Thursday, May 9, 2013

Grapefruit Interactions with Many Drugs Should NOT be Ignored

 “DO NOT TAKE WITH GRAPEFRUIT”  This or similar grapefruit warnings on medication labels can be a common sight, but how often are these warnings actually heeded? Are you or your aging parents at risk for not heeding the warnings? You can be at serious risk.

According to a recent article in the May issue of Nursing 2013, a recent study found that there are over 85 prescription and over -the-counter medications that interact with grapefruit. Of those, 43 can have serious adverse reactions such as GI (intestinal tract) bleeding, or can be toxic to the kidneys (nephrotoxocity).


Serious Consequences
Grapefruit interactions can also have serious cardiac affects such as torsades de pointes which is a type of ventricular tachcardia (very rapid heart rate) with dangerous potential for fatal consequences. Another potential interaction can result in rhabdomyolysis which is the rapid destruction of skeletal muscles.

Only a small amount of grapefruit is required to cause these interactions. Just 2 segments of a grapefruit or one cup of grapefruit juice is sufficient to cause effects. It is important to read the labels on foods and juices or sodas as they can contain grapefruit and should be avoided. Grapefruit is a healthy and nutritious fruit, but must be avoided by those taking medications that can interact.

Actions Altered by Grapefruit
Medication actions can be significantly altered by the grapefruit by increasing or decreasing the absorption of the medication or even delaying the action of the drugs.

One of the most common clasification of drugs that can interact with grapefruit is the statins which are cholesterol lowering drugs. Look for the warning label on these if you or your parents are on thses drugs. If in doubt, ask the pharmacist.

Some other common drugs that can be affected by grapefruit include oxycodone (i.e. Percocet, Oxycontin)  cyclosporin (immunosuppresant drugs used in Crohn's diseases or after organ transplant),  buspirone (Buspar),  nifedipine (Lisinopril), clopidogrel (Plavix) and fexofenadine (Allegra).

Anticancer agents, Erythromycin, Quinidine, and amyodorone (i.e. Nextarone or Cordarone) can have the tosades de pointes effect with potential fatal heart rate issues.

Always ask your pharmacist about food and drug interactions.  If possible, use one pharmacy so all of your medications and history can be overseen by a pharmacist. Be safe!

For further reading:

Friday, March 22, 2013

Keeping Your Aging Parents Healthy and Safe

Maintaining independence is legitimate goal for anyone, but for aging parents it takes on even greater importance. Independence means many things including privacy, dignity, and a long and productive life. A healthy lifestyle and safety are two important factors in maintaining that independence.

Prevention of chronic illness that can rob us all of our goal of independence in our older years is important. But when chronic illness is a factor, following medical advice and having regular check ups is essential. Understanding the illness, what medications, diet and activities will work best, how to avoid complications and what signs and symptoms need to be reported to your physician are key points to establish with your medical team.Helping your loved one set up a med box can be beneficial to ensure they take their medications as directed on a daily basis. Electronic medication delivery devices can ensure reminders and delivery of the exact amount if additional accuracy is needed.

Proper nutrition is one of the most important issues for older people. They don't often require the caloric intake of someone younger and more active. Sometimes 2 healthy meals a day can suffice, but they need to be nutritious. Small frequent meals and snacks can actually be better, but it all requires planning ahead and portioning out foods.

Grocery stores and especially big box stores sell in large portions. For instance, an older person is more likely to make 3-4 meals out a typical steak as it comes packaged from the grocery store. If they don't then divide that meat into portions and take care to store the portion they aren't eating today, they are not only likely to have food spoilage, but if they then consume the spoiling meat are susceptible to consequences such as nausea or diarrhea at the least.

Frugality Doesn't Always Pay Off
The elder generation today grew up during or shortly after the Great Depression and are less likely to throw something out that has spoiled. They will be frugal to a fault and ofetn suffer the consequences. Grocery shopping for your aging parent becomes more than just picking up a few items for them. Helping them to safely portion out the food and meal plan is important.

Frozen foods that can be easily microwaved are a great option when cooking is difficult, and leaving the stove on is a distinct possibility. However, be alert to the salt content especially if your loved one has heart or kidney issues, or is prone to some swelling in the lower extremities.

Read the labels. Some of these meals can also be high in sugar content. Often times manufacturers increase the sugar content particularly when the reduce the fat content. And watch the calorie counts. Grocery stores are packed with low calorie meals in the frozen food aisle. Your loved one may need more than 200 calories at a meal especially if they don't have additional food or snacks. Fresh fruits and vegetables in small portions make nutritious snacks.

Ensure, Boost, Instant Breakfast and other nutritious meal supplements help increase the calories and provide nutrients they may be otherwise missing. These tend to be sweet tasting and many people balk at drinking them. The contents can be poured into freezer safe containers and frozen for an ice cream-like snack. This is often more palatable.

Work with your loved ones to establish meal plans and help them package food safely so that they receive proper nutrition. It will go a long way in keeping them healthy, safe and living productive lives.

Thursday, February 28, 2013

Blog Post Nominated for Award

My blog post,  Important Terms Affecting End-of-Life Decisions, has been nominated for an award from Assisted Living Today as one of the Best Senior Finance and Legal Issues Articles for 2013.

You can vote (no registration required) for this article daily until March 7, 2013 . I greatly appreciate the honor and the recognition it brings to my work on this site.

Thanks to all.

