Allergies

Asprin

I am allergic to aspirin. What over-the-counter pain medication can I use?

Answer

If you are allergic to aspirin, that means you have a “salicylate” allergy and should avoid using products with this ingredient. There also is the likelihood that you are allergic to ibuprofen and naproxen – two other pain – relief medications available both over the counter (OTC) and by prescription. Acetaminophen may be a suitable choice for pain.
Anyone with a salicylate allergy also may be allergic to other oral OTC medications that have salicylate as an ingredient, such as Pepto Bismol® or Aspergum®, or to topical creams containing methyl salicylate, such as Ben-Gay. Always check the list of active ingredients on the drug label and packaging for the word “salicylate” or “salicylic acid,” and be sure to read the section on the label about product allergies. If you are unsure whether a product contains salicylates, ask your pharmacist before purchasing or taking it.

Penicillin

If you are allergic to penicillin, can you take clindamycin 150 mg?

Answer

Clindamycin is a potential alternative antibiotic for individuals who are allergic to penicillin or other penicillin-like medications. In addition, it is important to note that patients who are allergic to penicillin are also more prone to be allergic to other antibiotics. Therefore, if you have a drug allergy, you should always inform your doctor and pharmacist before starting any type of new medication. It is also a good idea to wear a medical alert bracelet or pendant, or carry a card that identifies your drug allergy. In case of emergency, it could save your life.

Drug allergies Definition

Drug allergies are a group of symptoms caused by allergic reaction to a drug (medication).

Causes, incidence, and risk factors

Adverse reactions to drugs are common, and almost any drug can cause an adverse reaction. Reactions range from irritating or mild side effects such as nausea and vomiting to life-threatening anaphylaxis.
A true drug allergy results from a series of chemical steps within the body that produce the allergic reaction to a medication. One time (often the first time you take the drug), your immune system launches an incorrect response that is not noticeable. The next time you take the drug, an immune response occurs, and your body produces antibodies and histamine.
Most drug allergies cause minor skin rashes and hives. Serum sickness is a delayed type of drug allergy that occurs a week or more after exposure to a medication or vaccine.v Penicillin and related antibiotics are the most common cause of drug allergies.

Symptoms

Other common allergy-causing drugs include

– Sulfa drugs
– Anticonvulsants
– Insulin preparations (particularly animal sources of insulin)
– Iodinated (containing iodine) x-ray contrast dyes (these can cause allergy-like anaphylactic reactions)
Most side effects of drugs are not due to an allergic reaction. For example, aspirin can cause non-allergic hives or trigger asthma. Some drug reactions are considered “idiosyncratic.” This means the reaction is an unusual effect of the medication, not due to a predictable chemical effect of the drug. Many people confuse an uncomfortable, but not serious, side effect of a medicine (such as nausea) with a true drug allergy, which can be life threatening.

Symptoms

– Anaphylaxis, or severe allergic reaction (see below)
– Hives (a less common type of rash)
– Itching of the skin or eyes (common)
– Skin rash (common)
– Swelling of the lips, tongue, or face
– Wheezing

Symptoms of anaphylaxis include

– Abdominal pain or cramping
– Confusion
– Diarrhea
– Difficulty breathing with wheeze or hoarse voice
– Dizziness
– Fainting, light-headedness
– Hives over different parts of the body
– Nausea, vomiting
– Rapid pulse
– Sensation of feeling the heart beat (palpitations)

Signs and tests

An examination of the skin and face may show hives, rash, or angio-edema (swelling of the lips, face, or tongue). Decreased blood pressure, wheezing, and other signs may indicate an anaphylactic reaction.
Skin testing may confirm allergy to penicillin – type medications. Testing may be ineffective (or in some cases, dangerous) for other medications. A history of allergic-type reaction after use of a medication is often considered proof enough of drug allergy – no further testing is required. The same applies to other substances that are not considered drugs but are used in hospitals, such as x-ray contrast dyes.

Treatment

The treatment goal is to relieve symptoms and prevent a severe reaction. Treatment may include

– Antihistamines to relieve mild symptoms such as rash, hives, and itching
– Bronchodilators such as albuterol to reduce asthma – like symptoms (moderate wheezing or cough)
– Corticosteroids applied to the skin, given by mouth, or given intravenously (directly into a vein)
– Epinephrine by injection to treat anaphylaxis

The offending medication and similar drugs should be avoided. Make sure all your health care providers – including dentists and hospital personnel – know about any drug allergies that you or your children have.
Identifying jewelry or cards (such as Medic-Alert or others) may be recommended.
Occasionally, a penicillin (or other drug) allergy responds to desensitization, where increasing doses of a medicine are given to improve a person’s tolerance of the drug. This should only be done by an allergist.

Expectations (prognosis)

Most drug allergies respond readily to treatment. A few cases cause severe asthma, anaphylaxis, or death.

Complications are:

Anaphylaxis (life-threatening), Asthma and Death.

Calling your health care provider

Call your health care provider if you are taking a medication and seem to be having a reaction to it.
Go to the emergency room or call the local emergency number (such as 911) if you have difficulty breathing or develop other symptoms of severe asthma or anaphylaxis. These are emergency conditions.

Prevention

There is generally no way to prevent development of a drug allergy. If you have a known drug allergy, avoiding the medication is the best way to prevent an allergic reaction. You may also be told to avoid similar medicines. For example, if you are allergic to penicillin, you should also avoid amoxicillin or ampicillin.
In some cases, a doctor may approve use of a drug that causes an allergy if you are pre-treated with corticosteroids (such as prednisone) and antihistamines (such as diphenhydramine). Do not try this without a doctor’s supervision. Pre-treatment with corticosteroids and antihistamines has been shown to prevent anaphylaxis in people needing to get iodinated x-ray contrast dye.

