How Do Drugs Work? and General Health Topics

General Health Topic - Wearing ID While Participating in Sports

2009-10-05T13:08:00.002-05:00

Hello Everyone,

I am sadly writing about this topic again.

Another tragedy just occurred in the area, Two cyclists were riding a tandem bicycle on a common cycling route outside of town. A distracted motorist plowed into the rear of the cyclists killing the woman instantly. The male rider was still alive and taken to a hospital where he later died.

The female rider was wearing an ID bracelet and was able to be identified. The male rider was not wearing ID and was not able to be identified until the next day. At that time, the male rider was identified as the husband of the female rider.

Wearing a sport ID would not have saved their lives. However, it would have made identification of the riders easier, with quicker notification of relatives.

To motorist - Please pay attention to what you are doing! More cyclist and motorcycles are sharing the road. Pay attention to your surroundings! Please give cyclists a very wide berth if possible.

To cyclists - Pay attention to your surroundings!. DO NOT wear headphones while you are riding! Be careful.

There are many suppliers of Medical and Sports ID. Please get one.

I hope we will not have any more of these tragic stories.

Until later,

Dr. Paul

General Health Topic - Emergency ID

2009-09-30T07:17:00.001-05:00

Hello Everyone,

I was going to include this topic in my last post on Medical ID. However, since it is such an important topic, it deserves it's own article.

My last topic was on the importance or wearing Medical ID if you have a medical condition that warrants it. This topic is on wearing identification even if you do not have a medical problem.

Are you a jogger, cyclist or walker? Do you go to the gym, leave your ID in your car or in the locker? If so, you need to be wearing some type of sports ID.

There have been at least 2 incidences in the area where ID could have been helpful.

1. A man was struck by a vehicle while running. When he was taken to the local trauma center, he was unrecognizable due to his injuries. He did not have any ID on him and he was probably listed as a "John Doe". The doctors and nurses working frantically to save his life did not recognize him. Unfortunately, the patient died from his injuries. As it turned out, the patient worked in that emergency room.

2. A young man was out running and was hit by a vehicle. I am not sure but he may have died on the scene or later. However, he did not have any ID and it took authorities 5+ hours to identify the person

These are just two examples to show that carrying ID is important. In these two incidences, the ID would not have saved their lives. However, it would have been easier for the authorities to notify the men's emergency contacts.

An ID used while exercising should have your name, allergies, medical conditions, emergency contact information, doctors name and any other information that may be important.

There are sports ID that attach to the running shoe, wrist bands, ankle bands, cycling helmet stickers. I prefer to use the type that attaches to my running shoes. That way I don't have to remember to put anything on.

Many sports ID products also have reflective material to make the wearer more visible.

Even in the gym, wear an ID on your person. If you collapse after a hard session on the elliptical trainer, an ID in your locker will not help you!

There are many companies that provide sport ID products. make the small investment and be safe.

One last thought / comment. In at least one of the examples above, the jogger was wearing headphones.

DON'T WEAR HEADPHONES WHILE YOU ARE OUT RUNNING OR CYCLING!!!!!!!!!!

It is not safe. You need to be aware of your surroundings, cars, people, other runners, cyclists etc.

Until later,

Dr. Paul

General Health Topics - Medical Identification

2009-09-30T01:56:00.000-05:00

Hello Everyone,

It has been a while since I have written about this topic. However, several things have happened in the area which brings the topic to the forefront.

Wearing medical ID is so important and it is a potentially life saving practice. Are you diabetic, have a pacemaker, defibrillator or other heart condition? Do you have asthma, epilepsy or on anti-coagulation medicine? If you have any of these or other medical conditions, you need to let people know.

One of the easiest ways to notify people that you have a condition that requires special attention in the event of an emergency, is to be wearing some sort of medical ID.

For example, a gentleman is in the grocery store and faints suddenly. The bystanders come to his aid and the first thought may be that he has had a heart attack. The paramedics are called and they arrive in a few minutes but the patient has not revived. He is taken to a local hospital when he makes a full recovery.

Taking the same scenario, a gentleman goes down in the grocery store. This time he is wearing a medical ID bracelet that identifies him as having diabetes. This information is relayed to the paramedics. Since a common problem with diabetics is having an episode of LOW blood sugar (hypoglycemia), this could alert bystanders or emergency personnel that the first step to take would be to try to revive the patient with glucose. The patient is administered a dose of glucose in the store, he recovers and a trip to the hospital may not be necessary.

The Medical ID can be in the form of a bracelet, pendant or watch tag. I recommend that the ID be something that you wear, not just in your pocket. There are wallet cards, key fobs and other types, however, in the case of emergency, you may not have your wallet or keys on your person.

There are many companies that can provide you a Medical ID. They are not free, however, it is a good investment.

Please take a few minutes and obtain a Medical ID. It may save your life!

Until Later

Dr. Paul

General Health Topic - Exercise Induced Asthma

2009-08-27T22:49:00.002-05:00

Hello everyone,

Does this ever happen?.... you go to the gym and within a few minutes of starting your workout you are extremely tired or short of breath? Do you experience chest tightness, wheezing or coughing when you exercise? The first thing you may be thinking is wow, I need to get into better shape! If you do, you might have exercise induced asthma (EIA).

According to the American Academy of Allergy, Asthma and Immunology (AAAI) brochure to help educate patients, approximately 20 million Americans have EIA. Their airways may be overly sensitive to changes in temperature and humidity, especially colder, drier air. While exercising, many people start breathing through their mouths, bypassing the warm moist nasal passages which allows colder, less humid air to reach the lungs.

To know for sure if you have EIA or even a chronic asthma condition, you need to see your physician to get tested. If positive for EIA, work out a treatment plan with your physician and pharmacist. There are many treatments that are effective in controlling EIA.

Inhaled medications taken prior to exercise are helpful in preventing or controlling EIA. The medication of choice is a short-acting bronchodilator spray used 15 minutes before exercise. These medications, which include albuterol and levalbuterol are effective in the majority of patients. They work quickly and last for up to four to six hours. These inhalers can also treat EIA symptoms after they occur.

If symptoms are not readily controlled by medications, patients should talk to their physician.

A severe asthma attack is a medical emergency and if EIA symptoms cannot be controlled, more rescue medications may be needed. An "Epi-pen" (epinephrine injection) and emergency supplemental oxygen are items that should be available.

Enjoy your workout.

Dr. Paul

General Health Topic - Medical ID Cards

2009-08-15T13:00:00.004-05:00

Hello Everyone,

In a previous post I stressed the importance of EVERYONE carrying in their wallet or in their purse a copy of their medication lists and other important medical information.

Here is a link you can use to generate a FREE medical ID card that has your medical conditions, medications, physician information that you can carry with you at all times.

http://www.medids.com/free-id.php

If your spouse, significant other, children or other people in your care are on multiple medications, you should also carry a copy of their medical information as well. I have seen many occasions where a person will present to an emergency room, unable to speak and the family member that is with them does not know the medications the person is taking.

http://www.medids.com/free-id.php

Please take a few minutes to enter in the information and generate an ID card for yourself and loved ones.

Thanks,

Dr. Paul

General Health Topic - New System to Eliminate Tattoos

2009-08-13T22:30:00.004-05:00

Hello Everyone,

A tattoo is forever. Or is it? At one of the hospitals where I work, on one Saturday per month, they host a tattoo removal clinic. Several practitioners donate their time and equipment to perform laser tattoo removal.

This clinic is "PACKED"!!!. There are so many people that are enduring this painful procedure to have their tattoo removed. I suppose that they wish that their tattoo wasn't so permanent.

Check out this new system that has been developed to fade tattoos without the use of painful lasers.

If anyone tries it out, please let me know the results.

Thanks,

Dr. Paul

General Health Topic - Cardiac Arrest or Heart Attack?

2009-02-17T10:00:00.002-06:00

Hello Everyone,

Here is a great article from Bottom Line's "Daily Health News" that I want to pass along. some great information here that just might save a life!

Cardiac Arrest or Heart Attack

A heart attack and cardiac arrest are the same, right? Wrong. While many of us use the terms interchangeably, those in the know are aware that they are two very different things. And, most importantly, that they require very different emergency treatment. A person's likelihood of surviving a cardiac emergency has much to do with what happens in the moments after it becomes apparent that something terrible is happening. Always call 911 first... but be aware that what you tell the dispatcher can make the difference between life and death... and what you do while awaiting the arrival of emergency personnel is not exactly the same for people suffering cardiac arrest as it is for those having a heart attack.

The reason the distinction is important is that a person in cardiac arrest needs a defibrillator immediately and the results of a new study show getting immediate care can save lives. Researchers found that one symptom in particular -- noisy breathing, in the form of gasping, gurgling, moaning, snorting, even snoring -- is both a result of cardiac arrest and a predictor of the likelihood of survival. I urge you to read this article all the way to the end in order to understand some important differences that truly may end up saving a life -- yours, someone you care about, even that of a stranger in line behind you at the supermarket.

In order to understand, let's first define the terms. A heart attack is what happens when the heart does not receive enough blood due to a blockage, leading to muscle damage. Cardiac arrest is when the heart stops pumping blood due to an arrhythmia (ventricular fibrillation). This can be caused by a heart attack but can also result from previous damage to the heart from a heart attack or from other heart conditions.

RECOGNIZING CARDIAC ARREST:
EVERY SECOND COUNTS

Cardiac arrest strikes immediately and without warning. If a person is upright when cardiac arrest occurs, he/she will immediately collapse due to a loss of consciousness. Signs of cardiac arrest include a sudden loss of responsiveness (for instance, no response when you tap on the victim's shoulder or call his/her name)... abnormal breathing sounds (gasping, groaning, moaning, even snoring -- which can sound halting, labored or like gurgling). These sounds are evidence that blood flow to the brain and body has been severely impaired and the brain can no longer coordinate the functions of normal breathing.

How to respond...

Call 911.
Report whether the person is breathing or not and describe what the breathing sounds like to the dispatcher.
Perform CPR (cardiopulmonary resuscitation). If a person's heart stops beating, even bystanders who are untrained in CPR can help: Simply push hard and fast in the center of the chest until emergency personnel arrive. Aim for 100 compressions/minute. The 911 emergency dispatcher can also tell you how to properly perform CPR. A victim who receives CPR and/or defibrillation doubles or triples his chance of survival.
Get an automated external defibrillator (AED), if one is available, and use it at once. Commonly available in malls, airplanes, gyms and office buildings, AEDs help restore normal heart rhythm. Though it is vastly better to have a person who is trained in its use administer the treatment, the AED is designed to quickly guide even the untrained responder through the right steps in its lifesaving use.
Important: In the University of Arizona study, published in the December 9, 2008, issue of Circulation, presence of abnormal breathing correlated with a greater likelihood of survival. The study found that of patients who received emergency intervention (CPR), 39% of those who had gasped survived... compared with just 9% of those who did not have abnormal breathing. Survival plummeted among those who didn't get bystander help (21% of gaspers, compared with 7% for non-gaspers), with the odds decreasing steadily in relation to how long it took for emergency medical services to be administered.

RECOGNIZING HEART ATTACK:
EVERY MINUTE COUNTS

About one in four Americans recognizes the warning signs of a heart attack and would call or seek help for someone appearing to have a heart attack, according to a study from the Centers for Disease Control and Prevention. Once again, immediate action is critical, since faster intervention reduces the amount of muscle damage... and extensive muscle damage can lead to cardiac arrest, right away or down the road.

The warning signs: The most widely recognized symptom of a heart attack is crushing chest pain, often radiating to one or both arms. But many individuals who have heart attacks do not experience such obvious symptoms, warns Keith Churchwell, MD, assistant professor of medicine and executive medical director of the Vanderbilt Heart and Vascular Institute in Nashville, Tennessee. In fact, some heart attacks are "silent," without the classic symptoms, or sometimes (though rarely) with no symptoms at all. Other signs include arm, jaw, neck, back or abdominal pain, chest discomfort or tightness... shortness of breath... faintness... nausea or vomiting. Women are more likely than men to experience shortness of breath, nausea, vomiting, and back or jaw pain as their primary symptom.

How to respond...

Call 911. Even if you're not sure that symptoms constitute a heart attack, don't take chances. Calling 911 is nearly always the fastest way to get treatment, and people with chest pain who arrive in hospitals by ambulance receive care more promptly.
Do not use a defibrillator on a person who is not in cardiac arrest. A heart attack by itself is not a reason to use a defibrillator and its use in this situation would be dangerous and could cause death.
Chew an aspirin. Aspirin has anti-clotting properties, and chewed aspirin enters the bloodstream faster.
Note: The American Heart Association offers online CPR and AED training at www.americanheart.org. This should be paired with hands-on instruction. To find a CPR class near you, enter your zip code or state at www.americanheart.org.

Alertness to the signs and symptoms of cardiac arrest and heart attack is the single best way to increase the odds a person will survive. Listen to your body, Dr. Churchwell urges, and see your doctor if something seems amiss. If someone near you collapses, move quickly to get help. Seconds and minutes will make a difference and doing something is always better than doing nothing.

Source(s):

Keith Churchwell, MD, assistant professor of medicine, executive medical director, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee.

American Heart Association, www.americanheart.org.

General Health Topics - Selecting A Nursing Home

2008-12-03T00:51:00.002-06:00

Hello Everyone,

At some point in time almost everyone may be faced with a decision to place a loved one in a nursing home. It is a very difficult decision both for the person being admitted into the home as well as the family.

There are many nursing homes in your area. While I feel that most of the caregivers in the homes do care and try to do the right things, there are some homes that perform those duties better than others.

There is a website www.medicare.gov that lists 50 nursing homes that consistently fail to meet quality of care and safety standards. When you go to this website, click on "Compare Nursing Homes in your Area".

While it doesn't list the best homes in your area, it can alert you to the homes you need to avoid. And, according to Kerry Weems, acting administrator for the Center for Medicare and Medicaid services, in the May 15th edition of "Bottom Line", if your loved one is in one of the homes listed, consider moving to a better nursing home.

Hopefully this information can help in making this very difficult decision.

Until then,

Dr. Paul

General Health Topic - Time for your Annual Flu Shot!

2008-11-01T08:23:00.001-05:00

Hello Everyone,

Flu season is here. Now is the time to get your annual flu shot.

The following folks are the ones who really need to get vaccinated:

Over age 50
Any age if you have chronic medical conditions such as high blood pressure, irregular heartbeat, history of stroke or heart attack, diabetes, compromised immune system, anemia, asthma or other breathing problems
If you live in a nursing home
If you live in a house with people listed above
Health care workers

Check with your local pharmacy, Dr's offices, County Health Departments etc. concerning locations to get your flu shots. Many locations give the shots at low or reduced cost. Many locations will bill Medicare on your behalf if you are a qualified recipient.

