One at a time...Our Surgeon General's Message

Okay, I'm still on a high from meeting our amazing Surgeon General, Dr. Regina Benjamin yesterday! (I hope she doesn't mind that I am posting this picture.) I want to share a story she told us yesterday -you know how I always say stories are more powerful than statistics, right? Here it is:

A girl was out jogging along the beach. She saw an old man meticulously walking along, bending over and picking up starfish stranded from the tide, and tossing them back into the ocean. He was still there, plugging along, on her return. She could stand it no more, and asked him, "Why bother picking up these starfish? Look a the hundreds of them along the beach! The sun is out, the tide has receded, and they are all going to dry up and die." The wise old man looked at her, then deliberately bent down and picked up the next starfish. Holding it gently in his hand, he turned to the jogger and replied "because it matters to THIS one" and returned it to the sea.

Why bother educating our patients to eat more fruits and veggies when fast food heart-attack-on-a-plate is everywhere? Why take the time to educate about the real risks of physical intimacy and the awkward topic of STDs? Because ONE AT A TIME, it makes a WHOLE WORLD of difference, and together, we will turn the tide!

BOTTOM LINE: Let's ALL follow America's Doctor's advice, and MAKE A DIFFERENCE for at least ONE person today (even if that one person is YOU!)!

Proud to Be a Family Physician!

This week I am in Denver at the American Academy of Family Physician's Annual Scientific Assembly. This is a terrific conference, chock-full of the latest evidence-based medical advice. Each year I leave here with new tools to help my patients, although as I have mentioned in previous blogs, today's hot news may be that yesterday's advice was wrong!

Here are a few things that I learned or reinforced today:
1. Using Tylenol (acetaminophen) and Advil (ibuprofen) together is not only safe, but has a more powerful punch for pain relief than either drug alone.

2. Prescribing narcotic pain relievers for acute low back pain prolongs the disability from the back pain (we should use muscle relaxants and less addictive pain relievers.)

3. Using the Framingham risk assessment tool will help me to counsel patients on whether or not they should take a cholesterol lowering medication.

4. Pushing diabetics to lower their Hemoglobin A1C's (a long term measure of blood sugar levels) as low as possible can actually lead to worse outcomes than accepting a mid-range level.

5. I had the pleasure of hearing and meeting our Surgeon General, Dr. Regina Benjamin, as she addressed our academy. I am proud that she is a fellow FAMILY PHYSICIAN and admire her vision of healthier, more FIT Americans!

BOTTOM LINE: Physicians, like all professions, must continue to learn and re-learn what evidence and OUTCOME based studies teach us really help our patients! Stay tuned for more insights from this week...

Did U 4Get? Medication Reminders

Ah, texting- the new language of our youth! As we embrace technology, I believe there will be many beneficial uses of the tiny screens upon which our culture is becoming increasingly dependent. There are multiple "apps" out there, for example, that help people track behavioral changes such as exercise, or count days without junk food (or soda, or alcohol, or cigarettes or candy bars!) In my practice, I have seen these simple electronic tools really help my patients improve their health.

Along those lines, there is an interesting study recently published in the medical journal Obstetrics and Gynecology, entitled Using daily text-message reminders to improve adherence with oral contraceptives: a randomized controlled trial. This was a small, short study with just less than one hundred young, high school female graduates followed over three months. The women were randomized to receive a daily text message reminding them to take their birth control pill, and their compliance was both self-recorded and externally monitored.

The results surprised me, frankly. I would have thought simply participating in such a study, none-the-less receiving a DAILY reminder would have yielded near perfect compliance. Unfortunately, what was seen was that BOTH groups missed a significant number of pills each month (4.9+/-3.0 for the text-message group and 4.6+/-3.5 for the control group.) It's possible the difference in the groups was small because women in both groups used additional reminders such as alarms on their cell phones.

The other disappointment is that the girls' self-reporting of missed pills was markedly below their true number of missed pills, which strongly suggests that they could be underestimating their true risk of becoming pregnant if they are sexually active.

BOTTOM LINE: While technology may be able to help us towards healthy lifestyles, daily text medication reminders may not be an effective tool (at least in this setting.) Physicians need to emphasize (and patients need to implement!) strict compliance with oral contraceptive pills.