References

Grammer LC. Drug Allergy. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 275.

Asthma

Question

get a funny taste in my mouth after using my asthma inhaler. Is it OK to drink water right after taking it?

Answer

You are encouraged to rinse your mouth right after using an asthma inhaler — not only to remove the aftertaste, but more important, to avoid developing an oral fungal infection. You can rinse your mouth with water, or drink milk or a soft drink, for example, to remove the taste an inhaler may leave in your mouth.
Tasting your inhaled medication, however, often is an indication of poor inhaler technique. Proper inhaler technique ensures the delivery of the desirable amount of medicine to your lungs and less medicine residue in your mouth.
Even with good technique, however, it is important to rinse your mouth when you are taking certain drugs called inhaled corticosteroids (ICs) — for example, Flovent® (fluticasone) or QVAR® (beclomethasone) etc. The residue these medications can leave in your mouth increases your chance of developing an oral fungal infection such as thrush (oral candidiasis). Review your inhaler technique with your doctor or pharmacist to minimize your chances of developing an oral fungal infection, and be sure to read all the patient information supplied with your medication. If you are not certain if your inhaled medication requires rinsing your mouth afterward, ask your pharmacist.

Question

What’s the difference between the different kinds of asthma medications?

Answer

There are several types of medications used to treat asthma. Some are considered long-term control medications; they are used daily to prevent asthma symptoms and attacks. Others are quick-relief medications, used in the event of an asthma attack.
Long-term control medication controls inflammation and swelling in the lungs’ airways. Patients are directed to take this type of medication every day—even if they are feeling fine.
Quick-relief medications are for use during an asthma attack. Unlike long-term control medications, they do not reduce inflammation. Instead, they relax and open airways to increase airflow.
If you are being treated for asthma, be sure you understand when to use your medications. If your current asthma treatment does not include a long-acting medication, discuss with your physician if one is right for you.

Birth Control

Conception

How long does it take to get pregnant after stopping either birth control pills or Depo-Provera® shots?

Answer

Some doctors recommend that you wait at least one menstrual cycle before trying to become pregnant to allow the birth control drugs to entirely leave your system and your body to resume normal ovulation (usually within one to three months). If you are waiting out this time before trying to conceive, use a barrier method of birth control (such as a condom). A waiting period also allows you to make sure your health habits are optimal for pregnancy (not smoking, avoiding alcohol, and getting folic acid in your diet).
If you were ovulating irregularly before you started the pill, it may take you longer to conceive than a woman who ovulates regularly. The time it takes to become pregnant varies from woman to woman.
Remember that most home pregnancy tests should be used seven to 14 days after your last missed period. If you try to test too early, the hormone that these tests detect may not have accumulated in your urine. This will result in a false negative result.

Condom effectiveness

How effective are male condoms at preventing sexually transmitted diseases and pregnancy?

Answer

Male latex condoms are not full-proof, but they can be a very effective over-the-counter (OTC) product for preventing sexually transmitted diseases (STDs) and pregnancies.
Pregnancies that occur even with male condom use usually are due to human error such as breakage of the condom during intercourse, semen spillage during withdrawal, or waiting too long to put on a condom.
Male latex condoms are very effective in reducing STDs spread through semen or vaginal secretions, including chlamydia, HIV, gonorrhea, and trichomoniasis. (Natural, or lambskin, condoms, however, do not prevent the spread of STDs.) Latex condoms also can provide some protection against genital ulcer STDs such as genital herpes, syphilis, and chancroid. Because these STDs can be transmitted via skin contact, condoms provide a lesser degree of protection against them.
To prevent STD transmission, safe sex means always using a latex male condom when participating in any form of sexual activity with another person. Be sure to follow the instructions for proper condom use to avoid breakage or slippage, which obviously will reduce the effectiveness of the condom. Store condoms in a place where they can not be damaged inside their wrapper by extreme temperatures or get punctured. And since oil-based lubricants can weaken latex, avoid using such products with condoms. Water-based lubricants are recommended for use with latex condoms.

Effectiveness Levels

Effectiveness Levels

Do over-the-counter topical antibiotics (such as Polysporin® (Triple Antibiotic Ointment) reduce the effectiveness of birth control pills?

Answer

Antibiotics taken by mouth can potentially decrease the effectiveness of estrogen-containing oral contraceptives. Therefore, it is important to practice an alternative method of contraception during and after taking the oral antibiotics until your next menstrual cycle.
Regarding topical antibiotics such as Polysporin® or Triple Antibiotic Ointment, these medications are not significantly absorbed into the bloodstream and therefore do not kill the normal flora in the stomach. As a result, topical antibiotics are not expected to reduce the effectiveness of oral contraceptives.

Missed Pills

I forgot to take my birth control pill yesterday. Should I take two tablets today?

Answer

To achieve maximum contraceptive effectiveness, birth control pills should be taken exactly as directed at intervals not exceeding 24 hours, preferably at the same time each day. The effectiveness of oral contraceptives depends on strict adherence to the dosage schedule. Missing a pill may cause spotting or light bleeding. Also, you may experience an upset stomach on the day the missed tablet is taken with the next regularly scheduled tablet.

If you are prescribed a 21-day or a 28-day supply call and ask your physician or pharmacist what to do.

Children’s Health

Cold Products

Please explain the new regulations about cold products for children.

The label change will recommend that some products not be given to children under the age of 4 years because of the risk of serious and potentially life-threatening side effects; labeling on some products will recommend against their use for children under age 2 years. Previously, most of these products were not advised for children under age 2 years.
The voluntary label change is intended to help prevent and reduce the misuse of these products in children, as well as to better informs consumers about their safe and effective use. These manufacturers also are introducing new child-resistant packaging and new measuring devices for use with their products.

