Archive for the ‘medicines’ Category

How To Tackle an Ingrown Toenail

The last time I was at a family gathering, my sister asked me, “What’s your favorite over-the-counter product?”

That’s easy to answer: it’s New Skin®. Normally used to seal up cuts and scrapes, I love to recommend it for a completely different condition: ingrown toenails.

I ’ve spent years and years fighting the pain of getting ingrown toenails on both of my big toes. Then, as a pharmacy student sitting in class, one of my professors mentioned a product  called Outgrow® that he recommended for avoiding ingrown toenails. “It’s brushed onto the skin where an ingrown toenail likes to form and like magic, it will “toughen up” the tender skin and keep the nail from cutting into it. Eventually, the nail is forced to grow out straight.”

“Aha!” I immediately went out and purchased a bottle and used it very successfully for years, until I misplaced it somehow during a move out of state. I didn’t worry about it at first, thinking I could just buy another one. But alas, when I went to the pharmacy shelf to pick up another bottle, I couldn’t find it anywhere. Further research revealed that the manufacturer had discontinued their original formulation several years back. I was willing to try anything, so I ordered the new version. Unfortunately for me, the “new” formula proved totally useless, and I was again plagued with painful ingrown toenails.

Years and many ingrown toenails later, I renewed my search for something like the original version of Outgrow® that would  toughen up or protect my skin. I’d used New Skin® before on cuts, and wondered, “Could this work to prevent an ingrown toenail?” Another plus is that New Skin® contains an anti-infective compound called 8-hydroxyquinoline which can help heal your ingrown toenail! When I tried it, it worked so well that I happily recommend it to anyone else needing to avoid ingrown toenails.

Here’s how to use New Skin® to prevent or treat an ingrown toenail:

  1. You’ll need a bottle of New Skin®, a toothpick, a place to apply it that you can wipe up the mess if you spill or drip, and at least 15 minutes of drying time.
  2. Soak your toes in warm water to soften your toenail. You can also do this right after a warm bath or shower.
  3. Dry your foot well.
  4. Brush on a thin layer of New Skin® along the skin of the nail that tends to or which is already curling under your tender skin.
  5. While still wet, use the toothpick to lift up the edge of your toenail just a bit and work some of the liquid New Skin® underneath it so that the liquid is between your nail and your skin. You don’t need a thick coat, just enough to spread along the nail where it likes to curl.
  6. Let it dry for at least 5 minutes.
  7. Repeat if needed with a second “coat”, letting it thoroughly dry before putting on socks.

One 2-coat application lasts me several months. You’ll notice that your toenail will grow out nice and straight instead of cutting into your skin. Enjoy the freedom from the pain of pesky ingrown toenails!

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Is It a Stool Softener or a Laxative?

Q: What’s the difference between a stool softener and a laxative?

A laxative encourages movement of the stool and assists you in eliminating feces. The word laxative means “to loosen” and is related to the word “lax” which means loose or relaxed. A laxative works to “loosen” your bowels and relieve constipation. Stool softeners are actually considered a type of laxative called emollient laxatives.

When you become constipated, it’s often because the muscles of your intestines are not moving as well as they should, slowing down the removal of your feces. The longer it takes your feces to move from your small intestine to your rectum the more water gets pulled out of it along the way, making your stool smaller, harder and more painful to eliminate. An emollient is a substance that works by softening or increasing moisture. Two types of stool softeners that work as emollient laxatives are docusate and mineral oil.

Docusate is a surfactant that acts just like a detergent or soap. Like detergents, docusate decreases the surface tension of water and helps it move water into your stool. Although docusate doesn’t directly stimulate the muscles of your intestines or the movement of stool, it can help avoid and relieve constipation by counteracting how much water your stool loses as it moves through your intestine. Docusate is usually easy to tolerate but may occasionally cause diarrhea or stomach cramps. Unlike mineral oil, it doesn’t interfere with absorption of nutrients or any vitamins.

