What is Your Health Worth?

The answer to the above question really is priceless. Your health is one of the few things that truly affects you directly every single day. No one escapes it. Whether you feel like a million bucks or feel like someone just stomped a hole in you, you get to deal with your health and only you have the power to change it.

That’s right, only you have the power to change it. No one else can.

Sure you can visit a doctor to seek out treatment or advice, but it is you that made the decision to go, not the doctor. It is you that made the decision to take the prescribed medication. It’s you that decided to eat or not to eat something. It’s you that has control.

I thought it’d be fun to put some numbers up to look at this question. They won’t be exact, especially since everybody’s situation is different, but it will give an idea of money attached to healthcare.

Without any major hospitalizations here are a few things to consider:

If you have been diagnosed with hypertension at the age of 35 (something that isn’t uncommon) you can expect to be taking something for that, usually lisinopril is one of the first choices. You can get a 90 day supply at your local WalMart for $10. That’s $40/year. At first you’ll have a couple visits to the doc from the time you’re diagnosed as follow up to make sure you’re doing well on the medication. If you have a $35 copay that’s between $70-$105 total visits for the year, at least for the first year and assuming you go to the doctor for nothing else that year.

3 visits = $105

1 year of meds = $40

Total = $145

Subsequent years would look like this:

1-2 follow up visits/year = $35-$70

1 year of meds = $40

Total = $75-$110

Over 20 years ~ $1500-$2300

Now this is assuming a few things. First you don’t ever have problems keeping your blood pressure from going up after the initial diagnoses and treatment, which is rarely the case for most. This also assumes you have no problems with the initial medication and have to get it changed, although this wouldn’t add a whole lot.

If you’re on two blood pressure medications, this jumps to $2300-$3000 over 20 years. This of course is no mortgage but still it adds up. If you happen to be taking a beta blocker like metoprolol as one of those blood pressure medications your cholesterol might go up just enough to trigger a prescription for something like simvastatin. Add another 10 dollars a month for that one.

Simvastatin $120/year

Metoprolol (assuming the cheap immediate release) $40/year

Lisinopril $40/year

2 visits/year $70

Over 20 years ~ $5400/20 years or $270/year

If you become borderline diabetic because of the simvastatin and the metoprolol in combination or were already there and these push you over you might add some metformin into the mix for blood glucose control. Three months of twice daily metformin will run you another $40/year.

Total ~ $6200/20 years or $310/year

We’re still not even close to a mortgage, but we’re increasing.

Now we’ve only discussed the financial part of all of this. Metoprolol is also going to sap some of your energy because it prevents chemicals like epinephrine and norepinephrine from having their full phsyiological effect. What does this mean? Well as I said it will probably sap some of your energy depending on the dose. It won’t necessarily make you drowsy, but it will make you tired easily.

Simvstatin as well as others have the tendency to cause muscle pain and weakness. I’ve had members of my family experience this, and I’ve experienced it myself. Many older folks attribute this to older age. I call nonsense. Yes we do degenerate as time goes on but my own grandmother was able to walk again in her 80’s after stopping simvastatin. It really can be that bad for some.

I’ve talked to others who’ve told me about lisinopril or losartan (angiotensin converting enzyme inhibitor and angiotensin receptor blocker respectively) who describe feeling like people who are on metoprolol do, with a lack of energy. Not enough to keep them from being out and about, but enough to make a few dread having to do anything because they have no energy to do it with.

Instead of medications doing some physical activity 2-3 times per week and backing off on total calories every day will likely achieve what most medications are seeking to achieve. Going on a brisk walk and having only one plate at dinner are two things that go a long way in improving health.

Think about it for just a moment; if you have only 1 plate, or maybe a smaller portion, you save on food and caloric intake. Eating till you have to undo your pants button is ok on Thanksgiving, Christmas and your birthday,…ok and maybe 1-2 other times/year but that’s it. If having to loosen your belt regularly after eating is a habit I can tell you that the belt is only going to get tighter and tighter.

Taking a brisk walk or going on a hike or riding the bike or whatever it is you might find joy in will get your heart pumping and muscles working. Blood pressure will go down as some of the fat comes off and you will feel more energized and not get out of breath while doing things you love.

I personally wish I could go back to Tahiti now that my heart is conditioned better to be able to stay underneath the surface while snorkeling with the fish longer.

