Health & Blackness

Protecting yourself from potentially cancer-causing ultraviolet (UV) sunrays is important year-round, but especially during the hot summer months.  And yes, practicing sun safety is important even for those of us with melanated skin.

Damage from UV radiation can occur in as little as 15 minutes, and over time can lead to eye damage, a weakened immune system, sun spots, wrinkles, and skin cancer in the worst cases.

You can practice sun safety by:

• Limiting your outdoor activities from 10:00am – 2:00pm, when UV radiation is the strongest.
• Wearing protective clothing like long-sleeved shirts, pants, and wide-brimmed hats to protect yourself from direct sunlight.  Generally, dark clothing provides better protection than light-colored clothes.
• Using sunscreen.  Use products with a sun protection factor (SPF) of 30+.  The higher the SPF, the better protected you will be.  Additionally, you’ll want to choose a “broad spectrum” product that offers both UVA & UVB protection.  Apply sunscreen 15 minutes before sun exposure, and reapply every 2 hours.  If swimming or sweating excessively, you’ll want to reapply more frequently after drying off.  If participating in water activities, you may also consider using a water-resistant sunscreen product.  Some cosmetics, such as lipsticks, foundations, and moisturizers offer UV protection as well.  Also be sure to check the expiration date of your sunscreen periodically to be sure it is still effective.
• Protecting your eyes from cataracts by wearing sunglasses that offer at least 99% UV protection.
• Taking advantage of shade provided by trees, umbrellas, or other shelter.
• Performing monthly skin exams.  Schedule an appointment with your provider if you notice any of the following: a sore that will not heal; a new or changing growth or mole; hyperpigmentation; or changes in the integrity of the skin such as bleeding, oozing, scaliness, etc

Definition/Cause.  Sometimes referred to as a “brain attack,” a stroke occurs when the blood flow to the brain is blocked.  There are 2 different types of stroke.  An ischemic stoke occurs when the arteries to the brain are blocked by plaques.  Less common, though more dangerous, hemorrhagic strokes occur when a blood vessel in the brain breaks and leaks blood.  Hemorrhagic strokes may be caused by hypertension, overuse of blood thinners, a fall, or an aneurysm.

A transient ischemic attack, also knows as a TIA or “mini stroke,” occurs when blood flow is blocked only temporarily and there is not any lasting brain damage.  Having had a TIA in the past increases your risk of having a true stroke in the future.

Risk factors.  Risk factors for stroke include smoking, hypertension, diabetes, high cholesterol, lack of physical activity, obesity, an irregular heartbeat (atrial fibrillation),  and a family history of stroke.

Symptoms.  Potential signs of stroke include trouble walking, dizziness, loss of balance, confusion, trouble speaking, blurred vision, feeling numb or weak in the face, arm, or leg, and sudden severe headache.

Act FAST.  If someone you know begins to show signs of stroke, remember the FAST acronym:

• F(ace) – Ask the person to smile.  Does one side of their face droop?
• A(rms) – Ask the person to raise both arms.  Are they only able to lift one side?
• S(peech) – Ask the person to repeat a simple sentence.  Are their words slurred?
• T(ime) – Remember when dealing with a possible stroke, time is of the upmost importance.  For every minute someone is experiencing a stroke, 2 million brain cells die.  Those damaged brain cells cannot be repaired or replaced.  Additionally, the clot buster used for stroke treatment can only be used within 90 minutes of the first sign of stroke.  If you observe any of the signs above, call 911 immediately.  Recognizing symptoms and acting FAST can save a life or limit long-term disabilities.

Long-term complications.  Potential long-term effects of stroke may include difficulty speaking or swallowing, memory loss, cognitive deficits, pain, changes in behavior or emotion regulation, paralysis, and loss of ability to care for oneself.

Prevention.  High blood pressure is the most important risk factor for stroke, so it is important that you get your blood pressure checked regularly.  If you have been diagnosed with hypertension, diabetes, and/or hyperlipidemia, be sure to take your medications as prescribed by your doctor.  If you are a smoker, consider quitting.  Drink only in moderation.  Strive for at least 150 minutes of mild-to-moderate exercise each week.  Try to make healthy food choices and limit your intake of sodium, cholesterol, and fats.  Also make efforts to manage your stress and get adequate sleep.