The following are medication safety tips for parent and caregivers:
– Do not give children medications that are labeled only for adult use.
– Always consult your doctor or pharmacist if you have any questions about using cough or cold medicines in children.
– Choose OTC cough and cold medicines with child-resistant safety caps, when available. Keep them tightly closed and out of the reach of children when not in use.
– Read the “Active Ingredients” section of the “Drug Facts” label of the medicines you choose. It tells which symptoms the active ingredients are intended to treat. Cough and cold medicines often have more than one active ingredient, such as an antihistamine, a decongestant, a cough suppressant, an expectorant, or a pain reliever and fever reducer.
– If you are giving more than one medicine to a child, make sure the medicines do not have the same type of active ingredients. If you use two medicines that have the same or similar active ingredients, your child could be harmed by getting too much of that ingredient.
– Always follow the directions for how to use the medicine in the “Drug Facts” part of the label: how much to give and how often you can give it. If you have any questions about how to use the medicine, ask your pharmacist or other healthcare professional. Overuse or misuse of these products can lead to serious and potentially life-threatening side effects, such as rapid heartbeat, drowsiness, breathing problems, and seizures.
– Only use measuring devices (cup, spoon, dropper, for example) that come with the medicine or those specially made for measuring drugs. Household spoons come in different sizes and are not meant for measuring medicines.
– Remember that OTC cough and cold medicines do not cure the cold or cough—they only treat symptoms, such as runny nose, congestion, fever, and aches. And they do not shorten the length of time your child is sick.

Head Lice, Infant Diarrhea…

Head Lice

My 5th-grader’s school sent a note home about some students having head lice. Is there anything I can do to prevent my child from getting it?

Answer

While head lice can often spread rapidly in school populations, there are steps to take to prevent being infected—and also steps to take to get rid of lice.
Head lice is a very common infection that occurs among children and teenagers. They are at highest risk because they usually are in close contact with other children (through school or day care) and tend to share personal belongings. The only way to prevent head lice is to tell your child not to share personal items such as combs, brushes, scarves, hats, helmets, or hair accessories with anyone. Also, tell her to avoid head-to-head contact with other children while playing. Avoiding the use of bedding or pillows immediately after someone infected with head lice is also recommended. Using a medicated product for the treatment of head lice — such as Nix® or Resultz® or Zap® —is not a preventive measure.

Parents who get a note from school about an outbreak of head lice should follow these steps:

Check your child’s hair for lice and nits (lice eggs) every three to four days. Nits commonly look like dandruff, but they cannot be easily brushed off the hair. Also check behind the ears.
Be alert to symptoms of infection: intense itching, red bumps on the scalp, or the feeling of something moving on the hair. If your child experiences any of these symptoms and/or if head lice can be seen in the hair, then using a medicated shampoo is recommended, such as Nix® or Resultz® or Zap® (Follow the directions on the package.) Note: If your child is under 2 years of age or if you are pregnant, talk with your doctor first before beginning treatment. Notify your child’s school.
In addition to using medicated shampoo, wash all clothing and bed linens in hot water ( 55°C or 130 °F). Any items that cannot be washed in hot water should be placed in large, sealed garbage bags for two weeks. Vacuum all carpets and furniture.
Any combs, brushes, and hair accessories used by the infected person should be left to soak in rubbing alcohol or medicated shampoo for one hour, or they should be replaced.
Some people may need to retreat with a medicated shampoo after seven to 10 days. If the infection has not cleared up after two weeks of treatment or there are sores on the scalp that look infected (yellow pus), stop treatment and see a doctor.

Infant Diarrhea

My 6-month-old baby has had diarrhea all morning. I can’t get an appointment with my pediatrician until much later this afternoon. What can I do in the meantime?

Answer

The primary concern for an infant with diarrhea is dehydration. Diarrhea will cause your baby to lose fluids and electrolytes. It therefore is important to rehydrate your baby with an oral rehydration product to prevent dehydration.

…Infant Diarrhea, Teathing Pain

Be alert to these signs of dehydration:
– Dry or sticky mouth
– Few or no tears when crying
– Eyes look sunken into the head
– Soft spot (fontanelle) on top of the head looks sunken
– Fewer than six wet diapers per day, going six to eight hours without urinating, or urinating very little
– Dry, cool skin that lacks elasticity
– Lethargy
– Dark-colored urine

Oral rehydration solutions and electrolyte products are available over the counter. Some contain a special mix of electrolytes and fluids; some are in the form of freezer pops; some are in the form of strips that require drinking water to supply the fluid. You may wish to keep these products on hand so they are ready to use as the need arises.
As with any medication you give your child, read the instructions fully, and follow the directions to the letter when administering the remedy (how much, how often, etc.). Until the pediatrician can examine your baby, call the doctor’s office and have him or her give you further recommendations on what liquids/food you can give your baby in the meantime.

Teething Pain

What remedies can I use to safely treat my baby’s teething pain?

Answer

When babies’ teeth come to the surface, they put pressure on the periodontal membrane. Before resorting to medication, try these suggestions:

Wash your hands with warm soapy water. Then gently rub your baby’s gums with a clean finger or a moistened sterile gauze pad. This “massage” may relieve your baby’s discomfort.

Give your baby a teething ring made of firm rubber or a bottle filled with water. Some teething rings can be placed in the freezer so that the cold can help soothe the pain.

Always consult your pediatrician before giving medication to treat teething pain. There are many products available, but let your pediatrician make a recommendation as to what is suitable for your infant. Your doctor may recommend an over-the-counter remedy such as acetaminophen or ibuprofen. Do not give your baby any medicines that contain aspirin.
It’s important to note that fever is not a sign of teething. If your child is running a fever of 38 degrees Celsius or 100.5 degrees Fahrenheit or more (measured orally; rectal temperatures can be 0.5 to 1 degree higher), contact your doctor and report any other signs of illness.

