When you (or loved ones) are taking prescription or over the counter medications…there is a lot you should be worried about, and a lot that your pharmacist may not be telling you.

Most people are aware, for example, that several medications taken together can sometimes cause harmful interactions. Most also know that drug allergies can pose significant hazards. (These are topics of other articles in this series). And, many people know that young children, elderly adults, pregnant women, nursing women, and severely debilitated people may all be at higher risk for adverse drug events.

But what most people don’t know is that a simple blood test can be one of the most important pieces of information in determining the correct dose of many medications…and the results of that test are almost never available to your pharmacist, especially if your pharmacist fills your prescription in a retail drugstore. (And, that’s a bummer.)

The test I’m talking about, of course, is the ’serum creatinine test’ (’SEAR-’em cree-AT-tuh-neen tehst’. It’s a difficult name to pronounce and a difficult test to understand…but one that you NEED to know about if you or loved ones are taking over-the-counter or prescription medications.)

A serum creatinine test gives a physician or pharmacist an estimate of kidney function.

Serum creatinine is the ‘bean counter’ of modern medicine… letting folks know if the beans (the kidneys) are working as well as they should.

Why is that important?

Well, kidney function is extremely important in determining the correct doses of many medications since the kidneys (along with the liver) assist in the removal of medications from the body.

Almost all medications (and/or their chemical by-products) are either removed by the liver, by the kidneys, or, in many cases, by both the kidneys and liver working together.

So, simply put, when the beans are not working well, many medications will accumulate in the body and increase the risk of drug side effects. And that’s an even bigger bummer. (The same is true for liver problems, and we will talk about that in another article in this series.)

As a result, patients with reduced kidney function often need LOWER doses of many medications.

So how does this all work?

Well, creatinine is a chemical that occurs and circulates naturally in the human body. It is the result of normal protein break-down. And, like many medications, creatinine is normally removed from the blood by the beans. So, when the kidneys are not working well, the level of creatinine circulating in the bloodstream will start to go up…just like the blood level of many medications.

Physicians and pharmacists are routinely and easily able to determine how much creatinine is in the blood with the results of a serum creatinine test. (This test is part of a very common panel of blood tests. And, if the serum creatinine is high, many drugs need to have a lower dose.) The normal value for serum creatinine is about 0.4 to 1.5 mg/dl…but that can vary a bit from lab to lab.

So remember: ‘kidneys no work…serum creatinine go UP’.

Now, serum creatinine is not the best measure of kidney function (there are other tests that are much more accurate), but results of the serum creatinine test are usually the most readily available…and cheapest…and are generally accurate enough for most purposes…so serum creatinine is the de facto standard for estimating kidney function…most of the time.

The gold standard test that doctors use for measuring kidney function is called ‘creatinine clearance’ (cree-AT-tuh-neeeen CLEAR-uhhh-nce) However, not many patients get this particular test because it is pretty darn inconvenient…and smelly. You have to collect all of your urine for 24 hours and keep it in the fridge. Not a lot of volunteers for this test…

Creatinine clearance is the volume of blood that the kidneys clear of creatinine in a given amount of time (and it is usually reported as milliliters per minute).

So, when kidney function decreases, creatinine clearance (the amount of blood that the kidneys are successfully ‘cleaning’) also decreases.

So remember: ‘kidneys no work…creatinine clearance go DOWN’. (Note: this is easy to remember because it is the exact opposite of what you were initially thinking, and the opposite of what happens with serum creatinine. Most of medicine is like this.)

Now for the super tricky part just for those gunning for an A. There is a way to ‘guestimate’ creatinine clearance using serum creatinine…isn’t that neat. And, that’s probably the best way to determine renal function if a measured creatinine clearance is not available.

What you do is run the serum creatinine value through a fancy equation that will give you an estimated creatinine clearance, which is itself an estimate of kidney function. (Estimates of estimates of estimates…that’s the kind of exacting science I live for.)

