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Best Practices for Drug Dosing

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Determining the right drug dose can be confusing. Based on several factors—including age, sex, weight and lifestyle—the dose you take for a particular drug will vary. Physicians take these factors into consideration when writing drug prescriptions (and there are instructions in the drug package), but it can be helpful to know some of these factors before beginning a medication regimen. It’s important to let your doctor know about any health changes, adverse drug reactions or other drugs you may be taking before a dose is determined.

What is a Dose?

A therapeutic dose is the specific amount of drug you take, measured in weight (grams), quantity (e.g. capsules or tablets) or volume (e.g. mL or drops). Sometimes a dose may be measured by the number of inhalations or sprays (e.g. for nasal sprays). Determining the amount, and the frequency with which you take a drug, is called a dosage regimen.

Determining a Dosage Regimen

A dosage regimen might be: 3.5 tablets, once per day (mornings), with food, for eight weeks. Other regimens might include injections, suppositories or liquid solutions. The optimal dosage regimen produces the best health outcomes with the least harmful side effects. A doctor will determine the best regimen by taking into account:

  • Age – Drug dosing has a lot to do with metabolism, which tends to vary with age. Infants and young children require lower doses than adults, while the elderly may require more or less based on their overall health.
  • Weight – Also related to metabolism, a patient’s weight determines the optimal dose. The less you weigh, the less you should probably take.
  • Drug Form – Most drugs will go through an absorption process before circulating freely in the bloodstream. Oral drugs and injections to fat and muscle are absorbed to varying degrees, while intravenous injections enter the bloodstream directly.
  • Other Drugs – Certain drugs interact or interfere with others. If you’re taking any other drugs, it’s very important to inform your doctor. Other diseases can also impair drug metabolism.
  •  Sex – Men typically need higher doses than women.
  • Ethnicity – Studies have shown that African–Americans tend to require higher doses than Caucasians. Asians tend to require the lowest doses.
  • Liver and Kidney Health – Drug metabolism and toxicity is handled by the liver; therefore, patients with impaired livers are particularly sensitive to drugs. Chronic Kidney Disease (CKD) also affects drug metabolism.
  • Lifestyle – Smoking, alcoholism, obesity, diet and regularity of exercise affect drug dosage.
  • Genetic Factors – Some people are born with sensitivities to certain drugs, such as Warfarin (a blood thinner). Be sure to get tested before taking these drugs.
  • Environmental Factors – Studies have shown that drug metabolism can be affected by stress, occupational exposures, sunlight, pressure changes, pregnancy and changes in overall health.

What You Can Do

When taking a medication, it’s a good idea to keep an eye on how you’re feeling. Every drug has side effects, but you probably shouldn’t feel ill or incapacitated. Consult with your doctor on what to expect. She will monitor your health and, when necessary, change the dosage regimen to fit your individual needs.

Understanding Nutrition Labels

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Reading through nutrition facts can feel like deciphering hieroglyphics. We want to make healthy decisions, but it’s hard to make sense of the confusing chemical notations, unit conversions and daily value recommendations on food packages. And other labels like “low fat” and “all natural” can be vague and misleading. Seems like a mess, right? Fortunately, like learning a new language, understanding nutrition labels becomes simpler with a few basic vocabulary words.

What is “Fat?”

Not all fats are unhealthy. Unsaturated fats, such as those found in nuts, fish and vegetable oils are healthy and even help reduce LDL cholesterol. Saturated fats, however, can raise cholesterol and should be consumed in moderation (the US Department of Health recommends that only 10% of daily calories come from saturated fat). As of 2006, the FDA also requires that trans fats be listed on all nutrition labels; these are the riskiest types of fats, and are found in many processed foods and snack items. Take a good look at the “total fat” row in the nutrition label, and check to see what portion comes from saturated, unsaturated and trans fats.

