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managing_medications

8 Tips To Help You Manage Your Medications

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For many ailments, treatments most often involve some type of medication. Whether it’s an antibiotic to treat an infection, a statin to control cholesterol, or even a simple daily aspirin to reduce the risk of heart attack, we take the medications our providers recommend and hope for the best.

Painkillers, statins, sleeping pills, and other commonly prescribed medications all have their proper place in managing our health but can have unintended side effects. It is the provider’s responsibility to carefully explain what to expect from taking a particular drug.

Routinely evaluating prescriptions is extremely important, especially for older adults whose bodies are less efficient at metabolizing and clearing medications from the bloodstream, which can increase the risk of being overmedicated. Those who take multiple medications must be particularly aware of possible side effects and interactions with other drugs.

Here are 8 important tips to help you safely manage your medication intake.

1) Keep a list of all the medications and supplements you are taking, the prescribed dosages for each, why you are taking them, and the prescribing provider. Provide a copy to a family member, friend, or caretaker and keep a copy of this list in your wallet or on your refrigerator in case of an emergency.

2) Review your medications with your provider on a regular basis to ensure that the medications and doses are still appropriate.

3) Report any new symptoms you are experiencing as a result of taking a new medication to your provider as soon as they occur.

4) Be sure to tell your provider about all of the herbal remedies and nutritional supplements you are taking as they can interact with your prescribed medications.

5) Before you start a new medication, ask your provider about any potential side effects or interactions of your medications, medicinal herbs, and supplements.

6) If your medication seems ineffective, make sure to speak up so your provider can reconsider the drug or dosage.

7) Missing your meds may trigger unexpected symptoms or side effects so make sure to take your medications as directed to avoid complications.

8) If at all possible, use the same pharmacy for filling your prescriptions. This allows the pharmacist to determine if there are any interactions or side effects you should be aware of – especially if multiple providers are prescribing for you.

In summary, be sure you know what medications you’re taking and why. If you have questions, ask!  Your provider and pharmacist are important resources and can help guide and manage your medications.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

This article was originally published in March 2015. It was reviewed in October 2024.

strengthen_your_immune_system

5 Ways to Strengthen a Weakened Immune System

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We have heard it a million times before. One of the keys to maintaining a robust immune system is lowering inflammation. An article published on MDLinx online mentions several ways we may unknowingly be weakening our immune system. Factors discussed in the article include:

  1. Eating foods that contain too much fructose
  2. High daily stress levels
  3. Lack of adequate sleep (…starting to sound familiar?)
  4. Sunburn
  5. Loneliness

None of the items above are particularly surprising – we know what’s good for our bodies (not fructose!) and our minds (definitely not stress) – so how does the immune system become compromised?

When inflammation goes awry

Inflammation is one of our body’s defense mechanisms; it’s a normal, healthy, and necessary biological function. When the body identifies a threat or a foreign invader, it releases inflammatory chemicals to initiate the repair process. But under repeated “assaults” it can remain in a state of heightened inflammation and this is when the trouble begins.

When the body is constantly producing inflammatory chemicals, the function of the Central Nervous System which controls most bodily functions is undermined and can compromise other systems like the immune system. When the immune system is weakened, the cells that are meant to help fight infection become damaged, and the body’s ability to fight disease is diminished. One can literally get caught in a debilitating cycle of cellular degeneration and dysregulation.

The items mentioned above, as well as any of the following, can contribute to a cycle of sustained inflammation when left untreated:

  • Undiagnosed bacterial or viral infections
  • Exposure to mold or other toxins
  • Physical trauma/concussions
  • Surgery
  • Undiagnosed food intolerance
  • Nutritional deficiencies
  • Anxiety disorders/ PTSD
  • Narcotic medications

Questions? Give Us a Call!

703-532-4892 x2

Reversing the cycle

If you notice that you’re often sick, fatigued, or have frequent digestive issues, it may be a red flag that your immune system is weakened. With a better understanding of how inflammation may be contributing to your condition, the next step is to initiate practices and, if necessary, seek treatments that will calm the inflammatory cycle. Here’s what helps:

  1. TRY AN ELIMINATION DIET. For six weeks, avoid all foods with wheat, soy, milk, and milk products (foods that often trigger allergies or sensitivities that promote inflammation). Eat only fresh fruits, vegetables, brown rice, fish, chicken, and eggs—these foods, in general, are the least likely to cause inflammation. After six weeks, add back one category of food—such as dairy—per week. Note whether these foods have a negative effect on your energy, mood, or level of pain. If so, eliminate that food from your diet entirely.
  2. MEDITATE. A 2020 review looking at the effects of mindfulness meditation on the immune system concluded that “mindfulness meditation appears to be associated with reductions in pro-inflammatory processes, increases in cell-mediated defense parameters, and increases in enzyme activity that guards against cell aging.”
  3. SLEEP. Make adjustments to your sleep environment and aim for at least 7 hours of sleep per night. This is at minimum what your body needs to be able to carry out important repair functions like reducing inflammation, tissue repair, and hormone production.
  4. CUT BACK ON OTC MEDICATIONS. Non-steroidal anti-inflammatory drugs (NSAIDs) like Advil, Motrin, and Aleve can cause gastrointestinal issues like intestinal ulcers and bleeding when taken chronically to manage pain. NSAIDs can also increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. Taking pain relievers routinely to manage pain may actually cause your pain to worsen; the body begins to forget how to fight it on its own. Use OTC medications sparingly and try alternative therapies such as yoga and acupuncture as well as anti-inflammatory supplements* like turmeric.
  5. WHEN YOU NEED TO SEE A PHYSICIAN, CONSIDER ONE WHO PRACTICES FUNCTIONAL MEDICINE (FM). In looking for clues that may be contributing to symptoms of illness or disease a Functional Medicine physician will systematically assess and optimize six major areas of health, including the immune system. In doing so, FM doctors have a more complete picture of one’s overall health and underlying conditions or deficiencies that may be causing inflammation. FM doctors utilize several modes of treatment, including stress reduction & management, mind-body tools, improving nutrition, healing your gut, supporting detoxification, exercise, acupuncture, herbs/botanicals, IV Therapy, supplements, manual medicine, and when needed, medication.

*Ask your physician about any potential side effects or interactions before taking any new medicinal herbs and supplements.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

prescription medication laying on top of dollar bill

3 Tips on Lowering Prescription Costs

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Are you paying too much to fill your prescriptions? Is your co-pay too high? There are some alternatives and tricks to getting better rates on your medications that insurance companies, and sometimes even your pharmacy, don’t want you to know (or are legally not able to disclose).

Here are a few tricks to make sure you get the best rate* on your prescriptions:

TIP # 1: Discuss with your physician whether generic medications, if available, would be appropriate for you.

Generic formulas tend to be less expensive than their brand name counterparts and may be just as beneficial.

TIP # 2: Ask the pharmacist whether the cash price for your medication is cheaper than your copay price.

We believe that drug benefit plans pay the largest portion of prescription costs and that copays are the most practical way to pay for prescriptions.  That, however, is not always the case.  Pharmacies are restricted by law from disclosing the cash price for a medication that may actually be less expensive than your copay.  If you specifically ask for the cash price, they are allowed to tell you.  It is worth asking.  It just might be cheaper to pay for the medication without going through your insurance.

TIP # 3: Look into getting a discount card.

You may have seen commercials for companies such as GoodRx that offer discounts cards, coupons, or apps that allow you to check pharmacy prices and get the best deal in your area. There are a number of companies offering this service now. Here is a partial list for your convenience:

GoodRx
SingleCare
HelpRX
ScriptSave WellRx
‎RXsaver by Retailmenot

The Kaplan Center has available to you GoodRx and SingleCare cards available in the office. If interested, please ask and we will gladly provide them to you.

If you feel like you’re being taken advantage of by our healthcare system, the best thing that you can do is talk to your physician and your pharmacist and ask questions. We encourage you to share this information with your friends, family, and neighbors. Let’s help everyone get the best and cheapest medications possible.

 

By Nash Nortey
Medical Assistant Supervisor

 

*While it may get you a better price, keep in mind that when you pay by cash or use a discount card for prescriptions, your purchases will not be applied towards a deductible. If you have a high deductible and numerous medical expenses, it may make more financial sense to pay with your insurance.

What Your Pharmacist Can’t Tell You, Unless You Ask

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Naturally people are under the assumption that paying for their medications through their insurance plan allows them the best price available, however, this is not always the case. Consumers are losing out on potential savings because of “gag clauses” that prevent pharmacies from disclosing lower prices for prescription medications if paid “out-of-pocket” instead of using their prescription benefits. In fact, a 2018 study in JAMA found that about 1 in 5 prescriptions are being overpaid!