Definition/Cause: A heart attack occurs when a clot blocks the blood flow of an artery.  Over time, cholesterol and other substances may build up in the walls of the arteries, causing them to narrow.  During a heart attack, the blood vessel becomes completely blocked, which can lead to organ damage.  Atherosclerosis is the clinical term for  the buildup of cholesterol (plaques) in our arteries.

Risk factors: Factors that may increase your risk of a heart attack include age (males >45 years old, females >55years old); tobacco use; high blood pressure; diabetes; high cholesterol; lack of physical activity; obesity; family history of heart disease; stress; illegal drug use; and history of preeclampsia during pregnancy.

Symptoms: The symptoms that are experienced during a heart attack vary from person to person.  One person may not experience any symptoms, while a heart attack for someone else may be instantly fatal.  Potential symptoms include chest pain, shortness of breath, nausea & vomiting, sweating, fatigue, feelings of anxiety or impending doom, lightheadedness, and dizziness.  If experienced, the severity of symptoms will also vary person to person.

What to do: If you or someone you love is experiencing symptoms of a heart attack, call 911 immediately.  If you have the medication nitroglycerin or aspirin in the home, take them while waiting for the ambulance.  Nitroglycerin helps reduce chest pain, while aspirin helps to prevent your blood from clotting.  Once at the hospital, the doctors will decide the appropriate interventions and medications for treatment.

Prevention:  Manage your risk factors.  If you smoke, consider quitting.   Drink only in moderation.  Strive for 150 minutes of mild/moderate exercise each week.  Make healthy food choices, particularly with regards to your saturated and trans fat intake.  Maintain regular doctor’s visits.  If you are hypertensive, diabetic, and/or have high cholesterol, be sure to take your medications as prescribed.  Make efforts to reduce your stress.

If you have several risk factors, you may also consider discussing adding aspirin to your medication regimen.  Taking a daily aspirin dose of 81-325mg helps to prevent blood clots, which should decrease your risk of heart attack.

Hyperlipidemia is the clinical term for high cholesterol.  Cholesterol is a waxy substance that is found in the fats in our bloodstream.  Our bodies need cholesterol to build healthy cells, but too much cholesterol can increase our risk of heart disease. Excess cholesterol in our blood builds up along the walls of our arteries.  Over time, our arteries begin to harden and narrow, decreasing flow throughout our bodies.  A heart attack or stroke occurs when the blood vessels to either our heart or brain become completely blocked.

Symptoms.  Generally, high cholesterol does not have any symptoms.  Most people are diagnosed after having their bloodwork done at their doctor’s office.

Risk Factors.  Risk factors of high cholesterol include smoking, obesity, poor diet, lack of exercise, high blood pressure, diabetes, and a family history of heart disease.

Cholesterol Goals.  It is recommended that adults get their cholesterol checked at least once every five years.  When you get your labwork done, four different numbers are reported:

• Your total cholesterol score is calculated using the following equation: HDL + LDL + 20% of your triglyceride level.  Ideally, your total cholesterol should be <200mg/dL.
• LDL is our “bad” cholesterol.  The lower your number, the better.  While the latest recommendations no longer identify a specific target goal, traditionally we want our LDL<130mg/dL.  If you are diabetic your ideal LDL<100mg/dL; if you have blood vessel disease such as atherosclerosis, you want your number to be even lower (<70mg/dL).
• HDL is our “good” cholesterol.  HDL absorbs excess cholesterol, and returns it back to our liver where it is then eliminated from our bodies.  Since higher numbers are better, our goal is >40mg/dL.  The best way to increase your HDL is to exercise regularly.
• Triglycerides are a type of fat found in our bodies that increases our risk of heart disease.  Our triglyceride goal is <150mg/dL.

Lifestyle Changes.  If your cholesterol is already elevated or you’ve identified that you have several risk factors which may increase your risk of high cholesterol, there are several lifestyle changes you can begin to make to help lower your cholesterol numbers.

• Avoid foods that are high in cholesterol, trans fats, and/or saturated fats.  Trans fats are found in many processed and fast foods.  Saturated fats are those fats that solidify at room temperature (picture the bacon fat that’s left on your plate after it has cooled).  Cholesterol, trans fats, and saturated fats all increase your cholesterol.  Aim for less than 300mg of cholesterol per day.  Less than 10% of your fat intake should be saturated fat.  Try to eliminate trans fats altogether.  Monounsaturated fats, found in olive, peanut, and canola oils are healthier substitutions.
• Eat more whole grains, fruits, and vegetables.  These foods are high in fiber, which can help to lower your cholesterol.
• Eat heart healthy fish.  Fish like cod, tuna, and halibut have less fat than other meat and poultry.  Other fish like salmon, mackerel, and herring are high in omega-3-fatty acids, which promotes heart health.
• Exercise regularly.  Strive for at least 150 minutes of mild-to-moderate exercise each week.
• Drink in moderation.  As we’ve already learned, ladies should have no more than one drink per day.
• Avoid smoking.  Smoking is damaging to your blood vessels, and further increases your risk of heart disease.