For adults, that equation is the famous ‘Cockcroft-Gault equation corrected for ideal body weight and gender’…the equation everyone loves to hate. The Cockcroft-Gault equation (presumably named after Drs. Cockcroft and Gault…or maybe just Dr. Cockroft-Gault, or maybe Lara Croft), is generally considered very reliable since it has never been well validated in young patients, old patients, thin patients, fat patients…basically all the patients it gets used on. So go figure. Double bonus points if you can remember this:

For men, creatinine clearance =

((140- Age) ‘ IBW) / (72 ‘ SCr)

For women, creatinine clearance =

((140- Age) ‘ IBW ‘ 0.85) / (72 ‘ SCr)

Where Age is in years, IBW is ideal body weight in kilograms, and SCr is serum creatinine in mg/dl.

Now once you run this a few times, you’ll find that creatinine clearance for young healthy people is about 100 ml/min (we’ll just leave off the ‘ml/min’ part from now on).

And, dead people have a creatinine clearance of about 0, depending on how healthy they are.

Everyone else falls somewhere in between.

(Now someone in the back of the room is saying, ‘I just ran this on myself and I have a creatinine clearance of 150′. Well aren’t you special? In fact, young good-looking people can have creatinine clearances of 130, 140, or more…but it doesn’t do a whole lot of good since 100 is perfectly acceptable. In fact, it’s just another case of overachiever overkill.)

Now, if someone has a creatinine clearance of 80, that means that they have about…80% kidney function.

And, if someone has a creatinine clearance of 50, that means that they have about…50% kidney function. (Are you following all of this?)

Many drugs that are eliminated by the kidney will require moderate dosage reductions once a patient’s renal function is in the 40-60 range.

Patients in the 20-40 range will typically require very large reductions in dose.

And, patients who are in the ‘less than 20′ range will often need HUGE dosage reductions for medications eliminated by the kidney (or better yet, they’ll need to take medications that are removed by some other organ altogether…if such an alternative is available).

One last tidbit to consider. Renal function declines as people age. No getting around that. But, the rate of decline is different for different people. By the time you’re 50 years old, there is a reasonable chance you’ll have moderate renal function (or worse)…by the time you’re 80, you’ll almost certainly have some important degree of renal impairment… and you probably won’t even know it or feel it.

Now that you know more renal physiology than you ever, EVER wanted to know…let’s get back to the main thread of this article…medication safety.

If you (or a loved one) are at risk for having decreased kidney function (and I’ll tell you who such folks are in just a second), you need to step up to the plate and get a handle on this issue (because there is a very good chance that your physician and pharmacist either didn’t have renal function data or didn’t consider it when coming up with a dosage for you).

Here are the steps I recommend for everyone taking prescription or over-the-counter medications:

1) For everyone: If you have access to the results of a recent serum creatinine test (it is probably part of your annual physical and you may have gotten a copy), memorize it or write it down and then say to your physician or pharmacist when you get a medication, ‘Say, I think my serum creatinine is about X. So, does this medication need any dosage adjustment in order to be safe for me?

2) If you are in one of the following categories, you should expect your physician and pharmacist to have considered your renal function before dosing a medication:

• known kidney disease;
• age greater than 50;
• history or heart attack, angina, stroke, or other artery blockages;
• history of diabetes (any type);
• history of high blood pressure;
• prior exposure to chemotherapy drugs;
• prior prolonged exposure to IV antibiotics;
• frequent use of pain medications (especially non-steroidal anti-inflammatory drugs, but others as well).

So you might say to your physician or pharmacist, ‘Is this drug removed by the kidney, because I have condition X that could decrease kidney function and I just want to be safe.’ If the drug is removed by the kidney, you might also ask the physician or pharmacist to tell you what your serum creatinine is…and if he or she does not have this information, a big red flag should be going up in your head.

3) If you are not in one of the categories in question 2 and you don’t have a serum creatinine available, don’t worry. You’re probably safe. But you may want to ask your physician if there is a serum creatinine in your chart and if so, what it is.

4) If you are on dialysis of any sort, serum creatinine is not all that useful for dosing medications. Just make sure your physician and pharmacist are aware that you are on dialysis and perhaps ask, ‘Now is this the usual dose for someone on dialysis?’

These are some of the steps I hope you will consider the next time you get a prescription or over-the-counter medication so you can be sure that that you (or your loved one) are getting the right dose.