Can You Smell That?

Did you know that smells provide your strongest sense of memory? A quick whiff of sunscreen make take you to childhood beach memories, hairspray back to high school, freshly baked cookies back home or perhaps a certain cologne to a special person. Yesterday, I had the pleasure of smelling "fall" as I hiked through a beautiful aspen grove, the path covered in what my daughter calls the "crunchy golden blanket" of leaves. Too bad we can't bottle up that marvelous smell of nature!

Smell might be the sense we think about the least- until there is a problem with it. Without smell, taste is muted, leading to either decreased appetite or overeating (or over-spicing!) as we try to find something to satisfy a craving. If you wonder about your sense of smell, see if you can distinguish some common smells such as cinnamon, peanut butter, vanilla, coffee or lemon.

What causes your sense of smell to decrease or disappear? Some people are simply born without a sense of smell. Most commonly, however, we see transient lack of smell (the medical term is anosmia) from nasal congestion due to colds or allergies. Smoking, of course, not only destroys taste buds, but also decreases the ability to smell. Overuse of nonprescription nasal sprays such as Afrin is another common cause. Less common are medical disorders such as zinc deficiency and hypothyroidism, and rarely loss of smell can be a sign of diseases in the frontal lobe of the brain such as tumors or dementia.

BOTTOM LINE: If you notice you can no longer distinguish smells very well (and have no obvious cause such as a cold, chronic allergies or smoking habit), it's time to head to your doctor for a check up!

Avandia Latest News

Last week, the FDA issued more restrictions regarding the diabetes medication Avandia (rosiglitazone). You can read the full notice at FDA.gov, but I will try and hit the highlights for you.

Avandia is a "TZD" which is a class of medications that helps to increase the body's sensitivity to insulin in diabetics. We have seen that it is very effective at lowering blood sugars. Unfortunately, it was discovered that this class should NOT be used in diabetics who also have congestive heart failure. Now, additional studies have shown that there is also an increased risk of heart attack and stroke in patients who took Avandia. At this time, the other drug in the same TZD class, Actos (pioglitazone) is not proven to have the same risks, though many experts are concerned this will be a class effect. Europe has completely withdrawn Avandia from the market, but in the United States, patients doing well on Avandia may discuss the risks with their physicians before making a decision whether or not to continue this drug.

What should YOU do if you take Avandia? There is no need to panic, but schedule an appointment with your doctor to discuss what is best for you. My advice is to take this news as a wakeup call that it is time to STOP LOOKING TO PILLS for an answer for your diabetes, and get serious about the behavior modifications in your diet and exercise that are necessary to reverse your disease! Yes, there are patients with adult onset diabetes who are thin and fit (I have three such patients in my practice) but the vast majority are significantly overweight. The GREAT news is that I have seen time and time again that when patients really embrace healthy eating and daily exercise ("MORE") the high blood sugars, high blood pressures, and high lipids (cholesterol) not only improve, but often disappear!

In Western medicine, we are conditioned to find the quick fix for disease states by prescribing the "right" pill. We have invented wonderful medications that improve the quality and quantity of life. However, the longer people take them, the more long term side effects we identify. What is safe and the "best" practice today is often the next great lawsuit tomorrow. I am NOT anti-medication, but I am most definitely PRO-behavior modification when that choice exists to treat the same problem.

BOTTOM LINE: If you take AVANDIA, please schedule an appointment with your physician and ask for concrete suggestions for a healthier lifestyle!
PS. For a jump start towards "MORE" health, check out my January 2010 blogs: More, More Exercise Buddies, More Fun, When is a pound really gone, etc.

Menopause Matters! Take a Deep Breath and Read On...

So, yesterday I was talking about night sweats, and I mentioned the night sweats associated with menopause. Other than estrogen, is there anything else you can do for those major power surges that leave you soaking the sheets? Absolutely!

We have several NON-hormonal medications that we can use to improve night sweats and hot flashes. Blood pressure medications, antidepressants, and newer nervous system drugs can all be used.

