Technorati Tags: Cancer, colon cancer, Diabetes, health care, Healthcare, pharmacist, pharmacy

What kind of pills are these?

Worried about those capsules you found in your teenager’s room? Not sure about some of those leftover pills still in the bathroom cabinet? There’s a good chance that our Pill Identification Wizard (Pill Finder) can help you match size, shape, colour… then lead you to find the detailed description in our drugs database.

NOTE: As a general rule, we should all periodically check our medicine cabinets for any expired, re-bottled, or unidentified pills. The safest bet is to keep all medications in their original bottles or packets, with pertinent labeling and instructions attached, to avoid confusion and mistakes.

Most pills can usually be identified by color, size, shape and a combination of letters and numbers.

Click here for a Pill Identification Wizard

Technorati Tags: Medicine, Pill Identification

By Kristina Fiore, Staff Writer, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco. .

CHICAGO — Women ages 40 to 49 with no family history of breast cancer have similar rates of invasive disease as those with familial risk, radiologists reported here, firing yet another salvo at government mammography guidelines. Among a group of more than 1,000 breast cancer patients, 64% of those with no family history of breast cancer had invasive disease, as did 63.2% of those with family history, a non-significant difference, according to Stamatia Destounis, MD, of Elizabeth Wende Breast Care in Rochester, N.Y., and colleagues. “We were intrigued and surprised by the data,” Destounis said during a press briefing at the Radiological Society of North America meeting, noting that general wisdom suggests women with a family history are at greater risk of developing the disease than other women. “Since there’s no difference in the rate of invasive breast cancer for women in their 40s whether they have a history of breast cancer or not, the recommendation should be that women in their 40s have screening mammography yearly,” Destounis said. In 2009, the U.S. Preventive Services Task Force recommended against routine screening for women ages 40 to 49, leaving patients and clinicians to make individual decisions based on their risk. Mammograms should start at age 50, the committee said, and be performed every two years. Yet the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists, and other groups have called for continued screening in this age group, which Destounis said has led to confusion among patients and their doctors. Still, the debate has shown few signs of letting up, as studies have continued to flood in — some showing that screening women 40 to 49 offers a robust mortality benefit while others have found only a trivial benefit. Destounis and colleagues reviewed data on all breast cancer patients seen at their clinic between 2000 and 2010, with a total of 1,071 patients ages 40 to 49 treated for 1,116 cancers. A total of 373 of those had been diagnosed via screening at their clinic; 61% of those patients had no family history of the disease, while 39% did. There were no significant differences in terms of the percentage of patients in either group who had a personal history of the disease. The investigators also found that similar percentages of patients with and without familial risk had disease that metastasized to the lymph nodes (29.4% of those without versus 31.3% of those with). “We agree with the ACS, which recommends screening for every woman in her 40s,” Destounis said. Gary Whitman, MD, of MD Anderson Cancer Center in Houston, who was not involved in the study, told MedPage Today there are “very few mammographers who feel differently about the need to screen all women at 40 years of age.” Edith Perez, MD, of the Mayo Clinic in Jacksonville, Fla., who also was not involved in the study, noted that it may show that family history isn’t necessarily useful for deciding whether a younger woman may be at greater risk of breast cancer, though this hypothesis would need further testing.

Technorati Tags: Breast Cancer, Cancer, Healthcare

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by Rosemary Gibson

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The October 19 Health Affairs briefing entitled “Saving Medicare Dollars and Improving Care,” sponsored by the ABIM Foundation and other funders, was a watershed moment in which ideas that would require less spending on health care that would actually improve care for patients were discussed on K Street. This is a great message for patients and, it so happens, for the super committee deliberations a few miles away.

Dr. Nancy Morioka-Douglas, Clinical Professor of Medicine/Family and Community Medicine at the Stanford University School of Medicine highlighted seven often unnecessary things done in primary care, such as EKGs in patients without symptoms, that were identified by the Good Stewardship groupconvened by the National Physicians Alliance.

Later, Dr. Steve Weinberger, Executive Vice President and CEO of the American College of Physicians identified sensible principles to guide the integration of a “less is more” theme in public policy, such as:

• Avoid interventions that don’t help and may harm
• Give incentives to physicians and patients to avoid low value care
• Use payment approaches that are politically feasible, medically appropriate and minimally burdensome
• Recognize that there will always be exceptions.