Having a plan and sticking to it will pay off dividens in the long run. It’s sad to see people who take their medications exactly as the doctor directs and have been doing so for a long time only to see them deteriorate. Don’t be a statistic. Change now! Plan for the future, however long that may be, and make a difference in your life.

I know the amount of money that we went over above isn’t a lot in the grand scheme of things, but that’s assuming you take the meds and nothing ever happens and you never deteriorate any further than where you are. Not having to deal with the side effects and not having to visit the doctor is worth going biking and feeling awesome at the same time.

CIAO

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Should I Give My Child Cough Syrup?

untitledWith the cold and flu season upon us many people come into the clinic with their children because, well, kids cough. No surprises there. I tell parents at least 20 times a day (no joke) about cough syrup. I understand that many parents are what we call “well worry” parents and they want their children to be healthy and happy. Nothing wrong with that. What kills me though is that so many people think drugs are going to be the answer. Some parents will come back and see another doctor to get something if the first one doesn’t prescribe.

*Facepalm*

PIccard

The feeling I get when someone is convinced that the only way to get better is to get medication that has been proven not to be better than placebo.

I think we should probably go over the obvious. Antibiotics don’t do anything to take care of a cough…unless that cough is due to a BACTERIAL infection. Some common signs of bacterial infection include, but aren’t limited to; fever, congestion, thick colored mucus, cough, earache, headache and generally feeling like crap. And these are just for upper respiratory infections.

VIRAL upper respiratory infections can include but aren’t limited to; congestion, thick mucus, cough, headache, earache and generally feeling like crap. Notice how viral infections like a common cold and bacterial infections look similar? That’s because they are, at least in their presentation.

Kids have a hard time and it is no fun for any parent to see their little tykes go through a cold. Draining down the back of the throat at night can cause the throat to become red and irritated and sore. Coughing usually ensues. No bueno.

This is where cough syrups supposedly come into help save the day. Guaifenesin is common and so is dextromethorphan. The two are often combined. You’ll see this as Robitussin DM or Q-Tussin DM. Guaifenesin basically hydrates mucus more so that people can expell it easier and dextromethorphan works in the brain to slow down and stop the coughing reflex.

For people that have this draining issue neither medication works particularly well. The mucus is already thin and the coughing comes from trying to expel it.

I’m not saying these two meds don’t have a place in therapy, but it’s probably not nearly as often as you might think. Heck the FDA doesn’t even recommend them in kids under 2 because they really don’t do anything and there’s the potential for problems.

One study looked at honey vs placebo and found that honey actually relieves cough better than placebo. [1] The funny thing was that placebo actually helped cough too.

A study just came out that looked at the efficacy of agave nectar vs placebo in children with cough. Agave nectar also gave relief to children. [2]

If you’re planning on giving you’re child honey for cough and they aren’t 12 months old, please don’t. Although the risk is low, there is a chance of botulism poisoining with infants ingesting honey and that is far worse than any cough they will have.

If you’re not sure and still want to give your kids diphenhydramine or dextromethorphan, a study from Duke showed that those faired no better than placebo. [3] In fact dextromethorphan actually caused more insomnia so less sleeping and still the chance of coughing.

For anyone interested in the agave nectar the doses were as follows:

3 mL for ages 2 to 5 months

4 mL for ages 6 to 23 months

5 mL for ages 24 to 47 months

The honey dose was about 7.4ml or 10gm.

If you’re kids are having some cough or you yourself are experiencing issues give some agave nectar or honey a try. I prefer honey in some ginger tea. It works great to fight off the beginnings of a cold. Just staying hydrated will also help.

CIAO

 

1.Cohen, Herman Avner, et al. “Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study.” Pediatrics 130.3 (2012): 465-471.

2. Placebo effect in the treatment of acute cough in infants and toddlers, Ian M. Paul, et al., JAMA Pediatr, doi:10.1001/jamapediatrics.2014.1609, published online 27 October 2014.

3.Paul, Ian M., et al. “Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents.” Pediatrics 114.1 (2004): e85-e90.

