Poison Prevention Week

March 16th, 2010

“Children Act Fast...So Do Poisons” is one of the basic themes of Poison Prevention Week. Young children exhibit a natural curiosity which allows them to learn about their world. As adults we have a responsibility to foster learning in a safe environment. This safety includes keeping medications and household chemicals out of a child's reach at all times. Leaving a container unattended for just a moment to answer a doorbell or a phone is enough opportunity for a child to discover the chemical with possibly tragic consequences.

The second theme is ”Poisoning Spans a Lifetime”. The elderly or those on multiple medications are especially at risk of harm if medications are taken in the dark or in a manner different from that prescribed. Medications should always be taken in the proper light so that labels are easily read and medication may be identified by color and shape. Special packaging is often helpful for those with complicated medication regimens as it allows for accountability of missed doses.

If a poisoning occurs what is your course of action? The National Poison Control number is 1-800-222-1222. Have the label of the drug or chemical handy when you call the poison expert. Tell the expert the age and weight of the victim as well as any existing medical problems they may have. Inform the poison control person how the victim came in contact with the substance (skin contact, splashed in eyes or swallowed) and for how long. Other important information includes: any first aid already given, if the victim has vomited, your location and the distance to the nearest hospital.

Happy and safe spring cleaning to everyone!

June L. Caldwell, RPh, FASCP

Alzheimer's Disease Awareness

November 30th, 2009

Early detection and treatment of Alzheimer’s Disease are key in halting cognitive decline. Awareness of the 10 warning signs of Alzheimer’s Disease (AD) in family members and friends may prompt treatment which will allow independence for a greater period of time.

The Alzheimer’s Association launched a new education campaign this year called “Know the 10 Signs: Early Detection Matters”.

10 Warning signs of Alzheimer’s Disease

1. Memory changes that disrupt daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks at home, at work, or at leisure
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality

The Pittsburgh Post-Gazette did a feature article last year on a former pilot who has early-onset Alzheimer’s with an update in their November 29, 2009 edition. This new article is quite timely for two reasons. One is that November is National Alzheimer’s Awareness Month. The second reason is that this gentleman is now in a drug trial for a promising investigational Alzheimer’s medication which may reverse cognitive decline rather than just slowing down the progression of the disease like current medications.

June L. Caldwell, RPh, FASCP

Honey Dressing

July 7th, 2009

Honey mustard is my favorite dressing for subs and salads. Dating as far back as the early Egyptians, honey was employed in a different kind of dressing – a wound dressing. Although the ancients were wise in choosing honey for first aid, they may not have been fully aware of the medicinal properties of honey that made it successful.

Honey is a super-saturated solution of sugars made from nectar. It is almost impossible for bacteria to grow in this type of solution. The natural acidity of honey also inhibits the growth of micro-organisms. Honey has hydrogen peroxide activity which is stronger in certain types of honey and destroyed by heating. Honey that is processed without heating or filtering is considered raw honey.

One serious concern with raw honey is that unheated honey could contain clostridium botulism spores. If this honey is used on wounds it may cause wound botulism. Recent studies have found that gamma irradiation of the honey inactivates the spores without destroying the hydrogen peroxide activity of the honey.

The availability of honey in developing countries is often greater than products of conventional wound therapy. In some areas it has even been successfully used to clean wounds. Honey dressings often work in medical cases where traditional therapy has failed. In the near future honey dressings will be commercially available.

June L. Caldwell, RPh, FASCP

Tick Removal

June 15th, 2008

If you are bitten by a tick infected with B. burgdorferi, the bacteria responsible for Lyme disease, you may also become infected. It is not the bite itself which causes the infection but saliva regurgitated by the tick near the end of the blood meal. The ticks cleverly release neurotoxins which numb the bite area to make most hosts oblivious to the attached tick. Some ticks also secrete a blood thinner to make it easier to get their meal. In most cases the tick needs to be attached to the host at least 24 hours to transmit the bacteria.

If you find an attached tick remove it as soon as possible. Save the tick in a secure place to bring to your doctor visit. Wash the area of the bite and your hands with soap and water. You may or may not develop a bull's-eye rash at the site. One of several common and relatively inexpensive antibiotics may be prescribed by your doctor. An infected bite left untreated may cause flu-like or arthritis-like symptoms which may be the first symptoms of Lyme Disease.

The best way to prevent Lyme Disease is to avoid getting bit by a tick in the first place. In the last Healthful Hints article we discussed preventative measures such as how you dress, type of activity, tick repellents and body checks for ticks. In the case of a tick bite employ the first aid measures above and follow-up with your family doctor.

June L. Caldwell, RPh

Tick Prevention

May 19th, 2008

Ticks, like spiders, are arthropods. If you have ever seen a pack of tiny spider-like creatures running around on a log, you have seen a bunch of brand-new ticks. So common sense tells you that sitting on a log is not a good idea if you want to avoid ticks. Log sitting was part of a recent study from University of California at Berkley. The study investigated whether specific human behavior increases the risk of tick exposure. The researchers found that you have a 30% chance of getting a tick on you after sitting on a log for only 5 minutes. Gathering wood and leaning against trees are two other risky activities mentioned in the study.

Some actions that can help prevent tick exposure are to wear long, light clothing and avoid the shrubs and grasses where ticks live. Tuck your pant legs into your socks so that a tick will be less likely to crawl into your shoe or up your leg. Light clothing and white socks will help you to see the dark colored ticks more readily. The use of DEET as a repellent is also helpful. When you return home discard your clothing for the wash (the heat of a dryer cycle will kill ticks), and do a full body check for ticks. Ticks may crawl on your body for several hours before finding a safe place to attach for a meal. The back of the knee and armpits are two favorite spots.

By being both proactive (the way you dress, using DEET) and avoiding certain activities (log sitting in the woods), you can greatly decrease your risk of tick exposure. What if, despite your best efforts, you still end up with a tick bite? Next time we'll discuss the best course of action for treating tick exposure.

June L. Caldwell, RPh

Walk to Wellness

May 5th, 2008

Walking is a low-impact way to reach a destination. An exercise that almost everyone can perform, walking improves your sense of well-being. The repetitive motion of your stride has a soothing, meditative effect. Solitary walks give you time to think through problems and get creative ideas while being inspired by nature. Striding it out with friends allows you time to catch up on each others' lives. Continuing your daily walks is also easier when shared with a friend or your dog.

A brisk walk is considered moderate activity. To achieve or maintain good health experts recommend moderate activity 30 minutes a day 5 days a week ore more. To work up to more vigorous activity such as jogging, consider wogging. Wogging alternates between walking and jogging. You can walk for 5 to 10 minutes then run for a minute or two, then return to waking. Vigorous exercise at least 30 minutes a day for 3 days a week or more has measurable health benefits. Check with your health care professional before starting any exercise routine.

Although walking is a great way to warm-up your muscles before starting a run or a yoga routine, it also has benefits all its own. So whether you want to help prevent Alzheimer's Disease or recover more quickly from surgery, it all starts with the first step.

June L. Caldwell, RPh

Knitting for Wellness

March 31st, 2008

In the Berta Hummel print "The Knitting Lesson", the German artist illustrates three young girls discussing knitting. Berta lived from 1909-1946, a time period when knitting was a class taught to girls in school. Today knitting is considered by most to be a hobby rather than an essential skill to be learned. Knitting as a form of needlework is currently experiencing a revival which includes celebrities such as Julia Roberts and Cameron Diaz. The March issue of Family Circle noted that more than six million teens and tweens are now knitting. Many knit as a step on the path to wellness.

The ability to relax is essential to wellness. The repetitive motions of knitting and crocheting can bring the mind and body to a "relaxation response" which is a state similar to that experienced through repetitive prayer, yoga and Tai Chi. Research at the Harvard Mind/Body Institute has found that when a person is knitting her heart rate can drop 11 beats a minute and her blood pressure can drop as well. Such results can have considerable health benefits for those who knit and crochet. These health benefits have been employed to reduce stress in difficult situations such as weight loss, smoking cessation and coping with chronic illness.

Grade schools across the U.S. are again teaching children to knit for not only the health benefits but also to boost creativity and math skills. Creativity allows for self-expression which also contributes to wellness. Even if you are following a prescribed pattern you still have a choice of colors and textures of yarn. You can also follow the example of many teens and seniors by donating your final knitted product to charity. The health benefits of helping others have been well documented. So follow the advice contained in the subtitle of the book Teen Knitting Club: Chill Out and Knit.

June L. Caldwell, RPh

Honey, I Shrunk

February 29th, 2008

The Baltimore Longitudinal Study of Aging, which followed 2,084 men and women aged 17-94 years from 1958 to 1993, found that height loss started around age thirty and accelerated with age. By the age of eighty, women averaged about 3 inches of height loss with men averaging about 2 inches. So, short of living on the space shuttle, what might you do to help retain your height? How can you arrest the effects of gravity on your body?

Good posture is one way to fight against gravity and show-off your stature. Studies have shown that vertebral fracture account for about 30% of height loss, and the other 70% may be from changes in posture. You need to be aware of your body position when stand, sitting or sleeping. Yoga and Tai Chi (often called "moving yoga") help to relax and tone muscles. You can also do specific exercises to help your posture. If you have back, neck or pelvic injuries, ask your doctor to refer you to a physical therapist. Physical activity helps with both posture and in preventing osteoporosis. Weight-bearing exercise stresses your bones to make them stronger. As we age our bones become less dense and more brittle. Vertebrae can fracture and compress to cause loss of height and change in posture. Kyphosis, an abnormal curvature of the upper spine, may result from osteoporosis.

Osteoporosis can be detected by a bone scan. Your bone density will be reflected in a T-score. If your T-score is 0.0 to -1.5 maintain your bone health with proper diet, exercise and calcium plus vitamin D supplements. A T-score of -1.5 to -2.0 requires treatment if you have one or more risk factors. Major risk factors for white post-menopausal women include: current smoker, weight less than 127 pounds, use of oral corticosteriod therapy for more than 3 months, an immediate family member with a fragility fracture, personal history of fracture as an adult. A T-score of -2.0 requires treatment even if you have no major risk factors. Stand tall and find out your T-score today!