The discussion addressed the tip of the iceberg. The next step is to move to the big-ticket items where the literature is quite clear that patients are harmed by back surgeries for which there is no evidence of efficacy, cardiac bypass surgeries that are unwarranted, and duplicative and unnecessary diagnostic imaging that exposes patients to cancer-causing radiation, among many other tests and procedures performed that may cause more harm than good.

We can’t put all of the health care reform burden on patients, even with shared decision-making. Physician leadership is essential. That’s why this meeting will hopefully be the first of many conversations on K Street and on Capitol Hill.

In the end, this is all about good care of the patient. That’s the primary motivation. It’s also true that as a society, we don’t have money to waste. As I wrote in The Treatment Trap, the best way to preserve Medicare is to pay for things that improve health and well-being, and to stop paying for things that don’t. If we don’t get it right, and get it right soon, even the good things will be cut. Let’s act on the wisdom we have that knows the difference.

Rosemary Gibson led national quality and safety initiatives at the Robert Wood Johnson Foundation.  She is author of The Treatment Trap and Wall of Silence: The Untold Story of the Medical Mistakes that Kill and Injure Millions of Americans. This article originally appeared on The Medical Professionalism Blog.

Technorati Tags: Healthcare, Medical Tests, Medicare

Background: Tobacco use remains the leading cause of preventable morbidity and mortality in the United States.

Methods: The 2005–2010 National Health Interview Surveys and the 2010 Behavioral Risk Factor Surveillance System survey were used to estimate national and state adult smoking prevalence, respectively. Current cigarette smokers were defined as adults aged ≥18 years who reported having smoked ≥100 cigarettes during their lifetime and who now smoke every day or some days.

Results: In 2010, 19.3% of U.S. adults were current cigarette smokers. Higher smoking prevalence was observed in the Midwest (21.8%) and South (21.0%). From 2005 to 2010, the proportion of smokers declined from 20.9% to 19.3% (p<0.05 for trend), representing approximately 3 million fewer smokers in 2010 than would have existed had prevalence not declined since 2005. The proportion of daily smokers who smoked one to nine cigarettes per day (CPD) increased from 16.4% to 21.8% during 2005–2010 (p<0.05 for trend), whereas the proportion who smoked ≥30 CPD decreased from 12.7% to 8.3% (p<0.05 for trend).

Conclusions: During 2005–2010, an overall decrease was observed in the prevalence of cigarette smoking among adults; however, the amount and direction of change has not been consistent year-to-year.

Implications for Public Health Practice: Enhanced efforts are needed to accelerate the decline in cigarette smoking among adults. Population-based prevention strategies, such as tobacco taxes, media campaigns, and smoke-free policies, in concert with clinical cessation interventions, can help decrease cigarette smoking and reduce the health burden and economic impact of tobacco-related diseases in the United States.

Click here > to read the rest of this article from the CDC

Technorati Tags: Causes of Death, Causes of Illness, CDC, Tobacco Use

Arthritis Remedy Site image

Will physical activity reduce or increase your arthritis pain? Get tips on exercise and other common concerns when coping with arthritis symptoms and arthritis pain.

By Mayo Clinic staff

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You get all kinds of advice about exercise, medication and stress reduction, but how do you know what will work best for you? Here are some do’s and don’ts to help you figure it out.

Basics

Whatever your condition, you’ll have an easier time staying ahead of your pain if you:

• Talk to your doctor about all your symptoms, arthritis related or not. Sometimes seemingly unrelated problems are, in fact, connected.
• Give your doctor complete information about all your medical conditions, not just arthritis.
• Ask your doctor for a clear definition of the type of arthritis you have.
• Find out whether any of your joints are already damaged.

Everyday routines

Do some gentle exercise in the evening; you’ll feel less stiff in the morning. When you’re technically doing nothing — watching TV or sitting at your desk, for instance — be sure to:

• Adjust your position frequently.
• Periodically tilt your neck from side to side, change the position of your hands, and bend and stretch your legs.
• Pace yourself. Take breaks so that you don’t overuse a joint and cause more pain.

Technorati Tags: arthritis, Arthritis Pain, Arthritis Therapy

by NATASHA BURGERT, MD

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A recent issue of Pediatrics includes a new report detailing the need for doctors to improve patient teaching about fever and fever-reducing drugs.

