Acting FAST: A Basic Guide To Strokes

By Intern: Armond Schwartz

It is common to hear people talk about strokes, but what exactly is a stroke? Simply put, a stroke is when a blood vessel going to the brain is blocked, or busts. This causes the brain to be damaged either by lack of oxygen or from having blood where it does not belong. Luckily, only the parts of the brain directly affected are damaged. Unfortunately, sometimes these parts can be critical.  The type and extent of the damage dictates its severity.

There are two main types of strokes: hemorrhagic, and ischemic. There is also a third type of “mini-stroke” called a transient ischemic attack (TIA). Being familiar with the symptoms and risk factors for stroke can result in early treatment, and prevention. These interventions can prevent a stroke altogether, or minimize the damage. Stroke is the 5th leading cause of death in America and up to 80% of strokes are preventable.

Hemorrhagic strokes are the deadliest. They occur when the blood vessels that nourish the brain break or leak into the area on the outside or the brain, or directly into the brain. This type of stroke represents only 15% of all strokes, but is responsible for 40% of all stroke-related deaths. There are blood vessels within the brain as well as blood vessels located in between the brain and skull in a spot called the subarachnoid space. Because the skull creates a closed compartment, a bleed on the outside of the brain will put pressure on the brain and potentially cause damage.  A bleed in the space on the outside of the brain is called a subarachnoid hemorrhage.  A bleed directly inside of the brain is called an intracerebral hemorrhage. In the latter type of stroke, the free blood in the brain directly damages the brain matter.

What causes blood vessels to break? Sometimes blood vessels become weak, and bulge; this is called an aneurysm. These aneurysms can rupture and depending on the location, cause either a intracranial hemorrhage or subarachnoid hemorrhage. Additionally, some people have an improper structure to their blood vessels called an arteriovenous malformation (AVM) which has the potential of breaking, causing either subarachnoid or intracranial hemorrhages.

The other main type of stroke, called an ischemic stroke, is the result of a clog in the blood vessels supplying blood to the brain, thereby, depriving the brain of oxygen. The vessels carrying blood to the brain are called arteries. There are two types of ischemic stroke: embolic and thrombotic. Thrombotic strokes occur when a clot develops inside an artery supplying blood to the brain. Embolic stroke occurs when plaque or a clot from another part of the body enter an artery supplying the brain and blocks the blood flow. Ischemic strokes account for around 87% of all strokes.

The last type of stroke, called a transient ischemic attack (TIA) is like a “mini”-ischemic stroke. This type of insult will resolve on its own, generally within 24 hours. TIAs are not to be taken lightly though, 40% people who have TIAs will go on to develop a full blown stroke. In this way, TIAs can be seen as precursors to strokes. In fact, about 50% of all strokes occur in the days following a TIA.

All of this information sounds quite grim. But if caught early, some types of strokes are treatable. For this reason, it is important to know the signs and symptoms of a stroke.  A sign is something an observer can see, but symptoms are things that can only be felt by someone having a stroke. Stroke signs and symptoms often come on suddenly, and they include: sudden numbness or weakness in the face, arm, or neck; confusion or difficulty understanding speech; sudden trouble seeing in one or both eyes; sudden onset of balance difficulty or dizziness; as well as sudden onset of an unexplainable headache. Depending on the part of the brain effected, signs/symptoms can be present on one or both sides of the body. This sounds like a lot to remember. Luckily, there is an acronym to help:

F: Face Drooping

A: Arm Weakness or numbness

S: Speech Difficulty

T: Time to Call 911

If you or anyone around you displays the first of these three signs/symptoms, call 911 immediately. With strokes, early treatment is critical to limiting their severity. It is important to write down when the signs/symptoms began. If treated within the first 3 hours, ischemic stroke patients can get a medication to break up clots and restore blood flow to the brain, thereby minimizing the damage caused by the stroke. Additionally, there are surgical procedures that can be utilized to achieve the same desired outcome.

