Too Stupid to Be Free?

Do politicians really feel that passing laws to change the SIZES of soft drinks will actually combat the obesity problem faced in the US? British researchers have been arguing that overpopulation discussions shouldn't be limited to head counts but should also factor in the weight of people. America is GUILTY of being a part of the heaviest nations in the country. New York City and now Cambridge, MA is starting the political process of passing laws that demonstrate that we as consumers know less about what's good for us. North America has 6% of the world's population, but guess what? We have 34% of world biomass due to obesity. Obesity equals money and a drain on the entire health system. I believe that corporations could start changing things at work. Since we are a country at work, including a lot of women, we could start changing the menus at cafeterias. We could start changing the menus at fast food restaurants. The problem I have with the idea of government mandating this is the argument that is essential to more or less government. Does government know better than me when it comes to decisions about my health? Does government believe that it can decide for me? This is a loss of freedom, but at the rate things are going, it's obvious that the freedoms Americans have been allowed to enjoy (eating a large fry at McDonald's and a supersize coke, for example) might be taken away in the future.

For example, where I work, there is a salad bar, but the main food is pretty unhealthy. The portion sizes given could easily feed 2-3 people. This is in a hospital. Just upstairs from this cafeteria, cardiac bypasses are being performed to try to correct the very result of the damage caused by genetics and more often our diets. Irony at best. I'm guilty. Believe me, I struggle with my own weight being about 5'7" and around 150 lbs today is a little too much weight for my frame. I know that my IBW is 133 lbs. This means that I am 17 lbs overweight. Seriously. I believe it, too. Yes, I look thin to some, I suppose, but that is because of what I'm compared to. If the majority of Americans are overweight and obese, well there you go.

So basically, if the entire world was as heavy as we are, that would be equivalent to an extra 1,000,000,000 people.

Put less in your mouth. Move. PLEASE. Please before government mandates it. Though, at this point while sitting in Panera and blogging and seeing the people around me -- maybe it's time we lose a little freedom for the common good of people.

Maybe we are too stupid to be free.

I guess

Pass the Ritalin Please

Methylphenidate.  Ritalin.  Concerta.  Etc...  THE MOST PRESCRIBED MEDICATION FOR KIDS AGES 12-17. What in the world?

I guess I'm kind of shocked and then again, maybe I'm not as shocked.  ADHD is on the rise.  There's no doubt about it.  I worry about it in my own children, and I also worry that I'll dismiss any possible behavior ADHD-like to just being a kid.  I waver between the parents that over react to those that don't.

I remember when I was in pharmacy school, we would joke around that Sesame Street caused ADHD.  If Sesame Street caused it, you know that crazy shows like Yo Gabba Gabba with seizure-like strobes and constant music in your face jumping from topic to topic will cause it!  There are links to video games and ADHD.  There are links to TV and ADHD.  Scary considering even my vehicle has a TV in it helping to ease the kids on the way to visit the grandparents.

But, then there's the argument of what ADHD even is.  I know in retail pharmacy, a pharmacist has GOT to be able to juggle several different things at once.  I remember having a telephone in my ear, writing something down, and answering someone at the register all simultaneously.  I am a multitasking extraordinary gal.  But even on webmd, look at these signs of adult ADHD:

1.  Adult ADHD Problem No. 1: Difficulty Getting Organized

For people with ADHD, the increased responsibilities of adulthood -- bills, jobs, and children, to name a few -- can make problems with organization more obvious and more harmful than in childhood. While some ADHD symptoms are more annoying to other people than to the person with the condition, disorganization is often identified by adults struggling with ADHD as a major detractor that affects their quality of life.

SERIOUSLY?  There are not enough hours in the day to be organized with two small children and a full-time job.  I bet that the majority of all parents fall into this category.

2.  Adult ADHD Problem No. 2: Reckless Driving and Traffic Accidents

Attention deficit hyperactivity disorder makes it hard to keep your attention on a task, so spending time behind the wheel of a car can be difficult. ADHD symptoms can make some people more likely to speed, have traffic accidents, and lose their driver’s licenses.