Many Thanks-- We were named Runner UP
2013 ALTY Awards Runner Up

Monday, January 21, 2013

A Worse Than Average Flu Season

Health officials in the U.S. are now reporting that the flu is active in 48 states and they are calling this a "worse-than-average flu season;" especially for the elderly.

The very young and the elderly are often the most susceptible to complications from flu such as dehydration and pneumonia which can be fatal if not treated quickly.

Flu can quickly spread in assisted living settings, board and care homes and skilled nursing facilities. Often these facilities will quarantine their residents and limit outside visitors in an effort to stop the spread and allow the ill to recover.  Please observe the warnings and don't make a bad situation worse.

Flu vaccine is a must for the elderly, even those who live alone and rarely venture outside their home. Visitors can bring the virus in if they are ill or have been recently exposed. The germs can be passed along on surfaces of things such as newspapers, mail, and groceries. The virus can live on surfaces like doorknobs, counter tops, grocery carts, toilet handles, etc. Hand washing and wiping down surfaces can help contain the virus.

Hand washing is an absolute necessity!! Those visiting or caring for any older person need to be vaccinated and take precautions. Cough into your elbow. Toss tissues after a single use. Wear a mask in public. And wash your hands frequently!

The flu is a respiratory illness composed of any combination of sore throat, cough, runny nose, elevated temperature, chills and body aches. It will typically last 4-10 days.  Nausea, vomiting and diarrhea may also accompany these symptoms, but by themselves don't constitute true flu virus. There are several GI viruses active at this time as well.

There are antivirals such as Tamiflu available, but they must be started in the first 48 hours. Often people don't recognize they have the flu until much later and the antivirals will be ineffective. This year's strain seems to be resistant to the antivirals as well.

Contact your primary care provider or seek medical care at an urgent care or mini-clinics if your symptoms worsen, you're over 50, you have a compromised immune system, or have chronic diseases such as diabetes or heart disease. Try not to go to an Emergency Room for flu symptoms. It is far more costly and ER's need to be available for true emergencies. There are plenty of other options for care.

If you experience difficulty breathing, chest pain, a fever of 102 degrees F or more, or are unable to consume liquids, seek immediate medical care.

Plenty of liquids are essential to avoid dehydration and to improve flu symptoms by flushing your system. Fluids can take many forms such as popcycles, ice chips, soups, broths, Jell-o, electrolyte solutions like Gatorade or Pediasure. Even just frequent sips of cold or warm water will help hydrate. This is especially important in the presence of fever and chills when the body will perspire and lose fluids through the skin. Crackers and toast can help keep the tummy calm and able to tolerate medications.

Chicken soup is often one of the best tolerated foods for colds, sore throats and flu. It can be mild, or even spiced up with a little black or white pepper to aid in decongestant efforts. Hot or warm liquids may go down much easier for severe sore throats. If not, try icy liquids which may actually offer a numbing effect.

Tylenol (acetaminophne) or ibuprofen (Advil or Motrin)  in age appropriate doses, will help reduce fever and body aches. Many cough, cold and flu formulas available over the counter also contain acetaminophen or ibuprofen, so be sure to account for this dose and don't overdose. Tylenol should not exceed 3000mg per 24 hours! Some formulas contain alcohol and/or high levels of sugar which may not be good for some.  Read the labels or ask the pharmacist for assistance.

Cough medicines can cause nausea. Hot tea with honey and lemon may be more effective and easier on the stomach. Keep your mouth moist with sips of liquids and perhaps some hard candies to suck on. 

The cough may actually linger for about 3 weeks after other symptoms are gone. Be patient. However, if you start to feel better and then get worse again, seek immediate medical attention.

Rest and sleep are essential to recovery. Stay in bed. Don't venture out in public and expose others. Quarantine yourself from the rest of the household as well to minimize exposure.

Remember, prevention is the best medicine. Get a flu shot. Wash your hands frequently. Avoid crowds and anyone who is ill. Take care and stay well!



Monday, December 24, 2012

Happy Holidays!

Wishing each of you and your families and friends the very best and safe holidays!

photo © Kathy Quan

Monday, November 26, 2012

What is Caregiver Fatigue?

Those of us who are tasked with caring for aging parents and other loved ones can become overextended very quickly. Caring friends and family can even believe they are helping by "delegating" to us so that our loved one doesn't have to do it. All too often these well-meaning people wouldn't dream of stepping in and helping. And they have a long list of reasons why not such as not wanting to interfere or step on toes!!

See the bits of frustration and anger growing in that paragraph? No matter HOW much you love the person you're caring for, it can be come too much more often than you'd like to admit.

Caregiving is one of the most demanding roles ever invented. And when caregivers don't set some limits and replenish themselves, the task reaches "impossible" very quickly. They simply burn out and can't function in that role.

Learn to prioritize, organize and delegate what you can. The more you can control, the easier things will be. Schedule tasks and don't procrastinate the ones you don't like. That just adds to your stress. Ask for help before it becomes overwhelming and have a spouse, friend or other loved one with whom you can vent as often as needed to release these feelings.


Wednesday, October 31, 2012

Devastation from Hurricane Sandy

Living in So CA, disaster preparedness is always in the back of your mind. But who would have conjured up the amount of devastation in the path of Hurricane Sandy?!

I have friends and family smack in the middle of the destruction from the Jersey Shore to NYC. Thankfully they are all safe. This is a nightmare we won't forget. My thoughts and prayers are with everyone who has been affected by this event.

Take care and be safe. Don't get taken by scams. Be smart.