Healthy Living

Medications are powerful things. When used properly they cure diseases, heal wounds, prevent heart attacks and strokes, and prolong life. When misused they can cause injury, disease and even become lethal.

Medication safety is much more then just taking your medications as prescribed, it’s about getting the maximum benefit from them with the least amount of risk. Many people are surprised to know this, but you have more control over medication safety then even your doctor.

In order to get the maximum benefit from the medications that you are prescribed, you need to understand many things beyond what dose to take and how many times a day to take it. When is the best time of the day to take your medication? Can I take some of these medications at the same time? What should you do if you forget a dose? What side effects go away after a short time and which side effects do I need to call my doctor about? When should I start to feel better? What if I don’t feel better? What over-the-counter medications should I now avoid?

Although that sounds like a lot of information, it is really only the basics that everyone should know about all of the medications they take. You should also know why you are taking each medication and how it works. Many medications can be used for different conditions; your pharmacist will need to know why you are taking the prescribed medication so they can properly counsel you. Knowing how a medication works will help you understand the side effects that may occur and how to best manage them before you can get in touch with your doctor.

Did you know that medication safety also includes saving money? Mistakes can be costly. Missing just a few doses of an antibiotic can lead to a treatment failure which may need even more costly medications to treat. Improperly taking your cholesterol medication will decrease its effectiveness and may lead to needing two drugs instead of one to control it.

All of the above may seem to be an overwhelming amount of information to learn, but you don’t have to memorize it all. In fact the best thing to do is to keep a small notebook or file with this information. When your physician gives you a new prescription, ask him or her the above questions and write them down. When you get the drug information printout from the pharmacy, ask the pharmacist to highlight the important information and keep the printouts in a small file. Finally, always keep an updated and detailed list of your medications with you that can be given to all your healthcare providers so they are aware of exactly what you are taking and why.

A detailed list including the drug name, dose, how many times a day you take it, and the reason why. A list is the best way to ensure this information is safely and correctly communicated -- especially if you are out of town and need medical assistance or are being admitted to a hospital.

If you would like some help preparing a list or getting answers to the above questions, Backus Hospital will be hosting a “Brown-Bag” program on Wednesday, Feb. 20 from 7:30-11:15 a.m. in its entry level conference rooms. You can bring all of your medications and herbal products with you and sit with a pharmacist to discuss any questions or issues you have. They will also help you fill out a detailed medication list. To schedule a time, call 823-6374.

Michael Smith is a pharmacist and Clinical Coordinator in the Department of Pharmacy Services at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Smith and all of the Healthy Living columnists at healthyliving@wwbh.org

After all the holiday eating, most people are willing to scale down their calorie rich diets come January for foods that are more nutritious and contain less fat and sugar. So, what foods are both seasonal and are good choices to incorporate into your New Year’s Resolution Diet?

 The United States is one of the biggest producers of oranges in the world, despite the fact that their origin is South East Asia. There are three varieties of oranges: sweet, loose-skinned, and bitter. The sweet variety is best suited for eating and includes naval, Valencia, and blood oranges.

Many people have realized for years that oranges contain high levels of vitamin C (as much as 98 mg per large orange), which has been shown to protect against cancer and reduce the risk of cataracts based on some controlled studies (although more research is needed).

Eating oranges for their vitamin C content to treat the common cold has conflicting controlled studies, but oranges remain a healthy food nonetheless. They contain about 4 grams of fiber, over 300mg of potassium, and even have about 70mg of calcium (adults should consume 1,000 to 1,300 mg of calcium per day depending upon sex and age).

 Pears are cultivated and thrive in the northwestern United States, mainly Oregon and Washington, and were brought there by colonists in the 1800’s. Some varieties include Anjou, Red and Yellow Bartlett, and Bosc (the latter better for baking or cooking). Although pears do not contain as much vitamin C as oranges, they are still a good source of fiber (4 grams) and potassium (207mg), and have less than 100 calories per serving, making it an excellent snack choice.

