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.
9 times out of ten I'm taking polysporin out of the parent's hands when they ask if it will help with their child's "pink eye".
Last edited by Street Pharmacist; 02-20-2013 at 10:43 AM.
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.
Agreed with the rant on pharma, except to say that generics don't mislead doctors to increase sales (Vioxx, Abbott with Biaxinetc.). Also, the rebate system, which you refer to as "kickbacks", are essentially done anyways as provincial drug reform has ended it. It is the same process though as with all retail sales. I receive rebates on sales for everything from milk, to bread and seasonal gifts. The prices for molecules are set by provincial governments, so you negotiate your rebates to get the best deal from various manufacturers selling identical products. There's no ethical quandary there imo.
The "walk in" system is very broken. Here in Kamloops we have 20,000 people without a family physician and probably as many underserved. That leads to too much pressure on GPs who I agree are under compensated
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Didn't know the kickbacks were ended. Thanks for the info!
Agreed with the Polysporin drops. I do get a bit frustrated when patients come in for pink eye with their kids with a raging viral respiratory infection and ask for a "stronger antibiotic for their pink eye" after using Polysporin.
I'm glad you are taking it out of their hands because I am tempted to pull them off the shelf when I see them at the store! LOL
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...
Different people respond differently to any chemical - a dose that is perfectly safe for one person could have an adverse effect on someone else. It's actually really hard to come up with generally recommended dose ranges for the entire population for substances that have beneficial effects at lower doses and adverse effects at higher doses, because there can be overlap in the distributions where one person might be helped by (or even need) an amount that harms someone else.
In my ideal world there are no polysporin, visine or clear eye drops available.
AMEN! I get asked for eye care advice (majority conjunctivitis) probably about once/twice daily. I have never recommended visine except a few times for people who just needed cosmetic help for dry/tired eyes for meetings, etc. Polysporin cream/ointment is essentially the same problem though.
I literally will probably send the patient home with non drug advice, out a referral to optometrist/physician half the time they ask about any OTC issue.
Can you get your pharmacist brothers and sisters to rise up and put pressure on the stores that contain the pharmacies to stop carrying stuff like magnetic bracelets and homeopathic remedies? (Glares at Shoppers)
__________________ Uncertainty is an uncomfortable position.
But certainty is an absurd one.
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How many instances of allergies did you see to this stuff? As in 'serum/serum like sickness?' I'll explain further after you answer.
If you ask the 'crunchy granola' type parents, dribbling a little freshly expressed breast milk in the eye will cure it completely.
I haven't seen any cases but I don't really prescribe Ceclor - although I have seen a case with Bactrim, but there some mechanism with the metabolites of Ceclor that acts as a toxin to lymphocytes (part of our immune system) causing a serum-like sickness (fever, rash, and bony pains). It is differentiated from classical serum sickness in that it does not depend on high antibody titres or immune complexes.
These are more things we learn about in medical school, but have to somehow keep in the deep recesses of our brain until someone presents to us with it because it is relatively rare.
9 times out of ten I'm taking polysporin out of the parent's hands when they ask if it will help with their child's "pink eye".
I suspect part of the problem occurs when new parents, in the delivery room, see an antibiotic ointment used on the eyes of all new born's (in the USA). I think it's tetracyclin or eryhtromycin to gaurd against syphilis and gonorrhea.
From that point on, they think antibiotic ointments like polysporin for eye infections must be ok
My oldest and youngest both presented with what we were told was serum/serum like sickness in response to Ceclor. I realized my youngest was having the same sort of reaction when it occurred, so her response didn't get to the level that my oldest's did.
He presented with tiny hives to start, taken off the med, told to give him Benadryl, did that, hives came back. We were right in the middle of moving, so he was with my inlaws for the day. Everything seemed fine, then his joints started to swell, and when my mother in law called to say she thought maybe he needed to be seen in emerg, he had smallish red dots (petechiae? is that right?) and by the time we got out to their acreage, they were large - he looked like someone had worked him over with a baseball bat. The color reminded me of port wine stains. He also had trace amounts of blood in his urine.
