Does Drawing Salve Really Work?

Last week my phone rang as I was cleaning up the dinner dishes. Picking it up, I heard my neighbor’s voice on the other end. “Hi, Jerianne. How’s it going?”

“Fine, Louise. This is going to sound odd, but I was calling to see if you might happen to have some drawing salve I could borrow.”

“Actually, I DO. I found it when I was clearing out my Dad’s medicine cabinet a couple of years ago and kept it because I’d never seen a tube of drawing salve before. It has ichthammol in it. Is that what you’re looking for?

“Yes, exactly! Joe and I were in Mexico last week and today he noticed a red, swollen bump behind his left knee. It looked to me like some sort of tick embedded in his skin, so I used tweezers on it. I pulled some of it out but there are still some black things sticking out, maybe its legs? Ugh! We’re going to the doctor tomorrow but I wanted to put some drawing salve on it tonight to help the swelling and redness. Can I borrow your salve?”

“Sure. Come on down.”

Five minutes later I handed over my half-used tube of ichthammol, NF ointment. “Let me know how it works for you, okay?”

I’d kept that beat up tube of dark stinky ointment because you just don’t see that stuff much any more, and I wanted to find out more about it.

What does “drawing salve” do? The purpose of a drawing salve is to help a boil to come to a head so it can be drained. Another use is to “draw” splinters or other small foreign objects up to the surface of the skin where they can be removed by tweezers. Drawing salves are usually dark and often stinky. You put a small amount of a dark, stinky, and sticky ointment on a bandage then apply it to the area right over the splinter or boil, leaving it on overnight and reapplying if needed in the morning.

My neighbor was looking for ichthammol or ichthyol, which she was familiar with from her experience growing up around horses. Today when people talk about using drawing salve they mean an ointment containing ichthyol or ichthammol.

Ichthyol was discovered in the 1880s from shale deposits found around the Tyrol region of the Alps. Layered between the veins of this shale are layers of rock decorated with dramatic and detailed fossils of animals and fish. Called “oil-stone” or “stink-stone”, Rudolph Schroter found that when crushed and combined with steam, the shale, also called “oil-stone” or “stink-stone produced a distinctive oil high in sulfur. Schroter named the oil Ichthyol, or “fish oil” from ichthys, the Greek word for fish because of the beautiful and detailed imprints of fossilized prehistoric fish in the rock formations that surrounding the veins of shale.

Ichthyol became a major success. In the late 1880s Dr. Paul Gerson Unna, a famous German physician used ichthyol extensively in his remedies for skin problems. Ichthyol contains approximately 15% sulfur and has anti-inflammatory and anti-infective properties. Applied as an ointment, it softens the skin, allowing splinters and boils to come to the surface more easily.

Ichthyol is still mined and produced by the Ichthyol Company of Hamburg and used today, but under different names. The most common are ichthyol, ichthammol, ammonium bituminosulfonate and ammonium bituminosulfate. My old tube contains ichthammol USP, which is made by mixing ichthyol oil with a small amount of lanolin then combining that mixture with petroleum jelly or white petrolatum to make a 20% ichthammol ointment.

Jerianne called a couple of days later, thanking me for letting her borrow my ichthammol ointment. She’d put a dab of the smelly ointment on a Band-Aid® then applied it to the inflamed area behind Joe’s knee. When she peeked at it the next morning the redness was totally gone and the swelling had nearly disappeared. The doctor removed the rest of the mysterious bug parts and it was healing well.

You can find ichthammol ointment at your local veterinary supply or on the internet. Rite-Aid has its own house brand of ichthammol ointment, which also works well. It isn’t a commonly used product these days, so if you don’t see it on the shelf, ask the Rite-Aid pharmacist if he or she can special-order a tube for you.

Watch out for ointments from China. There is ammonium bituminosulfate from China that does not contain ichthyol or ichthammol and doesn’t seem to work as well, either. The real stuff is dark reddish brown and smells like fresh asphalt.

