Archive for July, 2016

Your Medicine and the Sun

It was a beautiful sunny midsummer afternoon, perfect for feeding the ducks. My seven year-old niece Crystal was staying with me, and after finishing our lunch of grilled cheese sandwiches and tomato soup, I loaded my backpack with water and a bag of old bread scraps before setting out for the duck pond at a local park.

Crystal tossed the first bread bits as far as she could. Soon the ducks swam over to gobble up the floating treats, creating squawking competition for each bit of bread. Laughing, she continued pitching the rest of the bread piece by piece into the quacking crowd. Once the bread was gone we headed for the swings, pumping our legs to carry us higher and higher into the cloudless sky.

“Aunt Louise, I feel hot. ”

“Let’s head for that big tree over there, and I’ll get you some water.”

Opening my pack, I fished out a water bottle and turned around to offer it to Crystal, nearly dropping it in shock when I saw her flaming red cheeks and arms. Heading back home, I kept thinking, “She had sunscreen on, so how could she have burned so quickly?”

Once we got home, I zipped into the kitchen to get a damp towel for Crystal’s face. Sitting right next to the sink was her prescription bottle of antibiotic. I’d given Crystal her morning dose right after breakfast and then left it out on the counter to remind me to give her next dose at dinner. Could her medicine have caused her to burn even through her sunscreen?

When my brother had dropped Crystal off the day before I had focused on the dosing instructions printed on the label of her bottle but overlooked the small yellow sticker over on the side that warned about exposure to sunlight. Luckily, her “burn” faded by dinnertime, but I’ve never forgotten how scared I felt.

Exposing our skin to sunshine causes our skin to react, either by “tanning” or “burning”. Sunlight contains ultraviolet radiation; there are wavelengths called UVA and UVB that can trigger skin reactions like rash, itching and even exaggerated sunburn. These effects are called photosensitivity reactions.

Sunburn, skin cancer and accelerated skin changes such as wrinkles and spots called photo aging are caused mostly from exposure to UVB radiation. UVB rays are most intense between 10 in the morning and 4 pm, and help our skin produce Vitamin D. UVA radiation triggers photosensitivity reactions in people taking certain medicines, like Crystal. Normal sunlight has approximately 20 times as much UVA radiation as UVB. Because UVB radiation causes more sunburn, 96% of the rays from tanning beds are UVA wavelengths.

Crystal’s antibiotic increased the sensitivity of her skin to the UVA wavelengths in the sunshine we played in that July afternoon. Back then; the sunscreen she wore protected her against UVB rays, which can cause sunburn, but not against UVA wavelengths, which can trigger photosensitivity skin reactions. Today’s sunscreen products are formulated to protect against BOTH UVA and UVB radiation.

The measure of how much protection a sunscreen product gives is called its SPF (Sun Protection Factor). The bigger the SPF number, the better the protection. For example, if you properly apply a sunscreen with an SPF of 15, you could stay out in the sun 15 times as long without burning as you could without it.

Sunscreens come in two main types: chemical and physical. Chemical sunscreens work by absorbing specific wavelengths of UV radiation before they penetrate your skin, while physical sunscreens reflect and scatter UVA and UVB radiation. The lighter your skin, the more quickly it can burn and the more protection you need.

4 Tips for Taking Medicines That Can Cause Sun Sensitivity:

  1. AVOID tanning beds or going outside into direct sunlight until you finish the medicine. When going outside during the day, cover up with long sleeves and a hat with a brim at least 4 inches wide, or apply sunscreen with UVA and UVB protection.
  2. Apply sunscreen at least 15 minutes before you expect to be outside in the sun. To be most effective, sunscreens need time to bind to your skin.
  3. Don’t skimp when applying sunscreen. The FDA estimates an adult in a swimsuit should use about 4 and 1/2 teaspoonfuls when applying sunscreen to their whole body.
  4. Reapply your sunscreen frequently, especially after swimming, playing in the water or sweating. And don’t forget to reapply sunscreen after drying yourself off with a towel.