Teathing

Definition

Teething is the growth of teeth through the gums in the mouth of infants and young children.

Information

Teething usually begins when a baby is between 6 and 8 months old. More teeth grow in from time to time until all 20 baby, or deciduous, teeth are in place. These teeth are normally in place by the time a child is 30 months old.

Such teeth include:

– Incisors – Canines – Molars in each jaw

The two bottom front teeth (lower central incisors) usually come in first. Next to grow in are usually the two top front teeth (upper central incisors), then the lower and upper lateral (side) incisors, lower molars, upper molars, lower canines, upper canines, lower lateral molars, and finally the upper lateral molars.
Note that some children do not show any teeth until much later than 8 months, and this is perfectly normal.

The signs of teething are:

– Biting on hard objects
– Drooling
– Gum swelling and sensitivity
– Irritability
– Sleeping problems
– Refusing food

The discomfort that results from teething is due to the pressure exerted on the tissue in the mouth, called the periodontal membrane, as the teeth erupt. This discomfort may be eased by a cool object such as a firm rubber teething ring or a cold apple. Gently rubbing the gums with a cool, wet washcloth, or (until the teeth are right near the surface) a clean finger, can also help.
Medications such as children’s Tylenol or over-the counter teething preparations containing a topical anesthetic can be helpful.
Never cut the gums to help a tooth grow in, because this can lead to infection. Teething powders should also be avoided. Children should NEVER be given aspirin due to the risk of developing Reye syndrome.

NOTE

Teething does NOT cause fever. If your child develops a fever greater than 38 degrees Celsius or 100.5 degrees Fahrenheit, as taken with a rectal or ear thermometer, look for other signs of illness.

Contact Lenses

Disinfection

How often do I need to disinfect my contact lenses?

This varies depending on the type of lenses you wear:

Soft and rigid gas permeable contact lenses (RGPs) should be cleaned and disinfected once per day. Always use the appropriate solution.

Extended-wear lenses should be cleaned and disinfected when they are removed, unless you have been directed to throw them away.

Disposable Lenses

Are disposable contact lenses better than the kind you keep for a long time?

Answer

One type of lens is not necessarily better than another, but there are some benefits to using disposable lenses. The more frequently contact lenses are replaced, the less potential for eye problems to develop. Previously, lenses were too expensive to replace often, so cleaning solutions were used to increase the longevity of the lens. With the introduction of disposable lenses, the cost of frequently replacing lenses has lessened. Another benefit of daily disposable lenses is that they do not require cleaning solutions.
Ask your eye care professional about a new type of silicon hydrogel lens, which is believed to provide for better eye health and comfort. Your eye care professional can help you determine which type of contact lens would be best for your eyes, your vision, and your lifestyle.

Drug Interactions

Can taking certain medications cause me to have problems with my contact lenses?

Answer

In general, over-the-counter (OTC) or prescription eye drops or ointments should not be placed in the eye while you are wearing your contact lenses. The only exception is for medications specifically made to be used while wearing contact lenses. Products not labeled safe to use with contact lenses may contain preservatives or chemicals that can damage the contact lens.
Certain OTC and prescription medications can cause irritation or damage contact lenses. Medications that cause dry eyes or blurred vision (for example, antihistamines, diuretics, tricyclic antidepressants, and oral contraceptive pills) can make wearing contact lenses uncomfortable.
In addition, contact lenses can become damaged from medications being excreted into the tears.
Always check the warning labels that come with over-the-counter and prescription medications. Select the right eye drops or other solutions for your type of contact lenses. If you are unsure, check with your doctor, eye care professional, or pharmacist.

Infection Symptoms

Infection Symptoms

How do I know if my contact lenses have caused a fungal infection in my eyes?

Answer

Because many conditions—from injuries to the surface of the eye to bacterial and fungal infections—can cause similar symptoms, only an ophthalmologist can diagnose a fungal infection in your eyes.
Symptoms to watch for include redness and/or pain that does not improve when the contact lens is removed, tearing, increased sensitivity to light, blurred vision, discharge, and swelling.
If you wear contact lenses and are experiencing symptoms such as those above, remove your lenses and consult your eye care professional immediately.

Pregnancy

I have heard that women sometimes have problems wearing contact lenses when they are pregnant. Why is that?

Answer

Hormonal changes during pregnancy sometimes can affect a woman’s vision, as can dry eyes and water retention. Some pregnant women may experience dry eyes, blurred or distorted vision, or even hemorrhages in the eye. A mother-to-be experiencing any of these changes should contact her obstetrician and optometrist or ophthalmologist. The doctor may recommend a change in prescription (a temporary switch to disposable lenses for the rest of the pregnancy may help save the patient money), limit the number of hours the lenses should be worn, or advise her to stop wearing the lenses until after delivery. These vision problems often go away soon after delivery.

Preventing Infection

I wear contact lenses and am concerned about getting an infection in my eyes. Can you explain this problem and what I can do to prevent it?

Answer

Daily care of your contact lenses also is critical to your eye health. The manufacturer of your contact lenses will have specific recommendations for storage and cleaning of its product. Familiarize yourself with those specific guidelines and follow them. Also, make sure you clean your contact lens case often and replace it every three to six months. Use a “rub and rinse” method for cleaning your lenses to decrease the amount of germs on your lenses and decrease your chance of developing an infection.
Always discuss your concerns and questions with your eye care professional.

Practice good daily hygiene

Always wash your hands with soap and water thoroughly, and then dry them with a “lint-free” method before you remove or insert your lenses.

