General

pain relievers

Whether a headache, toe pain, or a muscle ache after a prolonged tennis game, many of us has found our way into our local pharmacy with intentions to purchase over-the-counter pain medications.

Most people expect over-the-counter pain medications to be safe. However, there are several important side effects everyone should be aware of.

Two common examples are pain and fever reducing medications. These two medications can be found alone or purchased bundled with other medications in one pill for multi-symptom relief.

 

Acetaminophen (Tylenol)

–        Used for pain and fever

–        Although this medication is found over the counter, it has a black box warning issued by the FDA of “hepatotoxicity”, which means this medication can be toxic to the liver. This means there is a risk of acute liver failure which can lead to liver transplantation or death especially in doses of greater than 4000mg per day

–        This medication should be avoided by patients with history of prior allergic reactions to this group of medications and patients suffering from severe active liver disease

–        Caution must be taken if patient chronically uses alcohol, is dehydrated, malnourished, or has kidney disease

–        Adverse reactions to acetaminophen include anaphylaxis (severe allergic reaction), hypersensitivity reactions, rash, liver toxicity, acute kidney injury, chronic kidney disease if taken for a long time, anemia, and low platelets

 

Ibuprofen (Motrin, Advil), Naproxen (Aleve)

–        These medications belong to a class of medications called NSAIDS (Non-Steroidal Anti-Inflammatories)

–        They are used for treatment of pain, fever, and some inflammatory conditions such as arthritis

–        These medications also have a black box warning issued by the FDA.

o   Use of NSAIDs increases risk of serious and potentially fatal cardiovascular thrombotic events (such as heart attack and stroke)

o   NSAIDs also increase risk of serious and potentially fatal gastrointestinal adverse events that include bleeding, ulcers, and perforation of the stomach or the intestines.

  • Elderly patients and patients that have history of peptic ulcer disease or gastrointestinal bleeding are at a greater risk for serious gastrointestinal events.

–        Serious reactions reported with use of NSAIDs include

o   Gastrointestinal bleeding, ulceration, and perforation

o   Heart attack, stroke, blood clots

o   Hypertension

o   Heart failure

o   Kidney failure (many different types)

o   Liver toxicity

o   Anaphylaxis, allergic reactions including Stevens Johnson Syndrome

o   Bronchospasm

o   Rashes including sensitivity to light

o   Low platelets, Anemia, and low white blood cell count

o   High potassium

o   Abdominal pain, nausea, constipation

o   Ringing in the ears

Please consult with your doctor prior to taking any medications over the counter.

 

Buyer Beware!

The team of Concierge Medicine of Jupiter

 

pain relievers

ANTIBIOTICS are medications that are used to help us fight BACTERIAL infections.

When antibiotics are used to fight BACTERIAL infections, they help us recover, shorten duration of bacterial illness, and can save lives. It is appropriate to treat bacterial illnesses with appropriate antibiotic therapy. The type of antibiotic that is used to treat a bacterial infection depends on the type of bacteria, the location of the infection in the body, and most importantly, it depends on the patient’s specific needs.

Antibiotics are not meant to treat VIRAL infections. Not only are the antibiotics not effective if used in the wrong context, but they can cause harm. Different antibiotics have different side effects. Some people can develop allergic reactions to antibiotics that can be life threatening. Other antibiotics can alter the rhythm of the heart and can cause a life-threatening arrhythmia. There are antibiotics that can cause liver failure, kidney failure, and/or failure of other organ systems.

When antibiotics are used inappropriately, we suffer a great cost both personally and as a society. Overuse or misuse of antibiotics leads to antibiotic-resistance. What that means is that bacteria “learn” how to evade the antibiotic mechanisms of action and the medication is no longer effective when you really need it most. Consequences of this include longer duration of illnesses, more severe illnesses, more doctor visits, use of stronger antibiotics with more side effects, and higher chance of dying from a bacterial illness.

MULTIVITAMIN SUPPLEMENTATION

According to the Food and Drug Administration, Congress defined the term “dietary supplement” in the Dietary Supplement Health and Education Act (DSHEA) of 1994.

A dietary supplement is a product taken by mouth that contains a “dietary ingredient” intended to SUPPLEMENT the diet. The ingredients of these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. DSHEA places dietary supplements in a special category under the general umbrella of “foods,” not drugs.