June L. Caldwell, RPh

Morning Dance

January 17th, 2008

Try something new tomorrow morning to greet the day, gently stretch your muscles and connect with earth and sky. I learned this approach at Bethany Retreat House in Frenchville, PA. Based on a Lokota Native American tradition of acknowledging the four directions, this dance also has Christian elements. Four of the archangels are each assigned a compass point.

Uriel is the archangel of the East, the color yellow for this direction of the rising sun. As we face east we think of the renewal of relationships. Gabriel represents the South and is all colors (white). Stretching south we envision our ancestors and the owl as a spirit messenger. Raphael, "God has healed", is from the West. The color of dark blue or black, this compass point is known for healing powers. Michael, "likeness of God", is the archangel of the red North who represents mercy, love and forgiveness. The North is a place of wisdom which leads to the places and stories of the Lakota people.

At each compass point you do a series of movements which compose the dance. Start by facing the East and stand up straight. As you do a little hop from one foot to the next, stay in the same spot while bending and reaching down towards the earth and then up to the sky and then repeat. Reach both hands straight out in front of you (east) then back to your chest. Next, reach out your arms and hands in the same manner but to each side (north then south). Repeat these movements while facing each of the four directions in turn to enjoy a sense of renewal and connection.

June L. Caldwell, RPh

What Do Drug Expiration Dates Really Mean?

January 14th, 2008

Is one of your New Year resolutions to clean out your medicine cabinet? Are you wondering what those Expiration dates really mean? Medication does not suddenly "go bad" after that date. The expiration date is the date after which the manufacturer cannot guarantee that the product meets FDA (Food an Drug Administration) standards for stability.

Stability tests evaluate whether the drug meets the FDA standards to retain its identity, strength, quality, and purity for the length of the chosen expiration period. The manufacture does "in-house" testing during the period of time chosen for the drug. Maintenance of 90% potency is the common standard. Stability tests are generally performed under the ideal storage conditions for the drug. The expiration date stamped on the product package relates to the product in its original packaging.

How is the expiration date determined for a drug no longer in the original packaging? Drugs transferred from the original stock container to a prescription bottle have an expiration date of no greater than one year from the dispensing date. If the expiration date on the original container is less than a year then that date is used. The one year expiration date was set by the United States Pharmacopeia (USP) in 1985.

Storage conditions beyond the type of packaging also determine the stability of medications. Most drugs fair best at room temperature with low humidity. Extremes of temperature (storage in a vehicle) and high humidity (a bathroom) should be avoided. Some medications require refrigeration (36-46 degrees Fahrenheit) and most should be protected from freezing.

June L. Caldwell, RPh

Holiday "Cheer"

December 31st, 2007

Many people who seldom drink alcohol will do so this holiday season. Perhaps just a glass of red wine with New Year's Day dinner or spiked punch to ring in 2008. Although some view alcoholic beverages as a stimulant because it frees you from your inhibitions, alcohol depresses the central nervous system. This depression can dull pain, cause drowsiness, impair judgement and delay your reaction time. Remember to have a designated driver for the ride home.

A nightcap may aid in your getting to sleep, but alcohol's diuretic effect will be waking you up before dawn for a trip to the bathroom. Many of the symptoms of a hangover are from dehydration. Staying hydrated will replace lost fluids.

The action of alcohol as a gastric irritant has been used medicinally to stimulate appetite. Many years ago when I worked as a pharmacy intern at West Penn Hospital in Pittsburgh, we saw orders for wine with dinner. Alcoholic beverages lower your blood sugar to make you feel hungry, so alcohol is not a good substitute for food although it is high in calories.

Alcoholic beverages do not mix well with many medications. You may have a warning label on your prescription bottle or over-the-counter medication. If you are unsure, ask your pharmacist.

June L. Caldwell, RPh

Mono

November 26th, 2007

Infectious mononucleosis, commonly called "mono", is caused by the Epstein-Barr virus. Although not as contagious as the common cold, mono is spread through saliva, mucus and, on occasion, tears. Symptoms, which appear 4 to 6 weeks after exposure to the virus include sore through, high fever, headaches, swollen lymph nodes in your neck, poor appetite and fatigue. Most commonly found in teens and young adults, mono usually occurs once although you will always carry the virus. If you think you might have mono, see your family doctor.

There is no treatment for mono other than good self care: drink lots of fluids, get lots of rest, soothe your throat with lozenges or a gargle. Acetaminophen or ibuprofen may ease the headache and sore throat. Avoid sports activities and even regular exercise for about 4 to 6 weeks. One of the reasons to not engage in sports activity, especially contact sport, is that you want to protect your spleen. The spleen is a large gland in the upper left of your abdomen which filters the blood. Enlarged during mono, the spleen could tear open to cause a medical emergency.

June L. Caldwell, RPh

Vitamins and the Winter Athlete

November 14th, 2007

Winter athlete's have special vitamin needs which may be met through nutrition and supplementation. Although vitamins are found in the foods we eat, additional sources are often beneficial. A multi-vitamin is good insurance but not a substitute for a healthy diet.

Mild is not only an excellent source of calcium but is also fortified with vitamin D. Often called nature's most nearly perfect food, milk contains a wealth of protein. Fruits and vegetables are full of nutrients plus a good source of fiber. Try to get five servings a day.

People who live in the Northeastern U.S. get less sun, and therefore less vitamin D, than those in southern climates. A new recommendation is 1,000 IUs of Vitamin D each day to help ward off depression, cancer, and even high blood pressure.

Vitamin C and E act as antioxidants. Both help maintain the integrity of sell membranes which may be why many Vitamin C aids in warding off colds. The B vitamins act in metabolism of the foods you eat to give you more energy.

Omega-3 fatty acids are known to promote heart health by reducing the risk of heart attack, stroke, and hardening of the arteries. Did you know that these essential fatty acids found in cold water fish may also aid the brain by helping cells better communicate? Maybe fish is brain food after all!

June L. Caldwell, RPh

The Nose Knows

November 4th, 2007

When a cold or allergies cause nose congestion, you realize how much of the "taste" of food is really from the aroma. This sense of smell enabled our ancestors tell if a potential source of food was safe. Today we have rediscovered aromatherapy as a means to enhance our mood. The essential oil from lavender aids sleep, while peppermint eases nausea and headaches.

Frigid temperatures outside prompt our furnaces to kick on. Heating our homes and workplaces in winter causes inside air to be drier than the other seasons of the year. Low humidity is not a good thing for the mucous membranes in our nasal passageways. The inside of the nose may become irritated to the point of bleeding. Saline sprays are a good way to rehydrate the nose. Vaporizers and cool mist humidifiers both put mosture back into the air. Caustion must be taken with vaporizers to prevent steam burns whereas humidifiers must be more carefully cleaned to prevent bacteria and mold growth. Extreme changes in temperature irritate the nose due to expansion and contraction of the nasal blood vessels. You can moderate the temperature of the outside are by lossely wrapping a scarf around your mouth and nose. Setting your thermostat at a reasonable temperature will not only save on your heating bills but also be easier on your nose.

Another way to soothe the nose is to avoid excessive nose blowing. Use only gentle exhalations when needed. Infants may benefit from nasal aspirators which gently extract mucus plugs. Antihistamines are generally not reccommended for infants and young children because these medications may cause too much drying. Mucus serves the important function of trapping germs and foreign particles such as dust and spores.

Decongestant nasal sprays work well but limit their use to 3 to 5 days to avoid rebount congestion. Saline sprays are not limited by duration of use. Saline nasal gels have more staying power than saline sprays and are safer than petroleum jelly because they are water-based. A nasal irrigation of salt water is possible through use of a neti pot. I used a neti pot during my last sinus infection. Although the sensation while irrigating was like doing somersaults in the ocean, the saline irrigation did help. If you nasal problem does not resolve please contact a health-care professional.

June L. Caldwell, RPh

Super Bug

October 22nd, 2007

MRSA (methicillin-resistant Staphylococcus aureus) is a potentially fatal form of "staph" infection. Usually harmless when found on the skin, this bacteria may cause skin irritations after entering the body through a break in the skin barrier. The methicillin-resistant form of staph was named when it first outsmarted the broad spectrum antibiotics used in hospitals over forty years ago. In the 1990's MRSA was starting to be seen in the wider community beyond hospitals. The death of a Virginia high school senior last Monday is linked to an invasive form of community-acquired MSRA (CA-MSRA).

Both they Mayo Clinic and the PA department of Health recommend the following as preventative measures to avoid the possible spread of CA-MRSA:

• Wash your hands properly and frequently.
• Do not share personal items such as shaving razors, towels or sports equipment.
• Cover any breaks in the skin with a sterile bandage.
• If you do acquire a skin infection (redness, swelling, sensation of warmth) contact a health-care professional.

Spread by skin-to-skin contact, CA-MRSA is more common in military units, prisons, or schools.

"Super Bugs" have become resistant to antibiotics as an evolutionary survival mechanism, but some of the blame lies with humans as well. Antibiotics that are prescribed for viral illnesses or self-limiting bacterial infections lead to antibiotic resistance. Not finishing a course of appropriately prescribed antibiotics may also contribute to "Super Bugs". Antibiotics may enter our food and water through animals fed antibiotics and run-off from feedlots into our water systems.

June L. Caldwell, RPh

Mascular Degeneration

March 4th, 2007

My daughter thinks I'm ancient because I remember when TV programs were only in black & white. Some programs are naturally more suited to black & white than color. One that readily comes to mind is Rod Serling's The Twilight Zone. Mr. Serling had a segment on an extremely nearsighted bank teller who lover to read books. He would go in the bank vault on his lunch break so he could read in peace. During one such lunch break a nuclear holocaust occurred and he was the lat human alive on earth. He is excited to finally be rid of his nagging wife and boring job. He can read to his heart's content! He finds the ruins of the library and stacks a pile of books for each month of the year. His exertion causes his coke bottle glasses to slip off his face and onto the ground. As he fretfully searches for this essential tool to correct his vision he hears the sickening sound of his glasses being crunched by his shoe.

This story reminds me of a person who is retired and finally has the time to read voraciously but has vision problems and so cannot pursue their favorite past-time. Age-related macular degeneration (ARMD) is the most common cause of severe vision loss in persons over 60 years of age. As the name implies, the condition is more common as we age. Exposure to UV light is one of the causes of ARMD so protect your eyes from the harmful rays of the sun. Smoking greatly increases your risk of ARMD. Genetics also plays a role whether or not you will develop ARMD. You can't pick your family genetics, but you can make a lifestyle choice to stop smoking if you smoke.