Wear and replace your contacts on the schedules prescribed by your eye care professional. Wearing them too long or overnight can also increase your risk for developing a fungal infection in your eyes.

Replacement

Replacement

How often do I need to get a fresh pair of contact lenses?

Answer

How often you replace your contact lenses for a new pair depends on the type of lenses you wear:

§ Some soft daily wear lenses may last a full year. Some soft disposable lenses are discarded after one day; extended wear lenses are discarded every two weeks.

§ Rigid gas permeable lenses can last several years.

Schedule

What is the longest amount of time I can keep my contact lenses in?

Answer

How long can you wear your contact lenses on any given day? The answer depends on the type of lenses you wear and your eye care professional’s recommendation.

Different lenses are made for different wearing schedules:

Daily wear lenses—which include both soft and rigid gas permeable lenses—must be removed before bedtime or a nap.
Only extended wear lenses can be slept in/kept in for the prescribed time (usually overnight or up to seven days).
To protect your eyes from potentially serious problems and injury, be sure to follow your eye care professional’s recommendation.

Sleeping

Is it OK to wear my contact lenses while I am sleeping?

Answer

Daily wear lenses—including both soft and rigid gas permeable lenses—must be removed before bedtime or even a nap. Certain extended wear contact lenses are designed to be left in while you sleep; however, be sure to discuss your wearing schedule with your eye care provider, since your needs may be different.

Always be sure to carry your lens container and soaking solution in case you need to store your lenses before getting some shut-eye.

Swimming

Can I wear my contact lenses when I go swimming?

Answer

While a lot of people like wearing contacts for sports activities, swimming is one that should be skipped while wearing contact lenses. Do not wearing contact lenses while swimming because of the danger of contamination from bacteria and chlorine, which can result in an eye infection. Soft contact lenses actually absorb chemicals from the water in which you are swimming.
Another swimming-related problem is that contact lenses can adhere to the eye after swimming. If that happens, the contact lenses can usually be loosened by applying several drops of rewetting solutions or saline in the eye. If they do not loosen within a half-hour, contact your eye care professional.

Diabetes

Alternate Site Testing

What is alternate site testing?

Answer

The term alternate site testing (AST) means using parts of the body other than the fingertips to obtain blood for blood glucose testing. AST offers fingertip protection and less pain. Alternate site testing areas can be the upper arm, thigh, calf and the fleshy parts of the hand.
Various blood glucose meters offer AST in addition to finger-stick testing.

When should you alternate site test (AST)?

– In a pre-meal or fasting state (more than two hours since your last meal)
– Two hours or more after taking insulin
– Two hours or more after exercise .Whenever you feel that your glucose level is changing rapidly, the fingertip measurement is more accurate than AST. AST is not recommended for pregnant women. In addition, readings before meals are more accurate than after meals.

Remember: Finger-stick testing is still important.

Be sure to check your blood glucose monitor owner’s manual and consult your healthcare professional or diabetes educator for information and instruction on alternate site testing.

Blood Glucose Testing Pain: Isn�t it painful to prick your finger over and over?

Answer

Many diabetes patients would describe the blood glucose monitoring experience as a pinprick or pinch with very slight pain. A lancet (special needle) is used to produce a very small amount of blood for testing the person�s blood glucose level. These lancets are usually spring loaded and/or adjustable to reduce pain. In addition, some newer models of blood glucose monitors allow testing on areas of the body other than the fingertips.
There are some ways a patient can reduce the amount of pain:
Avoid testing at the pad of the fingertips, which is a more sensitive area. Instead, test on the side of the fingertips.

Many lancet devices can be adjusted to change the lancet puncture depth. The patient can adjust the setting to get the necessary amount of blood with the least pain.

Avoid testing over and over on the same fingertip. Rotate testing to allow the test sites to heal in between tests.

(AST)

AST

Alternative site testing (AST) is another option: Depending on the glucose meter used, the thigh, calf, abdomen, palm, upper arm, or forearm can be tested instead of the fingertips. AST may not be as accurate as fingertip testing, however, and is not recommended during pregnancy, when very low blood sugar is a concern, or during times of rapidly changing blood sugar.
Lancets should always be changed between tests. Reused lancets may become dull and therefore more painful to test with.
Do not test on unhealed or infected sites.
A diabetes patient should always check with his or her doctor if there is significant pain despite trying these techniques. Significant pain may be a sign of impaired wound healing, improper testing procedure, or some other serious problem.

Control Solution

When should I use the glucose control solution for my blood glucose meter?

Answer

Control solution is used to validate the accuracy of the meter. It is important to run periodic control tests to ensure that the meter and test strips are functioning and giving reliable results.
It is essential that people with diabetes keep their blood sugar levels in their target range. Glucose control will prevent the onset of diabetes-related complications such as heart disease, neuropathy (nerve pain), nephropathy (kidney disease), and retinopathy (retina damage).
Although control tests may be performed at any time, these tests are strongly recommended:

when the meter is new.
before using a new batch of test strips.
when the cap has been left off of the strip vial, allowing the strips to oxidize.
when the strips have been stored in an area of extreme temperature and/or humidity.
– when the machine has just been thoroughly cleaned.
– when test results do not coincide with how you feel.
– when the test is repeated and the levels are not what is expected.
– when you want to verify that you are performing the test correctly.
– There is no universal control solution. Most companies manufacture a control solution that is specific to a particular strip.

Skin Problems

Skin Problems

Can diabetes cause skin problems?