Additionally, realize that both caffeine and alcohol can trigger night sweats. Often, decreasing or avoiding these substances will significantly improve the problem. Regular exercise, stress reduction, and vegetable-based diets can help as well.

There is a new technique that I learned about from Dr. Julia Edelman's excellent book, "Menopause Matters: Your Guide to a Long and Healthy Life" as well: paced respiration. Amazingly, this technique can reduce hot flashes by 80%, and there are NO untoward side effects! It involves "breathing slowly and deeply. You breathe only 5 to 7 times per minute- much slower than the normal breathing rate".

If you or any woman you love has questions about menopause, this book is chock-full of sound medical advice and I highly recommend buying it. Dr. Edelman clearly addresses the pros and cons of hormone replacement, bioidentical hormones, herbs, and issues affecting women's health from age 35 and beyond.

BOTTOM LINE: For an excellent resource on all things related to menopause, check out Menopause Matters, by Dr. Julia Edeleman.

Can't Sleep? Don't SWEAT it...

Trouble sleeping is one of the most common complaints that we see in family medicine. We all know how lack of sleep affects our performance the next day, and if you go several nights without a good night's rest, before long you are feeling miserable all the time!

Laurie Sanchez, a writer with Lifescript.com (a website that focuses on healthy living for women) asked me for some expert commentary for her article entitled "5 Common Sleep Disorders: Disturbing or Dangerous?" (Check out her full article by clicking on the link.)

Ms. Sanchez focused on sleep apnea, grinding teeth, restless limbs, night sweats and adult bed wetting from overactive bladder. These are each worth discussing, but since she asked my opinion about night sweats, I'll touch on that today.

Night sweats are very common in women, particularly in women over forty (hello, peers!) You do not have to be in menopause to start having these sweats, either. Very often women begin to find that alcohol or caffeine use may trigger episodes of night sweats. Additionally, there are multiple medications that can cause day or nighttime sweats, especially antidepressants. A variety of medical issues such as low blood sugar, infection, and thyroid disease can also trigger these laundry-producing events.

BOTTOM LINE: For the occasional night sweat- DON'T sweat it- but for new onset, frequent, or DRENCHING night sweats, get in to see your family doctor and figure out what's going on!

Glucosamine and Chondroitin- the Latest Research!

Okay, on the list of drugs to keep in your medicine cabinet, there are two you might want to remove...unless YOU feel relief from them. For years, doctors have been recommending glucosamine and chondroitin for relief of the aches and pains associated with arthritis. A large meta-analysis was recently published in the British Medical Journal entitled Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. The study evaluated nearly 4000 patients, across ten separate trials.The questions were whether or not these medications provided (A) pain relief and/or (B) any improvement in narrowing of joint space (that is part of the visible decline in arthritic joints, as seen on xray.)

Unfortunately, neither end point was observed. As such, the recommendations from this study are that doctors not encourage patients to try these medications, and that health insurers should not cover the cost of these drugs.
On the flip side, the study recognized that there were no dangerous side effects of glucosamine or chondroitin, so if patients subjectively feel they are getting relief, the use of these drugs need not be discouraged.

BOTTOM LINE: The latest evidence shows that glucosamine and chondroitin do NOT improve pain from hip and knee arthritis, nor do they delay progression of disease.

World Alzheimer's Day

Today is World Alzheimer's Day, and a new report was released on Capital Hill that documents the global cost of Alzheimer's and related dementias to be more than $600 BILLION, and 70% of the costs occur in North America and Western Europe!! Dementia actually costs 1% of the entire world's GDP (gross domestic product.)

This disease affects all societies, and with our aging population, the cost is anticipated to increase drastically. "People with dementia, their families and friends are affected on personal, emotional, financial and social levels. Lack of awareness is a global problem. A proper understanding of the societal costs of dementia, and how these impact upon families, health and social care services and governments may help to address this problem."

On a personal level, my mother died after a twelve year struggle with Alzheimer's, and now my father is fading away from Parkinson's dementia. The emotional toll alone is devastating, but the financial and time consumption adds dramatically to the burden of this disease. If this illess has not affected your family or loved ones yet, be aware that chances are very high that it will. Increasing awareness of dementia should help focus more attention on research for both cure and prevention of this crippling disease.

