Street's Health Discussion. Volume 1 Issue 1

[Minnie]

Originally Posted by Street Pharmacist

Many pain and rheumatology specialists are increasingly prescribing it, though I personally haven't looked or seen any evidence for it.

My daughter was told to take it because of the side effect of some of the drugs they had her on, to start with. Bone thinning? Don't quote me on that - I can't remember, it's been a long time - I suppose if I dug around in my docs on my laptop, I'd find it - I kept pretty detailed notes about everything to do with her treatment when she was in 'crisis.' They also had her taking Calcium at that time, because of the same drugs.

We continue to take it, her included, because all of us came up as deficient when tested. We take it year round because most of us are very fair skinned, and so we don't spend a lot of time in the sun without being lathered up. I feel like I get sunburn from the oven lightbulb, lol, so I'm pretty careful about the sun. I've already had one suspicious mole removed (thankfully, it turned out to be nothing) so I'm careful.

Originally Posted by Ashartus

My son had an unusal infection a couple of years ago we couldn't get in to see his family doctor for a couple of weeks. A doctor at a walk-in clinic prescribed antibiotics right away. When that didn't work, he prescribed a different antibiotic. When we finally got in to his family doctor, she sent us to a specialist who right away could tell what it was and that it was not treatable by antiobiotics but rather had to be surgically removed. The walk-in clinic doctors in general just don't seem to be interested in figuring out what the problem is though, they just want to deal with the patient as quickly as possible.

The doctors at Children's were very upset with us when my daughter ended up back in there fall of 2011 because we refused their efforts to just throw drugs at her when they didn't know what was going on. One of these drugs was one she was on in the spring, when they thought she had a wretched nerve problem in her foot, what they thought was the result of the trauma to said nerve from her accident.

During that course of treatment, we perceived no benefit to what was going on with her and so with our GP's help weaned her off of it - in fact, the effect on her was entirely negative. IIRC from some reading a while ago, the drugs they use to treat things like RSD/CRPS (Neurontin and the like) and other nerve disorders, helps very little or not at all. That's not to say there aren't patients who do find it helps, but they are learning for the majority, there are no benefits.

They tried to say it was the RSD and through our extensive reading about the subject, we felt that it was incorrect - her symptoms just didn't match up, and they only arrived at the diagnosis initially, with a 2 minute observation and no other testing. They wanted to throw Gabapentin/Neurontin at her again, a drug that made her shake like she had Parkinson's and caused such gastrointestinal distress they thought she had C-Diff. So when she ended back up in hospital, they wanted to throw that at her. When we insisted that they do some major testing instead, insisted that perhaps they get Rheumatology involved, they were VERY pissy with us. Sorry no. You are actually going to get your damn hands dirty on this one, and figure this the feck out, not just throw multiple drugs at it and hope that one might work but hey, who the feck cares about the incredibly bad side effects you've just subjected my kid to?

/rant over. Sorry.

[troutman]

Blog from Dec 2010:

New Recommendations for Calcium and Vitamin D Intake


http://www.sciencebasedmedicine.org/...amin-d-intake/

A couple of my correspondents have been screening their patients for vitamin D deficiency and they report that at least half fall in the “very low” category <20ng/mL. Doctors are giving large doses (often a weekly 50,000 IU pill for several weeks) to quickly get their patients back into the “normal” range. Then a 2000 IU or even a 5000 IU daily dose can be necessary to keep them at that level. Are they treating a true deficiency? Or are they uselessly trying to move people from one side of a normal bell curve to the other? When half of our patients fall into the “abnormal” category, it bothers me.

There can be too much of a good thing. Gary Null inadvertently sounded a note of caution when he managed to poison himself with one of his own products. The manufacturer of Null’s Ultimate Power Meal supplement got the math wrong (by a factor of a thousand, no less!) and overloaded the supplement with 2,000,000 IU of vitamin D instead of 2000 IU. Null nearly died. The IOM recommends an upper limit of 4000 IU a day.

http://www.webmd.com/diet/news/20101...ease-vitamin-d

The majority of Americans and Canadians are getting sufficient vitamin D and calcium, the new guidelines state. Some adolescent girls aged 9-18 may fall below the daily recommended level of calcium intake, and some elderly people may have an inadequate intake of calcium and vitamin D.

