Archive for October, 2016

Bone Health: Is a Fracture in Your Future?

Osteoporosis is a condition of weak bones, which makes them more likely to break. Ten million Americans have osteoporosis and 44 million have thinning bones, according to the National Osteoporosis Foundation (NOF), a health organization dedicated to preventing osteoporosis and broken bones though awareness, education and research.

In the United States, one out of every two women and one in four men over age 50 will have an osteoporosis-related fracture in their lifetime. Twenty-four percent of seniors who suffer a hip fracture will die within one year of the event. If you are female your risk of having a bone break from osteoporosis is equal to your risks of breast, uterine and ovarian cancer COMBINED.

My mother died of complications from osteoporosis. She broke her left wrist when she was 74 years old, tripping in downtown Seattle when trying to catch a bus. Four years later she fell onto her right when getting out of bed in the middle of the night. Her right knee swelled up and she insisted it was “just my knee”, refusing to go to the doctor. Nearly 2 weeks later when the pain hadn’t gone away she finally agreed to get it checked but by that time the ends of her broken bones had slipped down and were already knitting back together. She suffered from the discomfort and inconvenience of her right leg one inch shorter than her left one for the rest of her life.

Although its complications show up in old age, osteoporosis starts in childhood. Nearly 90 percent of our peak bone mass is built before we turn 20 years old. At middle age that begins to reverse and we lose 1% of our bone mass per year, doubling to 2% per year for women after menopause. The thinner your bones are to start with, the more likely you’ll eventually experience a fracture.

Here are 5 tips to help keep your bones healthy and strong:

  1. Get the calcium and vitamin D you need every day. Eating a variety of foods rich in calcium is a critical step to building and maintaining strong bones. Green leafy vegetables like broccoli, Brussels sprouts and kale are good sources of calcium, as are dairy products like milk and yoghurt. Calcium and Vitamin D supplements are also helpful.
  1. Do regular weight bearing and muscle-strengthening exercises. Getting up and moving is one of the best things you can do for your bones. Weight-bearing activities like walking, cycling or dancing help signal your body to keep your bones strong.
  1. Don’t smoke.My mother smoked since she was 18 years old. Quitting smoking could have helped her avoid the fractures that plagued her final years.
  1. Talk to your doctor about your chances of osteoporosis and ask about bone density testing.If you have passed menopause or have taken certain drugs, especially prednisone or corticosteroids, you may have thin bones without knowing it. Testing your bone density helps determine how likely you are to have a bone break in the future and if you are at risk, your bone loss can be slowed with medicine and other strategies. My mother never realized she had thin bones until she broke her wrist. With screening and the bone-building drugs available today she may have avoided the hip fracture that shortened her life.
  1. Try eating prunes every day. A recent study showed that eating prunes every day could make your bones stronger. The study participants ate 100 grams (about 10 prunes) every day for a year. Luckily,   you don’t have to eat quite that many to benefit your bones. I suggest taking it slowly and building up to what you can manage, as prunes are a natural stool softener. I weighed out 100 gm of dried plums (prunes) and found that 100 grams is 9 of the Mariani® brand of dried plums sold by Costco. With my family history, I decided to eat at least 5 prunes a day, and see if I could work up from there.

Is there a fracture in your future? Keeping your bones strong and healthy includes getting enough calcium and Vitamin D, doing some weight bearing exercise every day, quitting smoking and asking your doctor or medical provider about bone density testing. If you do have osteoporosis, there are bone building drugs available, from tablets you take every week or every month like alendronate (Fosamax®), Actonel® or Boniva®, to injections given daily, every 6 months or even once a year. And even prunes!

To find out more about osteoporosis and how you can prevent it, check out the National Osteoporosis Foundation website at

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The Best Non-Prescription Pain Relievers

Q:             Which non-prescription pain medicine is the best to use?

There are 4 pain medicines you can buy without a prescription: Tylenol®, Aleve® Advil®, and Motrin-IB®. Which would be best for you to use depends on what type of pain you need it for and whether you have certain kinds of medical conditions.

Tylenol® is oldest of the pain medicines available over-the-counter (OTC). Also known by its generic name acetaminophen, Tylenol® is very safe to use as long you avoid taking too much of it. Taking more than 8 Extra-Strength tablets of 500mg acetaminophen or 12 tablets of regular strength or 325mg Tylenol® in one day can permanently damage your liver, especially if you do it frequently.

The other 3 pain medicines you can buy without a prescription are closely related to each other and all work in the same way. The active ingredient in Aleve® is naproxen and the active ingredient in both Advil and Motrin-IB is ibuprofen. Ibuprofen and naproxen are called non-steroidal anti-inflammatory drugs or NSAIDs for short. NSAIDs are powerful painkillers that are quite effective for certain types of pain associated with inflammation: muscle aches, sprains or strains, tension headache, and dental pain.