Serving Sizes

The most important item to check for is the “Amount Per Serving.” Everything, including total calories, depends on how the FDA and the manufacturers define one serving. This can lead to confusion when a “portion” (how much we actually eat) differs from the serving size listed on the nutrition facts. For example, one serving of pasta sauce might be 2 Tbsp, but if you plan on eating 6 Tbsp you will need to multiply everything else on the label by three. The same goes if a portion is smaller than one serving, only you should divide instead of multiply.

Calories

Try not to confuse calories and calories from fat. An 80-calorie serving might contains 25 calories from fat, or it might contain only 5 calories from fat. That’s a big difference. Check the nutrition label for this information, and multiply by the number of servings you plan to eat to find out how many calories from fat you are actually consuming.

The Labels on Front

  • Low-sugar and Low-fat

Again, think in terms of calories. Just because something is “low-fat” or “low-sugar” doesn’t mean it is low in calories. In fact, low-fat foods are often high in sugar, and low-sugar foods are often high in fat. The food manufacturers just compensate with other unhealthy calories.

  • Enriched and Fortified

If something has been added, it often means something else has been removed. Foods fortified with vitamins are sometimes deficient in fiber and important minerals in order to reduce the total cost of manufacturing. Check the nutrition facts to check for healthy proportions of all nutrients.

  • Natural and Organic

The “natural” label doesn’t mean much of anything, and is not controlled by any health agency. Likewise, many manufacturers claim their food items are organic by their own definitions. Truly organic foods must be certified, so look for the “Certified Organically Grown” label before shelling out the extra money.

Other Resources

Think about using other resources besides the nutrition facts, such as calorie-tracking mobile apps and diet recommendations online. The less you have to read, multiply and think through, the easier it will be to keep a healthy diet.

Warning Signs for Diabetes

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It’s important to listen to what your body is telling you. Have you been unusually hungry, thirsty, fatigued or dehydrated? If symptoms persist—especially those related to energy and metabolism—it could be a good idea to get tested for diabetes. Over 300 million people have the disease worldwide (mostly type 2), and the International Diabetes Federation estimates this will double within the next 20 years. If left untreated diabetes can lead to severe complications, including death. Advances in diabetes have made the disease more manageable, but it’s important to keep an eye out for early warning signs in order to reduce long–term health risks.

Type 1 or 2?

Both types involve an imbalance of sugar (glucose) in the bloodstream, so most of the warning signs will be similar—hunger, thirst, fatigue, dehydration, frequent urination and blurred vision. Type 2 diabetes is more common, and the symptoms are typically milder (indeed, many people won’t know they have the disease until long–term damage has occurred). Type 1, known as juvenile diabetes, develops much more quickly and leads to severe symptoms. Treatments will differ (type 2 may not require insulin shots), but the major warning signs tend to look the same.

Major Signs

  • Frequent urination, frequent thirst:
    • If there’s too much glucose in your bloodstream, your kidneys will want to drain it all out through urine. The need to urinate frequently—especially at night—could therefore be a sign of diabetes. Increased thirst is a related warning sign: the more you urinate, the thirstier you’ll become, and with your blood–sugar constantly out of flux, you’re especially likely to gravitate toward sugary drinks.
  • Fatigue:
    • Diabetics don’t produce enough insulin, which is the hormone that allows your body to use the glucose in your bloodstream. Less insulin means less glucose (the kind you use, anyway), which means less energy. If you feel unusually tired, it could be a sign of a blood–glucose imbalance.
  • Hunger:
    • Increased hunger is related to increased fatigue—the less glucose your body gets to use, the less energy you actually absorb from your food. The result? You’ll want to eat more and more to make up for the lost glucose.
  • Vision trouble:
    • Blood–sugar impacts fluid consistency and agility around the lenses of the eyes. When glucose levels fluctuate unexpectedly, the lenses could swell and lead to blurry vision as you try to focus.
  • Weight Loss
    • It’s a paradox: you eat more, but you weigh less. Unexpected or abrupt weight loss can be a sign that your body isn’t getting enough glucose, despite how much you’re eating.
  • Infections, numbness, foot pain and wounds
    • Diabetes is an autoimmune disorder, which means that your immune system will be weaker in fighting infections and healing wounds. A weak immune system is also related to nerve damage and less effective blood–flow. Persistent infections, such as yeast infections, could therefore be an early warning sign of diabetes. Likewise, wounds might take unusually long to heal. Numbness, especially in the feet and other extremities, might indicate nerve damage.

