National Prescription Drug Take-Back Day

If you have expired, unused, or unneeded prescription drugs in the house, the Drug Enforcement Administration (DEA) wants to make it easier for you to dispose of them.  Saturday, September 26th has been designated as the 10^th annual National Drug Take-Back Day.  Sites throughout the United States have been chosen for unwanted prescription drug disposal from 10 a.m. to 2 p.m.

Can one day really make a difference?  The DEA has tried to make the process of prescription drug disposal as convenient as possible by assigning thousands of collection sites throughout the country. Since Take-Back Days were instituted, more than 4.1 million pounds (over 2,100 tons) of prescription 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 the drugs in this group 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.  In general, however, it is best 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, the Federal Drug Administration (FDA) advises that you to take the following steps:

1. Take your prescription drugs out of their original containers.
2. Mix drugs with an undesirable substance, such as cat litter or used coffee grounds.
3. Put the mixture into a disposable container with a lid, such as an empty margarine tub, or into a sealable bag.
4. Conceal or remove any personal information, including Rx number, on the empty containers by covering it with permanent marker or duct tape, or by scratching it off.
5. The sealed container with the drug mixture, and the empty drug containers, can now be placed in the trash.

Why the concern about unused drugs?  Keeping used prescription 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.

Prescription 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 enter your zip code, county, or city.  Alternately you can call 1-800-882-9539 to find out the nearest National Prescription Drug Take-Back Day disposal site.

Managing anxiety without medications

From time to time, everyone experiences anxiety.   We worry about our security, our families, our jobs, and our health. Often, these fears are appropriate and help to keep us and our loved ones safe and secure.  But when anxiety develops without provocation or persists when the threat or concern is no longer present, counterproductive thought patterns and physical symptoms can develop. The effect of anxiety on our mental state can result in loss of energy, withdrawal, confusion, inability to think clearly, and sleep disruption. Physical symptoms produced by free-floating anxiety include increased heart rate, trembling, weakness, hives, and difficulty breathing.   A number of medications are available for treating anxiety.  Many people, however, would prefer to manage their anxiety without medications. Even those on anxiety-reducing medications may need additional help from time to time. Fortunately, there are a several methods of managing anxiety that do not involve taking medications.

1.  Refrain from having negative thoughts.   One trait shared by many people with an anxiety disorder is having negative thoughts or imagining the worst possible outcome. For example, hearing about someone who developed cancer brings about a fear of developing cancer themselves.  Cognitive-behavioral therapy is a field of psychology that focuses on the ways that we think or interpret situations.  An important principle of cognitive therapy is learning to analyze things more objectively.  For example, in an anxiety-provoking situation, you can ask yourself---what is it about this situation that is upsetting?  Is there any real danger or cause for concern to me?
 
2.  Address unhealthy lifestyle traits. Our lifestyle can also affect how effectively that we deal with anxiety.  Some people use alcohol, caffeine, or nicotine as short-term solutions for their anxiety. In the long run, however, self-medicating with these substances is usually counterproductive.  Anxiety can interfere with sleep, and many people with an anxiety disorder use medications to help them sleep. Unfortunately, chronic use of sleep medication can lead to dependence and lack of quality sleep. Substitutes for sleep aids include taking a warm bath, meditating, or reading until sleepy. Getting adequate sleep recharges your brain and improves your focus, concentration and mood, and allows us to better address potentially stressful situations.

3.  Learn to relax.  Although relaxing may come easy to some people, those who suffer from anxiety may have a hard time stepping away from anxious thoughts.  Relaxation may come in the form of reading books, watching movies, or taking a long walk. There are also specific techniques for promoting relaxation that appear to work through a reduction in activity in the sympathetic nervous system. This serves to decrease blood pressure, heart rate, and muscular tension. Mastering relaxation techniques to treat anxiety requires practice and may require training from a professional. Some of the most commonly practiced methods of relaxation are:

• Progressive muscle relaxation (PMR). In PMR, you deliberately contract and then relax certain muscle groups. When the contraction is over, you turn your attention to noticing how the muscles relax as the tension flows away. This allows someone practicing the technique to appreciate the difference between tense and relaxed muscles.  PMR usually starts with the muscles in the feet and progresses up the body to end with the muscles in the face.
   
