I have had really bad belly aches and diarrhea -will this go away when my period stops?

My reply:

Yes, it should go away when your period stops. You can also take some ibuprofen (Advil, Motrin) to help with the diarrhea and bellyache.  Please see the article Why Midol? to learn about using Pamprin and Midol.

Your uterus is contracting, trying to push out the menstrual fluid which can be painful (ibuprofen can help).

During your period, your body makes something called prostoglandins which can cause diarrhea. Ibuprofen lessens the prostoglandins and helps get rid of the diarrhea.

Hope this wasn’t too much info!
Take care and feel better!

First, some background-what is gout all about?

It is a condition caused by chronically high blood levels of urate/uric acid.  Only 1/3 of patients actually develop symptoms.  Joints are the most commonly affected by the high uric acid -like the big toe!  Gout can also cause kidney stones. 

What kind of symptoms does gout cause?

Gout can cause swelling, redness and tenderness of the joint -which most people describe as “painful!”  The good news is that most gout attacks will eventually clear up (within a few days to a few weeks) even without treatment.

How is gout treated?

There are two ways to treat gout -by decreasing the amount of urate in the system by increasing clearing the urate from the system OR by decreasing the amount of urate produced by the body.

Typical treatments include allopurinol, colchicine and NSAIDs.

What are the new medications available to treat gout?

1.  Uloric (febuxostat) : This medication works like allopurinol -so it helps lower uric acid in the body.  It hasn’t really been proven to be any better then allopurinol with typical dosing.  So, with the price being about 20 times more then allopurinol (!)  go ahead and stick with allopurinol.  Uloric can be used IF allopurinol is not tolerated.

2.  Krystexxa (pegloticase): This medication works by breaking down the uric acid.  This medicine can seriously lower uric acid levels -the bad side is that it is 10 times more expensive then Uloric (which is 20 times more expensive then allopurinol) …pricey!  AND it has some major side effects, including risk of severe allergic reactions, gouty flares and possibly making heart failure worse.  Some major thought weighing positives and negatives should be done before starting on this med.

There you go -some info on the new meds.  Have some questions or input -LOVE to hear from you!  Please leave a comment or email me at nova@getpharmacyadvice.com

Back to reality.

Here’s a pressing matter, not really, but let’s make believe for a second here!  I had to do a little investigation earlier today because the increasing number of phone calls from patients seeking the “OC” oxycontin as compared to the “OP” oxycontin was really starting to peak some serious interest.

It didn’t take me too long to figure out what all the fuss is about! 

Here’s the deal,  oxycontin (we’re talking brandname) has been reformulated…the old form was imprinted with “OC”, the new tablets are stamped with the letters “OP.”   The two tablets are said to be bioequivalent (meaning they have the same active ingredient and should absorb into your body at the same rate and extent). 

When you have two bioequivalent tablets, it would be unlikely that they would differ significantly in their therapeutic or adverse effects.  However, there are a couple of differences between the two oxycontin tablets, not counting the difference in what’s imprinted on the pills.

Difference #1: The new tablets take a little longer to get to peak levels in the body, which may make it seem less effective.

Difference #2: The new tablets reach a slightly higher peak level in the body, which can cause more side effects. 

Difference #3: The new tablets are harder to crush or chew .  It’s not easy to turn them into a powder to snort or to dissolve them to be drawn up into a syringe for injection.  Bottom line, they’re harder to abuse so they’ve lost their street value! 

For those who find the new oxycontin tablets are really not working for you, ask your doctor if you can titrate the dose or even switch to a different opioid of a long-acting nature.

Need more info or have some questions?  E-mail me at Cate@getpharmacyadvice.com or leave a comment below. 

Will be back soon!

I’m in the great state of Maine right now!  Ahhh, the beauty of the internet! 

Here’s a question/answer situation from a GPA.com member about ketorolac, a Non-Steroidal Anti-Inflammatory Drug (aka a pain reliever):

Hi Cate,
 
Here is a question that I have not been able to find the answer to:
Why is Toradol (ketorolac) limited to 5 days usage when given
by mouth?  Is it simply the adverse GI effects?

The restriction of keeping the max duration of treament with ketorolac at 5 days does pretty much boil down to the serious GI adverse effects associated with the medication.  When I say serious GI adverse effects, I mean GI issues that have resulted in death!   

Prior to label revisions on the product, the incidence of ketorolac-induced GI adverse effects was much higher than most of the other NSAIDs (evidence from studies).  Chances of experiencing GI adverse effects with ketorolac increase with higher doses and longer duration of treatment.  

Studies have shown that ketorolac works no better than the other members of its class.  Now, we do know that some NSAIDs work better than others for certain individuals.  Not everyone is the same!  Maybe ketorolac is the best for one person, but that’s not the case for most people.   

