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Your Largest Organ

I think we’ve all been talked to to death about protecting our skin from getting burned and overexposed to the sun. If you’re at least 35 or older, you may even remember the days of baby oil mixed with iodine as the way to get a great tan. And the more tan you are, the more beautiful you are, right?Patricia Krentcil

Except when you over do it and look like leather.

I confess I still like the look of sun-kissed skin; however, I now attempt to get it out of a self-tanning lotion.

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We had a scare in our family recently that makes me even more leery of getting too much sun. Last year my younger sister found a spot on her upper arm that wouldn’t go away. She thought it was just some type of pimple. It  wasn’t a scary looking black color, it was flesh-colored. It wasn’t larger than a pencil eraser or asymmetrical. The only thing that bothered her was that it wasn’t clearing up. She went to her primary care doctor for something else, and “by the way, what do you think about this thing on my arm?” Luckily, her doctor did not blow her off, but removed it and sent it for biopsy. About a week later, he called her to say it was melanoma.

That news was unexpected, and threw us all for a loop. If you start reading about melanoma, you realize that the odds aren’t good for survival. She had to go to a specialist who removed more skin in that area, looking at the cells under a microscope as he went, until he got to clear cells. That was a good sign, that he was able to get to normal cells instead of continually finding more cancer cells. Thankfully, my sister is cancer-free; she will be monitored on a regular basis for any recurrence for the next few years.

I’m sharing this story with you because I read an article today that says melanoma is on the rise in our teenagers. While our kids are still in our homes, we need to harp on them to use sunscreen, no matter how annoying we are. We also need to be good parents and slather our little kids (6 months and older) with sunscreen anytime they’re out in the sun. At the pool, the sunscreen has to be on at least 15 minutes before getting in the water for it to work, and reapplied often. Teach them at an early age that wearing sunscreen is important. But for those of us who grew up in the age of baby oil and iodine, it’s too late to reverse the sun damage that’s already happened. So, we have to keep an eye on our skin with regular checks of our largest organ, our epidermis.whaleskin

 

What makes you more prone to developing skin cancer?

  • If you had blistering sunburns as a teenager
  • If you had outdoor summer jobs for 3 or more years as a teenager
  • If you have pale skin that doesn’t tan easily (burns instead)
  • If you have red or blonde hair
  • If you have blue eyes
  • If you have many moles or freckles
  • If you have HIV or any condition that makes your immune system not work well
  • If you are taking immunosuppressants
  • If you have a family history of melanoma.
  • If you are older than 65 years of age.

People who are non-medical may feel they can’t tell if something is normal or abnormal. In school, I was taught this way to remember how to tell if a skin lesion could be a concern:

The A-B-C-D-Es of Skin Cancer

abcde-of-melanoma

Anytime you find a spot that concerns you, please go see your healthcare provider to get it checked out.

It’s a good idea to have your skin checked out once a year, especially if you fall into any of the at-risk categories. In the meantime, use your sunscreen with SPF of 30 or higher, limit your time out in the sun, especially between 10am to 4 pm, and dress in protective clothing such as a hat and sunglasses when you are outside. Take care of yourself. ¡Salud!

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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:  http://www.deadiversion.usdoj.gov/drug_disposal/takeback/
  • 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:
Medicine
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]
Diazepam
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. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flushing_list

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!

CAGE yourself

CAGE

Have you ever wondered if you drink too much? The CAGE questionnaire is a screening tool that can be used by yourself or your healthcare provider to see if you have a problem that needs evaluation. It’s not used to diagnose alcoholism, only as a way to see if a person possibly needs help or support.

The questions are:

  1. Have you ever felt you should cut down on your drinking?
  2.  Have people annoyed you by criticizing your drinking?
  3. Have you felt bad or guilty about your drinking?
  4. Have you ever had a drink first thing in the morning to steady your nerves
    or get rid of a hangover (eye-opener)?

If you answer “yes” to 2 or more questions, that’s an indication of an alcohol problem.

There are the different levels of misuse:

  • Risky or hazardous use–having more than 4 drinks in one day for men or more than 3 drinks in one day for women
  • Harmful use–drinking that causes physical or mental harm (i.e. falls, high blood pressure, unclear thinking)
  • Alcohol abuse–drinking that causes a person to lose his job or have decreased work or school performance, neglect home responsibilities, driving while drunk, and/or have legal or social problems
  • Alcohol dependence (alcoholism)–a craving for alcohol, physical dependence (get the shakes without a drink), loss of control over drinking, and a need to drink an increased amount to feel the effect.

For those with a positive screen that fall under the “Risky or hazardous use”or “Harmful use” categories, brief counseling with more than one session has been found to be effective. For those who fall in the “Alcohol abuse” or “Alcohol dependence” categories, brief counseling hasn’t been shown to work well; a treatment program with ongoing support would be more effective.

I’ve noticed that a lot of my patients are really not aware of what is considered “drinking in moderation.” For men, this would be no more than 2 drinks a day or no more than 14 drinks per week. For women, moderate drinking is no more than one drink a day or no more than 7 drinks per week. A drink is considered to be 12 oz of beer, 5 oz of wine, or 1.5 oz of liquor.

drink

Please see your healthcare provider if you have questions or concerns about your alcohol use.

Source: http://www.uspreventiveservicestaskforce.org/uspstf12/alcmisuse/alcomisart.htm

When to see your healthcare provider for that cold

I found out quickly when I got out of school that a lot of people schedule an appointment to see their healthcare provider as soon as they get a stuffy nose, low-grade fever, or sore throat. When these patients came in to see me, most expected to get an antibiotic. According to the CDC, “antibiotic resistance has been called one of the world’s most pressing public health problems,”http://www.cdc.gov/getsmart/antibiotic-use/fast-facts.html, so it might help to know how to tell the difference between a viral illness and bacterial illness.

A viral illness:

  1. usually begins with feeling achy, tired, maybe a fever of <100.5.
  2. may include a stuffy nose, sneezing, a cough and sore throat.
  3. tends to be worse the first three days or so, then you start feeling better, but may keep a stuffy nose and cough. (“I sound bad, but I feel better.”)
  4. may cause a stuffy nose, sneezing or a cough that can last up to two weeks.

With a viral illness, no antibiotic is needed. Over the counter products for symptom relief are recommended.

  1. Acetaminophen or ibuprofen is effective for sore throat, headache or body aches.
  2. Decongestants work really well for a stuffy nose (but are not recommended for people with high blood pressure).
  3. Saline nasal spray or a sinus wash work well for some people.
  4. A cough suppressant like Delsym or Robitussin can be effective.
  5. Throat spray and lozenges may be used for sore throat.
  6. Read the labels on combination products, like Tylenol Cold or Advil Sinus, to make sure you don’t double up on any ingredients.
  7. Remember, children under the age of 4 should not be given cough medications. Always read the label for age recommendations and proper dosing on any medications for children.

How do you know when to go and be seen by your healthcare provider?

  1. Fever > 100.4, or any fever that lasts longer than three days.
  2. No improvement after 7 days of being sick.
  3. Sore throat without a cough or runny nose.
  4. Symptoms that don’t improve with over-the-counter products.

Remember, it’s not the color of your mucous that means you need an antibiotic, it’s how long you’ve been sick and how bad your symptoms are. ¡Salud!

 

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