• Autogenic training. Instead of tensing and relaxing muscles as in PRM, autogenic training, involves imaging that certain parts of the body are becoming warm or heavy while breathing deeply and slowly.  Autogenics also involves the use of encouraging or positive messages during the relaxation process, such as "my heartbeat is calm and steady" or "I feel supremely calm".
   
• Meditation. Meditation is an ancient technique for encouraging relaxation. The word meditation comes from the Latin word meditari which means to concentrate. There are a number of types of relaxation, but most involve focusing on something specific, such as a word, a sound, or on one's own breathing.  Most major religions have included some form of meditation into their practices. 
   
• Guided imagery. In guided imagery, the imagination is used to create relaxing images.  The specific image is usually one that is particularly enjoyable or relaxing, such as lying on the beach.  Often more than one sense is incorporated into the image, such as the sound of the surf, the smell of salt air, and the breeze coming off of the ocean.  When under stress, people who practice this technique are able to "retreat" to their special place.

4.  Get moving!  Exercise is one of the healthiest self-care measures for anxiety. Virtually any form of exercise, from aerobics to weightlifting, will work. In addition to boosting the production of mood-enhancing neurotransmitters called endorphins, physical activity has also been shown to improve self-esteem and reduce symptoms associated with anxiety and depression.  Some forms of exercise, such as yoga or tai-chi, provide both meditative as well as exercise benefits.  Taking a walk can even serve as a means of breaking out of a vicious cycle when negative thoughts or free-floating anxiety tries to take control.

5.  Share your anxious thoughts with someone. Talking to a close friend, family member, counselor, or religious advisor about your anxieties is another way to gain a different perspective from your own.  Issues that seem insurmountable may become less overwhelming with another's insight.  A counselor may also be able to offer behavioral strategies that will enable you to better manage anxiety-provoking situations and thoughts. Group therapy with other people suffering from anxiety disorder can provide some reassurance that you are not alone.

Are asthma cases on the rise?

Asthma is a chronic lung disease characterized by episodes of airflow obstruction known as asthma attacks.  During an asthma attack, small muscles surrounding the airways contract, resisting the flow of air into and out of the lungs. Inflammation and swelling of the airways is also a consistent feature among asthmatics.  Asthma attacks can be triggered by a number of factors including cold air, exercise, infection, allergens, occupational exposures, and airborne irritants such as tobacco smoke. Symptoms of asthma include wheezing, coughing, shortness of breath, and chest tightness.

Statistics indicate that the number of people with asthma in the U.S.  appears to be on the rise. According to the Centers for Disease Control and Prevention (CDC), about one in 12, or about 25 million people in this country has asthma.  This number is up from around 20 million people with asthma as recently as 2001.  Of those diagnosed with asthma, the greatest rise in asthma rates affects African American children.

Two questions pertaining to asthma have puzzled medical researchers over the past couple of decades: 1) what causes asthma to develop in the first place and 2) what is responsible for the increasing incidence of people with asthma?

What causes asthma? The answer to this question remains unanswered.  Doctors know the "triggers" for asthma attacks, such as cold air, exercise, cigarette smoke, etc., but the reasons that asthma develops in people is still being researched. Fortunately, even though there is no cure for asthma, treatment is available to manage the disease and in many cases, prevent its symptoms.

Why is asthma on the rise? Although a definite explanation has not yet been found, several theories for the increased incidence of asthma have been developed.

1. A leading theory is known as the 'hygiene hypothesis'.  This theory suggests that living conditions in this country might be so clean that children are not being exposed to germs that teach their immune systems to tell the difference between harmless and harmful irritants. Although not universally accepted by the medical community, this concept is supported by studies that show that children living around animals on farms or attending daycare develop fewer allergic diseases.
    
2. The rise in asthma cases may also be due to an increase in environmental allergens and irritants. These include airborne pollens which appear to be increasing due to global climate change and “urban pollution” such as ozone and particulate matter from industry and car traffic.
    
3. Some studies have found evidence suggesting that obesity predisposes to the development of asthma.  It is not clear, however, whether this is related to body weight alone, or perhaps due to a less active lifestyle which could affect lung strength and function.
    
4. Some research indicates that increased use of certain medications, particularly antibiotics, contributes to the increase in asthma. Researchers suggest that early antibiotic use changes the bacterial flora, which impacts the development of allergic diseases such as asthma.