BOTTOM LINE: Read the 2010 World Alzheimer's Report for a sobering look at the staggering costs of dementia.

Coming Up or Running Out- the GI Drugs in the Cabinet

Finishing up what doctors keep in their medicine cabinets, I need to include the GI (gastrointestinal) emergency stash- drugs for throwing up and diarrhea.
For one or two episodes of vomiting, we simply cautiously hydrate with sips of gatorade and wait and see. However, for those occasional wicked stomach viruses that cause nonstop puking all night, we reach for a prescription that we keep on hand- phenergan (promethazine). This drug comes in suppositories as well as pills, and we know when a family member is ready to deal with a suppository, they really need it! Note that phenergan makes you sleepy, which is often a desired side effect, but it also can be addictive- this is for infrequent intense nausea, not for daily use!

What about the other end? No prescription here, we simply keep OTC liquid and pill forms of Imodium. The most important thing with diarrhea is to stop dairy products for a couple days, as you become temporarily lactose intolerant after a day of loose stools.
We also keep a bottle of acidophilus (probiotics) tablets for preventative use when someone is on an antibiotic (to avoid diarrhea from killing off the good bacteria in the gut.)
This is perhaps the least frequently used part of the medicine cabinet, but desperately desired when the occasion arises.

BOTTOM LINE: Phenergan and Imodium make up the gastrointestinal portion of our medicine cabinet.

Stuffy Head? Ears? Nose? Try this!

What else do I keep in my medicine cabinet? Well, we've covered pain medicines (aspirin, tylenol and ibuprofen), anti-histmine for an allergic reaction, cough syrup, and the two basic creams- steroid and antibiotic. What about something for stuffy head/nose/ears?

While I certainly stock the plain old little red pills "sudafed" (generic pseudoephedrine), we also rely on the old-fashioned remedy of Vaporub. A dab of that on your neck & chest goes a long way towards clearing your head. A new product I really like is Sudacare Shower Soothers (we call them the "hockey pucks" in our house)- large tablets that you pop onto the floor of your shower, then as the water hits it, you are enveloped in a steam shower of menthol that works wonders on clearing your head!

Cool mist humidifiers- with or without any menthol product added- can make a huge difference during the winter when your house is dried out from using the heater. Don't underestimate the relief these old-fashioned remedies can provide!

BOTTOM LINE: Basic decongestants like pseudoephedrin (sudafed) or home remedies such as menthol products can provide relief from stopped up ears, nose or sinuses.

Got any COUGH syrup? Medicine Cabinet Staple #8

As I discuss what drugs most doctors keep in their medicine cabinets, the next medication that comes to mind is cough syrup.
I typically keep an over-the-counter cough syrup such as Robitussin DM or Triaminic Cough and Cold or the generic store equivalents. The primary ingredient you are looking for is the "DM"- the dextromethorphan. This is the cough suppressant portion. The other active ingredients tend to be decongestants and antihistamines. I usually pick the pure cough syrups rather than the cough and cold combo's, because I like to choose my own decongestants/antihistamines (to control side effects like sleepiness.)

Ever wonder why a medication would have an expectorant (guaifenisen) and a cough suppressant? What's up with that? Do you want to loosen it up and cough it out, or stop the cough? Well, actually, a combination is not bad. It stops the annoying little throat tickle type cough, but allows you to cough effectively to clear your lungs.

What about prescription cough syrups? Honestly, we usually have ONE bottle of some kind of codeine or hydrocodone cough syrup in the house, though typically I find it is expired when I reach for it in the middle of the night for a coughing family member! These are ADDICTIVE, so if you have a tendency towards preferring medications that give you a slight "buzz", this is NOT something you should keep around your home. If, however, you have developed a cough that is lasting all night long, preventing you and your bed partner from sleeping and leaving you with sore stomach muscles from all that coughing, a prescription cough syrup may be the right answer. Ask your doctor!

Also, please see "cough, cough, cough" for further discussion of why it is worth your time and effort to head to the doctor for a cough, even if it is from a cold (and therefore antibiotics will NOT help!)