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New Options For Your Allergies

Allergies can be an occasional annoyance or a source of ongoing misery. They can even change your life. One guy I knew, Steve, after finally reaching his lifelong dream of becoming a veterinarian developed a very serious allergy to dogs and cats while in his very first year of practice.

After trying every antihistamine and desensitizing treatment available at the time, Steve’s allergies were still so severe that he faced a tough choice: to completely change his veterinary practice to taking care of other animals instead of dogs and cats, completely give up his lifelong dream of being a veterinarian, or risk dying from an anaphylactic reaction to one of his patients. He eventually left the veterinary world behind to become a pharmacist, graduating a couple of years after me.

Many years ago I had a customer called Connie, who came in frequently seeking help for her allergies. After years of sniffling and sneezing she was told she was allergic to cats. The trouble with that was she had 2 Siamese cats that she refused to part with. Sasha and Lucy were her best buddies: they slept with her every night and she dressed them up in cute outfits every Halloween and Christmas.

Back then I only had a few antihistamines and a couple of nose sprays to offer to Connie, but today I can show her many more options. Claritin®, Zyrtec® and Allegra® are newer antihistamine pills now available without a prescription. Claritin® (loratadine), Zyrtec® (cetirizine) and Allegra® (fexofenadine) each had great success as prescription antihistamines and are widely available today without a prescription.

In addition to those pills I can also suggest 2 new nose sprays that can really change Connie’s life. These nasal sprays contain anti-inflammatory medicine that works similar to prednisone and are very effective for allergy symptoms of the nose, called allergic rhinitis. Now she doesn’t need to go to a doctor to benefit from them. Nasacort AQ 24 Hr® was the first nose spray with triamcinolone, a prednisone-like ingredient. Available without a prescription, Nasacort AQ 24 Hr® has been joined by Flonase Allergy Relief® which contains a different cortisone-like ingredient, fluticasone. These nose sprays are one of the most effective ways to treat allergic symptoms, especially those that involve the nose like sneezing, sniffling and stuffiness.

Up until now, the only nose sprays we had available for allergies that didn’t need a prescription could not be used for more than a few days at a time. Afrin® (naphazoline) and Neo-Synephrine® (phenylephrine) sprays work by causing the blood vessels in your nose to shrink, relieving your stuffy nose. Trouble is, your relief only lasts a short while; if you continue using them they eventually stop working and your congestion comes back even while you are still using them. This is called rebound. Some people can use these intermittently for months and manage to avoid getting rebound stuffiness, while others find their nose spray only works for about 3 days before it quits. If you have high blood pressure or a heart condition, you should avoid this type of nose sprays completely, as they increase blood pressure.

Nasalcrom® is a nose spray for allergies that works by blocking your allergic symptoms. It only works if you start using it several weeks BEFORE you are around whatever you’re allergic to, and has to be used 3-4 times daily for best effect. Unlike Afrin® or Neo-Synephrine®, Nasalcrom® can be used safely in children 2 years and older and can be continually used for years without losing its effectiveness.

Nasacort AQ® 24 Hr® and Flonase Allergy Relief® contain a cortisone-like medicine that can effectively relieve nasal congestion, runny nose and sneezing with just one or two sprays a day. Kids as young as 2 years old can safely use Nasacort AQ 24 Hr® and Flonase Allergy Relief® can be used safely in children 4 years old and older. Another great thing is being able to add any antihistamine pill to either Nasacort AQ®24 Hr or Flonase Allergy Relief® for even more relief.

If Connie walked into my pharmacy today, she would have 3 new antihistamine tablets and 3 more nose sprays to choose from for relieving her stuffy nose, and Lucy and Sasha could continue sleeping with her every night. My 3 Scottish Terriers would be SO jealous!

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Which Medicine to Pack When You Travel

Q: What medicines should I pack when going out of town? We have several trips planned and I want to make sure I have the right stuff.

