Addressing Prescription Opioid Abuse, Starting with Efforts to Prevent Overdose Deaths

The rise of prescription opioid abuse during the last decade has produced a significant increase in deaths from opioid overdose. Methadone, with 4 million prescriptions written for pain in 2009, has now joined oxycodone, hydrocodone, fentanyl, and morphine as the primary agents.

Overdoses of prescription opioids have also changed the U.S. landscape for poisonings. In the last 3 decades medication contributions to poisoning rates have risen from 55% (1980) to 90% (2004 and 2008), with over 40% of medication related poisonings stemming from prescription opioids.

Recently, much was made by the media when vehicle traffic deaths were exceeded by drug overdose deaths (Figure 1 below), the impetus for this dramatic shift being the rise of prescription opioid abuse (Figure 2 below). In addition to the majority of deaths occurring in 45 to 54 year olds, increases have also occurred in children/ adolescents and the elderly.

 

 

 

Sun Poisoning

Sun poisoning doesn’t really mean you’ve been poisoned. It is often the term used for a severe case of sunburn. This is a burn from ultraviolet (UV) radiation that inflames your skin. Sun poisoning can also refer to other reactions. Two examples are polymorphous light eruption and solar urticaria.

Signs and Symptoms of Sun Poisoning

Within just 15 minutes of being in the sun, you can become sunburned, but you might not know it right away. The redness and discomfort might show up a few hours later. You can become severely sunburned if you stay in the sun a long time and don’t wear protection. You are at greater risk if you have light skin and fair hair.

 

Severe sunburn or sun poisoning can cause symptoms such as:

  • Skin redness and blistering
  • Pain and tingling
  • Swelling
  • Headache
  • Fever and chills
  • Nausea
  • Dizziness
  • Dehydration

 

Other Types of Sun Poisoning

Sun poisoning may also refer to two types of reactions to sunlight. The cause is unclear, although the immune system is believed to play a role. This may occur after exposure to certain drugs or chemicals or as part of a systemic disease. But sometimes the cause is unknown.

Polymorphous light eruption (PMLE). At least one in 10 Americans is affected by PMLE, a reaction that does not appear to be linked to drugs or diseases. More common in women than in men and beginning at any age, PMLE occurs in people who are susceptible and are exposed to intense sunlight that they are not used to. For example, people living in northern climates could experience this if taking a winter vacation in a tropical climate.

In some cases, this reaction gets better each year, but some people have reactions that become more extensive without treatment. How much sunlight individuals can tolerate varies from person to person.

 

Symptoms are a severe skin rash, usually appearing within 30 minutes to several hours of going out in the sun. The rash may be itchy and have these characteristics:

  • Small bumps all over the body
  • Dense clumps of bumps
  • Hives, usually on the arms, lower legs, and chest

 

A hereditary form of PMLE occurs in Native Americans. It can last from spring until fall. Symptoms at first include redness, burning, and itching, which usually last two or three days, but can persist for weeks.

 

Other symptoms may begin within a few hours of sun exposure but go away within hours.

They include:

  • Fatigue
  • Chills
  • Headache
  • Nausea
  • Solar urticaria. Symptoms may develop within minutes of exposure to sun. If large areas of skin are involved, symptoms may include:
  • Itchiness
  • Redness
  • Raised areas on the skin (wheals) or blisters
  • Wheezing
  • Dizziness
  • Loss of consciousness
  • Although the blisters usually go away within hours, you may experience the reaction off and on throughout the years.

 

Treating Sun Poisoning

For severe sunburn, these simple remedies usually do the trick:

  • Get out of the sun.
  • Take a cool (not cold) shower or bath or apply cool compresses.
  • Drink extra fluids for a few days.
  • Take ibuprofen or acetaminophen to relieve pain.
  • Use aloe gel or another moisturizer.
  • Completely cover sunburned areas when going outside.

 

Seek immediate medical care for these symptoms:

  • A sunburn that forms blisters, covers a large area, or is very painful
  • Facial swelling
  • Fever and chills
  • Upset stomach
  • Headache, confusion, or faintness
  • Signs of dehydration

 

Treatment for PMLE depends on its severity. Other than staying out of the sun and protecting yourself when you are, you may not need treatment. The rash can clear by itself within seven to 10 days. For solar urticaria, antihistamines are effective in some cases.

