with coronary arterial spasm countered by combination with diltiazem. am J Cardiol (1983) vol. 52 (3) pp. 230-3

10) Shubrooks et al. Variant angina pectoris: Clinical and anatomic spectrum and results of coronary bypass surgery. am J Cardiol (1975) vol. 36 (2) pp. 142-7

"There’s nothing more powerful than an idea whose time has come", said Victor Hugo (1802-1885), recognized as the most influential French writer and poet of the 19th century. The man who brought us "Les Miserables" and "The Hunchback of Notre Dame" has been proven right on the above quote time and time again.

The idea that prescription medications can make us live longer, feel better, and even enjoy our lives more has swept the western world. Over half of Americans take at least one prescription drug each day for a chronic condition, this according to a USA TODAY report- and that report is now almost 4 years old. among seniors, over 28% of women and 22% or more of men take at least five medications on a regular (usually daily) basis. The above-mentioned report stated that a Karen Walker of Paterson, N.J., takes 18 prescription medicines daily for high blood pressure, diabetes, chronic back and shoulder pain, asthma and the painful muscle disorder fibromyalgia. Personally, I know of a number of Americans over the age of 65 who are taking 10 or more different prescribed medications every single day.

Annual spending on prescription medications grew from $559 in 1992 to $2,810 in 2010, this according to the Prime Institute for Families USA.

The data from one report showed that over the last 5 years, the retail price for the most popular brand-name drugs increased 41.5%, while the consumer price index rose only 13.3%. in a survey conducted by the federal government for its Consumer Price Index, which incidentally included the price for generic drugs as well as brand name drugs, it showed a price increase of 3.4%, which is also far above the rate of inflation for 2009.

The biggest percentage increase for a brand name drug was for Boehringer Indelheim’s incontinence drug Flomax, which increased 24.8% even though the patent for the drug expired last year. The generic version of the drug is tamsulosin. The price rose 6% in 2009 to $5.40 a day for AstraZeneca’s (AZN) Nexium. for Plavix from Bristol-Myers Squibb (BMY) the increase was 8.8% to $5.06 a day; for Prevacid from Takeda, the price rise was 7% to $5.50 per day, while 20 mg Lipitor from Pfizer (PFE) rose 4.1% to $4.03

The 10 most prescribed drugs and the 10 best-selling drugs in the U.S. read like a "Who’s Who" in the world of Big Pharmaceuticals. it is with this kind of knowledge that investors can see some opportunistic trends.

Invest in yourself and in the products you are using

For example, I take an average of two prescribed medications (plus one prescribed "medical food" called "deplin") each day. one of the medications that I use is made by a publicly-traded company French company, Sanofi-Aventis (SNY).

Sanofi engages in the discovery, development, and distribution of therapeutic solutions to "improve the lives of everyone" according to the company’s website. Sanofi offers a range of healthcare assets, including a broad-based product portfolio in prescription drugs, OTC/OTX, generics, vaccines, and animal health.

From an investment perspective, Sanofi pays a 3.7% dividend, has year-over-year quarterly earnings growth of 26%, and an operating margin of 21%. Operating margin is a measurement of what proportion of a company’s revenue is left over after paying for variable costs of production such as wages, raw materials, etc. A healthy operating margin is required for a company to be able to pay for its fixed costs, such as interest on debt.

Speaking of debt, Sanofi reports almost $25 billion in debt, and with the fact that they are headquartered in Europe, that is a significant negative. That being said, Sanofi and Novartis (NVS) the Swiss pharmaceutical giant that pays a 3.6% dividend and is selling at less than 10 times forward earnings, are being avoided by investors due to locale.

This is the kind of situation that smart investors are looking for! Profitable companies with "pipelines" filled to over-flowing with new products that are being shunned over the fact that they reside in Europe. for Pete’s sake, these are multi-billion companies with billions in cash.