The macula is a small central area of the retina. When the macula breaks down in the 'dry' form of macular degeneration (MD), yellow deposits called drusen are formed. In the 'wet' form of MD abnormal blood vessels grow which may cause permanent scarring and the loss of central vision. Wet MD accounts for about 10% of those with MD but causes for more loss of vision than Dry MD. The dry form may lead to the wet form of macular degeneration.

Since the early stages of macular degeneration may not have any signs, it is important to have yearly vision check ups even if you do not have other problems with your eyes. Symptoms of macular degeneration may include distortion of straight lines, changes in color perception, distortion or white out of central vision. Most people with MD have good peripheral vision. Because of the loss of central vision they will not look you straight in the eye but from the side (periphery) where they can see you best.

Other adaptations include listening to audio books instead of reading visually. Magnification is often helpful as is broad spectrum lighting. Special vitamins with antioxidants and zinc have been shown to help macular degeneration (ARED Study). Ask your healthcare professional what is best for you or your loved one.

June L. Caldwell, RPh

Sugar and Spice

February 26th, 2007

"Sugar and spice and everything nice..." starts the nursery rhyme describing little girls. The association between sugar and spice is the subject of recent studies by the Nutrient Requirements and Functions Laboratory (NRFL) of the United States Department of Agriculture (USDA) concerning cinnamon, glucose tolerance and diabetes. The lead researcher is Richard Anderson, Ph.D., CNS. One study, done in humans who had type 2 diabetes, showed an average improvement in blood glucose in the range of 18 to 29%. Improvements where also demonstrated in triglycerides, total cholesterol, and LDL-cholesterol. This study is published in Diabetes Care, vol.26, 2003.

NRFL researchers also found that the active components of cinnamon are water-soluble and so are not found in cinnamon oil. The active components are stable even when heated so cinnamon tea and foods cooked with cinnamon will still have the medicinal effects. The study in humans showed that about one half of a teaspoon of cinnamon per day or less will improve blood glucose, total cholesterol, LDL-cholesterol, and triglycerides. This dose of one half of a teaspoon or less is considered safe and relatively side-effect free. Commercial preparations are also available.

Remember to tell your health care professional when you use any herb or alternative therapy. Do not stop your traditional medications without the knowledge and consent of your doctor. Traditional and alternative therapies can complement each other if communication is open.

June L. Caldwell, RPh

Salmonella Poisoning

February 19th, 2007

Grandma finishes scraping out the batter bowl then calls for any takers to "lick" the bowl clean before the bowl hits the suds in the sink. This scene from "The Walton's" television show was played out in my childhood as well. I hesitate to encourage this tradition in my own kids because of increasing concerns of salmonella in raw eggs. Once the creation is properly baked, any salmonella present in the egg batter is harmless. The salmonella bacteria may be found in raw eggs, raw poultry, and beef, and on unwashed vegetables or fruit if the soil is contaminated.

The recent salmonella outbreak that was linked to peanut butter gives one pause to consider what salmonella poisoning means to an infected person. The classic symptoms are abdominal cramps, diarrhea, fever, and headache. The infection usually clears up in 5 to 7 days. If the diarrhea is sever or includes vomiting, intravenous fluids may be required to prevent dehydration. See your doctor or health care professional if you have symptoms. A stool sample may be taken to determine the presence of salmonella bacteria. If the infection has spread to the intestines from the bloodstream your doctor can prescribe antibiotic treatment. Non-symptomatic people may be carriers of salmonella, even a mother to her unborn child.

To prevent salmonella poisoning wash your hands and all food preparation surfaces especially after handling raw eggs or meat. Wash your hands immediately after handling reptiles such as iguanas, turtles or lizards. Don't eat or drink foods with raw eggs or raw unpasteurized milk such as homemade eggnog or cookie dough.

June L. Caldwell, RPh

Good News in the Fight Against Cervical Cancer

February 12th, 2007

January marked Cervical Cancer Awareness Month. This February remind the women you love (mother, sister, wife, daughter, or friend) to get screened for cervical cancer. The cancer that killed about 3,700 women last year.

The latest introduction in the arsenal against cervical cancer is a new vaccine from Merck called Gardasil. Gardasil is currently the only vaccine that may guard against the Human papillomavirus (HPV) Types 17 & 18 which case 70% of cervical cancer cases. It has been found safe and effective by the FDA (Food and Drug Administration) in preventing precancerous lesions in women 16 to 20 years old. Studies suggest that the vaccine boosts HPV immunity in 9- to 15-year-olds. Given in a series of three injections over three months, Gardisil prevents precancerous lesions in 98% of the women studied for up to 3 & 1/2 years. The injections may cause side effects such as pain, redness at the site of injection, swelling, itching, fever, nausea and dizziness. Ask you doctor or healthcare professional if Gardasil is a good choice for you or your daughter. Gardasil does not protect against all types of cervical cancer and is preventative only if the women is not already infected so routine Pap tests are still required.

Until the Pap test was introduced in 1955, cervical cancer was the most common causes of cancer death in American women. The Pap test determines whether or not cervical cells have become abnormal because of infection from HPV. Precancerous lesions of the cervix usually have no symptoms so the Pap test was a breakthrough in finding cervical cancer in its early stages.

There is also a test available which determines if you have HPV. There are about 100 strains of HPV and 8 out of 10 people have some strain of HPV in their lifetime. If you test positive for HPV that does not mean that you will get cervical cancer as the virus often resolves on its own. The high-risk types of HPV that don't resolve may cause pre-cancerous lesions which should show up on you Pap smear. So a positive HPV test reinforces the need to get a yearly Pap test. Prevention is our best weapon in the fight against cervical cancer.

June L. Caldwell, RPh

Proper Storage of Medications

February 5th, 2007

Most medications are stored at room temperature. Controlled room temperature is defines as 59 to 86 degrees Fahrenheit (15 to 30 degrees Celsius). Room temperature is not well controlled in the bathroom, although this is the traditional place to store medications. The water used at the sink, tub or shower is often very warm and creates steam. The warmth and moisture will break down medications over a period of time. You may have noticed the moisture absorbing packet (desiccant) marked "Do Not Eat" in a medication bottle. The manufacture inserts these desiccants to ensure the stability of their product.

The kitchen is not an unlikely place to store medications as many medications are taken with food. When you are deciding a spot to set the prescriptions avoid the kitchen windowsill. Temperature variations from the glass and sunlight from the window could cause harm to medications. The kitchen or dining room table is a good place unless you have small children and therefore the need to keep medications up and out of their reach. In this case a kitchen cupboard away from the stove and sink is a wise choice.

What if your medication requires refrigeration? Make sure that your refrigerator is not so cold that the medication freezes. The temperature in the refrigerator should be near 40 degrees Fahrenheit. I've had people tell me that they put all their medications in the refrigerator because it keeps them fresher. This is not true. Do not refrigerate your medicine unless it requires this temperature range. Certain prescriptions, like Miacalcin, are refrigerated only until opened and then must be used within a certain time.

Most pharmacies have storage information listed in the printout you receive when you get a new prescription. If you need additional information ask your pharmacist.

June L. Caldwell, RPh

Frostbite, Hypothermia and the Winter Athlete

January 28th, 2007

Cold stiff fingers transformed into "burning" digits over the stove at the Sylvania Ski Club's ski chalet on Cowley Hill. As young athletes, we often skied longer than we should have before coming in to warm up. The rope tow up the slope lured us into a false sense of warmth as we made yet another run down the hill. I wouldn't be able to endure the pace of downhill skiing today.

One of the ways to prevent frostbite is to limit your exposure to the cold. Outdoor athletes should come into shelter to warm up when the feel numbness or tingling - the warning signs of frostbite. Gradual re-warming is the treatment for frostbite. Do not rub the area because this may damage the tissue. If not re-warmed the reddened skin from the initial stage of frostbite will turn white and then hard in the severe stage. Untreated tissue will blister and gangrene may set in.

Never-mind the tradition holds that the St. Bernard rescue dogs in the Alps carried small wooden kegs of alcohol on their collars to aid stranded travelers. Alcohol provides a sensation of warmth initially but it expands the blood vessels to cause further heat loss. Some medications, such as beta-blockers, may cause you to be more sensitive to the cold because blood flow to the hands and feet is lessened. Smoking and caffeine also constrict the blood vessels. Eating will fuel your body and produce heat to keep you warm. Some of my best meals were sandwiches heated over a fire and eaten with fellow deer hunters.

To protect yourself and your family from the dangers of frostbite and hypothermia remember to dress in layers of clothing that cover all exposed areas. Keep your clothing dry. Sweating from overexertion or wetness from a break through the ice put you at risk for hypothermia. When your body loses more heat than it can make hypothermia results with the body temperature significantly below normal (98.6 degrees Fahrenheit). The majority of body heat is lost through the head making the wearing of head gear very important. Mittens work better than gloves to keep your hands warm. Young children and the elderly are at greater risk of hypothermia and frostbite as those with circulatory problems. If you notice signs of hypothermia (slurred speech, slow pulse, mental confusion, loss of bladder control and stiff muscles) or frostbite get medical help immediately.

June L. Caldwell, RPh

Pet Therapy

January 16th, 2007

My first dog was a gentle beagle-dachshund mix named Princess. The neighborhood terror toddler nicknamed "Duke" often used her body as a pillow to nap on in the living room while his mom chewed the fat with my mom in the kitchen. Trekking across the creek and up the hillside with her was a great stress buster. She was my confidante until her untimely death the fall of my freshman year in college.

The unconditional love of our pets is a calming influence in our lives. A study of 92 cardiac patients hospitalized for angina or heart attack who had a pet at home had better one-year survival rates after discharge than those without pets. One study found that the presence of a pet was a higher boost to survival rates than a spouse or friends. Pets not only accept you as you are, they need you to survive. Many patients have a stronger will to live because they feel that their bets need them.

Many nursing homes and even hospitals now employ pet therapy. Animals elevate the mood of patients and increase their level of social interaction. The animal may be a pet brought from home but more often are specially trained and certified. Medication costs decreased an average of $3.80 per day per resident to $1.18 per resident per day in new long term care facilities in New York, Missouri and Texas that have animals and plants as an essential part of the environment to relieve loneliness, helplessness and boredom (Montague, 1995).