[Street Pharmacist]

Originally Posted by HELPNEEDED

Do you believe the spiro cream could work to stop/slow/reverse MPB like finasteride?

Hmm. In theory it sounds like it could. Big unknown for me would be absorption (most meds aren't absorbed into the skin) though this one is likely lipophyllic enough it should be absorbed. It should be much safer than finasteride anyways

[Street Pharmacist]

Originally Posted by troutman

Blog from Dec 2010:

New Recommendations for Calcium and Vitamin D Intake


http://www.sciencebasedmedicine.org/...amin-d-intake/

A couple of my correspondents have been screening their patients for vitamin D deficiency and they report that at least half fall in the &ldquo;very low&rdquo; category <20ng/mL. Doctors are giving large doses (often a weekly 50,000 IU pill for several weeks) to quickly get their patients back into the &ldquo;normal&rdquo; range. Then a 2000 IU or even a 5000 IU daily dose can be necessary to keep them at that level. Are they treating a true deficiency? Or are they uselessly trying to move people from one side of a normal bell curve to the other? When half of our patients fall into the &ldquo;abnormal&rdquo; category, it bothers me.

There can be too much of a good thing. Gary Null inadvertently sounded a note of caution when he managed to poison himself with one of his own products. The manufacturer of Null&rsquo;s Ultimate Power Meal supplement got the math wrong (by a factor of a thousand, no less!) and overloaded the supplement with 2,000,000 IU of vitamin D instead of 2000 IU. Null nearly died. The IOM recommends an upper limit of 4000 IU a day.

http://www.webmd.com/diet/news/20101...ease-vitamin-d

The majority of Americans and Canadians are getting sufficient vitamin D and calcium, the new guidelines state. Some adolescent girls aged 9-18 may fall below the daily recommended level of calcium intake, and some elderly people may have an inadequate intake of calcium and vitamin D.

The question I haven't seen answered yet (granted haven't looked hard) is why is the "normal" level where it is? What is it based on? If it's arbitrarily of population studies in a sunny area, then it doesn't mean anything

[Street Pharmacist]

Originally Posted by Minnie

My daughter was told to take it because of the side effect of some of the drugs they had her on, to start with. Bone thinning? Don't quote me on that - I can't remember, it's been a long time - I suppose if I dug around in my docs on my laptop, I'd find it - I kept pretty detailed notes about everything to do with her treatment when she was in 'crisis.' They also had her taking Calcium at that time, because of the same drugs.

We continue to take it, her included, because all of us came up as deficient when tested. We take it year round because most of us are very fair skinned, and so we don't spend a lot of time in the sun without being lathered up. I feel like I get sunburn from the oven lightbulb, lol, so I'm pretty careful about the sun. I've already had one suspicious mole removed (thankfully, it turned out to be nothing) so I'm careful.




The doctors at Children's were very upset with us when my daughter ended up back in there fall of 2011 because we refused their efforts to just throw drugs at her when they didn't know what was going on. One of these drugs was one she was on in the spring, when they thought she had a wretched nerve problem in her foot, what they thought was the result of the trauma to said nerve from her accident.

During that course of treatment, we perceived no benefit to what was going on with her and so with our GP's help weaned her off of it - in fact, the effect on her was entirely negative. IIRC from some reading a while ago, the drugs they use to treat things like RSD/CRPS (Neurontin and the like) and other nerve disorders, helps very little or not at all. That's not to say there aren't patients who do find it helps, but they are learning for the majority, there are no benefits.

They tried to say it was the RSD and through our extensive reading about the subject, we felt that it was incorrect - her symptoms just didn't match up, and they only arrived at the diagnosis initially, with a 2 minute observation and no other testing. They wanted to throw Gabapentin/Neurontin at her again, a drug that made her shake like she had Parkinson's and caused such gastrointestinal distress they thought she had C-Diff. So when she ended back up in hospital, they wanted to throw that at her. When we insisted that they do some major testing instead, insisted that perhaps they get Rheumatology involved, they were VERY pissy with us. Sorry no. You are actually going to get your damn hands dirty on this one, and figure this the feck out, not just throw multiple drugs at it and hope that one might work but hey, who the feck cares about the incredibly bad side effects you've just subjected my kid to?