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Which is the Best Antihistamine For You?

Q: Every summer my nose runs and my eyes itch from my allergies. Claritin® has worked for me in the past but for some reason this year is different. I tried Allegra®, but it’s not helping, either. What other antihistamines could I try?

Antihistamines work by keeping histamine locked away inside your body. Histamine is a compound that triggers inflammation and is stored in special cells in your body called mast cells. When you come in contact with something you’re allergic to, your mast cells open up, spilling out histamine and triggering the symptoms we associate with an allergic reaction: stuffy or runny nose, itchy eyes and sinus pressure.

Because they work by preventing histamine from escaping from your mast cells, antihistamines work best if you take them at least 1 hour BEFORE being exposed to what sets your allergies off.
Which antihistamine you should try depends on which one will work best for you and how drowsy it makes you. There are 2 main categories of antihistamine medicines to choose from: sedating ones and non-sedating ones. The sedating antihistamines are older drugs that often cause drowsiness and dry you out. This drying action can actually help relieve your runny nose and watery eyes. Newer antihistamines don’t drowsiness but may not be as effective at drying up a runny nose.

Some antihistamines relieve allergy symptoms better with some people than with others. Many people have to try more than one before they find the one that works best for their allergy symptoms while causing the least drowsiness.

How important to you is avoiding drowsiness? Older antihistamines cause at least some drowsiness in most people. If this is a concern for you, start with the newer antihistamines because they cost little to no drowsiness.

One of the best antihistamines to try first is loratadine, also known as Claritin® and Alavert®. It’s taken only once a day, and rarely causes drowsiness. If loratadine isn’t helping you, another newer non-sedating antihistamine is Allegra®, or fexofenadine, available in either twice a day or once a day versions.

If either of those is not working for you, try cetirizine (Zyrtec®). It’s more likely to cause you some drowsiness compared to Claritin® or Allegra® but because it’s more drying than either of them it can help dry up your runny nose. You only have to take it once a day and it causes minimal drowsiness.

If Claritin®, Allegra® or Zyrtec® aren’t giving you enough relief, you can try one of the older sedating antihistamines. The most powerful is Benadryl® also known as diphenhydramine. It helps with serious allergic symptoms but will cause drowsiness in most people. In fact, you can buy diphenhydramine as a sleeping pill without a prescription as Tylenol PM® or Sominex II. Benadryl® needs to be taken 3 to 4 times a day for best results. Some people take it just at night and substitute another antihistamine during the day.

There are other older antihistamines still available, including chlorpheniramine, brompheniramine, and triprolidine. Triprolidine causes less drowsiness than the other older antihistamines and seems to have the most drying action as well. Surgeons used to avoid having their nose drip while doing surgery. Its main drawback is that it’s only available as Actifed®, a combination with the original formulation of Sudafed®. I really like how effective it is for runny nose, watery eyes and nasal congestion.

4 Tips on how to choose an antihistamine:

1. Take a dose of your antihistamine BEFORE you come in contact with what you are allergic to, if possible. That way you’ll get better results than if you wait until your nose stuffs up and your eyes start itching.

2.  If you have to drive or use machinery, choose one of the newer non-sedating antihistmines like loratidine (Claritin®), fexofenadine (Allegra®) or cetirazine (Zyrtec®) first.  Everyone is a little different in how they react to a medicine.

3. If your first antihistamine choice doesn’t help you, try another one. It’s not unusual to get good results with one yet very little relief from another.

4. An antihistamine can be purchased as a single agent or combined with other medicines, like a decongestant. I recommend you avoid the Sudafed PE® that is sold on the shelf which contains phenylephrine because it is not as effective as the original formula of Sudafed® containing pseudoephedrine. If you need a decongestant for a stuffy nose I recommend the original version of Sudafed®, available from your pharmacist.  You will need to bring photo identification to purchase it. Triprolidine/pseudoephedrine (Actifed®) is a good choice for runny and stuffy nose symptoms.

