Trailing Thoughts

The short time I have been working in the Point, I have received a variety of questions, but the majority of the questions are associated with a sinus headache. This is unusual for me, because in the years I spent in the Glendale St. store, I only received a few questions regarding sinus headaches. This has made me wonder if there is something with Point Place that causes an increase in sinus headaches.
What is a sinus headache? Well, it is a headache that is associated with the swelling of the membranes lining the sinuses. This is the spaces adjacent to the nasal passages (behind the cheeks, nose and eyes). This swelling leads to air, mucus and pus being trapped in the sinus region, which results in inflammation, thus pain. This pain presents in the form of an ache under the eye or cheek area or teeth pain ( normally upper portion of teeth). Many times the pain will worsen when you lie down or bend forward or with sudden head movements. Additionally, cold and damp weather can make a sinus headache worse. The pain is worse in the mornings (all night long the mucus has been collecting and not draining) and will feel a little better as the day goes on. The pain can be a dull to severe pain that mostly occur in the front region of the face. To treat sinus headaches, reducing the swelling and inflammation reduces the pain. Also, draining the sinus passages reduces the pain.
How to achieve the dissolution of a sinus headache can be resolved ( in most cases) with a few simple things at home. First is to use OTC pain relief ( like aspirin, acetaminophen, ibuprofen) which are anti-inflammatories, which decrease the swelling. Another choice is to breathe in moist air. A hot shower, a vaporizer, or a cool- mist humidifier can help with putting moisture in the air. Also, hot and cold therapy can help. Vary hot and cold compresses ( 3 minutes a piece, 3 times with each element) a few times daily can help relieve the pressure & inflammation, thus the headache. Nasal rinses can be used to increase the drainage, clearing the passages. If the sinus headache is associated with a person’s allergies, sometimes an anti-histamine (Benadryl or Claritin) or decongestant (pseudoephedrine)can be used- but be careful about over use, which can cause rebound congestion or in other words, make the congestion worse.
Keep in mind if the headache is not relieved or that it is getting worse over a period of time, there may be something else that is wrong and seeking medical attention is the best solution. Sometimes the headache may be a result of a sinus infection, and an antibiotic might be the only thing that works. Talk with your doctor if your headache does not resolve.
As to the Point Place area, I am not sure if this is just a coincidence or the real reason. If anyone has anything to point out, feel free to comment.

I have Tarascon PDA software on my PDA and I must say this is a cool edition. They have added where people can get assistance for drugs they cannot afford. Or you can check out the website:

http://needymeds.com/

It presents an easy format for people to find ways of getting assistance!! Medications are not cheap and if you meet different criteria, there is possible help for you!

I try to read the peach section of the blade ( the Toledo newspaper) every day– I just glance at the other pages headlines – most of the time the stuff is too depressing to read about, and I know I live a sheltered life and for now, I would like to keep it that way. But I have come off the point of this post. Mr. Woods state that Americans are too quick to adapt new drugs that come out, though extensive studies have been done, there are rare side effects that do not occur until millions of people are taking a drug and that they are costly. Here is my response:
When I say that everyone is unique and that people have different personalities even raised in the same environment, it does not suprise anyone. Drug metabolism is just the same — in general, it acts similar, but some people have different responses to medications because something makes the reaction unique. Sometimes that is not the case, like in the case of the drug Thalomid– a drug that was used in the 50s and 60s as a sedative. It was thought to be so safe that even pregnant women were given this drug. As it turns out, many babies were deformed– ok– so we have a side effect that has affected a lot of babies, thus this resulted in the drug being withdrawn from the market. But it turns out, it does have its niche and has been reintroduced into the US drug market with safety precautions– and if used safely– with a complete risk versus benefit analysis — it can be used to treat a symptom associated with leprosy. Now lets compare this with the new drug Crestor ( a “super statin”). There have been reports that Crestor does induce liver failure and has a higher risk associated with this then the other statins. Okay, knowing this why would people need to use this drug? Well, in some cases, cholesterol control does not exist, even maximizing the cholesterol lowering diet and drugs available, so people do a risk analysis and determine if Crestor would help. When people make these decisions that should realize that the monitoring tests associated with these drugs are for a reason and not put them off. They should have have Liver Function Tests done on a regular basis and other parameters.
With so many people on any of the “statins”, risk of liver failure exists, but it is a rare side effect– does this mean that everyone should stop taking statins? No, but they would be stupid not to realize they have parameters that might require testing and that they should follow through with these parameters. The whole point of this was to say that drugs affect people differently and we need to approach this with every medication we take ( even aspirin, which has been around for over 100 years, can affect people differently).
Now lets address the cost issue: Ok, I will admit, the newer treatments will cost more, but sometimes the treatment outcome will outweigh the cost. I know people that suffer from migraines and none of the older treatments work, but the drug Axert works for them. Axert is not cheap, but offers the relief that the older drugs could not. But this is not always the case. When I have someone that cannot afford the newer medication, but did not tell their doctor this, I offer to call their doctor and recommend a therapy change to something that I have available in a generic drug. But sometimes when this is not the case, and the person needs the expensive medication, I try to come up with something that will work for the patient, like maybe a manufacturer discount card. Many pharmacists will do this for their patients, so don’t be afraid to talk to your pharmacist.