BOTTOM LINE: Pick a cough syrup with DM from your pharmacy, and have it in your medicine cabinet this cough & cold season!

Medicine Cabinet Staple #7: TUMS

What else is in the front of my medicine cabinet? This season's favorite flavor of TUMS. Over the counter antacids are still the fastest way to speed relief for indigestion, and a quick fix for an extra blast of calcium (especially in rapidly growing pre-teens and teens.) Yes, there are fancier and more expensive acid blockers out there (see my "Q&A about GERD"), but I only keep TUMS in my cabinet because it works fast and it is inexpensive and easy to take: no water required! Our family prefers the rapid, smooth-dissolve texture and flavor of the name brand product versus the generic equivalents, but the other brands work as well.

Calcium supplements were recently in the news with a link to heart disease, but the take-home message is that it is better to get extra calcium from your diet than to rely on a pill. Additionally, if you are going to take calcium supplements chronically (whether it's via an antacid or other supplement product), Vitamin D should also be supplemented.

Another use of antacids/calcium supplements beyond indigestion is for nighttime leg cramps. Occasionally "growing pains" (leg pain, typically worse at night during growth spurts) often respond to an extra helping of calcium in the evening.

Antacids can potentially block absorption of other medications, so it's best to take them alone. If you find you are needing the antacids more than once or twice per week, it's time for a visit to your doctor to determine the cause and a more lasting solution.
BOTTOM LINE: Keep a bottle of antacid tablets in your cabinet to have on hand for occasional indigestion or leg cramps.

More Cream- Medication Cabinet Staple #6

Continuing along our "what doctors keep in their medication cabinet" theme, the next item is another cream: generic triple antibiotic cream or ointment. When someone scrapes their arm, leg, or other unfortunate body part, I grab for a bottle of non-stinging wound cleanser foam, the antibiotic cream and a bandaid. If we can easily flush the area with water, that's my first cleanser of choice, but often this is an outdoor adventure accident (or sporting event, etc.), so I keep the cleansing foam in my first aid kit for a quick fix. After the wound is "clean", I plop on a small amount of antibiotic cream, and top it off with a bandage.

Does the brand matter for the cleanser or cream? Not really- the ingredients are very similar, if not identical. I typically buy the generic brand of triple antibiotic cream that has a bit of topical anesthetic in it for pain relief. I do have a preference on the bandages, however. Here it is all about "location, location, location." There are specific bandaids made for fingers and heels that are designed to allow flexion while keeping the bandage snug, and I will happily pay extra for them. Otherwise, it's age dependent. Our family is past the Disney princess and Care Bear bandaids, but is still all about "cool" bandaids with fun colors or stripes. The younger the age, the more important the fun factor!

Again, a disclaimer. We have a very high prevalence of antibiotic-resistent bacteria that can cause skin infections, the most common being MRSA (Methicillin Resistant Staph Aureus). Over the counter products will NOT cure this infection. If your cut stays looking red and irritated or the redness is growing rather than shrinking, please see your doctor!

BOTTOM LINE: Make sure to stock a triple antibiotic cream along with a foam cleanser and your favorite bandages in your cabinet!

Stop that Itch! Medicine Cabinet Staple # 5

I am focusing on what medications doctors keep in their home cabinets, and the next item on the list is not a pill, but a cream: HYDROCORTISONE cream or ointment. This is a steroid- not the pump you up/Arnold Schwarzeneggerr type steroid- this is the anti-inflammatory steroid. Grab this when you need to stop an immediate irritation on the skin, such as bug bites or poison ivy. If you've got something new, red and itchy on your skin, very likely this cream will help!
Having said that, know that there certainly are infections or other skin conditions that will not improve with steroid cream, and indeed can be made worse. Obviously, if your itchy rash is not rapidly improving, see your doctor!

This is not something to use on your face or other tender parts, however. Limit your use primarily to your extremities (arms, legs, fingers and toes) and trunk (back, chest and belly). Steroid creams are also not for long-term use, as they can cause thinning and damage to the skin if used chronically.

BOTTOM LINE: For insect bites & stings, and other new itchy "things", try some over-the-counter strength topical steroid cream.

What about Tylenol?

