Archive for April, 2015

The Ticks Are Coming

Last week my husband Charlie saw a spider on the dining room floor, so he stepped on it but it wouldn’t smash. Stamping his foot on it had no effect. Getting down on his knees for a better look, he yelled to me, “Honey, there’s a TICK on the dining room floor. Must have come in on one of the dogs”.

For us in the Northwest, our winter weather ended up going east, giving the good folks in the Midwest and the East Coast OUR winter right on top of theirs. If ticks are already out and about it’s going to be a tick-fest this summer.

Ticks carry diseases in their saliva, which can infect their victim. In the Pacific Northwest we are likely to encounter 3 species of ticks that can transmit disease to humans. The Brown dog tick and the Rocky Mountain wood tick can transmit Rocky Mountain spotted fever, while along the Pacific Coast the Western blacklegged tick carries Lyme disease.

The best way to remove a tick from yourself or your pet is to see it BEFORE it latches on and brush it off. Wearing light colored clothing helps you see them more easily. Wearing long sleeved shirts and tucking your pants into your boots keeps their access to your skin limited.

When you get home from an outing where you are exposed to ticks (tall grass, or woodsy, brushy areas) shower within 2 hours to get the best chance of rinsing them off or finding them before they get dug in. We check our 3 Scottish Terriers and each other frequently during the summer months, looking for new “freckles” or bumps. You can’t be too careful with Lyme disease and Rocky Mountain spotted fever out there.

The next best way to remove a tick is to take fine-pointed tweezers and grab the tick as close to your skin as possible. Pull upward nice and STEADY, up, up UP. Avoid tugging or jerking the tick, which can cause tick body parts to break off and get left inside the bitten human or pet.

Having removed many a tick, over the years I have tried nearly every method (sane or insane) to get them to detach themselves QUICKLY so I don’t have to grab and patiently puuuuull them out. I’ve tried verbal threats (“Don’t make me get my tweezers and GRAB you!”), which had absolutely no effect. I’ve heard of people using lit matches (“Hold STILL for heaven’s sake, or I’m going to set your hair on fire!”). DON’T use Vaseline®, as it makes that tick so darn slippery your tweezers can’t get a grip. Forget nail polish. It makes it hard to grab that little guy, and then Heaven help you if you haven’t got polish remover close by.

Which brings me to the mystery of liquid dish soap to remove a tick. Reading about it on the Internet, my friend Denise and I thought, “Hmm, sounds like it COULD be useful someday…” We gave it a lukewarm thumbs-up, to be tucked away with other someday-possibly-useful bits of information like 48 ways to reuse fabric softener dryer sheets.

Then one summer when my 3 Scottish Terriers went to stay at Denise’s house, she found a tick –a TICK FOR HEAVEN SAKE- on my 6 year-old Scottie Jamie. Jamie was a gentle soul whose nickname was Spook because he was black, hated loud noises and liked to lurk under kitchen chairs. Denise decided to try out the dish soap trick.

After she put a dab of liquid Dawn on Jamie’s neck where the tick sat, to her amazement it immediately began a frantic backstroke and within moments was OUT, completely out. After wiping it off with a tissue, she told me that it was the EASIEST and MOST EFFECTIVE way to do that she had ever imagined. And you can clean the skin afterwards so easy, too!

I’ve used it twice since, with equally impressive results. Don’t encase the whole tick, just put a dab of the soap at the skin where the tick is attached. It makes cleaning the bite area really easy, too. I now pack liquid soap on every picnic and camping trip.

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Magnesium: An Amazing Mineral

Magnesium is an amazing mineral and micronutrient. Essential for making bone tissue, it’s also a key ingredient in the action of nerves and muscles and a critical component in many enzyme reactions in your body.

A good source of magnesium is unprocessed foods that have lots of fiber, especially dark green leafy green vegetables, whole grains, legumes, and nuts. Magnesium is also found in tofu, avocado, bananas and raisins. Although whole wheat has abundant magnesium, when processed into white flour 80% of the magnesium is lost.

Some common medicines and remedies that use also contain magnesium. When you buy a box or bag of Epsom salts, you are taking home powdered magnesium sulfate, my favorite for soaking sore feet and puncture wounds.

Many laxatives also contain some type of magnesium. If you need a little help to “move things along”, you can choose a fizzy solution of clear magnesium citrate or a milky white liquid called magnesium hydroxide, also called milk of magnesia. Magnesium is also used as antacid to neutralize excess acid in the stomach in both tablets and liquid as Maalox®, Mylanta®, and Rolaids®.

