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Just Breathe

I just read an article in Health Day that states only one out of 136 caregivers participating in a study published recently in the Journal of Asthma knew all the steps to take when helping a child use an inhaler with a spacer (the study states 10 steps, but a quick look online shows variations anywhere from 8-12 steps).  As a healthcare provider, this is concerning to me.  I wonder how much of what I teach sticks with my patients?

The American Lung Association gives these statistics about children and asthma:

  • Asthma is one of the most common chronic disorders in childhood
  • Asthma is the third leading cause of hospitalizations in children under the age of 15
  • Asthma is one the the leading causes of school absenteeism

Clearly, it’s important that inhalers are used correctly to keep children in school learning and out of the hospital. So, what are the steps to help a child get his/her asthma medicine? Here is a great patient handout produced by the Health Plan of San Mateo:


The two steps missed most commonly in the study were having the child take at least 6 slow breaths after the inhaler was pressed and waiting 30 seconds before releasing the second dose.

I plan to not only demonstrate proper inhaler use, but will reinforce the education with a handout similar to this. For all of you parents out there with asthmatic children, please make sure you are helping your child with his/her inhaler using all the recommended steps.  Remember to see your healthcare provider if you have questions about the use of, or how to give, any medicines. ¡Salud!

Just a Few Grains’ll Do Ya


Have you been told that your blood pressure is a little high? Maybe you’ve been given a blood pressure medicine by your healthcare provider, but you’ve resisted taking it. The most common thing I hear is, “I don’t want to have to take a medicine every day.” So what lifestyle changes could you try to keep from taking a medicine for your blood pressure?

Besides getting at least an hour and a half of exercise in per week and losing weight, cutting back on your salt intake could make a difference. Salt may make our food taste better, but too much can have bad effects on our health. It can raise blood pressure, make the kidneys work harder, cause swelling in the tissues, and make us at higher risk for heart disease. Educating yourself on the foods that have more salt than others may help you lower your intake of salt by making better choices.

Foods that are typically higher is sodium are

  • Fast foods,
  • Canned foods,
  • Frozen meals,
  • Snack foods like chips, pretzels, crackers and nuts,
  • Marinades and flavorings, especially Teriyaki sauce and Soy Sauce, and
  • Packaged deli meat.

Read the nutrition label for how much sodium per serving a product contains and how many servings are in the container or package to see how much sodium you’re taking in when eating the above types of food. It might be an eye-opener!

The American Heart Association recommends no more than 2300 mg a day of sodium for most people. For those age 51 years and older, and those of any age, including children, who are

  • African American (more salt sensitive than other races) or
  • have high blood pressure,
  • diabetes, or
  • chronic kidney disease,

should limit their intake to 1,500 mg of sodium per day.

Sometimes, even with lifestyle changes, you may still need a blood pressure medicine; family history can play a strong role in whether you’ll develop it. I’m usually willing to allow my patients at least 3 months of lifestyle changes before putting them on a medicine. So–get out there and exercise, drop a few pounds, and cut back on your salt! ¡Salud!




Got Drugs?

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The question of what to do with leftover medications is a good one. As a healthcare provider, I need to know the answer for my patients, and wanted to pass the information I found on the FDA’s website along to my readers.