 

Other treatment or prevention for either type of reaction may include:

  • Topical corticosteroids
  • Sunscreen with both ultraviolet B (UVB) and ultraviolet A (UVA) protection
  • Phototherapy with psoralen UV light (PUVA) to desensitize skin to UV light
  • Low-dose antimalarials (for PMLE)

 

If you are on medications, check with your doctor to see if any might be making your skin more sensitive to sunlight. Here are examples of drugs that might do that:

  • Acne medications
  • Antibiotics
  • Antidepressants
  • Diuretics
  • Heart drugs
  • Birth control pills
  • Topical antibacterials, fragrances, or antifungals

 

Preventing Sun Poisoning

Don’t forget the basics of sun safety. Apply sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed areas of skin. Make sure it protects against both UVA and UVB rays. Do this15 to 30 minutes before going out in the sun and reapply about every two hours.

Limit exposure during the hottest hours of the day — between 10 a.m. and 4 p.m. And remember that water, snow, and sand can intensify damaging rays of the sun. Finally, make sunglasses, a hat, and protective clothing standard sun gear.

Daily Aspirin: Worth the Risk?

Study Finds Higher-Than-Expected Bleeding Risk in Daily Aspirin Users

Millions of people take aspirin every day to lower their heart attack and stroke risk, but new research may change some of that thinking.

Daily aspirin use was associated with a higher-than-expected increase in the risk for major bleeding in an Italian study published this week in the Journal of the American Medical Association.

The risk for serious bleeds was five times higher than has been reported in clinical trials of daily low-dose aspirin, says researcher Antonio Nicolucci, MD.

He noted that while daily aspirin therapy has been proven to lower the risk for a second heart attack or stroke in people who have already suffered one, the treatment’s usefulness for preventing a first heart attack or stroke is not so clear.

“People with a moderate-to-high risk for having a major cardiovascular event probably benefit from aspirin therapy, but the risks may outweigh the benefits for people with a lower risk,” Nicolucci tells WebMD.

 

Diabetes Linked to Bleeding Risk

Nicolucci and colleagues set out to examine how daily aspirin use affected the risk for major bleeds in people with and without diabetes.

To do this they followed close to 186,000 adults on daily low-dose aspirin therapy and the same number of people who did not take aspirin regularly for an average of about six years.

During the follow-up, about 2,500 people were hospitalized for bleeding in the brain and close to 4,500 were hospitalized for gastrointestinal bleeding.

The researchers were surprised to find that patients with diabetes had a 36% increased risk for these potentially life-threatening bleeding episodes even when they did not take aspirin. Aspirin use did not appear to influence this risk for people with diabetes one way or another.

Diabetes is a major risk factor for heart attack and stroke, and low-dose aspirin is recommended for most diabetic men over age 50 and diabetic women over 60 when other heart disease and stroke risk factors are present.

American Heart Association past president Robert Eckel, MD, says more study is needed to understand the impact of diabetes on bleeding risk.

“The finding that diabetes in and of itself conveys a risk for bleeding is a new one,” he tells WebMD.

 

Statins May Lower Bleeding Risk

The study also suggested a protective role for cholesterol-lowering statin drugs against bleeding.

Taking statins was associated with a lower risk for both gastrointestinal and brain bleeding.

Nicolucci says the study’s findings highlight the importance of considering an individual patient’s cardiovascular and bleeding risk when aspirin therapy is being considered.

“Many things influence bleeding risk, including the use of anti-inflammatory pain drugs, other drugs, and even alcohol and smoking,” he says.

Eckel, a professor of medicine, physiology, and biophysics at the University of Colorado in Denver, echoes the researcher’s sentiments.

“We have known for some time that aspirin therapy is associated with a higher risk for bleeding,” he says. “That is why it is so important for patients to understand their bleeding risk before starting treatment.”