Although these treatments can help minimize the damage of strokes, not having a stroke altogether is best. Wouldn’t you agree? That is why familiarizing yourself with the risk factors, and discussing stroke prevention strategies with your doctor is instrumental. Age is a common risk factor; for every decade of life after age 55, your stroke risk doubles. Having a family history of stroke is another risk factor, as is having a previous stroke, heart attack, or TIA. Females have a higher risk of stroke than do males. Additionally, women taking birth control medication or hormone replacement therapy have an elevated stroke risk. African Americans have a higher risk for stroke. Other risk factors include: diabetes, high blood pressure, high cholesterol, heart disease, peripheral artery disease, cigarette smoking, obesity, poor diet, sickle cell anemia, and sedentary lifestyle. If you have some of these risk factors it would be a good idea to talk with your healthcare provider about screening and preventive stroke measures. Anticoagulant and antihypertensive medications can help prevent a stroke. These measures, combined with discontinuing smoking, eating a healthy diet, and exercising regularly can help ensure a healthier lifestyle.

More information about strokes can be found at:

www.strokeassociation.org

www.stroke.org

References:

Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. Stroke. In:Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison’s Manual of Medicine, 18e. New York, NY: McGraw-Hill; 2013.http://accessmedicine.mhmedical.com/content.aspx?bookid=1140&Sectionid=63497791. Accessed January 22, 2016.

Strokeassociation.org. Stroke Treatments. 2016. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/Treatment/Stroke-Treatments_UCM_310892_Article.jsp#.Vq6kw_krKhc. Accessed January 19, 2016.

Strokeassociation.org. Learn More Stroke Warning Signs and Symptoms. 2016. Available at: http://www.strokeassociation.org/STROKEORG/WarningSigns/Learn-More-Stroke-Warning-Signs-and-Symptoms_UCM_451207_Article.jsp#.Vq6khPkrKhc. Accessed January 29, 2016.

Stroke.org. Signs and Symptoms of Stroke. 2014. Available at: http://www.stroke.org/understand-stroke/recognizing-stroke/signs-and-symptoms-stroke. Accessed January 18, 2016.

Stroke.org. Stroke facts. 2014. Available at: http://www.stroke.org/understand-stroke/what-stroke/stroke-facts. Accessed January 16, 2016.

 

Know Your Bones

By Intern: Armond Schwartz

An unfortunate consequence of growing older is that your bones become weaker. Bone strength and density peaks in the your twenties.  As bones lose density they become more brittle and susceptible to fracture. Osteoporosis is a disease of low bone density. Low bone mineral density at levels above the cutoff for osteoporosis can still lead to bone fracture. Osteoporosis is more common in women, but can also occur in men.  In fact, Osteoporosis is the most common bone disease.

Bones are a living part of our bodies. They are continually being rebuilt and broken down. In this way, new bone replaces old or damaged bone. Old bone is recycled and important minerals such as calcium and potassium are used in the biological processes of the body. This continual recycling system remains in balance during youth meaning bone rebuilding equals bone recycling. Generally, around the age of 30-45 this system loses balance and favors recycling over rebuilding. This leads to the loss of bone density. This system falls into even greater imbalance for women after menopause. Although bone seems like a completely solid structure, it is made up of varying degrees of passages and canals. As bone density decreases, the porous open spaces in bones increases. Our body uses minerals build bones, calcium is a primary building block for bones and Vitamin D helps our bodies absorb calcium.  Collagen and potassium are also important for bone health.

National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2014.OR

Osteoporosistreatment.link. Healthy Bone Vs Osteoporotic Bone | Osteoporosis Treatment. 2015. Available at:

http://www.osteoporosistreatment.link/tag/healthy-bone-vs-osteoporotic-bone

Over 9.9 million Americans have Osteoporosis and over 43.1 million Americans have low bone density.  Because of the aging population these figures will most likely increase. Loss of bone density is so common that one out of every two Caucasian women will suffer an osteoporosis related bone fracture. This figure drops to one out of every five for males. The incidence of osteoporosis is lower amongst the African American population.  It is important to understand that both low bone density as well as osteoporosis can lead to fracture.  Other common risk factors for osteoporosis include advancing age, menopause, parental history of hip fracture, low body weight, cigarette smoking, excessive alcohol consumption, sedentary lifestyle, long term glucocorticoid use (steroids such as prednisone), chemotherapy, radiation, low calcium intake, and vitamin D insufficiency. There are many diseases that can increase the risk for osteoporosis, some more common diseases include Rheumatoid arthritis, Lupus, Celiac Disease, Inflammatory Bowel diseases, Diabetes, Hypo/Hyperthyroidism,  Hypo/Hyper Parathyroidism, Depression, and Eating Disorders.

