Archive for the ‘Medicine dangers’ Category

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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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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Caffeine as Our Drug of Choice

Every morning at 6am Pacific Standard Time you’ll find me in my kitchen in front of a silver machine concocting a cup of jump-start for my day. My well-used Gaggia Classic espresso machine relieves my caffeine deprivation every morning with an aromatic, high-octane blend of caffeine, water and milk. As I write this my 16-ounce unflavored latte steams by my right elbow.

I’m not alone when performing this ritual of drinking coffee before engaging my brain. 100 million Americans are also daily coffee drinkers and 60% of us consider coffee a mandatory part of our morning routine. There’s even a National Coffee Month each August to celebrate our addiction.

Although Americans purchase a large proportion of the world’s supply of coffee beans and are the home of Starbucks®, Seattle’s Best® and Dunkin’ Donuts®, we aren’t the world’s most dedicated coffee drinkers. In fact, we only rank 25th in per capita coffee consumption, out-caffeinated by the Top 5: Finland, Norway, Iceland, Denmark and the Netherlands.

Coffee is a definitely a worldwide beverage. Green, or unroasted coffee beans are the second most traded and valued commodity in the world, behind only crude oil. We call coffee “Java” because when coffee as a beverage first became popular in the 19th century the highest quality of beans came from the Philippine island of Java.

Why do we love coffee so much? Probably because it naturally contains caffeine, the most widely consumed stimulant in the world. Found in over 60 different plants, caffeine’s effect on the brain can be detected in amounts as low as 10mg, a fraction of the 100mg dose found in an average 8-ounce cup of brewed coffee.

As the most common psychoactive compound ingested in the world, caffeine is found in beverages all around the globe: coffee, tea, a South American drink called mate, and kola nut. Kola nut extract was originally added to carbonated beverages to flavor them, although today soda manufacturers use synthetic sources of flavoring and caffeine in their cola flavored products.

Enterprising entrepreneurs have added caffeine to other things besides soda. Need the pick-me-up quality of caffeine but don’t want coffee breath? Try one of the popular energy drinks like Red Bull® or 5-Hour Energy®. There’s even Stay Alert® chewing gum with 100mg of caffeine per stick, about the same amount found in a good ol’ cup of java. Not interested in drinking a beverage to get your day going? Wired Waffles® brings you 200mg of caffeine per waffle to jump-start your day or you can use their caffeinated pancake syrup.

If the thought of putting caffeine into foods bothers you, welcome to the club. The Food and Drug Administration (FDA) has concerns about the amount of caffeine in foods, particularly since waffles, pancake syrup, gum and candy are attractive to children.

As I sip my morning coffee, I wonder, “Should caffeine be allowed to be added to foods that don’t naturally contain it? Should we let other products besides our traditional beverages provide us with caffeine?”

One consideration is the fact that we vary in our sensitivity to caffeine’s side effects. Some of us can drink a pot of coffee and go right to sleep while others experience side effects like heart palpitations, tremor, anxiety and insomnia after only one cup. Some heart patients are advised to avoid caffeine completely because of the risk of increased blood pressure and heart rate.

The currently recommended limits of caffeine intake are 300-400mg per day in adults and 100mg daily in teens and young adults. The FDA is concerned about whether to approve food products containing caffeine as an additive because little is known about the effects of caffeine in small children, young adults, or in pregnancy.

In 2010 the FDA forced the withdrawal of caffeinated alcoholic beverages like Joose® and Four Loko® because of studies indicating that combined ingestion of caffeine and alcohol could lead to life-threatening situations. The FDA determined that caffeine consumption masks the sensory cues people use to track their level of alcohol intoxication. Young adults drinking the alcohol/caffeine combinations found in products like Four Loko® continued drinking well beyond what they usually drank with blood alcohol levels 2-3 times higher than those drinking beverages containing only alcohol.

You can find more information about caffeine in foods and other interesting topics on the FDA website under Consumer Updates: Just don’t ask me any tough questions before I have my morning cup of Joe…

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Choosing a Medicine for Your Aches and Pains

Q: There are so many choices out there for aches and pains. Which medicine is best for me?

When you have mild to moderate pain like a headache, sore muscles or aching joints there are 4 pain medicines you can buy without a prescription: aspirin, acetaminophen (Tylenol®), ibuprofen (Advil®), and naproxen (Aleve®). Which one should pick?

Aspirin is the oldest of these four options and is available in two strengths: low dose or “baby” aspirin which are 81mg each and the adult dose of 325mg, which is exactly 4 times the 81mg dose. Many Americans take one aspirin a day to prevent heart problems because of how it works as a blood thinner. If you take any prescription blood thinner medicine like Plavix®, warfarin (Coumadin®), or one of the newer ones advertised on the television, don’t take more aspirin for relief of your headache pain. Since aspirin can upset your stomach it’s best to take it with food or a full glass of water.