In 18 Ohio minimum and medium-security penitentiaries, model inmates relieve their boredom by raising dogs rescued from the humane society. These dogs are then trained to be seeing-eye dogs. The task gives the inmate a sense of purpose and elevates their self-esteem. These eighteen Ohio prisons have less disciplinary problems than Ohio prisons without dogs.

Although petting a dog can lower your blood pressure, so can watching fish swim in an aquarium. Whatever type of pet you choose will benefit your health so long as it fits your lifestyle and temperament.

June L. Caldwell, RPh

Food Psychology

January 7th, 2007

When I was about five years old my family took a summer vacation to visit my Aunt Mary and Uncle Em in the Riverdale neighborhood of the Bronx. One morning Aunt Mary made my four brothers and me breakfast so that my mom and dad could have the rare treat of sleeping-in. I had never had blueberries on my cereal before but I answered yes to her request. Unfortunately, I did not like the combination and would not finish the bowl of cereal. My aunt then proceeded to lecture me about the starving children in India.

Research shows that people will often eat what is on their plate even if they are already full (maybe they have an Aunt Mary tape playing in their head). At Cornell University in Ithaca, NY they call it Food Psychology.

Portion size is a huge influence on our eating habits. The "super size it" mantra of the fast food industry is part of the problem although as awareness grows many chains are responding with healthier food and portions. Cornell research has shown that if you eat your ice cream in a smaller bowl with a small spoon you will be more satisfied than with the same amount of ice cream in a large bowl with a larger eating utensil.

Another visual illusion concerns the shape of the glass that you use. You will unknowingly pour 34% more into a tall narrow glass than a short wide one. This study was done at a "Weight-loss Camp" with veteran bartenders.

The distance between you and the food you may eat is also a factor. Food that has to be taken out of the cupboard is less likely to be eaten than food on the counter that is readily available for "grazing". You will eat half as many M&M's if you move the candy dish six feet from your desk.

Larger package sizes make you use or eat more. One reason is because you perceive that the cost per serving is less and secondly because it is more difficult to keep track of your usage. If you buy bigger packages to save money, it is best to repackage into smaller portions.

With respect to my Aunt Mary, I have to tell you that she was a fabulous cook. It was one of the ways she won my Uncle Em's heart. Cornell researchers today would call her a great domestic cook or the "nutritional gatekeeper" of her family.

June L. Caldwell, RPh

A Healthy New Year

January 1st, 2007

Let's make it a healthy 2007 by developing some healthful habits to reduce stress.

One way to reduce unwanted stress in your life is to stay connected. Mentor a high school student who may be interested in your occupation. Connect to your community through volunteer work in your church or other organization. Although keeping in touch with family and friends may be an effort, it is usually rewarding.

Stay connected with your natural surroundings by taking walks this winter. Europeans are leaner than Americans mainly because they walk more than they ride. So far our weather has been mild and good for safe footsteps. Take some deep breaths and drink in the beauty of nature. You may want to take along your music or listen to the chatter of chickadees and blue jays.

When it snows think about cross-country skiing. You will see more wildlife than when downhill skiing and it is less expensive too. If you don't fancy skiing, why not join the snow-shoeing craze? There was a workshop recently at Sizerville State Park in which you made your own pare of snowshoes.

Walking may be the best way to find some much needed solitude although there is power in numbers. If you try to quit smoking or balance your diet with a friend your possibility of success is increased. Commiting yourself to a schedule or routine with another person will help you stay on track with your goals.

June L. Caldwell, RPh

Music as Therapy

December 17th, 2006

A familiar song can transport you back to a different time and place. Music from the band Boston sends me back to making popcorn boxes at the Emporium Theater while smelling the best buttered popcorn ever. Different music affects us in various ways.

The Mozart effect relates to how this composer's music increased the ability of young people to learn and recall information. Music can also help patients who have dementia. Musicians trained in this area are called music therapists. Rather than playing at their audience in a concert hall, these musicians take their cue from the patient as to pieces they play and the tempo.

Tempo was also found to be more important than personal style for music to benefit the heart. This from a recent small study by Bernardi in healthy young subjects half of who were also accomplished musicians. Vital signs such as heart rate, blood pressure and breathing varied with the tempo of the music. As you might predict, faster tempos increased the heart rate, blood pressure and breathing while slower tempos had a calming effect. Overall, vital signs improved over what was recorded prior to listening to music. The results merit further study.

Music played during surgery has lessened the need for pain medication for most patients. Many hospitals now use this technique to help save money and increase patient satisfaction.

Studies done on diary farms have shown that music affects the amount of milk produced. The farmer may prefer country music but it was discovered that cows produced the most milk when classical music was piped into the barn.

June L. Caldwell, RPh

Stages of Grief

December 11th, 2006

The holiday season is a wonderful blend of shared traditions and memories. For most people this time of year is a joyous one. For others the memories are bittersweet due to the loss of a loved one. Depending on where you are in the cycle of grief and the extent of your support system, the holiday may be more or less difficult.

Elizabeth Kubler-Ross, a Swiss doctor, did pioneering work with dying patients, writing the landmark book On Death and Dying. In this book she explains what is commonly called the Grief Cycle. The cycle from active to passive emotional states that dying patients experience can also be applied to what friends and family go through when their loved one is gone. The stages include: shock, denial, anger, bargaining, depression, testing, and acceptance. You may get stuck in a stage or even take a step back and re-enter an earlier phase. The amount of time spent at each stage is not predictable, but depends on the individual and the circumstances.

One of my older brothers suffered through the loss of his wife to colon cancer when their son was just a toddler. He told me that the most difficult part for him was the period after the initial loss when the overwhelming outpouring of support from friends and family had subsided. Then true loneliness settled in. We need to remember these lonely people in our lives in this busy season of the year.

June L. Caldwell, RPh

Goldenseal

December 3rd, 2006

The Cherokee Indians gathered goldenseal (Hydrastis canadensis) to use for skin diseases and sore eyes. The pioneers learned of this herb's use from the Native Americans. Goldenseal gained reputation over time as a general bitter tonic to remedy digestive and urinary disorders. It was the main ingredient in Dr. Pierce's Golden Medical Discovery, a proprietary medicine in the early 1900's.

The roots and rhizomes of this diminutive forest plant contain the alkaloids berberine and hydrastine. Berberine gives the plant the golden color that is its namesake. Goldenseal's immune stimulating properties may come from berberine's activation of the type of white blood cell (macrophage) which swallows invaders like bacteria and viruses. Although the herb does not effect both the circulatory and nervous systems, the effects are too uncertain to use for a beneficial effect. It is unlikely that goldenseal would be taken in toxic amounts because of its natural bitterness.

In the past claims were made that goldenseal, as powerful blood purifier, would enable one to falsely pass a urine drug test. Scientific studies have since shown this claim to be untrue.

Goldenseal is used today primarily for its antiseptic properties. It may be applied to the skin for this purpose. Often combined with echinacea, goldenseal is also taken internally to combat the common cold and flu.

June L. Caldwell, RPh

Echinacea

November 26th, 2006

Before the introduction of sulfa drugs in the 1930's, echinacea was the most popular plant drug of the Lloyd Brothers pharmaceutical company of Cincinnati. Today echinacea has again gained popularity as an herb that both treats and prevents the common cold and flu. Also known as the purple coneflower, this herb is available in three varieties that are used medicinally. It is often combined with other herbs such as goldenseal.

The variety of echinacea grown as well as the type of soil, time of harvest and other growing conditions all effect the potency of this herb. The variability of potency makes the effective study of the purple coneflower a challenge. The active ingredient of the plant has not yet been identified which makes standardization of echinacea products somewhat unreliable.

Although early studies suggest an immune stimulating effect, a recent study in young, healthy volunteers did not show results in preventing colds. Research, mainly from Germany, suggests that echinacea may help shorten the duration of a cold. I have used this herb for colds with some success. Take the herb with food to help avoid upset stomach. It may also cause a tingly sensation on your tongue which seems to be a harmless reaction.

Echinacea appears to be safe for most people when used short-term. I recommend that echinacea not be taken for more than 10 days to two weeks continuously to obtain the optimal effect of the herb. If you are allergic to daisies, marigolds, mums, or ragweed, you may also have an allergic reaction to echinacea. People with autoimmune diseases like rheumatoid arthritis and lupus should avoid echinacea. If you take immuno-suppressant medications echinacea may render them less effective. Check with your health care professional before taking herbs especially if you have other medical conditions.

June L. Caldwell, RPh

Nails and Your Health

November 19th, 2006

Did you ever get a small white speck on your nail and wonder where it came from and what it meant? One stray white patch is most likely from a local injury to the nail root or matrix (this is the growing part of the nail that is still under the skin) which has now grown out and is visible. Numerous white patches on the nails may indicate a zinc deficiency. Zinc is an essential mineral but is only required by the body in minute quantities.

The appearance of your fingernails is a reflection of your overall health. The color and texture of your nails give clues to potential medical conditions. Nails grow an average of 1 centimeter every 100 days. Nail growth rate varies depending on your age, gene pool, season of year, and how much you exercise. Toenails take about twice as long to grow as fingernails. A fungal infection is a common nail problem which causes the nail to crack and even peel. Fungal infections of the nail often require professional treatment. If your thyroid hormone is low, your nails will become dry and brittle. White nails may indicate liver diseases such as hepatitis while yellow nails that are thick and slow to grow may point to a lung disease like emphysema. Anemia (deficiency of hemoglobin in the blood) may cause the nail bed to become pale or white. While nails do not tell the whole story, their appearance may aid your physician in determining the state of your health.

The following are some tips to keep the nail itself healthy. Keep your nails clean and dry. Apply moisturizer to your nails and cuticles everyday especially in the winter when indoor air is dry. Avoid biting your nails. If you wear artificial nails check your real nail often for a green tinge which is a sign of bacterial infection. Don't remove the nail cuticle. File your nails in one direction, rounding the tip. Finally, eat a balanced diet, taking vitamins if needed. If your overall health is goo, your nails will be strong, smooth and shiny.

June L. Caldwell, RPh

Medicare Part D

November 11th, 2006

Parts of this article cover events which have already passed.