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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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New Options For Your Allergies

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

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

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

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

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

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

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

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

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

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Which Medicine to Pack When You Travel

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

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

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

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

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

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

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

Bon voyage and safe travels!

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Does Bag Balm® Get “Too Old”?

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

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

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Medication Safety: Question Everything

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And watch out for wiener dogs running with fireworks…

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The Medical Version of “Telephone”

Have you ever played the game “Telephone”?  No?  Well, maybe you called it “Gossip”.
“Telephone” is a game for a group of at least 3 people that starts with everyone making a line or with enough people, a circle. One person (Player Number One) starts the game by thinking of a “secret phrase” or short sentence. They whisper their phrase word for word carefully to the person standing immediately to their right.

After hearing the “secret phrase” from Player Number One, Player Number Two turns to their right and whispers the secret sentence onward to Player Number Three. Player Number Three whispers the phrase exactly as they heard it from Player Number Two into the ear of Player Number Four. This goes on around the circle until the secret phrase is whispered to Player Number One, the one who started it all.

When Player Number One gets the final version of the secret phrase, he or she shares it with the group, along with the original version. The fun is in hearing how each word develops such a wacky variation from start to finish that the final version is practically unrecognizable from the first. Traveling through 5 different people, “Peter picked a peck of pickled peppers” transforms into “Pass me some spotted pickles for my pizza.”

The variations you “hear” in the phrase as it is whispered to you are what make this game so funny. The more the original phrase gets bent out of shape, the funnier it gets.  How does a simple message get so distorted so quickly, transforming it into something nearly unrecognizable from its original meaning?

Have you played “Telephone” recently? If you have gotten medical care from more than one place, either from a specialist, an urgent or convenient care clinic, emergency department or hospital, you’ve played the medical version of “Telephone”.

In America, we value having choices. And for most of us, we have several options of where to go for our medical care. Choosing our own doctors, dentists, and hospitals is important to us, but there is a dark side to having multiple options for care. Every time we change systems or go outside our current care providers, we start a round of “Telephone” which opens up the opportunity for our vital medical information to get missed, miscommunicated or misunderstood.

You may remember when your family had one doctor, who saw you at his or her clinic and came into the hospital to care for you if you became sick or injured. That focused care rarely happens today. Today’s hospitals hire doctors to take care of any patients admitted to their facility, called hospitalists. Hospital-based doctors allow other doctors to concentrate on seeing patients in their clinics without having to go to the hospital after a long day at the office.

Today’s medical care system is made up of shift workers. Hospitalists and nurses work in specific time segments or shifts, and when it’s time to go home they transfer the care of their patients to someone else, called a “hand-off”. They must communicate what needs to be done to their colleague coming on shift. Will that new clinician always understand and follow through? Every time a hand-off occurs is an opportunity for misunderstandings and particularly for omissions. This version of “Telephone” can lead to life-threatening deviations from the original plan of care.

Do you or a loved one see a medical specialist, like a cardiologist or urologist? Have you been seen in the emergency room or hospital recently? Moving from one care setting to another is called a “transition of care”. Every time you get medical care from another setting is an opportunity for mistakes, omissions, and misunderstandings to occur.

When 86-year old Jessie fell and broke her hip at home, she didn’t have a medication list ready when the paramedics came to take her to the nearest hospital. The hospital had to piece together bits from her family doctor, cardiologist and urologist. Missing crucial information about current medications or giving the wrong dose because of outdated medical records at a specialist’s office can be devastating.

One of the most critical tools to keep yourself safe and your loved ones safe from medication errors and omissions from medical versions of “Telephone” is keeping a current list of your medications and showing it to EVERY medical provider you see. More information about transitions of care and how you can protect yourself is available at http://www.ntocc.org/WhoWeServe/Consumers.aspx.

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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 www.KnowYourTeeth.com, in their reference section under D (for dry mouth).

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