/rant over. Sorry.

"Bone Thinning" or decreased bone density is a major side effect of prednisone, which I'm guessing your daughter was put on. Reading your story I truly feel for you. Do you have a GP or pharmacist you trust that can look into things and advocate for you?

[Street Pharmacist]

Originally Posted by fotze

I have known folks in the drug marketing world. What up with the super expensive wine and cigar tastings for docs? 'Conferences' in sun destinations?

Are antibiotics where the big money is? What about things like nexium?

Nexium is now generic, so that gravy train is likely done. These events are dying as patents are expiring like crazy these days and new molecules aren't arriving like they used too. Not sure, but I would guess the money in biologics would mean fancy trips for education conferences at sunny destinations. That would likely only be for the specialists who prescribe them. Not much money in antibiotics as very few are patented anymore. Biaxin XL, Suprax and Avelox are the only ones off the top of my head.

[Minnie]

Originally Posted by Street Pharmacist

"Bone Thinning" or decreased bone density is a major side effect of prednisone, which I'm guessing your daughter was put on. Reading your story I truly feel for you. Do you have a GP or pharmacist you trust that can look into things and advocate for you?

Yes, plus a host of other things, at one time or another. There was another med they had her on that also had potential to cause some bone density issues but off the top of my head, I can't recall the name of it - they had her on a ##### ton of meds once Children's got involved.

They did a swab of her foot about a month into the beginning of our 2 year odyssey with this, in the emerg here in S'more. Then they promptly lost it because they couldn't find it anywhere, so we were told. *eyeroll* Children's never did another swab, once they were involved in the process, not even when they went in to irrigate and debride, when they decided she had Osteomyelitis. Up until that point, they had used Clindamyacin, either orally or via IV. We put her on a probiotic that the hospital recommended, in hopes of alleviating some other issues.

So they treated 'blind' so to speak - presumed Staph A and used Piperacillin-Tazobactam to treat - that was the PICC line. Holy hell did she look like that stuff was killing her, instead of making her better.

Then when things hit the fan again that fall, they decided she never did have Osteomyelitis. Several months later, her Rheum finally gets a report that they managed to find the swab (over a year later) - or least find the results and that oh yes, it was a Staph A infection. *more eyerolling* So they went back and forth on whether or not it was Osteo and not Osteo. I tell you, that entire thing was a cluster from start to.....well, I was going to say finish, but this will never be over for her.

Our GP and our local pharmacist have been outstanding, as was her physio. They are really what got us through all this, because it certainly wasn't Children's that did crap all, I can tell you that.

[Street Pharmacist]

I may be biased, but I think a good pharmacist is one who knows you and will advocate and explain things for you. Because of accessibility (no appointment necessary) we are often point of first contact and can help direct a patient through what really can be a confusing process. No one will be a better advocate for you and your family than you, but a pharmacist can give you advice to help make those decisions

[Minnie]

We've 'been with' this local team of pharmacists for 6 years. I should say it wasn't just one pharm - it was the whole team of them. I'm sure ours isn't the only complicated scenario they've dealt with (when it came to the multitude of meds the docs had the kid on, plus the biologic since then) but they are phenomenal. We have been supremely fortunate over the years to have had really great pharms. We lived up near Red Deer for 8 years and our pharm there knew I had issues with migraines and made sure to let me know about all the meds, etc, that could/might be effective for treatment.

Again, our local pharms have been so amazing we wrote a recommendation to the national office and they contacted them with the recognition. I mean, we tell them all the time how appreciative we are but we figured everyone should know, LOL.

[Codes]

I wouldn't so hastily claim viruses aren't living. But that is a different debate. But obviously, you're right, antibiotics don't work on viruses, as the mechanisms for reproduction of viruses and bacteria are very different.