If you are employed, ask your employer if they will be sponsoring a flu vaccine clinic. Or, organize a health fair at your office and make arrangements to have flu shots given at that time. Contact me if you need more information on how to set up a health fair. Many employers will provide flu shots at no cost because it may result in fewer sick days taken by the employees.

I have included some links for more information.

http://www.cdc.gov/flu/protect/keyfacts.htm

http://www.nlm.nih.gov/medlineplus/spanish/tutorials/influenzaspanish/htm/index.htm

http://www.walgreens.com/storelocator/find.jsp?check=true

Remember - THINGS TO DO THIS WEEK

1. Read Dr. Paul's notes

2. Go Grocery Shopping

3. GET FLU SHOT

4. Pay Bills

Please let me know if you are finding this information helpful. If you have any suggestions for future topics, let me know.

Thanks for your time,

Dr. Paul

General Health Topic - Know YOUR Medications

2008-10-12T13:14:00.002-05:00

Hello Everyone!

Drug, Medications, Pills Tablets, Capsules, Suppositories, Troches, Injections, Nasal sprays, Eye drops, Ear Drops.........

It's hard to keep track of them all.I know that the goal is for folks not to HAVE to take drugs. Because when we do, it usually means something is not quite right. It could be high blood pressure, cancer, headache, constipation or a myriad of other problems. Of course, sometimes we take drugs because we want to...like vitamins to try to stay healthy. Hopefully YOU don't have to take any medications. But, if you do, do you know what they are? What the drugs are for, the strength of the medications, how you are supposed to take them?I am not talking about a conversation like this:

Dr. Paul "Hi Ms Garcia, I need to update your medication profile, tell me the drugs you are taking."

Ms Garcia "Hello Dr. Paul. I am taking a little blue pill in the morning. I think it is for my heart and I take a round pink pill at night. I'm not sure what it is for."

I know what you are thinking, It doesn't go like that, does it? Yes it does! Or you might be saying, That sounds like me! Or my Mom/Dad, or my Grandmother/Father.

As a pharmacist that conversation doesn't help me one bit. More importantly, IT DOESN'T HELP YOU!

See how this one sounds to you.Dr. Paul "Hi Ms Garcia, I need to update your medication profile, tell me the drugs you are taking."

Ms Garcia "Hello Dr. Paul. I am taking Lasix 20mg in the morning at 8am for my blood pressure. I also take Coreg 6.25mg twice daily at around 8am and 8pm for my blood pressure."

Now we're talking.But wait, you are probably saying, How am I supposed to remember all those crazy sounding names and numbers and stuff. I'm lucky to remember to take the pills!I realize that. It's hard to remember brand name and generic names of drugs. They are hard to pronounce and the chemical name....forget it! They also come in all sorts of mg strengths and sizes... it can make your head swim.

Here come the pointers.Looking at your medication bottles, write down the name of the drug, the strength, how often you are supposed to take it, etc. on a piece of paper. If you know why you are taking it, write that down as well. Do that for every drug you are taking.

Now, take that list and put it in your wallet or purse. Make copies of that list and give them to your kids so they know what you are taking.Try to remember to update that list every time you add or delete a medication. So next time you need to know the drugs you are taking, pull out your list.You can write the list with your computer, print it out and that way it can be more legible. Easier to update as well.. There are forms available online or you can pick up medication cards at your pharmacy if you need themThere are many great computer programs available to help you keep track of your medications and health information. Some are free, some charge for their product. They are all good. Probably way better than you are using now.

Here are some links that you may find helpful:http://www.theguidetogoodcare.com/http://www.mymedilist.org/So get up right now. No, not later....Right now and get your list together. Don't forget to put it in your purse or wallet. It may save your life one day.

NO Kidding!

Until later,

Dr. Paul

General Health Topic - "The History of Medicine"

2008-07-28T15:36:00.000-05:00

Hello Everyone,

Here is a little something that will hopefully brighten your morning.

The "History" of Medicine

"Doctor, I have an Earache."

2000 B.C.: "Here, eat this root."

1000 B.C.: "That root is heathen, say this prayer."

1850 A.D.: "That prayer is superstition, drink this potion."

1940 A.D.: "That potion is snake oil, swallow this pill."

1985 A.D.: "That pill is ineffective, take this antibiotic."

2008 A.D.: "That antibiotic is artificial. Here, eat this root!"

Author Unknown

Thanks,

Dr. Paul

General Health Topic - OTC Recommendations - Continued

2008-07-04T12:00:00.005-05:00

Hello Everyone,

See....I told you it wouldn't be a month till my next post!

Since it is the middle of the summer and time for outdoor activities, I am going to cover the OTC products for the skin that pharmacists recommend most. This list was published in the June 2008 edition of Drug Topics.

Acne preps/treatments

Oxy
Neutrogena

Skin Moisturizers

Eucerin Facial
Lubriderm

Canker/Cold sore remedies
Abreva
Zilactin

Diaper Rash Remedies

Desitin
A&D Ointment
Note: my personal favorite - Beaudreaux's Butt Paste

Insect Repellents
OFF!
Cutter

Poison Ivy Treatments
Cortaid
Ivy-Dry

Athlete's Foot Remedies
Lamisil
Clotrimazole

Sunless Tanners
Neutrogena
Coppertone

Topical Anesthetics
Solarcaine
Aloe Vera Gel

Wrinkle Creams
Oil of Olay
Neutrogena
La Mer

Suntan / Sunscreen Products
Coppertone - High SPF
Neutrogena - High SPF

Try not to spend too much time out in the sun. Use plenty of high SPF sunscreen, stay in the shade if possible and stay hydrated.....with water.

Stay Cool!

Dr. Paul

General Health Topic - OTC Recommendations - Continued

2008-07-04T08:30:00.000-05:00

Hello Everyone,

Where does the time go. I have been traveling so much, I have not had a chance to write very many articles. While preparing for today's post, I realized that it has almost been one month since my last post. I apologize for that.

With that said, here is the continuation of the Drug Topics article of the brand that are recommended most by pharmacists.

Today we are going to list the gastrointestinal medications:

Bulk Laxatives:
Metamucil
Citrucel

Fiber Supplements:
Metamucil
Benefiber....Note - my personal recommendation. No grit, no residue, mixes well with any fluid (except carbonated beverages) and can even be placed in foods.

Stimulant or Irritant Laxatives:
Bisacodyl
Senokot

Saline Laxatives:
Magnesium Citrate
Phillips Milk of Magnesia

Stool Softeners:
Docusate
Colace

Antacids:
Mylanta
Maalox

Antigas Products:
Gas-X
Mylicon

Antidiarrheals:
Imodium
Loperimide

H2 Antagonist:
Prilosec OTC
Pepcid

Hemorrhoidal Preps:
Preparation H
Anusol

Hopefully if you have any stomach ailments, this list will help.

Until next time. I won't be a month later....I promise!

Dr. Paul

How Do Drugs Work - OTC Recommendations..Continued

2008-06-07T14:44:00.004-05:00

Hello Everyone,

In my last post I was going over the top recommended OTC products as published by Drug Topics in a recent pharmacist survey.

Here are some more recommendations:

Antihistamines:
Claritin
Benadryl

Sinus Remedies:
Sudafed
Claritin

Throat Sprays
Chloraseptic
Cepacol

Aspirins:
Ecotrin
Bayer

Next post will include products for stomach problems.

Until then....

Dr. Paul

How Do Drugs Work - Over the Counter (OTC) Drug Choices

2008-06-04T11:08:00.005-05:00

Hello Everyone,

When you walk into the Over the Counter (OTC) medication section at your neighborhood drug store, it can be pretty confusing. There are rows and rows of OTC drugs for headache, colds, constipation, diarrhea...almost every malady that you can imagine.

It seems like almost every brand of OTC medication touts itself as #1 Pharmacist recommended. Well, there are actual studies out that survey Pharmacists and I will let you know which are the #1 drug choices.

The Pharmacy journal Drug Topics surveyed pharmacists to get their top recommendations for several OTC product categories. to see the complete survey visit http://www.drugtopics.com/.

Over the next several posts, I will let you know the choices Pharmacists recommend most.

Adult Cold Preparations:
Robitussin Cough and Cold
Sudafed

Children's Cold Preparations:
Dimetapp
Pediacare

Adult liquid Cough medications:
Robitussin (family of products)
Delsym

Children's liquid Cough medications:
Robitussin (family of products)
Delsym

Flu Remedies
Theraflu
Tylenol

Antihistamines
Claritin
Benadryl

So far I agree with the majority of the recommendations. One additional thing that I tell my patients is that if a generic equivalent is available for these products....buy that instead.

Stayed tuned for more reco's

Dr. Paul

General Health Topic - Nursing Home Selections

2008-05-17T12:55:00.003-05:00

General Health Topic - Heart Health and Gum Disease

2008-05-04T14:27:00.004-05:00

Hello Everyone,

Can preventing diseases of the gums and bone that support the teeth with regular brushing and flossing prevent heart disease?

According to the American Academy of Periodontology (AAP), people with periodontal disease are almost twice as likely to have coronary artery disease (heart disease). One study found that the presence of common problems in the mouth, including gum disease (gingivitis), cavities, and missing teeth, were as good at predicting heart disease as cholesterol levels. The evidence isn't clear yet but it is worth noting.

At this time, in addition to all the other steps you are taking for heart health (diet, exercise), it may be a good idea to take a few extra minutes a day on your oral health. In addition to fresh breath and gleaming choppers, you may be helping your heart.

Floss on.....

Dr. Paul

A Little music to Feel Better

2008-05-01T23:28:00.001-05:00

STROKE Recognition - Revisited

2008-04-14T00:50:00.002-05:00

Hello Everyone,

STROKE IDENTIFICATION:

It is well known that the sooner a patient is diagnosed and treated after experiencing an acute stroke the better the outcome is likely to be. However, it is often difficult for a non-stroke specialist to recognise and diagnose stroke. There is a method going around and listed on numerous Internet resources that tries to increase the awareness and importance of rapid stroke identification.

This portion of the post was copied from an email that I received.

RECOGNIZING A STROKE - Remember the "3" steps, S T R .

"Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke Now doctors say a bystander can recognize a stroke by asking three simple questions:
S * Ask the individual to SMILE.
T * Ask the person to TALK to SPEAK A SIMPLE SENTENCE(Coherently) ( I.e. It is sunny out today)
R * Ask him or her to RAISE BOTH ARMS. NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out their tongue. If the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke.
If he or she has trouble with ANY ONE of these tasks, call 911 immediately and describe the symptoms to the dispatcher. A cardiologist says if everyone who gets this e-mail sends it to 10 people; you can bet that at least one life will be saved."

This stroke recognition system appears to be a variation of a widely used field diagnostic test used by paramedics and other first responders. The FACE, ARM, SPEECH TEST (FAST).

Results from a study funded by The Stroke Association indicate that ambulance paramedics can accurately identify a stroke patient before they arrive in hospital.

The Face Arm Speech Test (FAST) has been developed as a stroke identification instrument.
The test assesses 3 neurological signs of stroke: · facial weakness · arm weakness · speech disturbance

FAST has been incorporated as an integral component of ambulance paramedics training module, and is included in the rapid ambulance protocol. http://www.stroke.org.uk/research/stroke_research_news/faster.html

Please pass it on to all your friends, family and patients.

Thanks,

Dr. Paul

General Health Topic - New Drug Disposal Guidelines

2008-03-30T23:30:00.001-05:00

Hello Everyone,

In a previous post, I wrote about how drug residue is being found in the drinking water in many communities accross the US. In response to this potential problem the bigwigs in Washington came out with new guidelines for disposal of prescription drugs.

Remember, many of the drugs that are found in water are from the drug being ingested by a patient and then being excreted in either urine or feces. The wastewater treatments that are currently available are not designed to remove drugs, drug residues or drug metabolites.

The goal of these new guidelines is to not add more drugs to the water system by following the old guidelines of flushing expired or unused meds down the toilet. In addition, the new guidelines suggest taking the unwanted drugs and rendering them unfit for human use and therefore preventing drug diversion.

Here are the new guidelines:

(Washington, DC)—In the face of rising trends in prescription drug abuse, the Federal government today issued new guidelines for the proper disposal of unused, unneeded, or expired prescription drugs. The White House Office of National Drug Control Policy (ONDCP), the Department of Health and Human Services (HHS), and the Environmental Protection Agency (EPA) jointly released the new guidelines, which are designed to reduce the diversion of prescription drugs, while also protecting the environment.

The new Federal prescription drug disposal guidelines urge Americans to:

Take unused, unneeded, or expired prescription drugs out of their original containers.
Mix the prescription drugs with an undesirable substance, like used coffee grounds or kitty litter, and put them in impermeable, non-descript containers, such as empty cans or sealable bags, further ensuring that the drugs are not diverted or accidentally ingested by children or pets.
Throw these containers in the trash.

Flush prescription drugs down the toilet only if the accompanying patient information specifically instructs it is safe to do so.

Return unused, unneeded, or expired prescription drugs to pharmaceutical take-back locations that allow the public to bring unused drugs to a central location for safe disposal.

http://www.whitehousedrugpolicy.gov/news/press07/022007.html

Call your local pharmacy and see if they will accept your unused prescriptions. I think that will be better way than adding the meds to a landfill.

As soon I find more information, I will pass it along.

Thanks,

Dr. Paul

General Health Topic - Dirty Lemons, San Antonio Investigation

2008-03-27T06:00:00.002-05:00

Hello Everyone,

The other day I wrote about DIRTY Lemons. The original article that I cited tested lemons in restaurants in the Northeast.

Well, a local TV station and reporter Jaie Avila, saw the article also, (maybe they read my post) and decided to do their own testing. They recruited Dr. Annette Fothergill at the University of Texas Health Science Center to do the testing of restaurants in the San Antonio Texas area. What follows are the results the WOAI News 4 investigation copied from their website:

"We tested lemon slices from 10 restaurants around San Antonio, and believe it or not, half of them were found to be contaminated with either E-coli, or fecal bacteria from human or animal waste. Who knew lemons could be such a magnet for germs? Even some researchers assumed it might act as a natural disinfectant for your drink.

Dr. Fothergill said before the tests, "Citrus fruit is very acidic, so I'm thinking a lot of bacteria won't survive that kind of environment."

Well, the petri dish doesn't lie. All kinds of nasty stuff showed up when the Trouble Shooters took lemon wedges from local restaurants, and had them tested.

We started by visiting restaurants in different parts of the city, where we ordered water or tea with a slice of lemon. Then, as researchers instructed us to, we used hand sanitizer before putting the lemons into sterile plastic bags and taking them to the lab.

Some of the restaurants kept their lemons pretty clean, like the Denny's at 410 and Perrin Beitel. The lemon slice we got at the Village Inn on Southeast Military also got high marks; nothing but some common, harmless bacteria. When we tested a lemon we were served at the Pizza Hut in the 600 block of San Pedro, the petri dish turned bright pink.

