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The major topics of Influenza, Longevity, Magnets, Multiple Sclerosis, Muscle Relaxants, Non-Steroidal Anti-Inflammatory Drugs, Osteoporosis, Otitis Media, and Menopause are cover above.

Minor topics are covered below include Impotence, Infant Mortality, Irritable Bowel, Kidneys, Leg Pain, etc.:

Impotence: Losartan Helps: Study of 160 men for high blood pressure found 88% report some improvement in sexual functioning on the angiotensin II inhibitor losartan.

Impotence: Pelvic Floor Muscle Exercises Help Men, Too: 55 men, average age 59, who had experienced erectile dysfunction for six months or longer. The men were given five weekly sessions of pelvic floor exercises and did daily home exercises. They were assessed at three and six months. The study found that 40 percent of the men regained normal erectile function, 35 percent had improved function and 25 percent failed to show improvement. The pelvic floor exercises also resulted in dramatic improvement in the 65.5 percent of the men with erectile dysfunction who suffered dribbles of urine after urinating. Exercises done 4-5 times per day with 8 reps of 5 second holds and 8 quick contractions. Avoid straining, obesity, coughing problems. Univ of the West, Bristol, England, 7/11/03

Impotence: Exercise Helps Prevent: Health Professionals Study follow-up of 31,742 males 53-90yo, Rimm, Harvard, Annal Internal Med 8/03. Running 3 hr/wk 30% lower risk than those doing little exercise. 15-20% reduction from brisk walking 3 hr/week. 30% equivalent to adding 2-5 years to sex life.

Impotence: Very Common; Exercise Cuts in Half: age-adjusted prevalence rates of ED among men attending primary care clinics was 57.4% in Nigeria, 63.6% in Egypt, and 80.8% in Pakistan. Older age, diabetes, peptic ulcers, prostate disease, depression-related symptoms, and caffeine consumption were independently associated with increased prevalence of ED, whereas being moderately active to very active at work (hard physical labor) and during leisure time (strenuous exercise) was associated with half the prevalence of moderate-to-complete ED. Our multicultural study demonstrates that in every country studied, high proportions of men older than age 35 have some degree of ED (57-81%). Both severity and prevalence increase consistently with age. Factors associated with ED are similar, but their distribution differs across countries. International J Impotence Research (2003) 15, Suppl 1, S8-S14.

Infant Mortality: War Sanctions Said to Kill Kids: More than 3000 children have been dying every week in Iraq as a result of the decade long oil embargo that was enforced on Iraq after its invasion of Kuwait. The total increase in the number of children who have died as a result of the embargo is around 1.6 million since 1990, with year on year increases through 2003. In this period the number of major surgical operations on children has been cut more than in half; paediatric laboratory investigations have dropped by a similar proportion; and the number of low birthweight babies has increased six-fold. The report shows that the quality of health services, especially for children, declined sharply in Iraq since sanctions were enforced, in August 1990. It details how Iraq has become a nation with many health indicators that are at or below levels more traditionally associated with some of the world’s most undeveloped and poorest nations. Journal of Maternal-Fetal and Neonatal Medicine (2003;13:64-7). Saddam College of Medicine in Baghdad. Rosemary Hollis, director of the Middle East program at the Royal Institute of International Affairs, one of the world’s leading centers for the analysis of international issues, criticized the balance of the article. She said, "I don’t think it washes to put all the blame on the Iraq government or to put it all on the sanctions themselves. It is miserable combination which is the result of disastrous policy failure. "Unwittingly by setting up a sanction regime that was run through the Iraqi regime in terms of the food distribution, the UN Security Council cemented in power what had been a rather shaky government system." BMJ 3/6/03. In fact, Iraq actually stopped producing biological and chemical weapons in 1991 and destroyed their last stockpiles in 1995 thanks to the U.N. inspection process.  There is absolutely no evidence that Iraq has had no prohibited weapons of mass destruction since then.  The U.N. inspection team wanted to report this in 1975 through 1977, but the U.S. government would not allow them, since this would have lifted the embargo.

