Out with the OLD, In with the NEW (AKA Healthy New Year's Resolution #1)

Happy 2016! Hard to believe we are nearly half way through January as I look at my home STILL filled with Christmas decorations. Many of us tackle the new year with a cleaning or de-cluttering frenzy after we pack up the holiday decor. In fact, it can be overwhelming as we survey overflowing closets, desks and kids rooms...wishing for that magic wand to neatly organize our lives. I once read an organization plan that suggested a better chance of success if you tackled ONE specific area and thoroughly completed it before you moved on- whether that was one drawer of your dresser, a single shelf of books, or even cleaning the kitchen sink itself. So...instead of the sink or coat rack, may I suggest starting with your MEDICINE CABINET? Whether this means a simple first aid kit or an entire bathroom or kitchen cabinet, let's get rid of the old and bring in a few selected new supplies.

Expired medications, in my experience, are rarely harmful in and of themselves, but they often have lost effectiveness. There is no point in saving the last few drops of prescription cough syrup from 2007...it's not going to help you any more. If you are having an allergic reaction and your diphenhydramine (Benadryl) or worse, your Epi-Pen, has expired...this is not a good time to find out how much their effectiveness has decreased! Ditto with anti-nausea medications. In general, solid tablets have extended shelf lives more than liquids. Additionally, with liquids such as eye drops, the preservatives break down, allowing potential bacterial growth (and the obvious possibility of causing rather than treating an eye infection.)

However, taking leftover "spare" single or several antibiotic pills actually MAY be harmful- because as you partially treat an infection, you make the bugs effectively only weak and dizzy, not dead...and now you have a strain of bacteria that is resistant to new antibiotics. Just say NO and toss these.

Expired bandaids? Okay, you can keep those. But compression wraps (ACE wraps)? If you have washed them a dozen times- unlikely they have enough spring left in them to do their job. High quality splints from old injuries (wrist or ankle)? I keep those as long as they can be cleaned.

Once opened, over-the-counter acne medications with benzoyl peroxide (hello, high school and college students!) TOTALLY lose effectiveness after only a couple months- explains more than a few breakouts. Toss 'em.

Bottom Line: Make a HEALTHY START in 2016 by cleaning out your MEDICINE CABINET this weekend!

Life or Death Advice! (& Another Medication Recall)

No need to panic. There is nothing terrible or scary going on, but McNeil Consumer Healthcare is recalling certain batches of Tylenol 8 hour, Tylenol Arthritis Pain, and Tylenol respiratory products (Tylenol Sinus, Allergy, etc.) as well as some lots of Benadryl, Sinutab, Sudafed and Rolaids. Go to McNeil's Product Recall Information site to check lot numbers on any of these products that you have in your medicine cabinet. These recalls are an admirable part of the company's internal scrutiny upon discovery that in some instances, cleaning procedures were considered insufficient or poorly documented. There have been no complaints of any adverse medical consequences...and goodness knows in our legal climate, we'd be aware of them if there were!

However, I wanted to use this medication recall as a REMINDER TO CLEAN OUT YOUR MEDICINE CABINET! Along with the bevy of New Year's resolutions, fresh starts should include your basic home pharmacy. It will do you little to no good to reach for your pain reliever or topical antibiotic cream if they are out of date. Just like your pantry (surely a topic for another day), I'd bet you will find old prescription medications along with numerous expired OTC cough and cold products. TOSS THEM OUT!

I think the most critical medication in the cabinet is diphenhydramine (Benadryl). If someone in your house is stung by a bee, or eats the wrong food or has another trigger for a severe allergic reaction, you want that Benadryl to be CURRENT! Now, this literally can be a matter of life and death.

BOTTOM LINE: Take a half hour TODAY and clean out your medication cabinet, checking expiration dates (and lots, if it is one of the meds noted above) and then head to the store and REPLENISH your supply!

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.

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!

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.

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.