Unfortunately, the financial burden of prescription medications often causes patients to change the dose to make the medication last longer or choose not to take the medications at all. This is especially concerning for patients taking medication for chronic illnesses. At a time when premiums, deductibles, and copays are far from affordable for the average American, finding ways to make your prescriptions more affordable is essential.

How did we get here?

Pharmaceutical Benefit Managers (PBMs) are companies that act as intermediaries between pharmacies, drug manufacturers and insurance companies. The role of PBMs in the prescription drug marketplace is quite far-reaching, yet surprisingly most consumers know little or nothing about them. PBMs establish formularies (the list of drugs covered by the health plan), decide which pharmacies are included in the network, process claims, and even operate their own mail-order pharmacies. PBMs negotiate deep discounts with drug manufacturers, and in return, those manufacturers benefit from having their drugs widely available to consumers. PBMs reimburse pharmacies a certain percentage for each medication, and charge plan sponsors (insurance companies) much higher rates for those same medications, pocketing the difference. Very simply, PBMs make enormous profits as a result of cleverly crafted contracts and operate with virtually no oversight.

These “gag clauses” that ultimately hurt the consumer are found in many of the contractual agreements between PBMs and pharmacies. If pharmacists don’t play by the rules and volunteer lower-cost alternatives, they risk being penalized and/or dropped from the network.

What is being done about it?

Recently there has been a movement to create more transparency for consumers when buying their medications. Many states have already passed legislation, or have bills pending, that ban the practice of gag clauses. The “Patient’s Right to Know Drug Prices Act” is one of two new bills recently introduced in the Senate. This bill advanced last month for a full Senate floor vote and there is hope that the other, “Know the Lower Price Act” will too.

The bottom line is that you or your trusted advocate must be proactive in every aspect of your healthcare. The only way to really know if you are receiving the lowest possible price for your medications is to do some research and ask a lot of questions. Here are some tips that may help you lower the cost of your prescription drugs*.

  1. Pay with cash: Ask your pharmacist if paying by cash will get you a lower price. Many pharmacists are not allowed to disclose that information to their customers unless they are specifically asked.
  2. Shop around: A recent Consumer Reports’ Special Report on drug costs found that there were enormous discrepancies in costs for several common generic drugs depending on where a prescription was filled. For example, after comparing cash prices from chain pharmacies, supermarket drugstores and independent pharmacies, a one month supply of atorvastatin (generic Lipitor, 20mg) ranged from $10.00 at the online pharmacy HealthWarehouse.com, to $135.00 at CVS & Target!
  3. Look for discount programs: Find out if your pharmacy has an in-store discount program or prescription card that allows you to receive additional savings on your prescriptions.
  4. Use an online service: There are some free, online services that can help consumers quickly get information on where to get the best cash price for a prescription.Good Rx – Collects prices and discounts from thousands of pharmacies. Consumers can get a discount card and/or coupons to present to the pharmacist for savings.
    Blink Health – Account holders purchase directly through Blink Health but pick up at their local, participating pharmacy.
  5. Ask about alternative options: Generic or other brand name medications may be less costly and a suitable substitute.

* These tips require paying for your prescription by cash rather than insurance. While it may get you a better price, keep in mind that these purchases will not be applied towards a deductible. If you have a high deductible and many medical expenses, it may make more financial sense to pay with your insurance.

The Kaplan Center does not endorse any program or site mentioned in this article. Consumers are encouraged to exercise due diligence to make the best, most informed decision on their own behalf.

opioids

The Problem With Opioids for Chronic Pain

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Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. – Hippocratic Oath

When it comes to the treatment of chronic pain, the medical profession may be in violation of what can be regarded as the first medical ethic: First do no harm.

In 2015, a report – The Role of Opioids in the Treatment of Chronic Pain – published by an independent panel of experts convened by the National Institutes of Health, stated:

    Together, the prevalence of chronic pain and the increasing use of opioids have created a “silent epidemic” of distress, disability, and danger to a large percentage of Americans. The overriding question is: Are we, as a nation, approaching management of chronic pain in the best possible manner that maximizes effectiveness and minimizes harm?

More recently, the Centers for Disease Control in an attempt to address the massive public health crisis identified by the NIH issued a new set of twelve guidelines aimed at reducing the risk of opioid over-prescription and over-use. Although these recommendations are not yet mandated, they are a necessary first step in rethinking how we look at chronic pain treatment and how narcotics are prescribed.

