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Monday, January 31, 2011

The Wall 30k race report

This year I was intent on running a better race than last year's 30k, at which I sucked. I haven't raced in a while, but for some reason all day yesterday I had a good feeling about this race. That should've worried me since I usually do best for races that I am totally unprepared for!
It was surprisingly warm - 60's and super humid - and I wore shorts for the first time in ages. Also my Karhus!
Why thank you, I do find our linoleum rather quaint.
I carpooled over to Destrehan-the-ugly, dragging brother Abe along, and arrived in time to pick up my number before the start. As we walked up to the start I clicked on my Garmin. I had decided to run with it as an experiment to see how it felt for a race. If I liked it, I was going to use it for the Mardi Gras marathon in two weeks.
Uh-oh. My Garmin was completely dead. I must not have had it all the way on the cradle. I didn't have a back-up watch, and there is no time on the course, so I had to run this one on my own! I've never run a race without time before!
Because of that, I can't really comment on my pace. I know I felt really good and was running merrily along for most of it. I chatted with runners I passed on the first half (once we thinned out, one man passed me and no one else for the first half, but I passed a number of people. This might mean that I started too fast. Sure wish I knew). I enjoyed hitting the turn around and looking for other runners I knew. I'd seen Abe already, who was 5th, and saw others after I turned the corner.
Suddenly, out of the blue, my calf cramped on me. Oh my gosh. I had no idea that a calf cramp would be so painful! I staggered, slowed, and tried to run through it; it wasn't budging. Here is where I started getting passed - two girls and a guy - that is the worst when you're limping and everything already! I eventually stopped to massage it and tried to walk it out. I am here to tell you that doesn't work. I asked the volunteers at the next aid station (the cramp occurred about mile 10; they were between 12 and 13) if an ambulance was near. I did not think I could finish with this pain! They offered to radio for it, but eh...I decided I didn't feel like waiting. So I gritted my teeth and ran through it. It hurt like the dickens.
Can you tell it hurts? That is a scary face. Yikes.
Finally the race ended - those last miles seemed to take forever - and I squinted at the clock as I approached. I ran a 2:21:40, and actually beat the 2:23 pace band I had printed for myself before I changed my mind and decided to take the Garmin. Only I have no idea how fast I started or how much the cramp slowed me or anything because I only saw the finish time! I was third female overall - admittedly, it was a small field - and I'm actually happy with the race overall. I feel like it was a good training run for the upcoming marathon, and with a watch or Garmin and non-crampy leg I will have a better run. I am trying to figure out why I cramped (I never have before) and I think I was dehydrated; I had two cups of coffee and no water before the race and actually no water on the course, either, this was the first warm-weather run for me in a long time and I under-hydrated.
I'm pleased that despite the cramp, my actually energy levels were fantastic. I wasn't fatigued and I felt comfortable at the finish. That's the best kind of race. I hate finishing and feeling bleah.
This year's Wall definitely beats last year, which was bitterly cold, windy, and miserable. I'll call it a success!
Side note - The Karhu experiment flopped, too. I have never worn them for long distances and I got several blisters and a black toenail. I still love these shoes for shorter runs, just not distance.

Sunday, January 30, 2011

I love this - travel coffee cup

I love this ceramic mug from Starbucks because it is microwaveable. There is nothing more annoying than having your coffee get cold at work...while you answer 7000 phone calls.... and not being able to reheat it. I find this ceramic design much more practical - if my coffee cools, I can just zap it for a few seconds!
You can buy this design and similar ones at Starbucks for an arm and a leg. I think this was $14. That's too much, but the less expensive versions are often not safe for the microwave. For once I paid full price and I think it was worth it!

Saturday, January 29, 2011

Follow up: a day in the life of a pharmacist

...Answering a few questions about my rough day last week....
Stephanie asked if I filled the iron prescription whose dose I questioned.
No, I didn't. Pharmacists don't HAVE to fill prescriptions that they feel are not appropriate; I told the mom my concerns and she agreed to bring the rx back to her doctor.
Side note/complaint: There is no earthly reason why a non-medical staff member should be allowed to call in a prescription. A chain is only as strong as its weakest link: I have seen many, many, many errors due to secretaries or receptionists calling in prescriptions or answering questions and not really knowing what they're doing. If a pharmacist has to take the call and write the rx down, a nurse or doctor should have to call the rx in.
Shelly said her dad treated himself with ivermectin from a pet store  for "scabies" and his immune system rebelled. I find that both extremely resourceful and super dangerous! But I bet he saved money on the ivermectin. The human stuff is pricey.
I really want to meet Shelly's dad. I bet he's a hoot. 
Kovas decided to annoy me by referencing Webmd. Two things to say about this: one, as internet sources go, Webmd is actually very good. Two, I don't mind this kind of thing. I keep up with health pop culture so I can talk to my patients and know what they're talking about. People often say, "I read online..." and at least it means they are concerned about their own health!
Although last night a girl called me crying after reading up on her rx for Valtrex. "I got the wrong drug!" She sniffled. "I have a mouth sore, not yucky bumps on my junk!" I respectfully did not laugh but assured her that although Valtrex IS used for genital herpes, it is also used for oral herpes which caused her mouth sore. She told me she was never Googling anything again, she was so upset.
Lindsay thanked me for checking allergies. You're welcome! Just my job! But PLEASE tell your pharmacists your allergies. Many people think telling their doctor is enough, but we are here as a "double check" and we need to know, too!
On Thursday a mom picked up a prescription for Bactrim suspension for her 8 year old. I asked for allergies and she told me her daughter was allergic to Risperdal. No problems there, so I filled her prescription. When she got home she called me and said she read that Bactrim was a sulfa drug. I said yes, it is. "But all my kids are allergic to sulfa!" she cried. " I told my doctor." 
She had told her PEDIATRICIAN but she didn't tell the EMERGENCY ROOM RESIDENT who wrote the rx! And she didn't tell me! Luckily she hadn't given the drug to her child yet.
Lisa was concerned about rx error rates. Yeah. Always double check your medication. A recent 20/20 program discovered a 22% error rate in dispensed prescriptions.That included mistakes all along the chain, from the doctors and nurses to the pharmacists and techs. You should always check your rx before leaving - skim the paperwork to see if the drug treats the condition you have - and ask to be counseled by the pharmacist. I have caught multiple mistakes this way.
The most recent survey of pharmacies indicates a 1% error rate that is attributed to the pharmacy as the cause. The report by 20/20 highlights other errors, too - legal glitches, staff training problems, and failure to counsel. That's not going on at MY pharmacy, but you better err on the side of caution and always assume the worst! Always double check your rx!