This month I'm talking about which drugs doctors keep in their cabinets, and so far I've covered aspirin, diphenhydramine (benadryl), and ibuprofen. So, what about tylenol (acetaminophen)? To be honest, I rarely use it. Do we keep it around in the medicine cabinet? Yes, but this is not typically my go-to pain reliever.

You may have heard that it is the number one pain reliever used in hospitals- and that may be true. Tylenol is very easy on the stomach, as opposed to NSAIDs (like ibuprofen, trade name Advil or Motrin) and probably more importantly, tylenol does not have the potential to increase bleeding (again, as compared with the NSAIDs, which do have that potential.) Therefore, people in hospitals who are post-operative or have nausea are going to do better with tylenol.

In general, ibuprofen seems to work better to lower high fevers, and there is person to person variability regarding whether tylenol or NSAIDs work better for other aches and pains. Studies show tylenol is equally effective to NSAIDs in relieving arthritis pain, despite the fact that tylenol has no anti-inflammatory effects. Tylenol has potential to harm the liver, so patients with chronic liver disease or alcoholism should avoid it completely.

Tylenol comes in many forms- liquid, melting lozenges, tablets, capsules, and caplets- all equally effective.

At any rate, I personally tend to use tylenol as an adjunct to ibuprofen. They work on different pain pathways, and have different side effect profiles, so they often are complementary. If you have a high fever and took ibuprofen only a couple hours ago, yet you are spiking again, reach for the tylenol. The same goes for headaches or other pains. Additionally, many people find that combining a tylenol together with an ibuprofen is more effective for pain relief than taking a full dose of either drug.

BOTTOM LINE: Keep Tylenol (Acetaminophen) in your medicine cabinet for fever or pain relief, especially when used in combination with ibuprofen or other NSAIDs. If you have stomach or kidney issues, Tylenol may be your pain reliever of choice!

Doctor Preferred Medicine #3- Ibuprofen

Okay, back to what drugs doctors keep in their home medicine cabinets... The first drug I mentioned was aspirin, then diphenhydramine (benadryl), and today-ibuprofen. I have to confess that this is without a doubt the most used medication in our house. Now, I do not believe in medicating every ache or even temperature, but when one of us is in pain or has a high fever, ibuprofen is our drug of choice.
When the kids were little, we kept liquid ibuprofen around (for fevers and teething primarily) but now happily, everyone in our family can swallow pills, so we have a bottle of caplets.

Ibuprofen has many trade names- Advil and Motrin being the most popular, I believe. They offer capsules, gel caps, tablets and liquids. Generic ibuprofen typically works just as well, though some people prefer name brands for taste or texture. (We buy generic.) Ibuprofen is a Non-Steroid Anti-Inflammatory Drug, NSAID for short. This class of drug works well for muscle aches, joint pains, tooth pain, post-operative pain, menstrual cramps, headaches and fevers. For chronic problems such as arthritis, longer acting preparations may be more appropriate.

Many people pop NSAIDs like candy- not a good idea! Yes, we often prescribe ibuprofen at higher doses than the OTC label recommends, but that is for acute, short-lived problems. Taking NSAIDS at high doses can be a danger to your kidneys, and do NOT use these daily for extended periods without consulting your physician. Also, be aware that NSAIDS can cause fluid retention, which may raise your blood pressure, and they can irritate the stomach lining (leading to ulcers.) Wow- that sounds like a commercial, but those are real precautions.

BOTTOM LINE: Keep a bottle of ibuprofen in your medicine cabinet for muscle aches, joint pains, fevers, headaches, etc.- this is a "go-to" drug for many minor maladies, but must be used with caution.

Gluten-Free Heavenly Pancakes! ( A Brief GF "Commercial")

Okay, forgive the interruption in talking about the secret stash of medicines doctors keep in their cabinets- I guess you can consider this a commercial, though I personally do not stand to profit! However, I had to break in because this morning, my kids and I devoured the most DELICIOUS GLUTEN-FREE pancakes!