A Brief History of Opioid Medication Use/Misuse

In 1997, the American Academy of Pain Medicine, in an acknowledgment of 1) the severity of the suffering of patients with chronic pain, and 2) the medical profession’s inability to provide many of these patients with acceptable treatment solutions, issued a consensus paper endorsing the use of opioid medications for the treatment of chronic non-cancerous pain. The Academy openly acknowledged that one of the problems with the long-term use of opioids is addiction. In response, the medical profession began making the distinction between addiction and dependence. Addiction was defined as a craving for opioids with the intention of getting “high” consistent with drug-seeking behavior. Dependence, on the other hand, was defined as any situation in which an opioid medication was prescribed for medical reasons, with a dosage sufficient to control the pain, and a significant improvement in the quality of life of the patient. While the intention was noble, the consequences have been quite disastrous.

Since the release of the AAPM’s paper, the sales of prescription opioid medications measured in grams has skyrocketed. Between 1997 and 2007, sales rose by 866% for oxycodone, 525% for fentanyl, 280% for hydrocodone, and 222% for morphine. As reported in Pain Physician in July 2012, “Gram for gram, people in the United States now consume more narcotic medication than any other nation worldwide.” The report goes on to document that over 90% of patients taking opioid pain medications were prescribed these medications for the treatment of chronic pain.

In 2011, approximately 17,000 drug overdose deaths involved prescription opioid medications. The CDC also reported that “In 2007 there were more opioid analgesic deaths than overdoses involving heroin and cocaine combined.” While a significant number of these drug overdose deaths are associated with diversion of the medication to people who were not originally prescribed the medication, 60% of the deaths occurred in patients that were given prescriptions based on the prescription guidelines by medical boards.

Furthermore, significant side-effects from opioid medications include increased risk of birth defects, falls and fractures, addiction, constipation, heart attacks, a decrease in the production of testosterone, and in some cases, hyperalgesia, an actual worsening of the pain.

Deciphering the Problem

While the NIH report and recent CDC guidelines offer a number of important policy and institutional points to address, I believe that the fundamental basis of our problem comes from a lack of understanding of what we’re treating. Acute pain and chronic pain (not associated with ongoing tissue damage such as in cancer) are two very different phenomena in the body.

1. Chronic pain is not a thing but one manifestation of a complex physiological process that frequently impacts many body systems, including sleep, gastrointestinal, psychological, and endocrine. Thus, we must take a whole-person approach in our diagnosis and treatment, which requires looking at multidisciplinary treatment options.

2. Unquestionably the evidence supporting the use of long-term opioids in the treatment of chronic pain is insufficient. We need better studies to help us understand when long-term use is beneficial.

3. Physicians need to be better educated about the diagnosis and treatment of patients suffering from chronic pain. Ultimately the use of long-term opioid medications is an admission of treatment failure. The recent CDC guidelines are a step in the right direction in this regard.

As a pain specialist, I believe there is an important role for opioid medication, but that role should be limited. Opioids should only be prescribed with close monitoring by the diagnosing physician, for the purpose of relieving pain and improving quality of life when all other medical approaches have been exhausted.

First, do no harm. Opioids should be medications of last resort.


Dr. Kaplan explains how treating the symptoms of chronic pain is contributing to a system of mismanagement in this country. He discusses why we must shift the way chronic pain is treated by addressing its root cause – inflammation of the Central Nervous System.

Is It Safe to Keep Taking Your Pain Reliever?

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Why No Pain Pill Is Totally Safe

By Julia Westbrook

We break down the hidden side effects of three common pain meds.

It’s time to reevaluate how we deal with pain. Pain meds, even the ones that are easily available or ones we think of as safe, can have unintended consequences that take a toll on your body.”We think they’re safe because they’re available over-the-counter, and we consume them like they’re candy,” says Gary Kaplan, DO, author of Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression. “But we need to be much more thoughtful in how we handle our aches and pains.”

Before you reach into the medicine cabinet, consider these lesser-known side effects of pain pills.

Acetaminophen

Acetaminophen (the ingredient found in Tylenol) seems to have the fewest drawbacks, but that doesn’t mean it’s perfectly safe. “It’s OK as long as you do not exceed the recommended dose,” says Dr. Kaplan. “When you exceed the recommended dose, the real risk becomes liver toxicity and damage to the liver.” He stresses that this is why you cannot drink alcohol when taking acetaminophen.