If you are missing a tooth or a group of teeth, you may find that you are afraid to smile, you don’t like to speak because you think you sound funny, or you may not be able to eat certain foods that you enjoy. Until recently, your only option was to replace these missing teeth with dentures. Patients often complained that dentures were uncomfortable and inconvenient.

Dental implants remove the embarrassment, irritation and self-consciousness often associated with dentures and older methods of tooth replacement. Dental implants are permanent. Unlike dentures and other removable alternatives, dental implants can be maintained exactly the same as your natural teeth. Flossing, brushing, and regular checkups with your dentist are all that’s needed to care for your dental implants.

Florida implant dentist Dr. Gary Kodish comments, “Dental implants have been hugely successful in Fort Lauderdale and Miami. My patients are continuously overjoyed by their new smiles. Their only regret is that they didn’t perform the procedure sooner.”

Dental implants are artificial tooth roots that are anchored into or on top of your jawbone. Dental implants are a safe, effective way to replace a single missing tooth, two or more teeth, and even entire rows of teeth. Although each case is different, the total time for an implant dentistry procedure can be up to eighteen months. This includes the initial evaluation through your final “teeth” being implanted.

Dental implants are the best replacement for natural teeth. Implant dentistry can improve your appearance and self-confidence at any age. Dental implants are available to anyone missing all or some of their teeth, including children, adults, and the elderly.

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There are a lot of fabulous stories about Cetyl Myristoleate (also known as CMO or CM) floating across the Internet. Mine is one of them. There have been a number of articles published in little known journals or magazines. There have been four small booklets published. One making fantastic claims, all four filled with anecdotal evidence but offering no real research to back up the claims. There are a number of Doctors sharing the results they are having with their patients but so does every other wonder-working product. The question is, are there any scientific studies to back up any of these claims? The answer is yes. To date there are several patient studies and two double blind studies completed. I will mention the three most prominent below.

Dr Len Sands of the San Diego Clinic completed the first human study on the effectiveness on Cetyl Myristoleate in 1995. There were 48 arthritis patients in this study. All but two showed significant improvement in articular mobility (80% or better) and reduction of pain (70% or better). Obviously the study had its flaws. One doctor conducted the study, there was no control group and the number of participants was small. Even so, it suggested to many that maybe there was some hope here and that more scientific studies should follow.

The first double blind study followed two years later. Dr. H. Siemandi conducted a double blind study under the auspices of the Joint European Hospital Studies Program. There were 431 patients in the study, 106 who received cetyl myristoleate, 99 who received cetyl myristoleate, and glucosamine, sea cucumber, and hydrolyzed cartilage and 226 who received a placebo. Clinical assessment included radiological test and other studies. Results were 63% improvement for the cetyl myristoleate group, 87% for the cetyl myristoleate plus glucosamine group and 15% for the placebo group.

In August of 2002, a double blind study was published in the Journal or Rheumatology. The study included sixty-four patients with chronic knee OA. Half of the patients received a cetyl myristoleate complex and half a placebo. Evaluations included physician assessment, knee range of motion with goniometry, and the Lequesne Algofunctional Index (LAI). The conclusion was that the CM group saw significant improvement while the placebo group saw little to none. In fact in their conclusion the state that CM “may be an alternative to the use of nonsteroidal anti-inflammatory drugs for the treatment of OA”.

Advanced Medical Systems & Design, Ltd completed the last study I would like to mention in Oct 2001. It was not a double blind study but the study included 1814 arthritis patients. The results showed that over 87% of the subjects had greater than 50% recovery and over 65% of those showed from 75% - 100% recovery following a sixteen day regimen. I know that this is not the most scientific study but a study this large does suggest that there could be a positive benefit to the use of CM in the treatment of arthritis.

Conclusion: There is mounting evidence that CM can be effective in the treatment of many forms of arthritis. While it is true that the evidence from these three studies can not be considered conclusive, it is a beginning. It should challenge you to think out side the box and consider that just because it did not come from a drug company does not mean that it will not work. With over 10,000 people a year dying from Nsaids would it not be great to find a safer and more effective product. Especially with the cost of prescription treatments for arthritis costing into the hundreds and good Cetyl Myristoleate products can be found for between $20 and $40.