The open enrollment period for Medicare prescription drug plans starts this Wednesday, November 15th and ends December 31st, 2006. Even if you are currently enrolled in a plan you may have changes in your plan such as what medications are covered and the amount you pay as your premium. Make sure that your medications are still covered by your plan. You should have already been mailed a notice of any changes in your current plan. If you decide to change your plan, or sign up for the first time, you'll want to do it by December 8th so that your enrollment will be in effect by January 1st, 2007.

The yearly deductible for 2007 is $265 (it was $250 in 2006). Plans with no deductible will charge higher premiums. Some plans will cover medications that were not covered before such as benzodiazepines (anti-anxiety medications). The plans with more coverage and better options will have the greatest increase in premiums.

The 'donut hole' is a coverage gap which occurs when your yearly drug costs (includes both what you and the insurance company have paid for medications) exceed $2,250 (increased to $2.400 in 2007). Continue to use your plan while in this gap as what you pay counts toward your yearly total. When your annual drug costs reach $3,850 (increased to $5,451 in 2007) The plan kicks back in with catastrophic coverage and lower copays. Some plans have coverage in the 'donut hole' but may only cover generics or your copays may increase. In order to help avoid the 'donut hole' use generics or lower cost medications if possible. The higher premium of a plan which has coverage in the 'donut hole' is generally worth the cost if you pay over $200 a month for prescriptions.

The best plan for you may not be the best choice for your friend or neighbor because your medications and financial situations may be different. There are about ten to twenty new plans this enrollment period. If you are eligible for Medicare Part D coverage, have no other credible coverage, but decide not to sign up by December 31st you will be penalized. The penalty is $2.50 a month for every moth past the first month you were eligible for Medicare Part D benefits. If you have credible coverage you should receive a letter from your insurance company verifying this fact. Please keep this letter in a safe place. If you need to sign up at a later date this proof of credible coverage will prevent your being penalized.

June L. Caldwell, RPh

Cold Hands, Warm Heart

November 5th, 2006

Several winters ago I thought that the heater in my vehicle needed fixed. I could not seem to keep my hands warm on the drive home to Emporium from Coudersport. Then I noticed that several of my fingers would turn white if I held an iced beverage. I never did make an appointment with the mechanic to fix the car's heater, reasoning that I had Raynaud's Disease not a malfunctioning heater.

Raynaud's Disease is a hypersensitivity to cold temperatures in which the fingers or finger and toes have decreased blood flow due to the constriction of blood vessels. The fingers and/or toes turn white and sometimes blue. The condition usually lasts for a few minutes but may last up to an hour. When re-warmed the fingers or toes may turn red before becoming a normal color. The nose and ears are areas that may also be involved. When exposed to cold temperatures, your body constricts the blood flow to the extremities in order to retain core body temperature. In Raynaud's this response is exaggerated. The cause is not known in Primary Raynaud's but emotional stress may also be a trigger. Although there may be some pain or numbness usually no long-term damage is done. Primary Raynaud's is most common in women aged 15-45.

Secondary Raynaud's occurs as a result of other diseases such as carpal tunnel syndrome, hypothyroidism, lupus, rheumatoid arthritis, scleroderma, or atherosclerosis. Smoking, injuries to the hands or feet, certain medications (such as beta-blockers), history of frostbite, chemical exposure (plastics) and several years of using vibrating tools may also cause secondary Raynaud's.

To treat Raynaud's avoid cold temperatures and emotional stress. Exercise will help increase circulation. Quit smoking and avoid decongestants because both constrict blood vessels and may aggravate the condition. I find holding a warm cup of tea very helpful although you do nat want to overdo the caffeine. Wool or synthetic socks wick moisture better than cotton to keep your feet warm and dry. The old hunter's trick of placing your hands in your armpits works well but does look a little odd. Windmilling your arms will also increase circulation to your hands but looks even stranger in public. Moving to a warm climate may help but even southerners get Raynaud's.

Medications have been used to treat Raynaud's with mixed results. Calcium channel blockers are one possibility. I had a patient in one of my practices who used nitroglycerin patches on her fingers. A study this year showed that Viagra was successful in treating Raynaud's. Alternative therapies include biofeedback, gingko biloba and niacin.

Reduced circulation from Raynaud's may lead to ulcerations and delayed healing of infections in affected areas. Generally Primary Raynaud's Disease is more of a nuisance that a disability although gangrene has occurred in rare cases. If you think you may have this condition, contact your health care professional.

June L. Caldwell, RPh

Vitamin D - The New Super-Vitamin

October 30th, 2006

Since we changed our clocks to fall back an hour this weekend, many of us will be both going to work and coming home in the dark. This means that we north-easterners will be receiving even less of the sunshine vitamin, vitamin D.

Vitamin D has been in the news quite often lately. In fact the vitamin is actually a precursor hormone for steroid calcitriol. It has long been known that vitamin D is needed for proper calcium absorption into the bones and teeth. Cortisol is a building block of the cell itself which may be why vitamin D promotes a healthy immune system. As many as 18 different types of cancer are more prevalent among people who are vitamin D deficient. These cancers include breast, lung and prostate. It appears that vitamin D not only prevents but may help cure cancer.

Vitamin D is found in the following foods: egg yolks, salmon, tuna, cod liver oil, and fortified milk. Although we have these dietary sources as well as the synthesis from the sun, many people still need supplementation. How much vitamin D is enough? The daily recommended intake (DRI) standards for vitamin D of 200 IU (international units) daily for adults 19-50, 400 IU daily for ages 51-70 and 600 IU for those over 70 are now thought by many experts to be too low. The FDA is slated to issue new guidelines soon. A blood test from your health care provider can determine your present concentration of vitamin D. Additional supplementation should be done under the care of you physician. Symptoms of toxicity include nausea, vomiting, constipation, and in more sever cases, confusion.

Recent research shows that 1000 IU daily may prevent type I diabetes, depression, high blood pressure, multiple sclerosis, and colon cancer. Dermatologists are concerned about the increased risk of skin cancer with increased sun exposure. We need to find a balance between getting enough vitamin D and not putting ourselves at risk for skin cancer. Approximately 20 minutes of sun exposure a day works for most people. If you are interested in more information on vitamin D check out the September 2006 issue of Reader's Digest.

June L. Caldwell, RPh

How to Prevent Falls

October 8th, 2006

A good friend of mine from high school came home last week to visit her mother. We enjoyed the homecoming parade march by the pharmacy Friday afternoon and the football game that evening. Unfortunately there was a sad note to her visit. Her main reason for coming home was to help her mom who had been injured in a fall. That it was also homecoming weekend was a happy coincidence.

My friend's mom has lots of company with other seniors. In 2003 more than 1.8 million seniors were treated in emergency rooms for fall-related injuries and more than 421,000 were hospitalized. Among older adults the majority of fractures are caused by falls. In 2000, direct medical costs totaled 179 million dollars for fatal and 19.3 billion dollars for nonfatal injuries.

As we age our vision and balance may not be as acute as in our youth. Hard wood floors with area rugs are attractive but also a fall hazard. For safety's sake gather up the throw rugs and give them to a charity like Country Blessings. The bathroom is an area that many need safety equipment like grab bars for the tub. Keep items that you use everyday on shelves that are easy to reach so that you avoid using a step stool. Strengthen your lower body and improve your balance through regular exercise. Tai Chi is one type of exercise program that has been proven effective. Have your vision checked yearly to correct problems with corrective lenses or cataracts.

Ask your doctor or pharmacist to review all your medications (prescription and over-the-counter medications including herbals) to check for potential interactions and side effects. It may be possible to reduce the number of medications your are taking, especially those which may increase your risk of falls such as sleeping pills and anti-anxiety medication.

June L. Caldwell, RPh

When is a Sore Throat Strep Throat?

October 2nd, 2006

A local mom asked me to write an article about when to call the doctor if your child has a sore throat. Her main concern was the possibility of strep throat.

Strep throat is a bacterial infection near the back of the throat and tonsils. The streptococcal bacteria that cause strep throat come in several strains. The strain most commonly involved in strep throat is A beta-hemolytic streptococcus. Most cases of sore throat are viral and do not require antibiotics. Only about 10% of adults and 30% of children with a sore throat have group A strep.

A sore throat is probably viral if you also have cold symptoms like a cough, runny nose, and sneezing. If you have at least two of the following symptoms you should be tested for strep throat: fever over 101 degrees F (38.3 degrees C), swollen tonsils and lymph glands, pus or white patches on the tonsils or in the back of a bright red throat. The sore throat in strep throat comes on without warning and is unrelenting.

You are contagious while you have the symptoms and until you are on antibiotics for 24 to 48 hours. If you do not seek treatment, you are contagious for 2 to 3 weeks even if you no longer have symptoms. Because of your ability to pass on strep throat, you should seek treatment even though strep throat will go away on its own in up to a week's time. Antibiotics will kill the bacteria to decrease the risk of the bacteria spreading to other parts of your body and will decrease the amount of time you are contagious.

June L. Caldwell, RPh

Diet and Kidney Stones

September 24th, 2006

Kidney stones are hard solids made of substances released from the kidneys. The composition of urine usually prevents the formation of the crystals that may build up on the kidney walls. If a large stone becomes lodged in the urinary tract it may block the urine flow to cause severe pain.

Some people are more prone to have kidney stones. Family history of stones, low fluid intake, history of gout, a diet high in salt and animal protein, a diagnosis of diabetes or high blood pressure, being overweight, and use of some medications such as triamterene are all risk factors for the formation of kidney stones.

Traditional wisdom was to avoid calcium if you have recurrent kidney stones because many stones are composed of calcium. A recent study, in men with recurrent kidney stones composed of calcium oxalate, concluded that diets with normal amounts of calcium but lowered amounts of animal protein and salt work better than a low-calcium diet. If you have calcium oxalate stones limit your protein intake to no more than 8 ounces a day and your salt intake to no more than 3 grams. Your health care provider may also want you to limit your intake of foods high in oxalate such as nuts, chocolate, spinach, beets, rhubarb, strawberries, cranberries, wheat bran, soy, coffee, tea and cocoa.

Another preventative measure is to drink plenty of fluids. Water is the best, although some experts now recommend lemonade. If your physician approves a calcium supplement, consider trying calcium citrate. When found in the urine, citrate helps to hinder kidney stone formation.

