Dr. Deb

30 people have died thus far because a drug was contaminated with essentially mold due to lack of sterile conditions at the plant where the drug was made. A fungus contaminant found in injectable steroids called preservative-free methylprednisolone acetate produced by The New England Compounding Center is believed to have infected 419 patients with meningitis and joint infections killing 30 people at last count according to the CDC. How did this happen? Do you know if the drugs your health care provider gives are safe?

What appears to be the root of the problem is The New England Compounding Center calling itself a compounding pharmacy when is reality they were acting like a drug manufacturing plant, without FDA regulation.

What is the difference between a drug manufacturing pharmacy and a compounding pharmacy?

The major difference is the FDA strictly regulates a drug manufacturing pharmacy while a compounding pharmacy is not under FDA jurisdiction. State pharmacy boards oversee compounding pharmacies but the amount of oversight varies from state to state and many are self-regulated, meaning we don’t see change until there is a problem.

Don’t throw the baby out with the bath water as some compounding pharmacies provide an incredible service. The idea of a compounding pharmacy is for the pharmacist to brew up specific treatments for individuals with a doctor’s prescription that may not be manufactured by major drug companies.  This happens every day in hospital IV therapy. I have used my local compounding Kunkels Pharmacy for hormones such as testosterone, estrogen and progesterone many times and have great faith in their techniques and quality assurance. Compounding drugs are also of great use when there is shortage of medication.

Since the FDA is not regulating the pharmacies, many times the patient and the doctor do not know the quality and safety of the compounded products dispensed unless they have personally investigated their quality assurance methods like I did with my pharmacy.

The New England Compounding Center took advantage of this lack of regulation and instead of a Mom & Pop pharmacy, they set up as a drug manufacturing plant producing 17,000 units of the steroid. They are supposed to have a prescription for each one so they were most likely in violation of their state license. Many of the doctors in the 23 states that received the drug may not have realized the steroids were compounded and not strictly regulated.

Dr. Deb’s Tips for Safer Medications

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160,000 kids will stay home from school today, not because they are sick, but because they are afraid of being bullied. One in every four kids gets bullied and it takes a village of support to stop it. Tomorrow is Unity Day where we ask you to wear ORANGE to unite and end bullying.

Bullying is not just the big kid that steals lunch money from the nerd at recess.

Bullies come in all shapes and sizes and may even be your own child. It can be the seemingly sweet petite girl that starts rumors or intentionally leaves someone out. Using friendship as a weapon as in, “I won’t be your friend if you don’t ….,” is a form of bullying. Even a “joke” or  “I was just kidding,” is an indirect form of bulling. Cyberbully or posting mean things online takes bullying to a new level because you don’t see the reaction of the person that you have hurt.

Parents, students and teachers all have a role to play to unite and prevent bulling.

Dr Deb’s Tips to Prevent Bullying

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Flags are flying, bunting is up, summer is in full swing and we are just waiting to set off the fireworks off. I love 4^th of July so I am updating my safety tips. They are similar to 2 years ago but the difference is this year, I will actually follow them.

Days after I wrote my blog in 2010, my 5-year-old nephew became a burn statistic when he grabbed the hot end of a sparkler. Like you, we had done sparklers our whole lives without incident so didn’t really think they could cause so much damage. It may feel awkward and you may even receive some slack for making kids wear a life jacket in your pool or discouraging fireworks but I thought about speaking up and I didn’t. Fireworks, pools, cocktails all mean summer but in an instant can turn dangerous, even deadly, so don’t ignore these safety tips.

Dr. Deb’s 4th of July Safety Tips

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On average, 38 children die every year when left alone in a car. Inside car temperatures can rise 20 degrees within 10 minutes, even on a mild day in the 70s. On a day like today with a temp of 95, your car may be 115 degrees within 10 minutes. Most of these deaths happen when overwhelmed parents are distracted and “forget” or don’t realize how a quick errand can turn deadly. This happened close to home when a vice principal of a local school forgot her child was in the car on the first day of school, as her husband normally dropped the baby off at daycare. She was distracted and overwhelmed, like many parents are but her baby lost her life because of it.
Why are cars so dangerous for heat stroke?

The sun gets trapped within in the car, bouncing off the surfaces allowing car temps to rise quickly, especially cars with dark interiors. Within 10 minutes the car will increase 20 degrees and almost 30 degrees within 20 minutes. On a day like today with a temp of 90 your car may be 110 degrees within 10 minutes. That quick little errand can turn deadly. Contrary to popular belief, cracking the window does not dramatically decrease the temperature or protect children.

