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Friday, December 15, 2017

Watching for drug interactions

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This month, I got bronchitis (again!) It had gone through the whole family and I thought I wasn't going to get it because I am a germaphobe and so careful with washing my hands.

But, as soon as the scratchy throat started, I knew I was in for the long haul.

With any medical condition that needs a prescription, it's hard to juggle medications and find one that won't interact with another.

As my cold turned into bronchitis, I knew it was time for an antibiotic and an oral steroid. How did I know? I have an Asthma Action Plan that Asthma Doc filled out for me. 

Asthma Action Plans are like stop lights - green, yellow and red zones. Each zone tells you what to do if you are in that zone. Green means "GO", or you are good and not having symptoms. Yellow means "CAUTION" because you are starting to cough, are short of breathe, wheezing, etc. The Red Zone means "STOP" and call 911 or go to the closest hospital.

I was in the bottom of the yellow zone because I was taking my controller inhaler twice a day, using my nebulizer with albuterol, and was still struggling to breathe. 

You can see that this Asthma Action Plan says "Keep ORAL STEROIDS on hand in case you fall into STEP 3 of the yellow zone or into the red zone." 

Since my steroids had expired, I had to call the doc to call in a prescription. Since I have asthma, and was coughing up colored phlegm, he decided to put me on an antibiotic too.

However, Pharmacist called to say there was a possible drug interaction between the many medications that I take. 

I am SO glad he flagged that as a problem! That's why it's important to always use the same pharmacy.

If you have to use an after hours pharmacy, make sure they know about ALL of the medicines you usually take. My pharmacy has a program that will alert the pharmacist to a drug interaction.

There is also a website you can use, on click on the Drug Interactions Checker. (It's not a substitute for talking to your doctor or pharmacist, but can help in a pinch.) 

I found out that I could have had some VERY serious complications if I had taken the antibiotic that the doc called into the pharmacy. So, doc called in a different medication.

It's taken 2 weeks, and I missed a week of work (and time I could have spent getting ready for Christmas!) but I am on the mend.

Make sure you know what to do if you are in the green, yellow or red zones for asthma. And if you need a new medication, make sure you use your regular pharmacy to check for drug interactions. Or tell the after hours pharmacy about ALL of the medicine you take so they can check for a drug interaction.

If you are already sick, the last thing you need is a serious drug interaction!


Thursday, December 7, 2017

New Epinephrine autoinjector for babies and small children!

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For those of you that have kids with food allergies (or maybe you have them yourself!?) You know how scary it to be to try to eat out at times.

I don't trust anyone! How do I know if they have the same cooking utensils on my chicken that they used on seafood? 

Did they put my chicken on the same area of the grill as the seafood when they cooked it?

Are there desserts that have tree nuts on the tray? If so, Son #2 can't eat ANYTHING on the tray because it is all contaminated!
Whew! It can be tiring to always be on the lookout for food allergies.

If you have babies or younger kids with food allergies, that can be really scary. Because they didn't make epinephrine auto injectors for them - until now!

The needle length and dose of this auto injector is made just for them. 

Kaleo is the same company that makes Auvi-Q, known as "the talking auto injector". It looks very different from other auto injectors (it's about the size of a pack of gum.) And  it will "talk you through" using the device, step by step.

Kind of helpful if you panic during an allergic reaction.

I didn't see a photo of the new Auvi-Q, but its' the 0.1 dose. The dosing for older children and adults is usually 0.15 or .3, so this dosing is much less. 

If you have a baby or small child with food allergies, talk to your doctor and pharmacist about getting the new auto injector. 

It is expected to be available "the first half of 2018". 

Good luck!

Monday, November 27, 2017

Using an inhaler for younger kids

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Last week, I wrote a post on the "Most Common Inhaler Mistakes", which was mostly for older kids and adults.

If you have a younger child, let's review the right way to use an inhaler.

The first thing you may notice is that there is a mask on the end of the spacer (the spacer is the long tube that is attached to the inhaler.) So, you will have a spacer with 1) an inhaler attached to one end and 2) a mask attached to the other. See the photo above. 