Over the weekend, which teaching girl scouts about celiac disease and wheat allergies (and earning the "Let's Get Cooking" badge), the girls and I discovered a new brand of Gluten-free flours and mixes. We made chocolate chip muffins using "King Arthur's GF Muffin Mix" with soy milk (Vanilla Silk milk- because that's what was in our fridge- so these were "GFCF"-gluten free casein free) and let me tell you, they were scrumptious! And not, "wow, that's really good FOR GLUTEN-FREE", but actually delicious, in and of themselves! They had an almost sugar cookie flavor (perhaps some almond extract?) taste, and a moist, delicious, cup-cake texture. No grit!

After that success, last night I purchased a box of the pancake mix from the same maker, and voila- this morning's feast! Forget butter and syrup when you've got cool whip and fresh strawberries. We all wolfed down round one, and went back for second helpings. I showed a bit of restraint and grabbed this picture before finishing my second one...

For the record, I'm sure there are many new GF mixes and products that are delicious. We like the Betty Crocker GF Brownie mix, for example. But we've also tried a bunch that have flopped, so I wanted to share this latest success story for the ONE in ONE HUNDRED Americans who have celiac disease.

BOTTOM LINE: Gluten-free does not mean giving up all your favorite foods (especially breakfast)- try some new GF recipes, mixes, and products and share with me the ones you love!

Drug #2 in My Medicine Cabinet

This week I'm talking about what most doctors keep in their own medicine cabinets. The first drug was ASPIRIN, which I discussed yesterday- how appropriate for Labor Day, right? What's next?

Diphenhydramine, better known as BENADRYL. This drug is probably the best known antihistamine. We use it for it's good effects- fighting allergic reactions- AND for its major side effect: SEDATION. Did you realize that benadryl is the sleep-inducing agent in all the "PM" medications (like tylenol PM and advil PM)? All they do is add some benadryl to the well known pain medication.

I tend to keep benadryl both in the liquid and in the tablet form, in case we have someone who cannot swallow pills (either young or old!) who needs immediate antihistamine for what may be a serious allergic reaction- to a bee sting, or food, or even medication.

Of note, I do NOT keep the topical benadryl preparations around for itchy rashes- I use topical steroids (hydrocortisone) for that type of problem, as they are more effective.

So, itchy & sneezy and can't sleep? Benadryl is a great choice, unless you feel too hung over from it in the morning. Some people (like myself) feel groggy way longer than the suggested 8-12 hours after taking benadryl.

BOTTOM LINE: Item number two in my medicine cabinet is diphenhydramine (trade name, Benadryl).

What's in YOUR Medicine Cabinet?

Ever wonder what doctors keep inside their medicine cabinets for their families? Well, my friends (and patients) have definitely asked me, so I thought this week I would share with you my answer. Before I launch into the first ingredient, however, let me encourage you to head directly to YOUR cabinet and THROW AWAY EVERYTHING THAT IS EXPIRED! Just like you should check your smoke detectors a couple times per year, you should also take a look in your stash of medical supplies and toss everything that is expired. Yes, I realize that tiny bottles of prescription medications (especially eye drops, for example) can cost a small fortune, but the only thing worse than "wasting" them by not finishing them is depending on them to work later, when their potency is gone. Don't wait till someone is having a bad allergic reaction to discover your benadryl is long expired!

So, what's the first medication on my list? ASPIRIN- yep, good old-fashioned aspirin. Actually, I keep the enteric coated aspirin, because it's easier on the stomach, but you get the picture. Why do we have aspirin in our cabinet? Not for headaches, though it certainly could be used for that malady. We keep it for several reasons:

1. Heaven forbid a grownup in our home (or neighbors') appears to be having a heart attack- the FIRST response is to have them swallow an aspirin.
2. Studies show that an adult aspirin a couple times per week reduces the incidence of colon polyps (and therefore, hopefully colon cancer, which runs in our family.)
3. Before sitting on a plane or going for a long car ride, a single aspirin can help prevent blood clots from forming in your legs (DVTs- deep vein thromboses.)

BOTTOM LINE: Throw away ALL expired medications, and start your family's medicine cabinet supply list with ASPIRIN.

Flu Vaccine- It's Time AGAIN!