Start making these lifestyle changes today, and you should find that your cholesterol levels improve.  Lowering your cholesterol will help improve your heart health and decrease your risk of heart attack and stroke long-term.

Diabetes.  Sugar diabetes.    Blood sugar.  Blood glucose.  We’ve all heard our grandparents, aunts, and/or uncles use these terms, but what exactly do they mean?  Diabetes is a group of diseases that result in excessive blood glucose (blood sugar) in the bloodstream.  Type 1 diabetes, or juvenile diabetes, occurs when the body is unable to produce insulin.  Type 2 diabetes, which is much more common, occurs when the body fails to produce enough insulin or resists the insulin that it does produce.

So what is insulin?  Insulin  is a hormone produced by your pancreas that regulates the movement of glucose (sugar) into your cells.  When our bodies work normally, we obtain glucose from our diet, or as it is released from our liver.  After digesting our food, that glucose is absorbed into our bloodstream.  Normally insulin operates as a key that allows  glucose to enter our cells and be used as  source of energy.  If our key (insulin) does not work, that glucose remains in our bloodstream.  Our key may be faulty because we either don’t make enough insulin, or our cells have become resistant to it.  Over time, persistently having too much glucose in your bloodstream can lead to serious complications such as blood vessel disease, nerve damage, kidney damage, and vision loss.

Risk factors.  Risk factors for diabetes include being overweight, lack of physical activity, family history of diabetes, African American heritage, increased age, and having had gestational diabetes while pregnant.

Symptoms.  While diabetes is associated with certain symptoms, many people are diagnosed without exhibiting any of them.  Common symptoms include increased thirst, frequent urination, increased hunger, weight loss, fatigue, blurred vision, slow-healing sores, frequent infections, and/or areas of darkened skin.

Diagnosis.  The preferred method for diagnosing diabetes is the hemoglobin A1c test.  Think of this test as a “panoramic view” of your blood glucose as it tells your healthcare provider your average reading over the past three months.  An A1c level of >6.5% on two separate occasions indicates you have diabetes.  A result between 5.7-6.5% is considered prediabetes; a normal result is <5.7%.  Fingersticks are not an ideal diagnostic tool because they are more like a “snapshot”.  They tell us what your blood glucose is at that very moment, which can be greatly affected by what your last meal was, and how recently you ate it.

Prevention/Management.  The single most important mechanism for preventing or managing diabetes is to monitor your diet.  Carbohydrates are the food group that most significantly affect our blood glucose.  This is because when our body digests carbohydrates, they turn into glucose.   When selecting your carbohydrates, try to choose complex carbohydrates.  Complex carbohydrates require more energy during the digestive process, and so less glucose is released into your bloodstream.  Complex carbohydrates include wheat, corn, brown rice, oats, barley, quinoa, oatmeal, beans, peas and lentils.

It is also important that you exercise regularly.  As previously discussed, strive for at least 150 minutes of mild/moderate exercise each week.  Exercise requires energy, which uses up the glucose stored in your cells.

If you are a smoker, give serious thought to quitting.  Both smoking and diabetes are damaging to your blood vessels.  Smoking while diabetic further increases your risk of stoke and heart disease.

Alcohol is high in sugar, and therefore can raise your blood glucose.  It is advised that women try not to exceed one drink per day (no more than two drinks a day for men).

If you’ve already been diagnosed with diabetes, be sure to take your medications daily as prescribed by your doctor.  It is also especially important with diabetes medications that you pay close attention to mealtimes.  Taking your medication while skipping meals may lead to low blood sugar, which can quickly become a dangerous situation.

