My way with angina victims
MEDICAL NEWS WEEKLY
Volume 12 Number 4
Thursday
January 31, 1980
My way with angina victims
ERIC TRIMMER
After trinitrin and beta-blockers, “what next for angina?" asks Dr P J B Hubner in my latest Prescribers' Journal (vol 19, no 5) and goes on to give "consideration for coronary artery surgery" as the short answer to the question.
But clearly his heart isn't in it, and it is rather nice to see someone providing, in this rather austere little journal, some helpful advice not overflavoured by the credo that so often argues that therapeutics is after all a pretty static science and all those new drugs that the reps try to sell us when trinitrin and beta-blockers fail (like Pexid, Adalat, Cordilox and Synadrin) are just pipe dreams of the pharmacological industry that should be best left on the shelf.
They often can be useful and angina patients are so pleased when you make them feet better.
Recently I've been "Doing It My Way" for angina victims by means of a bit of therapeutic nostalgia.
I mean, of course, dear old amyl nitrite. Not only does it put the local chemist in a flap but in some patients it's really effective.
Let me explain. A few weeks ago I received a book entitled Isobutyl Nitrite and Related Compounds and I would have floor filed it, hadn't I recognized the name of one of its authors - Thomas P Lowry, who is a psychiatrist at the University of California.
Of course, I don't have to tell you that the alkyl nitrites are aliphatic esters of nitrous acid and that amyl nitrite was used first of all for angina by Sir Lauder Brunton in 1867.
But did you know that butyl nitrite and isobutyl nitrite have been used extensively (in the US) as the primary ingredients of room odorizers and they have been claimed to be fantastic olfactory aphrodisiacs.
Now it may have just grazed your consciousness that from time to time some naughty people abuse drugs. In this country when this happens we put a voluntary prescribing ban on them and the shades of CURB can be seen to be falling fast.
Happily in the US when it became wide knowledge that the alkyl nitrites were being used for such wicked purposes as enhancing sexual sensations they decided to sort it out before seeing how fast they could ban these compounds.
To cut a long story short some three thousand odd emergency room specialists and over two hundred forensic pathologists were lobbied for help and statistics. Surprisingly the results were quite disarming.
A few teenagers had got nasty headaches trying to "augment" their orgasms with amyl nitrite. A few more got woozy. One "presumed death" in the Midwest after nitrite inhalation was found to be a multiple drug user.
The conclusion of my old friend Thomas Lowry is that the data suggested "mini morbidity and zero mortality associated with amyl, butyl and isobutyl usage".
One of my patients told me that since he's had his "poppers" he's been a "new man in every way, doc".
I'm beginning to realize what he is hinting at.
©1980 MEDICAL NEWS WEEKLY, London, England