I can't believe I'm talking about work on my day off. Ugh. I'm going for a short run to keep my legs fresh for my 30k tomorrow. Have a fantastic weekend!

Friday, January 28, 2011

Happiness is...

...Successfully selling all of your Ebay items.
And whoever snagged that Michael Kors top for $0.99, that's the deal of a lifetime, so enjoy.

Wednesday, January 26, 2011

Ever have a great run?

Maybe it's because my cold is finally going away. Maybe it was the cold, dry air. Maybe it was the pretty park views in the sunrise. Perhaps it was the shoes - I wore my Karhu "fast" shoes instead of my heavier Saucony's. Either way, everything clicked on today's run. 
I did over ten miles at 7:30 pace and feel great! It took me awhile to warm up but once I did I picked up my pace and ran around 7:25 for the last five miles. Hopefully I can run a similar pace for the first half of Sunday's 30k. After that I can just slow down and muddle through. I never did figure out how to do negative splits...
Happy hump day! Have a great one!

Tuesday, January 25, 2011

A day in the life...

Work has been insane. Have I mentioned this? Here's a sample of crazy just from today:

- I call the pediatrician on a child's iron supplement dose. The baby is under 2 years and the dose is roughly four times an adult dose. The NON-MEDICAL PERSONNEL receptionist who answers the phone authorizes the dose. I ask her to let me speak to a nurse or doctor and she refuses, telling me that she's allowed to speak for the doctor, and that's the dose, period.
- A customer asks me if there is anything over the counter for scabies. I tell him no; he tells me he doesn't have insurance so I recommend an inexpensive clinic nearby. He returns in an hour and literally shakes his fist in my face, hissing that he is furious with me. I ask him what's wrong and he replies that he spent $300 on a clinic visit (yeah, didn't follow my advice on the clinic) and that the doctor told him the drug was over the counter so he wasted his money. I look at his prescriptions; he has two prescription-only drugs. I cheerfully fill his prescriptions, despite the fact that he actually really shook his fist in my face. I am not sure who said permethrine 5% and Vistaril were over the counter but um, they aren't.
- I call a doctor's office to get the strength on a prescription.His nurse tells me they are too busy to take my call and will call me later. I tell her the patient had oral surgery and needs this pain medication now. She tells me she'll call when she has a chance. She calls me 6 hours later. For 4 of those hours the patient sat in my waiting room, whimpering softly and bleeding on the floor.
- I am filling a prescription for Bactrim, an oral antibiotic, when I see that the patient has a sulfa allergy. Bactrim is a sulfa drug. I call her doctor about the allergy, and I'm told that the rx (which is typed) should be for Bactroban, a topical antibacterial ointment. I have no idea how this happened (the directions were to take twice a day by mouth - clearly this was not for a cream) but if it hadn't been for the allergy I would never have caught the mistake.
- A customer calls in his own prescription over the phone - ie, a forgery for a controlled substance. Then he's stupid enough to call me right back, this time as the patient, not pretending to be the doctor, and uses the same voice. "Is my prescription ready? My doctor just called it in." DUMB.
- A nineteen year old is discharged after a kidney transplant and brings in his prescriptions. Because he's a transplant patient, he has Medicare. His prescription insurance (medicare part D) says to bill part B because he's a transplant patient and part B covers transplant drugs. Only his drugs aren't all on the covered drugs list by medicare B. So neither medicare is paying and there is no substitute for his drugs and this poor kid is weak and ill and broke.
- A man throws up in the waiting room. In the ensuing drama, a woman grabs her rx from the counter where we are ringing her up and runs out without paying. Her copay was $3.
- Eleven of our top twenty drugs are on manufacture back-order. ELEVEN. No one can get their drugs and they don't understand that it isn't my fault and I'm trying to help. Try explaining this scenario 180 times a day.

Where is my alcoholic beverage???

Sunday, January 23, 2011

I love this - salt cellar

This might become a new series...if I can find enough things I love. Kind of hard to do when you're a jaded pessimist so we'll see.
Something I have found room in my stony heart for?

My stainless steel salt cellar. It is only 2" across and has a tiny stainless steel spoon.We use this instead of a salt shaker because we use kosher salt.

Something else I love. If you aren't using kosher salt instead of table salt you're CRAZY because it is awesome. Try it and see.
There is something so elegant about genteelly spooning salt onto your food instead of shaking a greasy glass tube like a mad man. The only drawback to the charm is having to endlessly explain it to guests. If you care, I bought the salt cellar on Ebay, but you can also buy it on amazon.

Saturday, January 22, 2011

World's Ugliest Shoes

I am now the proud owner of the world's ugliest shoe, courtesy of Target clearance.

Just look at these babies. Impossibly round toe? Check. Unsurpassable clompiness? Check. Weird top stitching? Check. Horrid fuzzy suede uppers? Check. Velcro? Check. They definitely meet the criteria for hideous shoe. But they were $6.00 and if you have to stand up for 8-9 hours a day you have to make sacrifices.
The only shoes that come close - and they are not in my closet, thank you very much  - are these.
Hm. On second thought, it's a bit of a toss-up. Those are pretty repulsive.