"This is an indication of a coliform, Klebsiella species, and it is an indication of fecal contamination," explained Dr. Fothergill.

That could mean the lemon wasn't washed, it was cut with a dirty knife, or an employee didn't wash up after using the restroom.

In a statement, Pizza Hut told us, "We have strict guidelines and this restaurant has very high health department scores. We are committed to providing a clean and safe dining environment for our guests."

We got a similar result from the lemon slice we got at the Sea Island Shrimp House on Southwest Military. Lab tests showed definite signs of fecal contamination. Sea Island said it was surprised by the findings, since it has received 6 perfect health scores and 3 Kitchen Cops Blue Plate awards, but adds, "We always welcome opportunities to improve our company practices and are identifying steps to go above and beyond the FDA and industry protocols."

Fecal bacteria was also present on the lemon wedge we were served at the Thai Corner restaurant in the 8400 block of Fredericksburg Road. The owner told us his "employees take great care in their own personal hygiene, including hand washing...And a dedicated cutting board and knives are used...to prevent cross contamination."

So, who served us the dirtiest lemon? That dubious distinction went to the Hooters in the 8500 block of Wurzbach. The lemon they put in our drink contained 3 different kinds of fecal contamination. "We have a mixture, a nice fecal cocktail here," said Dr. Fothergill.
Unlike the other places, the source of the bacteria is almost certainly human. Fothergill explained, "Quite clearly someone did not wash their hands before they handled lemons and sliced them, and put them on the cup."

We went back to Hooters to ask them about the results. One of the managers told us their policy is that servers use a fork to grab the lemon slice, instead of touching it with their fingers.
John Totin, Hooters Assistant Manager, explained, "So we use forks to put the lemon on to the drink."

The results of our investigation even made an impression on the researchers who conducted the test.

"I have now decided I will no longer put any citrus items in my drinks so I order them without. I don't even want them touching the glass anymore," explained Dr. Fothergill.

Some of the restaurants told us they would be changing the way they do things because of our findings.

Mama's Cafe on Nacogdoches, which served us a lemon containing E-coli bacteria, said it will no longer allow servers to put the lemon slice on the edge of the glass by hand, and anyone who handles them will use gloves or tongs.

That may have you wondering, what are the health department's rules for handling lemons?

Servers can only use their bare hands to handle or squeeze lemons if they wash their hands and use hand sanitizer each time. Even the restaurants admit, that 2-step process is so time-consuming, nobody does it."

http://www.woai.com/content/troubleshooters/story.aspx?content_id=43831ecc-e3bb-4c58-89f7-f67e8856b8f2

As more and more health officials, restaurant workers and consumers become aware of the potential problems, they will demand / force a change in the way food service workers handle our food. My thought is that we should also look at other citrus fruits that are commonly put into drinks. Has anyone thought to test the cherries or olives that they put into drinks? I think the tide has only just started to roll.

I eat at or have eaten at most of the restaurants listed in the WOAI article. Hopefully the restaurants that had problems will take the results as constructive criticism and do what is right.

Just as at the end of my last post, I think I'll go grab another glass of tea....with lime!

Until later,

Dr. Paul

General Health Topic - The Next Big Thing?

2008-03-26T07:02:00.000-05:00

Hello Everyone,

I thought I would pass along this funny story. As people are living longer and staying active, it could happen. Thanks to my good friends, Harold and Nancy for sending it to me.

Of course, when you stop to think about it, it could be the next big craze. Remember, you read about it here first!

Jacob, age 92, and Rebecca, age 89, living in Florida, are all excited about their decision to get married. They go for a stroll to discuss the wedding, and on the way they pass a drugstore. Jacob suggests they go in.

Jacob addresses the man behind the counter: "Are you the owner?"

The pharmacist answers, "Yes."

Jacob: "We're about to get married. Do you sell heart medication?"

Pharmacist: "Of course we do."

Jacob: "How about medicine for circulation?"

Pharmacist: "All kinds."

Jacob: "Medicine for rheumatism and scoliosis?"

Pharmacist: "Definitely."

Jacob: "How about Viagra?"

Pharmacist: "Of course."

Jacob: "Medicine for memory problems, arthritis, jaundice?"

Pharmacist: "Yes, a large variety. The works."

Jacob: "What about vitamins, sleeping pills, Geritol, drugs for Parkinson's disease?"

Pharmacist: "Absolutely."

Jacob: "You sell wheelchairs and walkers?"

Pharmacist: "All speeds and sizes."

Jacob: "We'd like to use this store as our Bridal Registry."

General Health Topic - Restaurant Lemons Loaded with Germs?

2008-03-23T08:00:00.001-05:00

Hello Everyone,

The latest potential health situation out there is based on a small study that was done in New Jersey. The study tested lemon wedges in 21 restaurants and found them teeming with bacteria.

I don't know about you, but here in Texas where we really enjoy our iced tea and margaritas, most people don't think twice about squeezing their lemon or lime into the drink and then plopping the wedge into the drink.

Health laws in most locations require lemons to be handled just like any other food item, with gloves or tongs. But its common practice simply place the lemon or lime wedge onto a drinking glass with bare hands.

If an employee's hands aren't clean, however, then touching the lemons is likely to contaminate them with bacteria. Also, were the lemons/limes washed?

In the study, the swabs of lemon wedges revealed everything from high counts of fecal bacteria to a couple of dozen other microorganisms -- many of which can make you sick. They found bacteria on the rind and on the flesh of the lemons.

Should we be concerned?

Some folks just freak out knowing that another person touched their food. And while there is no reason to doubt that bacteria was present on the wedges, the actual threat is yet to be determined. Has anyone actually become ill due to the bacteria on lemon wedges?

For me, the importance is to know that there is potential problem that will require more study. Hopefully, bringing this potentially unsafe practice to light will spur restaurant workers to be more diligent in handling our food.

We can also be more pro-active by requiring the restaurants that we frequent to use proper food handling techniques.

Until then, I am going to have another glass of tea. With lemon, you ask?

Of Course! Ok, maybe I'll just squeeze it in and discard the rest.

Later,

Dr. Paul

General Health Topics - Drugs Found in Drinking Water

2008-03-10T11:45:00.004-05:00

Hello Everyone,

There has been press lately concerning drugs found in drinking water.

Here is a blurb from AOL - "A vast array of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been found in the drinking water supplies of at least 41 million Americans, an Associated Press investigation shows."

How do the drugs get into the water?

"People take pills. Their bodies absorb some of the medication, but the rest of it passes through and is flushed down the toilet. The wastewater is treated before it is discharged into reservoirs, rivers or lakes. Then, some of the water is cleansed again at drinking water treatment plants and piped to consumers. But most treatments do not remove all drug residue."

Taken from http://news.aol.com/health/story/ar/_a/probe-finds-drugs-in-drinking-water/20080309184409990001

For more information click here: http://news.aol.com/health/story/ar/_a/probe-finds-drugs-in-drinking-water

It is hard not to pass drugs into the water supply in that manner.

However, if you have old medications that you need to dispose of, DO NOT flush the drugs down the toilet. Contact your local pharmacist and ask for the most current disposal recommendations for your area. If you have any questions, please contact me and I will get you the correct current information.

Thanks,

Dr. Paul

How Do Drugs Work - Antibiotics - Aminoglycosides

2008-03-01T06:00:00.001-06:00

Hello Everyone,

It's time to get back to how antibiotics work. Today we are going to talk about a class of antibiotics that many people don't know about or hear about often. The reason is that these drugs are given intravenously (IV). So, unless you or a family member have been sick with with an infection that required an aminoglycoside like gentamicin, tobramycin or amikacin, you will not be familiar with them. Neomycin is also an aminoglycoside and is mainly given for bowel prep before surgery.

Mechanism of Action: Aminoglycosides irreversibly bind to the 30S subunit of the bacterial
ribosome, which results in the bacteria being unable to synthesize certain proteins.

Spectrum of activity: gram-negative bacteria

Toxicity: Aminoglycosides can be toxic to the kidneys and can also cause hearing loss. Therefore when a patient is taking these medications, they are monitored closely for the amount of aminoglycosides in their blood. When these antibiotics are monitored properly they can be safely given.

Aminoglycosides are often given with other antibiotics. When combined, they have a synergistic effect. That means that both antibiotics dosed together are more effective than either antibiotic if given alone.

Stay tuned for the next post. Thanks,

Dr. Paul

General Health Topic - Heart Attack Signs

2008-02-23T06:30:00.001-06:00

Hello Everyone,

I know we are in the middle of a series on How Antibiotics Work but I read something online and I thought I needed to let you know.

The article, by the Centers for Disease Control and Prevention, stated that only 1 in 4 Americans know the warning signs of a HEART ATTACK and what to do first. I do not want my readers to be in the group that doesn't know about the warning signs of heart attack.

Here are the signs and symptoms and can include one or more of the following 6:

1. Chest pain (most common symptom)
2. Shortness of breath
3. Pain or discomfort in the chest
4. Discomfort in the arms or shoulder
5. A feeling of weakness or lightheadedness
6. Discomfort in the jaw, neck or back

According to the American Heart Association, women are more likely than men to experience shortness of breath and back or jaw pain.

If you, a family member or co-worker experience these symptoms...CALL 911.

Sometimes patients are rushed to the hospital for heart attack symptoms and it turns out to be something entirely different. Don't worry about that. Consider that the symptoms are heart attack symptoms until proven otherwise!!!!

For more information, check out the following links:

The CDC publication: http://www.cdc.gov/mmwr
The American Heart Association: http://www.americanheart.org

Hopefully, this information is helpful. Please pass it on to all your friends, family and co-workers.

Thanks,

Dr. Paul

How Do Drugs Work - Cephalosporins

2008-02-18T05:30:00.003-06:00

Hello Everyone,

The last post covered the first group of antibiotics, the penicillins. This post will cover the cephalosporins.

The cephalosporins are similar to the penicillins in that both contain an chemical structure called a beta-lactam ring.

The cephalosporins are classified by generation (1st - 4th generation) based on the types of bacteria they are active against (their spectrum of activity).

Here is a list of the cephalosporins:

1st Generation
• Cefazolin (Ancef, Kefzol)
• Cephalexin (Keflex)

2nd Generation
• Cefuroxime (Ceftin, Zinacef)
• Cefotetan (Cefotan)

3rd Generation
• Cefpodoxime (Vantin)
• Cefotaxime (Claforan)
• Ceftazidime (Tazicef)
• Ceftriaxone (Rocephin)

4th Generation
• Cefepime (Maxipime)

Generally speaking, the 1st and 2nd generation cephalosporins are active against gram positive organisms while the 3rd and 4th generation have activity against both gram positive and gram negative organisms.

The cephalosporins work the same way the penicillins do; they inhibit the formation of the bacterial cell wall.

Since the cephalosporins are structurally related to the penicillins, if a patient has a true penicillin allergy, they may also be allergic to the cephalosporins. The actual rate of cross-sensitivity is not well defined. Therefore if a patient has a penicillin allergy (anaphylaxis, urticaria or angioedema) the cephalosporins should be avoided.

For more information on cephalosporins, please check out:

http://www.surgicalcriticalcare.net/Lectures/antibiotics.pdf

Please let me know if you have any questions or comments.

Stay Well,

Dr. Paul

How Do Drugs Work - Antibiotics - Penicillins

2008-02-15T06:00:00.002-06:00

Hello Everyone,

Today we are going to discuss the Penicillins. There are several different types of penicillins, however, they have all the same basic mechanism of action (MOA).

Natural Penicillins
• Penicillin G
• Penicllin G procaine
• Penicillin G benzathine
• Penicillin VK

Penicillinase-resistant Penicillins
• Nafcillin
• Dicloxacillin

Aminopenicillins
• Amoxicillin
• Ampicillin

Carboxypenicillins
• Ticarcillin

Ureidopenicillins
• Piperacillin

Penicillin B-Lactamase inhibitors
• Amoxicillin-clavulanic acid
• Ampicillin-sulbactam
• Ticarcillin-clavulanic acid
• Piperacillin- tazobactam v

Mechanism Of Action (bactericidal/bacteriostatic) - Penicillins act by inhibiting bacterial cell wall synthesis. They inhibit enzymes that create a cross-linkage between the bacterial peptide chains and prevent the formation of the bacterial cell wall. These enzymes are the penicillin-binding proteins.

Spectrum (Gm+, Gm-, anaerobes) Gram +: streptococci, Enterococcus, but NOT
S. aureus. Gram - : only a few (E. coli, Proteus spp, a few others)…lots of resistance

No below-the-diaphragm anaerobic activity

I f you would like some more in-depth inormation on penicillins or antibiotics in general you can check out:

http://www.surgicalcriticalcare.net/Lectures/antibiotics.pdf
http://students.washington.edu/rhochi/antibiotics.pdf

Next post will cover the the cephalosporins.

Stay well.....

Dr. Paul

How Do Drugs Work - Classes of Antibiotics

2008-02-10T18:00:00.000-06:00

Hello Everyone,

I was at a meeting all last week and I didn't have time to write. I am glad to be back.

On my last post I wrote about different types of bacteria, Gram Positive, Gram Negative and Anaerobes. Now I am going to start talking about the different types of antibiotics that are used to treat the different types of bacteria.

Now you might think that the antibiotics are used to treat different types of conditions like pneumonia or skin infections. However, the antibiotics are selected to work against the most common type of bacteria that cause those conditions (empiric therapy) or to treat the actual type of bacteria once it has been identified.

There are several different classes of antibiotics that are used to treat the different types of infections. The mechanism of action that these antibiotics use to halt the growth of bacteria (bacteriostatic) or to kill the bacteria (bacteriocidal) is different for the different types of antibiotics.

Some of the antibiotics are effective against Gram Positive organism, some are effective against Gram Negative organisms, some are effective against both types to some degree and others are effective against the anaerobes.We will discuss the different mechanisms of action for these antibiotics.

For now, I just want to introduce the different classes of antibiotics. Here they are in no particular order.

Penicillins
Cephalosporins
Tetracyclines
Aminoglycosides,
Flouroquinolones
Carbapenems
Macrolides
Sulfonamides
Glycyclines
Oxazolidinones
Monobactams
Other various agents that don't fit the above catagories.

Stay tuned for more information on the different classes of antibiotics.

Thanks,

Dr. Paul

How Do Drugs Work - Antibiotics - Part 1- Bacteria

2008-02-01T06:00:00.000-06:00

Hello Everyone,

Before we talk about antibiotics, we need to know a little about the clinical bacteria that cause illness.

There are bacteria which normally occur on the outside of the body on our skin and in our nose and mouths. There are also bacteria that normally live inside our intestinal tract. Usually, those bacteria do not cause any problems for us. There are portions of the body that are sterile and do not contain any bacteria such as blood or spinal fluid.