You’ll find docusate more effective as a preventative than as a laxative because it works more slowly. You should allow 12 to 72 hours for it to work. Most of the time it will give you results within 2 days but can take up to five days for full effect. It’s often combined with a stimulating laxative for a faster effect.

The other emollient laxative is mineral oil. Mineral oil is a liquid that helps to soften the stool but doesn’t change the amount of water in it like docusate does. Mineral oil is not as safe to use as docusate because if you aspirate or inhale it by accident it can cause life-threatening irritation to your lungs called aspiration pneumonitis. Mineral oil interferes with absorption of fat-soluble vitamins like vitamin A, D, E and K, and can cause oily leakage out of the rectum. Avoid taking docusate along with mineral oil as a laxative. Docusate will help mineral oil get absorbed into your body instead of staying in your intestines, where it needs to be to work.

5 Tips for Using Docusate Successfully as a Stool Softener:

  1. Increase your water and fluid intake when taking docusate; this will increase its effectiveness. Because docusate works by helping move water into your stool, drinking more fluids help it do its job better.
  2. If you are on a sodium-restricted diet, look for the calcium form of docusate instead of the more common sodium formulation. Docusate calcium comes as a 240mg capsule instead of 250mg, like docusate. It’s sometimes hard to find; if you don’t see the calcium form of docusate on the shelf, ask your pharmacist.
  3. Docusate sodium comes as liquid-filled capsules in two sizes: a 100 mg size and a much bigger 250 mg size. If you have any trouble swallowing capsules, you should select the 100 mg capsules, but because the 100 mg and the 250 mg are usually about the same price, the 250mg capsules are a better value.
  4. Although I have seen root beer flavored mineral oil, most mineral oil is bland tasting. Docusate is not bland. It tastes just like soap! Avoid biting or cutting docusate capsules unless you like the taste of your mother washing your mouth out with soap. The syrup is nearly as bad; it ranks consistently at the bottom of our liquid taste tests and the soapy taste can linger for hours.
  5. If you need a faster result, combine docusate with a more stimulating laxative like senna or bisacodyl. Senakot-S® and Peri-Colace® are examples of combination products.

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How To Take Your Thyroid Medicine

Q: My husband takes a thyroid medicine called levothyroxine. He went to his doctor last week because he’d been feeling tired and the doctor told him it’s because he’s taking his thyroid pills wrong. All these years he’s taken it with his other morning pills at breakfast, but now he’s supposed to take it 30 minutes BEFORE his breakfast instead. He’s tried to make the switch but it’s really hard for him to remember to take it first thing in the morning. Is there anything we can do?

Levothyroxine is a very potent medicine; even small changes in the dose can create big differences in how much energy you have. How much levothyroxine you need can depend not only on how much medicine is prescribed by your doctor, but also on HOW you take those pills. Your husband may not be getting the entire dose of his thyroid medicine because food can interfere with the ability of levothyroxine to get into your body.

Like most medicines, in order to do its job levothyroxine must first get into your body. It needs to jump from a pill sitting in an amber prescription bottle all the way into your thyroid gland, where it works to support your metabolism and give you energy.

When you swallow a pill it doesn’t magically dissolve in your stomach and do its thing right then and there. Most medicines need to get into your bloodstream first before they can get to where they need to go and do what they are supposed to do. Although your pills dissolve in your stomach they can’t jump into your body from there. Instead, medicines and nutrients have to leave your stomach and move into your small intestine before they can be launched into your body.

Your small intestine is a busy place. Its walls are covered with blood vessels and specialized cells designed to transport nutrients and medicines into your bloodstream, where they get carried on throughout your body and delivered to where they need to be, like levothyroxine going to your thyroid gland.

The process of medicine going from a pill you swallow to entering your bloodstream is called absorption. Some medicines are better at being absorbed than others. While many medicines are completely absorbed after you take them, other medicines like levothyroxine can run into trouble along the way, resulting in less of it getting into your body and doing its job.