Speeding?  Ok, yes I may find myself rushing to work because there was an epic meltdown at the daycare and I am late for work.  Especially since I clock in to work.  Seriously?  Let's not even mention most of the moms out there or a lot of them that text and drive.  Ok, so maybe I haven't had a traffic accident or lost my license, but maybe I was just lucky.

3.  Adult ADHD Problem No. 3: Marital Difficulties

Many people without ADHD have marital problems, of course, so a troubled marriage shouldn’t be seen as a red flag for adult ADHD. But there are some marriage problems that are particularly likely to affect the relationships of those with ADHD. Often, the partners of people with undiagnosed ADHD take poor listening skills and an inability to honor commitments as a sign that their partner doesn’t care. If you’re the person suffering from ADHD, you may not understand why you’re partner is upset, and you may feel you’re being nagged or blamed for something that’s not your fault.

Marital problems?  This again is vague.  You are going to have marital problems trying to juggle all that is life.

4.  Adult ADHD Problem No. 4: Extreme Distractibility

Attention deficit hyperactivity disorder is a problem with attention regulation, so adult ADHD can make it difficult to succeed in today’s fast-paced, hustle-bustle world. Many people find that distractibility can lead to a history of career underperformance, especially in noisy or busy offices. If you have adult ADHD, you might find that phone calls or email derail your attention, making it hard for you to finish tasks.

Uh... yeah.  This is me.  But isn't this everyone????

5.  Adult ADHD Problem No. 5: Poor Listening Skills

Do you zone out during long business meetings? Did your husband forget to pick up little Jimmy at baseball practice, even though you called to remind him on his way home? Problems with attention result in poor listening skills in many adults with ADHD, leading to a lot of missed appointments and misunderstandings.

Ok, so maybe hubby forgot because he was up all night with a teething toddler?  Maybe I zone out during meetings because I'm just TIRED.  Ever think of that one?

6.  Adult ADHD Problem No. 6: Restlessness, Difficulty Relaxing

While many children with ADHD are “hyperactive,” this ADHD symptom often appears differently in adults. Rather than bouncing off the walls, adults with ADHD are more likely to show restlessness or find they can’t relax. If you have adult ADHD, others might describe you as edgy or tense.

Who has time to relax?  I'm still trying to organize as in #1!!!

7.  Adult ADHD Problem No. 7: Difficulty Starting a Task

Just as children with ADHD often put off doing homework, people with adult ADHD often drag their feet when starting tasks that need a lot of attention. This procrastination often adds to existing problems, including marital disagreements, workplace issues, and problems with friends.

I can start a task... it's finishing!!!

THE LIST GOES ON.

So basically I'm just trying to point out that life with small children and working is going to make any adult seem to be suffering from these symptoms.  Children?  I believe that so much more is expected of them at school and they are fighting within themselves to listen and be still during school.

We are RUSHING to use medications as a quick fix.  How about find out WHY little Johnny is having trouble at school?  How about some behavioral therapy?  How about having a good school?  How about not just turning to medications that have some pretty bad side effects?  You don't want to stunt your kids' growth right?  Methylphenidate may slow children's growth or weight gain. Your child's doctor will watch his or her growth carefully.  Along with other side effects listed on the link above.

We need to take this study seriously.

Memorization, the Power of Mnemonics

Now that I have committed to the large mental task of taking on the BCPS exam, I'm finding memorization for the sake of memorization to be lacking. Rather than waste the moments I have studying repeating over and over what organisms doxycycline covers, I've started creating this microorganism world mentally that will connect all aspects through the use of mnemonics. Another technique I've debated is the use of songs. But creating songs still requires more memory time. Oh, and a different part of the brain.

