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.

What’s Insomnia?

Identifying insomnia is a little like the old joke about art: you know it when you’re having it. For people with insomnia, though, it’s no laughing matter. Having reduced or interrupted sleep is as bad for your physical and mental health as getting the wrong, or not enough, food.

People suffering insomnia may experience difficulties falling asleep, waking too early, or sleeping in small bursts throughout the night. Worse yet, someone with sleep difficulties wakes up and doesn’t feel rested, may have trouble focusing, and worry about their sleep problem to the point where they can’t sleep for worrying.

What Can I Do?

Like any other health problem, a combination of medication and new behavior can make a big difference. Behavior changes sleep specialists recommend including exercising regularly early in the day, reducing caffeine consumption, and making sure there’s no TV in the bedroom.

A medication can help reinforce these changes by allowing you to get unbroken, healthy sleep. One medication many physicians recommend is Ambien.

I Don’t Want To Take Sleeping Pills!

Over the years, “sleeping pills” have gotten some pretty bad publicity. Many 50’s movie thrillers involved villains sneaking sleeping pills into the unsuspecting hero’s drink. Famous people (like the poet Sylvia Plath) attempted suicide with sleeping pills. It’s no wonder that you might feel reluctant to take a pill to help you sleep!

But modern drugs that help with sleep are much safer and gentler than the drugs of the past. Ambien works with a chemical in your brain called GABA. GABA helps calm the activity of certain brain cells, allowing you to sleep. Because the drug has a gentle effect on GABA, you won’t wake up in the morning feeling like a zombie - you’ll be refreshed and ready for a new day.

The Doctor’s Office

You don’t need to visit a sleep specialist to get a prescription for Ambien, though you will need to speak with a physician. Talk with your doctor about your current sleep pattern (keeping a sleep diary before your appointment can be useful) as well as the medications you are currently taking.

If Ambien seems like a good match for you, your doctor will probably prescribe it for 7 to 10 days. In rare cases, she may extend the time you use it.

A week of Ambien can help break the cycle of sleeplessness, letting you recover your natural, healthy sleep pattern. Very, very few people (1-2% of people taking Ambien) experience very mild side effects (diarrhea, drowsiness, or dizziness). You should work with your doctor to prescribe you the lowest effective dose for you, since you don’t need the nighttime drowsiness to linger when you’ve got a big meeting with your boss the next day!

Why Can’t I Just Stay On Ambien Since It’s The Best Sleep I’ve Gotten In Years?

One of the few problems with Ambien is that it can become habit-forming (addictive) if used for several weeks. In fact, if your doctor prescribes it for two weeks or more, do not go “cold turkey” and stop the medication all at once; instead talk with her about creating a plan to taper off your dosage gently until you’re ready to stop.

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I am a strong believer in Cetyl Myristoleate for the treatment of arthritis. For the last three years I have been researching and writing about Cetyl Myristoleate. I am constantly searching for new research and contact and interview every doctor I can find that works with it. The purpose of the article is to evaluate the claims made about Cetyl Myristoleate on the myriad of web sites that sell it. It you want more information on the research that documents the effectiveness of Cetyl Myristoleate then do a search for my article, “Cetyl Myristoleate: Science or Speculation”.

Cetyl Myristoleate is an Immune Modulator. This is a tough question. We do not have any medical research yet that documents that it is an immune modulator. Many doctors believe that it is based on observations of their patients. Some people respond so well it appears that the benefits go beyond joint lubrication and a decreases in inflammation. Base on these results some doctors theorize that it is helping to correct some peoples immune systems. While this sounds wonderful it is a bold statement to make. I am not ready to call it an immune modulator.

Cetyl Myristoleate is a cure for arthritis. This is not only a bogus claim it is a lie. Not only is it a lie it is illegal to make that claim. If you are at a web site that makes this claim, leave, this person is not the kind of person you want to do business with. They need to be reported to the Federal Trade Commission.

