Thursday, September 27, 2012

National Drug Take-Back Day

If you have expired, unused, or unneeded drugs in the house, the Drug Enforcement Administration (DEA) wants to make it easier for you to dispose of them. Saturday, September 29th has been designated as National Drug Take-Back Day and sites throughout the United States have been designated to take your unwanted drugs for disposal. Drugs may be turned in at these sites from 10 a.m. to 2 p.m.

Can one day really make a difference? During the last Drug Take-Back Day on April 28, 2012, over 276 tons of unwanted or expired medications were turned in for proper disposal. Law enforcement offices as well as other locations were some of the 5,600 sites that were made available to turn in unwanted drugs. During the four Drug Take-Back Days that have been conducted so far, over 1.5 million pounds of unwanted drugs have been removed from circulation.

Why not just flush them down the toilet? Many drugs can be thrown in the household trash and it may be appropriate for a few drugs to be flushed down the toilet. Flushing is recommended for the small group of medicines that may be especially harmful, or even fatal, if they are ingested by someone other than in whom they were prescribed. Most of this group of drugs are narcotic pain medicines. When flushing is recommended, specific disposal instructions will be included on the drug label or in the accompanying patient information sheet. It may be best, however, to dispose of these medicines through a drug take-back program.

What if no instructions for disposal are available? If no instructions are given on the drug label the safest thing to do is to take them to a take-back program site. If there is no take-back program available in your area, drugs can be thrown in the household trash but the Federal Drug Administration (FDA) advises that you:
  • Take them out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to people who may intentionally go through your trash.
  • Put them in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag.
Why the concern about unused drugs? Keeping unused drugs in the home represents a risk for unintentional use or overdose as well as for illegal abuse of certain drugs, such as narcotic pain relievers. Additionally, concerns have been raised about trace levels of drugs found in rivers and lakes, and in some community drinking water supplies. The FDA, however, contends that most of the trace amounts of medicines found in water systems to date are a result of the body's natural routes of drug elimination.

Drug take-back programs for disposal are the best way to remove expired, unwanted, or unused medicines from the home and to reduce the chance that others may accidentally take the medicine. To find a collection site near you, go to the DEA search page and click the 'Find a Collection Site Near You' button then enter your zip code, county, or city. Alternately you can call 1-800-882-9539 to find out the nearest National Drug Take-Back Day disposal site.

Friday, September 21, 2012

Detecting and Treating Actinic Keratoses

Following the abuse a summer's worth of sun can deliver to the skin, now is a good time to review the features of a common skin condition related to ultraviolet exposure, actinic keratosis (AK). This is particularly important since AKs are considered to be pre-cancerous with a certain percentage of them advancing into squamous cell skin cancer.

What is an AK?  Actinic keratosis, also known as solar keratosis, is a skin lesion that develops on sun-exposed areas of the body such as the face, arms, backs of hands, and lips. They are often rough in texture, resembling warts, and may be felt before actual changes of the skin are noted. Their color can range from flesh-toned to brown or red. Most are small, less than a half inch across. Up to 10% of AKs will advance to become squamous cell skin cancer. Most AKs cause no symptoms, but itching or burning at the site of the skin lesion may be reported.

Who gets AKs? The most current estimate is that up to 58 million Americans have AKs. Most of these people are over the age of 40, since AKs tend to develop slowly following years of sun exposure. They are seen more often in people with fair skin and lighter hair color, but anyone who has had significant sun exposure can get them. AKs also occur more commonly in people with an impaired immune system, such as someone who has had an organ transplant or is on medications to suppress the immune system. The recent trend to use sun lamps or tanning booths has contributed to an increase in the number of AKs that occur each year.

How are AKs diagnosed? Experienced examiners can often make the diagnosis by just looking at the skin lesion. In some cases, a skin biopsy may be necessary to distinguish an AK from skin cancer.

How are AKs treated? Once skin lesions are confirmed to be AKs, it is best to have them removed since it is impossible to know which ones could become cancerous. The following are some of the most commonly used methods for AK removal:
  1. Topical Medications. These include the FDA-approved medications, 5-fluorouracil (brand name Efudex, others), Imiquimod (brand name Aldara), and a newer medication Ingenol mebutate (brand name Picato). 5-FU ointment or liquid is the most widely used topical medicine for AKs and is effective for visible AKs as well as for those that are not yet apparent. Imiquimod 5% cream works by stimulating the immune system to destroy the lesions. Ingenol mebutate is a gel that is applied for only 2 or 3 days, depending on the concentration of the gel and the location on the body being treated.