With summer here, traveling gives you a chance to get away from your usual routine and see new horizons. Unfortunately, you can get injured or sick whether you are at home or on the road. If you aren’t prepared, motion sickness, intestinal disturbances and minor injuries can derail you from enjoying family gatherings or vacations.

Before you walk out the door to your adventure make sure you’ve packed all of your regular prescription medicines and a current list of all your medications. I recommend using pillboxes when taking your medicines on the road with you. Packing a pillbox instead of taking all your pill bottles with you takes up far less space and is less disastrous if you accidently leave your pills behind somewhere. Using pillboxes has another advantage when packing for a trip: filling up your pillboxes before you leave will alert you to when you’ll run out of medicine before you get back home.

What if you discover that you don’t have enough doses to last until you return? If you usually get a 30-day supply of pills, you can ask your doctor to refill it for a larger quantity, like 90 days. You could also explain to your pharmacist that you’ll be gone when your next refill is due to be filled, and ask if you can refill your medicine early. Some insurance programs allow one early refill or “vacation refill” per year for certain medicines. If you have to pick up your refills every time from the doctor’s office, you’ll need to plan ahead with your doctor and pharmacist. Medicines for pain or anxiety that can’t be called or faxed to the nearest pharmacy can cause problems if you need more while out of town.

When traveling outside the United States, be extra cautious about your food and drinks to avoid spending your vacation visiting the local bathrooms instead of the beaches or museums. Always avoid ice: never drink a freshly opened bottle of water or soda that has been poured over ice! But if you do end up with nausea, vomiting or diarrhea on your trip, AVOID taking anti-inflammatory medicines such as naproxen (Aleve®) or ibuprofen (Advil®, Motrin-IB®) for pain, swelling or fever. Taking naproxen or ibuprofen while dehydrated can seriously damage your kidneys. Seriously! Until you can keep fluids down, if you need a painkiller, take acetaminophen (Tylenol®) instead.

Along with your prescription medicines I recommend packing some non-prescription medications to treat common conditions that may arise. Here’s what I always bring on a trip:

  1. Acetaminophen (Tylenol®). Relieves aches, pains and fever, including tension headache from staring at maps and backache from riding all day in cars or planes.
  2. Meclizine (Bonine®, Dramamine® Non-Drowsy Formula). My personal favorite is chewable 25mg tablets to prevent motion sickness. Indispensible when traveling in moving vehicles or roller coasters that go backwards and upside down.
  3. Loperamide (Imodium®-AD). This is the very best way to stop diarrhea in its tracks, so you can spend your vacation on the beach instead of in the bathroom.
  4. Pseudoephedrine (Sudafed®), the kind you have to sign for. My husband’s ears always get blocked up when he travels by plane, so I make sure we have this for him to protect his ears from painful changes in pressure. Instead of pills you can use naphazoline (Afrin®) nasal spray.
  5. Diphenhydramine (Benadryl®). This is a miracle worker for bee stings, bug bites, minor rashes and allergic reactions.
  6. Naproxen, 220mg tablets (Aleve®) or ibuprofen (Advil®). Great for emergencies like tooth pain or muscle aches. DON’T USE IT if you have vomiting or diarrhea, have serious heart failure, are allergic to aspirin, or have had a bleeding ulcer. Use acetaminophen (Tylenol®) instead for aches and pains if you can’t safely take naproxen or its cousin, ibuprofen.
  7. Dried Prunes. I pack these as insurance against constipation. Research shows that eating 5 prunes is just as effective as taking a stool softener, and I adjust the “dose” up or down according to my needs. Don’t like prunes? Pack your favorite laxative instead. I recommend Miralax® because it’s reliable, powerful yet gentle on the body.

Bon voyage and safe travels!

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Does Bag Balm® Get “Too Old”?

Q: Does BB (Bag Balm®) ever get too old? I’ve been working on this 10oz (I think) can for some time. It is darker than when new. Still smells the same… I hate to give it up! I was raised on the stuff, so were my kids, so are their kids and now a great grand daughter.