Answer

Approximately one-third of all patients with diabetes will develop some type of skin disorder covering a range of severity. The disorders can be as minor as localized itching or severe enough to require amputation. It’s important to take all skin conditions seriously and remember that even a minor cut can lead to amputation of a limb if left untreated.
It is essential that people with diabetes keep their blood sugar levels in their target range. Glucose control will prevent the onset of diabetes-related complications such as heart disease, neuropathy (nerve pain), nephropathy (kidney disease), and retinopathy (retina damage).
Although control tests may be performed at any time, these tests are strongly recommended:
Dry skin can affect people with diabetes. High glucose levels and frequent urination commonly cause diabetic patients to become dehydrated. Dehydration, in turn, increases the tendency to develop dry skin. Dry skin can then crack and become infected with bacteria or fungi.
High blood glucose and poor circulation reduce the effectiveness of white blood cells (the infection-fighting cells). Therefore, an individual with diabetes will require medical care to prevent infection and compensate for his or her underperforming immune system.
People living with diabetes frequently experience itching and other skin changes. Diabetes can cause changes in the blood vessels and arteries, which can lead to changes in skin color. In addition, these individuals are at risk for developing other skin changes such as blisters, redness, rashes, or waxy skin.

If you have diabetes, these tips may help prevent skin damage and infections:

Wash and dry your skin thoroughly, and maintain good hygiene. This improves your body’s ability to fight and resist infection.

Use talcum powder to keep skin dry in areas such as the groin where skin frequently rubs against itself.

Use a mild soap with moisturizer, and apply skin cream to your body after bathing. Avoid bubble baths.

Apply lotion to the top and bottom of your feet. (Check the directions on the product you are using. Some products should not be applied between the toes, due to increased risk of fungal infections).

Skin Problems

Skin Problems

Avoid very hot water when bathing. Test the water to ensure that it is comfortably warm before stepping into the tub.

Keep your home humid during cold or dry months to prevent your skin from drying.

Keep your blood sugar levels under control. Chronically high glucose levels are associated with dry skin.

Do not ignore any signs of wounds�particularly on the feet. Even the smallest cut can progress to a serious infection. Clean all wounds with soap and water, and avoid products containing alcohol and iodine. Cover the clean wound with sterile gauze, and use a topical antibiotic only under a doctor�s supervision.

Consult your doctor immediately if you experience any wounds (burns, cuts, etc.) that look severe.

If you develop any chronic skin conditions, consider consulting a dermatologist (skin doctor).
It’s a good idea to keep a record of your doctor’s recommendations for moisturizing lotion and other skin care products. Also, document the most recent date when a healthcare professional examined your skin.

Traveling with Supplies

I have not traveled since the time I was diagnosed with diabetes. What should I do when I travel with my diabetes-related supplies?

Answer

�Notify the Security Officer that you have diabetes and are carrying your supplies with you. The following diabetes-related supplies and equipment are allowed through the checkpoint once they have been screened:

Insulin and insulin loaded dispensing products (vials or box of individual vials, epipens, infusers, and preloaded syringes).

Unlimited number of unused syringes when accompanied by insulin or other injectable medication; lancets, blood glucose meters, blood glucose meter test strips, alcohol swabs, meter-testing solutions.

Insulin pump and insulin pump supplies (cleaning agents, batteries, plastic tubing, infusion kit, catheter, and needle); insulin pumps and supplies must be accompanied by insulin.

Glucagon emergency kit.

Traveling with Supplies

Traveling with Supplies

Urine ketone test strips.

Unlimited number of used syringes when transported in Sharps disposal container or other similar hard-surface container.

Sharps disposal containers or similar hard-surface disposal container for storing used syringes and test strips.

�Insulin in any form or dispenser must be clearly identified.

�If you are concerned or uncomfortable about going through the walk-through metal detector with your insulin pump, notify the Security Officer that you are wearing an insulin pump and would like a full-body pat-down and a visual inspection of your pump instead.

�Advise the Security Officer that the insulin pump cannot be removed because it is inserted with a catheter (needle) under the skin.

�Advise the Security Officer if you are experiencing low blood sugar and are in need of medical assistance.

�You have the option of requesting a visual inspection of your insulin and diabetes associated supplies.�

Be sure to also check with your airline or cruise line to make sure you are meeting any of their particular regulations as well. Always be sure to carry copies of all current medication prescriptions from your pharmacist and get a note from your family physician in case of emergency while traveling.

Urine Test Kits

What is the difference between the urine test kits for people with diabetes?

Answer

Three different kinds of urine testing kits are available for testing three different substances in the urine: glucose (sugar), ketones, and microscopic amounts of protein (microalbuminuria).

Glucose test kits: Before the development of blood glucose meters, urine testing was the only method for gauging a person�s sugar levels. However, it has always been a very imprecise method for a variety of reasons:

Urine test strips cannot detect glucose (sugar) until the blood glucose level is above 180 mg/dl. This means a person�s blood sugar level could still be high (hyperglycemia) or even dangerously low (hypoglycemia) but still not be detected.
Urine glucose testing is highly subject to user error because it requires color interpretation of the urine test strip via a color-scale comparison. This becomes an issue with people who are colorblind or have poor eyesight, and certain drugs and vitamin C can change the color of the urine and thus provide an invalid measurement.

Glucose test Kits…

Glucose test Kits…

The reading reflects the level of blood glucose from a few hours earlier�not at the present moment�and often is misinterpreted.
As a result of these shortcomings, healthcare professionals recommend that anyone needing to closely monitor blood glucose levels use a blood glucose meter. However, urine strips can be useful in certain populations who physically cannot or will not test themselves with a blood glucose meter.

Ketone test kits: Ketone bodies are the byproducts of the body burning fat, rather than glucose, to fuel provide energy. When fat is used for energy instead of glucose, the preferred fuel source, the liver produces substances called ketones. If ketones build up, they can lead to a life-threatening condition known as diabetic ketoacidosis.