Friday, January 21, 2011

Deep post: The Philosophy of Just Enough

I thought I'd take this cold day off and compose a post about my life philosophy. I think you need to know this. And I think I need a reason to not go outside into the cold awfulness of this gray morning and run (*shiver*). So here goes.
I want, in my life, to always be in the best. Not "the best", but in the list of bests. One of the top 10%. One of the few. The kind of person whose notes you would borrow ... but who doesn't sit in the front of the class. I want to know about American literature, but I don't want to be an American lit expert, because I also want to know a little bit about calculus and a little about herbal supplements and I don't have enough gray matter to be expert in everything.
I want to know just enough.
This extends to every area of my life.
I want to eat healthfully, but not to the point of being vegan, counting calories, or cutting out coffee.
I want to stay fit and slim, but I'm just there - I'm not super skinny, not super strong, nothing that would require extra effort.
I want an A in every class, but I'm happy with a 97 instead of a 100 (but not a 94. Let's not cut things TOO close).
I don't want to look like a slob, but I absolutely refuse to "do my hair". It looks good enough with just a brush. And I look good enough with just concealer.
My sis and I obviously both subscribe to the "Who does their hair?" theory. I think we look good enough!
I should call all of my brothers once a week. But I think Facebook or an email is just enough to assuage my guilt and keep tabs on all their crazy antics.
Why am I like this? Shouldn't I feel bad for not trying my hardest or giving it my all or doing the best that I can?
Yes and no. Here are my reasons for this philosophy.
1. I'm all about expending minimal calories. When I read Cheaper By the Dozen as a child, the character of the father instantly clicked with me. His job was to devise ways to save movement and energy - basically to make processes more efficient. I thought, "That's the job for me!" I had always done the same thing. How can I clean the bathroom with the least actual work involved? How can I arrange the boys' bedrooms so that getting dressed only requires opening two dresser drawers?
And nowadays it's more like, How can I qualify for the Boston Marathon with only 9 seconds to spare?   How can I get to work exactly at 10 am, not 9:58 (but not 10:02 either)? How can I make a good beef stew using the crock pot and taking exactly 4 minutes of prep time instead of a great beef stew in the dutch oven taking 40 minutes of prep time? How can I know enough music theory to carry a tune and understand music without actually learning piano?
2. It's psychological. Always leave others knowing you have a little more to offer. I don't want to show people all I've got.That leaves me vulnerable.I like to hold back a little so I always have an ace up my sleeve. For example, if you write a book and put everything you know into it, how can you write a sequel? If you always wear full make-up, how do you dress up to go out to dinner on Valentines Day? If you knock out a 2:59 marathon, how will you ever improve or PR ever again?
3. It gives you space. I am not the BEST artist. But I'm pretty good. The extra time and dedication it would take to be the best is far too much for a hobby. So I use that extra time and dedication and apply it to something else - studying HIV treatment, for example. The jump from "really good" to "the best" is enormous and requires intense effort and a huge amount of time. But if you are satisfied with "really good", then you are creating free time and brain space ot apply to another area in which you would like to be "really good".
But there are obviously drawbacks to this tactic.
1. You lack the feeling of giving something all your effort.
2. You can appear lazy to others.
3. You will never be the expert in anything.
4. If you take it too literally you will probably get fat.

How about you? Do you do your best at everything? Do you triage items by importance? Would you be content with being just good enough? Does this post make you think I'm a disgusting slob?

Thursday, January 20, 2011

Never Iron Again

I do not iron my clothes. I think clothing that needs care is silly. I don't have time to iron just like I don't have time to sew my sleeves on after every washing like ladies did back in 1742.

Me in my work clothes. Not. Image from here.

Here is how I never iron.
1. Buy wrinkle-resistant dress shirts. Obviously. Yet when I married hubby he had plenty wrinkle-producing button downs that were so hopelessly wrinkled after washing that they required dry cleaning. FYI I also do not dry clean. I'm cheap, remember? We slowly phased these burdensome dress shirts out (Yes, he received dress shirts for just about every holiday for a few years).
2. Do not use the permanent press settings on your washer and dryer. They are too gentle and will not shake the wrinkles out.
3. If your clothes can take warm water, wash in warm to release wrinkles. Rinse in cold.
4. After washing, remove clothes from the washer and vigorously shake each item out, "snapping" them like you're about to fold a beach towel. Toss in dryer.
5. Use a timed dry or auto dry for 15 to 20 minutes; take out at once and immediately shake clothes out. They might already be dry. If some items are still damp return to the dryer for 15 minutes. Do not over-dry clothes: it just bakes wrinkles in.
6. Like I said, as soon as clothes come out of the dryer, shake them out - then smooth slacks out on your bed. Basically I "iron" with my hand for a second before folding. Shirts I hang as soon as I can.
7. If you take something out of your closet or dresser and it has re-wrinkled, hang it from the shower curtain so it can steam. If it requires tumbling, tumble in the dryer with a wet towel or washcloth.

Wednesday, January 19, 2011

Next race: The Wall

Well, I did it. I signed up for another race. I couldn't stand sitting around all winter waiting for the Mardi Gras Marathon, which is a full 2 months after my most recent marathon, the pretty awful Thunder Road in Charlotte. So I signed up for The Wall, a 30k the last weekend in January. Much like last year, I signed up for this race while out of shape and sick, thinking it would be an incentive. I think last year this is the race that nearly killed me. I was extremely injured - like, every part of my body - and got a bad bacterial infection after. This might have been related to running 18+ miles in bitter cold wind in capris and layered cotton T-shirts, since I didn't own any cold weather running clothes last year.
This is a picture of the course last year AFTER THE FINISH. At the start it was darker, colder, and bleaker. And the bridge looked even more like a torture instrument.
Just seeing this picture from last year gives me knee pain.

Now, I've come a long way running since last year. For one thing, I have two working knees as opposed to one knee and one water balloon full of tiny daggers. For another, I bought running tights. Take that, cold weather! I also have a few more long runs under my belt, by which I mean I've done a couple of marathons. I don't really do that well on the long runs if they aren't a race... which is precisely why I'm running The Wall.

This year, I have a few goals for The Wall.
1. Stay with the pack. Last year a large group of runners started early, allowing the state championship competitors to start together. I started late and ended up stranded right in the middle between the fast people and the slow people. Zero wind protection and zero companionship.
2.Start strong. I had only one long run under my belt last year and wasn't sure how to pace myself; combined with the rough head-wind I started out extremely slowly.
3. No Wall at the The Wall. I thought there was course support last year (because the flyer said there was) but there was only water. Or I was so slow there was only water left when I got there. My blood sugar plummeted. This year I'll bring Gu!
4. Beat my time from last year. Hahahahahaha! If I don't beat last year's pathetic time of 2:55 it means I walked it.

What's your next race? Do you use races for long runs? Have you ever had a horrible, terrible running experience and then willingly chose to recreate it? Hee hee.

Monday, January 17, 2011

Ask a pharmacist: Which NSAID should I take? Part II

Well, the time has come to conclude my verbose post on NSAIDS. Where we last left off we had talked about how NSAIDs work, and what side effects are common with NSAIDs.
Now here is the useful part: Which NSAID should you take?