So, a common organism that lives on the skin and is always present can cause significant problems if it gains entrance to an area that is usually sterile.

Knowing the type of bacteria that is causing an infection is usually one of the first things a physician needs to know. You are probably saying, "The last time I had an infection, the doctor prescribed an antibiotic right away. There in no way she could know what type of bacteria it was." True....kind of. There are many types of infection that are caused by the same types of bacteria. For example, pneumonia is usually caused by one of three types of bacteria. In addition, if the pneumonia was aquired out in the community or inside a healthcare facility will also give a clue as to the type of bacteria that cause the infection. Based on that knowledge, the physician can narrow the bacterial field and prescribe an antibiotic based on the suspected bacteria. Prescribing or administering an antibiotic based on common pathogens is called "EMPIRIC THERAPY".

However, knowing the type of bacteria is key. So, how are those bacteria classified?

Clinical bacteria are grouped into five categories based on gram stain appearance under the light microscope. Two groups have a general rounded shape (The COCCI) and stain either red or blue. Two groups have a general rod-like shape (The BACILLI) and stain either red or blue.

The organisms that stain blue or that can uptake the stain are called GRAM POSITIVE.

The organisms that stain red are called GRAM NEGATIVE.

There are some antibiotics that are affective against both Gram positive and Gram Negative organisms. Those are called BROAD SPECTRUM ANTIBIOTICS.

There are some that are effective against primarily Gram positive organisms as well as some that are effective against primarily gram negative bacteria.

Therefore, knowing if an organism is gram positive or gram negative is considered by many to be the single most important chacteristic of clinical bacteria.

Gram negative organisms have thinner cell walls and the cell wall composition is different from that of gram positive organisms. This difference also accounts for some general distinctions in susceptibility to antibiotic drugs.

In addition to the Gram Stain characteristic, knowing if the bacteria do or do not require oxygen to replicate is important. Some bacteria can grow only in the absence of oxygen and they are known as ANAEROBES. If they require oxygen, they are know as AEROBES. If the are flexible and grow in both conditions they are called FACULTATIVE ANAEROBES. Anaerobes account for 5 - 10% of all clinical infections. There are antibiotics that are effective against anaerobes.

Well, this is just a start and I will continue with my next post.

To be continued....

Dr. Paul

How Do Drugs Work - Antibiotics

2008-01-24T05:05:00.000-06:00

Hello Everyone,

Since the name of this blog is "How Do Drugs Work", I figured it was time again to talk about some different drugs and how they work.

Say you are not feeling well, you go to the Doctors office and you have some type of infection. Have you ever wondered how the Doctor decides which antibiotic to prescribe for you? How does the Doctor decide what strength of antibiotic to give you? Is one antibiotic better than the other?
In the upcoming series of topics I am going to discuss:

An overview of the different types of bacteria

Which type of bacteria can cause which type of illnesses.

The different classes of antibiotics.

Which classes of antibiotics work against which type of bacteria.

How the antibiotics work to eradicate the bacteria.

How different antibiotics work in different ways.

How some bacteria can become immune to some antibiotics.

Why it is important to take your antibiotics as directed.

That is a bunch of material to cover and I plan on addressing those topics in multiple posts.

Stay tuned.

Dr. Paul

General Health Information - Bell's Palsy

2008-01-19T06:50:00.000-06:00

Hello Everyone,

My last two posts have covered strokes and recognition of strokes. A colleague of mine wrote and stated that it would be a good idea to cover Bell's Palsy since the symptoms are often confused with that of a stroke.

What is Bell's Palsy?

Bell's palsy is paralysis of the face caused by an irritation of cranial nerve VII (seven). It occurs with no apparent cause. Cranial nerve VII controls most facial muscles, including those needed to smile, blink, and wrinkle the forehead. The nerve also controls the function of certain salivary glands and the lacrimal (tear) glands as well as the tiny muscles inside the ear that dampen loud noises. The nerve also controls the function of some salivary glands and the lacrimal (tear) glands. This does not include the facial paralysis associated with known causes such as infection or stroke.

Some evidence suggests that the cause is inflammation of cranial nerve VII is triggered by a viral infection, possibly a virus in the herpes family. People with diabetes or high blood pressure, and pregnant women, are at slightly greater risk, but most patients have no known predisposing factors

The classic symptom of Bell's palsy is weakness on one side of the face. The weakness may range from difficulty blinking all the way to a complete paralysis on one side of the face with an inability to close the eye. Onset usually occurs acutely, but the weakness may worsen for 24 to 48 hours before stabilizing

Most patients with Bell’s palsy recover completely or or some have minimal lasting effects, even without treatment. The percentage may increase with medical treatment.

Using the S-T- R stroke identification method one would find a patient with Bell's Palsy unable to Smile. However, they would probably be able to Talk and form complete sentences and would be able to Raise their arms.

Facial paralysis does not always indicate Bell's Palsy. It is best to have a patient evaluated by their physician to rule out other causes of facial paralysis.

Hopefully this information will help distinguish different situations you may run into.

Please email me if you have any questions.

Dr. Paul

General Health Topic - Stroke Identification

2008-01-14T06:00:00.000-06:00

RECOGNIZING A STROKE - Remember the "3" steps, S T R .

"Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke

Now doctors say a bystander can recognize a stroke by asking three simple questions:

S * Ask the individual to SMILE.

T * Ask the person to TALK to SPEAK A SIMPLE SENTENCE(Coherently) ( I.e. It is sunny out today)

R * Ask him or her to RAISE BOTH ARMS. NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out their tongue. If the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke.

If he or she has trouble with ANY ONE of these tasks, call 911 immediately and describe the symptoms to the dispatcher. A cardiologist says if everyone who gets this e-mail sends it to 10 people; you can bet that at least one life will be saved."

This stroke recognition system appears to be a variation of a widely used field diagnostic test used by paramedics and other first responders. The FACE, ARM, SPEECH TEST (FAST).

Results from a study funded by The Stroke Association indicate that ambulance paramedics can accurately identify a stroke patient before they arrive in hospital.

The Face Arm Speech Test (FAST) has been developed as a stroke identification instrument.

The test assesses 3 neurological signs of stroke:
· facial weakness
· arm weakness
· speech disturbance

FAST has been incorporated as an integral component of ambulance paramedics training module, and is included in the rapid ambulance protocol.
http://www.stroke.org.uk/research/stroke_research_news/faster.html

Please pass it on to all your friends, family and patients.

Thanks,

Dr. Paul

General Health Topic - Stroke - What Is It?

2008-01-11T10:02:00.000-06:00

Hello Everyone,

This was sent to me as a suggested topic and I agree that we need to spread the word.

About Strokes - There are two types of strokes (also called a cerebrovascular accident).

An ischemic stroke occurs when the blood supply to all or part of the brain is cut off. Most strokes are of the ischemic type. A transient ischemic attack (TIA) is a transient stroke that lasts only a few minutes. It occurs when the blood supply to part of the brain is briefly interrupted.

A hemorrhagic stroke is when a blood vessel bursts in the brain.

Without oxygen, brain cells begin to die. Permanent disability or death can result. High blood pressure, smoking, and having had a previous stroke or heart attack increase a person’s chances of having a stroke.

Stroke is the third leading cause of death in the United Sates. In 2002, stroke killed 162,672 people, accounting for about 1 of every 15 deaths in the United States. Four million Americans who have survived a stroke are living with impairments and 15 to 30 percent are permanently disabled. The American Heart Association also estimates that stroke cost about $68 billion in both direct and indirect costs in 2005 in the United States alone. For more information check out the following: http://cdc.gov/DHDSP/library/fs_strokesigns.htm

With timely treatment, the risk of death and disability from stroke can be lowered.

It is very important to know the symptoms of a stroke and act in time.

Signs of a Stroke - The National Institute of Neurological Disorders and Stroke notes these major signs of stroke:

•Sudden numbness or weakness of the face, arms or legs
•Sudden confusion or trouble speaking or understanding others
•Sudden trouble seeing in one or both eyes
•Sudden trouble walking, dizziness, or loss of balance or coordination
•Sudden severe headache with no known cause

If you think someone is having a stroke, you should call 911 immediately.

I'll post more information on stroke identification in the next article.

Thanks,

Dr. Paul

General Health Topic - Four Healthy Changes Can Prolong Life 14 Years

2008-01-10T23:57:00.000-06:00

Hello Everyone,

I don't know if you have read this article that was published by a group of British researches in the Journal PLoS Medicine.

I have included the article that was written by Michael Kahn from Reuters and can be found at the following link:

http://body.aol.com/news/health/article/_a/four-healthy-changes-can-prolong-life-14/20080108121809990001

Four Healthy Changes Can Prolong Life 14 Years
By MICHAEL KAHN, Reuters
Posted: 2008-01-10 11:36:29
Filed Under: Health, Healthy Living, Diet & Fitness

LONDON - People who drink moderately, exercise, quit smoking and eat five servings of fruit and vegetables each day live on average 14 years longer than people who adopt none of these behaviors, researchers said.

Overwhelming evidence has shown that these things contribute to healthier and longer lives, but the new study actually quantified their combined impact, the British team said."These results may provide further support for the idea that even small differences in lifestyle may make a big difference to health in the population and encourage behavior change," the researchers wrote in the journal PLoS Medicine.

Between 1993 and 1997 the researchers questioned 20,000 healthy British men and women about their lifestyles. They also tested every participant's blood to measure vitamin C intake, an indicator of how much fruit and vegetables people ate.

Then they assigned the participants -- aged 45-79 -- a score of between 0 and 4, giving one point for each of the healthy behaviors.

After allowing for age and other factors that could affect the likelihood of dying, the researchers determined people with a score of 0 were four times as likely to have died, particularly from cardiovascular disease.

The researchers, who tracked deaths among the participants until 2006, also said a person with a health score of 0 had the same risk of dying as someone with a health score of 4 who was 14 years older.

The lifestyle change with the biggest benefit was giving up smoking, which led to an 80 percent improvement in health, the study found. This was followed by eating fruits and vegetables.

Moderate drinking and keeping active brought the same benefits, Kay-Tee Khaw and colleagues at the University of Cambridge and the Medical Research Council said.

"Armed with this information, public-health officials should now be in a better position to encourage behavior changes likely to improve the health of middle-aged and older people," the researchers wrote.

The article also contained the following tips:

Be as lean as possible without becoming underweight. A body mass index (BMI) between 21 and 23 is the ideal recommendation.

Be physically active daily for at least 30 minutes.

Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar and fat, or low in fiber).

Eat more variety of vegetables, fruits, whole grains and beans. Earlier this year, the CDC reported that Americans are not consuming enough vegetables and fruit in their diet.

Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats. Processed meat -- such as bacon -- consumed per day increases the risk of colorectal cancer.

If consumed at all, limit alcoholic drinks to two for men and one for women a day. Alcohol is linked to an increased risk of throat, breast and liver cancers.

Limit consumption of salty foods and food processed with salt/sodium.

Don't use supplements to protect against cancer, opt for a balanced diet.

Researchers also suggest against smoking or chewing tobacco in any form because of the increased risk of cancer and other serious diseases.

Hope this information helps,

Dr. Paul

General Health Topic - How are Your New Year's Resolutions Holding up?

2008-01-08T21:28:00.000-06:00

Hello Everyone,

Just a quick note of encouragement to stick to those New Year's Resolutions you made. How are they holding up? Are you doing anything special to help you stay with your program?

Drop me a note so I can pass on your success stories.

All the best,

Dr. Paul

General Health Topic - Clinical Research Studies

2007-12-30T11:43:00.000-06:00

Hello Everyone,

Are you generally healthy, non smoker, have a little free time and would like to make some extra $$$. If so, you may want to participate in a Clinical Research Study.

In San Antonio, Austin and most major cities around the country, there are Physician Offices, Clinics and Research Companies that are conducting clinical research studies.

Participating in clinical trials is beneficial in many ways. First, that is the way that medications are tested in humans. Secondly, to entice participation in those studies, the pharmaceutical companies sponsoring those trials, pay people who enroll in those studies. That is how people use clinical trials to make some extra money.

Clinical trials are conducted in a series of steps, called phases. Each phase is designed to answer different and separate research questions.

If you are going to participate, it is helpful to know and understand the different phases.

· Phase I: Researchers test a new drug or treatment in a small group of healthy people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.

· Phase II: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.

· Phase III: The drug or treatment is given to large groups of people to confirm its effectiveness, (usually the study subjects have the condition the medication is intended to treat) monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.

· Phase IV: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use.

There are other types of studies that are conducted. One of the other types of study is bio-equivalence studies. In those studies, a generic drug manufacturer is trying to prove that their generic formulation is the same as the brand name product.

Additional Resource Information on clinical trials can be found at http://clinicaltrials.gov/info/resources

Many of the Clinical Research Companies like CEDRA or PPD conduct phase I trials. If you decide to participate in one of the phase I trials, there are some things that should be considered.
Length of Study

How many inpatient visits and how long is each inpatient stay.

How many blood draws will there be.

How many out patient visits are there.

How frequent are the follow-up visits.

Do you mind being stuck with a needle for frequent (very frequent) blood draws.

Can you swallow pills, tablets and capsules. (There are many subjects that enrolled in a trial and at the time of dosing, they admit that they cannot swallow tablets. That is a huge waste of time for the patient and the investigating company. It is also a large expense for the investigating company and the loss of income for a person that could not participate due to the study being full.)

What type of drug is being investigated.

Are you a picky eater. (Many studies require that all the subjects eat the same meals. You are expected to eat everything that is put in front of you in a specified time. Usually, there is no menu selection available. You eat what is provided.)

For more information on clinical research companies and to get an idea what trials are available, please check out:

http://www.cedraresearch.com/

Good Luck,

Dr. Paul

General Health Topic - Redirect Unused Medical Supplies to Those In Need

2007-12-29T11:05:00.000-06:00

Hello Everyone,

Even though it is always time to help those in need, around the Holidays, it seems to take on special importance.

If anyone has received home Intravenous therapy or has had a family member that has used home health care services, the supplies that are provided to assist in the therapy are not all used and can add up. Those leftover items like syringes, gauze, tubings and dressings are still sterile, however, they can not be reused in the United States.

Don't discarding those unused items. There are non-profit clearing houses that can re-direct those supplies to disaster victims and patients in need throughout the world. If you are interested in donating unused medicals supplies, here is a list of organizations that can help:

REMEDY (Recovering Medical Equipment for the Developing World)
http://www.remedyinc.org/ http://www.med-eq.org/

Medical Bridges, Inc.
http://www.medicalbridges.org/MB_donate_MedSupplies.htm

Project Cure
http://www.projectcure.org/procure/procuredonate.aspx

Note: These organizations may be associated with groups that may or may not be in line with your personal and/or religious beliefs. If you are concerned about that, please investigate before donating supplies or money.

