All posts by RX Integrative Solutions

OTC Pain Patches, Wraps, TENS Units – Oh, What A Relief It Is!

Introduction
The use of topical analgesic patches,  thermal wraps, or TENS units is one way to manage ACUTE pain instead of taking oral opioid narcotics and non-steroidal anti-inflammatory drugs (NSAIDs), including acetaminophen.

Please first discuss the use of topical analgesic patches, wraps, or TENS units with your primary care physician (PCP) before trying them out for CHRONIC pain, as she/he knows your medical and surgical history, medication allergies, and is in the best position to guide your pain management if you are already taking other oral analgesic medications.

Popular active ingredients in analgesic patches include methyl salicylate, menthol, camphor, capsaicin, and lidocaine. Advantages of patches over oral analgesics include delivery of medication directly to the involved area, avoidance of most GI-related side effects, and ease of administration. Disadvantages can include skin burns (as some patches contain irritating ingredients).  Patches with metal backing should not be used at the same time as heating pads or thermal wraps to avoid skin burns.  Any OTC analgesic patch can cause unwanted skin irritation, reddening, burning, or medication allergy in those who are sensitive to any ingredients.  Wraps can cause excess heat and TENS units can cause excess nerve stimulation.

Topical analgesic products work as counter-irritants, local anesthetics, thermal (heat) generators (wraps), or electrical nerve stimulators (TENS units).

Medications included in counter-irritant patches are classified into three categories, that:

• increase local blood flow (methyl salicylate)
• cool the skin area (like menthol, camphor)
• intentionally irritate/redden the skin area and distract from a deeper pain underneath it without increasing blood flow to the skin area (capsaicin)

Methyl salicylate is an analgesic, an anti-inflammatory agent, can dilate local blood vessels and raise skin temperature.

Menthol (oil of wintergreen), derived from Mentha piperita (peppermint), cools the skin and increases skin blood flow by dilating blood vessels.

Capsaicin, derived from hot chili peppers, works by depleting substance P in the nerve endings and is thought to temporarily decrease the number of nerve fibers in the involved skin area. It takes up to six weeks for pain sensation to return once capsaicin topical therapy is discontinued so skin monitoring is advised.

Lidocaine, a local anesthetic, is thought to interrupt the pain signal by its action on damaged peripheral nerves and may be useful in treating neuropathic pain. For most people, the amount of lidocaine absorbed through the skin is not problematic. However, for some in whom unpredictably higher lidocaine absorption and blood levels occur, the cardiac properties/side effects may be a concern. OTC lidocaine patches are to be used as directed on the package label for up to 7 consecutive days MAX.

Thermal analgesic wraps (e.g., ThermaCare) can increase both local skin and muscle blood flow. Wraps contain activated charcoal heat cells, iron powder (for conductivity), and sodium chloride.

Icy Hot Smart Relief TENS Unit Starter Kit, example of an FDA Class II approved medical device, uses nerve stimulation to help relieve back & hip or knee & shoulder pain. TENS stands for ‘transcutaneous electrical nerve stimulation.’

Quell is a new FDA Class II approved medical device that is somewhat costly. It’s called a wearable technology that also uses nerve stimulation to allay pain.

In general, TENS units work by sending pulses to the nerves in a particular area and up the spinal cord. This is thought to reduce pain signals from reaching the brain by triggering the release of our own endorphins.

Patch/Wrap Safety Tips
• Wash your hands with soap and water after applying
• Do not reuse
• Do not use for longer than 7 days without consulting your PCP for advice
• Apply 30 minutes after a shower; remove one hour before a shower
• Dispose of safely to avoid unwanted exposure to children and pets

TENS Unit Safety Tips
• Do not combine with heat wraps or topical medication-containing patches
• Do not combine with oral Rx or OTC pain medications unless instructed to do so by your PCP
• Start with the lowest level of electrical stimulation/intensity and increase if needed to manage your pain

More well-designed, long term studies involving OTC analgesic patches/wraps/TENS units are needed. Please talk with your pharmacist for more information on how to properly use topical OTC analgesic patches/wraps/TENS units.

This information is not meant to be a substitute to medical advice from your PCP.

 

#healthandwellness  #holistichealth

Medication Overprescribing – Time to Start Thinking Out of the Box (Pill Vial)

Many seniors are taking five medications a day.  Some are taking many more than that.  Are USA physicians overprescribing?  Is there a way we can encourage them to start thinking out of the box and consider other evidence-based non-invasive modalities first, whenever possible?

Here’s a list of medications that may be problematic for seniors (American Geriatrics Society 2019 Beers Criteria). Take this article to your primary care physician for discussion of med risk/benefit if you are taking any of them.

https://nicheprogram.org/sites/niche/files/2019-02/Panel-2019-Journal_of_the_American_Geriatrics_Society.pdf

What Do Older Men, Restful Sleep, and Heart Health Have In Common?