Women who are in the know have told me that the pain from a kidney stone blockage ranks right up there with the pain and discomfort of childbirth. Talk about motivation for sticking to your diet!

June L. Caldwell, RPh

Combat Methamphetamine Act of 2005

September 17th, 2006

Tucked in legislation to reauthorize the USA Patriot Act that the president signed into law is the "Combat Methamphetamine Act of 2005". The law requires retailers of cough and cold medications containing pseudoephedrine (PSE) to log sales and move product behind the counter by month's end. The purpose of the law is to regulate the sale of common chemicals used to make methamphetamine. Before this law there was a voluntary program called "Meth Watch".

The new law requires that a log be kept by retailers. Sales are limited to 3.6 grams of base PSE pre day and 9 grams per 30 days. The log includes the name and quantity of the product as well as the name and address of the purchaser along with state or federal photo identification. The log may be written or electronic and must record both the date and time of purchase.

Many cough and cold products contain pseudoephedrine (PSE). PSE is a decongestant. Phenylephrine, a decongestant which is older and possibly less effective than PSE, is not subject to the new regulations. Many manufactures will reformulate their products to contain phenylephrine instead of psueudoephedrine. The cough and cold product companies know that their products will sell better in a self-service aisle so they are willing to incur the expense of reformulation.

Although this new law will inconvenience both retailers and consumers it is worthwhile if it has the intended effect. If you have ever seen pictures of meth users you realize how much this illicit drug devastates peoples' lives. Methamphetamine labs produce hazardous chemicals and are prone to explosions. This law combined with increasing public and law enforcement awareness should help make our communities safer places to live and work.

June L. Caldwell, RPh

Taking Care of Your New Tattoo

September 4th, 2006

Tattoo shops may appear to be a sign of the times, but a tattoo is actually a form of self-expression which has existed since antiquity. Make sure you use a certified tattoo artist who follows proper infection control procedures, such as sterilizing needles or using disposables, to avoid getting hepititis and other serious infections such as MRSA (methicillin-resistant Staphylococcus aureus). Proper care of your tattoo will keep it from fading and help prevent scarring and infection.

Using simple soap and water will go a long way in avoiding infection from your tattoo. The healing tattoo is actually a wound which may ooze for several days. Avoid touching the tattoo unless you are cleaning it, making sure that your hands and fingernails are clean first. Do not let others touch your healing tattoo as infection has been spread from skin-to-skin contact. You may moisten the bandage with a clean cool trickle of water to aid in its removal if it is stuck to the tattoo.

Apply a thin layer of triple antibiotic ointment to the tattoo up to four times daily. If you are allergic to triple antibiotic products use A&D ointment instead. If the tattoo develops a heavy scab or becomes tender consult a health-care professional. After 5 days replace the antibiotic ointment with a quality lotion that is free of both dyes and fragrances. Moisturize the tattoo with this lotion for a minimum of 14 days.

Avoid UV light from the sunlight or tanning beds. Not only will UV light cause a tattoo to fade, it may also cause an allergic reaction. Use a sunscreen or wear a bandage over the tattoo. Until the tattoo is totally healed do not expose it to bacteria by swimming or immersing it in a hot tub. If you wear clothing over the tattoo make sure that it is clean and comfortable.

June L. Caldwell, RPh

Tips to Avoid Caregiver Burnout

August 28th, 2006

• Immerse yourself in information about your care receiver's disease/condition
  Through the patient's physician, nurse, pharmacist, local library, support groups, and association related to the care receiver's disease, and the internet you can educate yourself so that you both understand the condition and know what to expect.
• Make Time for Yourself
  Taking the time to recharge your batteries is very important because care giving is stressful. Reward yourself by doing something that you enjoy. Don't feel guilty about keeping yourself healthy. It also benefits the person that you are caring for when you gain a better perspective from time apart.
• Ask for Help
  The Area Agency on Aging, Senior Citizen Centers, Respite Care from a local nursing home or assisted living facility, community nurses, PDA Waiver Program, Meals on Wheels, local churches and support groups are there for you to utilize. Friends and family who offer help need to know how to help in a task specific way.
• Have a Sense of Humor
  Laughing at the funny things in life is a great stress buster. Other stress relievers include yoga, meditation, progressive relaxation, therapeutic touch, and guided imagery and regular exercise.

June L. Caldwell, RPh

Yeast Infections

August 20th, 2006

Yeast thrives in moist, dark, warm places. My mom knows this fact. That's why she put her bread pan in a small bathroom near a sunny window. The bread would grow well there as the yeast multiplied. She would then take it out to the kitchen to punch the dough down and separate it into loaves that would emerge from the oven as delicious, mouth-watering bread.

Yeast growing out of control on your own skin is not a delicious prospect. The recent very warm and humid weather in our area has increased the likelihood of yeast infection. A yeast-like fungi, Candida, is the cause. In yeast skin infections, or cutaneous candidiasis, the yeast normally found on the skin grows exponentially to cause a red, scaly rash on the skin which may weep a clear liquid. The infection may also manifest itself as pimples. Creased areas of the skin like armpits and the groin as well as the area underneath a woman's breasts are prime areas for this type of infection. Candida may cause diaper rash in infants. People who are diabetic, immunocompromised, obese or on antibiotics are at greater risk of yeast infections. Yeast infections are not considered to be contagious.

In addition to the skin, yeast may also infect the mouth (thrush), nail beds, and vaginal area. Thrush appears as painful whit patches on the tongue and inside of the cheeks. Signs of nail beds infected by yeast include swelling, pus, pain and a white or yellow nail that detaches from the nail bed. Vaginal yeast infection may cause itching and burning. There may be redness externally and a white or yellow discharge from the vagina.

Mild cases of yeast infection may be effectively treated with over-the-counter remedies. Ask your pharmacist about the creams, solutions, and powders that are available. A diagnosis involves a medical history and physical assessment by your doctor. A skin scrape sample viewed under a microscope verifies the diagnosis. Oral medications may be used if the yeast infection is severe or if the infection occurs in someone with a weakened immune system.

June L. Caldwell, RPh

Hay and Hydration

August 13th, 2006

Have you ever helped on a farm making hay? As the saying goes, you "make hay while the sun shines", so it is usually a got endeavor. When we had our dairy farm near Mansfield, I made huge pots of iced tea reminiscent of Grandma Bauer's up Plank Road Hollow with our own honey as sweetener. Water just didn't seem to quench a hay maker's thirst and carbonated beverages don't hydrate you as well as iced tea. Tea also contains antioxidants and can be decaffeinated.

While you might not be loading up a hay wagon this summer, you may be doing an equally strenuous activity like marching band camp, football practice, yard work or your daily run/walk. Hydration is important before, during and after your workout. The old rule of thumb was to drink 6 to 8 glasses of water a day. This 'rule' is now being challenged. Most sports drinks contain electrolytes along with water and a sweetener and flavoring as well.

The following is a synopsis of recommendations by The American College of Sports Medicine. Prehydration means drinking about 17 ounces of fluids approximately 2 hours before exercise. This time period give your body time to absorb the fluid and rid itself of excess. During exercise start drinking early and at regular intervals (about ever 15 minutes). Ideally the fluids you drink should be cooler than air temperature and readily at hand. When you exercise less than one hour there is little difference between the effects of plain water and a carbohydrate-electrolyte drink. If you exercise longer than one hour, the fluids you drink should include carbohydrates (4%-8%) to help delay fatigue. Carbohydrates may include starch (such as malodextrin) or sugars (glucose or sucrose). Sodium should be added as well to help promote hydration, improve the flavor, and help prevent the possibility of low sodium (hyponatremia). Hyponatremia may occur if you drink an excessive amount of fluid or sweat profusely.

If you stay properly hydrated you not only enjoy your activity more, you will also increase your performance. You will be able to make more hay while the sun shines.

June L. Caldwell, RPh

Swimmer's Ear

August 7th, 2006

Swimmer's ear is an outer ear infection (otitis externa). It is also called "tropical ear". What we commonly refer to as an "ear infection" is a middle ear infection (otitis media). Both of these types of ear infections are more commonly found in children and young adults. Swimmer's ear is caused by water or moisture trapped in the outer ear and ear canal. This water most commonly comes from swimming, but also is possible from showering or bathing. A scratch to the delicate lining of the ear canal with a sharp object such as a pencil is another possible cause.

Common symptoms of swimmer's ear include an itchy outer ear (sometimes red and scaly as well), pain if you move your outer ear or push on the bump (tragus) in front of your ear, feeling of fullness or blockage in the ear, mild hearing loss, drainage, fever, and swollen lymph nodes.

Prevention of swimmer's ear is achieved by keeping the outer ear and ear canal dry by gently using a towel, paying attention to signage concerning contaminated swimming areas, wearing ear plugs while swimming, and avoiding putting objects in the ear. As a former competitive swimmer and lifeguard, I learned a technique for water in the ears after swimming that freed me from using earplugs. First, you lean over with your hands on your thighs above the knees. Then you use gravity as your friend to get the water out. Tilt your head sideways and then towards the ground using a gentle back and forth motion.

Treating the early stages of swimmer's ear consists of drying out the ear canal. Several non-prescription products are available for this use. Ask your pharmacist. Self-care for mild cases includes using a warm (not hot) heating pad and over-the-counter anti-inflammatory medication to ease the pain. Keep the ear dry and do not clean the ear or swim until the infection clears. If you have severe pain, a fever, or drainage contact your family doctor.

June L. Caldwell, RPh

Yoga: Relax and Stretch

July 30th, 2006

Remember Miss Patty on that 60's TV morning children's show telling you to "Stretch and grow and reach for the stars!"? Yoga is similar. The poses in yoga allow you to stretch and tone certain muscle groups. A prescribed routine of poses relaxes from head to toe.

A Kathy Smith yoga video obtained from Special K box tops was my introduction to yoga. The tape saw so much use that it finally refused to play in the VCR. By this time, I had the routine memorized and no longer needed Kathy Smith, although I missed the Eastern-style music sound track. Tapes are OK but you really should have sessions with an instructor. Yoga instructors will make sure you are doing the poses properly. I had a neighbor up on Pickle Hill, just outside of Mansfield, who encouraged me to attend several yoga sessions with Reba, an instructor who came down from Corning, NY. We are fortunate to have several instructors available in this area.