There are many factors that are leading to the evolution of the so-called super bugs, most of which have been listed in the topic already. But, I can't re-iterate enough how irresponsible it is to allow mass use of antibiotics in the farming industry. The problem is that it is quite simply the easiest and cheapest way of doing things. One area of research I'd like to pursue in my career is looking for alternatives to antibiotic use in the animal production industry. Vaccination is a bit of a hot topic right now, and there are several very promising vaccines, but cost is a major factor against widespread implementation; cost per vaccination per animal, and the fact that there multiple bacterial and viral targets that need to be considered for each production animal.

I'm very interested in pursuing research into "gut remodelling" using harmless bacteria that confer probiotic benefits onto the host by naturally targeting pathogens that normally inhabit the gut. I'm of course more interested from a public health standpoint than an agricultural standpoint, but there is certainly cross-over between targeted pathogens.

[Minnie]

Street Pharm - can we talk Ceclor?

[Azure]

Originally Posted by troutman

Blog from Dec 2010:

New Recommendations for Calcium and Vitamin D Intake


http://www.sciencebasedmedicine.org/...amin-d-intake/

A couple of my correspondents have been screening their patients for vitamin D deficiency and they report that at least half fall in the “very low” category <20ng/mL. Doctors are giving large doses (often a weekly 50,000 IU pill for several weeks) to quickly get their patients back into the “normal” range. Then a 2000 IU or even a 5000 IU daily dose can be necessary to keep them at that level. Are they treating a true deficiency? Or are they uselessly trying to move people from one side of a normal bell curve to the other? When half of our patients fall into the “abnormal” category, it bothers me.

If low vitamin D levels are 20ng/mL, and getting them up to the normal level of 48ng/mL, why exactly is it a problem supplementing with a lot of vitamin D? 50,000IU per day might be a lot, but if someone is deficient, getting them back to normal levels should be a priority. Either way, that article is borderline stupid.

Every single study ever done has shown that you have to literally take 50,000IU of Vitamin D PER DAY, for several months before it becomes a problem. In other words, since Vitamin D usually comes in pills of 1000IU, that would be 50 of those pills per day. That is insane and extremely unlikely that anyone does that.

There can be too much of a good thing. Gary Null inadvertently sounded a note of caution when he managed to poison himself with one of his own products. The manufacturer of Null’s Ultimate Power Meal supplement got the math wrong (by a factor of a thousand, no less!) and overloaded the supplement with 2,000,000 IU of vitamin D instead of 2000 IU. Null nearly died. The IOM recommends an upper limit of 4000 IU a day.

[/I]http://www.webmd.com/diet/news/20101...ease-vitamin-d

Gary Null is a moron. 2,000,000IU per day is insane and stupid, and anyone that eats the diet he did with those moronic power meals deserves to get sick.

The majority of Americans and Canadians are getting sufficient vitamin D and calcium, the new guidelines state. Some adolescent girls aged 9-18 may fall below the daily recommended level of calcium intake, and some elderly people may have an inadequate intake of calcium and vitamin D.

¸
This is simply not true.

Three-quarters of U.S. teens and adults are deficient in vitamin D, the so-called "sunshine vitamin" whose deficits are increasingly blamed for everything from cancer and heart disease to diabetes, according to new research.

http://www.scientificamerican.com/ar...-united-states

[Street Pharmacist]

Originally Posted by Minnie

Street Pharm - can we talk Ceclor?

Of course! It's actually on topic!

[troutman]

Good post Azure. Both of our references are dated, and I think the recommendations could be moving in another direction. I am interested in this, as my doctor recommends I take1000 IU per day of Vitamin D (especially in the winter).

More research is needed. There is probably no harm in taking larger doses within reason.

http://www.realclearscience.com/blog...-problems.html

Over the past two decades, hundreds, if not thousands, of studies have been published touting the wide array of benefits offered by the "sunshine vitamin." At the same time, research has discovered that as many as three-quarters of Americans may be deficient in the vitamin. This information has convinced a lot of doctors and scientists that we all should be supplementing Vitamin D.