Senior men having difficulty sleeping at night due to extended periods of interrupted breathing may be at increased risk of heart-related death.  This problem is thought to be due to poor oxygenation (study indicator) stemming from sleep apnea and other related factors, according to an Australian study in European Heart Journal (2018). Researchers Linz and Baumert reported that men with ≥ 12 minutes of oxygen saturation below 90% during their sleep cycles increased risk of heart-related death by nearly 60% in the study. The importance of restful, well-oxygenated sleep in relation to health and healing cannot be underestimated for many reasons.  If you suspect you are one of the individuals with sleep apnea or other sleep-related health issues, please talk with your primary care physician and ask for a sleep study to uncover the root cause of your problem and get help.

Holistic Health and Wellness Trends for 2019

Wondering where holistic health and wellness is going in America in 2019?  Here’s a short list of categories that will be popping up in the press and in the marketplace.  Oh, the places we will go!

Which of these is your favorite wellness topic and why?

  • Plant-based fish (in addition to plant-based meat)
  • Circadian rhythm’s impact on restful sleep
  • Brain health
  • Post-surgical recovery gadgets (foam rolling, TheraGun, more)
  • Ayurveda and the mind-body connection
  • Wine as a farm-to-table commodity
  • The microbiome (gut/immune health)
  • Telemedicine
  • The  endocannabinoid system
  • Wearable healthcare gadgets

For more information on upcoming events, health coaching packages, or to schedule a seminar/workshop on holistic health and wellness for your corporate or small group, please email Dr. Cathy Rosenbaum @ drcathy@rxintegrativesolutions.com or visit www.Facebook.com/rxintegrativesolutions.

Dr. Rosenbaum’s Upcoming Seminars/Workshops

Please ‘Like’ us on www.Facebook.com/rxintegrativesolutions to receive an ongoing list of seminars and workshops conducted by Dr. Cathy Rosenbaum.

Health & Wellness Seminar Topics for Your Church/Support/Corporate/Civic Group:

  • Health & Wellness Trends For The Future – Oh, The Places We’ll Go!
    * Pharmacogenomics, the Future of Personalized (Precision) Medicine & Gene Therapy (Disease Cures vs Treatment)
    * The A to ZZZZ’s of Sleep Health
    * Memory Health: Even Elephants Forget Sometimes!
    * Bottled Water Sources/Plastics/Filtration Systems- What You Don’t Know May Hurt   You!
    * Taking the ‘Poly’ Out of Polypharmacy (Overprescribing of Medications)
    * Eight Balance Points for Healing: Building Integrative Health & Wellness Tool Kits That Fit Your Health Goals & Lifestyle Choices
    * Herbs of the Bible
    * Homegrown Medicinal Herbs & Teas
    * Debunking Myths About Dietary Supplements
    * Medical Marijuana: The Healthcare Professional’s Perspective
    * Caregiving: From Compassion Fatigue to Compassion Satisfaction
    * The Truth About OTC Diagnostic Tests (e.g., Hair Analysis, Iridology, Electrodermal Testing, Antioxidant Skin Fold Testing, Saliva Testing,
    Thermal Biofeedback, Electromyography Biofeedback, More)
    * Antioxidants & Chemotherapy – Dance Partners or Double-Edged Swords?
    * Antioxidants & Health
    * A Primer of Nontraditional Medicine Practices in the Greater Cincinnati Area
    * Let’s Have Some Applause for Menopause
    * Men’s Health: Everything You Want to Know but Are Afraid to Ask
    * Vitamin-Crazed Insurance Policies: Are Multiple Vitamins Really Needed Throughout Life?
    * The Holistic Approach to Wound Care Management
    * The Holistic Approach to Managing Stress
    * Essential Oil Aromatherapy for Healing: Does This Modality Pass the Sniff Test?

Using Neti Pots – Be Safe!

Neti pots can be used to clean out mucus, allergens, and debris that build up on the nose and sinus cavity. They are safe if used correctly. A recent case report involving a woman who allegedly passed away from an amoeba acquired from unsterile water used in her neti pot over many months reminds us to do diligence when preparing saline water and cleaning pots to stay safe.

Please:

* Keep your neti pot clean regardless of whether it is made of plastic, ceramic, glass, or some other material.

* Use a safe water source for the saline solution you prepare for your pot (e.g., preferably sterile or distilled water).

* Use proper technique with your neti pot to get a good rinse. If you are unsure of how to use it, contact your favorite pharmacist for a quick demo.

The Center for Disease Control tells us to wash our neti pots after each use. Some of these pots are dishwasher safe, but not all. Please read the directions on the box.

Neti pots can be hand washed with dish soap and hot water and air dried. Don’t use hand towels that contain lint to dry them, as the lint can go up your nose and cause other issues.
If you think your neti pot is contaminated, you can use a chlorine bleach solution to cleanse it, but be careful to thoroughly rinse out any soap or bleach from the pot before you reuse it. This will prevent unwanted residue getting into your nostrils.

Don’t use tap water run through a Brita filter or any home filter unless you boil it for 3 to 5 minutes and then cool it down to room temperature first. Boiled water is storable for up to 24 hours.

For more information, please visit www.apha.us/CDCSafeNetiPots.

To schedule a one hour health & wellness consultation with Dr. Cathy Rosenbaum, please visit www.rxintegrativesolutions.com or email drcathy@rxintegrativesolutions.com. Be mind body spirit healthy.