  2. Destructive methods. These include freezing (cryotherapy), scraping (curettage), and burning (cautery). When freezing AKs, a cold substance, such as liquid nitrogen, is applied to the skin lesion. This kills the cells of the AK (along with some normal tissue). As the skin heals, the AK typically does not come back. Curretage requires the use of local anesthesia to numb the skin before using sharp instrument called curettes to scoop out the AK. It is usually done in conjunction with electrodessication, a procedure involving electrical current to kill any remaining AK cells. This last step is similar to cautery which uses electricity to “burn” away AKs.

  3. Photodynamic therapy involves applying a solution (5-aminolevulinic acid) to the skin that makes it more sensitive to light. Following this, a light source (typically a type of laser) is used to activate the medication that then selectively destroys the AKs. Following healing, new healthy skin appears.

  4. Chemical peeling is perhaps best known as a treatment for facial wrinkles or other signs of aging. In this procedure a chemical, such as tricholoracetic acid, is applied to the skin with resulting sloughing of the top layer of skin, along with the AKs.
Can AKs be prevented? Since the damage delivered through UV rays from the sun is cumulative, the development of AKs may be inevitable. Nevertheless, here are some of the ways to help prevent AKs from developing:
  • Avoid being in the sun during the peak hours for UV exposure between 10 AM and 4PM. Don't forget that snow and water can concentrate the sun's rays and increase the risk of burning.
  • If sun exposure is unavoidable, use a broad spectrum sunscreen that is effective against UVA and UVB radiation with a SPF of 30 or higher.
  • For extra protection wear long sleeves and long pants and a wide-brimmed hat.
  • Avoid tanning beds or lights. Despite claims of tanning bed companies and booths, the radiation (predominantly UVA) in the lights that they use increase your risk of developing AKs and skin cancer.

In order to detect AKs or skin cancer in their earliest stages, check your skin regularly and let your doctor know if you notice any suspicious lesions. Look particularly for changes in existing moles or for the development of new skin growths.

Monday, September 17, 2012

Healthy Words of Wisdom

Some of our greatest writers and thinkers, while not medical experts, per se, have provided some of the most profound health advice.

"A man's health can be judged by which he takes two at a time ... pills or stairs."  
~ Joan Welsh
Regular Stairsphysical activity is one of the most important things you can do for your health.  Some of the most important health benefits from getting regular exercise include:
  • Controlling your weight

  • Decreasing your risk of developing heart disease

  • Reducing your risk for developing type 2 diabetes

  • Improving bone density and strength

  • Reducing your risk of developing certain types of cancer

  • Increasing your chances of living longer

"A sad soul can kill you quicker, far quicker, than a germ."  
~John Steinbeck
Certain types of stress, in particular "social stressors" such as divorce or the death of a loved one, can lead to depression along with an increased risk of developing diseases such as hypertension and heart disease.  Two mechanisms have been proposed for this.  This first is behavioral through sleep deprivation, lack of exercise, and unhealthy eating practices.  The second is via the body’s endocrine system with the release of "stress hormones" that adversely affect various biological systems in the body.  Similarly, depression commonly accompanies chronic physical conditions and, if not addressed, can result in a worse outcome than in someone who has a more optimistic outlook.  The following are some of these medical conditions and the percentage of time that they are accompanied by depression:
  • Chronic Pain - 30-54%

  • Heart attack - 40-65%

  • Stroke - 10-27%

  • Cancer - 25%

  • Diabetes - 25%

"More die in the United States of too much food than of too little."  
~John Kenneth Galbraith
People whose weight is greater than what is generally considered to be healthy are labeled as overweight or obese.  For adults, these labels are determined by using weight and height to calculate a number called the "body mass index" (BMI).  Anyone with a BMI of 25 or greater falls into the overweight or obese category.  This increases your risk of developing the following conditions:
  • Heart disease and stroke

  • Type 2 diabetes

  • High blood pressure

  • Liver and gall bladder disease

  • Sleep apnea and respiratory problems

  • Osteoarthritis

  • High cholesterol

Around the year 47 BC, a prescription for healthy living was provided by Aulus Cornelius Celsus, writer of the medical encyclopedia, De Medicina.  This prescription holds up pretty well today:
  "Live in rooms full of light
Avoid heavy food
Be moderate in the drinking of wine
Take massage, baths, exercise, and gymnastics
Fight insomnia with gentle rocking or the sound of running water
Change surroundings and take long journeys
Strictly avoid frightening ideas
Indulge in cheerful conversation and amusements
Listen to music."