Avoiding Insomnia and Daytime Sleepiness

Nearly everyone has days when they feel sleepy. But for some people, excessive sleepiness actually gets in the way of daily work, childcare, and even leisure activities. This is known as hypersomnia, recurrent sleepiness that makes people want to nap repeatedly, even at work.

Not surprisingly, the problem of daytime sleepiness usually starts at night. Even missing just a few nights’ sleep, or not getting enough uninterrupted sleep, can slow you down and sour your mood.

Poor sleep habits are often the cause of daytime sleepiness. Before you go through any more groggy and crabby days, try these 12 ways to improve nighttime sleep and avoid daytime sleepiness.

 

1. Avoid caffeine or energy drinks after noon

2. Get adequate nighttime sleep.

That may sound obvious, but many of us succumb to shaving an hour or two off our sleep time in the morning or at night to do other things. Most adults need seven to nine hours a night, and teenagers usually need a full nine hours. Block out eight or nine hours for sleep every night.

 

3. Keep distractions out of bed.

“Reserve your bed for sleep and sex,” says Avelino Verceles, MD, assistant professor at the University of Maryland School of Medicine and director of the school’s sleep medicine fellowship. “You shouldn’t read, watch TV, play video games, or use laptop computers in bed.” Don’t do your bills or have heated discussions in bed either. They may leave you sleepless.

 

4. Set a consistent wake-up time.

People who have problem sleepiness are often advised to go to bed and get up at the same time every day, including on weekends. But randomly setting an ideal bedtime can lead to more frustration if you suffer from insomnia and already have trouble falling asleep, says Barry Krakow, MD, medical director of Maimonides Sleep Arts and Sciences Ltd. in Albuquerque, N.M., and author of Sound Sleep, Sound Mind: 7 Keys to Sleeping Through the Night.

Instead, Krakow suggests starting out by setting a wake-up time only. “Stick by that for the first few weeks or even months to establish a rhythm,” he says. “That process of always getting up at the same time helps to anchor the circadian rhythm. And if you do that and have a bad night, you’ll also to be sleepier the next bedtime.”

 

5. Gradually move to an earlier bedtime.

Another approach to getting into a consistent schedule is to try going to bed 15 minutes earlier each night for four nights. Then stick with the last bedtime. Gradually adjusting your schedule like this usually works better than suddenly trying to go to sleep an hour earlier.

 

6. Set consistent, healthy mealtimes.

Regular mealtimes, not just regular sleep times, help regulate our circadian rhythms. Eating a healthy breakfast and lunch on time — rather than grabbing a doughnut and coffee in the morning or a late sandwich on the run — also prevents energy deficits during the day that will aggravate your sleepiness. Plan to finish eating meals two to three hours before bedtime.

 

7. Exercise.

Regular exercise (30 minutes a day on most days) offers multiple benefits for sleep. Exercise, especially aerobic exercise, generally makes it easier to fall asleep and sleep more soundly.

Exercise also gives you more daytime energy and keeps your thinking sharp. And if you exercise outside in daylight, you get still more benefits. Sleep experts recommend 30 minutes of exposure to sunlight a day because daylight helps regulate our sleep patterns. Avoid exercising within three hours of bedtime.

 

8. De-clutter your schedule.

“If you don’t think you can allow seven or eight hours for sleep, then you need to look at your schedule and make some adjustments,” says Verceles. “Move some activities from nighttime to early evening or from early to late morning.” Try to eliminate tasks that aren’t really important. Getting enough sleep at night will help you function better during your remaining activities.

 

9. Don’t go to bed until you’re sleepy.

If you go to bed when you’re just tired, you probably won’t be able to fall asleep, Krakow says. “Distinguish between the feeling of sleepiness and being tired. Get into bed when you’re sleepy — eyes droopy, you’re drowsy, you feel like you’re nodding off. It’s a very different kind of feeling.”

 

10. Don’t nap late in the day.

Late afternoon napping can make daytime sleepiness worse if because it can interfere with nighttime sleep.

 

11. Create a relaxing bedtime ritual.

A relaxation routine before bedtime can help you separate from the day — especially from activities that are over-stimulating or stressful, making it difficult to sleep. Try meditation, soaking in a hot bath, listening to soothing music, or reading a book. A cup of herbal tea or warm milk can also be soothing, but skip those if they cause you to wake at night to go to the bathroom.