In addition to risks of liver toxicity, new research suggests that acetaminophen blunts not only your pain but also your emotions. In a study from Ohio State University, those who took acetaminophen did not experience the same emotional highs or lows as people taking a placebo.

Pregnant women should also be wary of acetaminophen. “What we thought were OK medications for pregnant women to be taking probably were not,” says Dr. Kaplan.

He explains that boys exposed to acetaminophen in the womb are at higher risk for undescended testes, leading to a higher risk for low sperm count and, potentially, in the long term, testicular cancer. The highest risk for this is during the second trimester of pregnancy, and it can occur with even low, intermittent use.

NSAIDs

Non-steroidal anti-inflammatory drugs, or NSAIDs are easily available over-the-counter, but they come with a long list of health concerns. “These medications that we’ve been told are completely safe, and we take them without a second thought, are, in fact, not completely safe and need to be used with great discretion,” says Dr. Kaplan. “They need to be taken only when needed.”

“The thing that everyone thinks about is the risk for gastric ulcers and bleeding from the gastrointestinal tract,” says Dr. Kaplan. “But the bigger risk is that, with regular use of these medications, we see small intestine ulcers that occur in upwards of 80 percent of people taking these medications regularly. This is going to cause a massive disruption of the gut flora.”

Dr. Kaplan points out that more and more research is coming out showing the impact of the gut on the brain. “So a healthy gut is absolutely essential to having a healthy brain,” he says. “If we’re taking medications that are causing ulcerations in the small intestine, completely screwing up our gut flora and completely screwing up our ability to absorb proper nutrients, when all is said and done, these are not good medications to be taking on a regular basis.”

Heart disease is another health concern associated with NSAIDs. The U.S. Food and Drug Administration issued a warning that NSAIDs can increase the risk for heart attack or stroke, even in otherwise healthy individuals.

Dr. Kaplan says that using these medications less than three times per week is probably safe, but more than that and you are taking a real risk.

And if you have a heart condition and are taking meds for that condition, definitely consult with your doctor about the potential for drug-drug interactions. For instance, Dr. Kaplan explains that if you’re taking aspirin to prevent a heart attack and then take ibuprofen for pain, the ibuprofen will negate the aspirin.

NSAIDs may also interact with antidepressants, increasing the risk of bleeding in the brain, or hemorrhaging, Korean researchers found.

Other risks of taking NSAIDs include increased sun sensitivity and potential kidney damage.

NSAIDs also have risks for pregnant women and babies during all three trimesters, says Dr. Kaplan. Taken during the first trimester, NSAIDs increase the risk for miscarriage. During the second trimester, NSAIDs can have similar effects on baby boys as acetaminophen. And during the third trimester, taking NSAIDs can lead to congenital heart issues in the newborn.

Opioids

The health impacts of prescription opioids are more well known, yet there are people who do take them regularly. “There is a time and a place for opioid medications, but it needs to be very limited and very thoughtful,” says Dr. Kaplan. “There are those with chronic pain on opioid medications, but this is really an admission of failure on our part in our ability to solve the problem because the opioids don’t fix the underlying problem, they just cover up the pain.”

Problems with opioids include constipation, low testosterone, and, since opioids are addictive, withdrawal. During pregnancy, they increase the risk for neurotube defects by about 2.2 times and can lead to withdrawal symptoms in the baby as well as preterm birth.

Looking for Alternatives

“Before we pop a pill, we need to stop and think about what may be causing the pain and what we can do to relieve the pain,” says Dr. Kaplan. Rather than covering up the pain, therapies that include icing, stretching, heat, acupuncture, massage, and physical therapy, eating curcumin-rich turmeric, and taking glucosamine sulfate can help resolve the issue.

“We want to look at how we can fix the problems that have health effects not only at the joint but throughout the entire body,” he adds.

As first seen on RodaleNews.com.

Is Your Medication The Root Of Your Chronic Pain?

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5 Pills That Might Be Hurting You

By Julia Westbrook

It’s time to stop ignoring the aches and pains and finally live a healthy life.

More Americans are suffering from chronic pain than have diabetes, according to a panel of researchers at the National Institutes of Health. While 29 million people are diagnosed with diabetes, the panel estimated that 100 million Americans live with chronic pain.

While the statistics are staggering, the scary truth is that, despite the apparent universality of pain, there isn’t nearly enough research on safe, effective treatments.