Novartis has over $11 billion in "levered free cash flow" and trailing-twelve-month revenues of almost $59 billion. its dividend is well-covered and when you read the company’s web site, you see its future is very bright.

Earlier I mentioned Astrazeneca PLC (AZN). it too seems ridiculously undervalued, with a forward PE ratio of 7.5. this $62 billion market cap company is determined to create value for its shareholders. this U.K.-based "cash cow" generated $33.55 billion last year through its ongoing efforts to discover, develop, and market their prescription medicines for cardiovascular, gastrointestinal, infection, neuroscience, oncology, and respiratory and inflammation diseases worldwide.

Its products include Crestor for managing cholesterol levels; Seloken/Toprol-XL for hypertension, heart failure, and angina; Atacand for hypertension and heart failure; Nexium for acid reflux; and Synagis for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus in pediatric patients. That’s why Astrazeneca is sitting on total cash (most-recent-quarter) of $10.78 billion and pays a 3.6% dividend that I think will be increased this year.

Looking at a one-year technical chart shows some reasonable entry-price levels to consider. I’ve also considered a comparison one-year chart for Astrazeneca and Bristol-Myers so you can see the contrasts. By the way, since Astrazeneca has only a $63.2 billion market cap and an impressive prescription drug line-up and a deep enough "pipe-line" of future products, don’t count them out as a possible take-over target.

When buying "Big Pharma", look for the inconspicuous

Everyone is chasing yield these days, and the more popular names like Abbott Labs (ABT), Pfizer and Johnson & Johnson (JNJ) are looking quite extended.

Many investors are looking for takeover candidates and companies that may be sought by bigger "fish". in 2011, global healthcare deals were up 6% to $127 billion, in part because of a 43% rise in acquisitions of U.S.-based pharmaceutical companies, this according to Marc Lichtenfeld, the Associate Investment Director of The Oxford Club.

It’s a well-known fact that a number of Big Pharma companies will be losing revenue in 2012 because a significant number of patents will be expiring on some of their blockbuster drugs. for example, Lipitor, which is made by Pfizer, will now have an FDA-approved generic version that costs half as much as the brand name.

It wouldn’t surprise me to see several big pharmaceutical companies try to acquire other companies as a form of replacing the earnings lost when their mega-drugs loose their patent protections. Marc and I both agree that one of the "targets" for the Big Pharma "acquirers" is Bristol-Myers Squibb (BMY). it is still a much smaller company than its competitors like Merck (MRK), with an almost $117 billion market cap, and Pfizer, with a $168 billion market cap.

Bristol-Myers Squibb has a market cap on around $57 billion, and from an investor standpoint pays a sweet 4% dividend. The company is trading at a forward PE of nearly 17, but that’s for the very reasons mentioned in the above paragraphs. plus, Bristol-Myers Squibb has a strategy of combining the strengths of a traditional pharmaceutical company and a biotech company. in fact, the company considers itself "a global biopharmaceutical company that discovers, develops, and delivers innovative medicines that help patients prevail over serious diseases".

Bristol-Myers Squibb focuses on areas of serious unmet medical needs, such as cardiovascular disease, mental illness, cancer, HIV/AIDS, hepatitis B and C, rheumatoid arthritis, type 2 diabetes, solid organ transplantation, and Alzheimer’s disease. its global reach and integrated commercial and manufacturing capabilities, along with the advantages of flexibility, innovation and entrepreneurial business style, are the hallmarks of its success. Bristol-Myers Squibb has a very strong balance sheet, with around $7 billion in cash and a share buyback program of $3 billion. this also hints that it may be undervalued. The one-year chart is impressive as well.

Another reasonable acquirer for Bristol-Myers Squibb might be a company like GlaxoSmithKline (GSK), the U.K.-based company that together with its subsidiaries, engages in the discovery, development, manufacture, and marketing of pharmaceutical products, over the counter (OTC) medicines, and health-related consumer products worldwide.