Diabetes Testing

If you recognize any of these symptoms, it might be a good idea to ask your primary care physician for a diabetes test. The most common method is a blood–glucose test (fasting or non–fasting). Other tests include the also oral glucose tolerance test and the hemoglobin a1c test.

Tips for Family Caregivers

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Do you find yourself taking on increasing responsibility for the care of a loved one? If so, you might be one of 65 million family caregivers in the United States today. A family caregiver is someone who cares for a relative, neighbor or friend who has suffered an injury, trauma or other disability. Unlike a typical healthcare practitioner, a family caregiver is unpaid and usually provides assistance in the person’s home. This is a tough and often thankless job, and it’s important to recognize caregivers for their important work. And if you’re a family caregiver, take this opportunity to learn a few tips to keep yourself balanced.

Talk to Doctors

Although care recipients spend much of their time resting at home, they will need to visit doctors for checkups, prescriptions and emergencies. As a family caregiver, you will likely take them to appointments, speak with physicians and follow up when needed. Managing all this can be overwhelming, but staying organized can help reduce stress. Before an appointment, write down all your questions and note down the symptoms you wish to discuss. Afterwards, review the prescriptions and physician’s instructions so that you’re completely clear on what you need to do. Most importantly, maintain good working relationships with their healthcare team so that everyone stays on the same page.

Rest!

Being a family caregiver is exhausting. Do yourself a favor and take regular respite breaks, whether it’s five minutes or five days. A respite break is an opportunity to recharge, both mentally and physically, and it’s important for care recipients as well; the more you rest, the better prepared you are to provide care. You can ask a friend or family member to take over for the afternoon, or you can find a trained volunteer to help with more complicated tasks. There are plenty of volunteer organizations at your disposal, such as the Interfaith Caregivers Alliance (ICA). And don’t forget to recharge your mind; read a book, watch a play or play some music to remind yourself that you are more than just your job.

Keep Track of Files

It’s not fun, but keeping track of all your care recipient’s medical information is essential to providing effective care. And, in the long run, it reduces the stress of constantly having to search for files. Some important documents to keep track of include the patient’s medical history, doctor’s contact information, insurance documents, prescription plans and legal documents (including a Living Will). Store these files in an easily accessible location and come up with an organization scheme that makes sense to you. Most importantly, keep all medical information up to date.

Remember: You’re Not Alone

Community is important. Don’t forget to seek help from other family caregivers who are going through some of the same struggles as you are. Find a local caregiver organization to share stories with, find online forums and reach out to local support groups. The Caregiver Action Network (CAN) is a great place to start, and many of their forums are very active. Caregiving is a journey, but it’s not a journey you have to take alone.

Advancements in Breast Cancer

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October is National Breast Cancer Awareness Month and a great time of year to get screened and learn about new treatment options. Breast cancer research has advanced considerably over the past 30 years, but there is still a lot to learn about this increasingly common disease. Thankfully, there is an active community of scientists, healthcare professionals and support groups engaged in educating the public and promoting better disease management. And their advice is simple: prevent, screen and treat.

What is Breast Cancer?

Breasts are composed of subcutaneous fat, but the lumpy feeling we associate with breast cancer only rarely occurs in fat tissue. Cancerous cells are more likely to develop in the lobes, lobules and ducts that join around the nipple. Ductal carcinoma is the most common type of breast cancer and can spread through the blood and lymph; lobular carcinoma is typically found in both breasts, but rarely spreads; inflammatory cancer, which swells the entire breast, is the least common breast cancer.