Many parents fear their child getting a fever, or have “fever phobia.” I certainly can understand why. Kids can do crazy things when they get fevers. They don’t sleep well, eat poorly, and behave strangely. Some children can even have seizures due to a quick spike in body temperature. So it isn’t surprising that beginning as early as the pre-natal consultation, parents ask questions about what to do when their child gets a fever.

Concern about childhood fevers is long-standing in our history. Fever superstitions and ancient fever remedies are ribboned throughout all cultures. For example, Romans would trim the fingernails of those affected with fever. Using wax to attach the fingernail clippings to a neighbor’s front door was thought to transmit the fever to that household. Note: Do not have ancient Romans as neighbors. And, even today, I will occasionally see children whose elders have used a method called cupping to literally suck the fever out of them.

So, here are 5 fabulous facts about fever. Some of these statements may be exactly opposite what our mothers have said about fever. The goal of this post is not to discredit grandma, but to decrease fever phobia and treat fever correctly. And with the right information, maybe the next time our pink-cheeked kiddos come to us with warm foreheads, we might not be so eager to jump to our medicine cabinets.

Please note: The following facts are NOT true for infants under the age of 3 months. Please talk to your pediatrician about newborns with fever.

1. There is no “number” on a thermometer that requires a trip to the Emergency Department.Nope, not even 104F degrees. With very specific exceptions, kids do not have to maintain a “normal” temperature during times of illness. Fever is a normal, healthy way for the body to fight common infections. Bacteria and viruses that attack our bodies love normal body temperature, but cannot successfully replicate in hotter conditions. Fever, therefore, reflects a robust immune system’s defense against these pathogenic attackers. The bacteria and viruses are the enemy, not the fever they cause.

So remember: fever is a symptom of illness, not a disease. Seeing a high number on the thermometer means your child’s body is doing its job to fight an infection.

2. The severity of fever does not always correspond with the severity of illness. So, what does that mean? A fever is generally defined as over 100F degrees. However, with few exceptions, the degree “number” over 100F really doesn’t matter. In fact, a fever of 101F degrees does not make more difference to me than a fever of 103F degrees.

I have kids running and playing in my office with high fevers. I have other children who look sluggish and sad with a reasonably mild fever. Every kiddo reacts to a fever differently. So regardless of the actual numerical value, look for signs of serious illness in your child. Observe his level of discomfort, level of activity, and ability to maintain adequate hydration. If you are concerned, call your pediatrician to discuss the next steps.

3. Fevers do not have to be treated with medication. Fevers help the body fight infection. Treating a fever is only necessary when you think your child is uncomfortable. The goal of administering antipyretic (anti-fever) medications is not to get a high temperature back to “normal.” They are simply medications to make your child feel better.

Fevers can make kids feel pretty lousy. Children can have altered sleep, unusual behavior, and poor oral intake. If these symptoms are upsetting to your child, please give a fever reducing medication. Treating fever does provide comfort, and may decrease the risk of dehydration.

As an aside, if you are coming to the pediatrician’s office because your child has a fever and her or she is uncomfortable, please give your child a fever reducing medication prior to coming to the office. You do not have to wait until the doctor “sees them with a fever.” A comfortable child is much easier to examine. And a good exam will often determine the cause of the fever, allowing for accurate treatment.

4. Half of you are dosing fever medications incorrectly. As many as one-half of parents do not administer the correct dose of fever reducing medication to their child. This includes both under-dosing and over-dosing. Medications should be dosed according to your child’s weight, not age. Always use the measuring device that comes with the medication. If you lose the dosing device, use only a standard measuring instrument (syringe, medicine cup) as a replacement. Household spoons and measuring spoons are not always accurate.

I often hear parents deliberately under-dosing their child. They say, “I didn’t really want to give him medication, so I just gave him a half-dose.”

A “half-dose” will do nothing. Don’t bother.

If you feel that your child needs medication, give the correct dose. If you have questions about your child’s dosage or the proper measuring device to use, call your pediatrician.

5. Fever does not cause brain damage. In a person with a normal functioning brain, and the ability to cool oneself, fever is normal response to infection. Every normal brain has a internal “thermostat” that will prevent a person’s temperature from getting high enough to cause brain damage. It is only when hyperthermia, or heat stroke, occurs when damage to the brain and other organs will occur. Hyperthermia happens in the rare instances when an individual’s brain cannot regulate temperature well (as in a rare case of brain injury) or when an individual is not able to cool oneself (as in a closed car on a summer day.) Fever due to illness in a normal child will not cause organ damage.