"Vitamin D may represent the single most cost-effective medical intervention we have today," Dr. Greg Plotnikoff told the Minneapolis Star Tribune.

Yet other doctors and scientists aren't so sure. Notably, in November 2010 an Institute of Medicine (IOM) panel conducted an in-depth systematic review of over 1,000 studies and found that reducing bone loss was the only definitive advantage of supplementing vitamin D. Moreover, they concluded that much of the research that had been conducted on the topic was unconvincing, lacking large subject groups, controls, randomization, and a placebo. Despite their findings, the panel still recommended that daily vitamin D intake be increased be increased from 200 to 600 international units per day for the majority of the population. Not enough, say vitamin D proponents.

The vitamin D dilemma continues to this day. But many large studies are currently underway which should shed additional light on the subject within the next couple of years.

[Street Pharmacist]

Originally Posted by Codes

I wouldn't so hastily claim viruses aren't living. But that is a different debate. But obviously, you're right, antibiotics don't work on viruses, as the mechanisms for reproduction of viruses and bacteria are very different.

There are many factors that are leading to the evolution of the so-called super bugs, most of which have been listed in the topic already. But, I can't re-iterate enough how irresponsible it is to allow mass use of antibiotics in the farming industry. The problem is that it is quite simply the easiest and cheapest way of doing things. One area of research I'd like to pursue in my career is looking for alternatives to antibiotic use in the animal production industry. Vaccination is a bit of a hot topic right now, and there are several very promising vaccines, but cost is a major factor against widespread implementation; cost per vaccination per animal, and the fact that there multiple bacterial and viral targets that need to be considered for each production animal.

I'm very interested in pursuing research into "gut remodelling" using harmless bacteria that confer probiotic benefits onto the host by naturally targeting pathogens that normally inhabit the gut. I'm of course more interested from a public health standpoint than an agricultural standpoint, but there is certainly cross-over between targeted pathogens.

Fair enough about the viruses, I am trying to keep technicalities to a minimum. Immunity delivery vehicles are fascinating. Vaccination patches I believe will be the future of vaccination. I have never heard of transferring/developing host resistance through gut flora. Sounds intriguing

[Ashartus]

Originally Posted by Azure

Every single study ever done has shown that you have to literally take 50,000IU of Vitamin D PER DAY, for several months before it becomes a problem. In other words, since Vitamin D usually comes in pills of 1000IU, that would be 50 of those pills per day. That is insane and extremely unlikely that anyone does that.

50,000 IU is where toxicity has clearly been observed, but there's basically not much data between 10,000 IU and 50,000 IU. Dose-response relationships suggest toxic effects probably begin somewhere between 10,000 and 40,000 IU. Still a pretty high amount. IOM recommended 4000 IU as the upper limit mostly because there aren't really many studies looking at adverse effects of vitamin D, and those that exist are relatively short-term with incomplete monitoring of possible effects and not enough statistical power to detect much. IOM also didn't view the evidence as supporting any benefits from doses above 4000 IU in their 2011 evaluation.

This also only applies for adults - in infants effects have been observed as low as 1800 IU, which is why recommended doses for infants and children are lower than for adults.

[cracher]

Originally Posted by HELPNEEDED

Totally off topic, but I must ask:

Is there any way, if I had a perscription, to get a 5% Spironolactone cream made?

Thanks man!

Check out SCRIPT pharmacy, across Macleod from Bolero/Smugglers. If there is anyone in YYC who can do it, it's them. I have Rx'd so many wierd topicals and they come through every time.

[theg69]

I saw this topic and will add my two-cents.

1) Vit D- increasing evidence that in addition to increasing bone density, it contributes to skeletal stability and has found some benefit in reducing the morbidity related to falls in the elderly. I recommend 2000 units a day for everyone (including myself). Most docs are on it themselves. Some docs still order Vit D levels. I don't because 99% of patients are either deficient or severely deficient -> so NO, sunlight exposure is not an adequate means for achieving Vit D.
Calcium is trickier - because there is mixed evidence re: cardiovascular events. Most recent evidence is that there was no significant increase in heart related events but that being said, I tell patients to try to achieve optimal Calcium via their diet and only if they are not intaking adequate amounts, to supplement on top of that. I have only seen 1 patient with potential toxic levels of Vit D - he was taking 10,000 units a day. I am comfortable with going up to 4000-5000 units a day myself.

