Allergic reaction

Recently a tragedy happened due to an allergic reaction in which a 3 year old boy passed away. I write today in honor of that boy. #inhonorofElijahSilvera

What is an allergic reaction?

An allergic reaction can be described as a hypersensitivity reaction of a body’s immune system in response to a foreign substance. So, when a foreign substance is detected by a body either by external contact or internally, our body has a mechanism to fight against it. And, sometimes this protective mechanism tends to cause harm to our own body. Such reactions are hypersensitivity reactions.

There are 4 types of hypersensitivities or allergic reactions-
1. Type I – Immediate
2. Type II – Cytotoxic or toxic to living cells
3. Type III – Immune complex
4. Type IV – Delayed

There are many components of the immune system involved in an allergic reaction. The above types are a broad classification. One has to take into account if one type of hypersensitivity can have additional outcomes. Example, an anaphylaxis from a bee sting (Type I) will also have inflammation and pain (Type IV).

Different manifestations of the allergic reactions are but not limited to hives, rash, urticaria, asthma, rhinitis, angioedema, or anaphylaxis. The anaphylactic reaction is the most dangerous of them all. It is immediate/acute and can cause respiratory and cardiovascular compromise along with flushing, urticaria, etc. Elijah Silvera had an anaphylactic reaction to dairy in the cheese.

Proper management is extremely important. First and foremost, It includes prevention of contact of the foreign substance that one is allergic to. In mild to moderate cases of allergies, OTC medications along with prescription medications can be used for treatment. In case of anaphylaxis, an epipen should be readily available. Timing is crucial. And call 911 ASAP.

So, the next time a person says (s)he is allergic to something, ask questions to see what you can do on your part to prevent an allergic reaction. Educate yourself. An allergic reaction can be severe and fatal as in case of #ElijahSilvera

Patient influence on safe medicine practice.

When a patient goes to a clinician, (s)he is often asked to fill a form. The form has many questions including age (date of birth), weight, height, allergies, any present or past illnesses, any disease states, current or past medications, medical history of immediate relatives, social habits as alcohol and smoking, etc. It seems like too much information being given out, right? It is for your own good. Let’s see how.

This information provides the clinician an overview of what is happening or happened in the past with your body. It will determine what new labs would be needed for any additional diagnosis or establishing base line for short term and long term goals.

The medical history of the immediate relatives would provide a picture of one’s genetic makeup and how likely the patient may have a genetic disease. Furthermore, there are options of genetic testing to back this up.

Once diagnosis is confirmed, medications are prescribed. The age, weight, height, allergies along with the other clinical information will assist in selecting appropriate medications to treat the condition.

It is also important to share the information with all the clinicians that a patient sees. It impacts the treatment of multiple conditions that one has. Example, a patient with diabetes, hypertension and asthma must share information with his or her general physician or primary care physician, endocrinologist (for diabetes), and a pulmonologist (if needed for uncontrolled asthma and complications). Especially, if they are based out of different clinics.

The entire information packet shared with your clinician (doctor or a pharmacist) thus prevents any adverse effects from happening by careful selection of medications for treating the condition(s). This is one of the ways a patient can help in practicing safe medicine.

IR, DR, ER, XL, LA abbreviations

I write today to talk about ER, LA, XL, DR, IR abbreviations behind some medications. What do they imply and how does it affect the effect of medications?

Prior to that, lets talk about formulations. Medications come in different formulations, i.e., different components have been put together with the active medication ingredient to make different forms of the drug. Different formulations include tablet, capsule, liquid, lozenge, inhaler, injectable, suppository and so on and so forth. Each of these formulations have a different mechanics not limited to absorption, time active in the body and time to get out of our system.

Based on the above, the oral formulations are classified into Immediate Release (IR), Extended Release (ER, XL) or LA (Long Acting) and Delayed Release (DR).

Most of the active medication ingredients get released from their formulation in the stomach – IR medications. The delayed release (DR) formulation bypasses the stomach acid and gets released later in the GI tract. Mostly because the acid may destroy the medication or alternatively, the medication upon release may harm the lining of the stomach.

The extended release (XL, ER) or long acting (LA) medications are specially formulated so that the medications have a longer effect on the body. Mostly these medications are dosed once – twice a day.

It is very important to recognize that most DR, XL, ER and LA formulations may not be crushed or broken.

Talk to your pharmacist or your physician if you are a good candidate for these special formulations. Not all medications have these formulations though. Nevertheless, It may bypass some side effects of the medications and reduce pill load.

Type 1 versus Type 2 diabetes.

Diabetes is a metabolic disease that involves how the insulin is produced in your body. Insulin is a hormone produced by pancreas in our body. It is the main regulator of glucose (sugar) in the blood.