Now that you understand the basics about osteoporosis and the associated risks, you might be wondering how osteoporosis is diagnosed? Osteoporosis and low bone density is diagnosed through a bone density scan. Often, a DXA- dual-energy X-ray absorptiometry scan is used, although, there are additional bone density scanning methods. These scans measure bone density at specific places in your body, such as the hip, pelvis and spine. The bone mineral density is comparted to that of an average young adult of the same gender. This comparison gives a score called a T score.  A T score between -1 and -2.5 means that the person is at risk for osteoporosis, this is sometime called Osteopenia.  A T score below -2.5 means the person has osteoporosis. It is always good to talk to your doctor about your bone health. Your healthcare provider can help you decide when is the right time to begin assessment for osteoporosis. Generally, all women should be tested if they are above 65 years of age, and men should be tested if they are above 70. If you possess risk factors you might be a candidate to begin bone density testing early. It does not hurt to initiate the conversation with your physician after the age of 50 so you can screen for any risk factors early.

The good news is that it there are various ways to help prevent and treat osteoporosis. It might be useful to think of these methods as a pie. The pieces of the pie include diet, exercise, and maybe medication.  The diet slice of the pie focuses on the building blocks of bone: calcium and Vitamin D.  In this way, it is necessary to make sure that your intake of calcium and vitamin D is adequate. Milk and other dairy products, such as yogurt and cheese, are good sources of calcium. 1000 to 1200mg of calcium per day is recommended. Vitamin D fortified milk is a great source of Vitamin D as well as calcium. 800-1000 IU (International Units) of Vitamin D is recommended as well for bone health.  If you are unable to get enough calcium and Vitamin D through your diet it might be necessary to take supplements.

Another slice of the bone health pie is exercise. Weight bearing exercise increases bone density by increasing muscle mass. Some weight bearing exercises include: lifting weights, using tension bands, and using weight machines.  Walking, jogging, and other exercises also help increase bone density. It is best to discuss with your healthcare provider what types of exercises are best for you.  Decreasing alcohol use and discontinuing tobacco products can also decrease the risk for osteoporosis and help to reestablish bone density.

The last slice is medication. Based on your T score your doctor might decide a prescription medication would help with bone health. There are various types of medications, but they all help restore the balance in the bone building and recycling process, in order to increase bone mineral density. Your healthcare provider can help you make an individualized plan to ensure optimum bone health. This plan can include diet, exercise, and lifestyle changes and might include prescription medications. These interventions can help reduce your risk for fracture.

For more information, visit the National Osteoporosis Foundation at http://nof.org/ .

 

 

Bibliography

Askabiologist.asu.edu. Bone Anatomy | ASU – Ask A Biologist. 2016. Available at: https://askabiologist.asu.edu/bone-anatomy.

Lindsay R, Cosman F. Osteoporosis. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 19eNew York, NY: McGraw-Hill; 2015.http://accessmedicine.mhmedical.com/content.aspx?bookid=1130&Sectionid=79753850

National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2014.

Osteoporosistreatment.link. Healthy Bone Vs Osteoporotic Bone | Osteoporosis Treatment. 2015. Available at: http://www.osteoporosistreatment.link/tag/healthy-bone-vs-osteoporotic-bone. Accessed January 1, 2016

Rosen, HN, Drezner, MK. Overview of Management of Osteoporosis in Women. UpToDate, Waltham, MA.

The Hoopla About Movember

By Intern: Armond Schwartz

Movmeber is all about bringing awareness to men’s health issues, like prostate and testicular health. Many people are unaware of the job of the prostate and problems that arise with prostate as we age.  First, what is the prostate? The prostate gland is a male reproductive organ that sits below the bladder. It wraps around the urethra, the tube that carries urine in the penis. The job of the prostate is to secrete fluid during ejaculation to protect the sperm.[i] Because of its position on the urethra, the changes to the prostate can lead to problems with urination. The two biggest medical issues related to the prostate are Prostate Cancer, and Benign Prostatic Hyperplasia (BPH). BPH is the enlargement of the prostate.