2) Antibiotics - I do not prescribe Abx that often to be completely honest. It is my pet peeve with the walk-in doctors that they do prescribe them too much. It is not because most of them are bad doctors but think of it this way, what is the easiest way to get a patient out of your office? In a broken medical system where people resort to walk-ins and rushed in and out of appointments, it takes a shorter amount of time to give a Biaxin prescription than it does to explain that it is viral and does not need any drugs. Some patients are to blame as well - I have many patients who get mad at me for not giving them anything. So to stem this epidemic, we have to fix our medical system (but not overworking GPs, who by the way are the most undercompensated compared to specialists) and educating our patient populations.

3) In terms of pharma and drug reps, there are many ethical and legal considerations now. They are not allowed to provide "free incentives" and any dinner they sponsor must have "educational value". I think this is a topic people not in the industry should withhold judgement because they most likely do not know the facts. I am neither pro or against pharma but they are a necessary evil. Yes, they can be biased, but they are the ones who do most of the R&D.
I have actually more of a problem with the generic companies who rip off the drug as their own without doing any research and development. They then give kickbacks to the pharmacies that prescribe them as well.
There are a few medications in which the generic has been shown to be not as effective (bisphosphonates and bone medications are one of them). Its to the point where one of the endocrinologists went to the extreme of saying to prescribe generics is to perform medical malpractice (not saying I agree with that though).
Yes, they do have their bias, but what sponsor or maker or their own product doesn't. The key is for physicians to evaluate the evidence and do their own research.
I have seen physicians who refuse to see drug reps and then decided that they needed to see them again. For what reason? Because they were getting so outdated in terms of their drug knowledge. Sometimes, we need to see what else is out there. People forget that we work long hours, and we still go home and read, study, and have to do research to keep up-to-date. For some physicians, they need to spend time with their family so that gets neglected.
That's my rant with pharma, i think they get so villified its silly. People forget that generic companies are arguably bigger pharma now with bigger profits.
Again, education is key to ensure the best care of patients.

[Knut]

^ Fantastic post.

From an eyecare perspective. It is amazing how many patients with Viral or Allergic Pink eye are given antibiotic drops from a GP, or even a different Optometrist. It takes considerable counselling to convince someone they just need artificial tears, cold compresses and time to clear up their pink eye.

[Flabbibulin]

Originally Posted by Azure

If low vitamin D levels are 20ng/mL, and getting them up to the normal level of 48ng/mL, why exactly is it a problem supplementing with a lot of vitamin D? 50,000IU per day might be a lot, but if someone is deficient, getting them back to normal levels should be a priority. Either way, that article is borderline stupid.

Every single study ever done has shown that you have to literally take 50,000IU of Vitamin D PER DAY, for several months before it becomes a problem. In other words, since Vitamin D usually comes in pills of 1000IU, that would be 50 of those pills per day. That is insane and extremely unlikely that anyone does that.



Gary Null is a moron. 2,000,000IU per day is insane and stupid, and anyone that eats the diet he did with those moronic power meals deserves to get sick.


¸
This is simply not true.



http://www.scientificamerican.com/ar...-united-states

I can only speak for myself- i was prescribed a few thousand IU's a day and I began getting palpitations. Doctors attributed it to excess calcium absorbtion because of the vitamin D intake. I understand optimum levels of vit D is important, but PVCs/PACs are a pain in the butt, so I think I will stick to getting vitamin D through natural means, and maybe a small daily dosage of less than 1000 IUs. No major underlying issues going on; I am just more sensitive to chemical imbalances for whatever reason.

edit- I should clarify, as I don't want to make it sound like I am against Vitamin D supplementation. I am simply more susceptible to palpitations when there is some form of chemical imbalance in my body - excess calcium seems to be a trigger for me, but there are other factors, such as low potassium etc...