GlaxoSmithKline offers pharmaceutical products in various therapeutic areas comprising respiratory, HIV, central nervous system, anti-bacterials, metabolic, vaccines, oncology and emesis, cardiovascular and urogenital, and dermatologicals.

With its almost 5% dividend and selling at just over 12 times forward earnings, this global giant with a market cap of $219 billion continues to lose a good deal of revenue with its diabetes drug Avandia. Avandia was shown to increase the risk of heart attack for those who use it. in the past, Avandia helped generate between $1 and $3 billion in annual sales, and in 2012 it also loses its patent. GlaxoSmithKline may want Bristol-Myers for its diabetes drug Onglyza and the fact that Bristol-Myers generates over $5 billion a year in cash, with levered free cash flow of $5.26 billion.

Look overseas for yet another pharmaceutical bonanza

I’m referring to Teva Pharmaceutical Industries (TEVA) the Israeli-based pharmaceutical company that develops, produces, and markets generic drugs (approximately 1,450); and proprietary branded pharmaceuticals in various therapeutic categories and active pharmaceutical ingredients worldwide.

This productive company just hired a former senior executive at Bristol-Myers (Dr. Jeremy Levin) as its new CEO, and he has plans to make this company a lucrative star. The Board at Teva

…conducted an extensive search process and concluded that Dr. Levin, with his recognized strategic vision and deep knowledge of the pharmaceutical industry is the right person to lead Teva going forward. he has the demonstrated track record, broad global experience, and impressive leadership skills to continue to grow Teva.

Dr. Levin has more than 25 years of experience in the global pharmaceuticals industry, leading companies and people in the creation, development and delivery of medicines. he is recognized as a leader in creating commercial and R&D alliances. he joined Bristol-Myers Squibb in 2007. he has had direct responsibility for strategy, alliances and transactions, and managed its portfolio of alliances.

It’s in the "strategy, alliance and transactions" area that Dr. Levin will help Teva increase its shareholder value and profitability as a company. although its dividend is a paltry 1.5%, shares of Teva are selling at less than 8 times forward earnings. A forward PE of 8 tells me and potential acquirers that this company is undervalued. its balance sheet reveals it has $1.12 billion in total cash and $3.81 billion in operating cash flow. its year-over-year quarterly earnings were a negative (-) 12.80%, so there’s room for improvement and upside earnings surprises in the future.

So there’s a fairly complete overview of some of the "Big Investment Opportunities" that are available right now in the Big Pharma sector. The world is becoming more dependent on their products, and the door is open for acquisitions and joint-ventures that will enrich their bottom line earnings and the price of the their shares. meantime, most of these companies pay you enough dividends to make waiting worthwhile.

This investment theme is "…an idea whose time has come".

Disclosure: I have no positions in any stocks mentioned, but may initiate a long position in AZN, BMY, TEVA over the next 72 hours.

My husband was on Lipitor for three years. one day, out of the blue, he lost his memory.

He knew his name but not the date or where he had been the day before. he was able to tell me something was going on and he felt funny. this was extremely scary.

The amnesia lasted about six hours. during that time, I took him to the hospital, where he had several expensive tests. Finally, they ruled out a stroke and sent him home.

We figured it might be the Lipitor, and he has stopped taking it. instead, he takes niacin under his doctor’s supervision.

Atorvastatin (Lipitor) and other statins such as simvastatin and rosuvastatin may sometimes trigger a reaction called transient global amnesia (TGA). this is a sudden loss of memory that may last a few hours or occasionally as long as a day.

Many readers of this column have reported similar reactions. one man was put on Crestor in an effort to get his LDL cholesterol below 80: “I started taking the drug on Friday, and on Sunday I awoke with what was diagnosed as transient global amnesia. I played golf that morning and kept asking the same questions over and over. My golfing partners and my wife decided after nine holes that I should go to the hospital. this all started at 7 a.m., and I did not get any short-term memory back until 3 p.m.”