Three things: association, memorization, and location. So, for example let's say that we want to memorize community acquired pneumonia (cap). I imagine a room full I healthy men wearing caps and their choices are a macrolide or doxycycline. To memorize the macrolide I imagine them with macro lenses (macrolide) and they are shooting pictures of dachshunds on cycles (doxycycline). They have no other illnesses going on, and the treatment is at least five days.

See the technique? Men wearing caps, no other underlying illnesses to interfere with shooting macro images of dachshunds on cycles.

You may never forget it! Or at least I hope I don't come October.

Google mind maps to gain more information about these techniques!

Distracted Driving

I don't know about you, but lately on my commute to work, I have been paying attention to the number of drivers are distracted while driving. Whether it is actually reading a book while speeding down the interstate or texting and driving, it seems the trend is increasing. I have to make a concerted effort myself at times not to pick up my phone while my car is moving forward, though I still struggle during red lights!

I can remember way back in high school when the dangers were alcohol or even the one teen nearby who had reached way down to retrieve a CD to play while on a deadly curve and crashed ending her life. Back then, we didn't have cell phones so readily available.

Today, a typical teenager sends and receives about 100 texts per day, and more than half of all teens surveyed according to the CDC who released the results from an anonymous survey recently, state they text and drive.

Perhaps with the recent ruling of a Massachussets teenager to be criminally held responsible for texting while driving things may change. Aaron Deveau was sentenced to 2 1/2 years behind bars with a year to serve and the remainder suspended for the deadly crash that happened in February 2011 taking the life of a 55 year old man and seriously injuring his girlfriend. Deveau must also serve 40 hours of community service and surrender his driver's license for 15 years. He was only 17 years old when the crash occurred.

One split moment. One second.

If this doesn't send a message of the implications of making such a decision to text and drive, I'm not sure what can. I know it does me.

Bath Salts Turn Man Into Cannibal?

Seems like a lot of news agencies are jumping the gun on the "zombie attack" in Miami, FL's toxicology results. I have read at least five different news blurbs blaming "bath salts.". The way the articles are written one could assume its a definite assumption considering he removed his clothes and was attacking some innocent guy so heinously. It couldn't be anything else right? Actually dextromethorphan can cause this (at toxic levels), ecstasy or MDMA, and cocaine. Bath Salts are similar, so thus the comparison, plus a headline claiming bath salts did this makes for good publicity over just talking about bath salts.

One website even falsely claimed bathing in those salts produced the effect. Incorrect. It is the usual snorting, smoking, injecting, or ingesting that causes the effect.

Mephedrone, MDPV (3,4-methylenedioxypyrovalerone), methylone (3,4-methylenedioxymethcathinone), 4-fluromethcathinone, or 3-fluromethcathinone. These chemicals are so dangerous when ingested that the DEA used an emergency measure to list bath salts as a Schedule I narcotic that expires this September.

The bigger question is why would a person want to take something that could cause extreme paranoia, psychotic symptoms, hallucinations, delusions, teeth grinding, headaches, erratic behavior, visual impairment, and erratic behavior.

But let's wait until the toxicology results are back before we jump the gun. I'm putting my money on a mixture of substances.

The Sun-kissed Glow; The Precancerous Glow

It's that time of year again.  Summer.  Although it is not June 21st yet, it is that time of year where millions of people take a weekend vacation to the beach.  Including my family.  I noticed right away that one of my children seemed to be glowing a bit red where I had missed applying sunscreen.  Not good.  Her little area beneath one eye is pink now and puffy and to be honest, I just don't even look at tans the way I used to. I hate to admit that once upon a time in my teens and twenties, I coveted and regularly paid for tanning appointments.  A tan made me feel thinner which I desperately wanted to be.  My mother regularly tanned as well, though she won't now thanks to a brush with squamous cell carcinoma.  Seriously, if you tan or love to tan, give it up.  It's just not worth it later in life.  Hers looked like a wart.  I think she has at least 10 stitches?  Whatever the outcome, it is not worth it.