The good news is there are so many NSAIDs out there, there’s a good chance an individual would not have to rely on ketorolac as their only option for pain relief.    Knowing there’s no significant difference in efficacy between ketorolac and the other NSAIDs, prescribers should keep the use of ketorolac to a max of 5 days…why bother risking it?!  

NSAID-induced upper GI bleeding depends on the particular drug used, its dose, duration of treatment, patient risk factors (i.e. history of GI trouble, advanced age, etc.), and other medications on the patient’s drug list.  Based on clinical experience and data from studies, ketorolac would not be the drug of choice when deciding which NSAID to use for pain management.  This, as I mentioned above, is because of its high potential for causing GI adverse effects.   

When should ketorolac be used?  It should be left for those patients with moderate to severe acute pain who failed to get relief with other NSAIDs, who cannot stand the effects of opioids, or who need a lower dose of an opioid (using ketorolac in addition to the opioid allows for a lower dose of the opioid).  

Hope this info helps!  

Need some more information on this topic?  Did my message not make sense (sometimes I feel like my words can be confusing!)?  If so, leave a message below or e-mail me at Cate@getpharmacyadvice.com. 

Make sure you get your hands on our free video course on how to save money on your prescription medications…the holiday season is fast-aprroaching so best to have as much moolah in your bank accounts as possible!

Happy weekend!

Please leave us a comment about your experience!

90 Ways to Save Money on Your Prescription Medications -great FREE source for money saving tips and steps!

There are a couple of articles for background info about Diabetes Type 2 Overview and What is Diabetic Peripheral Neuropathy?

Which brings us to -How to treat diabetic peripheral neuropathic pain…

Number 1 treatment:  Blood glucose control!  If the blood glucose levels are kept within range, neuropathy can be slowed and possibly reversed.

In addition, to help with pain…

1.  Antidepressants

• Cymbalta (duloxetine) -typical dosing for DPNP is 60mg once daily.  It is only available in brand only-pricey!
• Elavil (amitriptyline) or Pamelor (nortriptyline) -both come in generic and are well tolerated but can cause drowsiness and general dryness (dry mouth, eyes…)
• Effexor XR (venlafaxine ER) -dosing is usually 15-225mg daily.  Brand only so pretty pricey.
• Celexa (citalopram) and Paxil (paroxetine) -these aren’t used alone but can be added on to other therapy

2.  Anticonvulsants

• Neurontin (gabapentin) -this is the most popular drug to treat DPNP.    It is available in generic.  Gabapentin should be titrated slowly because of side effects like dizziness and sedation.
• Lyrica (pregabalin) -like gabapentin but more potent (and expensive)
• Tegretol (carbamazepine), Lamictal (lamotrigine) and Dilantin (phenytoin) -all can help but aren’t usually used because of the major side effects.

3.  Pain Drugs

• Ultram (tramadol) -works well for pain in general and DPNP -it has pain and antidepressent activity.  Inexpensive and well tolerated.
• OxyContin (oxycodone CR) -major pain medicine -lots of side effects and can lead to addiction but when the pain is bad -it works!

4.  Topical -Lidocaine patches -work well as an add on therapy.  

5.  Natural Remedies

• Capsin (capsaicin) -topical cream that is made from chili peppers!  The big picture is, capsaicin causes enough irritation in the area that the pain receptors are overwhelmed and “shutdown”.
• alpha-Lipoic Acid -an anti-oxidant that helps decrease pain and numbness.  Typical dose is 600mg daily.
• Evening Primrose -500mg up to 8,000mg daily.  Helps nerves function better (more sensation; less pain)
• Borage Oil -1,000 -4,000mg daily.  Works similarly to Evening Primrose
• Acupuncture and Magnet Therapy

We would love to hear your personal experiences!  Please leave us a comment!

Would you like some help saving money on your prescription meds?  Please see our FREE video series on 90 Ways to Save Money on Your Prescription Drugs.

First off, what is neuropathy?   It is a general term used to describe disorders of the nerves. 

Then, what is diabetic peripheral neuropathy?

Diabetic neuropathy is due to high glucose in the blood that leads to nerve damage.  The damage can interrupt the signal traveling from a part of the body (ie foot) to the spinal cord and brain.   The damage can lead to the “pins and needles” feeling, pain and numbness.

People with diabetes also have a higher risk of infection -add this to a numb area on the foot and you have the makings for a serious infection.  Which is why foot care is a big deal for patients with diabetes.  I always tell this story when someone says, “I can deal with some tingling and numbness, what’s the big deal?”