Under DSHEA, the company that produces the dietary supplement is responsible for determining the supplement’s safety and that any representations or claims made about them are substantiated by adequate evidence to show that they are not false or misleading. This means that dietary supplements do not need approval from FDA before they are marketed.

Unlike drug products that must be proven safe and effective for their intended use before marketing, there are no provisions in the law for FDA to “approve” dietary supplements for safety or effectiveness before they reach the consumer. Once the product is marketed, FDA has the responsibility for showing that a dietary supplement is “unsafe,” before it can take action to restrict the product’s use or removal from the marketplace.

FDA disclaimer

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WHO MAY BENEFIT FROM SEVERAL NUTRIENTS IN MULTIVITAMINS?

Most people who have true vitamin deficiencies have underlying medical problems that either prevent absorption of a nutrient from the diet or its metabolism. For example, patients who have undergone a gastric bypass surgery, have been afflicted with malabsorption disorders, or suffer from chronic alcoholism are unable to obtain the right nutrients in their diet. It is best for most people to obtain vitamins and minerals from eating a well-rounded healthy diet.

However, some people benefit from certain vitamin supplementation. Pregnant women and women who might be pregnant are recommended folic acid supplementation, especially in the first trimester, to prevent neural tube defects in their babies. Pregnant women may also be recommended iron supplementation by their health care provider.

Patients that have vitamin D deficiency and/or suffer from osteoporosis or osteopenia are recommended Calcium and Vitamin D supplementation to help increase bone mineral density and decrease fractures in post-menopausal women.

People over age 50 tend not to absorb Vitamin B12 as well as vegans and they should obtain recommended intakes of vitamin B12 mainly from fortified foods or dietary supplements.

Individuals with poor nutrient intakes from diet alone, who consume low-calorie diets, or who avoid certain foods (such as strict vegetarians and vegans) might also benefit from taking multivitamins.

 

TOO MUCH OR TOO LITTLE? HOW DO YOU CHOOSE A MULTIVITAMIN?

When you are supplementing your diet with pill-form of multivitamins, how do you know if you are taking too much or too little?

Your doctor is the best person to ask about a supplement you are planning to take. In addition, the back of the vitamin bottle contains percentage of daily allowance of recommended supplement intake.

Supplement Facts

Special Considerations for Certain Population Groups

Most basic multivitamins usually contain both vitamins and minerals, mostly at levels that do not exceed the daily recommended values for these nutrients. However, people who take multivitamins and other supplements and who eat fortified foods and beverages might consume some nutrients at levels that exceeding the upper level of recommended intake, which increases the possibility of adverse effects.

Smokers and, possibly, former smokers should avoid multivitamins that contain a large amount of beta-carotene or vitamin A due to an increased risk of lung cancer, as it has been suggested in several studies.

Taking excess vitamin A (as preformed retinol but not beta-carotene) during pregnancy can increase the risk of birth defects in infants. In general population, over-consumption of vitamin A can cause staining of skin a yellow-orange color, loss of hair, developing dry and scaly skin, mouth sores, anorexia, vomiting, nausea, abdominal pain, and headaches.

Over-consumption of Vitamin D can cause high blood calcium levels, kidney stones from high blood and urine calcium levels, anemia, and kidney failure.

Information about different dietary supplements can be obtained online by reviewing dietary supplement fact sheets at National Institute of Health website:

https://ods.od.nih.gov/factsheets/list-all/

According to World Health Organization and Center for Disease Control, cancer is preventable and treatable. The leading causes of cancer are tobacco, infections, alcohol, obesity, and air pollutants.

Tobacco

–        Smoking damages DNA and causes cancer

–        Tobacco is associated with the following cancers:

o   Bladder

o   Blood (acute myeloid leukemia)

o   Cervix

o   Colon and rectum

o   Esophagus

o   Kidney and renal pelvis

o   Liver

o   Lungs, bronchi, and trachea

o   Mouth and throat

o   Pancreas

o   Stomach

o   Voice box (larynx)

–        Prevention: Smoking cessation/avoidance

Infections

–        Certain infections are associated with cancers

–        Human Papilloma Virus is associated with cancer of the cervix, vulva, vagina, penis, anus, and oropharynx.