Infant Mortality: Shaken Baby Syndrome Often Not Real: In the immature brain, hypoxia both alone and in combination with infection is sufficient to activate the pathophysiological cascade which culminates in altered vascular permeability and extravasation of blood within and under the dura." Researchers examined the dura of the infants in 50 cases of perinatal death from various causes, none of them violent. In most cases, they found the same pattern of dural bleeding as in three infants known to have died from abuse. Dural bleeding, says Dr Geddes, is probably common in infants and is not normally life threatening. In most cases described as "shaken baby syndrome" the actual cause of death is brain swelling secondary to hypoxia. Even in cases where violence against the child is known to have occurred, there is little or none of the axonal damage associated with head trauma in adults. Rather the damage is concentrated in the brain stem. Neuropathology and Applied Neurobiology (2003;29:14-22)

IVF Births Increased 64% with Lactobacillus: In a study of 91 women undergoing in vitro fertilization, the conception rates in women with bacterial vaginosis, intermediate flora and normal lactobacillus flora were 30% (3/10), 39% (12/31) and 52% (26/50). Early pregnancy loss occurred in 33% (1/3), 42% (5/12) and 31% (8/26) of women. The vaginal log concentration of hydrogen peroxide-producing lactobacilli was 7.3 in women with a live birth (n = 27) and 4.9 in those with early pregnancy loss (n = 14) (p = 0.1).  The live baby rate for women with bacterial vaginosis and intermediate flora was 22% vs. 36% for normal lactobacillus flora. Univ Washington. Relationship of vaginal bacteria and inflammation with conception and early pregnancy loss following in-vitro fertilization. Eckert LO, Moore DE, Patton DL, Agnew KJ, Eschenbach DA. Infect Dis Obstet Gynecol. 2003;11(1):11-7 

Kidney Infection: Blood Cultures Not Needed: In this prospective study, the investigators collected data on 583 women with uncomplicated Acute Pyelonephritis (not diabetics or abnormal G-U tract). Only 2.4% of cases were discordant, defined as those cases in which different pathogens were isolated from urine and from blood. The discordances made no difference in treatment. Clin Infect Dis. 2003;37:1127-1130

Kidney: Proteinuria Screen Only for Higher Risk: Routine screening for urine protein is cost-effective only when limited to high-risk groups, such as those age 60 and above or those with hypertension or diabetes. If over 60, $54,000 per QALY saved. ACE Inhibitors or Angiotensin II receptor blocker therapy prevents death or progression to end-stage renal disease. Johns Hopkins, JAMA 12/17/03

Kidney: Microalbuminuria Less With Higher Carotenoid Levels: Microalbuminuria may increase the risk for cardiovascular disease. In 9,575 US adults in the Third National Health and Nutrition Examination Survey, after adjustment for age, sex, race or ethnicity, education, smoking status, cotinine concentration, physical activity, alcohol use, fruit and vegetable intake, vitamin or mineral use during the past 24 hours, body mass index, systolic blood pressure, and total cholesterol, triglyceride, glucose, insulin, and C-reactive protein concentrations, concentrations of beta-cryptoxanthin (odds ratio for quartile of highest concentration compared with quartile of lowest concentration, 0.56), lutein/zeaxanthin (OR 0.59), lycopene (OR 0.64), and total carotenoids (OR 0.54) were associated inversely with microalbuminuria. Vitamin C, vitamin E, and selenium concentrations were not significantly associated with microalbuminuria.

Kidney Stones Prevented by Dairy, Fluid, Phytate Intake: In the Harvard 96,245 nurse 8-year follow-up study, nurses in the highest quintile for calcium in the diet had a risk rate of developing kidney stones of 0.73. High fluid had a risk of 0.68, and high phytate (grains, whole grains) 0.63. Dietary factors and the risk of incident kidney stones in younger women: Nurses' Health Study II. Curhan GC, Willett WC, Knight EL, Stampfer MJ. Arch Intern Med. 2004 Apr 26;164(8):885-91

Kidney Stones: Magnesium, Potassium, Fluid Help Prevent Kidney Stones: In an average of 10 years of follow-up of 45,619 men without a history of kidney stones, there were a total of 1473 symptomatic kidney stones documented. For men under age 60, but not for those over 60, the multivariate relative risk (RR) for stone formation in the highest fifth of dietary calcium as compared with the lowest quintile was 0.69 (P = 0.01). The multivariate RR for 1000 mg or greater of vitamin C per day vs. less than 90 mg/d was 1.41 (P = 0.01). Other dietary factors showed the following multivariate RR among men in the highest quintile of intake compared with those in the lowest: magnesium, 0.71 (P = 0.01); potassium, 0.54 (P <0.001); and fluid, 0.71 (P < 0.001). Animal protein was associated with risk only in men with a body mass index <25 kg/m(2) (RR, 1.38; P = 0.03). Sodium, phosphorus, sucrose, phytate, vitamin B(6), vitamin D, and supplemental calcium were not independently associated with risk. Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. Taylor EN, Stampfer MJ, Curhan GC. Brigham and Women's Hospital-Harvard. J Am Soc Nephrol. 2004 Dec;15(12):3225-32 