Pain medicines with anti-inflammatory action like ibuprofen or naproxen are much better than Tylenol® or acetaminophen for menstrual cramps and especially to prevent swelling and pain after a tooth extraction, but it comes with a price. NSAIDs can cause stomach pain and bleeding, interfere with how your kidneys work, or trigger heart failure from retaining excess water.

I recommend naproxen (Aleve®) over ibuprofen because it lasts longer. Naproxen lasts 8-10 hours while ibuprofen wears off in 6 hours. Years ago I tore a ligament in my right wrist while chopping wood in weather 20 degrees below zero. Some people should NOT be allowed to swing an axe, and I’m one of them! Even taking the most potent prescription strength of ibuprofen three times a day I’d wake up in excruciating pain night after night at exactly 3:25 am. After switching to the OTC strength of naproxen I slept blissfully through the night.

Always take an NSAID with a full glass of water or right after a meal to reduce your risk of stomach problems like burning, cramps, heartburn or bleeding ulcers. The extra water or food will dilute the medicine as it dissolves in your stomach, decreasing your chances of developing pain or bleeding.

When taking naproxen or ibuprofen it’s extremely important to drink plenty of water and avoid them if you are having vomiting or diarrhea. NSAIDs can cause problems with your kidneys, especially if you become dehydrated.

If you have a certain type of heart condition called congestive heart failure (CHF), you should avoid NSAIDs completely. Just ONE DOSE of ibuprofen or naproxen can trigger a deadly build up of fluid in your lungs.

If you have stomach or kidney problems, Tylenol® will be the safest medicine for you to treat mild to moderate pain… unless you take too much of it.

Unfortunately, taking more acetaminophen than you should is MUCH easier than you’d think. Following the dosing recommendations on your bottle of Tylenol® is not enough to prevent problems because acetaminophen is already in many commonly prescribed prescription pain medicines like Vicodin® and Percocet®.

You can also end up taking too much NSAID medicine without realizing it. In addition to OTC formulations, higher strengths of ibuprofen and naproxen along with several other prescription-only NSAIDs are widely prescribed as anti-inflammatory medicines. Taking an OTC and prescription NSAID at the same time increases your chances of having side effects like stomach pain, kidney problems or bleeding ulcers.


To choose the best OTC pain medicine for you, follow these guidelines:

  1. For muscle aches, sprains and strains, dental pain or menstrual cramps taking an NSAID like ibuprofen or naproxen will usually work much better for you than Tylenol® or acetaminophen. I recommend naproxen because it lasts 8-10 hours, but either naproxen or ibuprofen should help.
  1. If you have a stomach ulcer, kidney problems, congestive heart failure (CHF), or are taking a blood thinner, you should stick with Tylenol® or acetaminophen regardless of the type of pain you have, because it’s is a safer choice.


  1. Don’t double up on painkillers. Although it’s safe to take an NSAID anti-inflammatory medicine at the same time as Tylenol®, you should NEVER take more than one NSAID at a time or more than one medicine with acetaminophen in it at a time. Ask your pharmacist if you’re not sure if your prescription pain medicine has either acetaminophen or an NSAID in it.


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Brand vs. Generic Medicines: is There Any Difference?

October 17th, 2016. Filed Under: consumer information, medicines, patient information.
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Q: My insurance company stopped paying for the brand name medicine I have been taking for years because it’s now available as a generic. Within 2 weeks of starting on the generic version of my medicine my old symptoms started coming back. My doctor says that it’s the same medicine, but if that’s true, why do I feel different?

Generic medicines are considered equivalent to their brand name counterparts, but they are not identical. The Food And Drug Administration (FDA) requires that generic drugs meet the same standards as brand name products, but they don’t have to match them in every way.

Before they can sell a generic version of a medicine its manufacturer must show the FDA that their product contains the same active ingredient as the brand does at each strength. It comes in. The formulation (tablet, capsule, liquid or injection) and route of administration must also be the same as the original or “innovator” medicine. In addition, its manufacturing processes, quality control and testing must meet the same standards as any branded product. Many generics are actually made in the same facilities as their brand name equivalent.

The generic drug manufacturer must also prove to the FDA that its medicine is bioequivalent to the brand name drug. This is done by having volunteers each take standardized doses of the generic and brand name medicine with blood samples taken after each dose to measure the amount of each in their bloodstream compared to the other one. If the levels of the generic drug in the bloodstream are the same as the levels found when the brand name product is used, it is assumed that the generic drug will work the same in your body.

But there are differences between taking a generic and a brand name medicine. The biggest difference is in the price, with the average generic drug costing 80 percent less than the brand name version. According to a study of generic drug usage done by the US Government Accountability Office, in 2010 alone the use of FDA-approved generics saved $158 billion as prescriptions and in medicines used by hospitals. That’s an average of more than a billion dollars saved every other day.