Children cannot regulate their body temperature as well as adults so they warm at a rate of 3-5 times faster than adults. They can quickly have signs of heatstroke dizziness, confusion, hot dry skin; rapid heart beat hallucinations and loss of consciousness. Core temps of 107 are deadly as internal organs shut down.

Dr. Deb’s Car Hyperthermia Prevention Tips

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Most people do not plan to go to the hospital, and if they do, they may think to pack shampoo and a toothbrush. While I hate to have my color stripped by institutional shampoo, I have some far more important tips to have a safe stay and speedy recovery that you can start TODAY!

Dr. Deb’s Helpful Hospital Hints

1.Have the Discussion with ALL your family

Many times we are scheduled to go to the hospital, but often we end up there as an unpleasant surprise. Today is Valentine’s Day and one of the best gifts you can give to your loved ones is to advance planning for medical emergencies. This is not just for the elderly, but for all.

A Living Will gives advance directives for different medical scenarios and a Durable Power of Attorney for Health Care allows one person to make more specific choices if you cannot speak for yourself. In a crisis there are so many emotions and often it is the family member that feels most distant that will try to go against your wishes to resolve whatever existing conflicts they may have. Making your wishes clear to ALL family members today is essential. Every state has different forms and you can download them here.

2. Prepare a Medical Folder

Make a medical folder that contains copies your Living Will and Durable Power of Attorney for Health Care in addition to a current medication list, including herbal remedies, with doses. Key word is current.  It is also helpful to have a list of medical problems, past surgeries, allergies and a list of specialists with their phone numbers. Include your latest diagnostic test that is pertinent to your medical problems such as recent echocardiogram or EKG. Put this in a folder but keep a small copy in your wallet as well or consider an electronic record on a flash drive. My Chart is a medical record keeping system offered my many doctors’ offices and hospitals, which securely stores your medical information. You can logon via a website and they even have iphone and android apps.

3. Make it Safe

One of the biggest problems in medicine is the fragmented system. You must watch to be sure mistakes are not being made.

Write on your body yes and no on the limbs that are to be operated on.

Bring your own medications in a zip lock bag so you have them. Hospitals are often slow so you can take your medication from home if the hospital does not have it, but don’t take anything until you talk to your nurse.

Ask your nurse about what medication is being dispended EVERY TIME. Tell them your allergies EVERY time you are given medication to be certain there is not a conflict.

4.  Be your Best Advocate

Ideally we would all have a medical advocate that would know your medical history and all your medications but actually YOU are your best advocate. Don’t be afraid to speak up and ask questions.

A PEN AND PAPER is a must. Write down all the medicine they are giving you as well as the names and occupations of all the people that enter your room.

Most doctors only round once a day and usually when you are sound asleep in the early morning. Have a list of questions ready and take notes on the plan. Ask your doctor what test and medication changes will take place that day. You can double check that everything is carried out with your nurse throughout the day.

5. Be Nice

You catch more flies with honey and certainly being nice to the staff goes a long way. While it is important to be assertive, nurses have many patients and too much paper work so being kind and courteous is the best way to get their attention. Ask for your nurse’s name and how long their shift is. I also never found a nurses station that didn’t like treats so if you are generous it will come back to you tenfold.

6. Be Comfortable

Creature comforts are important so if you have time prepare a little bag or these can make great gifts if friends are admitted to the hospital.

Lip balm and Normal saline for the nose are critical as the hospital is so dry.

Ear plugs & Eye mask, as the hospital is not the place to rest with all the monitors and activity.

Glasses, hearing aids, and dentures so you can see, listen and eat.

Stool softener is critical for anyone taking pain medication. Ask for one as soon as you are given any narcotics or put some in your medication bag.

Hand gel, wipes and lotion will help you feel clean.

Pillow from home.

Personal Computing devices with caution: laptop, cell phone and iPod PLUS CHARGERS are great to have but there are sticky fingers in hospitals so don’t bring them unless you have an advocate that can watch them for you.

Toiletries; the hospital has shampoo and toothbrushes but you may like our own.

Ask for a private room: it is hard enough to get rest but with a roommate you never know how much noise they or their visitors will make. The cost of a private room is usually not that high and well worth the peace.

7. Get out of Dodge

The best way to get healthy is to get out of the hospital as soon as possible. This is not a spa vacation and requires work. Use inhaled sprirometry to open lungs and prevent infection. Walk as soon as they will let you. Ask your nurse to remove urinary catheter and IVs as soon as possible. For more tips read my previous blog on Surviving your Hospital Stay.

Happy Valentine’s Day! Instead of candy or flowers, give the gift of love and peace of mind.

Dr. Deb