Management of hyper/hypoglycemia.  Hyperglycemia is elevated blood sugar.  In addition to the symptoms listed above, hyperglycemia may be marked by weakness, confusion, dry mouth, and nausea/vomiting.  If you are feeling hyperglycemic, you should check your blood glucose and take your medication if you missed any doses.  On the other end of the spectrum is hypoglycemia.  Hypoglycemia occurs when your blood sugar is too low.  Symptoms of hypoglycemia include fatigue, paleness, shakiness, sweating, hunger, irritability and confusion.  If feeling hypoglycemic, try consuming a fast-acting carbohydrate such as candy, fruit juice, soda, or glucose tablets.

As the saying goes, “an ounce of prevention is worth a pound of cure.”  So what changes can you start making today to reduce your risk of diabetes?  If you’ve already been diagnosed, remember that while sometimes scary, diabetes is a manageable disease.  And if you start making some healthy lifestyle changes today, there’s a possibility the number of medications you need can be reduced (and in the best cases, stopped altogether)!

Once while leading a Health Promotion group, I asked my patients to explain what “hypertension” was.  I will never forget the veteran who responded, “that’s when you’re too hyper to pay attention!”

Though creative, that answer wasn’t exactly correct.  Hypertension is actually the clinical term for high blood pressure.  So what is blood pressure?  Your blood pressure is the force of blood pushing against the walls of your arteries, the vessels that carry blood from your heart to other parts of your body.  If your blood pressure is persistently elevated, it can damage your heart, leading to heart disease and stroke.

Blood pressure is measured using two numbers.  The top number, called systolic blood pressure, measures the pressure in your arteries when your heart beats or contracts.  The bottom number, called diastolic blood pressure, measures the pressure in your arteries when your heart rests between beats.

Ideally, our blood pressure should be <120/80mmHg.  If your blood pressure is 120-139/80-89, then you would be classified as “prehypertensive.”  Being prehypertensive means that your blood pressure is above goal, but with diet and exercise, you should be able to get it under control.  Anything higher than 140-90 is considered high.

Risk factors.  Risk factors for hypertension include diabetes, a high salt diet, physical inactivity, obesity, excessive alcohol intake, tobacco use, increased age, family history of heart disease, and African-American heritage.

Signs/symptoms.  Generally we do not feel our blood pressure rising, unless it is really extreme.  This is why hypertension is sometimes referred to as “the silent killer.”  It’s important to get your blood pressure checked at every doctor’s visit since you likely won’t experience any symptoms if it is elevated.

Prevention.  Address those risk factors that you can control.  Choose a diet that is high in fruits and vegetables.  Limit your sodium intake to <1500mg/day.  Look for foods labeled “low sodium,” “reduced sodium,” or “no salt added”.  Minimize your intake of canned foods, frozen foods, and processed meats as they are all generally high in sodium.

In addition to monitoring your diet, you can maintain a healthy weight by exercising regularly.  The US Surgeon General recommends 150 minutes of mild/moderate exercise each week.

If you are a smoker, give serious thought to quitting.  Tobacco use raises your blood pressure, and increases your risk of stroke and heart attack.

Alcohol can also raise your blood pressure.  Women should have no more than one drink per day (two drinks for men).

If you are prehypertensive, working to target these risk factors should help to keep you from reaching a state of persistent hypertension.  If you’ve already been diagnosed, these steps, along with taking your prescribed medication everyday, should still be beneficial in keeping your blood pressure at goal.

In our previous post, we discussed the importance of maintaining a healthy weight.  While a healthy diet contributes more significantly to our weight loss efforts, regular physical activity is still a good habit to develop.  Benefits of exercise include lowering our blood pressure; decreasing our risk of diabetes;  decreasing our bad (while increasing our good) cholesterol; improving our mood; boosting our energy; helping to relieve stress; and improving our sleep.

There are 2 types of exercise, and it is important that we find ways to do both.

• Aerobic activities make us breathe harder and cause our heart rate to increase.  Examples include walking/running, swimming, cycling, dancing, etc. and are more commonly known as “cardio” exercises.  These exercises generally help us to burn calories.
• Muscle-strengthening activities make our muscles stronger. Muscle-strengthening activities include lifting weights, using resistance bands, and doing push-ups, sit-ups, planks, etc. These exercises help us build muscle tone.