Lactose Malabsorption: Live Yogurt but not Standard Yogurt Helps Lactose Malabsorption: In a study of 12 men with lactose malabsorption and 12 controls, chronic consumption of yogurt containing live bacterial cultures ameliorated the malabsorption, as evidenced by lower breath-hydrogen excretion, but increased propionate concentrations. Am J Clin Nutr. 2000 Dec;72(6):1474-9; Numerous earlier studies have found the same results.

Lactose Malabsorption: Common in Nursing Homes and Helped by Live Yogurt: In a study of 53 healthy nursing home patients, 36% were found to be lactose intolerant.  Those randomly assigned to live-culture yogurt did best, while those receiving pasteurized yogurt were intermediate, and milk drinking had the most H2 breath excretion. Effects of yogurt and fermented-then-pasteurized milk on lactose absorption in an institutionalized elderly group. Varela-Moreiras G, Antoine JM, Ruiz-Roso B, Varela G. J Am Coll Nutr. 1992 Apr;11(2):168-71

Lead Levels Lower: In a study of 60 infants and toddlers from Jersey City homes high in lead, yogurt consumption was associated with lower blood lead levels. Hygiene- and food-related behaviors associated with blood lead levels of young children from lead-contaminated homes. Freeman NC, Ettinger A, Berry M, Rhoads G. J Expo Anal Environ Epidemiol. 1997 Jan-Mar;7(1):103-18

Leg Pain: Cyclo 3 Fort Helps Chronic Venous Insufficiency: Combo of Ruscus aculeatus 150mg, hesperidin methyl chalcone 150mg and ascorbic acid 100mg. 20 DB PC studies and 5 DB comparator studies with 10246 patients found reduced lower limb pain, cramps, heaviness, paraesthesias. P Boyle. Int Angiol 2003;22:250-62. Italy.

Low Back Pain: Exercise May be No Benefit: exercises to strengthen primarily muscles of the abdomen, lower back and buttocks, including sit-ups, pelvic tilts, squats and lunges, constitute traditional forms of core conditioning. The added strength is supposed to ease strain on the back by improving posture and by giving the back more support as it bends and twists. However, the theory has never been tested rigorously. Nadler looked at NCAA Division I male and female athletes in New Jersey. In the 1998-99 season, 164 athletes did their normal training but were given no special core conditioning program and served as the comparison group for the study. In the 1999-2000 season, 236 athletes were given additional core conditioning training, and served as the experimental group. Reebok Treatment Center researcher admitted no evidence for exercise for LBP. Researchers compared the incidence of low back pain complaints. Compuserv 1/20/02

Lungs: Lung Function Helped by Apples & Vit E: A study of 2500 Welshman found 5 apples/wk (138ml) and Vit E (39ml more lung function on FEV1) assoc with maintaining lung function in normal middle-aged men. Butland BK, Fehily AM, Elwood PC Thorax 2000 Feb;55(2):102-108

Lupus: Sat Fats Bad: Aggravating substances appear to include excess calories, excess protein, high fat (especially saturated and omega-6 polyunsaturated fatty acids), zinc, iron, and L-canavanine found in alfalfa tablets. Possible beneficial dietary compounds include vitamin E, vitamin A (beta-carotene), selenium, fish oils (omega-3 polyunsaturated fatty acids), evening primrose oil, flaxseed, a plant herb (Tripterygium wilfordii), dehydroepiandrosterone, and calcium plus vitamin D (if taking corticosteroids). Summary of research. AC Brown, U Hawaii, J Ren Nutr 2000 Oct;10(4):170-83