Let's go over them by type.
1. Aspirin. Aspirin gets it's own category, because it is unique. What makes aspirin different (besides the fact that it is sort of natural, as its precursor can be obtained from willow bark, did you know that?) is that its inhibiting mechanism (see last post) is PERMANENT rather than temporary. When aspirin binds to its target, it stays forever. So to overcome the effects of aspirin you actually have to produce more enzymes. That is why aspirin is used to keep the blood thin. People who take a daily aspiring to reduce the risk of heart attack or stroke usually take a enteric-coated tablet that won't dissolve in the stomach. It dissolves in the intestines, so stomach bleeding is less likely.
Technically aspirin falls into the salsalate class, and there are other drugs in this class, but they are used rarely - and generally for irritable bowel syndrome or Crohn's disease.
Do not take an aspirin daily unless directed by your doctor. He will give you a risk assessment to see if you are a candidate for daily aspirin therapy. Remember you are balancing the blood thinning benefits against the possibility of stomach issues, kidney damage, and high blood pressure.
Asthmatics should not take aspirin unless their doctor ok's it - aspirin - and to a certain extent, other NSAIDs - can exacerbate asthma, but not everyone is sensitive to it.
If you have gout, don't take aspirin for it. It will make it worse. 
Don't take other NSAIDS if you're taking aspirin to thin your blood as  the other drugs will counteract these effects.
2.Propionic acids: ibuprofen, ketoprofen, naproxen. These drugs are all available over the counter and as prescription (higher strengths). These drugs are great for short term relief of fever, swelling, cramps, and pain related to inflammation. They are all fairly rough on the kidneys and the stomach (naproxen especially), so use should be temporary - none of this "I take Motrin every day" crap. If your stomach is sensitive, ketoprofen (Orudis) is a good choice. It is milder on the stomach. If your pain is keeping you awake at night, choose Aleve (which contains naproxen), as it has an 8-hour duration of effect; the others will last 4 to 6 hours and you can awaken in pain late at night. Ibuprofen is superior in the class for menstrual cramps and fever reduction. Interestingly, there is not hard and fast data showing that naproxen increases the risk of heart attacks. This may be true or this may be the stats lying to us. I wouldn't let that influence your choice of drug.
3. Acetic acids: diclofenac, etodolac, indomethacin, and sulindac. These are all available by prescription only. They are killer strong and killer rough on the stomach. The first two come in extended release preparations that have longer duration of action. Indomethacin is outrageously good for gout but studies show that it is very hard on the stomach and may be very hard on the heart as well.
4. Napthylalkanones: Nabumetone. Rx only. Excellent for muscular pain, especially when associated with stiffness and tension.
5. Pyrroles: Ketorolac. Rx only. A wonder drug post-surgery: it actually beats our opioids like morphine for pain control. Unfortunately, if used for over 5 days or at a dose greater than 20 mg per day, it is extremely toxic to the kidney and can easily cause kidney failure. It should never be used longer than 5 days. I mean it.
6. Enolic acids: piroxicam, meloxicam. Rx only. My personal favorite class. Both are well-tolerated and can be taken just once a day, as the half-life is over 24 hours. They are wonderful for muscle pain and swelling, especially around the joints since maintaining control of swelling over a 24 hour period is important to allow healing of the joint. What's fantastic about meloxicam is that it is COX-2 preferential. It doesn't select for COX-2, like Vioxx did, but it tends to prefer the COX-2 enzyme, so there is very little stomach upset with this drug.
7. Cox-2 inhibitors. The only one left is Celebrex (celecoxib). Don't take it. It is expensive and no more effective than meloxicam. Incidentally it is a sulfonamide, so don't take it if you have a sulfa allergy.

In closing, runners should take meloxicam, but not before a long run as you risk kidney failure. Crampers should take naproxen or ibuprofen. Gout victims should consider short term therapy with indomethacin. Rich people should take Celebrex.

And any questions, ask me!


For some reason Blogger buried my Ask a Pharmacist post way back here. I expect all of you to have read it because the follow-up post is coming tonight. That's right, I'm giving you homework!
Just kidding.
I have to work today, but my husband is off. Are you off? If so, how are you spending your free Monday?

Friday, January 14, 2011

Fantastic day!!!

Today I randomly took a vacation day. Until this past autumn, I had never ever even used a vacation day thanks to my strenuous work(s) schedule. But when I got an email saying that there were days still available in January, I took one. Work has been very, very stressful lately and I needed a break. I decided I'm going to start taking days once in awhile, even if I burn through my vacation, because I can always take days off without pay. It's worth it to keep my sanity.
So far, today is turning into a crazy-good day! I skipped my run and went to a cardio kick-boxing class (eh, not much actual cardio going on there) since I have a little cold and it's freezing out. On my way back I treated myself to a Goodwill shopping "spree" (two pairs of new shoes, one is Franco Sarto for $3.49) - and as I checked out I got a call from my Big Boss.
I've been feeling pretty down about work lately and at first I didn't want to take the call - I was on vacation, after all! I've been fighting a losing battle at work - it keeps piling up, and I keep doing it all - and yesterday a customer actually brought me to tears with her verbal abuse (because her doctor denied her refill request for her lorazepam, because it was TWO WEEKS early. Definitely my fault, right?). I have tried to set an example at work and be assertive about what needs to be done, but the technicians either tell me yes, then never do what they are asked to do; or get angry and tell me they've never had to do this before/don't do it this way/shouldn't have to do this job. Unfortunately my pharmacy manager, while brilliant financially, is a poor manager of personnel, and keeps sweeping the problems under the rug (it doesn't help that he and I walked into the worst personnel mess in the history of the world). When I problem arises (example: a technician is three hours late for her shift, no call, no explanation, no anything), he says he will deal with it - but then he never does. Meanwhile the technician continues to come in late. On top of this, 99% of the paperwork and managerial tasks fall to me - needless to say, I'm burning out fast. So when I saw the corporate number I hesitated to answer.
But I did answer, and it was great news! I will be getting a promotion not just to a manager position, but to a brand-new animal: a new store with an entirely new concept. It's the first of its type in the state and only the second in our region. This position was why I was hired by the company, but legal delays were a big problem. Now the open date is suddenly looming fast - less than 2 months - and my bosses called me to ask if I would like to select my staff! Now that's what a call a great career: a niche job with my hand-picked coworkers.
I'm so grateful for all the opportunities I've had - this one is a biggie - so tonight we're celebrating with happy hour at The American Sector! Have a great Friday!