 

12. Avoid “nightcaps.”

People often think that alcohol helps sleep, but it actually robs you of deep sleep, which is essential for feeling well rested. When the effects of alcohol wear off during the night, you’ll probably be wide awake again.

 

13. Talk to your doctor about having a sleep study.

Daytime sleepiness can be caused by sleep disorders. If you are excessively sleepy consistently during the day even when you sleep well or if you fall asleep without warning during daily activities, you may have a sleep disorder such as narcolepsy or sleep apnea, a breathing problem that occurs during sleep. According to Krakow, undiagnosed and untreated sleep disorders are probably the greatest cause of daytime fatigue and sleepiness.

Problem sleepiness can also be caused by certain illnesses and medications. And mental conditions such as depression, post traumatic stress disorder, and anxiety are very commonly linked to sleep problems.

A sleep specialist can design a treatment program for you that treats the underlying sleep disorder and helps you develop better sleep habits and attitudes though cognitive behavioral therapy. Sometimes it takes a combination of medication and behavioral therapy to eliminate daytime sleepiness, but it can be done.

 

Reviewed on January 19, 2010

© 2010 WebMD, LLC. All rights reserved.

Love Your Heart

Photo: Hands holding a heart

Being smoke-free is important to heart health. This Valentine’s Day, give a special gift to yourself or someone you love. Quit smoking or encourage your loved ones to quit. Now’s the perfect time!

February is filled with heart-clad images celebrating Valentine’s Day. Although the history and evolution of Valentine’s Day are attributed to a number of different legends, what is certain is that February 14 is associated with love, care, and the heart. Nearly 50 years ago, February was designated as American Heart Month, which has further cemented the heart as an ever-present symbol during this month. This national observance raises awareness about the risks of heart disease and lifestyle changes that can reduce cardiovascular risks and promote healthy hearts. The Million Hearts™ Campaign, recently launched by the Department of Health and Human Services to prevent one million heart attacks and strokes over 5 years, is also keeping heart health in the forefront at this time.

Photo: A woman holding a paper heartGiven that February is recognized as a time to celebrate love, caring, and heart health, what better time to improve your own heart health or encourage loved ones to improve theirs by quitting smoking? About 130,000 cardiovascular disease deaths per year in the United States are attributable to smoking. Also, approximately 26% of heart attacks and 12-19% of strokes are attributable to smoking.  The Surgeon General has concluded that cigarette smoking greatly increases one’s risk for heart disease. Being smoke-free and eliminating exposure to secondhand smoke is important to heart health.

Smoking and Heart Health

When you smoke or are exposed to secondhand smoke, cells that line your body’s blood vessels react to the poisons in tobacco smoke almost immediately. Your heart rate and blood pressure go up. Your blood vessels grow narrower. Chemical changes caused by tobacco smoke also make blood more likely to clot. Clots can form and block blood flow to your heart.

Smoking is one cause of dangerous plaque buildup inside your arteries. Plaque clogs and narrows your arteries. This can trigger chest pain, weakness, heart attack, or stroke. Plaque can rupture and cause clots that block arteries. Completely blocked arteries can cause sudden death. Smoking is not the only cause of these problems, but it makes them much worse.

Secondhand Smoke and Heart Health

Photo: A woman holding a roseTobacco smoke hurts anyone who breathes it. When you breathe secondhand smoke, platelets in your blood get sticky and may form clots, just like in a person who smokes. Research shows that even spending time in a smoky room could trigger a heart attack. There is no risk-free level of exposure to secondhand smoke. Even brief exposure can be harmful to your health, especially if you are at risk for heart disease.

Quitting Saves Lives

You have years of life to gain and love to give by quitting smoking. Your risk for heart attack drops sharply just 1 year after you quit smoking. In fact, even if you’ve already had a heart attack, you cut your risk of having another one by a third to a half if you quit smoking. And because secondhand smoke also affects others and can increase their risk for heart attack and death, quitting smoking can help protect your loved ones. Make an effort during this heartfelt holiday to stop smoking and/or to encourage your loved ones to stop smoking.