No, Bag Balm® doesn’t go “bad” but you may want to make sure your can of Bag Balm isn’t so old that it has the old formulation, which contained mercury compounds. It should state that it contains 8-hydroxyquinolone on the side of the can.

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Medication Safety: Question Everything

One of my favorite videos is of a backyard July 4th fireworks display gone wrong: a little dachshund runs up to a lighted Roman Candle, grabs it in its mouth and runs around as fireworks shoot out sideways from the burning tube, scattering the watching crowd. Sometimes getting a new medicine can go sideways on you…

Jane is an 86-year-old just home from the hospital after not being able to catch her breath. At the hospital the doctor diagnosed her with congestive heart failure and changed her water pill to a stronger one to help keep the fluid out of her lungs. She was given a list of her medicines when she was discharged back home and the new medicine was on it, but when I saw her the next day she was starting to have trouble breathing again. Checking her pill bottles, I noticed that she had a new prescription for her old water pill instead of her new one.

“This isn’t the medicine that your hospital paperwork shows you should be taking.”
“I know, but when I asked the pharmacist about it he said that they filled the prescription with exactly what was called in for me. I thought maybe the doctor changed her mind.”
“Maybe. Let me check.”

Calling the pharmacy, I spoke to the pharmacist and discovered that her prescription wasn’t faxed to them but instead was called in.

“Was it called in by the doctor?”
“No, by a nurse at the hospital.”

I then called the doctor who’d prescribed Jane’s new medicine and asked, “Did Jane’s water pill get changed from torsemide back to furosemide?”

“No! I want her taking torsemide, not furosemide. Why?”
“Well, the nurse on the floor called in the new prescription as furosemide. Do you want me to send a new prescription for the torsemide?”
“Yes, please!”

If Jane had taken her paperwork to the pharmacy and showed it to the pharmacist, they wouldn’t have assumed that the doctor changed her mind but instead contacted the doctor to clarify the prescription. Instead, Jane almost ended up back in the hospital with the wrong medicine. She questioned it, but without having the paperwork with her to show the pharmacist, she just assumed the doctor changed it back and accepted the wrong medicine.

Then yesterday, 56 year-old Marjorie came in a for a blood thinner check. She’d gone to the emergency room the previous day with one side of her mouth drooping and trouble talking. Luckily, she got better and the doctors diagnosed a TIA, or transient ischemic attack, due to her blood thinner level being way too low.

“Marjorie, your chart shows that I increased your warfarin dose last week, and changed the tablet size, too. But you’re taking the same dose you were on before.”
“I thought we had changed my dose, but when I picked up my new bottle at the pharmacy the label and tablets inside were different than what you’d told me. I thought you’d changed your mind, so I took it the way the label said.”

When I called Marjorie’s pharmacy they insisted they’d never received any new prescriptions for her, so they refilled her current prescription, which was now the old tablet size and old directions.

“Marjorie, let’s fix this before you really DO have a stroke.”

These days, doctor’s offices send most prescriptions by electronic fax, which records it directly into the patient’s medical chart. Most of these faxes arrive, but when they don’t, it STILL looks like they arrived just fine. With an electronic fax there’s no way to tell the difference between one that arrived at its destination and one that didn’t. I sincerely believe that there’s a black hole in our universe, randomly sucking innocent electronic faxes traveling between doctor’s offices and pharmacies, causing medication mishaps and mayhem.

Here are 3 ways you can protect yourself against your medications going sideways:

1. Make a list of your medicines and update it with any additions and changes. Take it with you whenever you go to the doctor, the hospital, or your pharmacy.

2. If a doctor or other medical provider changes your medicine, get it in writing. Keep this with your current list of medicines and take it to the pharmacy when you pick your prescriptions in case there’s a discrepancy.

3. PLEASE ASK QUESTIONS! Question anything that doesn’t look right to you. With so many people involved and a fax-sucking black hole loose in the universe, omissions and misunderstandings can easily affect your medications. Speak up and question anything that doesn’t look right. Your health and safety may well depend on it.

And watch out for wiener dogs running with fireworks…

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