So what should you know about these two conditions and when is the right time to begin talking about these issues with your physician? It is always a good idea to initiate conversations with your doctor early. Generally, you should begin discussing prostate issues with your doctor at around the age of fifty. However, if you have a first degree relative who has had prostate cancer, such as a father, or a brother, you should begin talking to your doctor at the age of forty. Also because black men have a higher risk of prostate cancer, they should talk to their doctor about screening at age forty as well.  Also, men who have a diet high in red meat are at an increased risk for prostate cancer.[ii]

What exactly is BPH and who does it effect? BPH is extraordinarily common condition.  In fact, around fifty percent of men in their sixties have BPH. Over ninety percent of men over eighty have BPH. Common symptoms of BPH are difficulty urinating, to urinate often, a weak urine stream, difficulty fully emptying your bladder, and dribbling and leakage after you urinate.[iii] Some men may find it difficult to talk to the doctor about problems concerning urination. It is important because there are treatments, and Prostate Cancer could be the issues. In fact, BPH can be treated both through medication and through surgery.

The other major disease affecting the prostate is Prostate Cancer. Prostate Cancer sounds like a deadly diagnosis, but it can be effectively treated if caught early. In fact, in the United State Prostate Cancer has a ninety-nine percent survival rate at five years.[iv] Prostate cancer is also fairly common. One in six men living in the United States will experience prostate cancer in their lifetime.[v]  Prostate cancer is generally a slow growing cancer so early stage Prostate Cancer does not always produce symptoms. However it is good to know some common symptoms, these include: increased urination, urgency to urinate, bed-wetting, and erectile dysfunction. Less commonly, men notice blood in their urine or sperm.[vi] Because these symptoms are very similar to BPH, you should discuss any symptoms related to urination with your doctor.

Doctors have several tools to screen for prostate cancer. Your doctor can best decided which tests are appropriate. One of the most common is a blood test called PSA. PSA stands for prostate specific antigen, which can help your doctor screen for both BPH and Prostate Cancer. Another common test is the digital rectal exam, during which your doctor will feel your prostate with his or her finger. If either of the tests is abnormal there are additional tests that can help your doctor diagnose Prostate Cancer and discern it from BPH.

It is important to remember that as you age, it becomes common to have issues with your prostate. These problems can lead to problems urinating. This is common, and you should discuss your symptoms with your doctor as treatment might help.  As you approach the age of fifty you should ask your doctor if it is time to begin screening for Prostate Cancer. If you have a father, brother or child who has experienced Prostate cancer, or if you are black, you should talk to your doctor about screening at age forty.  BPH and Prostate Cancer are quite common and the first step towards detection and treatment is an early conversation with your doctor.

[i] Incontinence and Overactive Bladder Health Center. WebMD website. http://www.webmd.com/urinary-incontinence-oab/picture-of-the-prostate. November 15, 2014. Accessed September 17, 2015.

[ii] Papadakis MA, McPhee SJ. Prostate Cancer. In: Papadakis MA, McPhee SJ. eds. Quick Medical Diagnosis & Treatment 2015. New York, NY: McGraw-Hill; 2015. http://accessmedicine.mhmedical.com/content.aspx?bookid=1387&Sectionid=79290098. Accessed September 13, 2015.

[iii] Chao S, Chippendale R. Benign Prostatic Hyperplasia & Prostate Cancer. In: Williams BA, Chang A, Ahalt C, Chen H, Conant R, Landefeld C, Ritchie C, Yukawa M. eds. Current Diagnosis & Treatment: Geriatrics, Second Edition. New York, NY: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com/content.aspx?bookid=953&Sectionid=53375664. Accessed September 17, 2015.

[iv] Chao S, Chippendale R. Benign Prostatic Hyperplasia & Prostate Cancer. In:Williams BA, Chang A, Ahalt C, Chen H, Conant R, Landefeld C, Ritchie C, Yukawa M. eds. Current Diagnosis & Treatment: Geriatrics, Second Edition. New York, NY: McGraw-Hill; 2014.http://accessmedicine.mhmedical.com/content.aspx?bookid=953&Sectionid=53375664. Accessed September 13, 2015

[v] Uptodate page 1. Sartor, AO. Risk factors for prostate cancer. In: UpToDate, Volgelzang, N(Ed), UpToDate, Ross, ME. (Accessed on September, 11, 2015.)

[vi] Chao S, Chippendale R. Benign Prostatic Hyperplasia & Prostate Cancer. In:Williams BA, Chang A, Ahalt C, Chen H, Conant R, Landefeld C, Ritchie C, Yukawa M. eds. Current Diagnosis & Treatment: Geriatrics, Second Edition. New York, NY: McGraw-Hill; 2014.http://accessmedicine.mhmedical.com/content.aspx?bookid=953&Sectionid=53375664. Accessed September 13, 2015

June is Men’s Health Month!