–        Chronic infections with Hepatitis B and Hepatitis C can cause liver cancer

–        Prevention: Human papillomavirus (HPV) vaccine, Hepatitis B vaccination, treatment of active hepatitis B and hepatitis C infections

Alcohol

  • Drinking alcohol increases the risk of obtaining mouth and throat cancer, voice box (larynx) cancer, esophageal cancer, colon and rectal cancer, liver cancer, and breast cancer in women.
  • The human body breaks down consumed alcohol down into a chemical called acetaldehyde.Acetaldehyde damages your DNA and prevents your body from repairing the DNA damage. Damaged DNA can cause a cell to grow without control and cause cancer.
  • Prevention: avoidance of alcohol

Obesity

–        Obesity is associated with the following cancers:

o   Adenocarcinoma of the esophagus

o   Breast (in post-menopausal women)

o   Colon and rectum

o   Uterus

o   Gallbladder

o   Upper stomach

o   Kidneys

o   Liver

o   Ovaries

o   Pancreas

o   Thyroid

o   Meningioma (a type of brain cancer)

o   Multiple myeloma

–        Prevention: Healthy well-balanced diet and physical activity

Air Pollutants

–        Air pollution is associated with lung cancer, urinary tract/bladder cancer

–        Prevention: Reducing exposure to outdoor air pollution and indoor air pollution, including radon (a radioactive gas produced from the natural decay of uranium. Exposure to radon can occur in homes and buildings).

Sun Exposure

–        Causes cancers that include:

o   Melanoma

o   Squamous cell carcinoma of skin

o   Basal cell carcinoma of skin

–        Prevention: Includes wearing sunscreen (on skin and lips), wearing protective clothing and hats, avoiding peak sun rays at midday, and avoiding indoor tanning beds

 

Foods

–        Foods that are associated with cancer include processed foods, processed meats, red meat and charred food, sugar, fried foods, and alcohol

–        Red Meats and processed foods increase the risk of colorectal cancer (American Institute of Cancer Research)

–        Sugar and fast foods increase risk of obesity which increases risk of cancers

–        Prevention: Eating a balanced diet rich in healthy nutrients

Covid 19 Vaccine

So….a little birdie told us that some of you have been FULLY VACCINATED against the COVID-19 virus. What does that mean for you?

After a long year of COVID19 pandemic, the CDC guidelines are changing again. People who have been FULLY VACCINATED are wondering what activities are considered safe.

What is FULLY VACCINATED?

People are considered fully vaccinated for COVID-19 ≥2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or ≥2 weeks after they have received a single-dose vaccine (Johnson and Johnson (J&J)/Janssen).

As per CDC guidelines dated April 2nd, 2021, FULLY VACCINATED people can: 

  • Resume domestic travel and do not need to get tested before or after travel or self-quarantine after travel.
  • FULLY VACCINATED people do not need to get tested before leaving the United States (unless required by the destination) or self-quarantine after arriving back in the United States.
  • Visit with other FULLY VACCINATED people indoors without wearing masks or physical distancing.
  • Visit with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or physical distancing.
  • Refrain from quarantine and testing following a known exposure IF they are asymptomatic.

As per current CDC recommendations, FULLY VACCINATED people should continue to:

  • Take precautions in public such as wearing a well-fitted mask and practice physical distancing.
  • Wear masks, practice physical distancing, and adhere to other prevention measures when visiting with unvaccinated people who are at increased risk for severe COVID -19 disease or who have an unvaccinated household member who is at increased risk for severe COVID-19 disease.
  • Wear masks, maintain physical distance, and practice other prevention measures when visiting with unvaccinated people from multiple households.
  • Avoid medium- and large-sized in-person gatherings
  • Get tested if experiencing symptoms of COVID-19.
  • Follow guidelines issued by individual employers.
  • Follow CDC and health department travel requirements and recommendations.

Other considerations….

  • Sometimes you don’t know who is FULLY VACCINATED or who is at a high risk for severe COVID-19 infection.
  • CDC guidelines and Health Department recommendations will likely change as more information becomes available.
  • keep in mind: guidelines change quickly as we learn about this virus. Stay informed and stay safe!