(One thing I don't like about this photo is that the child is using a spacer, not a valved holding chamber. Usually, you would use a valved holding chamber with a mask. You can learn more from The University of Arizona Health Science Center. )

The mask kind of looks like an oxygen mask. It helps seal the area around the mouth and nose to get a nice, tight fit so the kids will get all the medicine from the inhaler. (For all of you parents with squirming kids - you know what I'm talking about!) It's hard to get them to sit still to take their medicine, so the mask helps with that.

You do the same basic steps as using an inhaler with a spacer:

  • Check the opening of the inhaler for crumbs or lint (you can find all sorts of stuff in pocket, purses and backpacks - which can clog up your inhaler!)
  • Shake the inhaler
  • Prime inhaler if needed (check out this website to see how many times to prime each brand)
  • Breathe out before you press down on the inhaler

If your doctor wants you to use a mask with a younger child, you hold the mask on your child's face while they breathe in and out 6 or 7 times. (With adults, you usually inhale from your spacer and then remove it from your lips.) 

I like to watch a video from Children's Health Care Atlanta, because if you look closely, you can watch the yellow valve go back and forth. That lets you know that your child is breathing in and out (and actually getting the medicine!) 

This video from UNC Health Care also shows how to use an inhaler with a spacer and mask, but is a little more detailed on how to clean your spacer and mask each week. It's important to clean them because if your spacer and mask are dirty, you will be inhaling any germs that are inside of them!

I hope this helps. To review how to use an inhaler or inhaler with spacer for older kids and adults, you can can watch these videos:

 As always, ask your doctor or pharmacist for help if needed.

Thursday, November 16, 2017

Most Common Inhalers Mistakes

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Last week, Hubby and I had a long awaited vacation to Hawaii. As we were waiting to board the plane, a woman near us started violently coughing and then used her inhaler. 

Hubby leaned over to me and said, "She isn't using a spacer!" I leaned back and said, "She didn't wait one minute between puffs either."

I wondered if I should say something? After all, if you don't use your inhaler the right way, you aren't going to be getting as much medicine as you THINK you are getting.

But would you want a complete stranger walking up to you and say, "I couldn't help but notice you using your inhaler. As a Certified Asthma Educator, I can help you make a few changes that would you allow you to get more medicine from your inhaler. May I show you?" 

I have found that there are Happy Travelers - you know, the kind who look amazing and are full of energy. Then there are those who have obviously had a little Dramamine or a few drinks. Or those who are just plain tired and cranky.

So, I will share the Most Common Inhalers Mistakes here on my blog. (Note - this is for adults and older children. For younger children, it works best to use a spacer with a mask. And they breathe in and out through the spacer for 5-7 times. I'll blog about that next time!)

  1. Not checking the opening of the inhaler for debris 
Why check the opening of your inhaler? Well, I have heard stories of people inhaling a dime, pocket lint, cookie crumbs, etc. Anything floating around in your back pack, purse or pocket can get stuck in your inhaler.

2. Forgetting to shake your inhaler   

When you shake your inhaler, that will mix the right amount of medicine and pressurized air. Kind of like when you have to shake a can a spray paint before you use it so it mixes up. 

2. Not priming your inhaler 

You should shake your inhaler and then spray a puff (or two, or three, or four) into the air. How many puffs you spray depends on the brand of your inhaler and each company is a little different (you should look up the directions for your brand of inhaler.)  American Thoracic Society says that when you prime your inhaler, that makes sure you get the right amount of medicine in the dosing chamber. They also have a nice graphic that shows the inside of an inhaler so you can see how it works.

3. Forgetting to blow out BEFORE you use your inhaler 

You need to empty your lungs FIRST so you can take a big breathe IN and inhale all of the Albuterol. If you forget to do that, it's a little hard to breathe in when there your lungs are already full of air.