By: Kandace L. West, PharmD, CGP

Consultant Pharmacist, Geriatrics

 

 

Prominent mustaches are on display for Movember (November), but June is men’s health month and a great opportunity to discuss prostate health. It’s a topic that needs more open discussion, because as men age the cumulative lifetime exposure to testosterone increases prostate size. Most men by the age of 80 have an enlarged prostate that can affect quality of life, the condition is referred to as benign prostatic hypertrophy (BPH). The term “benign” indicates that the enlargement is not cancerous, but rather an expected part of the aging process for men. Most men will live with an enlarged prostate (BPH) for the remainder of their lives, and the medications used to treat BPH are primarily used to reduce symptoms (e.g. urinary hesitancy, incomplete urinary evacuation). As a geriatric consultant pharmacist, my focus is on identifying any medications that could be exacerbating BPH symptoms in my male patients, ensuring they understand how the medications work and their potential side effects. Below is a list of the classes of medications that are used to treat BPH and what are some key facts about the medication that are especially important for older male patients:

 

-Alpha Blockers, generic (i.e. alfuzosin, doxazosin, tamsulosin and silodosin): this class of medications are helpful right away to promote urination by relaxing bladder neck and muscles in the prostate. The side effect to be cautious of in older adult men is dizziness. Therefore, be careful and slowly rise when going from a laying down/seated position to a standing position, pausing as needed.

-5 Alpha Reductase Inhibitors, generic (i.e. dutasteride, finasteride): this class of medications take up to six months to effectively ‘shrink’ the prostate by focusing on preventing hormonal changes that affect prostate enlargement. Be sure to swallow pill whole, to prevent irritation in mouth and throat.

-Combination drug therapy: for some men, a combination of alpha blocker and 5-alpha reductase inhibitors are recommended to increase effectiveness.

Please keep in mind that treatment is based on a number of factors (e.g. prostate size, age, overall health, and symptoms, etc). Remember to always discuss concerns regarding new or worsening symptoms, length of treatment and side effects with your physician and pharmacist. You can also find more information on the links below:

https://us.movember.com/mens-health

http://www.menshealthmonth.org/

http://www.cdc.gov/men/nmhw/

http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/definition/con-20030812

http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/benign-prostatic-hyperplasia-bph/Pages/facts.aspx#6

Teach Children to Avoid Toxic Household Products

On March 17, 2014, pharmacist Kandace L. West will educate kindergarten students at Porter Ranch Community School about ways they can avoid harmful products and stay healthy. Dr. West will present safety tips in a short 30 minute educational program that will include storytelling, games, and singing to reinforce the concept of avoiding poisonous substances and always asking an adult before using any products.

This discussion comes during the heart of National Poison Prevention Week, March 16-22nd, 2014, and will focus on the importance of educating children in primary grades (K-1st) to prevent accidental poisonings and drug overdoses.

This is a conversation for both kids and adults. America’s poison centers received over 3 million calls nationwide in 2012 from adults in need of help for a loved one who was exposed to poison, according to the National Association of Poison Centers.  The California Poison Control system reports the most common unintentional poisonings involved common household products including bleach and over-thecounter medication like acetaminophen (generic for Tylenol®).

The age group most likely to be the victim of accidental and unintentional poisonings in California in 2012 were children five years or younger and adults over 26 years of age.

Pharmacists like Dr. West play a tremendous role in providing advice at the National and California Poison Call Centers as well as in our communities to educate children and families about the potential dangers of common household products and medicines.

Poison prevention program at Porter Ranch Community School:

PRCS Kindergarten classes & Transitional Kindergarten

Monday March 17, 8:30-9:30am

12450 Mason Avenue

Porter Ranch, CA 91326

The Older Adult, medications and driving: What we all should know to keep safe.

By: Kandace L. West, Pharm.D.

Medications are a part improving the quality of life for many individuals and in many instances, a means of survival.   On average, 48.5% of Americans take at least one prescription medication and the expected prescription drug use is projected to increase with healthcare reform.[1] Older adults, aged 65 and above are also expected to contribute to this trend; taking on average roughly 14 prescription medications per year today.[2] According to the US Department of Transportation’s Federal Highway Administration, in 2011 the older adult, aged 65 and older, was 16% of licensed drivers on the road.[3] All of this serves as a reminder of the reality that more people are driving under the influence of prescription medications and over the counter products, and we just may not realize it.