Natasha Burgert is a pediatrician who blogs at KC Kids Doc.

Technorati Tags: Brain Damage, Children, Fever, Fever Medicine, High Fever, Pediatrics

by Shantanu Nundy, MD

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At 3am on Jan 1st 2010 my cousin-brother stubbed his last cigarette. New Year’s resolutions to quit smoking, lose weight, or change another bad habit are certainly not uncommon. Having tried — and failed — to quit a number of times before, my cousin took a bold, new approach to quitting.

Whether a cleverly devised plan, or just a whim, he decided to post his quitting on Facebook.

On January 4th, four days after smoking his last cigarette, he updated his status: “bring it on day 5!” Within hours, three people responded that they “Like” his comment; five others commented favorably with messages such as “Good for you!!!” and “Keep it going, bro.”

Encouraged by the support he received, my cousin posted another update three days later. Using his iPhone he wrote that he ”is one week non-smoking!!!” Again, within hours, eight people responded that they liked his comment and another two offered congratulatory remarks.

Though he didn’t necessarily realize it at the time, my cousin was creating a community of supporters through Facebook. The scientific literature is filled with evidence on the value of peer support for behavior modification. The “T” in the START mnemonic for quitting endorsed by www.smokefree.gov is to “Tell family, friends, and coworkers that you plan to quit.” This recommendation is based on the notion that smoking is not purely a chemical addiction; it has important environmental, social, and cultural elements, too.

Our peers do not only provide support for quitting on good days; they are equally invaluable on bad days. Three days after his last post, my cousin started feeling lousy. He posted having “a crazy head cold. Never felt this crappy in several years.” While he may have had caught a cold, it is more likely that he was going through nicotine withdrawal. Was this a simple update or a call for help? Seven of his friends responded offering home remedies and supportive messages. The next day he was feeling better and posted, “Twelfth smoke free day!,” garnering nine “Like”’s and seven enthusiastic comments. He responded, “Thanks for all the support everyone. Really helps me to stay on the path.”

People who quit often benefit from the support of a physician and other health care providers. Whether it be in the form of counseling, pharmacologic support, or referrals studies show that people who quit with the support of a health care provider have a much higher chance of success.

The problem is that assistance is often needed in real-time. I once shadowed a tobacco cessation counselor at my hospital who offered his cell phone number to every patient he saw, but this kind of dedication is rare. My cousin’s next post read, ”19th smoke-free day in a row. Maybe enjoy a cigar on the 30th day…let me ask my doctor…?” Here, too, surprisingly Facebook offered a solution. I immediately responded applauding him for his progress but also gently suggesting that it was probably too early for a celebratory puff.

Real-time support is critical because the decision to quit smoking isn’t made once. It’s made every day – in fact multiple times a day – whenever the nicotine craving hits. This is a major reason why social networks are so critical. Week 3 he posted that he ”… is wondering why day 21 is harder than 3,4,5 and 6 combined.” While my cousin could have called up 10 of his friends and told them that he was having a difficult time that day, it was clearly easier and perhaps more effective to post about it instead. After seeing his post, I called him to get his mind off of smoking.

Research in smoking cessation and behavior modification has demonstrated the importance of social networks. In recent years, there has been fascinating research showing, for example, that overweight people are more likely to have overweight friends and that happiness is contagious. The challenge in modern day society is how to activate these social networks to affect good.

Previous generations made greater use of formal networks such as religious gatherings, town hall meetings, and social clubs. While these avenues are still important today, increasingly technology is playing a role in defining our communities. While e-networks are less personal, this is not necessarily always a bad thing, especially when it comes to changing bad habits. They also benefit from a wider reach, being more real-time, and increasingly more dynamic.

Whether by design or accident, my cousin stumbled on an innovative approach to leverage social networks to quit smoking. And quitting smoking is just one application of e-social networks. Imagine the analogy for weight loss: “I lost 2 lbs this week!” soliciting responses of “Way to go!”, and “Feeling too lazy to go to the gym” being met with “You can do it! The hardest part is getting there!!”