Lupus: Cyclophosphamide Helps Severe Cases:14 patients with lupus underwent four days of high-dose intravenous cyclophosphamide. All had failed to respond to standard disease therapies and endured significant organ failure. After an average follow-up of more than two and a half years, five patients had complete responses and three of those patients have remained disease-free after completely discontinuing treatment. Six patients achieved a partial response and take lower doses of previously ineffective immune-suppressing drugs. Two patients did not respond to the therapy, and one patient had some response but developed new renal disease. Johns Hopkins, Arthritis & Rheumatism 1/9/03

Lupus: Fish Oil Helps Lupus: In a 24-week DB PC study of 52 systemic lupus erythematosus (SLE) patients, one group received 3 g MaxEPA fish oil and 3 mg copper, another 3 g MaxEPA and placebo copper, another 3 mg copper and placebo fish oil, and the fourth group received both placebo capsules. There was a significant decline in the lupus activity SLAM-R score from 6.12 to 4.69 (p < 0.05) in those subjects taking fish oil compared to placebo. No significant effect on SLAM-R was observed in subjects taking copper. The clinical effect of dietary supplementation with omega-3 fish oils and/or copper in systemic lupus erythematosus. Duffy EM, Meenagh GK, McMillan SA, Strain JJ, Hannigan BM, Bell AL. University of Ulster, UK. J Rheumatol. 2004 Aug;31(8):1551-6

Lupus: Fish Oil Helps: DB cross over of low fat, high fish oil diet 27 pt with active SLE. 20 g/d MaxEPA capsules or 20g olive oil placebo with standard low fat diet. 34 weeks completed by 17, 14 of whom were on MaxEPA achieved benefit. 13 on placebo had no benefit or were worse. AJ Walton, Annals Rheu Disease (England) 7/91;50:463-6.

Lupus: Fish Oil Helps SLE Mice: Fish oil vs. corn oil for 10% of diet. Corn oil shortened life span to 267 days and fish oil increased life span to 402 days. At 6.5 mo found increased proliferation response to T cell mitogens including bacterial superantigense and decreased anti-ds DNA Ab titers in fish oil group. Splenocytes of fish oil group had favorable changes. G Fernades, J Immunology (US) 6/15/94;152:5979-87.

Lupus: Kills 1000 American per Year: African-Americans die from Lupus at a rate of 137/10 million annually vs. European-Americans at 10/10 million. Women are 5-6 times more likely to die. 16,000 contract the disease each year. CDC. Atlanta AP 5/3/02

Lyme Disease: Rx Bites 2 Doses Doxycycline: NEJM 6/12/01 NY Med College found 482 with deer tick study of Rx within 72 hours that 3% those given placebos got the disease. Blood filled nymphal worst. Unfed they are size of a poppy seed and active May to July.

Mad Cow Disease: Chronic Wasting Disease in Deer Linked to 3 Human Deaths: 2 Wisconsin friends died of Jacob-Creutfeld in 1993 and a 3rd friend of Pick’s Disease in 1999. All had eaten deer repeatedly when together. Only 4-5 cases J-C diagnosed annually in Wisconsin. Wausau AP 7/31/02.

Malaria: Rx of Choice: 11/27/00 Med Letter says for chloroquine-resistant malaria new fixed-dose atovaquone/proguanil (Malarone) great for oral prophylaxis (daily) and Rx P. falciparum and others. Atovaquone also used for Pneumocystis carinii pneumonia and babesiosis. Cost for 14-day Rx $$$103 vs. $63 for Mefloquine (Larium)(preferred) 250mg QWk vs. $4 for doxycycline 100mg/d.

Malaria: GM-Modified Mosquitos May be Answer: Nature 5/23/02

Malaria: Azithromycin Dramatically Increases Effectiveness of Chloroquine: DB PC in India found either only 32% effective but combo with 96% effective within 28 days. 6/23/03, Nwaka, Pfiaer

Massage at Home Did Not Help Bed-ridden Elderly: In a random assignment study of 53 bed-ridden elderly over age 64 with no dementia, home massage rehabilitation therapy for 30 minutes by a massage practitioner 2 or 3 days a week for three consecutive months made no statistical difference between the intergroup changes over time in Barthel Index, Subjective Satisfaction and Refreshment Scale, Apathy Scale or Self-rating Depression Score (p = 0.35, 0.08, 0.70 and 0.55, respectively). Effects of home massage rehabilitation therapy for the bed-ridden elderly: a pilot trial with a three-month follow-up. Hirakawa Y, Masuda Y, et al. Nagoya University, Aichi, Japan. Clin Rehabil. 2005 Jan;19(1):20-7.