Type I Diabetes is a condition when the body’s immune system attacks the pancreatic cells and the body fails to produce enough or any insulin. It is characterized by increased blood glucose levels, A1C levels, low C-peptide levels. C-peptide is a byproduct of insulin production –> Low insulin production implies low C-peptide levels. There are ketone bodies present upon lab work. Ketones are a by product of fat metabolism in type I diabetic patients. The patient presents with symptoms of dehydration, weight loss, thirst and frequent urination. There is no cure for Type I diabetes. External insulin provided at different times along with diet modifications and exercise works best for Type I diabetic patients.

Type II Diabetes is not an autoimmune disease. It is a chronic condition in which insulin secretion is either impaired or the body has a difficulty using the insulin. The latter happens as a result of one’s lifestyle. It is diagnosed by a blood test similar to the type I diabetes. Some patients may show symptoms of thirst and frequent urination while some don’t. Hence, most of the times, this type of diabetes goes undiagnosed. The patients then tend to become ‘insulin resistant’. Management includes diet modification, exercise, and medications (insulin is usually given in cases of uncontrolled type II diabetes).

It is important to get a regular check up done to identify if you are at risk of Type II diabetes especially if you smoke or are overweight, or have a sedentary lifestyle, high blood pressure, high cholesterol, etc. That being said, both the types are equally serious as long term diabetes affects eyes, heart, kidneys and nerves.

So, make an appointment with your physician for a check up. And, in the meantime eat healthy, eat clean and start exercising.

The ABC’s of Diabetes – contd…

Did you know that there are 30.3 million people in the USA that were diagnosed with diabetes in 2015 and there are another 23.1 million people who remained undiagnosed. (Source: CDC’s National Diabetes Statistics Report, 2017)

How do you manage these ABC’s of diabetes. There is life style modifications including diet, exercise and then there are medications.

A 10 minute walk everyday is a good way to start. It will boost your metabolism, is a good cardio workout especially if you are sedentary and a breath of fresh air does no harm to anyone.

Diet modifications include simple changes like drinking more water, including fresh fruits and vegetables and excluding packaged foods. A good way to manage your blood pressure is to monitor your daily salt intake especially in those ready to eat snacks.

Smoking also contributes to increase in blood pressure and affecting diabetes. There are patches and gum available to help with nicotine cravings. Talk to your pharmacist in deciding where and how to start.

Medications – There are plenty of medications that help in reducing blood sugar, blood pressure and cholesterol. Each patient is different and not one medication works for all. Again, your physician and pharmacist will help you achieve your personalized goals.

Next time – difference between Type I Diabetes and Type II Diabetes.

The ABC’s of Diabetes

November is National Diabetes month. It is important to manage the blood sugar level for preventing health problems. With blood sugar are associated Blood Pressure and Cholesterol.

That brings me to the ABC’s of Diabetes.

A stands for A1C. The A1C test shows the average blood glucose level over the past 3 months. In well controlled diabetes and in people with no diabetes, the A1C should be below 7%.

B stands for Blood Pressure. Normal blood pressure is 120/80 mm Hg. For patients with diabetes, the goal is usually 140/90 mm Hg. Talk to your physician what your personal goal should be.

C stands for cholesterol. The good cholesterol (HDL) should be high and is good for you (remember H in HDL – high). Then there is bad cholesterol (LDL) that should be low. (L in LDL – low).

s stands for stop smoking. It has been shown that smoking and diabetes both increase blood sugar and constrict the blood vessels. This in turn can lead to increase blood pressure, cholesterol and poor management of diabetes.

So, how do you manage the above ABC’s of diabetes? Keep reading…

Antimicrobials and Antibiotics

Antimicrobials and antibiotics- any difference?
The word antibiotic is a commonly and broadly used term for any medication that one uses to treat an infection. Wrong!! That is antimicrobials. A term that can be used collectively for any medication to treat an infection cause by a micro-organism – fungal, bacterial, viral, protozoal, etc.

Then, what is an antibiotic? A medication used to treat an infection caused by a bacterial organism. Will it cure a fungal or viral infection? Of course not!

So, if your doctor didn’t prescribe you an antibiotic, there is a reason for that. You don’t have a bacterial infection. Ask your physician what the alternatives are. Most likely, you will need medications to treat infection (other antimicrobials) or simply manage the infection (rest, fluids, OTC medications, etc)

The next time you have an infection, please don’t demand antibiotics. Instead, talk to your health care professional, get educated and let them guide and manage your infection. Unneeded antibiotics lead to unintended side effects and potential antibiotic resistant bacterial infections. We don’t want that!