4.   Not using a spacer OR not inhaling BEFORE you puff the inhaler  

Okay, there are two options here. 

a. Use a spacer 

This is my choice because I am uncoordinated - I can't walk and chew gum at the same time! If you use a spacer, you just insert the inhaler into the end of the spacer and depress the inhaler. That allows the medicine to go into the spacer/holding chamber and stay there until you inhale it.

b. Inhale BEFORE you depress the inhaler 

Since the medicine in an inhaler comes our REALLY fast (one pharmacist told me it was over 50 miles per hour - or something like that.) So if you depress our inhaler and THEN breathe in, that puff will be at the back of your throat before you even have a chance to breathe in. You should put the inhaler between your teeth, and start to breath in BEFORE you press the inhaler. That way, the air is already swirling and being pulled down into your lungs, and the puff will go right down your lungs with it. 

This is hard to explain, so here's a video that shows How to Use an Inhaler.

5. Not holding your breath after you use your inhaler 

The New England Journal of Medicine listed this as one of the most common mistakes. You don't want to inhale, and then exhale right afterwards or you will blow all of that medicine right back out.
5. Not waiting 1 minute between puffs

 Why can't you do 2 puffs back to back? Well I had to study  "The Asthma Educator Handbook", 
 to prepare for my Certified Asthma Educator exam. In the book, it talks about how your lungs branch out 28 different times. That's a lot of twists and turns for the medicine to go through. A pharmacist explained it this way: The 1st puff will go about 1/2 way through your lungs (will sort of plow the way) and that takes time. If you wait one minute, the 2nd puff can quickly zip through that section of the lungs, then finish plowing to the end of the lungs (where the air exchange takes place.)

6. Forgetting to rinse your mouth after your controller inhaler

Controller inhalers can cause thrush if the medicine stays in your mouth. The doctor and pharmacist should tell you to rinse out your mouth after you using your controller (or maintenance) inhaler. But I always like to know WHY. The why is that you can get thrush. That's where the tongue turns white and you can also get sores on it.

So, I know that's a lot of information. With the families I have worked with, most report feeling better just by changing their inhaler technique. Some people have told me they have had asthma all their life, and they know what they are doing. And yet, they have been using their inhaler wrong for years! Once we play the video showing the proper inhaler technique, they are surprised. If they are willing to try it to change a few things, they are happy to see that they feel better and report that the medicine seems to be helping more. 
Take a minute to see if you are using your inhaler the right way!  

Wednesday, November 1, 2017

Leave it to asthma to ruin things!

Halloween is over for another year, and as usual, my co-workers did an AMAZING job decorating our office. 

It's hard to come up with a different theme each year, and this year it was The Great Pumpkin Charlie Brown. Each day when I would come back to the office, I would see something else they added. 

And true to Halloween and pumpkin patches, they brought in cornstalks and hay. It looked amazing, but I was instantly over powered by the smell of hay and cornstalks. And avoided the front office.

Within a few minutes, I had to use my inhaler. In fact, every morning for the past 3 days (since the cornstalks came), I have had to use my inhaler when I get to work. That's unusual for me.

 The cleaning crew walked in and the guy that usually vacuums for us stop dead in his tracks and looked at the floor. I shrugged my shoulders and told him it was just until Halloween. 

We reassured him that my co-workers said they would clean up. 

Since Halloween is over, I asked several of my co-workers if they could take the corn stalks out and throw them in the dumpster. 

Snoopy's house looks adorable, but I can't keep having asthma attacks every morning when I come to work. In fact, I am back in my office with my door shut and my fan blowing towards my door to try to keep the allergens out of my office.

Once again, asthma has to ruin things.

I told my co-workers that asthma has a habit of doing things like that. Where they aren't the least bit bothered by corn stalks or hay, my allergies and asthma are going crazy.

That's typical of asthma. I like give people the simplified version of asthma - that it's a "Drama Queen." For any of you that have teenagers, you know what I am talking about!

The technical term is "hyperresponsiveness and hypersensitivity." Which means that your body is overly sensitive to asthma triggers and your body over reacts.

It is what it is. It's a biological response in our bodies. We can't stop it from happening, but we can try to avoid things that set off our allergies and asthma. 

 I also try to "be part of the team", and didn't let anyone know that it was causing problems for me. But now that Halloween is over? OUT!!! 