Giving to these and other organizations can be inspiring and very fulfilling. Knowing that those supplies will be going to a good cause and not a landfill can be a great feeling.

Thank you for your support.

Dr. Paul

General Health Topic - Medicare Open Enrollment Ends Monday, December 31.

2007-12-27T00:06:00.000-06:00

Hello Everyone,

I want to remind everyone that the open enrollment for Medicare Part D, The prescription drug plan ends on Monday December 31, 2007.

For more information on the Medicare plan, please read my posting from Tuesday, November 13, titled General Health Topic - Medicare Fall Open Enrollment - November 15 - December 31 2007

Please pass on this information to everyone you know that may be eligible or people that have family members eligible.

Thanks,

Dr. Paul

General Health Topic - Are You Ready for An Emergency?

2007-12-25T07:25:00.000-06:00

Hello Everyone,

I was reading and have been hearing on the news about the ice storms that are gripping the Midwest USA. Snow storms are raging in the northeast and power is out in thousands of homes across the country.

For those out there that have a serious medical condition or if you have a family member with a medical condition we have to be thinking about our emergency plan.

If you have to be in frequent contact with your physician, what will you do if your phone or the Dr's phones are not working? Do you have a plan? Does your Doctor have a plan?

If you are on a medical device that requires electricity to operate, do you have a plan if your power is out for more than just a few minutes?

If your doctors office has a fire, how will you replace your medical records. Do you have a copy of your medical records. Does your doctor and pharmacist have a plan in place to replace the records if they are destroyed for any reason.

After Hurricane Katrina, thousands of people were left without any records of any kind. Their medical records were destroyed, lost and inaccessible. After evacuating, hundreds of cancer chemotherapy patients were hard pressed to tell their new doctors what kind of medications they were receiving for their cancer treatments.

Hopefully you get the point. With natural disasters, you have to be prepared and find out what kind of preparations your health care providers have in place.

Consider the area where you reside. Are you on or near the gulf coast where hurricanes are a threat. Do you live in an area where earthquakes are possible. Are wildfires a constant threat in your neighborhood. Does your area flood every time it rains. What will happen if there is a really big storm.

Please don't take for granted that someone else is going to do the planning for you. Please read or re-read my earlier post from Tuesday, October 30, 2007

Identify Yourself and your Medical Conditions

If you take care of an elderly parent or sick child, you have to plan for yourself and the person you take care of.

I know this is not necessarily a pleasant topic to have to think about. However, if you don't and something does happen, that is even worse. Many of us make New Year's Resolutions to try to better ourselves. Why don't we make a resolution to get our medical records in order and have an emergency plan. I can help you do that if needed. Email me for information.

Wishing you the best.

Dr. Paul

General Health Topic - Large Waist = Increased Heart Attack Risk

2007-12-23T09:31:00.000-06:00

Hello Everyone,

Need more motivation to lose that spare tire around the mid-section?

Did you know that increased waist size is an indicator that you may be at increased risk for a heart attack? True story! Why you ask?

Here's why.

There are two main areas where fat stores in the body. One is the fat under the skin (subcutaneous fat) and the other is deep in the abdomen, around organs like the liver and stomach. that deep stored fat (visceral fat) is the one that causes the problems.

The visceral fat near the liver provides a steady supply of fat that is converted into cholesterol. That cholesterol then circulates throughout the body which can be deposited in the blood vessels and clog them. Clogging of the blood vessels and arteries can cause heart attacks and strokes.

Visceral fat also acts like a body organ and can secrete chemicals (Interleukin 6 (IL-6), C-Reactive Protein (CRP)) that can cause inflammation in the body. That includes inflammation of the arteries. Those inflamed arteries can also become obstructed causing heart attacks and stroke. Studies also indicate that increased levels of IL-6 and CRP can predict the development of Type 2 Diabetes. There are other studies that support the hypothesis that body fat is the main determining factor of metabolic abnormalities and chronic low inflammation (Nutr Metab Cardiovasc Dis. 2004 Apr;14(2):66-72)

According to Dr. Paul Donohue, a man's waist should measure 40 inches or less and a woman's should be 35 inches or less.

Here is the good news. Walking, jogging, biking and swimming and other forms of exercise can reduce visceral fat.

I'm going to be on the treadmill soon. Right after lunch!

Until later,

Dr. Paul

General Health Topic - Getting Fit in the New Year

2007-12-23T08:16:00.000-06:00

Hello Everyone,

Yes, I'll have another little piece of cake, Thank You. And an extra tamale as well. Some eggnog sounds good. Margarita on the rocks will hit the spot. I really haven't eaten much, I've just been grazing at the buffet table. I am going to splurge a little... It's the holidays after all!

Sound Familiar?

I know I have a tendency to over eat during the holidays. There are so many goodies around this time of year. I can't get those little "Polvorone" cookies at any other time of the year. I have to get my fill.....Now!

The time for getting fit, eating right and taking off those unwanted pounds is just around the corner.

Getting fit in the New Year. That's the ticket!

The American Heart Association has a website that has an on-line nutrition and fitness tracker.

Find information on Start! for individuals at:

http://www.americanheart.org/presenter.jhtml?identifier=3041198

By using MyStart! Online for your free tracking tool, you can start logging your daily activity and nutrition. You’ll also receive weekly and monthly e-newsletters filled with tips and motivation to keep you moving.

It is about making small lifestyle changes for large health benefits. It helps you build regular activity and a healthy diet into your everyday life and ensures you're getting the right balance to achieve your long term goals.

There is also a section for Start! for employers. If you have a company check out:

http://www.americanheart.org/presenter.jhtml?identifier=3041223

For those that need extra little gadgets to get motivated and don't mind paying a yearly fee, you can check out:

http://www.ahastart.fitbug.com/

Start thinking about those New Year goals. After that next trip through the buffet line, that is!

Enjoy!

Dr. Paul

General Health Topic - Help with Holiday Grief

2007-12-22T13:37:00.000-06:00

Hello Everyone,

As Christmas gets closer and closer, it is a time for family, joy, gifts, parties and merriment. The little ones are looking forward to gifts of all sizes and shapes and they can barely contain their excitement.

For some people, the holidays are a time of sorrow, loneliness and grief. Some people have lost a loved one since the last holiday. The expectation of the spending the once joyful season without that loved one is not a pleasant thought.

This time of year always brings back family memories for many people. If those family members are no longer with us, the holidays can be a very difficult time.

There are professionals in the community that can help you cope with the feeling of loss and despair. If you are feeling blue and depressed, please seek help from your physician, preacher or other person that can get you through this trying time.

I learned of a professional that can help you through this once joyous, but now difficult time.

If needed, please check out:

www.margueriteoconnor.com

Marguerite O'Connor is a bereavement educator. She is a licensed funeral director and is a certified death educator.

Hopefully, she will be able to assist you if needed.

Until later,

Dr. Paul

General Health Topic - Sudden Cardiac Arrest Risk Factors

2007-12-21T01:36:00.000-06:00

Hello Everyone,

On my last post we discussed the differences between Sudden Cardiac Arrest (SCA) and a heart attack. Today we will talk about how to try to prevent SCA and some of the risk factors.

Sudden cardiac arrest can often strike active, apparently healthy individuals. What can a person do to try to prevent SCA?

First, a heart-healthy lifestyle is important in the prevention of coronary artery disease and other heart conditions.

Eat a heart-healthy diet. (www.nhlbisupport.com/cgi-bin/chd1/step1intro.cgi)
Exercise regularly.
Lose weight if you are overweight or obese.
Take your heart medications as directed.
Drink alcohol only in moderation.
Do not smoke.

Next, realize that eighty percent of SCA victims have signs of coronary artery disease. Many individuals do have signs or symptoms that could indicate an increased risk for sudden cardiac arrest. These are some of the symptoms:

An abnormal heart rate or rhythm (arrhythmia)
A rapid heart rate, even when at rest (tachycardia)
Episodes of fainting (syncope)

Thirdly, there are indicators that suggest high risk for sudden cardiac arrest, such as:

Prior sudden cardiac arrest
Prior heart attack
Heart failure ? (Shortness of breath, fatigue, or heart palpitations with physical activity and maybe at rest.)
Ejection fraction less than 40%
Family history of sudden cardiac arrest

Consult a cardiologist if you have any risk factors for sudden cardiac arrest.

By controlling underlying medical conditions or abnormal heart rhythms that can lead to sudden cardiac arrest, risk can be greatly reduced.

The following website has information on steps you and your family can take to help prevent SCA:

http://www.early-defib.org

As we get closer to the start of a new year, it may be a good time to make that resolution for a heart-healthy lifestyle.

There will be a few more posts concerning SCA and the medications that are used to control the risks.

Until then,

Dr. Paul

General Health Topic - Information on Sudden Cardiac Arrest (SCA)

2007-12-16T11:11:00.000-06:00

Hello Everyone,

On my last post I was talking about Automated External Defibrillators (AED). I received an email asking about how the AED works for heart attacks.

Sudden Cardiac Arrest (SCA) is very different from a Heart Attack. They are not the same thing! SCA results from an abrupt loss of heart function. The victim may or may not have diagnosed heart disease. The most common underlying reason for patients to die suddenly from cardiac arrest is coronary heart disease.

SCA is also known as Sudden Cardiac Death because when SCA occurs, the odds of survival are low. Time and mode of death are unexpected and it occurs within minutes after symptoms appear. The American Heart Association estimates about 325,000 people per year die from SCA without being taken to an emergency room or hospitalized. One of the most devastating aspects of sudden cardiac arrest is that it often strikes active, healthy individuals that seem healthy.

The causes of SCA are usually some underlying heart disease. All known heart diseases can lead to cardiac arrest and sudden cardiac death. Most of the cardiac arrests that lead to sudden death occur when the electrical impulses in the diseased heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both. This irregular heart rhythm (arrhythmia) causes the heart to suddenly stop beating. Some cardiac arrests are due to extreme slowing of the heart (bradycardia).

In the majority of adults that have a SCA, two or more major coronary arteries are partially or completely blocked by fatty buildups. Scarring from a prior heart attack is also found in two-thirds of victims. When sudden death occurs in young adults, other heart abnormalities are more likely causes. Adrenaline released during physical or athletic activity often acts as a trigger for sudden death when these abnormalities are present. Under certain conditions, various heart medications and other drugs can lead to abnormal heart rhythms that cause sudden death.

SCA is very different from a heart attack. Heart Attack refers to death of heart muscle tissue due to the loss of blood supply, not necessarily resulting in a cardiac arrest or the death of the heart attack victim. A heart attack may cause cardiac arrest and sudden cardiac death, but they are not the same thing.

Think of a heart attack as a problem with the heart's plumbing system. SCA is caused by a problem with the heart's electrical system. That is why an AED is effective in treating a patient with SCA but not a heart attack.

Brain death starts to occur in just four to six minutes after someone experiences cardiac arrest. Cardiac arrest may be reversible in some victims if it is treated within a few minutes with an electric shock to the heart to restore a normal heartbeat with defibrillation. According to the American Heart Association, a victim's chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation. CPR can double or triple a cardiac arrest victim's chances of survival. Few attempts at resuscitation succeed after 10 minutes. If someone becomes unconscious, call 9-1-1 immediately. They may be suffering from sudden cardiac arrest.

In my next post, I will cover some recommendations that can be taken to try to prevent SCA, who is at risk for SCA and if you are are at risk, how can you manage that risk.

If you have any other questions, do not hesitate to email me or post a comment.

Thanks,

Dr. Paul

General Health Topic - Automated External Defibrillators

2007-12-12T00:34:00.000-06:00

Hello Everyone,

Did you know there is a piece of equipment that is located in almost every airport, large sports stadium, shopping malls, government buildings, many private buildings that is there to save your life in case of sudden cardiac arrest (SCA)?

They are called AUTOMATED EXTERNAL DEFIBRILLATORS or AED's. The AED is a computerized medical device that is used on a patient that has collapsed due to cardiac arrest. An AED, when properly applied to a person's chest, can check the heart rhythm and it can recognize a rhythm that requires a shock.

Who is the rescuer? It may be you. AED's are designed to be used by non-medical personnel. An automated external defibrillator requires very little training to use. It automatically diagnoses the heart rhythm and determines if a shock is needed. Most AED's found in public locations are semi-automatic models which will tell the user that a shock is needed, but the user must tell the machine to do so, usually by pressing a button. This will give the rescuer the chance to sound the "ALL CLEAR" command. In most circumstances, the user cannot override a "no shock" advisory by an AED. When advising the rescuer that a shock is needed, the AED uses voice prompts, lights and text messages to tell the rescuer the steps to take.

In most classes that teach Cardiopulmonary Resuscitation (CPR), there is now a component that teaches how to use an AED.

Here is what the Red Cross says about AED's at http://www.redcross.org/services/hss/courses/aed.html:

"In the time it takes you to read this information, sudden cardiac arrest will have claimed another victim. Statistics show that more than 200,000 Americans die of sudden cardiac arrest every year. Up to 50,000 of these deaths could have been prevented if someone had initiated the Cardiac Chain of Survival, and an automated external defibrillator (AED) had been available for immediate use at the time of the emergency."

What is the cardiac chain of survival?

The cardiac chain of survival is a series of four critical steps. All four steps must be present to help ensure survival from sudden cardiac arrest. The four steps are:

Step one: Early access to care (calling 9-1-1 or another emergency number)
Step two: Early cardiopulmonary resuscitation (CPR)
Step three: Early defibrillation
Step four: Early advanced cardiac life support, as needed

The third step, delivering an electrical shock to the heart, which is known as defibrillation, is recognized as the most critical step in restoring cardiac rhythm and resuscitating a victim of SCA.

If you would like to read an account of how an AED and quick acting co-workers saved a life, please check out this link:

http://www.redcross.org/services/hss/notes/aedsave.html

What does this all mean to you?

I would like for you to be aware that these machines exist. They are all around. Next time you are in an airport or a shopping mall, look around. You have probably never noticed them before. If you or a family member are at risk of Sudden Cardiac Arrest (SCA) you should really note where the AED's are located.

If you work in a large building, find out from the building management where the AED's are located. If they do not have them, find out when they are going to get them. If you would like to start an AED program, please contact me for information.

One type of location that I think should have several AED's located strategically around the facilty is RV Parks. Many of the residents at RV parks are older and may be at higher risk of SCA. Any RV Park Residents out there that would like more information, please email me.

If you would like information on purchasing an AED, here is one of many links:

http://www.aedsuperstore.com/

Hopefully, you or your loved ones will never need to use an AED. However, knowing about them and how to use one can save a life.

Thanks,

Dr. Paul

General Health Topic - Another Prescription Assistance Program

2007-12-12T00:10:00.001-06:00

Hello Everyone,

I received a comment from Dr. Rich Sagall stating that he has an organization that also helps with Prescription Assistance called Needy Meds.