Anyone who would like to learn more about the impact of statins on memory may be interested in our one-hour radio interview no. 523, “the dark Side of Statins.” it is available at peoplespharmacy.com.

Doctors must rule out more common causes of sudden memory loss, such as a stroke or a seizure. Although there is controversy about whether statins can cause TGA, we have received so many reports that we think there is a connection.

Earlier this year, I saw one of your articles about the use of nitroglycerin patches for osteoporosis. are there any further studies on this?

I have severe osteoporosis and have used most of the available treatments, without success. I’ll see my endocrinologist next month and would like to discuss nitroglycerin with him.

Nitroglycerin has been used to alleviate the chest pain of angina since 1879. the drug, administered as sublingual tablets, topical patches or ointment, helps blood vessels relax and dilate. Side effects include headache, dizziness, low blood pressure and changes in heart rate.

Nitric oxide activates the cells that remodel bone, and nitroglycerin is a source of nitric oxide. Animal studies have shown that nitroglycerin shows promise against osteoporosis, but few clinical studies have been done, and they gave contradictory results (Annals of Pharmacotherapy, December 2011). Ask your doctor’s opinion of this potential therapy, but don’t be surprised if he says there’s not enough evidence yet to prescribe it.

I take metoprolol for blood pressure, and lately I have had trouble with cold hands and feet. I also have joint pain and shortness of breath. Am I right to suspect the drug?

Metoprolol is a beta blocker that might well be contributing to your discomfort. You can find more details about this medicine at peoplespharmacy.com.

Never stop a beta blocker suddenly, since it could trigger heart problems. Please discuss your symptoms with your doctor.

I’ve read about people using yellow mustard to get rid of leg cramps, and my theory is that the cure is walking to the kitchen. Stretching the cramp out relieves it within a minute or two.

To test yellow mustard, try it without getting out of bed. Keep a small jar at bedside and see if a spoonful taken lying down does the trick.

We understand your skepticism, since we do not know how yellow mustard might alleviate muscle cramps.

Some have suggested it is the vinegar in the mustard, since people also have reported benefit from pickle juice. others believe that the turmeric that makes mustard yellow is responsible, since it has anti-inflammatory activity.

One reader took up your challenge: “Although I do need to stand up when the worst cramps hit, walking to the kitchen to get the mustard is not what relieves the cramps for me. I keep little packets of mustard next to my bed. if I’m bothered in the middle of the night with a cramp in my calf, I open three packets of mustard and swallow them down. within minutes, the cramps ease off.”

I develop muscle soreness on prescription statins, so my cardiologist recommended red yeast rice. he said it works like lovastatin and advised me to avoid grapefruit. why?

Grapefruit affects many medications, including statins such as lovastatin, simvastatin and atorvastatin (Lipitor). it raises blood levels and increases the risk of side effects. since red yeast rice contains statinlike compounds, your doctor is being prudent.

We are sending you our Guide to Grapefruit Interactions with answers to frequently asked questions and a list of other drugs affected by grapefruit.

Anyone who would like a copy may send $2 in check or money order with a long (No. 10), stamped (65 cents), self-addressed envelope to, Graedons’ People’s Pharmacy, no. J-91, P.O. Box 52027, Durham, NC 27717-2027. it also can be downloaded for $2 from our website, peoplespharmacy.com.

Celery seeds work to prevent gout! I am 43 and have been fighting high uric acid since my first attack eight years ago. all the things I’ve tried (from apple-cider vinegar to tart cherries and green tea) are for acute attacks. nothing worked for daily maintenance.

I drink a minimum of 100 ounces of high pH water a day and still have issues. I had a small attack this week on my right ankle.

I searched the Web and read about celery seeds on your site. within 90 minutes of chewing celery seeds, the pain was almost gone. I have noticed the trips to the bathroom have increased, as celery seed is a diuretic, but I am impressed. from now on, celery-seed extract capsules will be a regular daily supplement.