Whether sold as Tylenol® or by its generic name acetaminophen, Tylenol® is the most popular and common painkiller sold in America. Although it is safe enough for kids to take, Tylenol® has a dark side: taking too much acetaminophen is deadly to your liver. Being available in over 200 different non-prescription products the popularity of acetaminophen makes it dangerous because its so easy to get too much.

If you take a prescription pain medicine you may already be getting acetaminophen. Look for the abbreviations APAP or ACET on the prescription label, or ask your pharmacist. If you have liver disease, don’t take Tylenol® until you talk to your doctor about whether taking it is safe for you and how much you can safely take for pain.

The other two pain relievers available without a prescription are closely related to each other and also to aspirin. Ibuprofen and naproxen were originally only given as prescription medicines, but now they are available in non-prescription products in addition to their stronger prescription doses. Aspirin, naproxen and ibuprofen relieve muscle aches and swelling better than acetaminophen and belong to a group of medicines called NSAIDs, or non-steroidal anti-inflammatory drugs.

When taking ibuprofen, also known as Advil® or Motrin-IB®, or its close cousin, naproxen, sold as Aleve® be careful to take it with food to avoid stomach pain and bleeding. NSAID medicines can also damage your kidneys, especially if you have kidney problems or take it when you are dehydrated.

Taking too much of an NSAID is particularly dangerous because it can cause stomach bleeding and kidney failure. In addition to the non-prescription NSAID remedies there are several prescription NSAIDs commonly prescribed. Ask your pharmacist if you are already taking a prescription-strength NSAID and if you are, avoid taking the non-prescription versions.

7 Tips for Taking OTC (over-the-counter) Pain Relievers Safely:

  1. For aching muscles and swelling, ibuprofen or naproxen usually works better than acetaminophen. Some people get more relief with one or the other. Ask your pharmacist before taking ibuprofen or naproxen to make sure that you’re not already getting a prescription product doing the same thing.
  2. Avoid taking an NSAID if you already take a blood thinner. Taking 81mg of aspirin daily is ok, though. Ask your pharmacist if you aren’t sure if you are on a blood thinner medicine.
  3. Watch out for taking too much Tylenol®. Healthy adults can take up to 4 grams per day, or the equivalent of 8 tablets of extra-strength acetaminophen. Older adults are should limit their Tylenol® use to 3.1 grams daily, or 6 tablets of extra-strength Tylenol®. If you take a prescription pain reliever ask your pharmacist to find out if it has acetaminophen in it, and how much.
  4. If you take aspirin daily for your heart, talk to your doctor o pharmacist before taking it for pain relief. It’s safer to take Tylenol® or another NSAID like naproxen instead.
  5. You can take both acetaminophen and an NSAID for pain at the same time, as long as you don’t take more than is safe for you. Your pharmacist is a medication expert and can advise you as to which one is best for you.
  6. If you have kidney disease avoid taking ibuprofen or naproxen for mild to moderate pain, and make sure that you stay well hydrated when taking either one.
  7. If you have liver disease, ALWAYS check with your doctor before taking Tylenol® or acetaminophen.


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How To Get Better Pharmacy Care

Being a patient in a hospital is a dangerous place to be because it puts you at risk of being harmed by a medication error. That’s because more doses of medicine and more powerful medicines are given to people who are sick enough to need hospital care.

No matter how much we try, we are all human, and mistakes will be made. Our best hope is to catch these medication errors before they get to the patient by training staff to be alert, building in safeguards that flag potential problems, and by clear communication between the pharmacy staff who fill each medication order and the nursing staff administering it to the patient.

There are two main systems hospitals use to provide medicines to patients: centralized and decentralized distribution systems. In a centralized system the pharmacy is in the basement and pharmacists work inside its walls. Nursing sends new medication orders down to pharmacy and receives them without ever seeing or talking to a pharmacist.
A decentralized system puts pharmacists on the floors or units, usually right next to nursing stations. Pharmacists and nurses work side-by-side to interpret orders that are sent along to the central pharmacy for filling.

In my 12 years as a hospital pharmacist I’ve worked in both decentralized and centralized pharmacy systems and there is a significant difference between them. In a centralized system, nursing and pharmacy have an adversarial relationship, where in a decentralized pharmacy system pharmacy and nursing respect and value each other. My observation is that in centralized pharmacy systems the only time nurses communicate with the pharmacy is by phone when things go wrong, like when they can’t find the next dose of their antibiotic or have run out of pain medicine. The nurse calls the pharmacy in frustration, complaining about how she doesn’t have the medicine and the pharmacy learns to dread getting called by nurses.