One of the most prevalent and difficult health conditions to treat in the physical medicine is low back pain. The difficulty in treating low back pain comes from the fact that there are numerous causes including herniated discs, bulging discs, degenerative discs, muscle spasms, facet arthritis, and sciatica. While the vast majority of low back problems are relieved in a few days, there are still millions of Americans suffering with severe and chronic pain. The number of opinions on how to treat low back pain are as numerous as the physicians trying to help the patients, until recently. The last few years has brought about a revolution in the treatment of low back pain where all types of healthcare providers agree on the best treatment.

Neurologist, orthopedists, family doctors, chiropractors and physical therapists are now all in agreement over the best therapy for low back pain, IDD therapy. IDD therapy refers to Intervertebral Disc Decompression. Intervertebral Disc Decompression is quickly becoming the treatment of choice for healthcare givers of low back suffers. The over whelming acceptance of Intervertebral Disc Decompression as the treatment of choice for low back pain comes from the extremely high rate of success found by the FDA. The FDA studies released noted that Intervertebral Disc Decompression was successful in a full 86% of all low back cases, without the need for surgery, injections, medication or pain. The FDA studies included patients with herniated discs, bulging discs, degenerative discs, facet syndrome, sciatica, arthritis and stenosis with most patients have several overlapping problems as seen by MRIs. Many of the patients in the study had sciatica and muscle spasms and still Intervertebral Disc Decompression gave significant relief to over 86% of the patients.

MRI findings Starting Pain level Ending Pain level 1. 3 herniated discs 10/10 1/10 2. Degenerative discs with disc herniations L4-5 10/10 2/10 3. Spinal Stenosis with disc degeneration 9/10 1/10 4. Disc degeneration with facet syndrome (arthritis) 8/10 1/10 5. Bulging discs L4-5, L5-S1 8/10 1/10 6. Disc degeneration with stenosis 7/10 1/10

These are some of the many patients results that have been achieved through Intervertebral Disc Decompression therapy at Monmouth Advanced Medicine in Freehold. These results are even more impressive when you consider that on average prior to trying Intervertebral Disc Decompression therapy. our patients tried; chiropractic care 72%, traditional physical therapy 76%, had spinal epidurals 44%, medication 100%, and spinal surgery 12% . Even when traditional treatments failed, Intervertebral Disc Decompression therapy offered dramatic relief.

Intervertebral Disc Decompression is so effective because it corrects the cause of the pain and not just the symptoms. A patient who receives Intervertebral Disc Decompression has a pair of harnesses placed around their waist and chest, a computer then generates a preset amount of decompression. The separation of the harnesses causes disc decompression and leads to negative pressure inside the disc, a vacuum is formed in the problem discs. The vacuum in the disc allows for the re absorption of herniated and bulging discs. The negative vacuum in a problem disc will also absorb water to help regenerate degenerative discs and help restore disc heights. Discs that have had the bulges, herniations, and degenerative changes reduced have more room for nerves, more room and movement for arthritic joints, have less spinal stenosis, and greatly reduced pain. Pre and Post MRI findings show that Intervertebral Disc Decompression therapy will reduce the size of disc herniations and bulges. Degenerative discs and arthritic joint spaces will increase in size allowing for more movement and less nerve irritation. The long term results achieved with the therapy are impressive.

To improve the long term results of Intervertebral Disc Decompression patients are instructed on how to properly stretch and lift to prevent future occurrences. While undergoing Intervertebral Disc Decompression therapy patients also receive traditional therapy to reduce pain, increase joint movement, and decrease muscle tightness. Patients who continue to do mild stretching and range of motion exercises daily have shown to have excellent long term results without exacerbations. The results achieved with Intervertebral Disc decompression therapy are unmatched and there are several additional benefits.