“We learned that sufficient clinical research doesn’t exist to show physicians how best to treat chronic pain in adults, many of whom suffer from multiple health problems,” said panel member and founding director of the Indiana University Center for Aging Research, Christopher Callahan, MD.

Instead, our medical system is heavily reliant on painkillers, both over-the-counter and prescription, despite the fact that, according to the panel, clinicians recognize that pain narcotics aren’t the solution for long-term pain treatment. (Here are 5 reasons over-the-counter painkillers are a bad idea.)

Gary Kaplan, DO, author of Total Recovery: Solving the Mystery of Chronic Pain and Depression, explains that medication—either for treating pains or treating other conditions—can be at the root of chronic pain. “Because of the powerful, short-term effectiveness of many drugs, we’re beginning to experience polypharmaceutical problems, where patients end up taking one drug to treat the side effects of other drugs,” he explains.

“The rough guideline I give my patients about taking medications is this: A drug has to work better than the side effects it creates,” he says. “If it doesn’t, get rid of it.” Of course, it’s important to do so under the supervision of your doctor, he adds.

While it’s easy to tune out the side-effect disclaimer on pharmaceutical ads, you may want to talk to your doctor if you’re experiencing chronic pain and are taking one of these prescriptions:

Statins

Statins are commonly used to lower cholesterol. “They can be the cause of cataracts and unexplained muscle pain. Some studies show they may increase your risk of developing diabetes,” says Dr. Kaplan.

Diet can have a big impact on cholesterol. Consider eating avocados, as research has shown that they’re a food that helps lower cholesterol.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

In the ultimate irony, your painkiller might be causing you more discomfort. “More than 70 percent of people chronically taking NSAIDs—such as ibuprofen (Advil, Motrin), naproxen (Naprosyn), diclofenac (Voltaren), and aspirin (Bayer, Bufferin)—will get ulcers in their small intestines, creating a permeability problem (aka leaky gut syndrome),” says Dr. Kaplan.

Leaky gut is associated with all kinds of painful issues, including food sensitivities, joint pain, headaches, and psoriasis.

Antibiotics

Speaking of your gut, taking antibiotics may be causing more painful inflammation than the infection itself. “Multiple treatments of antibiotics for any reason can profoundly change the gut flora,” says Dr. Kaplan. “Those changes can then damage the intestinal tract enough to create leaky gut syndrome, which will result in inflammation and activate the microglia.”

While he doesn’t dismiss the lifesaving importance of antibiotics, Dr. Kaplan recommends balancing their use with a probiotic supplement. And be sure to support a your gut bacteria with healthy foods.

Opioids

Another counterintuitive finding: Dr. Kaplan says that opioids can heighten your sensitivity to pain. “Additionally, these painkillers—such as codeine, hydrocodone (Vicodin), morphine (Avinza), and oxycodone (Percocet)—can lead to depression, constipation, and sexual dysfunction,” he says.

Instead of popping a pill for your pain, consider meditation as an effective treatment.

Sleeping Pills

Sleep is so important for your health, but popping a pill to get there isn’t the answer. “A chronic reliance on any type of sleeping pill—such as zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata)—can, in the short term, make it hard to focus and, in the long run, even shorten your life span,” says Dr. Kaplan. Plus, you might be missing key warning signs of sleep apnea.
Article reprinted from www.RodaleNews.com, Jan/2015

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Understanding the Risks of OTC Painkillers

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5 Problems With Over-the-Counter Painkillers

By Emily Mann

Pills you pop every day could be causing serious damage in the long run.

Aspirin is hailed as a miracle drug, and there’s not a person among us who hasn’t popped an ibuprofen or acetaminophen to deal with achy joints or a crushing headache.

But if you’re doing that every day, you could be causing long-term damage to your health, says Gary Kaplan, DO, medical director of the Kaplan Center for Integrative Medicine and author of a new book called Total Recovery: Solving the Mystery of Chronic Pain and Depression.

“The biggest misconception people have about over-the-counter painkillers is that they’re completely safe and harmless,” says Dr. Kaplan. “They are neither of the above.” In fact, most over-the-counter painkillers started out as prescription drugs but now are sold at lower doses without your needing to talk to a doctor.

And they’re all bad in their own way. While Dr. Kaplan does contend that low doses of aspirin (81 milligrams) do have some benefits for people with risk factors for stroke, heart disease and some forms of cancer, larger doses taken daily to deal with the pains of daily living do not. “People pop these things like it’s no big deal,” he says. “If you do this every day, in the majority of people, you’re doing real damage.”