When I was working in the Diabetes Clinic, I met Mr. B.  He had diabetes for many years.  He never really changed his eating/exercise habits and didn’t really keep an eye on his blood sugar.  We discussed some medicine and he started it- begrudgingly.  At this point Mr. B had a little non-painful peripheral neuropathy (just some numbness around the toes).  We did a full foot exam and talked about him (or someone else) checking the bottom of his feet everyday. 

Mr.  B. missed a few appointments over the summer (he was visiting his grandkids).  While away, Mr. B. stepped on a sharp stone -it made a small puncture on the pad of his big toe.  He didn’t feel it because of the numbness.  Fastforward 8 weeks,  Mr. B. comes in for his appointment with great stories about the grandkids.  We do a foot exam, Mr. B. has a serious infection and his right toe is amputated within a few days. 

I asked Mr. B. about the foot exams and he said, he thought it was silly and was embarrassed to ask someone else to look at his feet because sometimes he has trouble seeing the bottom of his feet.

What is it with infections being so serious in people with diabetes?  People with diabetes get infections more easily, heal slower and often don’t feel the warning signs due to neuropathy.

Number 1 way of avoiding diabetic peripheral neuropathy?  Controlled blood sugar levels!

Once a patient has diabetic peripheral neuropathy…

1.  Controlled blood sugars can slow the progression and may actually reverse some of the damage done. 

2.  Foot Care -this includes regular foot examines with a medical professional and checking the bottom of the feet and between the toes daily -for dry, cracked skin, calluses and early signs of infection.  I am, as most healthcare people are, very intense about foot care.  Even wearing socks so that the seam rubs the foot can lead to an infection!

3. Medications -there are no medications to specifically treat peripheral neuropathy.  There are drugs that can help control blood sugar and then there are drugs that can help with the pain caused by neuropathy. 

I will go into the medicines used to treat pain associated with peripheral neuropathy in the next article.

For now, there you have it -a diabetic peripheral neuropathy overview.

Please leave some feedback!

And Please see our *FREE* video course and manual on 90 Ways to Save Money on Your Prescription Drugs.

Here is a quick, quick video comparing generic sumatriptan and the new Sumavel DosePro

As always, we would love to hear from you so please leave a comment!

Would you like to learn how to save some money?  Be cool and watch our FREE video course on How to Save Money on Your Prescription Drugs.

So, just to go over some of the benefits of caffeine…

Headaches:  Taking caffeine with pain medication (Tylenol, Alleve, Motrin, etc.) works better than pain meds alone.  Caffeine helps the pain medicine get into the brain faster and more efficiently which leads to better pain relief!

Mental Alertness: Which is why most of us love a cup of joe in the morning!  Caffeine gets into our brain very easily and helps us be wakeful and focused (to a point).  When caffeine is mixed with taurine (like in Red Bull) it has shown a small increase in mental performance.  Even more effective is when caffeine is mixed with glucose (like most energy drinks).

Asthma: Caffeine can help improve airway function in people with asthma up to four hours -this is an FYI!  Definitely don’t take a cup of coffee instead of your inhaler.

Diabetes: Studies have shown that about 300mg of caffeine/day (about 2 cups of coffee) decreases the risk of developing diabetes type 2 by about 20%!

Bloating:Caffeine is a diuretic -it helps you pee some of that extra fluid out -this is why it is one of the ingredients in Pamprin.

Hypotension: People who have low blood pressure -a little caffeine throughout the day can help. 

Gallbladder and Parkinson’s Disease: 2-3 cups of cofee/day can decrease the risk of both gallbladder and parkinson’s disease. 

Weight Loss…not really: Caffeine is thought to suppress appetite, increase calorie burning and promotes water loss -unfortunately studies have shown that caffeine as a weight loss aid is of minimal, temporary benefit .

Some negatives about caffeine:  (just a few)

Caffeine can cause insomnia, nervousness, belly issues/nausea, increased heart rate, headache, agitation.  Caffeine can also worsen depression and anxiety. 

One more negative about caffeine…caffeine withdrawal -I won’t go into it here but you can watch the video Catie did about  caffeine withdrawal.

Small note here about the ultra popular Red Bull and Vodka drink.   I had a couple of people come into the pharmacy and ask…“Can Red Bull and Vodka kill me?”  It sounded funny to me at first but it is actually a really popular concern!  So, here is the dealio -no. 

However, taking in too much caffeine can be fatal (very rare!).  In addition, alcohol (the vodka) will increase the levels of caffeine (from Red Bull) in the body.  Lastly,  taking caffeine while drinking can cause a false sense of alertness so that people may think they are less drunk then they really are -so beware!

There you go a quickie -next time people are dissing on coffee, soda, red bull -go ahead and throw some statistics of the benefits of caffeine at them!

I know there are caffeine lovers out there -drop us a comment!

Also, why not learn How to Save Money on Your Prescription Drugs by watching our *FREE* video series -that way you can afford those expensive lattes!