Here is his comment:

Another source of information on all the PAPs is NeedyMeds (http://www.needymeds.com). We have data on over 1000 programs including PAPs, disease-based assistance, state and local programs, and more. All our data is current, easy to access, and free. We are approaching our 10 millionth visitor.

Rich Sagall, MD
President
NeedyMeds.com, Inc.
P.O. Box 219
Gloucester, MA 01931

A special thanks to Dr. Sagall for the valuable information. Please visit his website and tell your friends about his valuable service. 10 Million visitors! That's impressive.

Dr. Rich, next time you are in the S. Texas area, let me know. I'll treat for some great Mexican food. It's good to know that my blog is being read up in the great Northeast.

Thanks again,

Dr. Paul

General Health Topic - Medical Debt Assistance

2007-12-08T12:22:00.000-06:00

Hello Everyone,

On my last post, I wrote about getting help in paying for prescription medications. I was reading some information and found a reference to an organization that helps patients lower their hospital bills.

The following is an excerpt from that article from:

http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/10ThingsYourHospitalWontTellYou.aspx

The article was about Logan Roberts. "The 26-year-old had started work as a business analyst near Atlanta but had no insurance when he was rushed to an emergency room for an appendectomy. The uninsured can pay three times more for procedures, says Nora Johnson, the senior director of Medical Billing Advocates of America.Roberts was billed $21,000. After advice from advocacy group The Access Project, Roberts spoke with hospital administrators, telling them he couldn't pay in full. Hospitals frequently work with patients, offering payment plans or discounts. But to get it, you have to knock on the right door: Look for the office of patient accounts or the financial-assistance office. It paid off for Roberts, whose bill was sliced to $4,100, 20% of the original.

That organization, The Access Project, is out there to help patients and family members cope with medical debt, hospital billing and collection problems and helping the uninsured and patients on Medicaid. In addition, this very ambitious group is working on the national, state and local levels to affect change in health care.

The mission of the Access Project is to strengthen community action, promote social change, and improve health, especially for those who are most vulnerable. By supporting local initiatives and community leaders, The Access Project is dedicated to strengthening the voice of under served communities in the public and private sectors.

The Access Projects works with community organizations across the country to examine the consequences of medically-related debt for individuals and families. Their findings indicate that debt resulting from medical bills deters people from seeking future care, which can result in the need for more expensive treatment later on. In addition, medical debt can affect the overall financial security of families and can ruin their economic stability.

On their website, www.accessproject.org, they state that if you or a family member have medical debt, they would like to hear from you. They provide this information that for help with bill management and negotiation strategies, to contact Andrew Cohen at: (617) 654-9911 x231,toll-free (866) 918-5232 x231, or acohen@accessproject.org.

If you would like to help support this worthy project, They are currently taking donations. Your donations will help them to:

Continue to study the adequacy and cost of health insurance, and present the findings to interested stakeholders.

Provide direct technical assistance to groups in states where health reform discussions are taking place.

Increase their capacity to assist families struggling with medical debt.

Sponsor trainings for community leaders in locations across the country.

Develop new strategies to address the issue of increasing out-of-pocket medical expenses .

If you are interested in making a donation, please visit their website and click on "Donate Now"

I am going to close now so I can go make a donation.

Thanks for your support,

Dr. Paul

General Health Topic - Prescription Assistance Plans

2007-12-07T00:44:00.000-06:00

Hello Everyone,

I want to share this very important topic with you and I would like to ask you to forward this information to everyone you know that might benefit. Everyone could potentially benefit.

As you know, the cost of many prescription medications keeps rising. If you do not have insurance or a prescription drug plan, the cost of many of these drugs can be unaffordable.

I want to bring to your attention is a fantastic service called the "Partnership for Prescription Assistance"

The Partnership for Prescription Assistance helps qualified patients who lack prescription coverage get the medicines they need through public or private programs. Many patients can get covered medications free or at little cost.

They bring America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups together to provide a single point of access to more than 475 public and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies.

The Partnership for Prescription Assistance mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. In order to find out what patient assistance programs you may qualify for, all you have to do is answer a few short eligibility questions. Their web site will help supply you with the information you need to get involved in a program and will allow you to download applications online. You can then follow the instructions on the application to apply.

Here is the important link:

https://www.pparx.org/

The web site has areas for patients, for caregivers and also for prescribers. You can select on your particular state to find a free or discounted drug program. For patients in Texas, it will direct you to http://www.pparxtx.org/ and has items specific for Texans. They also have information in Spanish. On that site you can sign up for an e-mail newsletter as well.

To see a list of participating programs and companies, click on this link:

https://www.pparx.org/ViewCompanies.php

To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669).

Please pass this information along to all your family, friends and patients.

Hope you find this information helpful.

Thanks,

Dr. Paul

GENERAL HEALTH INFO - Drugs in the News

2007-12-05T17:58:00.000-06:00

Hello Everyone,

There has been an recent unfortunate medication error that has garnered alot of press. It appears that the twin children of the actor, Dennis Quaid were given an inappropriate dose of the anticoagulant drug, HEPARIN. Fortunately, the children are doing well and should make a full recovery.

Heparin is an anticoagulant that prevents the formation of blood clots in the body. It works by inhibiting the coagulation enzymes Thrombin (Factor IIa) Factor Xa and Factor IXa.

Heparin is used for the prevention of blood clots for patients that have had a heart attack, cardiac bypass surgery, prevention of blood clots in the legs and many other conditions where the formation of blood clots need to be prevented. The prevention of these conditions normally use higher doses of heparin. These doses are often called "Therapeutic doses"

Heparin is also used in lower doses for the prevention of blood clots forming in intravenous catheters or at the end of intravenous catheters. (Catheter Flush)

Heparin is not absorbed if taken orally so it must be given as an intravenous or subcutaneous injection.

The major side effect of heparin is unwanted bleeding. Heparin is also know as a "HIGH ALERT DRUG" A High alert drug is one that can cause significant harm to a patient even when used as intended. They cause harm more commonly and the adverse effects tend to be more serious.

I was asked, "How did this mix-up occur?"

Heparin is commercially available in many different strengths, reported as "Units/milliliter" (U/ML) (units/ml)

Because different conditions required different doses of heparin, most hospitals carry all the different strengths in their inventory.

Heparin is available in:

10,000 Units/ml \
5,000 Units/ml THESE ARE COMMON FOR THERAPEUTIC DOSES
1,000 Units/ml /

For Flushing Intravenous catheters the common strengths are:

100 Units/ml for adults
10 Units/ml for pediatric patients

In the incident with the Quaid children, they were supposed to receive a dose of the 10 Unit/ml Heparin but instead received a dose of the 10,000 Unit/ml heparin. That is a 1000 fold error.

See if you can see the potential for error in the following example:

Heparin 100u/ml IV as directed. - With the word "UNIT" not spelled out, the u could be mistaken for another zero. Therefore a dose of 1000 Units could be given instead of 100 units. Imagine if that order were hastily written out and not typed. It would be more difficult to read correctly. It can happen that easily!

There are many strategies out there to try to prevent these errors. The most important strategy is for the Pharmacists and Nurses to be constantly vigilant and aware that the potential for these errors exist. Check and Double check. If I am not sure, I ask. Then double check again!

For more information, please read the following from the Institute for Safe Medication Practices (ISMP)

http://www.ismp.org/Newsletters/acutecare/articles/20071129.asp

For information on High Alert Medications please see this link.

http://www.ihconline.org/ihi/ReduceHarmHighAlertMedications/PreventHarmFromHighAlertMedications.pdf

Thanks for your attention.

Dr. Paul

How Do Drug Work - NEW Non Sedating Antihistamine

2007-11-27T21:03:00.000-06:00

Hello Everyone,

On a previous post I wrote about Zyrtec (cetirizine) now being available over the counter (OTC).
There is now another non sedating antihistamine on the market.

YXZLAR (levocetirizine) was approved by the Food and Drug Administration (FDA) as a once-daily prescription antihistamine. It is classified as a non sedating antihistamine and indicated for the the relief of symptoms associated with seasonal or perennial allergic symptoms. It is also indicated for non complicated skin allergies. When a drug is INDICATED for a certain condition, that means that the FDA has approved that drug for that specific use.

The most common side effects of Xyzlar in adults were drowsiness, fatigue and dry mouth.

Here is an interesting medication phenomenon. See if you can see any similarities here.

ZYRTEC = CETIRIZINE

XYZLAR = LevoCETIRIZINE

Are they the same drug? No, not exactly. On a molecular level, in the world on medicinal chemistry, levocetirizine is an ENANTIOMER of cetirizine. More specifically, it is the active R-enantiomer. Think of your left hand as being an enatiomer of your right hand. They are the same, but reversed. Being the active enantiomer means that it is the levocetirizine molecule that actually provides the antihistmine effects.If anyone would like more information on the specifics of stereo-chemistry, please email me.

Anyway, I got carried away there.

So, if your allergy symptoms are being well controlled by Zyrtec (cetirizine) and since it is now over the counter (OTC), you may want to look for a prescription product. XYZLAR may be a good candidate to ask your physician about.

Thanks for your interest,

Dr. Paul

General Health Information - Non Sedating Antihistamines

2007-11-27T20:33:00.000-06:00

Hello Everyone,

On a previous post I talked about non sedating antihistamines. In that article, I referenced Zyrtec (cetirizine) as one of the prescription products available.

I just read that on 11/22, the Food and Drug Administration (FDA) approved Zyrtec tablets, chewable tablets and syrup for nonprescription, over the counter (OTC) use. It is approved for temporary relief of symptoms due to hay fever or other respiratory allergy symptoms.

Andrea Leonard-Segal, M.D., director, Division of Nonprescription Clinical Evaluation in the FDA's Center for Drug Evaluation and Research stated "The approval of Zyrtec for nonprescription use offers an additional treatment option for children and adults. As for all nonprescription drugs, consumers and caregivers should read and carefully follow all directions on the labeling."

What does this mean for you?

For many of you, to obtain this medication, you will not longer to need to visit your physician to get a prescription for Zyrtec. That's the good news.

For many more with prescription drug coverage, since Zyrtec is now OTC, the medication will no longer be covered. If you were paying a $10 co-pay for your Zyrtec, you will now be paying much more. That's the bad news.

I tried to research the prices of OTC Zyrtec but I was unable to find a current price. As soon as I find a price I will let you know.

Please consult with your Pharmacist or Physician for alternatives to Zyrtec if you would like to switch to a prescription product.

I will be posting some updated information on an alternative.

Thanks,

Dr. Paul

How Do Drugs Work - Nasal Steroid Sprays

2007-11-24T07:14:00.000-06:00

Hello Everyone,

The folks with allergies are still out there and in South Texas allergy season doesn't end anytime soon. So far, we have talked about antihistamines and decongestants that are used to treat allergy symptoms. There is another class of medications to use in your fight against seasonal allergies and these are the nasal corticosteroids.

Nasal corticosteroids, also know as Inhaled Nasal Steroids, reduce swelling and secretions by decreasing histamine and prostaglandins along with other substances in the nose. Nasal corticosteroids have been shown to improve symptoms of sneezing, itching of the nose, runny nose, and congestion.

According to the Joint Council of Allergy, Asthma and Immunology (JCAAI), nasally inhaled corticosteroids are the most effective medication class for controlling symptoms of allergic rhinitis. They also recommend that the inhaled nasal corticosteroids should be used as first line therapy for the treatment of allergy symptoms. The American Academy of Allergy, Asthma and Immunology (AAAAI) also recommend nasal corticosteroids for the initial management of allergy symptoms.1

Drugs in this Class

Beclomethasone Nasal Inhalation (Beconase AQ) 2x/day
Budesonide Nasal Inhaler (Rhinocort Aqua) 1x/day
Flunisolide Nasal Inhalation (Nasarel) 2 - 3x/day Generic available
Fluticasone Nasal Inhalation (Flonase) 1x/day Generic Available
Fluticasone Nasal Inhalation (Veramyst) 1x/day
Mometasone Nasal Spray (Nasonex) 1x/day
Triamcinolone Nasal Inhalation (Nasacort HFA) 1x/day
Triamcinolone Nasal Spray (Nasacort AQ) 1x/day

These medications are only available with a prescription. Therefore, you must schedule a visit to your doctor's office to get a prescription.

Most scientific studies state that the effectiveness between all nasal corticosteroids are similar. Since individual responses may vary, you may have to try several different brands to see which drug is the most effective for you.

These medications do not provide the immediate relief that other types of medication can. It is recommended that these corticosteroid nasal sprays be started before symptoms occur. So if you know that cedar season is coming, you should plan ahead and start your therapy. Remember, corticosteroid nasal sprays are not intended to relieve acute symptoms so they need to be used on a regular (daily) basis. Once control has been achieved the dosage should be reduced to the minimum dose to control your symptoms.

Side effects are generally minimal with nasal irritation (burning/stinging sensation) and taste disturbances (dysgeusia) being the most common.

As always, follow the prescribing directions. If you have any questions, please talk with your Pharmacist or Physician or email me.

Thanks for your support,

Dr. Paul

1. American Academy of Allergy, Asthma and Immunology. Practice parameters for diagnosis and management of rhinitis. Available at: http://www.acaai.org/NR/rdonlyres/C39594CA-ABDF-4DBA-93EC-1CFB3429D305/0/rhinitis.PDF. Accessed November 23 2007.

How Do Drugs Work - Non-Sedating Antihistamines

2007-11-21T07:35:00.000-06:00

Hello Everyone,

I'm sure it's been a very busy week for everyone and with all the holiday preparations, who has time to be sick. Or, who has time to feel drowsy or stay in bed because they are taking antihistamines for their allergies?

Good News. There are now medications that are called Non-sedating Antihistamines.

Claritin - Loratadine (OTC)
Clarinex - Desloratadine
Zyrtec - Cetirizine
Allegra - Fexofenadine

These are 2nd generation antihistamines that claim to be less sedating than their 1st generation counterparts such as Benadryl - diphenhydramine.

Studies have indicated that these non-sedating antihistamines are as effective as diphenhydramine.

Is there some wordplay going on here?

Are they NON-sedating or are they LESS sedating than their 1st generation counterparts.

Researchers looked at 18 different studies where researchers compared the effects and side effects of the 2nd generation antihistamines and diphendydramine against a non-active ingredient (placebo). When researchers go back and look at studies that have been completed and then summarize the findings of those studies is called a meta-analysis.

In those 18 studies, both the 2nd generation antihistamines and diphenhydramine caused significantly more sedation and psychomotor impairment compared to placebo. However, the diphendydramine caused significantly more sedation and psychomotor impairment than the 2nd generation antihistamines. There were a few exceptions to this trend.

Those studies support the conclusion that the 2nd generation antihistamines are LESS sedating than diphenhydramine. However, they are more sedating than placebo. Therefore, one could conclude that the 2nd generation antihistamines are LESS sedating but they are not NON-sedating.