Breast Cancer Prevention

There is only so much we can do to prevent breast cancer, and certain risk factors, such as genetic predisposition, are completely out of our control. We can, however, pay attention to our lifestyles, eat healthy, avoid carcinogens and take preventative medicines when appropriate. Lifestyle changes to consider include exercising, quitting smoking, drinking less alcohol and keeping a healthy weight. Studies have shown that obesity increases the risk for breast cancer, especially after menopause, so maintaining a healthy diet is critical. But lifestyle changes are never a sure bet; the truth is that we’re all cancer–susceptible to some degree, so the best way to beat breast cancer early is to screen for it.

Screening

This year’s Breast Cancer Awareness Month includes a National Mammography Day on October 16th. Of all the screening methods, mammography is by far the most common, though the medical community is split regarding its efficacy. Recent studies suggest that mammography screenings do not lead to a reduction in mortality among cancer patients generally. There is also the risk of over diagnosis—when pathology is detected, but the cancer never progresses to symptoms or death—which has been shown to occur to at least one in five women who receive mammograms. However, a more successful “work–up” process has been standardized in recent years that combines mammography, diagnostics and optional biopsy. Otherwise, there are also MRI screenings and clinical breast examinations, both of which have been shown to be efficacious.

Treatment

Breast cancer treatment varies widely based on the stage at which the cancer is found. Surgical procedures, such as mastectomy and lumpectomy, are standard measures taken to resect a tumor once found. If the cancer has spread beyond the original tumor, medication and radiation (chemotherapy) are used in tandem to halt metastasis and kill circulating tumor cells in the bloodstream. Estrogen blockers are the most common drugs used in breast cancer treatment, but current research is focusing on target–specific drugs that bind directly with cancerous cells, leaving a patient’s normal cells intact.

What Can You Do?

National Breast Cancer Awareness Month is an opportunity to stay informed and spread the word about developments in breast cancer management. Think about scheduling an appointment with your doctor for a preventative screening, practice self–breast exams regularly at home and get the facts straight about what you need to stay healthy. The more you know, the more prepared you will be.

Peanut Allergies in Children

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Peanuts—which are actually not nuts at all, but legumes, like lentils and peas—are the most common cause of severe food allergies in children. And the distinction is important: tree nuts, such as almonds, cashews and pecans can cause their own allergic reactions, but these nut allergies are typically less severe. An allergic reaction to peanuts, however, can lead to severe anaphylaxis (swelling), uncontrolled vomitting, cardiac arrest and even death. And it doesn’t take much, especially in young children: even trace amounts of peanut can lead to severe reactions in some cases. As a parent, this can be very scary. Fortunately, there are steps you can take with your family doctor to ensure that your child is properly diagnosed, treated and prepared in case of emergency.

Diagnosis

The incidence of peanut allergy is on the rise, particularly among young children, so it’s a good idea to take your child to the doctor if you notice any strange reactions to food. Even mild symptoms, such as itchiness or rash, can worsen over the years, sometimes developing into full-blown anaphalyxis. When you see your family doctor for diagnosis, she will likely recommend one of the following:

  • Blood test. This is a measure of allergen-specific antibodies, known as Immunoglobulin E (IgE), in the bloodstream.
  • Skin Test. The skin is exposed to peanuts (usually an extract), followed by a needle prick. The doctor will then check for bumps and rashes.
  • Elimination diet. Also known as an “oral challenge,” this test involves an elimination of peanuts for at least two weeks, followed by a steady increase in peanut exposure over time. If your child has experienced severe reactions in the past, this test is not recommended; the risk may be too high.

Management

Once a peanut allergy has been identified, your child’s best bet is simply to avoid peanuts altogether. Provide examples of food items that contain peanuts, and teach them not to accept any food before asking. It’s also a good idea to inform teachers, coaches and friends about the allergy. Peanuts are common ingredients in baked goods, candies, energy bars, cereals and granolas, so diet management is very important. Otherwise, be ready with treatment options in case of a reaction.

