General Health Topic - Clinical Research Studies

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

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.

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?

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prescription Medication and Traveling

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

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

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!

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!

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