Sally Fraleigh, a former registered nurse living in Maple City, Michigan, prided herself on being independent. At 82, with severe diabetes, disc degeneration and macular degeneration that caused some visual impairment, she was still able to live alone. But she was having increasing trouble seeing the small print on her insulin (injectable diabetes medication) bottles. One day, distracted by her dog’s barking, she mistakenly gave herself a large dose of her “short-acting” medication instead of the intended large dose of “long-acting” medication. Within minutes, the mix- up had plummeted her blood sugar to a seriously low level. “Fortunately, I realized my mistake right away,” says Sally. “I drank some juice with sugar and called the ambulance, and I was treated in the emergency room.” Sally is not alone in her experience. According to the Agency for Healthcare Research and Quality (AHRQ), 1.9 million people become ill or injured from medication errors (with both over-the-counter and prescription medications) each year. And this figure represents only those people who are hospitalized or who are treated in the emergency department as a result of the error. While many of these medication mistakes are made by healthcare professionals, consumers also play a part in making errors – and they can play an important role in preventing them, too. Here are five common medication mistakes and tips for how to prevent them:

Know Your Numbers:

Medications are removed from your body by your liver and your kidneys, which is the reason you should be aware of how well these organs are working, says Robert Gold, PhD, MBA, hospital pharmacist and instructor of clinical pharmacy at Purdue University, who wrote consumer health book, Are Your Meds Making You Sick?, out of concern for consumer safety (the book is available at Amazon.com). “When these filtration systems do not work as they should, drugs remain in the body for a longer period of time, which then increases the likelihood of problematic reactions,” says Dr. Gold.

Simple lab tests can determine whether your kidneys and liver are working well, he adds. Ask your doctor about this testing, especially if you have a chromic condition that may affect the function of these organs, such as diabetes, hypertension, or liver disease.

1. Taking the wrong medication.

There are many reasons for taking the wrong medication, from being distracted to getting up in the dark and reaching for the wrong pill bottle. Medication mix-ups can happen at the pharmacy level, too, when a pharmacist misinterprets an illegibly written doctor’s order, especially because there are many medications with names that are very similar. Also, some medication mix-ups aren’t always entirely accidental – many people share their prescribed medications with other people, which may result in an injury.

How to prevent: Prevent medication errors at the pharmacy level by questioning the pharmacist, advises Richard Kelley, MD, co-founder of Physician’s Way, a weight loss center in Austin, Texas. “Always take the time to review any medication you receive from a pharmacy with the pharmacist on duty. You may have to wait on occasion, but it is in your best interest that you or your family member receives the medication that was intended to treat the problem at hand. Ask the pharmacist if the prescription is reasonable for the medical issue being treated,” he says. When taking your pills, make sure that you read the name and the instructions before taking, even if you’ve taken them many times before. Never take your pills in the dark. And never, ever share your prescribed medications with others or take anyone else’s prescriptions! Your doctor writes a prescription with consideration for your specific health issues, not those of your friends or your spouse.

2. ‘Mixing and matching’ medications.

How many people, often celebrities, do you hear about in the news who have died because of mixing their prescription meds? Actor Heath Ledger’s autopsy report says that he died of acute intoxication brought on by the combined effects of several prescription medications, including oxycodone (a narcotic pain medication) and diazepam (a sedative).

How to prevent: Prevent a tragedy by asking your doctor or pharmacist whether two medications or substances can be taken together, recommends Moshe Lewis, MD, Chief of Physical Medicine at California Pacific Medical Center. “Learn about a medication’s potential interactions with alcohol, other prescription medicines and over-the-counter medicines,” he says. “You can and should ask your doctor, even if you decide to take a new non-prescription remedy. Over-the-counter medications, herbs and supplements are particularly misleading because we think of them as less harmful than their prescription counterparts. Yet every year, patients have to undergo emergency organ transplants due to haphazard combinations of seemingly harmless herbals.”

A similar problem exists with non-steroidal anti-inflammatory medications, used for pain and inflammation, such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve, Midol extended relief). “Using more than one non-steroidal medication can predispose you to kidney injury,” says Dr. Parker.