 Carrots are particularly nutritious and can be excellent this time of year. Carrots are known predominantly for containing large amounts of vitamin A, and are subject to the folklore that the British Royal Air Force ate enormous amounts of these vegetables to avoid radar in World War II. While this tale cannot be validated, it does hold true in studies that vitamin A improves vision (if deficient in vitamin A) and can help fight certain skin disorders. Not enough research has been done to confirm that this micronutrient has anti-aging benefits.

 Leeks are another good January vegetable choice, this one belonging to the onion family. Speaking of folklore, Nero supposedly ate leeks to improve the quality of his singing voice (I tried this and it doesn’t work). Leeks have been called scallions on steroids, and are easily located in supermarkets between September and April. They should be stored in refrigeration and wrapped loosely in plastic wrap. Leeks do not have nearly the vitamin content of carrots, oranges, or pears – but they are low calorie and contain some fiber.

Filling up on seasonal fruits and vegetables are far more healthful choices ringing in the New Year, especially when compared to the foods some of us indulged in throughout the holidays.

Whitney Bundy is a registered dietitian and Director of the Food & Nutrition Department at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Bundy and all of the Healthy Living columnists at healthyliving@wwbh.org.

If you develop aching and stiffness around the upper arms, neck, lower back and thighs, the cause might be polymyalgia rheumatica (PMR), which rheumatologists commonly diagnose in patients over the age of 50.

Thee symptoms tend to develop quickly, over a period of few days or week and occasionally overnight. Involvement of the upper arms, and difficulty raising them above the shoulders is common. Aching and stiffness are worse in the morning, and tend to improve gradually as the day goes by. Occasionally this aching occurs in joints such as those of the hand and feet.

Causes unknown
The cause is unknown. “Myalgia” is a term for “muscle pain,” but tests for muscle damage are not elevated. We now know that PMR is an arthritis that has a tendency to involve the shoulder and hip joints and the bursae around these joints. The pain in the arms and things comes from the nearby shoulder and hip joints.

Who gets PMR?
It occurs in older adults, and rarely in people younger than 50. Average age is greater than 60. Women are affected somewhat more than men, and the disease is more frequent in whites than non-whites.
PMR is not unusual – it is diagnosed more frequently than Rheumatoid arthritis in older adults.

Diagnosis and treatment
Blood tests that detect inflammation are helpful. These include ESR (sedimentation rate) and C-reactive protein tests. Both tests are elevated in most patients, but a small proportion of patients can have these tests normal.
When a physician strongly suspects PMR, a trial of Prednisone is given daily. If patients have PMR they have a response in a matter of few day s– and the response is dramatic. Ibuprofen, naproxen and Tylenol are only minimally helpful at best.
The Prednisone dose is gradually reduced over a period of 12- 18 months. The goal is to find the lowest helpful dose that keeps the patients comfortable. Clinicians monitor lab results on a regular basis while tapering the prednisone. Also, side-effects of chronic prednisone therapy are monitored, like increasing blood sugar, weight gain and osteoporosis.

A cautionary note
PMR can be associated with a more serious condition, giant cell arteritis (GCA). We advise all our patients with PMR to look for temporal headache, change in vision, and jaw pain. If any of this happens they are told to report to us right away or if they are having visual symptoms they should go to the Emergency Department to prevent blindness.

Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at healthyliving@wwbh.org

We usually never know the ripple effects of our choices but this time it made the news. It happened at a Starbucks drive-through in Florida in early December.

The chain of events began with an angry outburst of yelling and honking by an impatient customer. The man in the car in front, who happened to be a Tai Chi master, responded rather than reacted. Instead of the usual knee jerk reaction of “you push, I’ll push back,” he paid for the coffee of the man behind him. The miracle of the story is that the man who had been so impatient and enraged paid for the person’s coffee behind him; and so it went for the next 17 customers.

The Tai Chi master said “it wasn’t an idea to pay anything forward, nor was it even a random act of kindness, it was a change of consciousness,” he said. “Take this negative and change it into something positive.” Practicing Tai Chi had taught him how to step back and respond to the moment thoughtfully.