Treatment

If an allergic reaction does occur, epinephrine is the primary treatment for anaphylaxis. Be prepared by always carrying an autoinjector, such as an EpiPen or Twinject, and learn how to use the device just in case. The syringe should contain a complete dose, which can be injected with a needle in the upper thigh.

In case of severe reactions, such as abdominal pain and heavy asthma, it’s best to take your child to the ER or Urgent Care as well. Unfortunately, there are no approved therapies on the market to prevent or mitigate peanut allergy as such, but there have been recent advances that do show some promise. As a rule, strict avoidance is the best option to prevent allergic episodes; and, as always, hope for the best and prepare for the worst!

The Facts Behind a Fever

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A fever is a common, natural response that’s produced when there is an infection that the body is trying to ward off. Usually, it is more important to establish the underlying issue that is causing the body to create a fever in the first place than to treat the fever itself. Despite common misconceptions, not all fevers are dangerous and require immediate medical attention.

“Fevers help us fight illness by making our bodies an unfavorable environment for germs,” says Five Star Urgent Care Regional Medical Director Dr. LouAnne Giangreco. “The body starts trying to generate heat through shivering and wanting to get warm to try to reach a higher temperature. So when people develop a fever, they feel cold, not hot.”

A fever is defined as a temperature of above 100 degrees (F) orally or 100.4 degrees (F) in the rectum, in the ear, or on the forehead. Typically, as the fever rises, other more serious illnesses could be the cause of heightened temperatures. There are, however, some exceptions. For example, in the very young, the elderly, those with recent surgeries, and the immunosuppressed, lower fevers are often a concern.

In those who are healthy and not at the extremes of age, it is more important to consider the accompanying signs and symptoms. Fevers reaching 104 degrees (F) and higher in older children and adults should trigger evaluation even in the absence of other symptoms.

Acetaminophen or ibuprofen can be used to reduce a fever when patients are also feeling uncomfortable from a headache, body aches or fatigue, but most importantly it is to establish the underlying cause of the fever itself.

Responding to the Research: Your Top Health Questions Answered

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We hear the results of new medical studies daily in the news. With a never-ending supply of health information, consumers can be left guessing if they should change their daily habits and lifestyles based upon the new medical information. Five Star has cleared up the confusion surrounding three of these recent news reports.

  1. E-cigarettes have been making waves in the health world for some time. A recent report in Morbidity and Mortality Weekly reported an increase in e-cigarette usage in middle school and high school students. In middle school students, usage increased from 120,000 to 450,000 students with an even bigger spike among high school students reporting an increase of 660,000 to two million. E-cigarettes are harmful to youth as nicotine can affect brain development, promote addiction and lead to sustained tobacco use. Talk to your kids about the dangers of using E-cigarettes.
  1. Shifting to traditional wisdom, “an apple a day keeps the doctor away” has been a staple of nearly every home growing up, but does it really keep diseases and other medical conditions at bay? A recent JAMA Internal Medicine article provided no statistically significant evidence that people who eat more apples have less doctor’s visits, however, these individuals appeared to use less prescription medications. Even though there is not a decrease in doctor’s visits, apples are a healthy, low calorie food that provides soluble fiber and potassium. If you love eating an apple a day, we encourage you to keep it up.
  1. In a study in Occupational and Environmental Medicine, researchers looked at the potential impact of exposure to bleach in the home among more than 9000 children between the ages of 6 and 12. In this study, it was found that the risk of one episode of flu in the previous year was 20% higher and recurrent tonsillitis 35% higher among children whose parents used bleach to clean the home at least once a week. Similarly, the risk of any recurrent infection was 18% higher among children whose parents regularly cleaned with bleach. In this study, it is suggested that the irritant properties of bleach may cause inflammation in the lungs and make it easier for germs to take hold.
    1. Since this is an observational study, it is difficult to draw definitively conclusions about cause and effect. There may be other factors contributing to the increased risk of infection. At this point, there is not definitive evidence to stop regular cleaning with bleach. However, it does help to reinforce the importance of using adequate ventilation and appropriate dilution when cleaning.