3. Crushing/breaking/chewing your medication.

“Many pills are ingenious drug delivery systems in disguise, covered in layers of coatings to ensure that medication is released slowly and in strategic locations in your digestive tract,” says Dr. Lewis. “All of that ingenuity is completely foiled if you chew or crush the pill. Instead of sweet therapeutic relief, you’ll get an immediate and potentially fatal release of medication into the body."

How to prevent: Swallow your pills whole, unless your doctor tells you otherwise (for example, if you’re tapering down a medication and your doctor says you can break the pill for a half dosage). If you have trouble swallowing pills, ask your doctor or pharmacist if the medication comes in a liquid form.

4. Taking different products with the same ingredient.

This is a very common mistake among athletes who are being treated for an injury, says Ruth M. Parker, MD, Professor of Medicine and Pediatrics at the Emory University School of Medicine and Professor of Epidemiology in the School of Public Health. “People will see the doctor for pain and they’re often prescribed a narcotic that contains acetaminophen (a common pain reliever). Then if they still have pain after taking the narcotic, they’ll add an over-the- counter medication that contains acetaminophen, too. Taking too much acetaminophen can cause liver damage.”

A similar problem exists with non-steroidal anti-inflammatory medications, used for pain and inflammation, such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve, Midol extended relief). “Using more than one non-steroidal medication can predispose you to kidney injury,” says Dr. Parker.

How to prevent: Read the fine print on the label of any medication you buy so that you know what is in it and can avoid duplication. Also, recognize that many products, both prescription and over-the-counter, contain acetaminophen, including pain products, cold and flu medicines and certain sleep aids. You should never exceed the daily recommended maximum of acetaminophen, which is 3,000 mg. Everyone needs to know what they’re taking,” says Dr. Parker. “Then they need to do the math.”

5. Assuming that if one dose is good, two are better.

Many people think that more is better – if one dose of pain relieving medication doesn’t help enough, two will do the trick. This can result in an overdose of medicine.

How to prevent: “Medication should be taken in accordance with the instructions the physician intended,” warns Dr. Lewis. “Doubling medication or taking medications in excess can lead to serious consequences. Don’t assume that because you don’t feel an expected physical feeling from a medication that the medication is not working. Ask your doctor if you have any questions about the proper dosing of your medication.”

INCREASING MEDICATION LITERACY

We’ve all seen the ad: A severely allergic (depressed, asthmatic, constipated) person, previously rendered housebound (immobile, in pain) due to symptoms, now leaping through a field of flowers (cavorting on the beach) – freed by a certain prescription medication. Typically, the side effects of the medication are minimized by being read or flashed on the screen very rapidly. Such direct-to-consumer (DTC) advertising of prescription drugs, legal only in the United States and New Zealand, has been controversial, to say the least. Pharmaceutical companies contend that the ads, broadcast on TV and radio, seen in magazines and newspapers, the Internet and on billboards – educate consumers and encourage them to see their doctor for diagnosis and treatment. Congressional leaders, worried about increased health care costs, would like to regulate these ads and impose laws to stop them because they think that it’s too much information for consumers and too much pressure on doctors to prescribe the meds being advertised. And some doctors say that DTC advertising is dangerous, because it involves only the newest medications, sometimes found to have serious safety concerns only after consumers have knowledge of – and ask for – the medication.

Opinions aside, there’s no doubt that most people are woefully illiterate when it comes to medications. And it doesn’t hurt to learn more about them, says Thomas Giannulli, MS, MD, chief medical information officer at Epocrates, a drug reference application used by many physicians. “The more informed, the better,” says Dr. Giannulli. “I think it’s okay that people come in to the doctor with an idea of what they want. If you’re more informed, you feel free to have a conversation with your doctor, and you’ll have a better outcome. It’s a win-win situation.”

There are many consumer-oriented drug reference guides in print or online. One good choice is Medline Plus, a service of the U.S. National Library of Medicine and the National Institutes of Health, accessed at nlm.nih.gov/medlineplus/druginformation.html.

And Epocrates is an application that can be downloaded to your phone for free, says Dr. Giannulli. “It’s intended for medical professionals, but it’s a useful tool for looking up medications and learning more,” he adds.

Nick Cannon Speaks Out About Lupus
By Ingrid Dickson and Moshe Lewis MD

“The technical term is lupus nephritis. It’s a rare form of lupus that’s just attacking my kidneys, “Nick Cannon explained to Robin Roberts on Good Morning America earlier this month. At the end of 2011, the entertainer cut short his family vacation so that he could be hospitalized for mild kidney failure. Doctors discovered later that the problems were more widespread than they’d thought.