What does all that mean?

What is really important is HOW DO THEY MAKE YOU FEEL?

CONSIDER - If both diphenhydramine and the 2nd generation antihistamines can control your allergies... does one cause you to doze off and with the other you feel fine?

If that is the case, take the one that works for you. Remember, of the 2nd generation antihistamines, only Claritin in available without a prescription. The 2nd generation antihistamines are also more expensive. Consult with your Pharmacist or Physician for more information.

The 2nd generation antihistamine products are also available in combination with a decongestant, usually pseudoephedrine.

If you have any specific questions regarding your medications, please do not hesitate to email me.

Have a very happy Thanksgiving.

Dr. Paul

General Health Topics - What I Recommend for Allergies

2007-11-17T13:14:00.000-06:00

Hello Everyone,

It's allergy season. People are suffering....me included.

We have talked about using antihistamines and decongestants to combat allergy symptoms. Several readers have asked what is better and how should they take them.

This is what I recommend for Over the Counter (OTC) allergy treatment.

AM Dosing - 2 psuedoephedrine tablets or 1- (12 hour) psuedoephedrine tablet

AM Dosing - 1 spray in each nostril of Afrin 12 hour formula (oxymetazoline) nasal spray.

PM Dosing - 1 spray in each nostril of Afrin 12 hour formula (oxymetazoline) nasal spray.

PM Dosing - 25mg (1 tab) - 50mg (2 tabs) of diphenhydramine before going to bed.

Remember:

If you have high blood pressure, heart condition, diabetes, currently taking and MAO Inhibitor drug, glaucoma or prostate swelling you should not take the decongestant.

Diphenhydramine can cause drowsiness. Take appropriate precautions when using this medication

Overuse (> 4-5 days) of decongestant nasal sprays can cause rebound congestion. Do not overuse.

When sleeping, if stuffiness or post nasal drip keeps you from sleeping comfortably, prop yourself up on a couple of pillows.

Hopefully this can help you feel better. Please read all medication labels carefully.

Have a nice weekend,

Dr. Paul

How Do Drugs Work - Decongestants

2007-11-14T20:05:00.000-06:00

Hello Everyone,

As "Cedar Fever" gets worse in South Texas, more and more patients are reaching for over the counter (OTC) remedies to help them cope with the runny noses, itchy eyes and increased sinus, head or nasal congestion. An earlier article covered antihistamines which works well for the runny nose and itching.

Today we are going to discuss medications that patients take to fight that congested feeling. There are usually two types of congestion that patients experience. Chest congestion or nasal congestion. Most of the medications that we are going to discuss today are for nasal, head or sinus congestion.

Congestion problems? What medications can you take to fight that congestion. DECONGESTANTS! Be careful.... they are not for everyone.

Decongestants belong to a class of medications called sympathomimetics. That is... they mimic the action of the chemical in the body (neurotransmitter) that controls the sympathetic nervous system. The chemical in the body is norepinephrine, commonly called "adrenaline".

Adrenaline is the chemical in the body that controls the "Fight or Flight Response" in the body. You know the feeling..... something scares you and all of a sudden, your heart is beating faster, you are breathing faster, your blood pressure goes up and you feel anxious.

It speeds up the heart by stimulating the receptors in the heart causing it to beat faster.
It increases blood pressure by causing a the blood vessels to constrict (get smaller)
It stimulates breathing and opens your airways because if you are going to fight or run you need more oxygen.
It can give you more energy reserves by causing the liver to convert stored sugar to glucose that your cells can readily use for energy.
It can keep you awake.

It SPEEDS things up. SPEED! You have heard that term referring to illicit drugs. Well, speed belongs to the same family of drugs. In fact, there are many medications that belong to that same class of medication. Sympathomimetics have many medicinal uses... Attention Deficit Hyper Activity Disorders, Appetite Control, Weight Loss, Low Blood Pressure, Asthma Control, Nasal Decongestants.

So, Nasal Decongestants, How Do They Work? Medications like psuedoephedrine, phenylephrine, ephedrine and topical decongestants like oxymetazoline work by stimulating the receptors on the blood vessels in the sinuses causing them to constrict and relieving that stuffy feeling. That simple.

Recently the sale of psuedoephedrine was restricted. This medication is now kept behind the counter with the Pharmacist in an effort to control large sales of psuedoephedrine. Why is this? Psuedoephedrine is used in the manufacture of the illicit substance - methamphetamine.

Above I mentioned that nasal decongestants are not for everyone. This is why....

It speeds up the heart by stimulating the receptors in the heart causing it to beat faster.
If you have a heart condition, the increase in heart rate can cause problems.

It increases blood pressure by causing a the blood vessels to constrict (get smaller).
If you have high blood pressure, the increase in blood pressure can cause problems.

It can give you more energy reserves by causing the liver to convert stores sugar to glucose that your cells can readily use for energy.
If you have diabetes, the increase in blood sugar can cause problems.

It can keep you awake.
If you take decongestants late at night, it can cause restlessness and inability to sleep.

Decongestants should not be taken with other medical conditions. If you have any chronic illness, please check with your Pharmacist or Physician to see if these medications are safe for you.

Many of the combination cough and cold remedies have decongestants in them. Please take time to read the ingredient list before you make a purchase. If needed, please ask your Pharmacist for assistance. Remember, if the package says it is a non-drowsy formula, chances are it has a decongestant in it.

I am trying to keep these explanations easy to understand. If they are not clear or you would like more information, please let me know.

Thank you for your support.

Dr. Paul

General Health Topic - Medicare Fall Open Enrollment - November 15 - December 31 2007

2007-11-13T09:12:00.000-06:00

Hello Everyone.

Again, it is that time of year. This time it is for Medicare's fall enrollment period which starts in a couple of days on November 15 and runs through December 31, 2007.

For my readers that are eligible, now is the time to review your health care and prescription drug coverage and make changes if needed. If you are not enrolled in a plan, now is the time to enroll.

For my other readers that aren't eligible, I'm sure you know someone that is eligible, your parents, grandparents, neighbor, coworker. A friendly reminder for them would be appreciated.

I'll admit that I am no expert on Medicare health plans. However, there are many people that are and I have included many links for you to get as much information as you need. There are many plans and options available. If you have parents or grandparents that are eligible, please take time to help them decipher the many plans that are available.

As outlined in the Health and Human Services (HHS) website the three important steps to follow are:
1. Prepare - Gather information on the available plans looking at does your doctor participate in the plan, do the plans cover the medications you are taking, and all associated costs of the plans.
2. Compare - will the plans meet your needs, costs and customer service.
3. Decide - enroll in the plan that will work for you.

Here are a government links to gather more information:

Open enrollment Information - http://www.cms.hhs.gov/center/openenrollment.asp

State drug Plan Information - http://www.cms.hhs.gov/Partnerships/STDrugPlanInfo/list.asp

Official Medicare Site - http://www.medicare.gov/

Comparing plans - http://www.medicare.gov/Publications/Pubs/pdf/11163.pdf

The following links are provided by private business, insurance companies and different organizations. I do not endorse one product over the other. I am simply providing information to help you make your best decision. for more choices go to www.google.com and do a search on Medicare Plan providers in your area.

AARP Medicare Plan Information - https://www.aarpmedicarerx.com/

A good place to get started - http://www.medicareinteractive.org/page2.php?topic=counselor

Aetna - www.aetna.com/members/individuals/medicare/medicare_resources

Humana - http://www.humana-medicare.com/

This site compares plans in Texas - http://www.planprescriber.com/medicare/client/156904/web/index.jsp?group=156904&adwords=y&gclid=CNut_6uW2o8CFUV0OAodDQfH8w

There are many more avenues to gain the information you need to make your best decision.

Good luck.

Dr. Paul

General Health Topic - Gross Hotel Glasses

2007-11-10T12:10:00.000-06:00

Hello Everyone,

The other day I wrote an article about hand washing and using antibacterial wipes in groceries stores, hotels and other locations to try to prevent the spread of colds, flu, etc.

Yesterday I read an article in USA Today about the glasses in hotel rooms that I thought I would pass along.

Here is the article:

Gross hotel drinking glasses

Think the glasses in your hotel room are sanitized?

Unless they're plastic and wrapped, think again.
A reader alerted me to a report this week by the investigative team at Atlanta Fox 5 TV. They checked into a half-dozen area hotels and put a hidden camera in the bathrooms. What they found everywhere -- from budget to luxury hotels -- was disgusting: Housekeepers rinsing glasses in the bathroom sink. In one case, glasses were swooshed out after a housekeeper had been cleaning the toilet; in another, glasses were sprayed with what looked like a toxic mirror-cleaning product before being rinsed and dried.
Hotels typically say glasses are put through the dishwasher, but I have observed housekeepers swishing them out in the sink to save time near the end of a shift. Health experts interviewed by Fox 5 said the practice was a violation of rules and that dirty glasses could spread disease

http://blogs.usatoday.com/hotelhotsheet/2007/11/gross-hotel-dri.html

(Note: this article was cut and pasted from the enclosed link. I did not write it.)

I will try to pass along these tidbits when I find them in an effort to stay Healthy.

Have a nice weekend.

Dr. Paul

How Do Drugs Work - Antihistamines

2007-11-08T21:30:00.000-06:00

Hello Everyone,

Tis the Season.

Well, Thanksgiving and Christmas are coming but that is not the season I am talking about.

I am referring to ALLERGY SEASON.

You go to bed one evening and you wake up in the morning with nose dripping, red eyes, scratchy throat, wheezing, sneezing, hives, and maybe throat tightness.

That is your body's immune response to a substance that is causing irritation in your nose and throat. The mast cells in your body are producing histamines. The histamines and the other chemicals that they stimulate are responsible for your runny nose and itchy eyes. Histamines can cause allergic reactions in other parts of your body...like if you are allergic to peanuts or some prescription drugs.

To treat those symptoms, you need something to block the action of histamine. Something that works against the histamine, something that is "ANTI-histamine"

"Anti-Histamine" - Does that sound familiar?

Antihistamines are a class of medication that are used to counteract the action of histamines in the body. Specifically, they block histamine-1 receptors in the respiratory tract, GI tract and blood vessels. By blocking the receptors, the histamine is prevented from adhering or interacting with the receptors. The histamine can not then trigger the chemical cascade that then causes the symptoms that make you miserable.

Examples of antihistamines include chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), clemastine (Tavist),fexofenadine (Allegra), loratadine (Claritin) and cetirizine (Zyrtec). The less-sedating antihistamines (Allegra, Claritin, Zyrtec) are available either by prescription or over the counter.

Side effects commonly include drowsiness and dry mouth. Because they can cause drowsiness, many people can not take antihistamines early in the day and you should not take them before driving or performing any other hazardous activities. I usually recommend to my patients to take antihistamines at night before going to sleep. In fact, many people take diphenhydramine so they can sleep! Antihistamines can cause difficulty urinating, confusion, and an increased risk for falls or injury especially in older adults.

Antihistamines are also useful for treating hives. There are antihistamine creams, lotions and gels that can be applied topically to treat itching on the skin.

There are other types of antihistamines. However, they are not usually known by that name. Remember, there are histamine receptors in the stomach. When those receptors are stimulated, it causes the acid producing cells in the stomach to produce acid. Histamine-2 blockers (H2 blockers) are used as an anti-acid treatment for treating heartburn. Examples of H2 blocker medication include ranitidine (Zantac) or cimetidine (Tagamet).

Please stay tuned to future posts concerning other medications to treat allergy symptoms such as decongestants. There are many patients that should not take decongestants because of their other medical conditions. Please be careful because there are many combination allergy treatments that contain both antihistamines and decongestants. Please read the label carefully or ask your pharmacist for advice. If the package says "Non-Drowsy Formula" - WATCH OUT. That usually means that it has a decongestant in it. We will go over that information soon.

Hope you stay healthy.

Dr. Paul

An Ounce of Prevention

2007-11-07T09:56:00.000-06:00

Hello Everyone,

The saying goes... "An Ounce of Prevention is Worth a Pound of Cure".

In pharmacy, we spend most of our time providing medications to our patients that focus on curing or making health conditions better.

What we should really focus on is PREVENTION!

We should try to prevent the condition in the first place. Preventative measures are the key. That is going to be one of the focal points of this blog. Many of the diseases and conditions that we face are preventable. Getting proper exercise, eating right, stop smoking, getting immunized, regular health Check-up and Dr. visits, visiting the dentist regularly, age appropriate health screenings and tests (mammograms, colonoscopy), knowing our cholesterol level, wearing our seat belts, etc. are all things that we should do that will contribute greatly to our overall health.

Cough, Cold and Flu season is here. In an earlier post, we talked about flu vaccines and how they can prevent catching the flu. However, one of the easiest ways to prevent catching colds and flu is proper hand washing and personal hygiene.

How should you wash your hands and when should you wash them? Here are some hints and guidelines:

For effective hand washing:

Wet your hands under warm running water.
Apply a small amount of liquid soap.
Cover all surfaces of your hands with soap and water, rubbing vigorously.
Rinse with clean running water.
Dry hands thoroughly, using paper towels or a clean towel.

When should we wash our hands?

Before eating or preparing food
Immediately after handling raw foods, such as poultry
After going to the bathroom or changing a diaper
After contact with blood or body fluids (e.g., after sneezing, coughing, wiping your nose)
After touching animals or their toys and leashes
After touching contaminated or dirty items such as trash cans, cleaning cloths, drains.
Before dressing a wound, giving medicines, or inserting contact lenses
Whenever hands look dirty

Soap and water and proper hand washing facilities are not always available. Carry a small bottle of an alcohol based hand sanitizing gel such as Purell to use as needed. The following link has an interesting article that shows that using sanitizing gels can reduce the spread of stomach illness. http://www.medicalnewstoday.com/articles/30267.php

Carry a small package of antiseptic wipes (Purell Hand Wipes) for wiping off items that you come in contact with at the grocery store (shopping cart handles), hotels (Phones, remote controls), airports, parks, shopping malls, public restrooms and other public places.

Here are some additional links with information from the Center for Disease Control (CDC)

http://www.cdc.gov/print.do?url=http%3A//www.cdc.gov/ounceofprevention/

and from Lysol.

http://www.lysol.com/topic_germs.shtml

The CDC also publishes some good brochures and wall charts on hand washing. Here are those links:

http://www.cdc.gov/ounceofprevention/docs/oop_poster_12-13-05.pdf

http://www.cdc.gov/ounceofprevention/docs/oop_brochure_12-20-05.pdf

Please note: These publications are available for download only as *.pdf files. These files require Adobe Acrobat Reader in order to be viewed. Please review the information on downloading and using Acrobat Reader software.

If you have any suggestions for topics of discussion, please let me know.

