Earth Day; OTC Med More Expensive Than Prescription Med?; Pharmacists; Belly Upset & Arthritis Meds; Hospitalization & List of Home Meds.

So I have gotten back to the blog after celebrating Earth Day on April 22nd & Arbor Day on April 27th.  The following reflects the topics discussed on Let's Talk Medical with Doctor Gigi on Friday April 20, 2012.  Sorry for the delay, but one must celebrate holidays!

Earth Day:

Sunday April 22, 2012 we celebrated Earth Day.  This is a day upon which we seek to do something good for Mother Earth.  It began as a celebration on April 22, 1970, & it was this event which lead to the creation of the Environmental Protection Agency (EPA).  In other words, until 1970 there was no agency to oversee the health of our environment.  In the 42 years that we have celebrated Earth Day, we have actually celebrated the healthier environment which it has provided, & we have sought ways to improve it even more.  Things you can do to celebrate Earth Day include: bike to workbuy local productsuse less plasticsuse less petroleum products, recycleplant a tree or gardeninvest in renewable energy, or clean litter or trash from a park or roadside.  I hope that you found time to celebrate this year, but if you did not, put the date on your calendar for 2013... or better yet, celebrate in your own way by making small changes to your routine daily!  After all, without a healthy Earthis it really possible for you & I to be healthy?

OTC Med More Expensive Than Prescription Med?:

Prilosec is an H2-blocker.  It causes your stomach to produce less acid, thus it is used to treat stomach ulcers & gastroesophageal reflux (GERD).  Many people take it, but many do not know that it is cheaper if you get a prescription from your doctor.  There is a generic for Prilosec... called Omeprazole... which can be gotten from the pharmacy with a prescription.  The generic prescription version costs about $15 for a 90-day supply at WalMart & K-Mart, whereas the name-brand Prilosec OTC costs about $44 for the same 90-day supply.

The point is that just because a medicine can be purchased over-the-counter does not mean that it cannot be purchased with a prescription, & often times for significantly less!  Be sure to ask your doctor &/or pharmacist for advice if you take an OTC med frequently, as you might save money if you get a prescription for it.  And don't worry about the insurance saying that they will not pay for it because you can get it over-the-counter.  Simply tell the Pharmacist that you want to be "self-pay" for this medicine, & simply pay for it yourself... you'll still save money in the long-run!

Several medications should work this way, so be sure to inquire about them:
1)  Prilosec (= Omeprazole) - for treatment of ulcers & GERD,
2)  Zantac (= Ranitidine) - a weaker medicine to treat ulcers & GERD,
3)  Claritin (= Loratidine) - a non-drowsy anti-histamine to treat allergies,
4)  Motrin (= Ibuprofen) - an anti-inflammatory medicine to treat pain... works best if you ask for the 600 or 800 mg strength,
5)  Miralax (= Glycolax) - a laxative for chronic constipation.


Your Pharmacist is an invaluable part of your health... & finances!  He helps me to take care of you by helping to coordinate your care, as I am not always privie to the medication changes ordered by your other physicians.  He also watches for drug interactions & let's me know if he has concerns.  I find however that the Pharmacist is not always forthcoming with advise in regards to the cost of medications.  However, if you ASK about cost-effective options, he will often have some advise... so be bold & ask!

I recently thought that I would save my patient money by prescribing the old version of Detrol instead of the newer Detrol LA.  The original Detrol is given as a 2 mg pill which is taken 2 times per day, whereas the newer version, Detrol LA, is "long-acting" so it is given as a 4 mg pill ONCE per day.  I thought that the twice a day Detrol had a generic version, thus I thought it should be cheaper & wrote that prescription for my patient.  Obviously I was mistaken, & thankfully the Pharmacist alerted me that my good intentions were not going to help with the patient's cost.  With that knowledge, I changed the script to the once-a-day Detrol LA, as there is no need to inconvenience the patient with complicated dosing unless there is significant cost savings.

So get to know your Pharmacist, & don't be afraid to breach financial questions.  Realize that the best prices are likely found at large retail stores like WalMart & K-Mart, but the independent small pharmacy likely has a Pharmacist who owns the pharmacy & as such is begging to earn your business.  Though he may not have the lowest prices (because he cannot buy in bulk quantities like the large retailers), he is likely to take more time to advise you as to your choices, which in the long-run might save you more money than if you had dealt with the large retailer!

Also, it usually feels as though the insurance company dictates our healthcare, but remember they only control us if we let them.  We can use the doctors, pharmacists, physical therapists, etc. of our choosing.  It might cost a bit more, but if you can afford it, you just might find that your health is worth that investment!

Belly Upset & Arthritis Meds:

Most medications to treat arthritis are non-steroidal anti-inflammatory drugs... or what doctors call NSAID's.  They work by decreasing inflamation, which helps with the arthritis pain, but unfortunately they frequently cause stomach upset.  So what do you do if you have arthritis but cannot tolerate an NSAID?

The first thing to do is to be sure you take the NSAID with food!  NSAID's cause local stomach irritation, so putting food in the belly with the medicine will likely decrease this irritation.  It does not always solve the problem though as NSAID's also cause a decrease in the protective lining of the stomach, resulting in more susceptibility to the irritating effects of the stomach's own hydrochloric acid (which it produces).  Also, though Advil (= Motrin or Ibuprofen) is a great NSAID, it must be taken 3 times per day.  On the other hand, DayPro (= Oxaprozin) is a once-a-day NSAID.  By taking the DayPro less often, it is often better tolerated, so consider giving it a try.