Before getting into what that damage is, it helps to understand how these medications work. Aspirin, ibuprofen (sold as Advil and Motrin), and naproxen sodium (sold as Aleve) all fall into a class of drugs called nonsteroidal anti-inflammatories, or NSAIDs. They work by inhibiting prostaglandin, a hormone that can produce pain and inflammation in response to an infection or injury. Acetaminophen (or Tylenol) falls into a different category and seems to interrupt the pain messages your brain receives.

#1: Gut ulcerations
NSAIDs, particularly ibuprofen and aspirin, are rough on your stomach, and they’re just as rough on the lining of your gut. They create ulcerations and inflammation in the gut lining, damage that causes something known as a “leaky gut.” When your gut is leaky, it doesn’t absorb nutrients, which can lead to deficiencies (which can also contribute to pain problems), and problematic proteins and allergens, such as gluten, soy, or egg proteins, can escape, triggering food sensitivities. “Your gut is a very sophisticated filter,” Dr. Kaplan says. “It’s a very complex organ that’s not one to disrupt, but one that we disrupt all the time.”

Furthermore, NSAIDs disrupt the gut bacteria that control your immune system. As a result, you get sick more frequently and you might develop more chronic ailments.
Sixty to 80 percent of people develop gut inflammation within 24 hours of taking an NSAID, Dr. Kaplan says, and 50 to 70 percent of people who take them long term will develop chronic small intestine inflammation. And initially that might present as just feelings of bloating, gas or changes in your bowel movements, but over time, you might start experiencing chronic fatigue or develop food intolerances.

Questions? Give Us a Call!

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#2: Liver damage
Acetaminophen doesn’t cause those gut ulcerations, Dr. Kaplan says. Rather, its problem is that it will damage your liver—sometimes, in unexpected ways. Things like alcohol can interfere with the way your body breaks down acetaminophen, even if you’re taking a normal dose. “That leads to the potential to get a toxic level of acetaminophen in your system, which leads to liver damage,” Dr. Kaplan says. He’s also found that taking too many painkillers that contain caffeine can stress out your liver and interfere with sleep.

#3: Kidney damage
Along with your stomach, your kidneys are a major production site of prostaglandins, the hormones that NSAIDs are designed to silence. In addition to controlling the acid secretions in your stomach, prostaglandins help the kidneys fulfill their function of removing proteins and waste from your blood. Too many prostaglandin-inhibiting NSAIDs can interfere with that process, leading to kidney damage and a buildup of toxic waste by-products in your bloodstream. “As soon as we start seeing damage to kidneys, we tell people to get off all anti-inflammatory medications,” Dr. Kaplan says.

Furthermore, prostaglandin produces inflammation in response to damage your body is experiencing. “Inflammation is not always a bad thing,” he adds. “It’s critical for repair—inflammation cleans up damaged tissue and brings in new cells to repair it. When inflammation gets disrupted, the normal healing process gets disrupted.”

#4: Heart disease
You may remember a prescription painkiller called Vioxx that was pulled from the market a few years ago. The reason? It caused heart attacks, and it’s not the only one. “It’s a lower risk than with Vioxx, but all NSAIDs pose a risk,” says Dr. Kaplan. NSAIDs block an enzyme called COX-2, which works with prostaglandin to protect your arteries. When both are silenced by chronic use of over-the-counter painkilllers, your risk of heart disease increases.

#5: Hypersensitization
Here’s an ironic fact: Painkillers can heighten your susceptibility to pain. While this phenomenon has been seen mostly with prescription opioids (such as Vicodin or Oxycontin), studies have shown that acetaminophen and NSAIDs can have the same effect on headaches. “It’s called a rebound headache,” Dr. Kaplan says. “They dull your response to pain, so you need more medications to get to the same place. And you end up developing increased sensitivity to pain.”

So are we all supposed to just grin and bear it if we have a headache or a sore knee? “The occasional use is fine, less than once a week,” Dr. Kaplan advises. “But if you have pain that requires that you take over-the-counter pain medication on a regular basis, you need to seek medical attention.”

Ultimately, Dr. Kaplan’s beef with painkillers is that they aren’t dealing with deeper health issues. “Doctors have to start looking at pain as a symptom and not the disease,” he says. “We’re better off addressing the problem. We need to understand where the pain is coming from.”

Published on www.RodaleNews.com on April 11, 2014

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