Generic Plavix is now available

Well big pharma has been busy paying penalties earlier this year on patent infringement, but Plavix is now being made as a generic. That’s right, clopidogrel should be out soon at your local pharmacy if it isn’t there already. This comes 6 years after Bristol-Meyer-Squib tried to get Sanofi to delay making the generic version. The full article can be found at the following site:

http://www.medpagetoday.com/Cardiology/Prevention/32758

I do realize that it is a big of old news, but even when drugs go generic, it can take some time for things to move down the pipeline. Atorvastatin (Lipitor) went generic back in November, but unless your insurance covers it, your pocket book is more likely to suffer from the generic than the brand. This I don’t think will be the case with clopidogrel. Let me explain.

Normally when a drug goes generic, only 1 companies gets about 6 months of rights to make the generic available to the public. After that other companies can start getting into the game as well. Because only 1 company has the rights, there are only two forms available; the 1 brand name and the 1 generic. Supply in this case is less than demand. Prices remain high. And those companies usually charge a higher price than the brand as well. This is most definitely the case with atorvastatin. People have been asking me for months now why it is so high when it’s generic. Now it has been 6 months and so I would expect that the price of generic atorvastatin will be going down as the year progresses, but it won’t happen fast. Lipitor was a best selling drug for many years and companies are going to want to maintain some profits. The price will drop though.

Clopidogrel has 8 different companies making generics. Because of some genuine competition that should drive the price down more quickly than the atorvastatin once it hits the market. This will be good news for people that have had stents or are using the drug for stroke prevention or peripheral vascular disease.

Be aware that side effects will be the same regardless of the brand. It can still cause unnecessary bleeding in some cases including hemorrhagic stroke and GI bleeds or ulcers. So if you are already taking Plavix or are planning to change to a generic, please be aware that there are still risks involved.

With all that said, remember that a healthy dose of exercise, rest, and good foods are the best prescription for many ailments.

CIAO

The Brute

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

Are your legs cramping?

Cramps, especially at night, unlike being sore from lifting massive weights, is no fun at all

I talk to people who complain of leg cramps. I’ve actually had a few myself and know they are some of the most unpleasant ways to wake up in the middle of the night. I see magnesium used with limited success. Some tell me that if they quit taking their multivitamin the cramps reappear. I know people used to swear by quinine till it got pulled from the market. Some people will eat bananas in hopes of reducing the problem. Today I want to delve a bit into some medication related associations of leg cramps. Sometimes we forget that medication, any medication has drawbacks and just like water can be harmful at the right dose.

A study that came out earlier this year from Canada looked at quinine prescriptions before and after certain medications were prescribed in patients to see if there were any associations. I want to be clear that from this type of study we cannot definitely say that the following medication cause leg cramps. We just have some good associations to say “hey, there sure are a lot of people who seem to have cramping going on with these medications and they didn’t before”. Quinine, for those who don’t know, is a drug that was commonly used for malaria but worked well in people with cramps. The FDA said there was no studies saying that it worked and because it can cause heart problems, it got yanked from the market. It is under brand name again, Qualaquin, but that will cost you 1 arm and 1 leg per pill.

Just as a side note, acetaminophen or Tylenol has killed about 458 people/year during the 1990’s. Quinine has killed about 93 people since 1969. So we actively sell 1 drug over the counter that kills people regularly and causes 26000 hospitalizations annually but take 1 off the market because it has killed 93 people since 1969 and works on cramps. Way to go FDA, you sell-outs!

Here are your references for the above stats:

http://www.bloomberg.com/apps/news?pid=newsarchive&sid=an0NgFGyErgU&refer=worldwide

http://www.adrugrecall.com/quinine/quinine.html

Anyhow, back to the science. The researchers found some associations between a couple of different classes of medications and cramps. Here are your results:

Long acting beta agonists or LABAs, thiazidelike diuretics and potassium-sparing diuretics seem to be the main culprits. Statins and loop diuretics had some associations but were smaller than the aforementioned. Now it’s time to whip out that medication list and see if any might match up with these classes of drugs.