Friday, September 7, 2012

Hantavirus, who's at risk?

The Centers for Disease Control (CDC) recently announced that up to 10,000 people who visited Yosemite National Park this summer were at risk for developing an infection caused by Hantavirus.  Most of these potential victims stayed in the Park’s tent-cabins that, unbeknownst to Park authorities, had been infested with mice that carry the potentially fatal virus.  Since the span of time from exposure to development of symptoms can take as long as 5 weeks, those who may have been exposed were warned to watch carefully for symptoms and to see their doctors at the first sign of infection.

Hantavirus may be carried by several species of rodents including the deer mouse, the white-footed mouse, the rice rat, and the cotton rat.  The virus causes no harm to the host rodent but if contracted by humans can cause a deadly disease called Hantavirus pulmonary syndrome (HPS).  Initially identified in the “4-corners” region of the American southwest, Hantavirus has now been reported in more than 24 states in the continental United States, Canada, and South America.

Most often, Hantavirus infections develop in humans after they have inhaled the virus following disturbance of an infected mouse’s nest or when urine or droppings containing the virus are stirred up and released into the air.  Direct transmission after touching contaminated nesting materials or droppings and then touching eye, nose, or mouth can also occur.

Who’s at risk:  Hantavirus infections can occur in anyone who comes in contact with contaminated mouse droppings, urine, saliva, or nesting materials.  Activities that place someone at particular risk include:
  • Living or sleeping in houses or outbuildings that are infested with mice or rats infected with the Hantavirus.  This is particularly true if the structure has been closed for a period of time.
  • Using mice-infested trail shelters or the tent-cabins such as those at Yosemite National Park, when camping or hiking.
  • Housekeeping that involves cleaning up mice droppings.  This may be a problem particularly in the winter when mice tend to seek shelter indoors.  Vacuuming dropping or nesting materials is not recommended since this could release the virus into the air.
  • Working in mouse infested areas, such as crawl spaces, attics, basements, or between walls of the house.  Plumbers, utility workers, and pest-control personnel may be at particular risk while working in these areas.
What are the symptoms of a Hantavirus infection?  Symptoms typically develop between 1 and 5 weeks following exposure to the virus. Initially, people manifest flu-like symptoms, including fever, muscle aches, vomiting and diarrhea.  This can progress rapidly to HPS that causes cough, extreme shortness of breath, and shock (circulatory collapse).  In its most severe form, HPS progresses to kidney failure and death.

How are Hantavirus infections diagnosed?  Since the onset of HPS can develop fairly quickly, it is important to see your doctor if you think that you could be infected.  Flu-like symptoms, along with a history of exposure to potentially infected rodents, should alert the doctor to the possibility of this infection.  In addition to a physical exam checking particularly for lung involvement, laboratory testing including a complete blood count (looking especially at the number and type of infection-fighting white blood cells), kidney and liver function tests, and an x-ray of the chest are typically done.  Confirmation of a Hantavirus infection can be done by looking for antibodies to the virus or with a special test known as polymerase chain reaction (PCR).

Can Hantavirus infections be cured?  Not always, in fact, up to 50% of people with HPS die.  Current treatment is primarily supportive in nature by providing intravenous fluids, oxygen, and if necessary, mechanical breathing.  With certain complications of HPS, an anti-viral medication known as ribavirin may be used, although it has not been shown to be effective in all cases.

Prevention of Hantavirus infections: The CDC has offered the following recommendations for people to help avoid contracting this infection:
  • When opening an unused cabin, shed, or other building, open all the doors and windows, leave the building, and allow the space to air out for 30 minutes.
  • Return to the building and spray the surfaces, carpet, and other areas with a disinfectant.  Leave the building for another 30 minutes.
  • Spray mouse nests and droppings with a 10% solution of chlorine bleach or similar disinfectant. Allow it to sit for 30 minutes.  Using rubber gloves, place the materials in plastic bags.  Seal the bags and throw them in the trash or an incinerator. Dispose of gloves and cleaning materials in the same way.
  • Wash all potentially contaminated hard surfaces with a bleach or disinfectant solution.  Avoid vacuuming until the area has been thoroughly decontaminated.  Then, vacuum the first few times with enough ventilation.  Surgical masks may provide some protection.
For a complete rundown of ways and measures for avoiding mouse or rat infestations including how to keeping mice out of your home, how to safely trap and remove mice, and how to clean up mouse nest and droppings, go to the CDC’s website for more information.