I am not discrediting anything that Mr. Woods stated in his article, but I am trying to point out there is more to the picture then he introduced.

My grandmother recieved information for medicare approved discount cards… and asked should she get one? First what is a medicare approved discount card? It is a voluntary card that can give a discount on certain drugs ( usually 10 to 25%) for a small enrollment fee of $30 or less. A person must be eligible for medicare to enroll for a card. A person can only sign up for 1 card per year, so it is best to do some research before you choose a card. Keep in mind, if you are a senior citizen, most pharmacies already offer an automatic discount. Rite Aid is 10%. Another thing to keep in mind that you can only use 1 type of discount for a prescription.
What is the best way to choose a card? Well first you start with a list of the current medications that you are taking. By visiting www.medicare.gov or calling them, 1-800-MEDICARE, to get a comparison list of the cost to you. From there, you can choose your best option.
I will briefly cover 3 of the discount cards offered.
Pharmacy Care Alliance Discount Card:
Will give you up to 20% off some brand name prescriptions and up to 40% off
Many chain pharmacies, including Rite Aid, accepts the card.
Enrollment is $19 or $30 depending on options chosen.
It does not offer discounts in the following categories: weight-related, fertility, cosmetic, cough & cold prescriptions, vitamins, barbiturates, benzodiazepines, OTC drugs, and drugs covered under medicare part B.
They offer some services along with the card including a mail option.
They also maintain a decent website for drug information and interactions: www.drugdigest.org
FOR MORE INFORMATION: www.PCAcard.com

Rx Savings Access Card:
On covered drugs it offers a 15% minimum discount (it can be more) on brand and generic drugs.
Associated with McKesson, a well known name in the drug industry ( they also have the Together Rx discount program)
Accepted at many pharmacies, including Rite Aid
FOR MORE INFORMATION: www.RxSavingsAccess.com

Medco Preferred Prescriptiong Discount Card:
Save on selected drugs up to 30%
Accepted at many pharmacies, including Rite Aid
FOR MORE INFORMATION: www.medco.com/medicare/

I do not know what other pharmacies accept these discount cards. I can only speak for Rite Aid because that is the environment that I am familar with. These discount cards are only going to be good for 1 year at a time and will end in 2006 (when, as the government claims there will be prescription benefits to medicare recipients- this is just to cover the time period before it starts) Also there is a 600 dollar credit that some people might benefit from, but it is complicated to explain exactly who benefits, so it is best to contact medicare.

Some pharmacies will have information packages available to their patients, just ask your pharmacist.
We personally decided to not look into a card for my grandmother ( she does have insurance, and we feel this would not be an added benefit) but for the people that do not have money to pay for insurance or cannot get coverage and are covered by medicare, these are an option to save some money.
Remember there are other options for discount cards — if you need assistance, start looking – for instance AAA Travel offers a discount program to their members or most drug companies (Eli Lilly , etc. ) offers specific drug discounts. For instance, if you qualify and fill out the forms, it is possible to get a discount on a drug that the company makes. I knew a lady that qualified for prozac and reduced her amount from paying full price to a 5 dollar co-pay.
Also if you don’t qualify for any of these discount programs and do not have insurance, make sure when you get prescriptions, that you request a drug available in generic. You would not believe the amount of people that go to the emergency room with out insurance and come out with a prescription for an expensive antibiotic when they could have gotten something similar for a lesser amount if they just mentioned it to the doctors.