All you need is one 15 or 20 day protocol. There are several companies that make this type of claim. You will notice that the companies that make this claim are among the most expensive. I believe that they use this to justify their high prices. Who would pay this price on a regular bases. While the double blind studies show that many people start finding relief in this amount of time, they were all short term studies and did not evaluate how long the results lasted. Every doctor I have talked to has disagreed with this statement. The people who find relief from Cetyl Myristoleate usually start seeing good results by the two week mark. But they continue to improve for the next two to four weeks. Almost everyone who discontinues use finds that with in a couple of weeks their symptoms begin to return. But they also find that once they max out their benefit they need much less to maintain that level of relief.

Cetyl Myristoleate helps 97% if the people who use it. I have seen this claim several times. It is simply not true. The research does not back it up and neither do those doctors who use it in practice. The percentage is closer to 70%. Of course the percentage changes depending on the type of arthritis you have. With nearly 100 types of arthritis nothing is going to work well on every type.

Cetyl Myristoleate is an anti aging agent. This is a powerful marketing tool. Every one wants to look and stay young. There is no research to back up this claim. Some of the doctors I have talked to believe it base on their observations. I have over a dozen family members and friends who take CM faithfully and none of us look younger. Yet almost all of us feel younger because we can now do things again that we had to give up because of our arthritis. If this is what they are talking about I concur. But if they are claiming it will make you younger or keep you from aging I think they are stretching it.

It is necessary to take digestive enzymes with Cetyl Myristoleate. This is a hard one. I personally do not think everyone does. Some people have a hard time digesting fats. If taking CM causes you stomach upset then you need to take a digestive enzyme. Make sure it has lipase because it is the enzyme that digests fat.

Cetyl Myristoleate will help you grow new cartilage. This is another unfounded claim. There is nothing in CM to help you grow cartilage. Once the inflammation is down then your body may find it easier to replace the cartilage damaged by the inflammation.

Will Cetyl Myristoleate help me with my arthritis? I would like to end the article with the question most ask of me. The answer is I do not know. All I can say is the research and my experience and the experience of the doctors I have talked to says that there is a 60% to 70% chance. Be reasonable about your expectations. CM is not going to repair bone damage, remove calcium deposits or repair other types of damage created by your arthritis. If you decide to try it do not pay too much. There is no need to pay $50, $80, $100 dollars or more. There are several good products in the $20 to $50 range. If the first bottle does not work for you do not waste your money on a second.

Every year about this time doctors around the world are recommending that people go in and get their annual flu shot. What most people don’t know or understand is just how dangerous this could be, especially for children under the age of 12. When people call and say “My doctor is telling the family to go in and get a flu shot. Should I do it?”?I tell them they should learn about the side effects and decide for themselves?as a chiropractor and naturopathic physician I don’t’ have the time or energy to argue with family practitioners or family doctors who are obviously uneducated on the possible side effects or detrimental effects flu shots or vaccinations in general can have on the body.

I personally have never received a flu shot and have never been ill during the flu season. In my personal opinion I don’t think toxic chemicals and strains of different viruses growing on living tissue belong inside the body. Because of the demand, I want to share with you some of the research that we have found in the latest flu shot trend and the by-products of these supposedly sterile and non-harmful solutions.

I don’t know about you, but I sure would not want any of the following compounds in my bloodstream or deposited in my body. Let’s look at what we have found in the common vaccinations:

Ethylene Glycol: Ethylene Glycol is nothing more than the technical name for anti-freeze, the same stuff that you put inside your car engine. I don’t think I have to tell you what would happen if you ingest antifreeze.

Thimerosal: This is a mercury derived disinfectant and preservative which is used in a majority of the vaccinations and can result in brain injury over a long period of time leading into Alzheimer’s or Parkinson’s Disease, lack of memory, sluggish brain performance and also is known to induce auto-immune diseases such as lupus, rheumatoid arthritis, ALS as well as altering and depleting the immune system from working efficiently.

Phenol: Phenol is most commonly used as a disinfectant, also used as a dye, is listened as a carcinogenic agent (cancer-causing) agent and is also known as carbolic acid.

Neomycin and Streptomycin: These compounds are used as antibiotics which have side effects to include severe allergic reactions in some people. It always puzzled me why they are putting two different forms of antibiotics in a viral vaccine.

Aluminum: Aluminum accumulates in the skin, bones, brain and kidneys and can cause Alzheimer’s and Parkinson’s disease. Aluminum has also caused cancer in laboratory mice. It is commonly used as an additive in most vaccinations.