Although the active ingredients have to be equivalent, the inactive ingredients don’t have to be. And may change the way some people absorb their medicine. For example, tablets contain more than their active ingredient, like meatballs often contain more than just meat. Most tablets of medicine also have diluents or fillers to make up the size of the tablet, similar to rice or oatmeal used in a meatball recipe. Examples of fillers used for tablets are lactose, sucrose, kaolin, starches and cellulose. Then there’s an adhesive compound added to the powdered medicine called a “binder” to help it all hold together, like an egg added to a meatball recipe helps the meat and rice “stick” together as you form it into a ball. And sometimes a dye is added to the powder to color the tablet, which can cause reactions in people who are sensitive to dyes.

Many generic manufacturers use less expensive versions of filler, binder and dyes than the branded medicine, which is perfectly allowable by the FDA as long as the active ingredient is the same concentration as the original product.

There are more extended release generic medicines available now than ever before, and generics for these are harder to get “right”. Even between different brands of similar products, there can be differences in how much of the medicine is released into the body over a period of time. The FDA received complaints about a generic version of Wellbutrin® XL causing headaches, nausea and a return of depressive symptoms in some people. In October 2012 the FDA reversed its approval because of a difference in how the generic was absorbed and asked its manufacturer, Teva to remove it from the market.

If you notice a difference between how you feel when taking a generic medicine and the brand it has replaced, ask your doctor to report it to the MedWatch program that is run by the FDA, which tracks adverse events caused by medicines. Your doctor may also consider adjusting your medicine, changing it to another medication, or asking the insurance company to approve using the brand name product for you because of your bad experience with the generic.

You can find more information about generic medicines at

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Can Cod Liver Oil Improve Your Health?

Q: My neighbor swears by cod liver oil and says I should try it. Could it improve my health?

Drinking cod liver oil may help you if you happen to be deficient in either vitamin A or vitamin D. A type of fish oil, cod liver oil is a good source of the fat-soluble vitamins A and D. It also may contain Omega-3 essential fatty acids like other types of fish oil, helping ease achy joints and minor muscle aches.

Although it’s has been around a long time, cod liver oil didn’t start out as a medicine. It was originally a byproduct of the Norwegian fishing industry and commonly used to soften leather and as a hoof dressing for horses. Then in the 1800s German physicians discovered that cod liver oil cured children of rickets, a common disease at that time that caused serious bone deformities. It was also used successfully to treat joint aches, gout and “obstinate constipation”.

According to the United States Pharmacopeia (USP), Cod Liver Oil, USP is “a thin, oily liquid with a characteristic, slightly fishy odor and a definitely fishy taste” made by “steaming the livers of the Atlantic cod, then straining the oil that rises to the top of the vat or kettle”. Cod Liver Oil, USP lists 3 main ingredients: vitamin A, vitamin D and Omega-3 essential fatty acids.

By 1851, cod liver oil was declared “one of the most esteemed remedies currently available”. Doctors recommended it but children hated it and suggestions on how to improve the “fishy” taste of cod liver oil began to show up in medical and pharmacy references. The 19th edition of The United States Dispensary published in 1907 contains this advice for Cod Liver Oil, USP: “It may be taken alone or mixed with some vehicle calculated to conceal its taste and obviate nausea. Peppermint oil has been found to be helpful.” My favorite suggestion, taken from the same source, is to “chew a small piece of orange peel before and after taking the medicine.”

Cod liver oil may improve your health if your diet is low in either vitamin D or vitamin A. Vitamin D is essential to incorporate minerals such as calcium into new bone tissue. A nutritional deficiency of vitamin D causes rickets in children and osteomalacia in adults. In rickets, newly formed bone lacks minerals and is too soft, causing crooked bones and skeletal deformities. In adults, vitamin D deficiency causes weak bones, or osteomalacia. Deficiency of vitamin A can cause growth retardation, night blindness and an increased susceptibility to infections.

Each teaspoonful (5ml) of the official product of cod liver oil as Cod Liver Oil, USP contains 850 USP units of Vitamin A, 85 USP units of Vitamin D, and approximately 1 gram of Omega-3 essential fatty acids at a concentration similar to salmon oil.

The dose of cod liver oil recommended for children is one teaspoonful 3-4 times daily, and one tablespoonful (3 teaspoonfuls, or 15ml) 3-4 times a day for adults. Other formulations of cod liver oil besides the standard version contain extra vitamin A or D that’s been added by the manufacturer. The amount of Omega-3 fatty acids in cod liver oil varies, with formulas using Atlantic cod having the most and those from Pacific cod having little to none. It’s interesting that cod liver oil was considered helpful in chronic rheumatism (joint or muscle aches) because at least one product contained nearly the same concentration of Omega-3 fatty acids as today’s salmon oil supplements.