I need those cornstalks and hay out of the office.

Anyone else have fun with fall holiday decorations?


Monday, October 16, 2017

Trying to stay healthy....

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Well, it's that time of year again. Co-workers and family members are sniffling, wiping their noses and coughing.

And I am trying to AVOID them. 

Not easy when you live with one of them, and work with an office of sick people. 

The possibilities for germs are endless. And I try to avoid all of them. 

I use my sleeve to open doors (I'm not touching those handles!) I use my knuckle to punch the elevator button and then wash my hands when I finally get to my office.

I wash my hands after I touch the handle to the microwave and office fridge. Seriously....does anyone else have one of "those " office fridges that no one cleans out? I am tired of being the only one to clean the fridge, and have left that to someone else. I know no one is going to take time to clean the fridge handle if they can't clean the inside of the fridge!

And don't get me started on the people that don't wash their hands after they use the bathroom at work. Seriously?! I work with nurses! They should know better! I use a paper towel to open the bathroom door. 

Even out in public, I have to be careful. I just made a quick trip to the grocery store and always use the pop up canister of disinfecting wipes on the cart handle. Then, when I'm done and go out to my car, I use my pop up canister to wipe my hands again. 

Overkill? Nope, not when you have asthma! 

I had bronchitis this spring  and was VERY sick and missed a week of work. I also had to have a course of prednisone to get the swelling down in my lungs. However, prednisone can impair your immune system, so I have to be really careful now.  

Can avoid getting sick? Maybe not, but I am going to try!

Monday, October 9, 2017

Teal pumpkins for Halloween?

Why am I talking about the Teal Pumpkin Project? I mean, what does that have to do with asthma?

Well, a lot! 

70% of people that have asthma also have allergies (and many of those have food allergies, not just seasonal allergies.)  

In fact, I was just telling my co-workers how our family has to inspect ALL of the food we eat - family parties, work parties, church parties and even restaurants. EVERY time I eat at a restaurant, I have to ask the wait staff to make sure that my chicken breast is not cooked anywhere near seafood. I also have to remind them not to use the same utensils on my chicken that they are using on the seafood.

On Saturday, we went to lunch at a local bakery and sandwich shop and Son #2 ordered a gourmet grilled cheese sandwich. He knew that they make their own breads there, including some with nuts. So, he asked them to make sure there was no cross contamination. He told me that the cashier just looked at him with a blank look on her face.

So, Mama Bear came out, and I marched back up the counter and caught the eye of the manager and repeated our request. I let her know that I have an epinephrine auto injector, but would prefer not to use it. 

She said that she would make sure his sandwich is not cross contaminated by a knife, cutting board, or anything else that was used to slice bread with nuts. (The repeated requests get really old after a while......some people are quick to understand and help, while others look at us like we really weird. Which we are - but that is beside the point. )
Sometimes, I will pull out my epinephrine auto injector and show them so they know I am serious! 

Son #2 is in college now, but when he was younger, Halloween was a tough time because there are so many treats with tree nuts (cookies, candy, brownies, etc). Some kids are allergic to peanuts too, and that can make Trick or Treating a little scary! (Think costumes are scary? Try avoiding accidental exposure to a food allergen in Halloween candy!)

FARE (Food Allergy and Research & Education) has an entire website devoted to the Teal Pumpkin Project. What is that? The project is dedicated to:

"Raising awareness of food allergies and promoting inclusion of all trick-or-treaters throughout the Halloween season"

You can print out flyers, coloring pages, lawn signs  - all sorts of Teal Pumpkin Project to let parents know that your house is a place where they can trick or treat for allergy safe treats. 

Some families will only stock non-food treats. Other families will have 2 bowls - one with candy and one with non-food treats. FARE also has ideas for non-food treats (glow sticks, bubbles, mini slinkies, etc) Do whatever works for you!

So if you are shopping for Halloween candy, consider picking up some allergy-friendly Halloween candy or non-food treats for kids with food allergies.

We want them to be safe and happy and have a fun Halloween too!