Yoga, like most exercise, is best done on an empty stomach. Planning a session before your morning or evening meal works best for most people. Your muscles need warmed up before you start your yoga poses. A ten minute walk or a shower will suffice. The relaxation is more complete if you have relative quiet or suitable music. You may find it helpful to have a dedicated space for yoga. If the floor doesn't have a padded carpet, you will need a mat.

Awareness of your breath is integral to yoga. Your breaths should be deep and relaxed. Remember that you are not in competition with anyone, including yourself. How deeply you can go into the poses will vary from day to day. Relax and rejuvenate!

June L. Caldwell, RPh

Tips for a Good Night's Sleep

July 23rd, 2006

The hot days and warm nights haven't made for the best sleeping this past week unless you have air conditioning. The white noise fro the operation of an air conditioner or fan lulls many to sleep. I won a sound therapy device at the Christmas Dance last year which has a variety of sounds to choose from including a waterfall, thunderstorm, and my favorite, the ocean surf. When I close my eyes I envision myself at the Outer Banks. Works every time!

The following are some more hints for a restful night's sleep:

• Go to bed and rise at the same time everyday if possible, even on weekends.
• Exercise on a regular basis but avoid strenuous activity in the hours before sleep.
• Do not nap during the day unless it is before 5:30PM and limited to 20 minutes.
• Avoid the use of alcohol, nicotine and caffeine, especially later in the day.
• Make the bedroom quite, dark, cool and comfortable.
• Save the bedroom for sleeping and intimacy only.
• Avoid eating large meals before bed but a light carbohydrate snack may aid sleep.
• Limit your intake of liquids before sleep to avoid early awakening from a full bladder.
• Develop a bedtime routine that includes a relaxing activity before sleep.
• Check with your pharmacist about the potential sleep effects of your medications.

June L. Caldwell, RPh

Support Groups

July 10th, 2006

Lori Rakieski has written a book, Understanding Autism, The subtitle, "Useful information for Dealing with Autism from Parents Who have Lived with it 24/7", says it all. Mary Uber, who runs a local support group for parents of autistic children, asked us to sell the book at Emporium Pharmacy. She told us that proceeds from the sale of the book will go towards the group's activities.

Support groups are helpful to many people. As you participate in them, you realize that someone else in this world is in a situation similar to yours. People naturally relate better to someone who has true empathy for their plight. Support group members can often offer you true insight into your problem and let you know self-help tips that worked for them. Just knowing that someone else has survived a similar experience can help you to see some light at the end of the tunnel. For those caring for a loved one, time away from this important task is often a much needed break.

A special group of local ladies carpools o a water therapy session in St. Marys. Each person has a medical reason for this aquatic therapy. My mother belongs to this group. The interaction between these ladies in the carpool has created an informal support group that has become as important to my mom as the water therapy session itself.

Check out the local newspaper for support groups in your area. You may find that taking the time and effort is well worthwhile.

June L. Caldwell, RPh

Whooping Cough in Older Children and Adults

July 3rd, 2006

Whooping cough (pertussis) is making a come back in developed countries such as the United States and the United Kingdom. Immunizations for pertussis last only 5 to 10 years from the last dose, so more cases of whooping cough are being seen in children from 11 to 18 years of age as well as adults. The first pertussis-containing vaccine approved for adolescents os Boostrix. It contains a reduced amount of anitgens compared to the childhood vaccine for tetanus, diphtheria, and pertussis.

Pertussis is a very contagious repiratory illness cased by the bacteria, Bordetalla pertussis. In 2004, the U.S. had the highest recorded number of pertussis since 1959. About one-third of the 25,000 reported cases in 2004 where in adolescents aged 11 to 18. Whopping cough starts out similar to a common cold (runny nose, cough, sore throat, low-grade fever) but is followed by severe coughing spells that may last 1 to 2 months. Coughing may be so violent that it leads to vomiting. Only about 50% of those with pertussis make a "whoop" sound when they breathe in after coughing. People with pertussis usually look and feel fine between coughing episodes. Unlike infants, serious complications are rare in older children and adults.

If you are diagnosed with whooping cough your doctor will put you on an antibiotic. You are no longer contagious after the first 5 days of the antibiotic therapy. For these 5 days you should stay home and avoid contact with others. Pertussis is spread through contact from droplets from the mouth and nose of an infected person when they laugh, cough or sneeze. To prevent dehydration (loss of fluids) you should drink plenty of fluids. If you want to hear the sound of a person with whooping cough check whoopingcough.net.

Safe Contact Lens Wear

June 26th, 2006

Contact lens wearers now have another reason to be fastidious in the care of their lenses and eyes. There has been a recent increase in the number of cases of a rare but serious infection of the eye in normal contact lens wearers. This fungal keratitis caused by the Fusarium fungus may cause vision loss so severe as to require a corneal transplant.

The Center for Disease Control is still investigating the cause of these increased cases of fungal keratitis. Some of those infected used ReNu with Moistureloc which prompted a voluntary recall of this contact lens solution by the manufacturer, Bausch & Lomb, in May. In several cases the contact lens wearer wore her/his lenses overnight. Other rules of proper contact lens wear may not have been followed.

The american Optometric Association (AOA) offer the following six recommendations for Safe Contact Lens Wear:

1. Always wash your hands before handling contact lenses.
2. Carefully and regularly clean contact lenses.
3. Store lenses in a clean and proper case.
4. Use only cleaning products recommended by your optometrist.
5. Never re-use old solution.
6. Replace contact lenses as prescribed by your doctor.

The AOA lists the following as symptoms of an eye infection: sudden blurred or fuzzy vision, red/irritated eyes lasting for an unusually long period of time after removal of the contact lens, pain in and around the eyes, increased sensitivity to light, and excessive eye tearing or discharge. Please see your eye care professional if you have any of these symptoms. Your eyes are irreplaceable, so treat them with care.

June L. Caldwell, RPh

"RICE" Therapy for Sprains

June 19th, 2006

With nicer weather comes the tendency to overuse your muscles in yard work or play. If you get a sprain remember the acronym "RICE" which translates into four steps: Rest, Ice, Compression, and Elevation.

REST the injured area. Limiting your use of the muscle group involved will allow healing to occur as well as avoiding further injury. Rest until the sprained area no longer hurts.

ICE is a safe, effective and inexpensive way to reduce swelling and speed healing to the injury. Apply ice for 10 to 30 minutes on and off for 2 to 3 days. After the third day moist head may be applied twice daily for 15 to 25 minutes at a time.

COMPRESSION may be achieved by using a compression bandage such as an Ace wrap. Wrap the area tightly enough to give support but not so tight that you restrict blood flow.

ELEVATION helps reduce swelling. Raise the injured area above the level of the heart. When you go to bed remove the compress wrap and elevate the injured area.

Seek medical care if the injury is more serious than mild overuse or if a joint that "pops" is suddenly hard to use. Also check with your health care professional if the sprain does not respond to home treatment within a week to 10 days.

You can help prevent sprains by listening to your body. Stop your work or play and rest when you become tired. The break time will be well spent if you prevent an injury.

June L. Caldwell, RPh

Sun Safety

June 12th, 2006

Limiting your exposure to the sun is the key to preventing a sunburn and decreasing your risk of skin cancer. Avoid being in the sun when the rays are strongest, from 10AM to 4PM. Seek the shade whenever possible. Drink plenty of fluids so that you stay well hydrated.

The bulk of our sun exposure occurs before age eighteen so we need to protect our children. A small amount of sunscreen on the face and back of the hands is OK for babies younger than 6 months, but in general keep them out of the sun. Remember that UV rays come through even on cloudy days.

If you must be in the sun, wear a wide-brimmed hat and loose-fitting, tightly woven clothing. Your sunscreen should have an SPF (sun protection factor) of at least 15 (SPF 30 if you are sun sensitive). Apply a sunscreen at least 20 minutes before exposure. Reapply a "second coat" after you've been in the sun about 20 minutes. Make sure to use enough sunscreen. Reapply sunscreen every two hours and after a swim or heavy sweating. Don't miss applying to the back of your neck, back of hands, and tops of feet and ears. Lifeguards often use zinc oxide as a total physical sun block on their nose and lips. Water resistant sunscreens should be reapplied every 40 minutes and waterproof sunscreens every 80 minutes if you are in the water for extended periods of time.

Protect your eyes with sunglasses. Exposure to ultra-violet (UV) rays may increase risk of age related macular degeneration (AMD). AMD is the most common cause of irreversible vision loss in older people. Children as young as one-year-old should wear sunglasses with UV protection.

Certain medications may cause a photosensitivity reaction. This type of reaction manifests as an exaggerated sunburn and may be dose-related. The most common drug to do this is tetracycline antibiotics. St. John's wart is an herbal medication with this potential. Ask your health care professional if any of your medications may increase your sensitivity to the sun.

June L. Caldwell, RPh

Caution with Acetaminophen

May 29th, 2006

Acetaminophen is the generic name for the widely used non-prescription medicine commonly known as Tylenol. Also found in prescription medications in combination with other drug entities, acetaminophen is sometimes written as the abbreviation "APAP" which stands for the chemical name N-Acetyl-P-Aminophenol.

Generally considered safe, acetaminophen is also found in combination products over-the-counter for pain and colds and flu. It is useful for pain and fever but not for swelling. So, although acetaminophen does not help swelling and inflammation like aspirin and ibuprofen, it is easier on the stomach and generally OK for those on anticoagulant therapy.

At proper doses acetaminophen is quite safe; improper dosing of this medication, however, may cause liver toxicity. Statistics show acetaminophen to be the number one cause of drug-induced liver failure. Those who consume more than 2 to 3 alcoholic drinks a day are at risk of acetaminophen toxicity even at the maximum daily dose of 4 grams. Long-term dosing at 4 grams a day can also be toxic. Children are vulnerable to acetaminophen toxicity as their dose changes with age and two concentrations are available. Parents and caregivers should dose their child with the cup or dosing spoon that comes with the medication to avoid possible confusion. Ask your health-care professional for the proper dose for your child. Also be aware that many combination products contain acetaminophen as an ingredient.