Memory Forms in Three Steps: Research from Harvard in Nature, October 9, 2003, Matthew Walker reports from a study of 100 normal adults that motor skills memories form in three stages. A memory to be stabilized – and therefore become less vulnerable to competing information – it requires somewhere in the region of six waking hours, a memory needs several hours to be saved. The second stage of memory processing occurs during sleep. Study subjects who were tested 24 hours after their finger-tapping lesson – and following a night's sleep – were found to have improved or enhanced memory from the previous day. This stage of memory would be comparable to an editor coming in and opening a stable but messy file, and reorganizing it, refining it and tightening it up. Sleep is beneficial to the learning process. The final stage of memory is the "recall phase," which allows a previously stabilized memory to be modified. After the memory had been stabilized [after several waking hours] and enhanced [after a night's sleep] it once again became pliable so that it could be altered in the context of new ongoing experiences

Menarche: High Fiber, Canola, Olive Oil Delay Menarche, Reduce Breast CA: risk of early menarche for > 25 g/d dietary fiber half that of < 18 g, Malcolm Koo, U Toronto. 637 pre-menstrual girls in Ontario 6-14yo. menarche 8.5-15.6yo median 13.6yo. Estrogen binds with fiber. Higher fiber diets may expel more estrogen which correlates with later onset of menarche. Higher amounts of monounsaturated fats in their diet (such as olive and canola oil) also experience later onset of menarche. Early menarche <13yo correlates to a 10-15% higher risk of breast cancer, menstruating longer have increased breast tissue exposure to estrogen. Public Health Nutrition 5/30/02 

Menstruation: Blood Loss in Women: Modern women have more periods due to fewer pregnancies and much less breast feeding. Only old world apes and humans menstruate. No other mammals do. Apes have same heme and ferritin levels in males and females. Lower levels in modern females may be pathological. Heme manufactured in mitochondria. Says lower IQ in ten females due to iron deficiency. Also hair loss, decrease work ability, susceptibility to infection. Claims iron deficiency a major problem. BMJ 6/2/01 p1355

Menstruation: Dysmenorrhea: Vitamin K Used in China: This unscientific report claims benefit for primary dysmenorrhea in women ages 14-25. MedGenMed. 2004 Dec 27;6(4):45. 

Mental Illness: Higher for Low SES: Study of 10108 UK found RR 1.4 of neurotic disease in those with no car compared to those with access to 2 cars and 1.3 for those renting. Lowest neurotic in men in SES Class I 6% but Class II to V little difference at 12-13%. Women in Class I & II 15%, Class III 19%, Class IV & V 23%. Lancet 8/22/98

Metabolic Syndrome: Metabolic Syndrome Very Common: Diagnose if any three or more: waist measuring at least 40 inches for men, 35 inches for women; triglycerides at least 150 mg/dl; HDL levels of less than 40 mgs in men and less than 50 mgs in women; blood pressure of at least 135/80; and blood sugar of at least 110 mgs. CDC team used the definition to analyze data from a nationally representative sample of 8,814 in a 1988-94 health survey. 22 percent of U.S. adults have the syndrome, 6.7% among those in their 20s to 43.5% in their 60s. JAMA 1/16/02

Migraines: Riboflavin High Dose Helped: DB PC 3 months 400mg/d. Mitochondrial dysfunction from impaired osygen metabolism may cause migraines and B-2 may augment mitochondrial activity. 55 pt with >1 yr history of migraines and 2-8 attacks/months. Decreased after first month with 56% decrease in final month vs. 19% placebo. No benefit on severity. Effectiveness of high-dose riboflavin in migraine prophylaxis: a randomized controlled trial. Neuro 98;50:466-70. Univ Liege