“They thought it was just kidney disease, and then they were trying to figure out why my immune system was attacking my kidneys, and that was sort of the root of it all,” the star adds. It took a related spate of unexplained blood clots in Nick’s lungs for doctors to realize that Nick’s immune system was the culprit.

Nick Cannon, along his wife, singer and actress Mariah Carey and their infant twins have become the public face of a family afflicted with lupus. Systemic lupus erythematosus (SLE), or lupus, is a chronic, inflammatory, autoimmune disease that mainly affects women of childbearing age. Its symptoms range from unexplained fever, swollen joints, and skin rashes to severe organ damage of the kidneys, lungs, or central nervous system. Though Nick Cannon’s lupus nephritis is currently the most visible case of a lupus-related disorder, it is actually rare amongst men. The most vulnerable group in our population is African American women, who are three times as likely as Caucasian women to get lupus. African American women also tend to develop lupus at a younger age, and have more severe symptoms than Caucasian women.

Signs and Symptoms of Lupus

Along with lymphoma and syphilis, lupus is sometimes referred to as “a Great Pretender”. Its symptoms can mimic a plethora of other diseases, or look like nothing at all—just fatigue and weight loss. Often, as in Nick Cannon’s case, a collection of seemingly unrelated maladies provides doctors with the necessary clues for diagnosis.

My own patient, Jenny M., tells me of a perfect example of lupus’ mastery of disguise—she discovered her discoid lupus erythematosus by seeing a dermatologist for what she thought was eczema. Her dermatologist insisted that Jenny’s flakes were due to ringworm, and sent Jenny home with a prescription for antifungals. When these didn’t work, the puzzled doctor ordered a biopsy, and after a number of tests, discovered that Jenny’s scalp flakes were no mere reaction to an external irritant.

It would have been impossible for Jenny’s doctor to just glance at Jenny’s scalp and diagnose lupus—nor could he have run a quick test to rule it out. Currently, there is no single laboratory test that can determine whether a person has lupus or not. To assist the physician in the diagnosis of lupus, the American College of Rheumatology issued a list of 11 symptoms or signs that help distinguish lupus from other diseases:

You’ll notice that quite a few of these symptoms can only be found using lab tests for urine and blood analysis. The most useful laboratory tests identify autoantibodies in the blood. Correct diagnosis of lupus absolutely requires the trained eye of a doctor, so if you have any of these symptoms or findings, you should make an appointment.

Treatment
There is no cure for lupus, but there are treatments that can help to ease your symptoms. The goal of both the patient and the physician is to control acute severe flare-ups and develop a maintenance regimen that will suppress the symptoms.

There are several groups of medicines used to control the symptoms of lupus:

• NSAIDs: Non-steroidal anti-inflammatory drugs are a class of drugs that decrease inflammation. The most common is ibuprofen, but they all act to decrease the immune system’s inflammation response. Usually these are used in patients with joint pain, fever, and swelling, but they can decrease the autoimmune attack of lupus as well. Even though some NSAIDs are available over the counter, it is important to consult your doctor prior to using this class of medication. Frequent use of NSAIDs can court serious long-term side effects.

• Corticosteroids: Corticosteroids work by rapidly suppressing inflammation, and they remain the mainstay of lupus treatment. These are very potent drugs, and your doctor will prescribe the lowest effective dose. Prednisone is the most common corticosteroid used.

• Immunosuppressants: These work by blocking the production of some immune cells. This class of medications is reserved for patients with kidney and central nervous system lupus.

• Others: Methotrexate, intravenous gamma globulin and anti-malarials are other medications your doctor may recommend if multiple organs are involved.


Life with Lupus
Nick told Good Morning America that after his diagnosis, everything in his life changed in an instant—he went on a diet formulated to prevent flare-ups, dialed back his work, and rested.

“I have been ordered to sleep at least six hours a night. They say rest is probably the best medicine. I’m dealing with it. Of course, I’m not used to the medicines, but I feel like I’m starting to figure out a lot of holistic ways, meditation and stuff to get through it,” Nick explains.