Support to Quit

Photo: Hands holding a heartFor free quit support, call 1-800-QUIT-NOW (1-800-784-8669; TTY 1-800-332-8615). This service provides free support and advice from experienced counselors, a personalized quit plan, self-help materials, the latest information about cessation medications, and more.

Cessation services and resources are also available online atwww.smokefree.govExternal Web Site Icon. These Web sites provide free, accurate, evidence-based information and professional assistance to help support the immediate and long-term needs of people trying to quit smoking.

Send a Smoke-Free Valentine

Millions of greeting cards are sent each year on and around Valentine’s Day to express love and care. This year, use Valentine’s Day to promote a smoke-free, healthy heart. Send one of the following e-cards to your loved ones who smoke.

Preventing Colds and the Flu is in your hands

 

Following the tips below can cut your flu risk in half.

Wash your hands often (5x a day can help)!)

  • Use soap and water. Use a towel to turn off the faucet and open the door.
  • If there’s no water, use a hand sanitizer that contains alcohol.
For even more protection, talk to your health-care provider about getting a flu vaccine.

Stop the spread of germs.

Cover your nose and mouth with a tissue when you cough or sneeze.

Disinfect solid surfaces at work and home often. (e.g. door knobs, TV remotes, etc.)

Don’t touch your eyes, nose, and mouth.

Avoid close contact with people who have a cold or the flu.

 

Cold Versus Flu

What is the difference between a cold and the flu?

The flu and the common cold are both respiratory illnesses but they are caused by different viruses. Because these two types of illnesses have similar flu-like symptoms, it can be difficult to tell the difference between them based on symptoms alone. In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness, and dry cough are more common and intense. Colds are usually milder than the flu. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations.

How can you tell the difference between a cold and the flu?

Because colds and flu share many symptoms, it can be difficult (or even impossible) to tell the difference between them based on symptoms alone. Special tests that usually must be done within the first few days of illness can be carried out, when needed to tell if a person has the flu.

What are the symptoms of the flu versus the symptoms of a cold?

In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness, and dry cough are more common and intense. Colds are usually milder than the flu. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations.

Preventing seasonal flu: Get vaccinated

The single best way to prevent the flu is to get a flu vaccine each season. There are two types of flu vaccines:

  • “Flu shots” — inactivated vaccines (containing killed virus) that are given with a needle. There are three flu shots being produced for the United States market now.
    • The regular seasonal flu shot is “intramuscular” which means it is injected into muscle (usually in the upper arm). It has been used for decades and is approved for use in people 6 months of age and older, including healthy people, people with chronic medical conditions and pregnant women. Regular flu shots make up the bulk of the vaccine supply produced for the United States.
    • A hi-dose vaccine for people 65 and older which also is intramuscular. This vaccine was first made available during the 2010-2011 season.
    • An intradermal vaccine for people 18 to 64 years of age which is injected with a needle into the “dermis” or skin. This vaccine is being made available for the first time for the 2011-2012 season.
  • The nasal-spray flu vaccine — a vaccine made with live, weakened flu viruses that is given as a nasal spray (sometimes called LAIV for “Live Attenuated Influenza Vaccine”). The viruses in the nasal spray vaccine do not cause the flu. LAIV is approved for use in healthy* people 2 to 49 years of age who are not pregnant.

About two weeks after vaccination, antibodies develop that protect against influenza virus infection. Flu vaccines will not protect against flu-like illnesses caused by non-influenza viruses.

The seasonal flu vaccine protects against the three influenza viruses that research suggests will be most common.

When to get vaccinated against seasonal flu

Yearly flu vaccination should begin in September, or as soon as vaccine is available, and continue throughout the flu season which can last as late as May. This is because the timing and duration of flu seasons vary. While flu season can begin early as October, most of the time seasonal flu activity peaks in January, February or later.

Learn about Who Needs A Flu Vaccine. http://www.cdc.gov/flu/protect/whoshouldvax.htm

Treating colds and the flu is about comfort.

Get lots of rest, especially while you have a fever. Rest helps your body fight off illness.