LABAs (inhaled for diseases like asthma)

  • Salmeterol, Formoterol, Fenoterol
  • Advair (fluticasone/salmeterol) Symbicort (Formoterol/budesonide)

Thiazidelike diuretics

  • Hydrochlorothiazide (HCTZ)
  • Indapamide

Potassium-sparing diuretics

  • Triamterene-hydrochlorothiazide
  • Sprinolactone
  • Amiloride-hydrochlorothiazide
  • spironolactone=hydrochlorothiazide

Drugs with smaller associations

  • Statins
  • loop diuretics i.e Furosemide (1)

If you happen to be taking a medication in the first 3 categories and are having leg cramps, there is a good chance it may be due to the medication. A wise approach would be to ask your most awesome pharmacist or doctor if there are alternatives if you think one of these may be the cause of your nocturnal pains. I have talked with a few people who have told me that CoQ10 seems to work wonders for them. Others again say that magnesium works well, but most tell me magnesium just gives them the runs. I think CoQ10 is a good start, especially since I feel most people over 30-40 should probably be taking it anyway. I don’t recommend magnesium oxide. It is poorly absorbed and will definitely give you the diarrhea. There are other mixed forms which are better absorbed and might be therapeutically advantageous.

A good multivitamin helps some people although you have to be careful that they will actually deliver. Many vitamins won’t even dissolve in the stomach. Place a tablet in some vinegar and see what happens. If it stays relatively firm after 10-20 minutes then it probably won’t break down well in your stomach. Generally I think if something is working stick to it unless it is damaging your health in some other way.

The best thing to do would be eliminate the offending agent, if there is indeed one to begin with. This is where talking with that awesome pharmacist or doc comes in handy. Stopping the agent for a time and restarting to see if there is any change in the cramps is a great way to test the hypothesis for your experiment on yourself. If you stop the agent for a month or two and the cramps start to go away, you can re-challenge by starting the medication again to see if it was the problem. Most docs aren’t going to be keen on stopping most of the above medications because they are for blood pressure and asthma. This is where you need an understanding doc who can work with you rather than just treat a possible side effect of another medication. And as always, try getting some good exercise and taking a good look at your diet. If high blood pressure is causing you to take one of the above listed meds, then lifestyle modifications can often play a role in eliminating the problem, barring any unforseen complications. Again, this is where a good doc comes in handy.

CIAO

The Brute

1. SR Garrison, CR Dormuth, RL Morrow et al. Nocturnal leg cramps and prescription use that precedes them, a sequence symmetry analysis. Arch Intern Med. 2012 172(2); 120-126

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

Moderation, Moderation, Moderation

One thing that I try to live by and try to tell people all the time is moderation in all things. I love steak, but I don’t eat it every day, or even every week. I remember one time I had steak 5 nights in a row in some form or another. My body felt like it had a rusted nail sitting in it. That’s seriously the only way I can describe it. Steak overload isn’t good. I did it one other time a few years later and felt the same way. I learned my lesson.

I talk to a lot of people around the pharmacy (patients) that have diabetes. Many of them younger than myself which is always surprising and sad to me. I always wonder if it is sheer ignorance of lifestyle, lack o care or both that gets them into trouble. There is a nutritionist at the clinic where I work and after talking with her and just talking to the patients themselves, much of the diabetes problem becomes clear, at least where I live and practice.

Tortillas are a mainstay of the immigrant population where I live. One man I talked to stated he had 7-8 tortillas with some beans and rice, just for breakfast. Now I don’t know how big these were but a medium size tortilla has about 100 calories or so. Bigger ones can have well over 200, not to mention they usually are cooked with corn oil. Assuming he had medium tortillas, he ate about 800 calories just in tortilla, not including the beans and rice. That’s a lot of carbohydrate from all three foods for breakfast as well as a lot of calories from 1 meal. One doc I work with told me he had a patient who would eat 20 at a time. Assuming medium tortillas again, that is 2000 calories. Not to mention tortillas don’t exactly have a lot of nutrients in them.

I’m not trying to say don’t eat tortillas, I’m saying 1-2 might be a little better. Both patients above suffer from diabetes. Eating lots of tortillas and rice as a diabetic, or even as a non-diabetic is suicide by sugar to blood vessels. Maybe mixed with some veggies and some meat would be better than rice and beans.

Sitting in front of the TV is also a problem. I’m a bit of a hypocrite today as I have been in front of the TV a good bit today seeing as I’m sick right now (bad stomach problems). It’s not because I ate something like tortillas or wheat or something. I picked up some sort of bug from a potluck. I wasn’t the only one. I digress. TV can cause people to lose sleep, sex, and time doing other more productive things. I don’t think this is anything new, in fact I know it’s not, but people seem to watch endlessly anyway. I have no cable or satellite, but even my Netflix can cause me to watch a little too much if I’m not careful. And to think that I keep putting of getting the garden ready for the summer. I’m just too busy I suppose….too busy watching Netflix.