Thank you for your time,

Dr. Paul

How Do Drugs Work - Laxatives

2007-11-06T21:33:00.000-06:00

Hello Everyone,

Since the name of this blog is How Do Drugs Work, it is time to start talking about....... How drugs work! The medical term for how drugs work is their "Mechanism of Action (MOA)"

Today we'll talk about.......

LAXATIVES - medications that promote bowel movements. most of these products are sold Over the Counter (OTC).

To maintain good bowel health, remember to get exercise, eat fiber rich foods and drink plenty of fluids. If that doesn't help you stay "regular" you may need to take a laxative to get you back on track.

Saline cathartics -magnesium citrate, magnesium hydroxide (milk of magnesia, MOM), magnesium sulfate (Epsom salts), sodium biphosphate, sodium phosphate (Phospo-Soda).
MOA - Saline laxatives act by attracting water in the intestine and produce a watery stool.

Stimulant and irritant laxatives - Senna (Sennacot) and bisadocyl (Dulcolax) Sennosides (Ex-Lax Laxative) and Castor oil (Purge).
MAO - increase the peristaltic movement of the intestine which forces the stool out.

Bulk forming laxatives - Psyillium (Metamucil, Konsil), methylcellulose (Citrucel) and polycarbophil (FiberCon).
MOA - increase the bulk and volume of the stool, soften the stool and stimulate intestinal motility. This class of laxative is most effective when used daily and consumed with plenty of fluids.

Stool Softener - Docusate (Colace)
MOA - holds water within the stool, providing a larger, softer stool.

Lubricant laxative - Mineral Oil, Glycerin and Magnesium Hydroxide
MOA - Coats and softens the stool by slowing intestinal absorption of fecal water.

Hyperosmotic laxatives - Glycerin and lactulose.
MOA - holds water within the intestine.

Common side effects of laxatives - Laxatives can cause cramping, gas, bloating, nausea or diarrhea. Most likely to cause side effects are the stimulants. The side effects can include abdominal discomfort, faintness and cramps. The bulk-forming laxatives can cause bloating, gas or cramping at first. These symptoms should go away in a few weeks or less.

Interaction with medications - Your current medical condition and other medications you are taking are important things to consider when selecting laxatives. Laxatives can interact with many different drugs such as Coumadin (warfarin). Ask your pharmacist or doctor if you are not sure what type of laxative is right for you.

Laxative Abuse - Some people will abuse laxatives to rush food through their bodies before the calories can be absorbed as a weight loss scheme. This practice is not safe and can cause short and long term damage to the intestines and overall health. Abusing stimulant laxatives can cause the intestines to react only to the stimulant and will stop working without them. If you feel you may have a laxative abuse problem, please contact your healthcare provider.

Here are a few links with more information on Laxatives and how they work.

http://www.mayoclinic.com/health/laxatives/HQ00088

http://familydoctor.org/online/etc/medialib/famdoc/docs/otc-laxatives.Par.0001.File.dat/otc_laxatives.pdf

Thanks for your time,

Dr. Paul

Flu Shot Reminder

2007-11-04T23:21:00.000-06:00

Hello Everyone,

Flu season is here. Now is the time to get your annual flu shot.

The following folks are the ones who really need to get vaccinated:

Over age 50
Any age if you have chronic medical conditions such as high blood pressure, irregular heartbeat, history of stroke or heart attack, diabetes, compromised immune system, anemia, asthma or other breathing problems
If you live in a nursing home
If you live in a house with people listed above
Health care workers

Prescription Medication and Traveling

2007-11-01T08:51:00.000-05:00

Hello Everyone,

It's November 1st and the holidays are rapidly approaching. If you are currently taking prescription medication and you are planning travel to visit friends, relatives or to take a vacation, here are some helpful hints:

GENERAL TRAVEL

Travel with medications in their original prescription bottles that contain your name, medication name and directions for use. Do not place them in a pill box. They will be easier to identify and easier to show that the drugs are actually prescribed for your health. You don't want to have to explain to that customs official that those narcotics in that plastic baggy are actually prescribed for you.

If your medications include narcotics, controlled substances or needles, have your doctor write a short letter of explanation to verify that the items are needed. Get a letter from your Doctor if you have a pacemaker, implanted defibrillator, implanted pain pump, using an ambulatory pump for intravenous medications or an insulin pump.

Take along more of your prescription medication than you think you will need. It would be a shame not to be able to extend your visit just because you are running out of your blood pressure medication.

Going back to a previous topic, make sure to wear your medical alert bracelet to let people know if you have certain medical conditions. Also make sure you have a copy of your medication list in your purse or wallet if needed.

Try to bring along a copy of your prescription that has both the brand name and generic name of your medication. If you are abroad, it may help you find the right medication that you need.

AIR TRAVEL

Make sure to put medications in your carry-on bags. Do not place in your checked baggage. That way, if your bags are delayed or lost, you will have your medications with you.

Medications that are liquids, aerosols or gels need to meet the carry-on requirements of the Transportation Security Administration (TSA). I have included the link for you at the bottom of the page.

If you are diabetic, make sure you have your GLUCOMETER with plenty of testing strips, and lancets to check your blood sugar often. Traveling can be stressful and may cause your blood sugar to increase. Make sure you have snacks as well. If your plane is delayed or you have to sit on the tarmac for an extended period and you don't get a chance to eat, you don't want your blood sugar to go too low. Have some candy, some glucose tablets, some glutose or a box of juice.

If you have a heart condition, be aware that most airports have AUTOMATIC EXTERNAL DEFIBRILLATORS (AED). Make a mental note where they are located and make sure that your travel companions note their location as well. The AEDs can save your life. We will talk about those in a later post.

A long flight can really cramp your legs. They can also cause a condition called Deep Venous Thrombosis. (DVT) If you are prone to that condition, try to get up, stretch and walk around the cabin if you can. Keep that blood pumping.

Stay well hydrated.

CRUISES - Sea Travel

While on those ships, the food is fantastic. If you are diabetic, again, make sure you have your trusty GLUCOMETER with plenty of testing strips, and lancets to check your blood sugar often. Those yummy desserts can make your blood sugar go crazy. Don't let it get out of control.

If you are taking Coumadin (warfarin), make sure you don't drastically alter your diet. Try to maintain your current consumption of Vitamin K containing foods. If you don't know what those items are, drop me a line and we'll go over them.

If you are prone to sea sickness, talk with your Doctor or Pharmacist to see what remedies are most appropriate for you. Plan ahead. If you need a prescription, waiting to the last minute will add to your stress.

RECREATIONAL VEHICLE (RV) TRAVEL

Motor coach travel is cool in that you are in your home away from home. As you pull into your favorite RV Resort, find out what access they have to Emergency Medical Services (EMS), do they have AEDs available in the park, what other first aid facilities are close by. Is there a local pharmacy that will deliver to the park if a prescription is needed.

Carry a first aid kit in the coach.

Here are the links for more information:

http://www.aarp.org/states/nh/nh-news/helpful_tips_for_traveling_with_medications.html

http://www.tsa.gov/travelers/airtravel/prohibited/permitted-prohibited-items.shtm#1

While you are traveling there is one very important thing to remember as it is very vital to your health....

HAVE FUN ! ! ! ! !

Talk with you later,

Dr. Paul

Identify Yourself and your Medical Conditions

2007-10-30T09:18:00.000-05:00

Hello Everyone,

Do you, a family member or someone you know have any of the following medical conditions or taking certain types of medication?

Diabetes
Congestive Heart Failure (CHF)
Other Cardiovascular Disease
Pacemaker
Implanted Defibrillator
Asthma
Drug Allergies
Food Allergies
Taking Blood Thinners (Coumadin / Warfarin)
Taking Heart Medications (Lanoxin / Digoxin)
Seizures
Other serious Medical Condition

If you have any of those conditions or more..... you need to IDENTIFY YOURSELF!!!!!!!!

If you have any of those conditions or more..... you need to IDENTIFY YOURSELF!!!!!!!!

If you have any of those conditions or more..... you need to IDENTIFY YOURSELF!!!!!!!!

Above was not a typo. I want to get my point across!

Imagine if your Mom passes out in her favorite store. Did she have a heart attack? A stroke? Did she just slip and fall? It is hard to tell right now. She may have some symptoms but the store manager who goes to check it out may not have a clue.

However, if she was wearing her Medical ID bracelet that indicated that she is diabetic, the manager and then the emergency responders would be able to check first for low blood sugar (hypoglycemia). (A survey by American Medical ID indicated that 95% of first responders look for medical ID during emergencies). The treatment to reverse low blood sugar is relatively easy. Having that bracelet may save her life.

There are many suppliers of Medical ID bracelets. You may have seen order forms at many pharmacies. By the way, not only bracelets. There are necklaces / pendants, and charms. I have provided a link to an online supplier. http://www.americanmedical-id.com

(Note: I do not have any financial ties or receive any payment from my online links. I do a Google search, find a supplier that I would buy from and then make the reco.)

The above list of medical conditions is not a complete list of who should have a Medical ID. The link has some good information on their FAQ.

Hope you are finding this information helpful. Let me know. Please let your friends, family and co-workers know about this site.

Thank you for your time.

Dr. Paul

GOOD NEWS! - Now you can go to www.howdodrugswork.com to get to this site.

Pharmacy Mistakes

2007-10-29T10:28:00.000-05:00

Hello Everyone,

There has been some press this morning about the increase in pharmacy errors. Since you are now on your way to becoming INFORMED medication consumers, here are some helpful hints:

Note: some of these hints were posted on a CNN article written by Elizabeth Cohen with quotes from the Institute for Safe Medication Practices, (Hedy Cohen) University of California-San Diego (Dr. David Phillips) and the American Pharmacist Association (APhA Mitch Rothholz) http://body.aol.com/news/health/article/_a/dont-be-a-victim-of-pharmacy-errors/20071026123509990001

Take some responsibility for your own medications. Know what you are taking and why. Know what the tablets, capsules look like that you are taking. If the tablets / capsules in the new refill you just received does not look the same, ASK!!!!! Do everything you can to make sure that the drugs inside the bottle are the ones that are supposed to be there.

At pharmacies across America, the beginning of the month is extremely busy. The reason? Medicare entitlements renew at the beginning of the month. Social security checks are received at the beginning of the month. Dr. Phillips' research indicated that pharmacy errors increase by 25% above normal the first few days of the month. Try to schedule your refills for the middle or end of the month.

Don't wait until the last minute to get your refills. Plan Ahead.

When the Dr. writes you a new prescription, ask him/her what the drug is for. What is the name of the drug, the strength. Make sure the writing on the prescription is LEGIBLE!. Many pharmacy errors occur because the pharmacist mis-reads the prescription. The referenced AOL article talks about a lawsuit that was filed because a patient was given Matulane instead of Materna. You may be able to imagine how those two drugs could be mis-read having seen some of the chicken scratch that is out there. (Chickens, Please don't take offense and send me some threatening emails)

It's curious to realize that many people will research and read on the latest wines, cheeses and other food items and can quote the latest "Wine Spectator" score on that vintage of 2005 Merlot. However, they will not take the time and energy to know about the medication they are taking to control their diabetes.

Since you are reading this article, I'll try to help educate you on drug items of interest.

Be vigilant,

Dr. Paul

Here We Go!

2007-10-29T00:24:00.000-05:00

Hello Everyone!

Drug, Medications, Pills Tablets, Capsules, Suppositories, Troches, Injections, Nasal sprays, Eye drops, Ear Drops.........It's hard to keep track of them all.

I know that the goal is for folks not to HAVE to take drugs. Because when we do, it usually means something is not quite right. It could be high blood pressure, cancer, headache, constipation or a myriad of other problems. Of course, sometimes we take drugs because we want to...like vitamins to try to stay healthy.

Hopefully YOU don't have to take any medications. But, if you do, do you know what they are? What the drugs are for, the strength of the medications, how you are supposed to take them?

I am not talking about a conversation like this:

Dr. Paul "Hi Ms Garcia, I need to update your medication profile, tell me the drugs you are taking."
Ms Garcia "Hello Dr. Paul. I am taking a little blue pill in the morning. I think it is for my heart and I take a round pink pill at night. I'm not sure what it is for."

I know what you are thinking, It doesn't go like that, does it? Yes it does! Or you might be saying, That sounds like me! Or my Mom/Dad, or my Grandmother/Father.

As a pharmacist that conversation doesn't help me one bit. More importantly, IT DOESN'T HELP YOU!

See how this one sounds to you.

Dr. Paul "Hi Ms Garcia, I need to update your medication profile, tell me the drugs you are taking."
Ms Garcia "Hello Dr. Paul. I am taking Lasix 20mg in the morning at 8am for my blood pressure. I also take Coreg 6.25mg twice daily at around 8am and 8pm for my blood pressure."

Now we're talking.

But wait, you are probably saying, How am I supposed to remember all those crazy sounding names and numbers and stuff. I'm lucky to remember to take the pills!

I realize that. It's hard to remember brand name and generic names of drugs. They are hard to pronounce and the chemical name....forget it! They also come in all sorts of mg strengths and sizes... it can make your head swim.

Here come the pointers.

Looking at your medication bottles, write down the name of the drug, the strength, how often you are supposed to take it, etc. on a piece of paper. If you know why you are taking it, write that down as well. Do that for every drug you are taking. Now, take that list and put it in your wallet or purse. Make copies of that list and give them to your kids so they know what you are taking.
Try to remember to update that list every time you add or delete a medication. So next time you need to know the drugs you are taking, pull out your list.

You can write the list with your computer, print it out and that way it can be more legible. Easier to update as well.. There are forms available online or you can pick up medication cards at your pharmacy if you need them

There are many great computer programs available to help you keep track of your medications and health information. Some are free, some charge for their product. They are all good. Probably way better than you are using now.

Here are some links that you may find helpful:

http://www.theguidetogoodcare.com

http://www.mymedilist.org

So get up right now. No, not later....Right now and get your list together. Don't forget to put it in your purse or wallet. It may save your life one day. NO Kidding!

Until later,

Dr. Paul

First Post!

2007-10-28T00:08:00.000-05:00

Hello Everyone!

As the name of this blog implies, we will be talking about drugs and how they work in the body. It really is a fascinating subject. (At least I think so).

For example...Why are you supposed to take ibuprofen with food or at least a small snack? Is it because the ibuprofen tablet itself will cause a ulcer in your stomach? NO!! (Note - Here is the definition of Ulcer taken from www.medterms.com - Peptic ulcer: A hole in the lining of the stomach, duodenum, or esophagus. www.medterms.com/script/main/art.asp?articlekey=4829)

Another example...if you are diabetic, why shouldn't you take decongestants?

The answers to those and many other questions are due to how the drugs work in the body.

In addition to talking about how drugs work, we will talk about general health issues and maybe a few off the wall topics as well.

Look forward to talking with you.

Dr. Paul