Sometimes magnesium can interfere with important prescription medicines. Coming in contact with magnesium can cripple the effectiveness of powerful antibiotics. Magnesium can attach itself to the molecules of doxycycline, ciprofloxacin and levofloxacin preventing nearly 50% of their dose from getting absorbed into your body. You should avoid taking any vitamin and mineral supplement or any laxative or and acid containing magnesium for at least two hours before and four hours after taking any of these antibiotics.

Several years ago while working as a hospital pharmacist one of our patients had severe pneumonia. Once he got better he was transferred out of the intensive care unit and onto a nursing floor but within a couple of days he relapsed, ending up back in intensive care fighting for his life. The culprit was Maalox®, a liquid antacid containing magnesium. On the nursing floor he was receiving doses of Maalox® every 2 hours along with his oral tablets of ciprofloxacin, blocking half of his antibiotic from being absorbed, which nearly killed him. Once we realized this and stopped the Maalox®, he recovered quickly.

If your magnesium is too low it may affect your ability to keep your bones strong, putting you at risk for osteoporosis. Low magnesium levels in your body can also aggravate high blood pressure and contribute to migraine headache. Magnesium deficiency magnifies the effects of calcium or potassium deficiency. That’s because you can’t fix or correct low calcium or low potassium without first correcting low levels of magnesium.

Older adults are more likely to have a low magnesium level. As we age we are less able to absorb magnesium though our stomach and our kidneys tend to increase the amount of magnesium we lose through our urine. Older adults also tend to eat less magnesium in their diet and are more likely to have chronic diseases and take medicines that interfere with magnesium absorption.

Nearly all of the magnesium in our bodies is found inside cells and tissues and over 50% is found in bone. Because less than 1% of our body’s magnesium is in our blood, it may be hard to detect not having enough magnesium.

Here are some tips to help you maintain adequate magnesium:

1. Eat foods that are high in magnesium.
The best foods for magnesium are dark green and leafy vegetables, whole grains such as whole wheat and oats, nuts, and legumes.

2. Reduce or avoid taking potent acid blocker medicines called proton pump inhibitors.
These medicines interfere with your ability to absorb magnesium. If you take a medicine like Prilosec®, Prevacid®, Nexium®, or Protonix®, you may want to taper off of them or consider changing to a less potent stomach acid remedy like ranitidine (Zantac®) or cimetidine (Tagamet®).

3. If you take magnesium as a supplement, choose a form that is most easily absorbed.
There is evidence that magnesium from magnesium oxide or magnesium sulfate is less easily absorbed than magnesium from other sources like citrate, lactate, chloride, or aspartate.

A REMINDER: If you take an antibiotic such as doxycycline, ciprofloxacin or levofloxacin be careful to take any magnesium supplements or vitamins with magnesium either one hour before or 3-4 hours after taking your antibiotic. There’s usually a small sticker on the side of the bottle to alert you to this issue.

More information about magnesium is available at

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Another Pneumonia Shot

Q: What’s this about a new pneumonia shot? Do I need another one?

Probably. If you are 65 years old or older you should get two different “pneumonia shots” but you only have to get each of them once for lifelong protection. The vaccine that’s been used in infants is now recommended to be given to older adults in addition to the older adult formulation already being given.

Although many people call it a “pneumonia shot” it doesn’t really protect you against getting pneumonia. It really protects against infections caused by a particular bacteria. This bacteria has several names, including pneumococcus, Streptococcus pneumonia or S. pneumoniae. Pneumococcus can cause life-threatening infections of the lungs, the blood and the brain both in very young and in older people. Children younger than 2 years old and adults 65 years and older are most vulnerable to serious infection by pneumococcal bacteria.

Thousands of adults are hospitalized with life-threatening pneumonia caused by pneumococcal bacteria, and 18,000 adults age 65 and older die every year from pneumococcal infections. Pneumococcal bacteria can also cause an infection of the blood, called bacteremia and meningitis, which is infection of the lining of the brain.  According to the Centers for Disease Control and Prevention (CDC) based in Atlanta, pneumococcal bacteria are responsible for 1 out of every 5 cases of meningitis in the United States and are the most common cause of bacterial meningitis in children under 5 years of age.

Meningitis from infection with S. pneumonia is very difficult to treat with antibiotics. 40% of adults over the age of 65 who contract pneumococcal meningitis will die and those who survive are often left with permanent damage to their brain and nervous system. The CDC’s Active Bacterial Core Surveillance System documented 41,000 cases of serious pneumococcal disease with 4,900 deaths during 2006, and considers it one of the most preventable causes of death in the United States.