So, of course when you get to the beach and see hundreds of people flocking to the beach, you wonder... do people know about sunscreen?  Do they realize that the sunscreen industry is changing and that the FDA is also changing things?

Go ahead and lose the word sunscreen first.  Currently, sunscreen standards relate to UVB sun exposure, the primary cause of sunburns and a contributor to skin cancer and premature aging. Under the FDA's new rules, the sunscreens will also have to be tested and labeled to disclose UVA protection. Radiation from this type of sun ray is more deeply penetrating, passes through windows, and is linked to skin cancer and early aging.

This summer, if the FDA determines that a sunscreen protects both from UVA and UVB, it will be labeled broad spectrum.  Sunscreen will no longer be able to say they are waterproof or sweat proof.  No more labeling that a sunscreen can stay on longer than two hours without reapplying.

The playing field is about to become level, and it is most definitely time.

I personally use Blue Lizard Sunscreen, and I can't say enough good things about it.  My dermatologist recommended it, and I use it daily on my face!

Aeromonas Hydrophila

CNN LINK: So I had to embark upon understanding this flesh eating necrotizing fasciitis causing bacteria that has the life of Aimee Copeland on hold and on a ventilator in a hospital in Augusta, GA.   Only 24 years old, Aimee fell from a zip line and had a gash in her leg that was stitched up only to return to an ER a few days later with a bigger issue.  Necrotizing fasciitis.

Aeromonas hydrophila is a heterotrophic, Gram-negative, rod shaped bacterium, mainly found in areas with a warm climate. This bacterium can also be found in fresh, salt, marine, estuarine, chlorinated, and un-chlorinated water. Aeromonas hydrophila can survive inaerobic and anaerobic environments. This bacterium can digest materials such as gelatin, and hemoglobin. Aeromonas hydrophila was isolated from humans and animals in the 1950s. This bacterium is the most well known of the six species of Aeromonas. It is also highly resistant to multiple medications, chlorine, and cold temperatures.

Because of Aeromonas hydrophila’s structure, it is very toxic to many organisms. When it enters the body of its victim, it travels through the bloodstream to the first available organ. It produces Aerolysin Cytotoxic Enterotoxin (ACT), a toxin that can cause tissue damage.

Most of the time, this organism causes gastroenteritis.

Aeromonas is usually found in freshwater and marine environments; it is most prominent in the Northern Hemisphere during the warmer months. The skin of the lower extremities is the most common site of infection, usually after traumatic exposure to contaminated water or soil. Aeromonas infection and cellulitis often develop within 8 to 48 hours of exposure, and systemic signs are common. Manifestations may include hemorrhagic bullae, subcutaneous bleeding, and purpura.

Aeromonas is typically highly susceptible to penicillins combined with β-lactamase inhibitors, second- and third-generation cephalosporins, aminoglycosides, and fluoroquinolones.

When patients do not respond to antibiotics for presumed common cellulitis, it may be prudent to obtain further imaging such as CT or MRI of the affected limb to rule out soft tissue collections, soft tissue emphysema, and necrotizing fasciitis. Surgical debridement may be indicated for deep soft tissue infection, necrosis, and purulent collections that are inadequately draining.

I do hope Aimee makes a full recovery.  You can follow here progress here.

Depakote and Abbott's $1.6 Billion Mistake

Abbott never had FDA approval to promote Depakote for aggression and agitation in the elderly or schizophrenia. The total includes a criminal fine of $700 million and civil settlements with the states and federal government totaling $800 million. Abbott pleaded guilty to a criminal misdemeanor for misbranding the medication. Abbott is also going to pay 45 states $100 million to resolve liability with consumer protective laws. Luckily the Justice Department found no deaths due to this crime.

The company admitted that from 1998 through 2006, it "maintained a specialized sales force trained to market Depakote in nursing homes for the control of agitation and aggression in elderly dementia patients, despite the absence of credible scientific evidence that Depakote was safe and effective for that use," the Justice Department said in a news release.