Probiotic Dietary Supplement Safety & Efficacy Is in Question

Probiotic dietary supplements have become quite popular in recent years, touted for such conditions as general health (prevention), immune health (prevention), leaky gut, diabetes mellitus, and dysbiosis from antibiotic overuse, among others.

Probiotics are generally safe for a heathy person (Generally Recognized as Safe [GRAS] per the FDA classification).  However, some live  probiotic strains may negatively play on a weakened immune system in at-risk persons,  allowing unwanted organisms to enter the body and cause pneumonia, endocarditis, or sepsis.  Probiotic supplements are not for everyone!

Activia yogurt, kefir, kimchi, sauerkraut, tempeh, miso, and kombucha are examples of food sourced-probiotics. Culturelle and Align are popular probiotic dietary supplements. Florastor is a prescription medication.  Examples of probiotic strains include, but are not limited to, bacteria (e.g. Lactobacillus, Lactococcus, Leuconostoc, Pediococcus, Bifidobacterium, Bacillus) and yeast (e.g., Saccharomyces).

It’s important to choose the right probiotic product for your health needs with the help of your pharmacist, who can thoroughly evaluate the product  before recommending it to you.  Product criteria:

  • strain identification by genome sequencing
  • transmissible antibiotic resistant gene profile
  • toxicology in vitro and in vivo studies
  • clinical studies on efficacy (how well does the product work)
  • target population (healthy  vs sick)
  • product formulation and labeling (product purity, contaminants)

If probiotic manufacturers claim to treat/prevent disease, their probiotics should be studied and marketed as drugs, rather than as  supplements, upholding FDA regulation.  Probiotics are not drugs, not magic bullets, nor are they universally safe and effective.

The appropriate probiotic strain and formulation should be recommended by your healthcare professional based on your individual health needs.

For more information or to schedule a wellness consultation with Dr. Cathy Rosenbaum,  holistic clinical pharmacist and certified health coach in Blue Ash OH,  please visit www.rxintegrativesolutions.com.

–Dr. Cathy Rosenbaum

 

 

 

Kothari.  Probiotic supplements might not be universally-effective and safe: A review.  Biomed Pharmacother 2019;111:537-547.

Energy Drinks – Are Those Shots Really Safe?

Beverages like Red Bull, Rockstar, Monster Energy, 5-Hour Energy, Mountain Dew Kickstart, and Full Throttle are touted to increase energy, improve mental alertness, and enhance physical endurance. Some of these products are marketed as beverages while others are marketed as dietary supplements.

According to the Center for Disease Control and Prevention, between 2007 and 2011, the number of energy drink-associated emergency room visits doubled. In 2011, one in 10 of them resulted in a hospitalization. Some college students will unsafely consume energy drinks along with alcohol or other products/drugs (e.g., marijuana, OTC or prescription medications).

Ever looked at the nutrition label on the back of one of these products? They contain more than just caffeine and sugar, namely B vitamins, amino acids (taurine and carnitine), and other dietary supplements -> green tea extract, guarana, yohimbine, green coffee bean extract, bitter orange, glucuronolactone, ginkgo biloba, and ginseng. A single 16-oz bottle may contain up to 62 grams of added sugar, more than the maximum amount recommended in one day (15 teaspoonfuls – 250 calories).

In smaller quantities, caffeine may boost energy and alertness. In larger quantities, caffeine can negatively affect the cardiovascular system. Taurine may boost metabolism. In theory, extra carnitine may impact fat burn. The body is typically not deficient in endogenous carnitine, so it’s a waste of your money. Guarana contains caffeine. Green tea extract contains caffeine and the antioxidant EGCG. Green coffee bean extract contains caffeine. Yohimbine and bitter orange are central nervous system stimulants.

Ginseng does not impact energy and may lower blood sugar in diabetics – diabetics should be careful with its use. Ginkgo biloba has not been clinical proven to improve energy. Water soluble B vitamins protect nerves but may not improve energy. Thankfully, they will be eliminated by the kidney if taken in excess.

Glucuronolactone, a component of connective tissue, is metabolized into glucuronic acid and is touted to ‘detoxify’ (what?) in the body, a nebulous claim that is unproven in humans. It has no impact on energy.

Possible side effects from energy drinks include, but are not limited to, rapid heartbeat, heart palpitations, heart attack, and headaches. Caffeine and other stimulants may also be associated with anxiety, sleep problems, digestive problems, and dehydration.

If you feel you need to consume energy drinks, a good health rule is to consume them in moderation and remember that there may be negative outcomes. Talk it over with your primary care physician. Be healthy, eat whole foods, get ample restorative sleep, and stay safe.

REFERENCES:

Higgins. Energy beverages: content and safety. May Clin Proc 2010:85:1033-1941.
Sankararaman. Impact of energy drinks on health and well-being. Current Nutrition Reports 2018;7:121-130.
Uliah. Energy drinks and myocardial infarction. Cureus 2018;10;e2658

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Cathy Rosenbaum PharmD RPh MBA CHC 10/12/18©