If that does not work, perhaps you should change to Tylenol, as it is not an NSAID, & does not have GI (gastrointestinal) side-effects.  However, it is also not an anti-inflamatory, so it might not help the pain.  Some people are lucky though & do get significant pain relief, so why not try it?

If Tylenol does not help, there are other options.  Adding a proton pump inhibitor (= PPI), such as Prilosec to your daily routine will cause the stomach to produce less stomach acid, thus you will more likely tolerate the NSAID. In other words, the stomach can tolerate some irritation... it's own acid or the NSAID.  So if you must take the NSAID, get rid of the acid by taking a PPI as well. 

If you still find problems with the NSAID, you might need to change it to a COX-2 inhibitor such as Celebrex.  This medicine does not cause a decrease in the protective lining of the stomach, but does decrease inflamation.  Thus Celebrex is a great arthritic medicine, but it is much more expensive than most NSAID's.  If you have a Sulfa allergy, you also cannot take Celebrex.

So if Celebrex is not an option for you, perhaps you should change your NSAID to Mobic, which is somewhere between an NSAID & a COX-2 inhibitor.  In other words, it is likely safer than the usual NSAIDbut not as safe as Celebrex, but it has a generic version (= Meloxicam) which is certainly cheaper than Celebrex.

Some people get relief with a topical NSAID such as Voltaren gel.  Since it does not get into the stomach, it should be better tolerated, but it still can cause trouble, especially if you take the maximum doses which will still potentially decrease that protective lining of the stomach.  It works best for joints that are close to the skin, such as fingers, elbows, ankles, & knees.  The shoulder & hip joints are further from the skin, so the topical treatment does not penetrate them as well.  Voltaren gel is also pretty expensive, but it will soon lose it's patent... so watch for the generic soon. 

As a last thought, there is an odd drug called Cytotec which can be added to your NSAID.  Cytotec coats the stomach & thus protects it.  Though this sounds like a great idea, it comes with wierd side-effects, such as diarrhea & malabsorption of your other meds.  It basically binds to your stomach as well as to anything in there, so you must take all other pills several hours before or after you take Cytotec.  Cytotec is combined with the NSAID Voltaren & called Arthrotec, which is a great product to treat arthritis yet protect the belly.  Arthrotec is very expensive however, so you might ask your doctor to give you the Cytotec generic (= Misoprostolseparate from the NSAID as that is almost certainly a lot cheaper than the one combo product... as is usually the case!

Okay, one more option of which I have just become aware!  Apparently Cymbalta (= Duloxetine) which is an anti-depressant in the SNRI class has received approval as treatment for arthritis pain.  As it is an anti-depressant, it does not have the typical GI (gastrointestinal) side-effects caused by the  NSAID's.  It is also used to treat fibromyalgia pain & even neuropathic (= nervepain, so it tackles many types of pain.  Because of this, Cymbalta might help people who have multiple types of pain as well as those who have concommitant depression.  After all, chronic pain often causes depression, & often depression causes pain to hurt more... so one medication which treats both is fabulous!

Hospitalization & List of Home Meds:

When you get admitted to the hospital, the nurses insist upon getting a very detailed list of all of your home medications, including herbs & supplements as well.  They must know the dose of the products, as well as how often you take them.  Why do they care so much?

Well, there has been much talk about the medication errors that occur in the hospital, so in response to this, the government has charged the hospital (& thus the nurse) with getting the patient's home medication list so the physician can then simply decide which of those meds is to be continued during the hospital stay.  First, I would like to say that this has lead to more medication errors than you can imagine!  The nurses are not allowed to admit the patient or render care until the list is createdyet they often do not contact me to assist with its creation!  So, this is compiled from the patient's best recall or most recent list, which is often not correct.  I thus advise that you carry a very up-to-date list, & if you are not sure, insist that the nurse contact your doctor or family member... don't guess!

Also, once this list is created, it is presented to the physician for him to approve the meds that he wants you to take during your hospitalization, & to discontinue those that he feels are unnecessary.  This process also lends itself to problems.  Often doctors simply continue every medicine or supplement unless there is a specific reason to stop it.  In the old days, we did the opposite... we only ordered the medicines you absolutely needed!  So you now get many meds during your hospital stay, whereas in the past you only got the few you desperately needed.  Many of your home meds are not stocked by the hospital pharmacy & are thus substituted automatically with a similar but not identical product.  This can cause side-effects which can complicate your care & are difficult to identify.  Think about what you do instinctively when you are ill... you usually take only the medications that you think are absolutely necessary.  Though you sometimes don't make the proper choices, you at least try!

So when you go to the hospitalbring your medicines in the bottles, so the nurse can check them, & also note any changes that are not listed on the bottles!  Also, when your physician sees you in the hospital, be sure to ask him to give you only the most necessary of these meds, so your body & belly will not be taxed trying to deal with unneeded meds or herbs!

That concludes this blog, but please don't forget to check out the radio show... on Fridays at 1:00-1:45 PM Eastern time.  Listen locally to WTAN 1340-AM, or try the computer where you can listen live or to the podcast...  As always, feel free to ask questions or make comments via phone: (727)-441-3000 or toll-free (866)-TAN-1340, or via e-mail:
Here's to our health!

Doctor Gigi