With more than 90 strains called serotypes of pneumococcal bacteria floating around, these vaccines protect us against the strains most responsible for severe infections by targeting a polysaccharide compound unique to each.

The CDC is now recommending giving Prevnar 13 vaccine to older adults as well as young children, for two reasons. Prevnar 13 will give protection against one  serotype that’s not included in the other one. It’s also made with an extra protein, added which acts to trigger a stronger immune response, making it more effective.

The CDC recommends all adults 65 years old and older receive BOTH pneumococcal vaccines, Prevnar 13 and Pneumovax 23. Most adults need only 1 shot of each in order to achieve lifetime immunity, but not at the same time. These vaccines should be given at least 1 year apart. Medicare will pay for each one.

Do you need the “new” pneumonia shot called Prevnar 13?

1.    YES, if you are over 65 years old and have never had a pneumococcal vaccine. The CDC recommends you get the other vaccine (Pneumovax 23) too, but one year later than your first one.

2.    YES, even if you’ve already had a shot of the Pneumovax 23, as long as it was at least a year ago. If you were younger than 65 years old when you got your first pneumococcal vaccine, you may eventually need another shot of Pneumovax 23, but you need to wait at least one year after getting vaccinated with Prevnar 13 and at least 5 years after a previous dose of Pneumovax 23.

3.    YES, if you are not yet 65 years old but have a medical condition that puts you at a higher risk of getting a serious infection. Your doctor can help you decide if you should get it.

4.    Possibly, if you are a healthy adult between 50 and 65 years old. Because one dose of Prevnar 13 will cost around $180, I suggest checking with your insurance first to see if they would pay for any of it before making a final decision.

Medicare will pay for both pneumococcal vaccines regardless of which one you get first, but ONLY if you get them at least 11 months apart. More information about the pneumococcal vaccines is available at

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Bag Balm® For Canker Sores?

I am suffering from an ulcer on my tongue due to a temporary crown.  It probably would have healed by now but for having an extraction on the other side of my mouth, so I keep chewing on the side of the ulcer. I’ve tried several products without much success and I wondered if it was safe to put Bag Balm® on my tongue, which means I will inevitably swallow some of it. I know folks put it on their lips, but that isn’t quite the same of course. If Bag Balm® isn’t a good choice, what would you suggest?

There are several non-prescription remedies that can help protect the bitten area of your tongue and give it a chance to heal up. If you have already tried one of these and your tongue still has the ulcer 2 weeks later, that’s NOT normal. Please go back to your dentist or doctor and have them take a look at it.

Most of the time, having ulcers in your mouth is annoying and very uncomfortable but not serious. We don’t really know exactly why some people suffer from mouth ulcers, especially those unfortunate souls who have them frequently. Called canker sores or apthous ulcers, they show up as small but painful craters creating discomfort or a burning sensation when you eat or drink hot or spicy foods and liquids. Apthous ulcers can be caused by stress or provoked by injury, like biting the inside of your cheek, wearing braces that rub or poke, or getting carried away with enthusiasm when brushing your teeth.

The main goal of treating apthous ulcers is to protect that spot of raw tissue from exposure to the abrasion of poking at it with your tongue or bumping it while brushing or flossing your teeth, so you can eat and drink without experiencing excruciating pain. Several years ago I had several ulcers on the roof of my mouth, and whenever I took a sip of water or tried to eat anything the pain brought a flood of tears. I not only had second thoughts about eating or drinking, I had 4th or 5th thoughts.

What about using Bag Balm® on your tongue? Well, it won’t hurt you, but it probably won’t do much to protect that raw spot from the abrasion of chewing or the irritation of having hot foods or liquids in your mouth.

Do you just want to numb that spot, protect it by covering it, or numb and protect it at the same time? To numb it, the best choice is benzocaine, an effective local anesthetic that is available as both 10% and 20% concentrations. Camphor, menthol and phenol can also help decrease the discomfort, but are not as effective as benzocaine. To protect the ulcer, there are pastes and sticky films that coat the ulcerated spot. If you accidently bite it, though, THAT will still hurt!

The 2 top pharmacist-recommended products for canker sores are ones I have used personally: Orajel® Mouth Sore Gel, a pleasant flavored gel that numbs quickly, and Colgate OraBase® 20% Benzocaine, a sticky paste that numbs and protects.