Many of us residents in southern California can remember that fatal incident that occurred in Santa Monica, where an older adult motorist drove his car through a crowded open-air market on the Third Street Promenade. The motorist was 86 years old and there was a possibility of medications being involved in the accident. On October 20, 2006 the motorist was found guilty of 10 counts of vehicular manslaughter, and the trial brought attention to safety risk posed by elderly drivers.[4] The unfortunate reality is that prescription medications are very powerful and can be dangerous if taken not as directed.

As a Medication Care Pharmacist I am always taking the time to remind individuals that medications have the potential to do great good and harm. Some can cure people of diseases such as pneumonia, help someone live their life and go to work by alleviating otherwise debilitating pain, or help an individual survive a once terminal illness such as cancer. Prescription medications if taken correctly have the ability to improve an individual’s health and ultimately their quality of life, but if taken incorrectly, medications have the ability to harm not only to the individual themselves, but in some case others as well. So if you, your friends, or loved ones, are taking prescription medications, what are some things that you should know and do to keep safe, especially while driving?

(1)    Be aware that some Over-the-Counter (OTC) medications can impair your ability to drive safely. The number one culprits are sleep aids, anti-allergy medications and cold-flu products. Medications like Benadryl/Diphenhydramine that are often found in many OTC sleep aids, anti-allergy medications and cold-flu products can make someone feel drowsy, dizzy, sleepy, and have blurred vision. In the older adult population, they are more likely to feel confused and disoriented. If you are at the local pharmacy selecting any OTC product be sure to take the time and stop to ask the pharmacist if the medication you selected is okay to take while driving. Professional advice is always the best when it comes to what OTC product to take. So ask your doctor or the pharmacist, to ensure your safety before you buy an OTC product.

(2)    Other prescription medications that may impair driving include prescriptions for anxiety, some antidepressants, pain relief, and any products containing codeine. Many of these prescription medications will have a caution or warning label printed such as “do not operate heavy machinery,” or “may cause drowsiness, or dizziness,” and it is especially important to understand what these mean. If you a receiving a prescription medication from your doctor be sure to ask them about taking the prescribed medication and if it is okay to drive before you fill it at the pharmacy. Also, be sure when you are picking up your prescription at the pharmacy to tell the pharmacist of all OTC products, prescription medications, herbals, and supplements that you are taking because they may interact with the medication and increase the side effects of dizziness, drowsiness, sleepiness, and other unwanted effects.

(3)    If you are taking any medication it should be your responsibility to know how your body reacts to the medication and monitor your side effects. Part of that means that you have a conversation with your doctor and pharmacist for what side effects to expect, but also listen to your body and pay attention to any reaction to the medication so that you can notify both your doctor and pharmacist. This may seem very simple, but some individuals may be so busy, that they do not take the time to reflect on how their body is reacting to the medication. Your observations of how your body reacts to the medication may be useful insight for the doctor or pharmacist so that adjustments can made in the therapy (i.e. reduce dosage, change the class of medication, alter administration route or frequency, etc.) that will benefit you and ultimately keep you safe.

To learn more about how to keep safe with prescription medication use and driving please visit the following sites below for more information:

http://seniordriving.aaa.com/medical-conditions-medications/how-medications-can-affect-driving-ability-roadwise-rx

http://www.dmv.org/how-to-guides/medications-and-driving.php



[1] (Centers for Disease Control and Prevention, 2012)

[2] (American Society of Consultant Pharmacists, 2013)

[3] (US Department of Transportation, 2011)

[4] (CBS News, 2009)

Accepting the “New Challenge”

By: Kandace L. West, Pharm.D.