Thursday, January 13, 2011

Ask a pharmacist: Which NSAID should I take? Part I

I got a few real-life questions for a pharmacist last week, but you know what? They were all about vitamins. I didn't want to talk about vitamins again. So I found an imaginary friend question I liked better (although I will get to those questions. Except maybe the vitamin E one, way to pick a tough topic Termite!) This question is about NSAIDs - those helpful pain and inflammation killers that can be so confusing.

If you run, you probably take NSAIDS for pain and swelling. Actually if you have ever had pain, fever, cramps, or swelling you have probably taken NSAIDS. NSAIDS (non-steroidal antiinflammatory drugs) are agents that reduce pain and inflammation by modifying the COX enzyme pathway. These enzymes facilitate the production of prostaglandins which cause pain, inflammation, and fever. The name "NSAIDS" was chosen ages ago to distinguish them from steroids, which are a completely unrelated type of antiinflammatory.
To understand how NSAIDS work, let's review a little pharmacology.
It's easy, I promise.
First, let's talk about what happens when you are injured. Let's say you shut your thumb in the door. You're hurt, and your cells are hurt. When the door slams, it squishes your cell membranes, and they release a compound called arachidonic acid (with the help of phospholipase-A, an enzyme). This starts what we call the "COX pathway", your body's antiinflammatory response to injury. Arachidonic acid is broken down by the COX enzymes to create several products:  thromboxane, a compound that causes platelets to adhere to each other and cause clots; prostacyclin, a compound that causes blood vessels to enlarge and prevents platelet clotting; and certain prostaglandins, which cause swelling, pain, uterine cramping, and fever. Now right off the bat you probably wonder why your body responds to injury by making compounds that both CAUSE clotting and PREVENT clotting. It's all part of keeping balance during an injury to make sure your blood can bring the healing cells it needs to the injury sight ... yet you won't bleed to death either. The clotting pathway, however, is complex and goes beyond our scope today. So back to NSAIDS. Anyway, these prostaglandins are useful in healing your body, but they cause uncomfortable effects, too. For example, fever is meant to kill bacteria that might have invaded the sight of injury, but we don't always want to deal with fever. So we take drugs to stop these effects. The enzymes that break arachidonic acid down to the prostaglandins that cause inflammation and fever are COX-1 and COX-2. Since COX-2 is produced at the sight of injury and has these results, this is the enzyme we want to inhibit. However, most NSAIDS also inhibit COX-1. Basically they can't differentiate between the two enzymes, so they inhibit both. The problem with that is that while COX-1 can produce inflammatory prostaglandins, we need it for something else. It is present in our gastrointestinal tract at all times, helping to produce different prostaglandins required to maintain the natural mucosal lining in the stomach. If COX-1 is inhibited, these prostaglandins aren't produced, and the stomach becomes easily damaged and upset. Your lining can bleed, severely even.
It would make sense, then, to try to develop a drug that would just stop COX-2, which is only produced by the body at the site of injury. That would spare some side effects. Scientists tried this, and they succeeded. Remember Vioxx? Vioxx, of all the legal claims and law suits? Yeah, there was a problem with COX-2 selective inhibitors. Studies have shown that COX-2 inhibitors increase the risk of heart attack and stroke. I had a 6-paragraph explanation of why this might be so, but it was beyond boring and the conclusion was..."one of these two mechanisms may be the culprit..." so I cut it out. If you want more info, though, email me!
Of course, COX-1 or COX-2 or whatever, all NSAIDS have certain side effects and risks.Before I talk about specific NSAIDS, I'll review the side effects common to all drugs in the class.
Stomach upset: Any drug that reduces COX-1 upsets the stomach and may cause/allow intestinal bleeding. If you have a history of GI bleeding or take other drugs that can cause GI bleeding or have gastric ulcers, avoid NSAIDS.
Blood thinning:  All NSAIDS thin the blood. If you're on a blood thinner you have to discuss NSAID therapy with your doctor; he may allow it but will monitor you more frequently (I have had a patient die from a massive GI bleed due to self-medicating with over the counter ibuprofen. The combination of thin blood and gastric bleeding actually killed him).
Water retention and increased blood pressure: NSAIDS cause your kidneys to hold on to extra water. This will increase your blood pressure and can worsen heart failure, because your heart is burdened with extra fluid to pump.There is more to this, but it is a dry discourse. If you want more info, again, email me.
Kidney damage: NSAIDS can damage the kidney through several mechanisms; mainly they inhibit prostaglandins that allow vessels in the kidney to expand. The tightened vessels prevent the kidney from processing fluids, and the kidney can shut down and fail.
High potassium: It's all connected: the high blood pressure, water retention, and kidney damage are all linked, and they are linked to increased potassium, too (moral of the story: don't mess with your kidneys!). This is usually only a problem for people who already have problems with electrolyte balance or with their kidneys.
Tinnitus: All NSAIDS, but primarily aspirin, can cause ringing in the ears.
Liver failure: Possible with high doses of all NSAIDS. 
Pregnancy/breastfeeding concerns: You may take NSAIDS while breastfeeding. Do not take while pregnant (date shows increased complications when taken during your third trimester).
Who should not take NSAIDs/ask your doctor: Asthmatics, those with a history of stomach ulcer or GI bleeding, people on blood thinners, people with high blood pressure (even on medication since NSAIDs counteract the effects of certain blood pressure drugs - please talk to your doctor), people with heart failure, those who have a kidney disease.

Are you scared yet? Haha. This post is getting horribly long, so I'll leave you with this background and next time I'll go into the differences between different NSAIDS and which are best for which condition.

A note about sources: these posts are my opinion as a pharmacist and based on my training. If I have any fact-checking to do, I generally do it from a variety of reliable sources. If I ever directly use a study or some data, I will reference it. So far these have been too general to require that.

Wednesday, January 12, 2011

Does long-distance running change your body?