Orajel® Mouth Sore Gel has 20% benzocaine for pain relief. It doesn’t taste bad; it numbs the area pretty well and doesn’t get washed away by your saliva as quickly as a liquid.
If you accidently bite the inside of your cheek and create a painful hole, I recommend using Colgate OraBase® 20% Benzocaine. You dab the thick paste on the ulcer or sore spot, and it works as a bandage to protect it while also numbing it.  Be careful to dab in on; if you swirl it, it changes to a gritty texture that feels weird.

If you are allergic to benzocaine you can try Campho-Phenique®, which contains camphor and phenol, or a plain version of Colgate OraBase® that doesn’t contain benzocaine. Whichever product you choose, if your ulcer doesn’t go away within 2 weeks see your dentist or doctor to get it looked at. Two years ago I had a canker sore that did NOT go away in 2 weeks. Instead, it ended up being the first sign of something more serious. I’m really glad I got it checked out! You can find more non-prescription products recommended by pharmacists at

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The Dark Side of Chocolate

For many of us Easter is not just a religious event but also an opportunity for coloring hard-boiled eggs and making up baskets of candy. According to the National Confectioner’s Association, in 2013 Americans spent $ 2.1 billion on Easter candy, 70% of it chocolate.

It’s traditional to hide colored eggs and chocolates in preparation for a Sunday morning Easter Egg Hunt. The toddlers wander about in the spring sunshine while older siblings and cousins dash past, seeking out the brightly colored eggs and candies lurking under bushes, hidden along hedges, tucked into tall tufts of grass and nestled behind flower pots.

Seeking out brightly colored eggs and candies is fun for the little ones and entertaining for the older adults, but chocolate bunnies and treats in Easter baskets or set out for guests can be dangerous to our pets. Chocolate smells wonderful to dogs, causing them to seek it out and eat it. Although cats are unlikely to eat enough to cause a poisoning, most dogs will readily hunt down any chocolate that they smell and consume it, even enough to cause poisoning and death.

One of the compounds found naturally in chocolate is theobromine. Theobromine is closely related to caffeine, and if enough of it were concentrated in a capsule or tablet it would have a similar effect, increasing your energy level and mental focus. Theobromine is most concentrated in the outer shell of the cacao bean, which is discarded, leaving the precious, delicious inner bean to eventually end up in Hershey® kisses, Dove® bars and Starbucks® mochas.

The danger to animals wasn’t realized until someone thought of recycling the discarded cacao bean shells by adding them to animal feed. Suddenly, baby ducks, peeps, baby goats and young calves started dying, all with similar symptoms: vomiting, diarrhea, confusion, and seizures, followed by collapse and death. The deaths were eventually traced to the feed containing recycled cacao shells. Now cacao shells are re-used in landscaping mulch.

How much chocolate is dangerous to your dog? The smaller the dog, the less it takes for them to be poisoned. Also, the darker the chocolate, the more concentrated and more dangerous it is. A small (6-ounce) bag of semi-sweet chocolate chips is enough to kill an 18-pound dog. Baking chocolate squares are particularly dark and potent, with 2 squares enough to make a 50-lb dog sick or kill a 20-lb dog. Puppies and elderly dogs are at a higher risk of serious poisoning because they seem to be more affected by theobromine in chocolate.

If chocolate is so toxic to our pets, could toddlers or small children be at risk, too? Not really, because humans are experts at detoxifying and removing theobromine. Your human body has enzymes that work rapidly to break down theobromine, and they work twice as fast as the enzymes in a dog’s body. As a result, there are no cases of humans being poisoned by theobromine by eating too much chocolate, although there are plenty of cases of stomach upset from eating too much of the sugar and fat found in most chocolate candy.

Unfortunately, dark chocolate is not the only risk for your dog when eating Easter candy. Any type of chocolate or candy with a high fat content can be a danger, along with eating “people food” scraps containing fat. Eating high fat foods is dangerous to dogs because it can trigger pancreatitis, a painful inflammation of the pancreas that can lead to severe abdominal pain and death. My father-in-law loved to give his 12-pound 2-year-old Shih Tzu, Bolly, sausage patties every morning. For Easter Sunday dinner last year they had a big ham, and he shared some of that with Bolly, too. He had just given Bolly a piece of Easter candy when he suddenly started shaking and fell to the carpet, crying. They rushed him to the emergency veterinary hospital where he died that night from pancreatitis.

As you plan your Easter celebration, watch out for those killer chocolate bunnies. There’s more information about the dangers of chocolate and high fat foods to your pet at

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