Finally, though it is not as readily apparent, my cousin is not the only one benefiting from his Facebook posts. The positive effects of social networks go both ways. Friends following his posts are no doubt taking note of his success and being motivated to better themselves. His last post reads: “Still at it 41 days now. Feeling great and about to start a kick ass work out regimen.” Who knows? If he starts posting about his work outs on Facebook, I may just go to the gym more often.

Shantanu Nundy is an internal medicine physician who blogs at BeyondApples.org.

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Technorati Tags: Facebook, Quit Smoking, smoking

Technorati Tags: Medical Doctor, Physician, Social Media

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by Mike Cadogan, MB ChB

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Crossing multiple time zones can produce a constellation of symptoms known as jet lag.

Jet lag is most noticeable in the first 24-48 hours following travel and can last for up to 5 days before individuals return to normal functioning. Symptoms are closely affected by both the length and direction of travel. Symptoms include: reduced alertness, night-time insomnia, loss of appetite, depressed mood, poor psychomotor coordination and reduced cognitive skills. Work capacity and peak power are also reduced.

Factors affecting poor recovery from travel include

• A lack of sleep or very restless sleep during flight
• Dehydration from dry environment of the aeroplane cabin (contribute to tachycardia and headaches)
• Number of time zones crossed
• Direction of travel (westward travel is easier to tolerate than eastward)
• Fitness levels (fitter people adapt better after travel)
• Personality (outgoing types appear to adjust quicker)

One of the major challenges of travelling with elite athletes is to minimise the negative symptoms associated with international travel in as natural a way as possible. To best refine a travel management plan it is first prudent to understand the pathophysiology of the sleep/wake cycle.

Daily circadian variation exists in elite athletes with peak performance occurring in the afternoon and early evening with improved flexibility, reaction time, strength and mood at this time of day. International travel disturbs these circadian rhythms and can have a negative impact on performance.

Click to enlarge

Melatonin

Synthesis of melatonin by the pineal gland is inhibited by light and stimulated by darkness.

Melatonin has been dubbed the “hormone of darkness.” Secretion of melatonin commences each evening as the Dim-Light Melatonin Onset (DLMO), peaks in the middle of the night, and gradually falls during the second half of the night, with normal variations in timing according to an individual’s chronotype.

Increases in the level of melatonin causes the body to feel less alert and has an important role in inducing sleep and producing the symptoms of jet lag.

Dysregulation of melatonin secretion and circadian rhythm disturbances are thought to be the common links which underlie jet lag and affective mood disorders. As a result of its regulatory effects on the circadian system, it follows that melatonin may be used effectively to treat the range of symptoms that accompany transmeridian air travel.

Melatonin acts on MT(1) and MT(2) melatonin receptors located in the hypothalamic suprachiasmatic nuclei, the site of the body’s master circadian clock. Melatonin can reset disturbed circadian rhythms and promote sleep in jet lag and other circadian rhythm sleep disorders, including delayed sleep phase syndrome and shift-work disorder. Post-flight melatonin administration works efficiently in transmeridian flights across less than 7-8 times zones.

Pharmacological implications

Despite pathophysiological evidence, there is still a persisting culture of players requesting stronger sedative agents to assist in artificially creating a new time-zone sleep/wake cycle. Agents such as bezodiazepine (diazepam) and non-benzodiazepine hypnotics such as Zolpidem are still frequently prescribed to travelling elite athletes to reduce the negative symptoms of jet lag.

I am currently implementing a more evidence based approach to the management of circadian cycle disruption by administering melatonin or the newer melatonin receptor agonists. On this South African tour we are trialling the use of direct sunlight exposure for 30 minutes each morning (in addition to daily excersise regimes) and the administration of 2-4 mg doses of melatonin at normal bedtime in the setting of darkness (22:00 local time). So far the administration of melatonin has had a fantastic effect in organing an effective sleep/wake cycle for the players and has drastically reduced the administration of previously abused agents.

Ramelteon and agomelatine are melatonin receptor agonists which, compared to melatonin itself, have a longer half-life and greater affinity for melatonin receptors and consequently are thought to hold promise for treating a variety of circadian disruptions. We will trial these agents for the next international tour.

Mike Cadogan is a physician in Australia who blogs at Life in the Fast Lane.

Technorati Tags: Jet Lag, Melatonin