Minimum Wage $6.70 in Britain vs. $5.35 in U.S.; A Health Issue: When you here that the U.S. is the greatest and richest country in the world, you have to wonder.  The American poor working person is seriously exploited.  In early February, 2004, the Senate Republicans defeated Democrat efforts to increase the U.S. minimum wage to even $6.35.  While Minnesota Republican Sen. Rod Grams claimed that Republicans had to keep the minimum wage low because any increase could cause unemployment "that hurts the low-income workers the hardest," the minimum wage hasn't increased since the 1980s!  Of course, the wages of government workers, the U.S. Congress, and the president have steadily increased year after year and that they claim that doesn't hurt the economy.  Thanks to Bush, the extremely wealthy in America no longer have to pay any taxes at all.  Their billions of dollars in annual stock dividends are now totally tax free and they can pass on their growing riches to their children tax-free, too.  Is this a great country or what!  In England, there is a campaign supported by the British Medical Association to raise the British minimum wage since it too hasn't gone up in five years. Brit Med J  2/14/2004;328:366. Many of my patients are suffering due to receiving very low wages. If the U.S. minimum wage had kept up with inflation since 1954, it would now be over $8!  It should be at least $8/hour. Fewer wars, reasonable taxes on the rich, and a little more for the poor worker. 

Monosodium Glutamate: Chinese Restaurant Syndrome symptoms are a sign of B6 deficiency and relieved with B6 supplementation in DB study. Folkers, Hoppe Seylers Z Physiol Chem 3/84;365:405

Muscle Pain (Chronic) Linked to Vitamin D in Minnesota: All 150 patients screened with persistent, nonspecific musculoskeletal pain had unrecognized and untreated severe hypovitaminosis D. This risk extended to those considered at low risk for vitamin D deficiency: nonelderly, nonhousebound, or nonimmigrant persons of either sex. Nonimmigrant women of childbearing age with such pain appear to be at greatest risk for misdiagnosis or delayed diagnosis. Because osteomalacia is a known cause of persistent, nonspecific musculoskeletal pain, screen all outpatients with such pain for hypovitaminosis D. U Minn. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Plotnikoff GA, Quigley JM. Mayo Clin Proc. 2003 Dec;78(12):1463-70\

Myopia: Due to Genes and Reading: combination of genetic predisposition and visual experience, such as extensive near work, may lead to abnormal growth of the eye, resulting in myopia. The latest therapeutic interventions are discussed, but he suggests that, until they are fully developed, refractive errors should continue to be corrected accurately as overcorrecting may induce more myopia.

Nursing Home: Government Benefits: It pays in full for the first 20 days in a skilled nursing facility after a hospital stay of at least three days, but after that the Medicare beneficiary pays $99 (£68; €105) a day for days 21-100, and all costs beyond the 100th day in the benefit period. Thus for a maximum 100 day stay in a skilled nursing facility, the beneficiary would pay a total of $7920. Some help for elderly people in long term care comes from Medicaid, the cooperative federal-state program designed to provide assistance to low income Americans needing long term care in nursing or hospice facilities, or through home health care. The General Accounting Office of Congress estimated the average cost of nursing home care to be $55 000 a year in 2000. As the major funding source for long term care, Medicaid covers nearly 52% of nursing facility bills. To qualify for Medicaid, middle and upper income families must divest themselves of most of their assets. From 21 July 2000, a spouse at home could keep a maximum of $84,120 in assets and $1,383 in monthly income, before his or her partner lost entitlement to Medicaid. In Spain, many fewer NH beds. WHO recommends 5.0/100 over age 65. Spain ranges from 3.7 in Catalonia to 1.2 in Andalusia. Only 15% of elderly live on their own.

Orthostatic Hypotension Remedy: In a large, but low quality retrospective study of 399 patients with orthostatic hypotension by the manufacturer of Korodin Herz-Kreislauf-Tropfen, a herbal drug containing D-camphor (CAS 76-22-2; 2.5 %) and a liquid extract of fresh hawthorn berries (97.3%), which has been used since many years for the treatment of orthostatic hypotension, the adjusted odds ratio for improvement was 5.6, the adjusted mean increase of the systolic blood pressure the 2-fold compared to the control group of 91 patients threated with other remedies. The difference was highly significant and did not depend on age or initial blood pressure. In the test group two adverse events were observed which had no relation to the medication. Efficacy and safety of a herbal drug containing hawthorn berries and D-camphor in hypotension and orthostatic circulatory disorders/results of a retrospective epidemiologic cohort study. Hempel B, et al. Robugen GmbH Pharmazeutische Fabrik, Esslingen-Zell. Arzneimittelforschung. 2005;55(8):443-50. Ed: While the hawthorn is available, I found no such combination available except in Germany.  Also, increasing systolic blood pressure doesn't sound good.