Last year's flu season was a scary, challenging time for all of us, thanks to H1N1 (formerly known as the Swine Flu). The BAD news this year is that we're already seeing some cases of the flu, but the GOOD news is that we already have this year's flu vaccine available, and it will provide immunity to several strains of the flu, including the 2009 H1N1.

When is flu season? Though typically we say October to January, we'll need to start with September and most likely extend beyond February this year. Let's be proactive and line up early to receive a vaccination, and then follow up with consistent hand-washing and STAYING HOME if we get sick! I LOVE that all our grocery stores, and many other public places now have the anti-bacterial cleansers positioned right as you enter their store- USE IT!

WHO should get the flu vaccine this year? The CDC (Center for Disease Control) has recommended that EVERYONE over the age of 6 months receive it this year, so we can avoid the near pandemic we faced last year. It is especially important for people at high risk of serious complications: pregnant women, kids <5 years old, adults > 50 years old, anyone with chronic illness (asthma, diabetes, cancers, etc.) and health care workers. I would add TEACHERS to that list, as well.

BOTTOM LINE: Don't wait- head to your doctor's office or your pharmacy for a FLU VACCINE now!
(PS If you are a West Lake Family Practice patient, we are expecting our vaccine shipment to arrive next week.)

What IS this Pill?

Have you ever found a pill-perhaps on the floor of your bathroom, or in your teenager's room or in your car-and wondered what the heck type of pill it is? Or perhaps your mail order prescription arrives, and the pill doesn't look anything like the size, shape or color of the last prescription for the same drug, and you wonder if the pharmacy put the right "generic" equivalent in the bottle. What can you easily do at home to help identify the drug?

It turns out that there are multiple websites that can help you to identify what pill you are holding. My current favorite (which means that it worked the best the last time I tried to identify a stray pill) is http://www.drugs.com/imprints.php All you need to do is to enter in the color(s), shape, and any letters or numbers that you see printed or imbedded on the pill. The site then shows you any matches, including a picture that you can compare with the pill you are holding- voila!

So, if you tossed a bunch of different medications into one container for your last trip and now need to sort them out, or simply have found a stray pill, here is a beautiful use of the information highway. Click on the link above (or google "pill identifier" to pull up multiple sites) and save yourself a trip to the pharmacy!

BOTTOM LINE: Reliable websites are available to help you identify "stray" pills, whether they are over the counter or prescription.

I'm a Scorpio- but I don't like SCORPIONS!

Yuck! Not a great way to start the day, I can assure you. This is my foot next to the rather large scorpion that was scrambling towards me as I stepped out of the shower yesterday morning! No, I'm not so neurotic as to have a camera handy that second, but when I grabbed a shoe and killed it, I decided it wasn't smashed too badly, and that perhaps I should blog on this too common, unwelcome Texas houseguest.

So, what do you do if you (or a friend or family member) is stung by a scorpion? First of all, don't panic! Most of the time, a scorpion sting is like a bee sting- pain, burning, mild swelling and maybe numbness locally, that will resolve fairly quickly. If you live in Texas, we are fortunate that our scorpions, scary as they can look, are not severely poisonous. If you live in New Mexico or Arizona, watch out for the dreaded bark scorpion, which can cause more serious reactions such as severe swelling, shortness of breath, shock and even death. If you are stung and your symptoms rapidly escalate, go directly to an emergency room.

For the majority of stings, however, first aid will do. Wash the area immediately with soap and water. Ice and elevate the area if possible. Remove any rings, bracelets, watches or other constrictive accessories. If you are starting to swell up, take a diphenhydramine (benadryl) tablet/capsule. Topical steroid wont hurt, and might help a bit. Ice the area for about ten minutes.
A non-scientifically proven, but much recommended home remedy is to very quickly apply a paste of meat tenderizer (with papaya extract) and a bit of water directly onto the area that was stung. This seems to alleviate the pain more rapidly, and at worst case, it is not harmful. Finally, check the date of your last tetanus shot- if it is more than 7 years ago, go get a new one.

BOTTOM LINE: If you are stung by a scorpion in Texas, wash it with soap & water, apply ice, take some benadryl and see your doctor if symptoms escalate (or if you are behind on your tetanus booster.)
PS. Happy September 1st! You know what to do- change those AIR FILTERS!