Your husband will get more consistent results from taking his levothyroxine on an empty stomach because food and certain minerals can attach themselves to it and prevent it from making the trip through the wall of his small intestine into his bloodstream and on to his thyroid gland.

But the most important thing of all is taking it consistently, every day, the same way. His doctor will use blood tests to adjust his levothyroxine dose if he needs more.

Here Are 5 Tips For Best Results When Taking Levothyroxine:

  1. Levothyroxine is absorbed best on an empty stomach, either AT LEAST 30 minutes before a meal OR 3-4 hours after you’ve finished eating.
  2. If you have trouble remembering to take your levothyroxine first thing in the morning, try taking it at bedtime instead, as long as it’s been at least 3 hours since your evening meal. Taking it at bedtime may be easier to remember than taking it all by itself in the morning, especially if you take other medicines at the same time.
  3. If you forget to take your levothyroxine before breakfast, go ahead and take it anyway. Don’t worry, your stomach is not going to blow up, your intestines are not going to fall apart and your thyroid is not going to die. If you take levothyroxine with your meal you may not absorb the whole dose but if you skip entirely it you won’t get ANY of it absorbed! And that’s worse.
  4. If trying to take levothyroxine on an empty stomach is too complicated to do, don’t panic. It’s perfectly okay to take levothyroxine with your breakfast or other meal, as long as you take it that way all the time. Many patients are perfectly successful taking levothyroxine because they ALWAYS take it with their breakfast and don’t skip any doses.
  5. If you take calcium or iron supplements, don’t take them at the same time as levothyroxine. These minerals can significantly reduce the amount of levothyroxine that you absorb, so it’s best to separate them by at least 3-4 hours.

 

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Question About Newer Pneumococcal Vaccines

Q: In May of 2014, I was in the hospital for inguinal hernia repair and was offered the Pneumovax® 23, which I had been wanting for some time but none of my doctors would approve it. I did not ask for the Pneumovax® 23 at this time; it was offered to me and I accepted. I recently requested the Prevnar® 13, but my doctor denied it because I am not yet 65 (I understand the usual guidelines). I do have chronic health issues, which I believe would be an exception to the guidelines. What I don’t understand is, why give one without the other? Why be protected by 23 but not the additional 13?

The Pneumovax® 23 and Prevnar® 13 vaccines have 12 serotypes or variations, in common, which protect you against over the same 12 variations of the illness. Prevnar® 13 covers one more serotype, and Pneumovax® 23 covers 11 more serotypes. If you get immunized with Prevnar® 13 you are only getting 1 new serotype compared to the older vaccine.

What’s the main difference between the two vaccines? Although you don’t get as broad of coverage because of only 13 serotypes compared to 23 serotypes, the immune response from the Prevnar® 13 has been shown to be is a little bit better than with the Pneumovax® 23.

The Prevnar® 13 vaccine is recommended for all adults 65 years and older, but for younger adults ONLY IF you have a medical condition that causes you to be immunocompromised, such as removal of your spleen, HIV infection, organ transplant, chronic kidney failure, or long term use of immunosuppressive drugs like cortisone or Humira®. If you have one of those conditions, the Prevnar® 13 would give you a little better protection.

Since you received the Pneumovax® 23 before age 65, you should get another dose of it at or after age 65. However, for the best protection you should wait at least 11months or 1 year before getting the other pneumococcal vaccine. This means that if you get the Prevnar® 13 at age 65, you should wait a year before getting the Pneumovax® 23.

According to the Centers for Disease Control and Prevention (CDC), the maximum number of pneumococcal vaccines needed three: up to 2 doses of the older Pneumovax® 23 vaccine and only 1 dose of the Prevnar® 13. Most pharmacies carry both vaccines and can administer them to you. If your doctor declines to give you Prevnar®13, you have the option of going to your local pharmacy and having them give it to you.

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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 www.nof.org.

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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 http://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/understandinggenericdrugs/default.htm.

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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: https://www.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1.

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: www.fda.gov/ForConsumers. Just don’t ask me any tough questions before I have my morning cup of Joe…

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