  • Medicine Take-Back Programs On April 27, 2013, there will be a National Prescription Drug Take-Back Event. Follow this link for your state information:
  • Disposal in Household Trash If no Take-Back Program is available, follow these steps to get rid of your unwanted meds:
  1. Mix medicines (do NOT crush tablets or capsules) with an unpalatable substance such as kitty litter or used coffee grounds;
  2. Place the mixture in a container such as a sealed plastic bag; and
  3. Throw the container in your household trash.
  4. Before throwing out a medicine container, such as a pill bottle, remember to scratch out all information on the prescription label to make it unreadable.
  • Flushing of Certain Medications Some medicines could be so harmful to others if taken that the best thing is to flush them down the toilet. These medications are:
Active Ingredient
Abstral (PDF – 1M)tablets (sublingual) Fentanyl
Actiq (PDF – 251KB), oral transmucosal lozenge * Fentanyl Citrate
Avinza (PDF – 51KB), capsules (extended release) Morphine Sulfate
Daytrana (PDF – 281KB), transdermal patch system Methylphenidate
Demerol, tablets * Meperidine Hydrochloride
Demerol, oral solution * Meperidine Hydrochloride
Diastat/Diastat AcuDial, rectal gel [for disposal
instructions: click on link, then go to “Label information”
and view current label]
Dilaudid, tablets * Hydromorphone Hydrochloride
Dilaudid, oral liquid * Hydromorphone Hydrochloride
Dolophine Hydrochloride (PDF – 48KB), tablets * Methadone Hydrochloride
Duragesic (PDF – 179KB), patch (extended release) * Fentanyl
Embeda (PDF – 39KB), capsules (extended release) Morphine Sulfate; Naltrexone Hydrochloride
Exalgo (PDF – 83KB), tablets (extended release) Hydromorphone Hydrochloride
Fentora (PDF – 338KB), tablets (buccal) Fentanyl Citrate
Kadian (PDF – 135KB), capsules (extended release) Morphine Sulfate
Methadone Hydrochloride, oral solution * Methadone Hydrochloride
Methadose, tablets * Methadone Hydrochloride
Morphine Sulfate, tablets (immediate release) * Morphine Sulfate
Morphine Sulfate (PDF – 282KB), oral solution * Morphine Sulfate
MS Contin (PDF – 433KB), tablets (extended release) * Morphine Sulfate
Nucynta ER (PDF – 38KB), tablets (extended release) Tapentadol
Onsolis (PDF – 297KB), soluble film (buccal) Fentanyl Citrate
Opana, tablets (immediate release) Oxymorphone Hydrochloride
Opana ER (PDF – 56KB), tablets (extended release) Oxymorphone Hydrochloride
Oxecta, tablets (immediate release) Oxycodone Hydrochloride
Oxycodone Hydrochloride, capsules Oxycodone Hydrochloride
Oxycodone Hydrochloride (PDF – 100KB), oral solution Oxycodone Hydrochloride
Oxycontin (PDF – 417KB), tablets (extended release) * Oxycodone Hydrochloride
Percocet, tablets * Acetaminophen; Oxycodone Hydrochloride
Percodan, tablets * Aspirin; Oxycodone Hydrochloride
Xyrem (PDF – 185KB), oral solution Sodium Oxybate

This information was taken from the Federal Drug Administration’s website.

For anyone concerned about about the impact on the environment, the FDA makes this statement:

“We are aware of recent reports that have noted trace amounts of medicines in the water system. The majority of medicines found in the water system are a result of the body’s natural routes of drug elimination (in urine or feces). Scientists, to date, have found no evidence of harmful effects to human health from medicines in the environment.

Disposal of these select, few medicines by flushing contributes only a small fraction of the total amount of medicine found in the water. When a medicine take-back program isn’t available, FDA believes that any potential risk to people and the environment from flushing this small, select list of medicines is outweighed by the real possibility of life-threatening risks from accidental ingestion of these medicines.”

Remember to never share your prescription meds with another person.

Now, have a good day and annoy others with your newfound knowledge!

Get Your Pound of Cure

Did you know that the Affordable Care Act requires health insurance plans to cover preventive services with no cost sharing? This means your health insurance can no longer charge a co-pay, co-insurance, or deductible when you see an in-network provider for these services.


Services for Adults include screenings for:

  1. Abdominal Aortic Aneurysm
  2. Alcohol Misuse
  3. Aspirin use
  4. Blood pressure
  5. Cholesterol
  6. Colorectal Cancer
  7. Depression
  8. Type 2 Diabetes
  9. Diet
  10. HIV
  11. Immunizations
  12. Obesity
  13. Sexually Transmitted Infections
  14. Syphilis
  15. Tobacco Use

For more detailed information:

Services for Women and Pregnant Women include screenings for:

  1. Anemia (pregnancy)
  2. Bacteriuria (pregnancy)
  3. BRCA
  4. Breast Cancer Mammography
  5. Breast Cancer Chemoprevention
  6. Breastfeeding
  7. Cervical Cancer
  8. Chlamydia Infection
  9. Contraception
  10. Domestic and Interpersonal Violence
  11. Folic Acid
  12. Gestational Diabetes (pregnancy)
  13. Gonorrhea
  14. Hepatitis B (pregnancy)
  15. HIV
  16. HPV DNA Test
  17. Osteoporosis
  18. Rh Incompatibility (pregnancy)
  19. Sexually Transmitted Infections
  20. Syphilis
  21. Tobacco Use
  22. Well-woman Visits

For more detailed information:

Services for children include screenings for:

  1. Alcohol and Drug Use
  2. Autism
  3. Behavioral
  4. Blood Pressure
  5. Cervical Dysplasia
  6. Congenital Hypothyroidism
  7. Depression
  8. Developmental
  9. Dyslipidemia
  10. Fluoride Chemoprevention
  11. Gonorrhea
  12. Hearing
  13. Height, Weight, and Body Mass Index
  14. Hematocrit or Hemoglobin
  15. Hemoglobinopathies
  16. HIV
  17. Immunization
  18. Iron
  19. Lead
  20. Medical History
  21. Obesity
  22. Oral Health
  23. PKU
  24. Sexually Transmitted Infections
  25. TB
  26. Vision

For more detailed information:


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