June L. Caldwell, RPh

Leg Cramps

May 22nd, 2006

A sudden muscle spasm that is painful enough to wake you up at night is no picnic. What causes nocturnal leg cramps and how might you prevent them? Although generally the cause of nocturnal leg cramps is not known, several circumstances may elicit the painful contractions. Overexertion, dehydration, diabetes mellitis, electrolyte disorders (low magnesium, potassium, or calcium), Parkinson's disease, thyroid disorders, peripheral nerve injury, and pregnancy all may lead to muscle spasms. Medications, such as diuretics ("water pills"), laxatives, phenothiazines, statins, lithium, nifedipine and alcohol all have muscle cramps as a possible side effect.

Non-medicinal measures to prevent cramps include stretching exercises morning and evening, moderate exercise, smoking cessation, adequate fluids, applying a heating pad for 10 minutes before bedtime, and keeping blankets and sheets loose at the foot of the bed. To treat a leg cramp, straighten the leg and flex the foot towards the knee. Often you can get tech same result be walking on the affected foot. If you still have pain, a heating pad or ice pack applied to the affected area may bring relief.

Originally discovered to treat malaria, quinine has been used for leg cramps since the 1940's. The Food and Drug Administration (FDA) presently advises against the use of quinine for leg cramps because studies have not proved its effectiveness and the risks of therapy outweigh the benefits. Prescription medications studied for mocternal leg cramps include verapamil, diltiazem, and gabapentin. Non-prescription remedies include vitamin E, vitamin B complex and ginkgo biloba. Non-medicinal treatment and prevention should be tried before medicinal remedies are employed. Speak to your health-care professional about the best course of therapy for you.

June L. Caldwell, RPh

When the Tick Bites

May 15th, 2006

So what do you do, if despite your best preventative measures, you find a tick attached to your skin? Use fine-tipped tweezers to remove the tick. Firmly grip the head of the tick as close to the skin as possible and then steadily pull the tick away from the skin. A hot match, petroleum jelly, and nail polish should not be used because they don't always work. Swab the bite area with antiseptic. Kill the tick in alcohol and save it for future identification. If the tick has been removed within 24 to 36 hours, you will most likely not develop Lyme disease.

Lyme disease is caused by the spirochete Borrelia burgdorferi. You cannot catch Lyme disease from another person. A "bull's-eye rash", a sign of Lyme disease, is present in 80% of all patients. The slow-spreading rash typically appears in days to weeks of the bite. You have symptoms of fatigue, muscle aches, joint pain, fever and headache. If left untreated, Lyme disease may effect the heart and nervous system and cause arthritis-like symptoms. If the tick has been attached for 24 hours or more call your family physician. Antibiotics are available to prevent Lyme disease.

June L. Caldwell, RPh

Constipation Concerns

May 7th, 2006

Almost all of us have suffered from constipation at one time or another. Constipation is defined as the infrequent and difficult passage of stools. Common causes include poor diet, inadequate fluid intake, physical inactivity and poor bowel habits. Fresh fruits and vegetables as well as grains will aid bowel health. Diseases and conditions (such as hypothyroidism and spinal cord injury) contribute to constipation as do some medications like calcium channel blockers and iron preparations.

Fortunately, some medications may also help ease constipation. Fiber "laxatives" increase liquid absorption to the stool because of the added bulk which also stimulates the bowel. Stool softeners, such as docusate sodium, soften the stool to ease its passage through the intestine. Docusate sodium is usually a safe choice but does not work very well if you don't drink enough water.

If fiber and/or stool softener do not help, the next step is to try a stimulant laxative. Most stimulant laxatives were recently formulated so that their active ingredient is a form of senna. Stimulant laxatives irritate the lining of the intestine to increase the speed of the stool's passage. Conventional wisdom is that stimulant laxatives should not be used long-term, but some recent studies question the validity of such a statement especially in certain cases. Talk to you health-car professional if you find you need to use stimulant laxatives.

The forth type of laxative is osmotic. Milk of magnesium and lactulose are two examples of this type which act by keeping liquid in the intestine as well as drawing liquid from the blood and surrounding tissue. You must drink plenty of water if you use this type of laxative. If you are on a sodium-restricted diet, or have high blood pressure or kidney disease, you should not use this type of laxative.

Seek help from your physician or other health-care professional if the constipation lasts longer than three weeks, or it is coupled with pain or bleeding. It is a myth that a person needs to have a bowel movement everyday. Wast products from infrequent bowel movements do not poison the body and shorten your life. Remember to drink plenty of fluids, eat right and exercise sensibly to improve and maintain your bowel health.

June L. Caldwell, RPh

Good for How Long?

How long are medications usable? Are they OK to use past their expiration date? These are questions commonly posed to a community pharmacist. A patient is cleaning out their medicine chest and isn't sure what to keep and what to pitch. So they call their local pharmacist.

First of all let's define what an expiration date really means. The manufacturer will not guarantee more than 90% potency of the medication beyond that date. So if you use the medication anyway, it may not be as effective as if it were in date. Most drugs do not become toxic after they expire. Medications in the tetracycline family are a notable exception. Tetracyclines may be safely used for about six months.

The manner in which medication is stored will affect the freshness of the product. Contrary to popular modern bathroom decor, the bathroom medicine chest hidden behind the mirror is one of the worst places to store medications. The steam created from bathing and showering will accelerate the breakdown of medications. A motor vehicle is a poor storage place because of the extremes of temperature that are possible. Mailboxes are likewise not a place to leave medication for very long. Medication stored in the original sealed container may be good for 1 to 2 years beyond the expiration date. The standard for dispensed medications is an expiration of one year from the date dispensed or the manufacturer's expiration date if it is earlier.

June L. Caldwell, RPh

Head Lice: Nit-picking

Over the last 10 ears, the human head louse (pediculus humanis capitis), has become an increasing problem, infesting 10-12 million americans each year. The vast majority of these are elementary schoolchildren. Head lice affect rich and poor alike and have no regard for hood hygiene. Unlike the body of the louse, head lice have no direct infectious processes that are known to result from an infestation. They are mainly a nuisance and literally an irritation.

The irritation is caused by the saliva and excrement released as lice feed on the blood of their host. Although itching is often the first sign of an infestation it is not by itself a reason to treat. Schoolchildren should be instructed not to share combs, hats and other hair accessories, although most lice are acquired from head-to-head contact. Unlike fleas, lice cannot fly or jump or live on cats and dogs. Live lice are straw-colored with six legs well-adapted to grip a shaft of human hair. Head lice prefer the back of the head and the nape of the neck but may be found on beards and eyebrows. Lice cannon survive more than a day or two from a host.

Treatment should be done only if active lice or viable nits (eggs) are seen. Prophylactic treatment to prevent infestation is not recommended. When seen only be the naked eye, substances is the hair such as dandruff and dried hairspray may be misidentified as lice or nits. Unnecessary treatments may contribute to lice resistant to pediculicides (chemical treatment for lice) as well as give increased risk of toxicity. For initial treatment use an over-the-counter lice treatment (permethrin and pyrethrins) as directed on the package and manually remove lice and nits by combing. Once you comb your child's head daily until no lice are seen (about two weeks), you will have new appreciation for the word "nit-picking".

June L. Caldwell, RPh

How to Get the Most from Your Doctor Visit

How many times have you gone to see your physician with a half dozen questions in your head only to have them go right out the window the moment the doctor walks in the room? Even those of us with a good memory might want to write down our questions before the office visit. You may also need an explanation of something done or said during the exam itself.

In addition to your questions, think about why you made the appointment in the first place. Help your practitioner by describing your symptoms as well as their duration and intensity. A diary is often helpful especially for ongoing conditions like chronic headaches. Your family medical history is very important. Coupled with your own personal medical information, family medical history will point to your risk factors for particular medical conditions.

Have a list of your medications and vitamins handy. This list should include both prescription and non-prescription medications. Records and lab results from specialists should be forwarded to your primary care physician before your appointment.

When lab tests are ordered make sure that you know their purpose. Don't be afraid to ask about costs. If the physician does not follow-up by giving you the results, call the office. Do not assume that no news is good news.

Think about what lifestyle habits you have that are beneficial and that you want to continue. Also consider habits that you want to change to better your health and well-being. Ask your physician to work with you to make these changes a reality.

June L. Caldwell, RPh

Fat-soluble Vitamins

Vitamins A, D, E and K are fat-soluble. Since these vitamins are stored in the body, the may reach toxic levels. Other vitamins (such as C and B complex) are water-soluble so the body can only absorb a certain amount at a time. The unabsorbed amount is excreted in the urine, lending to a bright yellow color.

Vitamin A is found naturally in fish liver oils, liver, dairy products, carrots, peaches, squash, tomatoes, and all green and yellow fruits and vegetables. Beta-carotene in plants is a precursor to vitamin A. This important vitamin is needed for healthy bones, skin, and lungs and to fight infection. Too much vitamin A may lead to low energy, bone loss, abdominal pain, excessive sweating and brittle nails. The RDA (recommended dietary allowance) for adult males is 3330 I.U. (international units) daily and adult females is 2664 I.U. daily.

Vitamin D is the sunshine vitamin but is also found in egg yolk, fish, fish liver oil, tuna, milk, and dairy products. Vitamin D is important for healthy bones and muscle because it aids calcium and phosphorus absorption. Vitamin D toxicity produces higher than normal amounts of calcium in the circulation which may affect blood pressure and cause calcium deposits under the skin and in the kidney. The RDA for adult men and women is 400 I.U. daily until age 24 when the recommendation is lowered to 200 I.U. per day.

Vitamin E is found in animal or plant fats or oils such as wheat germ, soybean and safflower oil, raw seeds and nuts, eggs, leafy vegetables, beef liver, meat, milk, molasses, peanuts, legumes, unrefined cereal products and whole wheat. The antioxidant effects of this vitamin may also promote cardiovascular health. A recent study suggests that more than 400 I.U. per day may increase the risk of mortality because this is the turning point where vitamin E becomes a pro-oxidant rather than an antioxidant.

Vitamin K is present in green leafy vegetables as well as kelp, alfalfa, cows' milk, yogurt and egg yolks. This important vitamin is necessary for the formation of prothrombin which is required for blood clotting. Bile salts must be present for the intestinal absorption of Vitamin K to occur. Vitamin K is also produced by the bacterial flora of the intestine. Prolonged antibacterial therapy may destroy these helpful bacteria. Normally, however, the body is well provided with this vitamin.

June L. Caldwell, RPh