“The diet is the worst part,” he jokes. I can’t have any fast food anymore. No Happy Meals, nothing.” Most patients with lupus can lead normal, active healthy lives. The key to managing lupus is to recognize symptoms and to treat flare ups as soon as possible. It is important to work closely with your doctor, and to never stop or alter your medications without first talking with your physician. Research continues for new treatments, improving quality of life, and prevention and cure.


As for Nick Cannon, he may have stepped down from his radio show, but lupus has given him a new professional outlet. Look for his short documentary, The Incredible Health Hustle, which follows his trials in his first months after the lupus diagnosis. In a recent interview, he told Piers Morgan that he opened his life to a film crew in order to help others with lupus-type illnesses to know that they’re not alone.

Short on Money and Time? The One Area of Wellness to Concentrate On
Quick Summary: Put your wellness efforts into the one area that gets your company the most bang for limited wellness dollars and staff time.


The health care industry is massive and often complex. Your workplace communication about the field doesn’t have to be. And if you’re short on resources, it simply can’t be.


Think of your wellness messaging like a sharp arrow, focused on the one area of need that can make a big difference. So if you have to pick just one target for now, make it weight loss and improved blood pressure control.


Here’s how one success leads to another: One of Dr. Curtis M. Rimmerman’s patients is a man who has diabetes. Thanks in part to a wellness initiative begun by the patient’s employer, he has lost more than 10 percent of his body weight to get the disease under control. The patient no longer needs insulin, and next year he aims to go off blood pressure medication, Dr. Rimmerman says.


The success story underscores a point you can apply to wellness communication: Help employees attain a healthy weight, and other health benefits will follow like a domino effect. Target one area. You get results in more than one.


“Sometimes we make things more complicated than they need to be,” says Dr. Rimmerman, medical director of Cardiovascular Medicine at Cleveland Clinic. “The medical benefits of eliminating sodium and restricting calories clearly lowers blood pressure and leads to other positive effects.”


Points You Can Make to Employees

Here’s insight you can include in your upcoming wellness messages:


• Your blood pressure rises as your body weight increases. “Losing weight has the biggest effect on those who are overweight and already have hypertension,” Dr. Rimmerman says. Begin with a goal of losing 10 percent of your current weight, which is the healthiest way to lose weight and offers the best chance of long-term success, according to the National Institutes of Health (NIH).


• To lose one pound a week, you only need to burn 500 calories a day more (or eat 500 calories a day less) than usual. “Sustainable results require a realistic mindset,” Dr. Rimmerman says.


• Don’t use BMI as the only arbiter of healthy weight. Body mass index (BMI)—a measure of your weight relative to your height—is the most common measure used to determine if you’re overweight or obese. BMI gives an approximation of total body fat: a value of 25–29.9 indicates a person is overweight; a value of 30 or higher indicates obesity. But BMI alone doesn’t determine health risk, because someone who is muscular or has swelling from fluid retention (edema) likely has overstated body fat. Encourage employees to combine their BMI with waist measurement: A measurement of more than 35 inches in women and more than 40 inches in men is considered high.


• Routine exercise has greater benefits than pill popping. “Sometimes we’re practicing alchemists, and we try our best to make sure medications are working,” says Moshe Lewis, M.D., a physical medicine and rehabilitation physician at St. Luke’s Hospital in San Francisco. “But everyone’s different, and the best way to deal with high blood pressure medication is to prevent the need to take it.”


• Literally, start with small steps. “Going from zero activity to 10 minutes on the treadmill is a huge step in the right direction. These patients need a program that’s sustainable and attainable, one they can come back to day after day,” Dr. Rimmerman says. Graduate to moderate-level activities such as walking one mile in 15 minutes, swimming laps for 20 minutes, or gardening for 30 minutes.


•Eat less salt. You require only about 500 mg of sodium a day, but the average American ingests between 6,900 mg and 9,000 mg.


• Eat more fruits and veggies. According to the Dietary Approaches to Stop Hypertension (DASH) trial sponsored by the National Heart, Lung, and Blood Institute (NHLBI), when people with high blood pressure ate 8 to 10 servings of fruits and vegetables a day and 2 to 3 servings of low-fat dairy foods, they lowered their blood pressure within a month.


Next Steps:

• If time or money is of the essence, take a simplified approach to wellness communication and focus solely on weight loss.
• Modify the bulleted points in this article for your next wellness communication.


Hope Health, All Rights Reserved