Yes. And I'm not just talking black and blue nails.
Let me, at the risk of grossing all of you out, use myself as an example. Warning: the post below describes my inner thighs!
This past summer I trained for a marathon with a fairly typical 6-day a week plan (five days were running; one was cross training). My plan included three 20-milers prior to the race. Following that marathon, I ran three more marathons, two halves, and a 10-mile race - all in about 80 days. So let's talk about physical changes.
1. More fat. This is weird. Many first-time marathoners have commented to me that they gained weight. For my first marathon, I did not. Actually I got super skinny, but I was also deathly ill most of the time, so I don't know why I lost weight. But for my second marathon I felt pudgy all summer. I don't know how much my weight changed since I don't have a scale, but trust me, my thighs looked like two bottle of marshmallow fluff. Why? I'm thinking it was the repeated long runs. I got my body used to running really far, then going straight to work often with few calories after (I was often queasy post-run and had no time to eat at work). I think my metabolism adjusted to retain calories just in case I busted out another 20. My weight dropped significantly following the October marathon, and it stayed normal for the rest of the races. This could be because I only did one other long-run all fall.
2. Bad skin. I made you all look at my pimples. Ok, I have a confession to make: I purposefully irritated them prior to the picture to make them look worse. But it was still bad! Over the summer my extremely sweaty runs gave me acne; even this fall my face was bad enough for me to go to a dermatologist (it's better now). Long runs are the pits for pretty skin.
3. Funky muscles. I NEVER stretch. I know I should, but I am so lazy! The consequence of this is that I am muscle-bound. My hamstrings are especially enormous and tight. I actually cannot straighten my right leg completely while extended: the hamstring is too too tight. I think I should work on this.
4. Achy joints. NOT. Strangely, while my knees were my Achilles's heel last year (haha! I'm sorry, I just couldn't resist making a silly and confusing anatomical joke. I take it back), I've been basically pain-free this summer and fall. Post-race I might ache a tad, but it is gone in 24 hours.
All men stop reading at once! I am about to start talking about menstrual cycles!!!!!!!!!
5. Fewer periods. I'd love to be able to explain this one. Most people assume that extreme athletes and long distance runners stop having periods because their body fat is so low. I am here to tell you that this cannot be the case. At least for me it can't, because my body fat is most definitely nowhere near that point. Not even in my dreams. Ask my jeans about body fat!
Yet since training started in May, I had only three periods (one of which was during a marathon, oh joy) and two were extremely light. I am convinced that their is another reason behind this, perhaps one related to hormone production instead. Now I am not complaining about this. On the contrary, it's an incentive to keep running! Periods are suck-o!
6. Other cosmetic issues. I stuck this down here in the ladies-only section because guys probably don't care anyway. Let's face it: wind in your face gives you leathery skin. It gave me a few wrinkles, which I love. I really do. I think they add character! Constant jolting can make your boobs sag; I know I said this isn't about toenails but seriously, do you know a runner with pretty feet?; ladies get man-calves and men get froggy-legs; this might just be me but, he, most runners don't really have fab hair either. Who has time to style with all these extra showers? But in the end, it's so worth it. Because all of us runners have pretty INSIDES. Our hearts  are masterpieces and our vasculature is beautiful to behold. So if someone makes a crack about your runner's toes, they can just tell it to your HDL!
How has exercise or running changed YOUR body? Bonus points for photos of toenails!

Monday, January 10, 2011

Would you leave your car here overnight?

Only a Suburu dealership would be located on North Broad and think that was ok.
The chained-down table and barbed wire instill a sense of warmth and security, don't you think?

Soccer mom

I gave up on trying to rotate this picture. 

I always feel like a soccer mom in capris. Something about that temperature-conscious mid-calf cut makes me think of moms at Starbucks after yoga class, SUVs, and kids who go to fancy daycare.
We didn't go to fancy daycare. We got locked out of the house to commit murder and mayhem on each other in our fenced back yard for hours at a time while, presumably, my mother attempted to recover her sanity. It can't be easy having nine kids.
For some reason, when I put capris on, I feel all good-@ss. That is a term I invented to be the opposite of bad-@ss, because I can't think how else to describe it. I'm not going to push the pace in capris. The only thing I'm pushing is pedals. Haha, pun, they used to call capris pedal-pushers!
Shorts mean I'm running fast enough to get hot and sweaty.
Tights mean I'm tough enough to be out running even though it's freezing cold.
Capris mean I'm more worried about my bodily comfort and how my thighs look than a PR. And let me tell you, if I always put thigh appearance before speed, I'd still be walking.

Am I nuts for thinking this? Do you workout in capris, and if they feel wimpy to you? This question is for ladies. If you are a guy and you workout in capris, PLEASE send me a picture so I can mock you. 

I kept the Garmin.

This week I used my new Garmin 305 for the first time. My thoughts? I will probably use to map longer runs or to accurately pace speed work. Haha! As if I'll ever actually do any speed work! I just like to talk about it because it makes me feel like a real runner.
I strapped it on - it's bulkier and heavier than my old Walmart stopwatch, but it doesn't annoyingly catch my loose shirt like my Velcro watch band does  - and stood outside waiting for a satellite. It seemed like an eternity while I was waiting, but it was probably about 2 minutes. However, this is a major issue for me. I don't like waiting and I'm not very patient in general, so simply because of this 2-minute factor, I can't see myself bringing this on a lot of runs.
I did my regular 5 mile run: from my corner to St. Charles Ave, to Audubon Park; twice around the park, then home. I wasn't really sure how often to look at my pace. I was curious, since this was my first time seeing my pace while running, but I didn't want to veer into obsessed territory. I looked down about once a mile, when the Garmin beeped; I was doing 7:20 or 7:30 something every time except once, when I was doing 29:12 (???).
I had pre-set the auto-pause function to pause when I came to a stop, thinking this would be smart for street crossings. However, I had a little bit of an issue with it. I stopped to cross and the time kept ticking until my "pace" reached 59:59. Then the time stopped. My problem was that this took so long that I'd already crossed the street and started running again by the time it stopped, then it had to restart! I need to play with that to stop when my pace drops below a certain point (an alternate feature); say, 12 minute miles. Or I guess I could just use manual pause. Or I could just deal with it. It was about 15 or 20 seconds gap, so if I use the Garmin on longer runs I doubt it will affect the results.
When I got home I laughed out loud - the Garmin beeped at 5 miles the second I stopped; it read exactly 5.00 at my corner. In other words, the 5-mile route I use - based on estimates, car odometer readings, and the theory (nobody knows if it is true) that Audubon is 1.8 miles around - is exactly right.
I scrolled through my run history, eager for information that would change my running. I've always fretted about my fast starts and late burnouts, but to my surprise my splits were no more than 3 seconds different (This probably would not hold true for a longer run, though).
Now I realize that this post is beyond useless and outdated. I mean, everyone and their brothers use Garmins already, and probably have a newer model. Therefore while I am giving my conclusion below, what I really would love for you to do is to pass on suggestions for use - do you use the HR monitor?  Is it useful for interval training or long runs? How's the GPS? Has the software been helpful, or do you still track runs in Dailymile or the Thinman's Excel spreadsheet?
Now as for my conclusion - The Garmin will no doubt prove beneficial on longer runs in examining my pacing; perhaps I can also see the effects of calorie consumption or drop in temperature. A good blogger would have a report on this for you, but since it was rainy and ugly today...and the play-offs were on... I didn't run at all, let alone a long run (I'm a really lazy gal lately). I also have no concept at all of how fast I can run - like, a mile time-trial - so I can see the Garmin being really useful for speed work. Which I will do. Someday. Soon.
Until then, I will continue to eat king cake in front of the TV wrapped in a snuggly blanket.
Happy Monday!