Drink lots of fluids. This helps loosen mucus.

Soothe a sore throat by gargling with warm salt water. Or try throat spray or lozenges.

Use saline (salt water) nose drops. They loosen mucus and moisten tender skin in your nose.

Avoid alcohol and tobacco. They can make cold symptoms worse.

Use Tylenol® products for fever, body aches, sore throat, and headache.

The FLU Ends with U. Learn more: www.flu.gov

If you have flu symptoms, call your healthcare provider if:

  • you are 65 years or older. pregnant, or have a chronic medical condition, such as asthma, diabetes, or heart disease
  • your illness seems severe
  • you have a young child with flu symptoms

** Remember: Antibiotics don’t help the Flu. If you think you have flu symptoms call your doctor right away.**

 

March Office News

You might notice some new faces when you check-in next time. We’re always striving to improve the quality and efficiency of our patient care, and we hope you find our new people friendly and helpful.

You may also notice that we’re getting busier. There are some primary care doctors in the area who have stopped accepting insurance. This is good for our clinic, but we may have less tolerance for walk-ins and same day appointments on some days. Please keep this in mind if you’re thinking about putting something off until the last minute. We’ll still try to get you in the same day for “urgent care” needs, but the schedule is tightening.

If you are unable to afford the medical care that we provide, try the airport. There you can get a free full-body x-ray, a breast exam and if you mention the word “bomb”,  you’ll get a free prostate exam and a colonoscopy 😉

Health Insurance: Understanding What It Covers

What are “covered services”?

Your health insurance policy is an agreement between you and your insurance company. The policy lists a package of medical benefits such as tests, drugs and treatment services. The insurance company agrees to cover the cost of certain benefits listed in your policy. These are called “covered services.”

Your policy also lists the kinds of services that are not covered by your insurance company. You have to pay for any uncovered medical care that you receive.

 

What is a medical necessity? Is that different from a covered service?

Keep in mind that a medical necessity is not the same as a medical benefit. A medical necessity is something that your doctor has decided is necessary. A medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy.

Insurance companies determine what tests, drugs and services they will cover. These choices are based on their understanding of the kinds of medical care that most patients need. Your insurance company’s choices may mean that the test, drug or service you need isn’t covered by your policy.

 

What should I do?

Your doctor will try to be familiar with your insurance coverage so he or she can provide you with covered care. However, there are so many different insurance plans that it’s not possible for your doctor to know the specific details of each plan. By understanding your insurance coverage, you can help your doctor recommend medical care that is covered in your plan.

 

  • Take the time to read your insurance policy. It’s better to know what your insurance company will pay for before you receive a service, get tested or fill a prescription. Some kinds of care may have to be approved by your insurance company before your doctor can provide them.
  • If you still have questions about your coverage, call your insurance company and ask a representative to explain it.
  • Remember that your insurance company, not your doctor, makes decisions about what will be paid for and what will not.

 

 

What happens if my doctor recommends care that isn’t covered by my insurance?

Most of the things your doctor recommends will be covered by your plan, but some may not. When you have a test or treatment that isn’t covered, or you get a prescription filled for a drug that isn’t covered, your insurance company won’t pay the bill. This is often called “denying the claim.” You can still obtain the treatment your doctor recommended, but you will have to pay for it yourself.

If your insurance company denies your claim, you have the right to appeal (challenge) the decision. Before you decide to appeal, know your insurance company’s appeal process. This should be discussed in your plan handbook. Also, ask your doctor for his or her opinion. If your doctor thinks it’s right to make an appeal, he or she may be able to help you through the process.

Your Diagnosis — get more information

Many internet sources of medical information are not credible or reliable because almost anyone can publish on the internet, yet patients deserve to find out more about their illness if they so choose. One of the very best internet sources for patient-oriented information written in plain English is FamilyDoctor.org

Pain and exercise

If you’re in pain, you may feel a temptation to skip exercising, but there’s excellent medical evidence to support that exercise can help reduce pain and improve your quality of life. Remember, doing something is better than doing nothing…

Total Primary Care | 9188 E San Salvador Dr. #201 | Scottsdale, AZ 85258

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