I’ve been concerned for a long time about the tendency that my patients have to mix their medications with over-the-counter treatments and herbs. This is not a safe or wise approach, though most of the time, no major side effects occur.

Just this week, a patient called me to say she had a cold and wondered if she could take a common over-the-counter cold medication. On the surface it seems like an easy question with an automatic “yes” answer — except for one thing. She was taking the kind of antidepressant medication that can raise blood pressure, and the cold medicine she had in mind contains Sudafed, which can also raise BP. So my answer was actually “no.” More importantly, I felt glad she thought to ask me the question, as too many patients don’t think they need to discuss over-the-counter aspirin, Tylenol, or cold medicines with their doctors.

According to a new study in the Journal of the American Medical Association, approximately 2.2 million or 1 in 25 older adults, are at risk for potential major drug-drug interaction. Men are at greater risk than women. The study looked at close to 3 thousand people aged 57 to 85.     

The problem often occurred because of mixing prescription drugs with over-the-counter drugs and dietary supplements, which also contain active chemicals. Frequent problems involved mixing Coumadin (a blood thinner) with aspirin or garlic (which also thin blood), or mixing a cholesterol-lowering statin with dietary niacin (lowers cholesterol and can effect the liver). Aspirin, when taken with gingko, can also increase the risk of bleeding. Certain blood pressure medicines (lisinopril) can raise potassium, and many patients were also taking potassium at the same time (for use with diuretics). Unfortunately, these different and potentially conflicting drugs are often prescribed by different doctors, and there is no one who has the entire list or is coordinating care.
     
Here is my take:

1. This study brings home the point that physicians need to be in the loop on ALL medications their patients are taking, including over-the-counter pills and supplements.

2. Doctors need to address this with each and every patient and to go over potential interactions.

3. Elderly patients have SLOWER metabolisms, so the risk of a major complication from medicines competing with each other to be removed by the liver or kidney is much greater.

4. The Institute for Safe Medication Practices has an excellent Website which goes over medications at high risk for misuse as well at the latest news. They have recently launched a new website for the consumer, www.consumermedsafety.org, which is very accessible and user friendly.

5. Any concerns raised by reading this information, should NOT lead to automatically stopping medications that may be important, but rather should lead to a clarifying consultation with your physician.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth about the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

If you are suffering from a toothache, chipped tooth, loose filling or other dental emergency, it’s important to call your dentist as soon as possible. Toothaches may be an indication of a cavity or other serious problem — such as a bacterial infection — that will need to be addressed quickly and should not go untreated. Until a professional treats you, here are some at-home tips to calm oral pain and what to do when an unexpected emergency arises.

With most dental emergencies, severe pain may be a factor. Aspirin or aspirin substitutes should be avoided as they can slow clotting. If you cannot manage the pain without assistance, you may consider ibuprofen or naproxen sodium — but only if you have no previous allergies or medications that can interact with these painkillers. Be sure to check with your doctor or pharmacist and carefully follow your doctor’s and label instructions.

Cavity Calming Solutions
Applying ice (on and off) to the affected area or to the cheek may help sooth irritated nerves and reduce swelling. Oil of cloves (from the pharmacy), or even fresh cloves from the spice rack, have been known as an aid in relieving pain naturally. Never place an aspirin directly on a painful area inside the mouth. Very gentle massaging and flossing can help to remove irritants, while rinsing with a tepid crystal salt water solution will help reduce swelling and detoxify the mouth. Real vanilla extract placed on a cotton ball and then dabbed around an irritation may also help relieve pain.

Broken Tooth
Rinse your mouth with a warm crystal salt-water solution and get to your dentist as soon as possible. Bleeding may be stopped with gentle pressure to the gums, not to the tooth. Remember to bring any tooth fragments to the dentist with you and keep them hydrated in a solution such as milk or salt water. A soft piece of wax or a temporary filling material from the pharmacy may help to prevent further irritation.

Knocked-out Tooth
Hold or place your tooth in the socket if possible or wrap in clean, wet gauze until you can see a dentist. A tooth has a better chance of being saved and re-implanted if you can get to a dentist within 30 minutes. Call an emergency room or 24-hour dental service if you can’t reach your dentist in time. Biting down on a moistened tea bag may help sooth and slow bleeding.

Crown or Bridge Fell Out
Use a little petroleum jelly or denture adhesive available from the pharmacy under the crown to hold it in place — as a very temporary fix — until you can see a dentist. Do not chew on the crown or bridge.

Bitten Tongue or Lip
Apply a cold compress and gentle pressure to help stop bleeding. If bleeding does not stop, go to an emergency room.

Object Caught Between Teeth
If you cannot remove an object with gentle flossing, do not cut your gums or use any sharp objects to remove the obstruction. You should rinse with warm crystal salt water solution until you can see a dentist.

We often say the mouth is the gateway to total wellness. Treat your mouth with respect and care, including eating a healthy, antioxidant-rich diet, and exercising and brushing three times a day. Visit your dentist regularly for cleanings and oral health exams. Your dentist may be able to prevent a possible emergency by catching dental problems before they begin — saving you a lot of discomfort and a potential emergency visit later. And common dental issues, such as gum disease, may be precursors to other, more serious illnesses. Studies from Harvard and other major medical institutions have proven that poor gums can put you at high risk for diabetes, heart disease and other illness.

Many people see their dentist more than they see any other doctor. If you are like many who are afraid to see the dentist regularly, ask about “pain free” dental care. In fact, many of our patients find our treatments and procedures soothing and even comforting. Today’s dental science has come a long way — and patients should not be afraid to seek good oral health options. If you are concerned because you do not have insurance, talk to your dentist about possible payment options or other forms of help that may be available.
Dr. Gerald P. Curatola is a renowned aesthetic dentist and pioneer in the emerging field of rejuvenation dentistry, which improves patients’ overall health and appearance by integrating total wellness with cutting edge oral care and restorative procedures. In addition to his private practice, research, and work as a Clinical Associate Professor at NYU College of Dentistry, he is an internationally sought after speaker, author and expert who has been featured widely in print and broadcast media. For more information, go to DrGerry.net

There has been much debate surrounding the dramatic increase of asthma in the United States and throughout the world over past several decades.

A study released by a group of researchers from New Zealand published in the September 20, 2008  issue of the The Lancet found an association between paracetamol use in infancy (known as acetaminophen in the U.S., and a very commonly used non-aspirin containing analgesic) and childhood risk of asthma, allergy and eczema in children at 6-7 years.  The authors suggested  the use of this commonly prescribed pain reliever and fever reducer might be a risk factor for the development of childhood asthma. 

 There has been an increased use of these non-aspirin containing analgesics over the past five decades, especially in children.  Additionally, the researchers reported those children that were given more frequent doses were more likely to develop asthma on a risk adjusted basis. 

 It is important to note that approximately, and this is just an estimate,  about 10 percent of adults and children with asthma find aspirin and non-steriod anti-inflammatory drugs (NSAIDS) actually worsen their asthma.  Aspirin “intolerance” appears to be more common in those patients with moderate to severe asthma, particularly individuals that also have nasal polyps and sinus disease. 

Another study reported in the journal Thorax found at least in adult women that aspirin may reduce asthma risk.  The authors cautioned  their findings were “still not enough to recommend taking aspirin regularly.”  Separately, the incidence of asthma is increasing and other asthma researchers believe another cause for this possibly is an association with obesity and dietary factors. 

In any event I have not observed any issues with acetaminophen analgesics in our allergy and asthma patient population when used in appropriate dosages and for the correct reasons.  Obviously more work and further studies are needed to explain the explosion of new cases of asthma, both in adults and children.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.