Friday, January 7, 2011

Neighborhood businesses you should frequent

1. Your cobbler. I have a cobbler in walking distance and she and I are on first-name basis. If you have special shoe needs - perhaps your feet are as wide as Yetti's? Ahem - your cobbler can help. Cobblers can:
- Stretch leather shoes to fit: widen the toe box, raise the instep.
- Add arch support
- Re-heel worn dress shoes
- Lighten running shoes (including adjusting heel padding): a good cobbler will remove foam and reattach the outersole without affecting the balance of the shoe; if your shoes do not match within a couple of millimeters your gate will be affected so use a cobbler you trust.
- Repair non-shoe items like luggage, purses, saddles, and belts. Mine has replaced broken clasps and straps as well.
2. Your used book store. Most will work out a trade with you: You can bring in books you've read and swap them for "new" ones. By the way, a gift certificate to a used book store is a fantastic gift.
3. Your consignment shop. Slightly more upscale than the Salvation Army, clothing swaps or consignment stores can be a good source for pricey designer clothes or a specific brand. Banana Republic no longer makes their Ryan style pants (my favorite), but the owner of a consignment store nearby has promised to keep her eyes open for my size. She's found two of my favorite pairs, and both cost less than $10.
4. Your pharmacy. Definitely bring your pharmacist fresh coffee and the occasional King cake.* It will pay off when you have a UTI at 9 pm on a Friday and your pharmacist willingly gets yelled at by hunting your doctor down at his daughter's deb party so he can be (forced) to call in a prescription for you. Or just if you have the kind of health question that is complicated and time-consuming, but you want a professional to do a little research for you. Just how common are blood-disorders in people taking Zantac over the counter?
5. The farmer's market. Make friends with the vendors. They might give you some extra produce or day-old bread for French toast. They might also save the last Boston lettuce for you if you tell them you might be running late.
6. The running store. They may not have the lowest prices, but they have the most expertise and the best answers to your questions. Plus they probably have a bulletin board with upcoming events; they might have a running group; some have free seminars and training. Go hang out there, it smells like new shoes.
* I'm working tonight. I'd appreciate a snack. 

Thursday, January 6, 2011

American Eagle

Oh boy. Guess what I got in my email today? An American Eagle survey that asks me to "Tell American about my recent flight experience". Honey, don't get me started. I'm pretty sure they'll mark me as spam once they get this response.
Today I went to the gym to survey this year's crop of resolutionists. They're so cute in January - all the new gear and determination. I hope they don't all fizzle. I did weights and abs because I had avoided the gym most of this fall; I had races most weekends and I always worry about pulling something before a race. I had to go back because my arms were looking like Gollum's. I wanted to run a little when I got home but I decided to clean the house instead. As you see that translates into blogging instead.
Today was FREAKING HORRIBLE at work. I forgot my phone, it was busy, and all my techs had PMS. They were fighting with each other all day; one of them snapped at me two seconds after she walked in the door. I found a pile of paperwork that needed to be completed IN AUGUST in the back of the store; the pharmacist who is always late decided to tell me she was coming in an hour late; and a woman literally had a stroke because her medication was not in stock...although I gave her 3 tablets free of charge since that was all I had left on the shelf. My computer froze for the second time this week, an error that requires a complete internal rebuild (this takes several hours), and is due to excessive use. IE, we are doing too much work and out computer gives up (actually due to a server overload). Half the staff deals with stress by giving up, so I did 90% of the work today, all by myself. Do you ever feel like you're the only person working? I did today.
I forgot to wash my stainless steel water bottle last night and honestly the bottle tastes kind of funky! Yuck! I've always carried a water bottle around with me because I drink a great deal of water. I'm picky about the bottle because my job is so busy that the top has to open easily because I only have seconds of downtime to chug some.
What do you drink your water out of? Cup or glass? Reusable bottle? Plastic? Fountain?
I used to reuse a bottle like this and I loved it, but I decided reusing plastic for 3 years wasn't smart.

Thanks for all the interest and feedback yesterday about vitamin D. I will definitely get to some of the non-imaginary questions! As you could tell, I lean towards NOT taking drugs, OTCs, vitamins, or supplements when possible. Remember the old adage about "too much of a good thing"? It tends to hold true. I am wary of any isolated substance, especially when it can be obtained through lifestyle (ie, eat green leafy vegetables instead of taking iron tablets). The most interesting part about yesterday is that I got a spam comment on the post FROM THE TANNING BED INDUSTRY (I presume) encouraging use of "artificial UVB" to increase vitamin D. Good ol' Google caught it, though.