While the underlying causes for asthma and reasons for the increasing percentage of Americans with asthma are still under investigation, the Centers for Disease Control (CDC) are doing the following to help reduce the burden of this disease:

• Instituting measures to improve indoor air quality for people with asthma through smoke-free laws and policies.
   
• Teaching patients how to avoid asthma triggers, such as tobacco smoke, mold, pet dander, and outdoor air pollution.
   
• Encouraging doctors to prescribe inhaled corticosteroids for all patients with persistent asthma, and to use a written asthma "action plan" to teach patients how best to manage their symptoms.
   
• Promoting measures that prevent asthma attacks, such as increasing access to corticosteroids and other prescribed medicines.
   
• Encouraging home environmental assessments and educational sessions conducted by doctors, health educators, and other health professionals.

IMHO--Antibiotics and URIs

Recently, I wrote a Health Tip on the topic of "Summer Colds".  That particular tip was actually inspired by the viral upper respiratory tract infections that both my wife and I experienced a few weeks ago. While I usually try to avoid writing in first person in my Health Tips, an interesting side issue related to these infections has prompted this editorial consideration.
     
As mentioned in the article on summer colds, the common cold can be caused by more than 200 different viruses, with most of them belonging to class of virus known as rhinoviruses. During warmer
months, however, another class of virus, enteroviruses, becomes more prevalent.  While both rhinoviruses and enteroviruses produce typical cold symptoms (runny nose, sore throat, etc.), enterovirus infections appear to last longer and are more likely to be associated with certain symptoms such as headache, fever, diarrhea and conjunctivitis (pink eye).

Although there was some variation in the types of "itis-es" experienced by my wife or me, between us we pretty much covered the bases with pharyngitis (sore throat), otitis (ear ache), conjunctivitis (pink eye), bronchitis (cough), sinusitis (facial pain) and/or neuritis (skin hypersensitivity).  Almost certainly these symptoms were manifestations of a "summer cold".
 
While both of us have completely recovered from our infections, what has prompted this Health Tip is the repeated question that we received from family or friends (some of whom are in the medical field) when they found out that we were sick-----"Are you taking antibiotics?" 
 
With rare exception, viral upper respiratory tract infections are 'self-limited', meaning that they will resolve on their own in about a week.  Treatment for the most part is directed at specific symptoms, such as acetaminophen for fever or muscle aches or a decongestant for nasal stuffiness.  Antibiotics are ineffective at shortening the duration or severity of a viral infection such as the common cold.  In fact, inappropriate use of antibiotics has been responsible for causing a number of serious problems including the development of antibiotic resistance, allergic reactions, and diarrheal infections caused by a bacterium known as Clostridium difficile.
   
Antibiotic resistance in particular is considered to be one of the world's most pressing public health problems. The number of bacteria resistant to antibiotics has increased in the last decade, in large part because of inappropriate antibiotic usage. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. The resulting drug-resistant bacteria may not respond to treatment with previously effective antibiotics. This can lead to serious infections that require more expensive antibiotics including those that can only be delivered through an intravenous line.  There have been many instances in which resistant bacterial infections have resulted in hospitalization and even deaths.
 
In general, viral respiratory tract infections come on fairly quickly and are not associated with high fever or severe symptoms, such as shortness of breath, neck stiffness or coughing bloody phlegm.   Persistent symptoms that last more than a few days or symptoms that worsen after initial improvement suggest that the infection may be bacterial.  If in doubt about what has caused your infection or if you think that an antibiotic may be needed, by all means see a health care professional.  But don't just ask for antibiotics---find out from your doctor the most likely cause for the infection and learn about the most appropriate treatment.

In a nutshell, doctors should only prescribe antibiotics when a bacterial (rather than viral) infection is suspected, and should choose the specific antibiotic that is most likely to be effective for the bacteria responsible for that infection.  Colds, flu and most cases of sore throat or runny nose do not need antibiotics. They are caused by viruses and in most instances the body is able to combat the infection on its own.

Similar to other challenges in life such as losing weight or becoming physically fit, there is no magic pill that provides a shortcut to recovery from a cold.  It never hurts, though, to live a healthy lifestyle and have a strong immune system!