People are now living longer with HIV due to increases in research and development for antiviral therapies and now – possibly – prevention therapy for HIV infection for high risk groups (i.e. Tenofovir, read more here http://www.medscape.com/viewarticle/805739). This has led to a surprising problem not previously contemplated for people with HIV: how to live well and enjoy life while also controlling their disease? So while HIV/AIDS is no longer the terminal diagnosis it once was, no one would argue that it would be far better to not have to battle it at all. Therefore, the “New Challenge” is not only increasing awareness for this disease for the older adult population so as to prevent its spread, but also how to provide support for individuals with this disease, which is challenging enough at a younger age. September 18th is National HIV/AIDS and Aging Awareness Day and in honor of that, understanding the risk factors for what places an Older Adult at risk for HIV helps to prevent it from occurring and increase awareness.  So let’s talk about risk factors for HIV in the Older Adult:

(1)   Lack of awareness: For the older adult, there is a fundamental disconnect with who they see as the face of those infected. Posters and advertisements to get tested usually display younger counterparts – hip, youthful, and active. Never is an older adult considered at risk for the disease, even though there are a growing number of people living well into their older adulthood with the disease or being infected with HIV as an older adult in their 40s, 50s, 60s, or even 70s. Also, an older adult who already may be struggling with isolation associated with older age will perhaps be further distanced from others by the diagnosis of HIV.

(2)   Least likely to have protected sex: For the older adult, many grew up in a time when both condoms were rarely used, and HIV was not part of the Sexually Transmitted Disease flora. Fact was the only diseases that were heavily considered were those that were luckily curable: Chlamydia, Gonorrhea, and Syphilis. This previous experience, cemented in their consciousness, coupled with the ordinary discovery that menopause makes conception impossible, and at last drowned in the dangerous misconception that the older adult population is least likely to get HIV, are all the reasons why HIV/AIDS has so effortlessly claimed so many older adults.

(3)   Medications: The older adult man is likely to be taking pharmaceuticals such as Viagra or Cialis. A research study by Medical News today (04/30/2007) found that a third of sexually active men taking Viagra were unlikely to use protection despite not being in a relationship. Again, this ties into beliefs about protected sex, but also medications play a role in stimulating sexual activity. Those substances that impair judgment (e.g. illicit drugs, certain prescription drugs, and alcohol) may also have a role in increasing the risk for HIV when combined with sexual activity in the older adult population.

(4)    No routine testing in Primary Care: Do I need to explain this? Most primary care physicians do not routinely test for HIV; I think it should at least become part of an annual exam for individuals over 50? Ask for it during your next doctor’s appointment.

You can find more info about HIV and Aging here    http://aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/taking-care-of-yourself/aging-with-hiv-aids/

Needles, Shots and the Older Adult: Do they need Vaccines?

By: Kandace L. West, Pharm.D.

Needles, needles, needles . . . who can honestly say that they like to get a shot- anyone?  Most people are creeped out by the thought of needles, shots and blood! But, scheduled vaccinations are an important part of healthcare, especially for kids, and more importantly as we age for the Older Adult. The question I most often get as a Medication Care Pharmacist who specializes in geriatrics is: “why do I need to get shots? didn’t I get all of mine when I was a kid?” This question provides an excellent opportunity to explain the importance of vaccinations on an individual and a global healthcare level.

The first point is that immunizations are needed in our society because if administered to everyone, some diseases can become rare if not extinct. According to the CDC (Centers for Disease Control and Prevention), the greatest example of this is polio or diphtheria. For someone born today in the U.S., it is very rare to contract or develop these diseases.[1] This is because the U.S. has employed a strong effort to vaccinate against these diseases very early on and for those of us born here in the U.S. we often times have unknowingly experienced the luxury of vaccinations as an infant or during our childhood. However, there are many people in other parts of the world, who are less fortunate.

On a side note, The Bill & Melinda Gates Foundation helps to address the unfortunate odds for people born in other countries that cannot afford to provide vaccinations for their citizens. The Foundation is committed to eradicating a number of vaccine preventable diseases. For example, the Foundation has reduced the number of polio cases by more than 99%, saving 10 million children worldwide from polio’s lifelong debilitating paralysis.[2] The humanitarian effort produced by the Bill & Melinda Gates Foundation is tremendous because they are reducing the number of people affected by vaccine preventable disease and will in the near future eradicate this and other diseases from infecting and harming people worldwide.

http://www.gatesfoundation.org/

So, the next point is that although vaccines are routinely administered to children, there are a number of vaccine preventable illnesses in Older Adults. Getting recommended vaccines for Older Adults reduces complications and death from many vaccine preventable diseases. According to the CDC there are the 4 recommended vaccines for the Older Adult[3]:

http://www.cdc.gov/vaccines/adults/rec-vac/older-adults.html

(1)    Annual Influenza (Flu) vaccine: The flu is a very common illness that is usually seasonal (October-March). Every year the vaccine is tailored to protect against the most common strains of Flu anticipated to infect people worldwide. For this reason, it is important to get the Flu vaccine annually because it only provides coverage for that Flu season, becoming obsolete thereafter. Flu shots can be administered conveniently at community pharmacies without an appointment, and no longer requires a physician’s prescription.