Wednesday, January 5, 2011

Ask a Pharmacist: Vitamin D

Welcome to a new segment called Ask a Pharmacist. This is where I answer questions that nobody asked, but I think definitely should have been brought up. 
Today my imaginary friend Sally wants to know what all the excitement about Vitamin D means, and should she take a supplement?
Thanks for asking, Sally!
Vitamin D is produced by the body when UVB sunlight reacts with a cholesterol-based compound found in the lower levels of the epidermis. Fun fact: This process is dependent on both the liver (it requires an enzyme produced in the liver) and the kidney (the last step in activation). A disorder of either organ can affect vitamin D levels.
Vitamin D has one function in the body that we know of, but with many results. It binds to the vitamin D receptor. We usually associate vitamin D with increased absorption of calcium. This is because when vitamin D binds to its receptor (the "VDR") in the nuclei of cells, the VDR is activated and can regulate gene transcription (If your biology is rusty, this means that VDR now which proteins the genes are coded to make). VDR promotes the production of transport proteins that carry calcium into the blood stream from the intestine. This is why vitamin D is required for optimal calcium absorption.
Sally interrupted me just now to ask about other effects of vitamin D. It seems that she has heard a million stories about vitamin D preventing the flu or promoting healthy hair. 
Vitamin D is a subject of interest right now. There are several studies that indicate that activated VDR has other uses besides its calcium-related ones. There is evidence that vitamin D may:
- Increase the activity of the immune system. VDR has been shown to produce an antimicrobial peptide that triggers your macrophages to phagocytise invading pathogens; it also ups the activity of natural killer cells (a type of white blood cell that attacks invading organisms and causes their cells to burst).
 Low vitamin D increases respiratory infections and influenza.
- Decrease peripheral artery disease and cardiovascular risk . There are some studies which show an association between low levels of vitamin D and cardiovascular risk. However, these studies only show an association, not cause and effect and are lacking evidence.
- Prevent or delay cancer. There is evidence that the VDR in cancer cells may be altered of changed; there are several studies that link vitamin D supplements with decreased cancer diagnosis. Unfortunately at this time data are tenuous and mechanisms hazy, but keep your eye on this one.
- Vitamin D has been linked to healthy lungs in a number of studies which pointed to decreased asthma attacks or lowered respiratory infections with vitamin D supplementation.
Of course, we also know that vitamin D prevents rickets and osteomalacia and can treat and prevent psoriasis.
Why are there two kinds of vitamin D?
Most supplements contain cholecalciferol (or "D3"), which is produced by vertebrates. Ergocalciferol (D2) is usually obtained from fungi. Which is easier for us to use? Based on a variety of studies, no one knows.
How much vitamin D do I need?
Hm. Depends on who you ask. The recommended daily intake varies HUGELY based on which country's data you reference. The FDA recommends that adults take in 600 IU per day. You get 100 IU for every cup of milk; fatty fish contains 300-400 IU per serving; and up to 10,000 IU from ten minutes in the midday sun (varies greatly depending on skin tone and UVB content of sunlight).
So should I take a vitamin D supplement?
No. You should go outside everyday with no sunscreen. That's my opinion. But if you have osteomalacia or osteopenia or osteoporosis, you should take 600 IU per day.
If I take vitamin D, can I overdose? 
Yes, because vitamin D is fat soluble so it can't just dissolve in the urine and be flushed out. Your body stores excess instead. You can overdose by ingestion; usually toxicity is related to excess calcium and can be serious. In pregnant women, high doses will cause birth defects (mainly mental retardation). Pregnant woman should not supplement with vitamin D without medical supervision and labwork.
The chance of overdosing is slim as a study on the topic indicates that most people would need to take 50,000 IU daily for over a month to reach toxic levels.
Take home:
Evidence is abundant that we need healthy vitamin D levels. My firm recommendation is to increase sun exposure if you do not normally receive direct sunlight on your skin. Because dietary supplements tend to isolate vitamins outside of normal lifestyle ratios, I do not recommend supplementing unless you have a condition caused or worsened by decreased vitamin D.

Tuesday, January 4, 2011

Ole Man River half marthon race review

Ole Man River half marathon race review
There are now three half-marathons in New Orleans each year (the others are the Jazz half and the Mardi Gras marathon half) but this one is the oldest.
Me passing an ole man during the Ole Man. Hahaha.

The good: Fast, flat course in city park - scenic and easy - and typically the weather is nice at this time of year. The price is fantastic: $45 with our discount - and includes a long-sleeved tech T, a medal, and a pancake breakfast. You can pick your packet up ahead of time or race morning, but sizes aren't guaranteed if you pick up late.
The bad: No bad with this race. I do prefer the Jazz half if choosing amongst local races, only because the course is a little more interesting and spectator friendly. But I will absolutely run this one again.
The good-to-know: Parking is easy. Finish early before they run out of donuts. Prizes are 1st-3rd overall, 1st masters/grandmasters, and seniors, first five heavyweight division (?!?!) and age group 1st and 2nd. Cash prizes.

Monday, January 3, 2011

I use my husband.

Every winter when my hands grow icy cold I coax him over and stuff my frigid fingers up the back of his shirt. It's the best thing ever and he hates it. Today I went so far as to open a can of irresistible olives and wait until he stuck his piggy little hands in the can before I caught him! Ah! Warm-fingered bliss!

Sunday, January 2, 2011

Garmin: Keep it or return it?

(A sequel to the Ipod: keep it or return it? post in which I debated returning another of hubby's thoughtful gifts. I returned it.)

For Christmas this year David bought me a Garmin. I've never used one before, and I am not sure I should keep it. I'm afraid it will take the fun out of running. I like seeing improvement, but sometimes I just want to RUN. Tonight after work I just put on my shoes and went out for a run. I didn't bring a watch; I didn't bring an ipod. Sometimes I go running just  because I like running. I'm worried that if I start using a Garmin I'll obsess over every second and start thinking about my pace all the time instead of having fun. Then again, since I admit I'm bad at pacing myself, maybe I need it.

Do you have Garmin experience? Did having a Garmin change how you run?
What do you think?
Keep the Garmin?
Return the Garmin and buy $150 worth of gummy bears instead?

Saturday, January 1, 2011

Happy New Year!!!

Happy New Year to all of you. May 2011 bring you joy...and more importantly, may you bring joy to those you touch in 2011.
Happy New Year from me and the hubs!

This is a scheduled post because I am working today. Actually I worked last night and I work all weekend. I am probably miserable right now: it's the first of the month (busy!), first of the year (confusing! No one has the foresight to bring in their new insurance card and no one catches on that their deductible has reset!), a holiday (boo!), and we will be getting a big fat order of drugs to put up (boring!). 
So go eat some black-eyed peas and watch some football for me while I sling drugs. 

By the way, I have added a races page to the blog for easy access to race case you were thinking about following in my footsteps. The link it up at the top left, or you can click here