Intervertebral Disc Decompression has several other factors that have doctors and patients signing its praises. Intervertebral Disc Decompression is a form of physical therapy, so no medication, shots or invasive procedures are needed. An average patient will usually receive 24-32 Intervertebral Disc Decompression treatments with therapy over an 8 week period. A patient will start usually start to notice significant pain relief within the first 2-3 weeks. Patients are treated 3-4 times a week for 6-8 weeks without the loss of time from work or they are able to return to work faster than with traditional physical therapy. IDD therapy is totally painless so patients with even the most sever pain can receive treatment. The gentle and safe nature of the therapy has also made is useful for patients as young as 13 and as old as 90+. The high success rate and the quick results achieved with this therapy has also made insurance and Medicare reimbursement available. Patients praise the treatment for not just the pain relief the therapy offers, but for the return of more normal lifestyle.

Tom W., a school teacher stated,” I began to experience intense excruciating pain in my low back often accompanied with burning, shooting nerve pains and constantly spasming muscles associated with sciatica. I sought immediate help at a hospital emergency room where a needle in my lower back was used to kill thee pain. The next four months consisted of many visits to my orthopedic doctor, a MRI, X-rays, 12 epidural blocks, prescription painkillers and 3 months of intense physical therapy, all to absolutely no avail???.Your Intervertebral Disc Decompression and physical therapy regiment has been a Godsend to me. The process was generally painless and often comfortable and relaxing for me. I sincerely never felt physically better?” Patients who complete Intervertebral Disc Decompression therapy are often able to return to the activities that they thought they would never be able to do again.

Intervertebral Disc Decompression therapy is even effective when traditional therapies and surgery has failed. A recent review of patients showed that Intervertebral Disc Decompression offered over a 95% reduction in pain even when surgery, physical therapy, chiropractic, medication, and spinal epidurals failed. The American Academy of Pain Management recommends the therapy for all low back pain suffers, except those patients with severe osteoporosis and metal spinal implants. The high success rate, fast results and minimal side effects makes Intervertebral Disc Decompression the first choice for doctors who specialize in treating low back problems.

Hypnotherapy is one of the best known and most widely used treatments for IBS, and can offer sufferers a drug-free solution to their symptoms of diarrhea, constipation, stomach pain and bloating.

There are now many hundreds of hypnotherapists who offer what is called “gut-directed hypnotherapy” for IBS, which takes the general techniques of hypnotherapy and applies them directly to the abdominal pain and digestive symptoms which IBS sufferers struggle with. This type of hypnotherapy has been clinically tested and found to be very helpful to many IBS patients.

One of the first studies of hypnotherapy for IBS was conducted by Dr Peter Whorwell, a leading expert on IBS and hypnotherapy in the UK. A trial he conducted in the 1980s found that a group of IBS sufferers who had failed to respond to other treatments showed dramatic improvements when treated with gut-directed hypnotherapy. Since then, other therapists have shown similar results.

What hypnotherapy involves

Hypnotherapy in a medical setting bears no relation to the kind of stage hypnosis where volunteers are made to do ridiculous things in the name of entertainment. In fact, patients remain entirely in control of their own actions, and are simply coaxed into a kind of deep relaxation state.

While the patients is in this state the therapist will talk to you and make positive suggestions ? one typical method for IBS is to ask you to place your hand over your abdomen and imagine that a healing warmth is flowing from your hand to your stomach.

Some hypnotherapists will record each session for you so that you can listen to them again between your appointments, and therefore increase the effectiveness of the therapy.

Self-hypnosis

If you don’t have the time or the resources to visit a qualified hypnotherapist, you might find some relief in one of the self-hypnosis CDs available, which can be listened to in the comfort of your own home.

While you will not get an individual treatment program from a ready-made CD, you will be able to benefit from the general hypnosis approach, and you can choose to listen to the CDs whenever you have the time.

The IBS Audio Program, developed by the UK hypnotherapist Michael Mahoney, is the most widely used program for IBS sufferers, and is available on audio CD and cassette. The program is designed to be used over 100 days, and includes four CDs and a program booklet. The makers claim that around 80% of listeners experience a significant reduction of pain and bowel dysfunction.

The program consists of three therapeutic session CDs, with an introduction and five different hypnotherapy sessions. It also includes a bonus fourth CD (the IBS Companion), which explains IBS to non-sufferers.