Caffeine pills vs. coffee

DEAR DR. ROACH: You advised an 81-year-old farmer who was drinking an energy drink several times a week to "stick with coffee" in order to avoid the added sugar in the energy drink. What is your opinion of getting an equivalent amount of caffeine through over-the-counter caffeine pills instead of coffee?

I am a 55-year-old woman, and except for being overweight, I am in excellent health. I exercise daily, sleep well at night and have no complaints whatsoever. I get about six or seven hours of sleep a night, and am a naturally early riser. I do not drink either tea or coffee (don't like the taste), but I have found that if I take one half of a 200-mg caffeine pill immediately on arising, it does wonders for my mood and productivity. On some days I take a second pill in the early afternoon, and rarely, a third in the evening, though never later than 6 p.m.

Is there anything wrong with this? I've found that many people who drink several cups of coffee a day seem to look askance at me because I get my caffeine a pill. – A.C.

ANSWER: Some people drink coffee for the caffeine; some people drink decaf to avoid the caffeine; most people like both the taste and the caffeine effect. You are unusual in only wanting the caffeine effect.

A 16-ounce cup of coffee at a large chain contains 330 mg of caffeine. I don't see anything wrong with taking caffeine pills the way you are. However, some people won't sleep well if they’re taking as much as you are.

DEAR DR. ROACH: I just wanted to touch base with you about my diabetes. While my weight has stayed stable around 320 pounds, my sugar numbers have been increasingly hard to keep in line. I've maxed out on the oral medications we use. My latest A1c was 6.6. The doctor says it should be under 6 and that our next step is insulin. He asked me to try to lose 50 pounds over the next six months in order to get my sugar back under control.

I agree and want it to happen. I'm counting calories and cutting out carbs, and have started walking in the morning. I know I can't run, with no discs in my bottom three vertebrae. But even walking is hard. I walk until my leg goes numb, but I don't think it will be enough, and I may not even be able to keep that up. Even walking easy makes my hip hurt and leg go numb after about 20 minutes. – S.A.

ANSWER: I am surprised by your doctor's advice, because it's very clear now (from the ACCORD study) that an A1c (a measure of average sugar levels) of 7 percent has lower overall risks than an A1c of 6 percent for someone like you.

Exercise is always good, and my first thought is water. Getting in a pool will take pressure off your back, and you should be able to swim, walk in the water or do water-exercise classes to your heart's content.

Readers: Start reaping the benefits of exercise the moment you begin. To learn more, order the booklet on Aerobics, Fitness and Abdominal Exercises by writing: Dr. Roach – No. 1301W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: What can you tell me about laser iridotomy for angle-closure glaucoma? What are the risks? What is the success rate? Any other things that would help make a decision? – J.K.

ANSWER: Glaucoma is increased pressure inside the eye. Without treatment, it damages the optic nerve and can lead to vision loss, even permanent blindness.

Angle-closure glaucoma is caused by abnormal anatomy inside the eye, where the lens blocks the pupil, "closing" the channels that allow fluid to leave the eye. In acute closed-angle glaucoma, symptoms include headache, a "halo" around lights and severe eye pain. This is an emergency, since permanent vision changes may occur within hours to days, so the surgery is done immediately.

Ophthalmologists can suspect the condition based on exam and, if confirmed, will recommend treatment to prevent this emergency. It sounds like that is what has happened in your case.

I resist making a recommendation of laser versus non-laser surgery. In my mind, you trust your surgeon to use the right technique for you. However, in this case, laser is the standard treatment. I have read effectiveness rates of 60 percent to 95 percent. Complications are uncommon but can include inflammation and "ghost" images. Repeat surgery is occasionally needed.

DEAR DR. ROACH: I read your column regarding the high cost of the shingles vaccine. I am an insurance agent who is often asked about coverage for the shingles vaccine. The Affordable Care Act does include this under preventive care for individuals 60 and over. Preventive care is covered at 100 percent for health plans that are not grandfathered. (Grandfathered health plans are plans that have been continued virtually unchanged since 2010. They are not required to comply with all aspects of ACA, so these plans might not provide this service.)

You also may be interested in knowing that, in our area, the Department of Health clinic does offer the shingles vaccine for a fee of $5 for individuals over the age of 50 who do not have it covered under a health plan. I am not aware if this is unique to our area, or if it is a widespread provision.

ANSWER: Thank you for writing. Others wrote to me that their Department of Health paid for most or all of the cost. Some said they could get the vaccine covered at a pharmacy but not at physician's offices.

Readers: Shingles questions are among the most frequently asked. The booklet on the shingles virus answers many of them. Obtain a copy by writing: Dr. Donohue – No. 1201W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. To view and order health pamphlets, visit rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. (c) 2016 North America Synd., Inc. All Rights Reserved