From your friends at Concierge Medicine of Jupiter

Obesity

At Concierge Medicine of Jupiter, our philosophy is to change the idea that obesity is a character flaw caused by insufficient willpower, lack of discipline, or bad choices. Since 2013, the American Medical Association has recognized this condition as a true disease- one requiring treatment and management by medical professionals. Through research we now know that one of the hallmarks of obesity is disordered signals for hunger and satiety (the feeling of fullness) making it difficult or even impossible for many to lose weight and keep it off.

In the simplest terms- excess body fat is metabolically active and can cause an abnormal and unrelenting drive for feeding- making weight management even more difficult when compared to those who are not obese.

The pathophysiology of obesity is only partially understood and research is ongoing. Obesity is related to genetic, psychological, physical, metabolic, neurological, and hormonal impairments. It is intimately linked to heart disease, sleep apnea, certain cancers, and many other illnesses. It is also one of the major risk factors for poor outcomes in COVID19 infection. Obesity is one of the few medical conditions that can negatively influence social and interpersonal relationships.

The good news is that shedding even a modest number of pounds can have significant health benefits. Sustained weight loss of just five percent of body weight can significantly lower blood pressure, blood glucose and improve blood lipids.

Obesity has finally been recognized as a disease. We firmly believe it should also be treated as such- just as we do for high blood pressure, high cholesterol, and diabetes. There are new medicines that can be offered, surgery for advanced cases, and new diet and nutritional approaches with a proven track record.

 

Our physicians at Concierge Medicine of Jupiter, Catherine G. Drourr, M.D.  and Yana Shtern, M.D., have a passion for preventative medicine with nutrition and weight management a cornerstone of our practice. If you want to find out more information about our VIP membership practice, contact us at Concierge Medicine of Jupiter today to learn more about our personalized weight management program.

Hyperhidrosis is a condition that is characterized by excessive sweating and usually occurs mostly on the hands, feet, armpits, and face of the affected patient.

In normal cases, the body produces sweat episodically meaning that sweat is usually produced as a response to something whether it be stress, anxiety, when you are exercising, or when you are running a temperature after which it dissipates. 

In a small percentage of patients with hyperhidrosis, this exocrine function doesn’t stop and they sweat in conditions that don’t warrant it for e.g. in an air-conditioned space or while simply just relaxing. Hyperhidrosis can in some instances be linked to an underlying cause, however, in many cases, there is no known medical cause.

Hyperhidrosis can be classified into two groups – primary and secondary hyperhidrosis.

Primary hyperhidrosis

Primary hyperhidrosis can cause undue sweating in large quantities usually evident on the face, feet, hands, and underarms of the patient.

Secondary Hyperhidrosis

Secondary hyperhidrosis usually presents itself in larger areas that are dispersed all over the body and is caused by heat, underlying medical conditions, or even from some types of medication.

Many cases of primary hyperhidrosis are usually hereditary in nature. Patients with hyperhidrosis sweat from the eccrine gland which are found in large quantities on the hands, feet, face, and underarms. Overstimulation of the eccrine gland is what causes hyperhidrosis and sometimes all that is necessary to trigger excessive sweating is a mere thought of potentially feeling a certain way.

How is it treated?

Over the counter medicine can be used to treat hyperhidrosis. 

  • Anticholinergics affect the nerve glands to secrete less sweat. This medication comes in pill form, or in the form of a cream that is applied to the skin.
  • Botox injections
  • Anxiety medication
  • Low intensity electrical current treatments 

Surgery is usually the last resort. Doctors perform a thoracic sympathectomy where the doctor removes the nerves and sweat glands in the affected area. This can cause other side effects which include sweating elsewhere such as on the back, chest, and legs for example.

Secondary hyperhidrosis is usually caused by an underlying medical condition and causes sweat to be produced whilst sleeping. Secondary hyperhidrosis usually occurs all over the body and can be caused by the following factors such as pregnancy, hyperthyroidism, gout, shingles, menopause, and many others as well as certain medications used to treat conditions such as diabetes or depression. 

If you are suffering from this medical anomaly and want to find out more information about this condition, contact us at Concierge Medicine of Jupiter today for personalized medical care assistance with a difference.