Celery seed (Apium graveolens) has a long folk history. it has been used to treat joint pain (including gout), as well as headache, anxiety and gas.

It has even been tried as an aphrodisiac. there is little scientific evidence that it would stimulate sexuality or relieve any other ailments.

Nonetheless, an expert in botanical medicine, James Duke, Ph.D., recommends celery-seed extract for gout in his book “Dr. Duke’s Essential Herbs.” he has identified compounds in this natural product that have anti-inflammatory properties. if you continue consuming celery seeds, be aware that they may interact with drugs like levothyroxine for thyroid or lithium for bipolar disorder.

Angina is a form of heart disease where the blood flow to the heart is restricted by a blockage in one or more of the arteries that carry blood into the heart. Usually, the first sign Angina is a pain in the chest, not unlike a squeezing or pressing sensation. Angina is also referred to as heart disease or coronary heart disease. Other symptoms or conditions associated with angina or more generally heart disease are a high cholesterol level, high blood pressure, smoking, diabetes, a family history of heart disease, especially early on in life and menopause in women is also a condition that can suggest or contribute to developing heart disease. as always, prevention is better than cure so let us look at how you can help prevent developing angina or heart disease. most actions we can take to prevent heart disease are those that can prevent the onset of some of the symptoms of heart disease mentioned above. Your doctor or health physician can help you with these steps which are controlling high blood pressure or a high cholesterol level. Maintain a healthy diet. A dietitian can help you with this. Developing an effective dietary or meal plan along with moderate regular exercise can help avoid angina.

Once diagnosed with heart disease there are a number of medications that your doctor may or may not prescribe depending on the severity of your condition. Some of the medicines sufferers are prescribed are beta blockers, calcium channel blockers and nitrates. Those at risk of a second heart attack are usually prescribed to take aspirin everyday. This helps thin the blood.

Bypass is a surgical procedure where a vein or artery is sewn in place around the arteries of the heart, to provide an increased blood flow to the heart. This is usually done when most other procedures are not an option, like angioplasty, which is what we will look at next. Some sufferers may need heart surgery to treat their condition, one of which is called angioplasty. A very small balloon is inserted into an artery in the leg or arm. This balloon is then pushed up to the artery around the heart where it is used to push open the blockage.

Now that we have looked at what angina and heart disease is, let us look at how you could can look out for the signs that may lead to a diagnosis of angina or heart disease. Stable angina is quite hard to diagnose as it may present it’s self when the person is being active, and it will then go away rather quickly at rest. Some of the activities that can lead to symptoms of angina are moderate participation of sport or exercise like walking, dancing, light exercise in the gym or even just climbing stairs. Some of the symptoms you may experience while being active are difficulty catching your breath, you may also have pains in your chest, arms and neck. Symptoms like these are indicative of severe angina. if the symptoms do not go away, your doctor may prescribe a medication called nitroglycerin.

So how does this lead to a heart attack?, you may well be asking at this point. when your symptoms become irregular, in that they can no longer be described as begin purely stable or severe, this is called unstable angina, and is very strong indication that you are at higher risk of a heart attack. if your symptoms do not go away after resting from activity, or after taking your medication, seek medical help immediately. Get someone to take you to hospital or at least phone your doctor, but it is better to go directly to hospital, to be examined. They may order a set of tests, one being an ECG (an abbreviation of electrocardiogram). This test will allow them to see if there is any damage to the heart or arteries around it. X-ray’s may also be taken to show whether you are getting enough blood to the heart. another test they my perform is a stress level test by monitoring you while walking on a treadmill. A test called a cardiac cauterisation can also my taken. with this test, a thin tube is inserted into a artery and pushed up to the artery close to the heart. The dye injected into the area can also show if blood flow to the heart is restricted.