Decentralized pharmacies put pharmacists and nurses side-by-side, and the face-to-face contact fosters less blame and more cooperation. Pharmacy helps nurses find missing doses of medicines clarify orders and in general are seen as heroes instead of the problem.

The most striking difference between the two systems is in detecting and resolving potential medication errors. Nursing is the last link between a medication order and the patient. The nurse administering a medicine is the last opportunity to find a mistake or error before it gets to the patient. Let’s be honest here. Because we are human it’s not possible to completely eliminate medication errors. The best we can do is to recognize an error and correct things that aren’t right before they harm an innocent patient.

In a centralized system if a nurse notices something that “doesn’t seem quite right” they will tend to avoid calling the pharmacy, as the pharmacy already thinks they call too much and complain. Instead, they will let it go. In a decentralized system a nurse facing the same “not quite right” feeling will call over the pharmacist, saying, “Hey, could you take a look at this? What do you think?”

There’s a similar situation faced by older Americans when it comes to getting their prescriptions. Centralized pharmacy services are provided by mail-order pharmacies and decentralized services by local pharmacies.

Outside of a hospital, the last link in the chain of a medication error is YOU. Like hospital nurses in a decentralized pharmacy system, using a local pharmacy gives you the opportunity to develop a relationship with a pharmacist or pharmacists. When you see things that don’t make sense to you, you are more likely to ask the pharmacist for help than if you get your medicines through the mail.

Here are 5 tips on getting the safest pharmacy care:

1.    Look for non-mail order options in your benefit plan and choose local whenever you can.

2.     Keep a complete list of all of your medications, and share it with all of your providers, not just your doctors. Take it to your dentist, chiropractor, and each pharmacy that you use. Keep everyone in the loop avoids dangerous duplication or risky combinations of medicines.

3.    Establish a relationship with at least one pharmacist so that you feel comfortable asking them questions. This is an absolutely critical skill as our medications become more complex and more powerful and more dangerous.

4.    If you see something you don’t understand about the medicine please SPEAK UP. ASK! Mail-order pharmacies tend to discourage people questioning things. By not asking questions you are passing up an opportunity to discover a mistake before it gets to you.

5.    Insist on 90-day supplies from your doctor for your regular medicines. This limits the number of times a pharmacy is filling your prescriptions and reduces the possibility of an error,as you get only 4 or 5 refills a year instead of 11 or 12..

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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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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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Phytoestrogens For Hot Flashes

Q: Are phytoestrogens safer than prescription estrogens for treating hot flashes?

Not necessarily. Phytoestrogens are plant-based substances that can act just like estrogen in our bodies. Although they aren’t exactly the same, they can do some of the same things estrogen can because they way they are shaped allows them to fit into the same places as both prescription estrogens we take, called exogenous estrogen, and the estrogens we make in our own body, called endogenous estrogen.

There are approximately 20 phytoestrogen compounds found in various foods and herbs, with soy products and flaxseed having the highest concentration. Herbal products such as black cohosh and red clover also contain phytoestrogens.

Phytoestrogens can behave just like other types of estrogen, but are about 100-10,000 times weaker than our own enodgenous estrogen. They can also have the opposite effect. Phytoestrogens can act just like the prescription medicines tamoxifen or raloxifine (Evista®) which block estrogen’s effect on breast tissue, which helps prevent breast cancer.

For example, in women with a low level of endogenous estrogen such as in menopause, soy phytoestrogens will act just like our own estrogens on bone and breast tissue. But in premenopausal women who have normal endogenous estrogen levels, soy phytoestrogen has the opposite effect.  How does this happen? The phytoestrogen in soy can kick our bodies’ own estrogen off of its binding place on the breast cells, replacing potent estrogen that we made with the much, much weaker phytoestrogen.

Soybeans and soy products such as soy nuts, soy milk, tofu and tempeh are particularly high in a particular type of phytoestrogen called isoflavone. Because they are the most concentrated and available source of phytoestrogen, soy foods and soy concentrates have been studied the most.

Phytoestrogens are interesting to researchers because they can relieve hot flashes during menopause in some women. Researchers have noted that Asian women don’t suffer from hot flashes during menopause as commonly as Western women do. One major difference is believed to be their diet; a typical Asian diet contains a lot more soy than a typical American diet.

One particular isoflavone called genistein is the main phytoestrogen in soy-based foods. In research studies, an increased intake of genistein has been associated with a 10% reduction in hot flash symptoms.