Learning to step back and pause so that we are responding to our lives takes practice, and silence and stillness are our best teachers. We have however become so addicted to noise and busyness that stepping back and being in silence for even a few moments may be unsettling.

At a retreat some years ago, after being given the instruction to go off and be alone I was paralyzed. I didn’t know how, had never taken the time, and felt afraid. I would now describe my morning meditation experience as a cross between peace and the seven dwarfs; sometimes sleepy, happy, dopey, or grumpy, and sometimes restless or bored.

The learning is to be with whatever comes up, without judgment or manipulation. Over and over surrendering to the moment as it is and learning to be present in the midst of it. Little by little there is a subtle and deep shift with glimpses of connection to what is true beneath and beyond the surface of appearances. “There is no substitute for the creative inspiration, knowledge and stability that come from knowing how to contact your core of inner silence,” said teacher and author Deepak Chopra.

We can begin by making a quiet space in our day, a space in our home, a space in our mind to step back and begin to observe rather than identify with our thoughts, feelings and moods. Committing just five minutes each day will begin a life-changing momentum.

Practices like Tai Chi, Yoga, meditation and prayer may be helpful in teaching us to quiet ourselves, step back and be more fully present. The Sufi poet Rumi said: “Only let the moving waters calm down, and the sun and moon will be reflected on the surface of your being.”

Become the change you want to see.

Amy Dunion, a registered nurse and licensed massage therapist, is Coordinator of The William W. Backus Hospital’s Center for Healthcare Integration. This column should not replace advice or instruction from your personal physician. E-mail Dunion and all of the Healthy Living columnists at healthyliving@wwbh.org

Now that the New Year has arrived, there is an overwhelming amount of advice on how to improve health. The standard formula for reducing heart disease, stroke, and other chronic illnesses always includes eating a better diet, exercising regularly, cessation of smoking, and scheduling an annual physical.

One area of medicine often overlooked is the need for sufficient sleep. Life has become an endless stream of commitments, both social and occupational. Many people now work more than one job in addition to being available for family obligations. Often these activities come at the cost of sufficient sleep.

The issue of what constitutes adequate sleep is variable and depends on each individual’s age and health status. “Basal sleep” describes the amount of sleep the human body needs on a regular basis to perform optimally. “Sleep debt” is sleep lost due to variations in the sleep schedule. It is believed that the average, healthy adult requires between seven and eight hours of sleep each night. When this amount is not reached, sleep debt accumulates until an opportunity occurs to make up those hours and get back on a schedule.

Sleep requirements change at different stages of life. Infants and young children require much more sleep than the average adult. Teenagers typically have a sleep schedule that runs contrary to most daily routines. Teens may not become sleepy until late at night and then need to sleep later in the morning. Sleep deprivation often causes teens to perform poorly during early morning classes. College schedules offer more flexibility with late morning and evening courses. The elderly also have increased basal sleep demands and it is often difficult for them to initiate or maintain sleep. This is overcome by napping during the day.

Chronically, inadequate sleep results in serious health problems including obesity, diabetes, heart disease and depression. Sleep deprivation is also associated with an increase in serious motor vehicle accidents.

Adequate sleep recommendations include:
• Establish consistent sleep patterns, even on weekends
• Create a sleep environment that is dark, quiet, and comfortable
• Do not eat or exercise for two hours prior to going to bed
• Avoid caffeine, alcohol, and nicotine before attempting sleep

Consultation with your physician or a sleep medicine specialist may be necessary.
Unfortunately, society associates people who sleep or nap a lot with being lazy, while those who sleep very little are considered hard working. Sleep medicine has now determined these thoughts to be incorrect.

It is believed that the best way to start a diet and exercise program is by “shocking” your body. What better way to shock your system this New Year than by sleeping more.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Alessi and all of the Healthy Living columnists at healthyliving@wwbh.org.