These are some ways for us to integrate an exercise routine into our daily lives:

• Start slowly.  If it has been a while since you’ve worked out, start slow and work your way up.  Walking is usually a good place to begin.  As your endurance increases, you can make your workouts more challenging by increasing the duration, frequency, and/or intensity of your sessions.
• Choose activities that you enjoy.  You are much more likely to enjoy your workouts if they are fun.  Be adventurous and try new things.  There are so many new forms of exercise available.  Some that I’ve enjoyed include boot camp classes, high intensity interval training, Zumba, and even pole dancing.
• Find a partner.  Ask friends or family to work out with you.  Participate in group activities like obstacle courses, tennis, softball, kickball, flag football or basketball.  If you’re new to your city, see if there’s a local Black Girls Run group in your area.  You are more likely to stick with an exercise routine if you have someone holding you accountable or depending on you to be a part of the team.
• Find ways to burn extra calories throughout the day.  Park in the back of the parking lot.  Take the stairs instead of the elevator.  Take a walk during your lunch break.  Stand vs. sitting as often as you can.
• Mix it up. Try to avoid doing the same workout all the time.  Mix more difficult exercises with easier ones.  Alternate upper body and lower body exercises.  This helps to minimize both risk of injury and also “muscle memory”.
• Strive for 150 minutes of mild-to-moderate exercise per week. Whether that be 30 minutes 5 days a week or 60 minutes 2-3 days per week doesn’t really matter.  What’s important is that you find the time to get your exercise in each week.
• Reward yourself.  When you reach new milestones, do something to treat yourself.  If you drop a clothing size, buy a new dress to celebrate.  If you reach a weight loss goal, buy those shoes you’ve had your eyes on.

What types of exercises do you enjoy?  Have you come up with any creative ways to fit exercising into your busy schedule?  If so, please post your tips in the comments section!

When thinking about “healthy living” our weight is commonly one of the 1st things that comes to mind.  Beyond the effects our weight has on our appearance (and self-confidence in some instances), we know that obesity is linked to high rates of many diseases including high blood pressure, high cholesterol, type 2 diabetes, heart disease, stroke, and some cancers.

But how do you know what’s a healthy weight for you?  In the medical world, body mass index (BMI) is a common way to determine your ideal weight based on your sex and height.  BMI is often preferred over other calculations because it is strongly correlated with various metabolic conditions and diseases.  A BMI of 18.5-24.9 indicates a normal weight, 25.0-29.9 indicates being overweight, and a BMI>30.0 indicates obesity.  You can calculate your BMI here: http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html. 

After calculating your body mass index, you may have learned that you are considered overweight or obese.  So what next?  First and foremost, remember that your weight does not define you.  You are so much more than a number on a scale.  But if you’re inspired to lose some weight, you’ll want to focus on your eating habits to make the greatest impact.  We all know that when thinking about our weight, the 2 major components are our diet and exercise.  But what you may not know is that when trying to lose weight, our diet actually accounts for about 80% of our results (or lack thereof).  Regular exercise is still beneficial, but our efforts won’t account for much if we don’t get our eating habits under control first.

Make smart food choices

Your body needs to get enough vitamins, minerals, and other nutrients. Making healthy food choices means getting plenty of vegetables, fruits, whole grains, and fat-free or low-fat dairy products.  For sources of protein, seafood, lean meats/poultry, eggs, beans, peas, seeds, and nuts are optimal choices.

• Cholesterol, sodium (salt), and added sugars
• Trans fats, which may be in foods like cakes, cookies, stick margarines, and fried foods
• Saturated fats, which come from animal products like cheese, fatty meats, whole milk, and butter
• Foods made with refined grains, like white bread, noodles, white rice, and flour tortillas

Read the Nutrition Facts label 
Understanding the nutrition facts label on food packages can help you make healthy choices.

• Look at the serving size and the number of servings per package.
• Pay attention to the number of calories per serving size.  Calories are the amount of energy food provides when eaten and digested.  Calories that we don’t burn through our daily activities are stored as fat.
• Check out the percent Daily Value column.  Look for lower percentages (5% or less) of fats, cholesterol, and sodium.
• Generally you do not want to exceed 1500mg of sodium per day.
• Look for foods that have 20% or more of fiber, calcium, potassium, and vitamin D.

Keep a food diary.
Knowing what you eat now will help you figure out what you want to change.  Write down:

• When you eat
• What and how much you eat
• Where you are and who you are with when you eat
• How you are feeling when you eat

If you desire to lose some weight, I encourage you to revisit our SMART goals post to help you develop realistic and attainable goals.  If anyone has any other tips they have found beneficial on their weight loss journeys, please share them in the comments section.