How much soy does it take to experience a reduction in your hot flash symptoms? Most clinical studies have used 40-80 mg daily of phytoestrogens, particularly genistein. You can get 40 mg of genistein from ½ cup tofu, ½ cup soy nuts, or 1 cup of soy milk. Flaxseed, chickpeas, beans, peas, green leafy vegetables, cauliflower and nuts are other food sources of phytoestrogens.

Are phytoestrogens actually safer than estrogen in treating hot flash symptoms in menopause? Not always. In susceptible individuals soy extracts may actually trigger breast cancer. Soy has been shown to stimulate increased cell production in normal breast tissue, and the phytoestrogens found in soy and red clover may interfere with the effectiveness of tamoxifen, a medicine used to prevent breast cancer.

If you have a family history of breast or endometrial cancer, or have had breast cancer, you should avoid consuming large amounts of soy based foods and soy supplements. If you are vegetarian or vegan, don’t eat tofu or tempeh every day, and restrict your consumption of soy milk.

If you are not vegetarian, it’s unlikely that you’ll get enough soy in your diet to increase your risk of breast cancer. That’s not the case if you take supplements containing soy concentrate or herbal products marketed for “menopause support” such as Remifemin®. If you have a family history or an increased risk of breast cancer you should avoid taking supplements containing soy concentrates, black cohosh or other phytoestrogens as well as restricting your intake of soy-based food products.

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Chewing Gum Like Pete Carroll

10 years ago, I struggled with the “winter blues”, a type of depression called seasonal affective disorder (SAD). It would start in mid-November with a day or two of feeling down, and by Christmas Eve I was having “black cloud” days, one after another. I could “feel” a black cloud hovering over my head as I got up in the morning. All day long, wherever I went and whatever I did, that black cloud sucked up all my good feelings, leaving me feeling helpless and hopeless. I stopped eating, felt tired and sad all the time, and could barely get through the holiday activities or my days at work. At home, I cried a lot. Every year it got worse and worse, until finally I went to my doctor, who started me on an antidepressant.

Within a week after beginning the medicine, I started feeling more like myself, and over the next few weeks the black cloud slowly evaporated and my appetite and energy level recovered.

The medicine helped me feel almost normal except for one thing: my mouth always seemed dry. If I tried to talk, after a couple of sentences my throat would get tickly and scratchy. I’d cough and have to stop talking until I “wet my whistle”. Some days I drank so much water I wondered if I was going to grow a hump.

To help me keep talking during presentations without having to stop every few minutes to cough and sip, I started chewing gum, looking more like Elsie the Cow or Pete Carroll on the Seahawk sidelines than a clinical instructor delivering a lecture.

If you’d given me a choice between going back to my “black cloud” days and having a dry mouth, I wouldn’t have dared stop the medicine that was keeping me going. But when my eyes started burning, I spoke up and asked my doctor to taper me off the antidepressant. Within a month the black cloud came back and my appetite took a nosedive, so we restarted the medication. Things went okay for the next few months but the burning of my eyes finally drove me to see my eye doctor.

After finishing her examination, my eye doctor sat down next to me and confirmed what I had suspected: my eyes were too dry. Not only that, but my corneas were not getting enough moisture and were beginning to show damage.

“You don’t have a normal level of tears,” she explained. “If something isn’t done soon, your vision will be permanently damaged.” I was able to get wax plugs in my tear ducts, to keep my tear fluid from draining out so quickly. My eyes immediately felt better. Then, after not having a cavity in years, my routine dental checkup revealed accelerated gum disease and 2 new cavities.  I felt like my body was falling apart. Today, the connection is clear: side effects from medications like dry mouth are not just an minor annoyance. Your gums, teeth and eyes can also be at risk.

Tapering off my antidepressant again, this time I did some research and installed full spectrum lights: long fluorescent bulbs in my office at work and incandescent ones at home to help my body “get more sunshine”, especially during the dark winter months. That little jade plant in my office that had never seemed to do anything? After installing my new lights it turned a beautiful deep green, doubled in size and outgrew its pot in less than 2 months!

One of the most devastating side effects of taking medicines is dry mouth. Saliva is not just “drool”. It has vital antibacterial properties. A healthy adult makes about a liter and a half of saliva every day, rich in minerals that help your teeth resist decay and keep your gums healthy.

According to the Academy of General Dentistry, the most common cause of dry mouth is prescription and non-prescription medications, and 30% of Americans over the age of 65 have dry mouth. With over 500 prescription and non-prescription medications containing ingredients that can cause dry mouth, if you suffer from it, speak up and tell your doctor or pharmacist.

There’s more about dry mouth at the Academy of General Dentistry’s consumer website, in their reference section under D (for dry mouth).

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