Another thing for people that do have prescription coverage through their insurance. Be familar with your insurance company’s formulary– you can save a lot of money and time if you bring it with you each time you visit the doctor office and get something that is a preferred item than something that is not preferred. With one patient I encountered, they did not do this and came up with a $50 dollar co-pay because the doctor chose the drug that is not on the formulary, and when it was switched to the preferred it was only $5 dollars. ( How to get a formulary – contact the insurance company- there is a number usually on the back of the card, contact your benefits office or visit the insurance company’s website) .

I don’t know about other pharmacists, but I am always confused on what drug works on which enzyme or vice versa and can never remember the effect. From studying for the boards, I found this great link that has a pretty comprehensive table. I was very impressed and cannot wait for them to come out with the PDA version.

Reading the pharmacist letter, I came across this quote and realized how true it is… Last week I was trying to counsel a patient on the difference between Celexa and Lexapro and was having a hard time explaining that lexapro is celexa in a purer form. ( the same with albuterol and levalbuterol)

If you can’t explain it simply, you don’t understand it well enough.
- Albert Einstein

Moving on… I came across some information about low carb diet multivitamins that are appearing everywhere…. I really have not paid too much attention to them until I got a question about them…. there are many of these vitamins that are popping up, even Centrum is getting in with the game…. These vitamins are not low in carbs, just like regular vitamins… they just have great marketers behind the scenes. They do tend to have more B vitamins and antioxidants. Thus if you are a person that is considering the low carb diet, you do not have to spend the money and get the low carb vitamins, a regular every day vitamin is good enough– like Centrum. Also, for all of the low carb dieters– vitamins do not replace the necessary supplements that vegetables, fruits, and grains and dairy products provide for the body– keep the diet a healthy diet that is well balanced.

Yesterday while working, someone asked me about home menopause testing kits, I was not able to really help them so I decided to do some research on what these tests are really predicting and do they work? Well first I will answer the last part of the question. I personally would save my money- the urine tests that give values of FSH are not the greatest because it is not always constant with the results. Higher levels FSH can indicate menopause but they are not diagnosic of menopause. The other tests are saliva based tests and the concentration of hormones in the saliva really do not mimic the concentrations in the body, thus another possibility for false answers. Saliva tests are really not recommended based on many problems. The urine tests are FDA approved becuase of the reason that they are pretty accurate at saying there are high levels of FSH, but not for the reasons of what this test predicts.
An additional warning, patients taking birth control can have untrue results because the hormones from the birth control can mess with the results.
Now what exactly is this hormone, FSH? Follicle stimulating hormone (FSH) is produced by the pituitary gland and with women, FSH is responsible for stimulating the development & maturation of ovary follicles during each monthly period. FSH is found in blood and is excreted through urine, making it an ideal hormone to test for because most experts agree that the levels of FSH in the blood and the urine are similar. There is a increase in FSH right before ovulation starts. After ovulation, the ovary follicle ruptures, releasing an egg which causes the developed corpus luteum to produce & secrete progesterone and some estrogen. These secretions will cause the level of FSH to decrease. As women get older and menopause gets closer, women start having a decrease in ovarian function. In the long run, this causes FSH levels to increase. Here is where the testing kit comes in. It will try to measure the FSH. The urine tests require the first morning urine because this is the most concentrated urine of the day.
So do you want to spend anywhere from $20 to $160 dollars to test if you are experiencing symptoms of menopause? I suggest that you do not, but instead you should have a talk with your doctor.
Do not home treat your menopausal symptoms( ie. hot flashes, mood swings, irregular bleeding, sexual problems, sleeping problems, more anxiety, etc.) with herbs. There is a continuing debate on the uses of herbals and other hormone therapy and whether it increases more serious risks of health problems, such as cancer, in the future. The doctor and you should sit down and discuss the benefits and the risks associated with menopause symptom treatment.