Ketone testing should be performed by people with type 1 (insulin-dependent) diabetes when their blood sugar is 240 mg/dl or higher, or as directed by their physician. All people with diabetes who are sick, under stress, or whose blood sugar level is above 300 mg/dl should also test for ketones, as should pregnant women with any type of diabetes (type 1, type 2, or gestational). Anyone who suspects the onset of diabetic ketoacidosis should be tested for ketones immediately. Diabetic ketoacidosis is characterized by fruity breath, extreme fatigue, increased urination and thirst, vomiting, and eventual unconsciousness. Severe cases require patients to seek emergency medical attention immediately.

Microalbuminuria test kits: The presence of protein in the urine (microalbuminuria) is an early sign of kidney disease. Since people with diabetes are at a higher risk for kidney damage, the American Diabetes Association recommends that anyone with diabetes be tested annually for microalbuminuria. This test, which previously was available only through healthcare professionals, is now available in a home-test kit. These simple tests can be performed by the user and mailed to the company for a professional evaluation. Should you test positive, your doctor may recommend specific medications to prevent further damage to your blood vessels and kidneys.

DISCLAIMER

The information provided is not a substitute for medical advice. Consult your physician for diagnosis and treatment of your medical condition. Advances in medicine may cause this information to become outdated, invalid or subject to debate. Professional opinions and interpretations of the scientific literature may vary. ZINOHA Pharmacy�s terms of use and general warranty disclaimer apply to all services provided. If you are in need of immediate medical attention, contact your physician, poison control center or emergency medical professional. If you need to speak with a pharmacist for non-emergency matters, contact your pharmacist or call 1-403-238-2250 or e-mail us at zinoha@zinohapharmacy.com

Senior Health & Aging

Aging changes in organs – tissue – cells

Information

All vital organs begin to lose some function as you age. Aging changes have been found in all of the body’s cells, tissues and organs, and these changes affect the functioning of all body systems.
Living tissue is made up of cells. There are many different types of cells, but all have the same basic structure. Tissues are layers of similar cells that perform a specific function. The various kinds of tissues group together to form organs.

There are four basic types of tissue:

– Connective tissue supports other tissues and binds them together. This includes bone, blood, and lymph tissues in addition to the tissues that give support and structure to the skin and internal organs.

– Epithelial tissue provides a covering for deeper body layers. The skin and the linings of the various passages inside the body are made of epithelial tissue.

– Muscle tissue includes three types of tissue:

– Striated muscles, such as those that that move the skeleton (also called voluntary muscle)

– Smooth muscles (also called involuntary muscle), such as the muscles that surround the stomach and other internal organs

– Cardiac muscle, which makes up most of the heart wall (also involuntary muscle)

– Nerve tissue is made up of nerve cells (neurons) and is used to carry messages to and from various parts of the body. The brain is made of nerve tissue.

AGING CHANGES

Cells are the basic building blocks of tissues. All cells experience changes with aging. They become larger and are less able to divide and reproduce. Among other changes, there is an increase in pigments and fatty substances inside the cell (lipids). Many cells lose their ability to function, or they begin to function abnormally.
Waste products accumulate in tissue with aging. A fatty brown pigment called lipofuscin collects in many tissues, as do other fatty substances.
Connective tissue changes, becoming increasingly stiff. This makes the organs, blood vessels, and airways more rigid. Cell membranes change, so many tissues have more trouble receiving oxygen and nutrients and getting rid of carbon dioxide and wastes.
Many tissues lose mass. This process is called atrophy. Some tissues become lumpy (nodular) or more rigid.

Aging changes…

Aging changes…

Because of cell and tissue changes, your organs also change as you age. Aging organs gradually but progressively lose function, and there is a decrease in the maximum functioning capacity. Most people do not notice this loss, because you seldom need to use your organs to their fullest capability.
Organs have a reserve ability to function beyond the usual needs. For example, the heart of a 20-year-old is capable of pumping about 10 times the amount that is actually needed to preserve life. After age 30, an average of 1% of this reserve is lost each year.
The most significant changes in organ reserve occur in the heart, lungs, and kidneys. The amount of reserve lost varies between people and between different organs in a single person.
These changes appear slowly and over a long period of time. Even so, when an organ is worked harder than usual it may not be able to increase function. Sudden heart failure or other problems can develop when the body is worked harder than usual. Things that produce an extra workload (body stressors) include the following:

– Certain medications
– Illness
– Significant life changes
– Suddenly increased physical demands on the body, for example:

– A sudden change in activity
– Exposure to a higher altitude

Loss of reserve also makes it harder to restore equilibrium in the body. Drugs are detoxified at a slower rate. Lower doses of medications may be needed, and side effects become more common.
Medication side effects can mimic the symptoms of many diseases, so it is easy to mistake a drug reaction for an illness. Some medications have entirely different side effects in the elderly than in younger people.

AGING THEORY

No one really knows how and why people change as they get older. Some theories claim that aging is caused by accumulated injuries from ultraviolet light, wear and tear on the body, by-products of metabolism, and so on. Other theories view aging as a predetermined, genetically-controlled process.

Metabolism

Definition

Metabolism refers to all the physical and chemical processes in the body that convert or use energy, such as:

– Digesting food and nutrients
– Eliminating waste through urine and feces
– Breathing
– Circulating blood

Metabolism…

Metabolism

– Controlling body temperature
– Contracting muscles
– Functioning of the brain and nerves

However, no theory sufficiently explains all the changes of the aging process. Aging is a complex and varied process that varies in how it affects different people and even different organs. Most gerontologists (people who study aging) feel that aging is the cumulative effect of the interaction of many lifelong influences. These influences include heredity, environment, cultural influences, diet, exercise and leisure, past illnesses, and many other factors.