To reduce the prevalence of rickets in its children the United States began fortifying milk in the 1930’s with added vitamin A and D. Every 8 ounce serving of cow’s milk has 100 international units of Vitamin D which is 25% of its recommended daily intake and 150 units of vitamin A, which is 10% of its recommended daily intake. Today’s ready to eat cereals are also fortified with 10% of the recommended daily intake of both vitamins A and D. Rickets is now very rare in the United States.

Cod liver oil was one of the first effective vitamin supplements available, but thankfully there are more palatable options today to prevent deficiency of vitamin A and D. One tablet of either Centrum Silver® or Flintstones® chewable is today’s modern, and tastier, equivalent.

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Safe Medicine Disposal

Q:        How should I get rid of my old and expired medicines? I don’t want to just flush them down the toilet into our water supply.

You are not alone in having leftover medicines. In fact, nearly one-third of medicines sold to Washington State households go unused every year, according to a report by Take Back Your Meds, a group of over 270 health organizations, law enforcement, local governments and environmental groups. That’s about 33 million containers of unused pills just in the state of Washington. When you think about the rest of the country…Yikes!

Disposing of your unused medicines is a good idea. Keeping unwanted and outdated prescription medicines around your house invites abuse and theft. Removing medicines you no longer need helps keep habit-forming drugs from entering the lives of your children, grandchildren or their friends and keeps you from contributing to the rapidly growing problem of prescription drug abuse.

It’s not just the people you know who are checking out your medicine cabinet. In addition to friends of your children and grandchildren looking for your leftover pain pills, today’s home intruders look for prescription bottles of pain medicines sitting on countertops or stacked up in medicine cabinets, not just for flat screen televisions and laptop computers.

One of the safest ways to dispose of your expired, unused or unwanted medicines is to take them to a site participating in a take-back program. While it seems natural to return your unused medicines to your pharmacy, under federal law, pharmacies, doctor’s offices and hospitals can’t accept any outdated or unwanted prescriptions of controlled substances, such as narcotic painkillers like Vicodin® or medicines for anxiety such as Ativan® (lorazepam).

The Drug Enforcement Administration (DEA) began hosting national prescription drug take back events beginning in September 2010. Twice a year the DEA partners with local law enforcement agencies to give the public another alternative to disposing of their medicines besides putting them in the trash or flushing them down the toilet.

The 12th Annual National Prescription Drug Take Back Day will be Saturday, October 22, 2016, and as with previous national Take Back events you can bring your medicines to participating sites for safe, free disposal, no questions asked.

But now there’s no need to wait for the next Take Back Day. The DEA has encouraged communities to provide local drop box sites authorized by the DEA for year-round safe medication disposal. You can search by zip code, city or county to find the authorized sites closest to you on the DEA website:

If you can’t get to a take-back site near you, the Food and Drug Administration (FDA) recommends disposing of any potent pain medicines by removing them from their original containers and flushing them down a sink or toilet. This includes pain pills containing drugs like Vicodin® or hydrocodone, oxycodone, and patches containing fentanyl, also called Duragesic®. Although it seems harmful to the environment to flush them, it’s even more dangerous to leave them in your trash container. Just part of a pill or a used patch of these powerful pain relievers can be lethal to a pet or small child sucking or chewing on it.

Other prescription medicines can be safely disposed of by first removing them from their bottles and boxes and mixing the pills or capsules with something unappealing like kitty litter, coffee grounds, sawdust or even dirt, then placing them in a leak-proof container like a sturdy zip-lock bag before adding them to your trash bin.

Before putting empty prescription bottles into the trash, protect your privacy by marking out any identifying information such as your name, prescription number and drug name with a permanent marker, like a Sharpie®. Sometimes you can just peel the label off and crumple it up.

4 Tips to Safely Dispose of Your Unwanted or Expired Medicines:

  1. The best way to dispose of your medicines is to take them to a Take-Back location or event in your community. Many communities hold their own Take-Back events during the year in addition to National Prescription Take Back events held in the spring and fall.
  2. If you can’t get to a take-back location or event, remove any potent pain medicines such as hydrocodone, oxycodone, OxyContin®, or fentanyl patches and flush them down the toilet or sink. Don’t leave them in your trash to be found by a child or pet.
  3. Mix any non-narcotic prescription pills in with kitty litter, used coffee grounds, or even dirt before placing them into your trash. Using a plastic container with a secure lid or a heavy plastic zip-lock bag helps prevent leakage.
  4. Remember to remove or mark out any personal information and drug names before tossing used prescription bottles or boxes into your trash.

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