Formaldehyde: Formaldehyde is used as a preservative. It is also classified as a carcinogenic (cancer-causing agent) and causes the body fluids to become acidic in nature. Formaldehyde will start to preserve your tissues within the body.

I hope that when your doctor starts telling you that it is time for your annual flu vaccine you will present this material to him and ask him how all of these ingredients are going to prevent you from getting the flu. I’ll be very interested in knowing what his answer is to that question. As a side note just to let you know what is being injected to your body, these vaccines are strained through animal or human tissues like chicken embryos, monkey kidney tissue and embryonic guinea pig cells, to name a few.

So what am I supposed to do if I don’t listen to my doctor and I decide not to get an annual flu shot? Well, you have probably made the smartest decision you have ever made in your entire life. So let me give you 5 Simple Secrets and Bonuses to Sailing Through The Flu Season:

Secret #1: Reduce your intake of caffeine, alcohol and carbonated beverages and replace with purified water with addition of organic apple cider vinegar added. Two tablespoons per gallon or a capful per glass. Ideally, you should drink at least

The news has been full of the recent FDA findings on a new set of drugs to help relieve pain. These drugs have been approved for re-release, but it is unclear whether Vioxx will be available again and whether physicians will feel comfortable prescribing Celebrex and Bextra for many of their patients.

What happened to Celebrex and Vioxx?

Celebrex, Vioxx, and Bextra are all non-steroidal anti-inflammatory drugs (NSAIDs, pronounced en-said-z), similar to drugs like ibuprofen and naproxen, that are available over the counter (OTC). Celebrex, Vioxx and Bextra, (sometimes called Cox-2 inhibitors) however, use a slightly different method to achieve the same effect as their OTC cousins; this new method was supposed to limit the side effects some people experience on OTC drugs, including stomach and intestinal problems and allergic reactions. It was thought that because these drugs were less likely to cause such problems, they might be safer for patients with painful chronic conditions (like arthritis) to use for long periods of time.

Unfortunately, some studies of Cox-2 inhibitors suggest that while they don’t cause the sorts of side effects of other NSAIDs, they may create a greater risk of myocardial infarction (heart attack) or stroke. For people already at risk for these diseases (including those who have already experienced a stroke or heart problem), taking these drugs over the long run may significantly increase the risk of heart problems.

Now What Can I Do To Get Pain Relief?

Until a final decision has been made on each of these drugs, what can your healthcare provider do to help you with pain management? Here are important pieces of information to think about in determining what next steps to take:

* The Cox-2 inhibitors were not shown to be more effective than other NSAIDs, like naproxen. If you’ve been on or thinking about trying Vioxx or another Cox-2 inhibitor, you may be able to use an older anti-inflammatory drug. Naproxen, one of the older NSAIDs, may be an anti-inflammatory drug that actually lowers heart attack risk.

* Some people started on a Cox-2 inhibitors because they had a stomach ulcer or other risk factors for stomach or intestine bleeding (for example, people on blood thinners), which may be made worse by older anti-inflammatory drugs. For some people who are at risk for bleeding, other options like acetaminophen may be an option.

* There are lots of other medical options. Steroids can be used for shorter periods of time to manage inflammatory pain from diseases like arthritis and lupus. Opioids (drugs that resemble opium), such as oxycodone, codeine, and hydrocodone (Vicodin) can help with pain management, but they can have serious side effects, and some of them can be addictive, so working closely with your healthcare worker is key to determine if these will work for you. In addition, some antidepressants may help with chronic (long-term) pain, though the way this works isn’t yet known

* New procedures may be of assistance to you. Nerve block therapy (in which certain nerves are temporarily anaesthetized) can relieve pain temporarily. “Implantable “technologies, like spinal cord stimulation (SCS) systems and implantable drug delivery systems, do seem to help some people for whom other pain relief methods don’t work.

* If you aren’t getting the relief you need (with or without the use of Cox-2 inhibitors), you may want to consult a pain specialist. Some large hospitals (such as Stanford University) have departments devoted to pain management. The American Board of Pain Medicine and the PainConnection (at painconnection.org) can help you locate a pain specialist who can work with your other healthcare professionals to put a new treatment plan together for you.