(2)    Shingles Vaccine: Anyone who has had chicken pox as a child can get shingles as an adult due to reactivation of the virus that lies dormant in the body and many times, unfortunately it tends to be more serious in the older adult. This is because of the reduction in the body’s immune function that naturally occurs as we age. Shingles affects more than 1 million Americans who are 60 years and older, and often times 20% of the Older Adults who get shingles are left with long-term debilitating pain even after the rash heals and is resolved.

(3)    Tetanus, diphtheria, pertussis (Tdap) Vaccine: Each one causes a different disease. Tetanus is a serious bacterial infection that is painful and affects the muscles and nerves. Diphtheria is a serious bacterial infection that causes sore throat and swollen glands. Pertussis causes whopping cough that can be spread to infants and kids who are not immunized. This 1 shot reduces the risk of getting any of these 3 harmful infectious diseases and prevents its spread to others.

(4)    Pneumococcal Vaccine: This shot protects against bacterial infections in the lungs, blood, and brain. It can also prevent complications from the disease, including death, especially for many Older Adults who are more at risk.

There are some rare individual instances where vaccinations may not be given to an individual due to serious allergies, or previously experienced rare but serious side effects. But, for the majority of people in our population, it is not an issue and these vaccinations are pivotal in preventing and spreading disease. I hope that this emphasizes the importance of vaccinations not only for individuals here in the U.S., but for humanity worldwide and for our most vulnerable populations: children and the – equally important and often overlooked – Older Adult population.



[1] (Centers for Disease Control and Prevention, 21)

[2] (Bill & Melinda Gates Foundation, 2013)

[3] (The Centers for Disease Control, 2011)

SPF: Spells Summer

By: Kandace L. West, Pharm.D.

Summer is officially here! For Older Adults sun can be overwhelming and too much is never good. Short term sun exposure increases risk of dehydration and long term exposure for skin cancer. Protective clothing is one of the best ways to stay covered and protected from the sun. Never underestimate the value of a broad brim hat, thin long sleeves and pants, sunglasses, and if possible shade or a tent. If you will be participating in outdoor activities this summer, do you know the best sunscreen to get? It can be a little confusing and there certainly are many products out there when visiting the sunscreen shelf at the store.

So what is important when buying sunscreens for summer?

(1)    SPF: Sun Protection Factor is the most important number to know. The good thing is that there have been some new changes by the Food and Drug Administration (FDA) for sunscreen labeling. The minimum SPF that is now required to be sold for sunscreens is SPF 15. You will not find any sunscreens with an SPF less than 15. This is great, but American Academy of Dermatology recommends that most people purchase sunscreen with SPF 30.

http://www.aad.org/dermatology-a-to-z/health-and-beauty/general-skin-care/sun-protection/is-sunscreen-safe

 

(2)    UVA/UVB: UltraViolet light rays are also very important to know. Fortunately the FDA has made the decision making process on UVA/UVB easier. The easiest way to remember is UVA is for Aging and UVB is for Burning. You want a sunscreen that protects from both the sun’s harmful rays that cause long term skin damage and/or aging (UVA) as well as sunburn (UVB). Again, the FDA has made this decision making process easier by ensuring that all sunscreens sold have coverage for both UVA/UVB and refers to sunscreens having “BROAD SPECTRUM” coverage.

http://www.fda.gov/forconsumers/consumerupdates/ucm258416.htm

 

(3)    Waterproof/Sweatproof and all related terms out there. Be aware of the time frame needed to reapply. Many sunscreen users make the mistake of applying only once, because of the “Proof” term and get burned as a result! Always apply sunscreen 15 minutes before going outside or participating in water sports and re-apply often! Be sure to read the label as to when the sunscreen will need to be re-applied and keep track of time.

 

(4)    Check Expiration Dates! Most people often have the same old bottle in their bathroom or medicine cabinet and do not check the expiration date before using sunscreen. Please check the date before using and dispose if it is expired. It will not provide protection from the sun if it is expired.

 

Enjoy the summer!