Meds

Motrin vs. Tylenol for children: A pediatrician explains

Meds
March 12, 2019

As a pediatrician, I am asked by worried parents about what they should give their child with a fever, Motrin (ibuprofen), or Tylenol (acetaminophen) to bring down the temperature daily.

This question always requires more than a one-word response to the choice between anti-fever medications. An explanation of medication even being necessary for the fever and to clarify many long-standing fever phobia misconceptions.

Mainly, it is not necessary to treat the number …

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A paradigm shift in acute pain assessment and management

Meds
March 8, 2019

We have embarked upon a unique strategy to assess and manage pain. “Opioids Rarely Help Bodily Pain” is not a catchy phrase but a mnemonic related to educational learning which serves as the cornerstone of a new acute-pain management paradigm. As is known, the evaluation of pain is extremely difficult due to its subjective nature. However, this new evaluation not only accounts for the patients’ self-assessment but, for the first …

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The tip of the iatrogenic benzodiazepine iceberg

Meds
March 1, 2019

Life experience gives one an intimate appreciation for the meaning behind the saying “just the tip of the iceberg.” Everyone’s encountered something that turned out to be much larger and more complex than was initially understood. In my experience, medicine has yet to submerge its head underwater to discover the true depths of the sordid underside of what I’m calling the “iatrogenic benzodiazepine iceberg.” My own boat capsized on that …

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A Xanax prescription that should have been rejected

Meds
February 27, 2019

In hindsight, I should have never accepted a Xanax prescription from my doctor. What followed was catastrophic — rapidly developing tolerance and physical dependence on the drug and a prolonged illness. Three-and-a-half years later, I am still slowly tapering off Valium (having transitioned to a longer-acting benzodiazepine to aid in tapering) and experiencing debilitating symptoms daily.

I was unprepared for what happened to me by my medical …

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The conflict between pharmacists and their corporate superiors

Meds
January 24, 2019

Pharmacists play an essential role in today’s ever-expanding health care system today. They check for drug interactions, watch for signs of opioid overprescribing and try to determine whether a drug for one condition prescribed by one doctor will negatively impact the patient because of another diagnosis the patient has. In hospital units, their roles have become yet more complex — often serving on various quality committees, managing daily dosages of …

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A call for the end of routine opioid use after wisdom tooth removal

Meds
January 15, 2019

We are writing as a parent and a dentist to spread a message to parents and dental health care providers across Canada: there are alternatives to prescribing opioids after wisdom tooth removal.

Removing wisdom teeth is considered by many as a rite of passage for teenagers. It is one of the most common surgical procedures done in young people aged 16 to 24.

Amy’s 16-year-old son, Felix recently had his wisdom teeth …

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Don’t miss this adverse drug reaction when tapering benzodiazepines

Meds
November 27, 2018

“Alice Woods” is dying of metastatic breast cancer, but she cares little for awareness efforts like pink ribbons and catchy hashtags like #stage4needsmore. You see, Alice has akathisia due to an adverse effect from discontinuing Klonopin — a condition that has caused her far more suffering than her terminal cancer. It has also prevented her from receiving adequate cancer treatment and is, therefore, ending her …

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Suboxone for pain makes sense. Why don’t more doctors prescribe it?

Meds
November 19, 2018

Many patients who end up in Suboxone treatment have chronic pain. They were originally prescribed other opiates and ended up addicted to them.

Skeptics argue that is just substituting one opiate for another. But that isn’t quite accurate. More on that in a bit.

In my seven years of prescribing Suboxone for opiate addiction, I have often observed how potent a pain reliever this medication is, even in fairly low doses. More …

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3 ways physician-pharma partnerships are improving quality of care

Meds
November 4, 2018

We’ve all heard about the importance of greater stakeholder collaboration in health care. It’s the premise of current movements aimed at improving the outlook on some of the most costly, chronic conditions.

Like most physicians today, I maintain a tight work schedule to keep bottom-line margins in the black. On a daily basis, I see between 25 and 30 patients while also serving as the medical director of employee health for …

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When Western medicine fails patients and clinicians

Meds
November 3, 2018

It’s a common scenario: a patient shows up to my office lugging a bagful of over-the-counter supplements, defiantly informing me that they “don’t believe in prescription drugs.” In the very next breath, they present a lab slip with a list of bloodwork that their alternative medicine doctor wants me to order to help diagnose their myriad symptoms.

I’ll admit, my initial natural reaction in this situation was a feeling of annoyance …

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The answer to your prior authorization problem is simpler than you think

Meds
September 30, 2018

Prior authorizations (PAs) have become increasingly burdensome for providers — they contribute to 92 percent of care delays and an estimated 77 million are submitted manually each year. In fact, the process has become so burdensome that many physicians get fed up with the process end up writing for less-effective prescriptions because they know the preferred drug will require a prior …

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We should all care when patients get too many Z-paks

Meds
August 2, 2018

Many people seem to believe that the Z-pak possesses magical qualities. Patients come in requesting it for the common cold, because it worked for them in the past. Not only do many believe it cures the common cold, but they think it can treat any infection. Have a urinary tract infection? Just ask your doctor to prescribe a Z-pak! Sniffles got you under the weather? Do the same!

Anyone who believes …

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The double-edged power of the medications we prescribe

Meds
July 30, 2018

My patient, a rugged sixty year old with massively muscular forearms, gray chest hair at the V of his denim shirt, and a voice that suggested years of liquor and unfiltered cigarettes, lowered his voice and leaned forward.

“I’m not usually scared of anything, but for three nights now, ever since I started taking the Levaquin for this pneumonia, I have had the most horrific nightmares. I can’t even talk about …

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The other side of Suboxone

Meds
July 28, 2018

A lot has been written about Suboxone, the buprenorphine treatment drug. For many, Suboxone acts as an effective medication to treat opioid addiction. For others, it’s a highly-valued street drug that is commonly diverted and misused. To understand and acknowledge the darker side of Suboxone we have to look back at its history over the past 16 years.

History of Suboxone

Suboxone was first approved by the FDA in 2002 to treat …

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Prescription drugs are killing students and the educational system

Meds
July 11, 2018

The Centers for Disease Control and Prevention reports that 63,632 individuals died in 2016 as a result of drug overdose. Among these, 66 percent died from opioid overdose. The statistics are derived from in-depth research that was carried out by the research institute in 2016. The Centers for Disease Control and Prevention warns that cases of drug abuse are swiftly spreading geographically and increasing demographically. The …

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To Paxil, with love

Meds
May 12, 2018

In 1994, Penguin Books published what would become a national bestseller titled, Listening to Prozac written by Dr. Peter Kramer, a Clinical Professor of Psychiatry at Brown University at the time. Throughout the book, he debates the ethics of “cosmetic pharmacology” a term associated with the transformation of personality traits through medication. Kramer describes several patients as becoming “better than well” on Prozac — more socially adept, less inhibited, and …

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10 tips to help patients through benzodiazepine withdrawal

Meds
March 20, 2018

As physicians, we are experts at prescribing medications. However, we often fail miserably when it comes to recognizing adverse reactions and tapering medications. It’s something that is simply lacking in our medical training. I have become a victim of this with benzodiazepines, as I detailed in a prior blog post. Benzodiazepines, in particular, are very difficult drugs to taper. I would like to share with you …

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