We are moving into the coldest time of the year in New England. Although snow lovers might welcome the usual arctic blast, it can cause problems for those suffering from Raynaud phenomenon, which is a condition in which some of the body's blood vessels (commonly in the fingers and toes) constrict in an exaggerated way in response to cold or emotional stress.

Normally, blood vessels supplying the skin constrict or narrow in response to cold temperatures, decreasing blood flow to the skin, which helps to minimize heat loss. In people with Raynaud, the vessels constrict in an exaggerated way in response to cold and stress, causing the skin to change to a white color. The skin may then become purplish-blue, caused by low oxygen levels in the blood. When the vessel recovers, it dilates, allowing blood flow to resume; the skin may become red. Approximately 3-5 percent of people are affected by this condition.
According to uptodate.org and raynauds.org:

 There are two kinds of Raynaud – primary and secondary. Patients with primary Raynaud – most common in women, younger age groups and people with family history of the disease -- don’t have a related disease causing it. The underlying relation to cold is uncertain. Fortunately, most patients with primary RP are not significantly disabled by the condition and respond well to treatment. Some patients with secondary Raynaud have an illness, such as scleroderma or SLE, that injures or alters the blood vessels and impacts how they react to cold and stress. Secondary RP can be more difficult to manage because the underlying condition can physically damage the blood vessel.

 A Raynaud attack can be triggered by exposure to cold temperature or even by a shift in temperature from warm to cool. As a result, even mildly cold exposures, like air-conditioning or by the cold of the refrigerated food section in a grocery store, can cause a RP attack. Emotional stress and being startled can cause an attack as well.

 Most often, an attack affects the blood vessels in the fingers. The fingers or toes become suddenly cold as the blood vessels constrict. The skin color changes markedly, and may become pale (called a "white attack") or a purple or blue color (called a "blue attack"). Usually, the symptoms begin in a single finger and then spread to other fingers in both hands. The index, middle, and ring fingers are most commonly involved, while the thumb is often not affected. Symptoms subside as the provoking factor (cold or stress) is removed. After leaving the cold area and warming up, the discoloration resolves after 15 to 20 minutes and, as normal blood flow resumes, the skin "blushes" or becomes pink. Patients with severe secondary Raynaud can sometimes experience a serious decrease in blood flow that does not resolve even after the provoking factor is removed. Pain and ulceration of the skin (tips of the fingers and toes) can result.

 Raynaud is diagnosed based on the patient's description of typical symptoms following cold exposure. Through the history, a healthcare provider can usually distinguish Raynaud from more common complaints of cold hands or feet. Often, the clinician will witness the symptoms during the physical examination. Laboratory tests may be performed to determine whether any conditions that contribute to Raynaud are present. In addition, the small blood vessels (capillaries) around the nail beds may be examined.

Raynaud patients usually benefit from:

 Avoid sudden cold exposure by dressing warmly, wearing layered clothing, and using mittens or gloves.
 To end an attack —placing the hands under warm water or area, or rotating the arms in a whirling windmill pattern.
 Avoid smoking — the nicotine and other chemicals in cigarettes cause the blood vessels to constrict.
 Avoid medications - include decongestants, diet pills, some migraine remedies (ergotamine), and herbs containing ephedra.
 Reduce stress and use relaxation techniques to reduce anxiety.
 While the tips mentioned above are generally enough for patients with primary Raynaud (medication might be needed for cold exposure), patients with secondary Raynaud may require more aggressive treatment. Medications are usually needed to reduce the frequency of attacks and prevent ulceration of the skin of fingers and toes.

 Hospitalization can result if blood flow to a finger or toe is seriously restricted. Treatment then requires additional medications to dilate the blood vessels and to prevent blood clots. Medication or surgery may be used to block the nerves that trigger vasoconstriction in the affected area.

To avoid hospitalization or the worst case scenario, amputation, it is important that if you experience these symptoms you are examined by a healthcare provider. If this is something that you have been putting off or avoiding, put it at the top of your list for the New Year.

Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at healthyliving@wwbh.org