I’m suffering from congenital ventricular septal defect and severe pulmonary hypertension with Eisenmenger complex. Now I have polycythemia as well. How does Viagra help in pulmonary hypertension?
Your problem is a birth defect which probably started off as a ventricular septal defect, which has progressed to a situation where the pressures on the right side of your heart are higher than that on the left side. Normally the right side pressures or PA pressure would be less than 25 mmHg. The echocardiograph findings as detailed by you would indicate a reversal of pressures which, in medical parlance, is termed Eisenmengerisation. If the echo diagnosis is accurate, surgical correction would be very risky and not advisable. Sildenfil(Viagra) functions as a phosphodieaterase inhibitor, relaxing the lining of the arterioles and has been used in cases of Pulmonary Hypertension with benefits documented. This drug has recently been approved in the US for treating PH. However it has to be prescribed by your cardiologist and started in extremely small doses. The polycythemia or increased Hemoglobin, is the body’s response to less oxygen supply due to the admixture of pure and impure blood in a condition like yours. Any treatment options can only be made after a clinical examination.
Heart lung transplants are not done on a routine basis in India due to certain practical problems. The best centers are abroad but most of them are hesitant in accepting overseas patients due to the long waiting list of local patients.

Question: Are sleeping pills harmful?
Most sleeping pills are very safe, provided they are taken in the recommended manner, but if used constantly for many weeks or months, patients may find it very difficult to stop them as they become dependent upon them. The greatest problem with the use of sleeping pills is that they are taken unnecessarily, particularly by elderly people who do not need large amounts of sleep. These pills are better taken intermittently when really needed, and they will work far more effectively.

Question: As a 77 year old, my doctor has suggested that I take 100 mg of aspirin every day to reduce my risk of having a stroke or heart attack, but I have had a stomach ulcer in the past and take Zantac every day. I was told that I should never take aspirin again because of my ulcer. What should I do?
Aspirin is a marvelous medication, and one of the oldest in current medical use, having being first marketed by a German chemist (Bayer) in 1899. It may be used to relieve pain, reduce inflammation (eg. in arthritic joints), decrease the risk of bowel cancer and reduce the ability of blood to clot.
This last use makes it suitable to reduce the risk of blood clots in the brain (stroke) or coronary arteries (heart attack), and as a result it is widely recommended by doctors to be taken regularly by all patients over 50. When used to relieve pain, aspirin is taken in doses of 600 mg (two tablets), four times a day, but when used to reduce blood clotting, only a very small dose of 75 to 100 mg a day is necessary, and strangely, higher doses may be less effective in reducing the risk of clots.
Aspirin also has side effects, most commonly resulting in stomach pain, and sometimes bleeding from the stomach, but this effect is dose dependent, and the higher the dose, the greater the risk of side effects. Low-dose aspirin is available in special formulations that reduce, but do not entirely eliminate, the risk of stomach side effects. These are marketed as Astrix, Cartia and Cardiprin, and are subsidised by the government for pensioners under the pharmaceutical benefits scheme.
It is possible that you will suffer stomach side effects from taking low dose aspirin long term, and if this occurs there is a substitute medication (Plavix), that is much more expensive than aspirin, but it does not have some of the added benefits of aspirin (eg. against bowel cancer). It is only subsidized by the government under very stringent conditions.