Internet seems to get in the way of getting important things done. YouTube has replaced cable. I can find anything I want to watch with limited interruptions. Those commercials are starting to get annoying, so back to Netflix.

Exercise is great, but if you’ve ever over exercised you are doing your body no good. Muscles need time to recover and heal. Rest is a good thing. So is replenishing your muscles with good food and not starving.

These are just some thoughts from your friendly pharmacist. I talk to people all day long who use so many drugs. Many of them have genuine problems that require professional help. Others have problems that are usually self-induced. I very much dislike talking to women who believe they will find weight loss in a pill. They will try it for 2-3 months and may even lose a few pounds, but once the medicine is gone,  lifestyle replaces what little was lost quickly. I always counsel that exercise and diet will be their key to losing unwanted weight, but most just stare at me and give the look of “I really don’t care, just gimme my pills”.

Remember the moderation will bring more happiness in a life than overindulgence. Work is just as important as rest, and a sweet treat now and again is just as important as regular good nutrition. A good movie or book is a welcome distraction, but so are weight lifting or running. Life should be enjoyed and cannot be if moderation is not kept in all things.

CIAO

The Brute

Your Pharmacist

Something on my mind lately had been the idea of who people use for the healthcare. Most people think first of their doctor. Usually when something goes wrong with the body the doc is the first one to hear about it, barring loved ones of course. I’ve heard from some people over the years about how they weren’t that impressed with a certain doctor or nurse practitioner and the only thing I can tell them is, “FIND SOMEONE ELSE!”

Some people already have figured this out and they will search a doctor they like and works with them. Unfortunately for some insurance dictates which doctor and/or pharmacy one can use. For those of you…keep a stiff upper lip and start learning about health and diet through reading. It takes time and effort, a whole lot of effort, but it can be done.

If your doctor/pharmacist looks like this and gives you the time of day, more power to ya!

             

To the rest of you I would ask you consider the following; choose your pharmacist like you would choose your doctor. Go to a pharmacy where you can talk with your pharmacist like you would talk to your doctor. You might even get a few minutes more over your doctor. What a benefit to be able to talk with a healthcare professional without the hassle of an appointment. Some pharmacists will not oblige this very much. Some want to fill your script as fast as they can and say as little as possible because they have so much to do. Pharmacists like doctors have become very busy in the last 15 years. I know some people like to go to Walmart of other pharmacies where they have the $4 dollar generic list. I urge against this unless there is a pharmacist there that you can talk with and that is interested in you and not how fast they can get you outta there.

Where I work it can get crazy busy. So busy in fact that I seem to have time to do nothing because I’m being pulled in 3 or 4 ways at once. It’s not very fun at times. No matter what happens though, I think it important to give my patients the time of day. Some of them have been waiting for 30 min while we figure out where their script is, get insurance problems corrected and fill it to be able to dispense. I think it fair to give them some of my time if that is what they need.

One example of how spending a little time with a patient helped them enormously was with a diabetic patient who was having problems with her glucose meter. She had gone through almost 40 strips trying to get the thing to work properly, not to mention all the times she poked herself in the fingers to get all that blood. I couldn’t find anything wrong with the meter whatsoever. She said it just wouldn’t work. Everything looked good when I used. Not one problem but she insisted something was wrong. After spending  a good 5 min with her I finally asked how she was using it. After watching I noticed the problem; she was putting the blood on top of the strip where it couldn’t get into the sensors. After explaining it needed to go on the side, she thought herself a bit dumb for not knowing this. I reassured her it was fine and we refilled her strips because she was out.

The aforementioned was just one example of what I get to do everyday. Some patients don’t seem to give a rat’s behind about any of their meds. The doctor told them to take them and that’s the end of it. I find this unfortunate. Know what a medication is and why you’re taking it. If the doctor won’t tell you, then get a new one. If the pharmacist won’t talk with you about it, then get a new one. If two pharmacists are on duty and you want to talk with one specifically, then request it and don’t give up till you talk with him/her.

Remember, it’s your health that is being treated not your providers’. Got to someone that you feel is competent and helpful (they don’t go hand in hand). If your doc/pharmacist makes others or you look/feel like this:

then it’s time to fire his butt!

CIAO

The Brute