As we now know, there are certain precautions we should take when administering our medications to make sure we are taking them safely.  But there are EXTRA precautions we should take when administering medications to children.

• Avoid diagnosing your child yourself.  Discuss your child’s symptoms with a doctor or pharmacist to determine if prescription medications are needed (i.e. an antibiotic) or if over-the-counter meds will suffice.

• Generally, children under the age of six years old should not be given over- the-counter medications.  This is especially true for children under the age of two.  If an infant or toddler shows any signs of illness, it is recommended that you bring them to the doctor as soon as possible.

• Make sure to use children’s formulations of over-the-counter medications.  Usually they are available in liquid or dissolvable tablet formulations, which makes them easier for children to swallow.

• Read medication labels carefully, and be sure to follow the directions closely.  The dosing of many children’s medications is determined by the age or weight of the child, and children are more susceptible to overdose.  When reading the instructions be sure to pay attention to not only the dose, but also the dosing frequency.

• Use medicine cups, syringes, droppers or spoons when measuring liquids.  Kitchen utensils are not exact, and therefore, may cause you to accidently give too much or too little medication to your child(ren).

• Avoid giving aspirin to children under the age of 19.  Use of aspirin in children increases their risk of Reye’s syndrome, particularly when recovering from a viral infection (i.e. the common cold, the flu, or chicken pox).  Reye’s syndrome is a potentially fatal disease, and symptoms may include diarrhea, vomiting, rapid breathing, severe fatigue, seizures, and loss of consciousness.

• Keep medications out of reach of children and pets.  Easy access without supervision may lead to accidental overdose.   In 67% of emergency room visits for medicine poisoning, the medicine was left within reach of a child.

• Don’t coax your children into taking their medication by saying it’s candy.   As we’ve discussed before, this increases their chances of taking the medication without supervision, which may lead to possible overdose.

• If your child resists taking the medication because of the taste, you have several potential options.  You can consider mixing it with a small amount of applesauce or yogurt.  Many pharmacies also offer flavoring options for liquid medications.  Our cheeks don’t have taste buds, so if using a dropper or syringe, you can squirt the medication on the inside of the child’s cheeks a little bit at a time.  Please be sure to check with your pharmacist first, but in some cases, tablets can be crushed, or capsules can be opened and the contents poured into a soft food like applesauce.

• If your child spits up or vomits the medication, call your doctor or pharmacist to determine if the dose should be given again.

• Keep the National Poison Control Center number saved in your cellphone.  They can be reached anytime at 1-800-222-1222.

Do any moms have any additional tips/tricks they would like to share?  I’m also interested to know how old your children were when they were first able to swallow tablets/capsules, and how you knew they were ready.

Picture this…a friend says she wants to set you up on a blind date.  After rolling your eyes, you’ll likely have several questions for her.  What does he look like?How did they meet?  How long has she known him?  What kind of job does he have?  Does he have any kids?  Any baby momma drama or crazy exes?  Is HE crazy?  And if he’s so great, why doesn’t she want him?!

You ask those questions because you want to make sure you’ll be safe with him.  Or maybe you don’t want to invest time in someone you know won’t complement your lifestyle.  You want to know he will potentially help make your life better in some way.

If you ask lots of questions before you’ll agree to coffee or dinner with a blind date, don’t you think you should do the same before blindly taking a new medication?  Something that you will ingest, and will quite literally run through your bloodstream, thereby potentially affecting every organ it touches?

I encourage you to ask questions at the doctor’s office and/or pharmacy prior to starting any new medication.  The more you know prior to taking a medication, the better prepared you are to know what to expect from it.  Additionally, it is almost always easier to ask questions while you already have the provider’s attention, versus trying to call the office/pharmacy after you’ve left or having to make another trip back.

The following are some questions you may consider asking your provider the next time s/he recommends a new medication for you:

• How will the medicine help me?  How does the medication work in my body?

• How long does it take for the medication to work?  Will I feel it working?  Do I need to take it all, or should I stop when I feel better?  There are some diseases that don’t necessarily exhibit symptoms.  As a result, we don’t necessarily “feel” ourselves getting sick.  An example would be hypertension (high blood pressure).  Most of us don’t “feel” our blood pressure rising, unless it’s really extreme.  As a result, we don’t necessarily feel the effects of the medications used to treat that disease.  This does not mean the medication isn’t working.  On the other hand, if a medication is used to relieve symptoms of pain, nausea, or allergies, we know the medication is working when we no longer experience those symptoms.