"In addition, from 2001 through 2006, the company marketed Depakote in combination with atypical antipsychotic drugs to treat schizophrenia, even after its clinical trials failed to demonstrate that adding Depakote was any more effective than an atypical antipsychotic alone for that use."

Heaphy said Abbott earned about $13 billion from Depakote sales during the period investigated, but he said it was difficult to determine how much of that was the result of sales for illegal purposes. He expressed confidence that, once the fines are factored in, Abbott will not have profited from the improper practices.

Um... Ok. $13 billion minus $1.6 billion equals a profit.

No wonder this will keep happening.

AAFP Says No to Safe Use Class of Drugs

AAFP Says No to 'Safe Use' Class of DrugsBy Emily P. Walker, Washington Correspondent, MedPage Today Published: May 01, 2012

WASHINGTON -- The American Academy of Family Physicians (AAFP) has voiced its opposition to an FDA proposal that would allow pharmacists to dispense some drugs without a prescription.

Currently, the FDA approves drugs either as prescription or nonprescription, but the agency is considering adding a third class of drugs called "safe use" drugs, which would be regulated much as over-the-counter drugs are now, but with extra controls.

"The AAFP recognizes the important role of pharmacists in the provision of high quality healthcare; however, this proposed new paradigm would allow patients to receive powerful prescription drugs without the input of a physician," Roland Goertz, MD, chairman of AAFP board, wrote in an April 30 letter to FDA Commissioner Margaret Hamburg.

In a notice published in February, the FDA said it is considering a "new paradigm" where drugs that would normally require a prescription could be available without one if they met certain "conditions of safe use."

Those conditions could include restricting them to sale behind the counter at a pharmacy, or requiring an initial prescription but allowing refills at the patient's request.

Examples cited by Janet Woodcock, head of the FDA's Center for Drug Evaluation and Research, might be EpiPens or glucagon -- both of which are prescribed for possibly life-threatening conditions and which patients can easily find themselves without when they're needed.

Moving some prescription drugs into safe use status could allow patients to skip visits to the doctor, which the AAFP opposes.

"Only licensed doctors of medicine, osteopathy, dentistry, and podiatry have the statutory authority to prescribe drugs ... . Allowing the pharmacist authority to dispense medication without consulting with the patient's physician first could seriously compromise the physician's ability to coordinate the care of multiple problems of many patients," Goertz wrote in the letter to Hamburg.

In March, the FDA held a public meeting on its proposed plan and heard from stakeholders such as the AAFP, the AMA, which is also opposed to the safe use category, and the American Pharmacists Association (APhA), which is in favor of adding this third category of drugs.

Thomas Menighan, CEO of the APhA, said creating a safe use category could greatly improve access to drugs because pharmacists are the most easily accessed healthcare provider for many patients.

In addition to improving access for patients, reducing routine doctor's visits could free up physicians to spend more time with sicker patients, "reduce the burdens on the already overburdened healthcare system, and reduce healthcare costs," the February FDA notice read.

When nicotine replacement therapy changed from requiring a prescription to being over-the-counter, tens of thousands of people quit smoking, which represented a $2 billion annual "societal benefit," Scott Melville, CEO of the Consumer Healthcare Products Association, a trade group for over-the-counter drugmakers, said during the FDA's public meeting.

In addition, making heartburn medicines available without a prescription saves the healthcare system $757 million each year, according to Melville.

In order for the FDA to consider switching a drug from prescription to nonprescription, it must meet certain criteria, including that it must not be addictive; it must not have significant toxicity if overdosed; and users must be able to self-diagnose conditions for appropriate use and be able to safely take the medication without a physician's screening.

Presumably some of those same requirements would apply to drugs moved from prescription status to the new safe use status.

During the March public meeting, an ob/gyn argued that birth control pills -- especially progestin-only pills -- meet those criteria and should be available without a prescription.

The FDA is seeking comments on the proposal.

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My take? We have more drug training than physicians. It's all about the $.