Unlike the changes of adolescence, which are predictable to within a few years, each person ages at a unique rate. Some systems begin aging as early as age 30. Other aging processes are not common until much later.
Although some changes typically occur with aging, they occur at different rates and to different extents. There is no reliable way to predict specifically how you will age.

TERMS

ATROPHY

Cells shrink

If enough cells decrease in size, the entire organ atrophies. This is often a normal aging change and can occur in any tissue. It is most common in skeletal muscle, the heart, the brain, and the secondary sex organs (such as the breasts).

The cause of atrophy is unknown, but may include reduced use, decreased workload, decreased blood supply or nutrition to the cells, and reduced stimulation by nerves or hormones.

HYPERTROPHY

Cells enlarge

This size increase is caused by an increase in cellular proteins, such as the cell wall and internal cell structures, not an increase in the cell’s fluid.
When some cells atrophy, others may hypertrophy in an attempt to compensate for loss of cell mass.

HYPERPLASIA

The number of cells increases. There is an increased rate of cell division.
Hyperplasia usually occurs in an attempt to compensate for loss of cells. It allows some organs and tissues to regenerate, including the skin, the lining of the intestines, the liver and the bone marrow. The liver is especially good at regeneration. It can replace up to 70% of its structure within 2 weeks after an injury.

DYSPLASIA

DYSPLASIA

Tissues that have limited ability to regenerate include bone, cartilage, and smooth muscle (such as the muscles around the intestines). Tissues that seldom or never regenerate include nerves, skeletal muscle, heart muscle, and the lens of the eye. When injured, these tissues are replaced with scar tissue.

DYSPLASIA

The size, shape, or organization of mature cells becomes abnormal. This is also called atypical hyperplasia.

Dysplasia is fairly common in the cells of the cervix and the lining of the respiratory tract.

NEOPLASIA

The formation of tumors, either cancerous (malignant) or noncancerous (benign).

Neoplastic cells often reproduce rapidly. They may have unusual shapes and abnormal function.

References

Martin GM. Biology of aging. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 22.

SunBurns

First Aid

Definition

Sunburn is from over-exposure to the harmful ultraviolet rays of the sun. While the symptoms are usually temporary (such as red skin that is painful to the touch), the skin damage is often permanent and can have serious long-term health effects, including skin cancer.

Considerations

Keep in mind:
– There is no such thing as a “healthy tan.” Unprotected sun exposure causes premature aging of the skin.
– Sun exposure can cause first and second degree burns.
– Skin cancer usually appears in adulthood, but is caused by sun exposure and sunburns that began as early as childhood. You can help prevent skin cancer by protecting your skin and your children’s skin from the harmful rays of the sun.

Burns

There are three levels of burns:
– First-degree burns affect only the outer layer of the skin. They cause pain, redness, and swelling.
– Second-degree (partial thickness) burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering.
– Third-degree (full thickness) burns extend into deeper tissues. They cause white or blackened, charred skin that may be numb

Factors that make sunburn more likely:
– Infants and children are especially sensitive to the burning effects of the sun.
– People with fair skin are more likely to get sunburn. But even dark and black skin can burn and should be protected.
– The sun’s rays are strongest during the hours of 10:00 a.m. to 4:00 p.m. The sun’s rays are also stronger at higher altitudes and lower latitudes (closer to the tropics). Reflection off water, sand, or snow can intensify the sun’s burning rays.
Sun lamps can cause severe sunburn. – Some medications (such as the antibiotic doxycycline) can make you more susceptible to sunburn.

Symptoms

The first signs of a sunburn may not appear for a few hours. The full effect to your skin may not appear for 24 hours or longer. Possible symptoms include:
– Red, tender skin that is warm to touch.
– Blisters that develop hours to days later.
– Severe reactions (sometimes called “sun poisoning”), including fever, chills, nausea, or rash.
– Skin peeling on sunburned areas several days after the sunburn.

First Aid

First Aid

– Try taking a cool bath or shower. Or place wet, cold wash cloths on the burn for 10 to 15 minutes, several times a day. You can mix baking soda in the water to help relieve the pain. (Small children may become easily chilled, so keep the water tepid.)
– Apply a soothing lotion to the skin.
– Aloe gel is a common household remedy for sunburns. Aloe contains active compounds that help stop pain and inflammation of the skin.
– An over-the-counter pain medication, such as acetaminophen or ibuprofen may be helpful. DO NOT give aspirin to children.

Do Not

– DO NOT apply petroleum jelly, benzocaine, lidocaine, or butter to the sunburn. They make the symptoms worse and can prevent healing.
– DO NOT wash burned skin with harsh soap.

Call immediately for emergency medical assistance:

These signs include:
– Feeling faint or dizzy
– Rapid pulse or rapid breathing
– Extreme thirst, no urine output, or sunken eyes
– Pale, clammy, or cool skin
– Nausea, fever, chills, or rash
– Your eyes hurt and are sensitive to light
– Severe, painful blisters
– Call immediately if there are signs of shock, heat exhaustion, dehydration, or other serious reaction.

Prevention

– Avoid sun exposure during hours of peak sun ray intensity.
– Apply generous amounts of sunscreen with a sun protection factor (SPF) of at least 30. Pay special attention to your face, nose, ears, and shoulders. The higher the SPF, the greater the protection.
– Apply sunscreen 30 minutes prior to sun exposure to allow penetration. Re-apply after swimming and every 2 hours while you are outdoors.
– Wear sun hats. There is also SPF clothing and swimwear available.
– Wear sunglasses with UV protection.
– Use a lip balm with sunscreen.

Please visit ZINOHA Pharmacy for Sunscreen Products with competitive prices.