• How long will I need to take it?  Some medications may only be prescribed for a few days/weeks, such as pain medicine right after an injury.  Other medications may require lifelong treatment, such as those used to manage chronic conditions such as hypertension, diabetes, or high cholesterol.

• Can I get a refill?  How often/how many times can I get a refill?  Some controlled medications, also referred to as “C-II” medications, are never allowed refills as limited by DEA regulations.  Examples include medications that have a high risk of addiction such as strong pain medications (i.e. morphine) and amphetamines used for treatment of ADD/ADHD (i.e. Adderall).  For lesser controlled medications like benzodiazepines (i.e. Valium) and sleeping medications (i.e. Ambien), up to five refills are allowed on each new prescription.  However, early refills (usually less than 28 days from the previous fill date) are prohibited.

Your insurance company may not pay for early refills on any medication, regardless of whether or not they are controlled substances.  So if you need an early refill because you’re going out of town for an extended period, or the dog really did eat them, be prepared to either ask for an authorization or pay the “cash price”.  The cash price is the price an uninsured person would pay for that medication.

• How should I store my medication?  As we discussed in our last post, be sure to learn how your medication should be stored. The majority of medications can be stored at room temperature, but some require refrigeration, or storage in a dark area.  Other medications must be stored in the original manufacturer bottle.  Again, kitchens and bathrooms are generally not ideal due to heat and humidity.

• What side effects may I experience?  As we know, all medications have potential side effects.  Discuss the most common ones with your provider, and what you should do if you experience them.

• What can be done if I get side effects?  Discuss management of side effects with your provider.  There are some easy fixes for many side effects.  Stomach upset can usually be alleviated by eating a small meal prior to taking the medication.  If a medication is making you sleepy, it is likely best to take it at night.

When possible, try to avoid adding yet another medication to manage a side effect of a previous one.  For example, if a pain medication irritates your stomach, try not to add yet another medication to treat your GI upset.  Each new medication carries new potential side effects and drug interactions, creating a snowball effect.  Alternatively, see if eating a small snack just before or with the medication is helpful.

• Will I need labs or other tests to make sure I am receiving the correct dose?  Some medications like Dilantin, Depakote, and lithium require periodic blood tests to make sure you are receiving the appropriate dose.  The lab will determine the concentration of the medication in your blood to make sure it is within “therapeutic range.”  This means you have enough in your system to work effectively, but not so much that we worry about toxicity.  If the doctor learns that your medication level is too high or too low, s/he should adjust your level accordingly.

• What happens if the medication doesn’t work for me?  Ask how long it may take for your medication to start working, and how long before you feel the full effect.  Some medications, like mental health medications, can take up to 12 weeks to reach their full effect.  But if that window of time has passed, and you still aren’t feeling better, you should request a follow-up appointment with your provider to discuss alternative medications or therapies.

• Are there foods, drinks (including alcohol), other medications, or activities to avoid while I’m taking this medicine?  Grapefruit interacts with most statins, a common class of cholesterol medication.  Dairy may interact with certain antibiotics.  Some other meds may require that you avoid direct sunlight to minimize skin irritation (chemotherapy medications for example).  You will want to be aware of these limitations to be sure they are practical for you.  Someone who works outside in construction or landscape, for example, should not agree to take a medication that forces them to limit their time in the sun.

• Should I take this medication with food, or on an empty stomach?  Food, or lack thereof, can alter the absorption of certain medications in our body.  Again, discuss this with your doctor or pharmacist to make sure you are administering your medication properly.

• Does this new prescription mean I should stop taking any other medications?  Be sure to clarify if this new medication is an addition to the medications you are already taking, or a substitution for one of your other meds.  If it is a substitution, you should stop using the 1st medication before starting the 2nd (unless otherwise instructed).

• What happens if I miss a dose?  Should I take the dose when I remember it, or should I wait until the next dose is due?  For many medications, you will want to take your medication as soon as you remember it.  The exemption would be unless you’re within a few hours of taking your next dose.  Oral contraceptives (birth control pills) are one major exception here.  Follow the instructions that come with the medication carefully, but in most cases, if you miss a pill one day, you should take two pills the next day.

In summary, the more you know regarding any new medications, the better prepared you are to tackle any situation that may arise from taking that medication.  What are you thoughts?  Are there any questions you like to ask your doctor or pharmacist that I didn’t think of?