We were living in far northern Alberta at the time, so the docs consulted with docs at the UofA over the phone, and they treated with steroids. They were talking about sending him out by plane but the docs in Edmonton wanted to see how he responded to the steroids. We had to take urine samples to the hospital every day for a week or two after all of this, to make sure the blood trace was clearing up.
I figured out what was going on with my daughter pretty quickly, when she reacted, so her response wasn't like my son's, as I said earlier. Swollen joints, tiny hives, etc.
We just say our other son is allergic to it. We didn't see any point in finding out if he is. My kids are weird. Now, from my understanding, Ceclor is rarely ever prescribed anymore, because so many people had issues with it. My oldest is 22, and this was about 20 years ago.
Can you get your pharmacist brothers and sisters to rise up and put pressure on the stores that contain the pharmacies to stop carrying stuff like magnetic bracelets and homeopathic remedies? (Glares at Shoppers)
That would include me :blushes:
Here is the problem. Far, far worse than these is things like diet supplements, which I sell.
I am unabashed in telling patients how terrible they are. I routinely ask people to look up homeopathy because I can see they don't believe me. Trust me when I say I don't like selling them and will tell everyone I see near them what I think of them.
However, if I don't offer these things, I lose customers permanently for other things who come looking for these things. If they leave feeling like they can't get what they are looking for, they likely won't come back.
That and I do not really control what I carry as per franchise agreement
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How many instances of allergies did you see to this stuff? As in 'serum/serum like sickness?' I'll explain further after you answer.
If you ask the 'crunchy granola' type parents, dribbling a little freshly expressed breast milk in the eye will cure it completely.
Dispensed Ceclor maybe twice in 7 years. Not much need as other second generation cephalosporins are likely just as effective without the chance of this side effect as well as some other blood disorders. So short answer is never. As for the breast milk thing? Have not researched it myself, but I have a couple pediatrician friends who used is as their treatment of choice
For sore throats, I just give them Tantum (an oral mouthwash) if they REALLY want something.
For the erythromycin and tetracycline ointments - in Alberta, it is standard of care to give Erythromycin ointment to all newborns to reduce the risk of Gonococcal Opthalmia and blindness. It's not anything specifically directed at the patient, but STIs are generally more prevalent than the general population expects.
It is expected that 1 in 4 people have some form of STI at any given time.
Check out this cross-sectional study data:
Cross-sectional data from the 2003-2004 National Health and Nutrition Examination Survey (NHANES) indicate 24 percent of female adolescents aged 14 to 19 years had laboratory evidence of at least one of the following sexually transmitted diseases (STD): human papillomavirus (HPV, 18 percent), Chlamydia trachomatis (4 percent), Trichomonas vaginalis (3 percent), herpes simplex virus type 2 (HSV-2, 2 percent), or Neisseria gonorrhoeae [1]. Among girls who reported ever having had sex, 40 percent had laboratory evidence of one of the four STD, predominantly HPV (30 percent) and chlamydia (7 percent).
The majority of people that I get a positive result in (usually chlamydia, sometimes gonorrhea, sometimes Herpes), are usually in absolute shock. Remember to use protection!!! Herpes and Genital warts have no definitive treatment and can be with you for the rest of your life!
I suspect part of the problem occurs when new parents, in the delivery room, see an antibiotic ointment used on the eyes of all new born's (in the USA). I think it's tetracyclin or eryhtromycin to gaurd against syphilis and gonorrhea.
From that point on, they think antibiotic ointments like polysporin for eye infections must be ok
The bigger problem is everyone believes antibiotics are the solution to all illnesses. These are common myths in Canada:
-acute illnesses are from bugs and antibiotics treat them
-pink eye is done crazy bacteria that we all should ruin away from
The worse I feel or the longer it lays the more likely I need antibiotics
Summary: all popular supplements studied (Vitamins A, C & E; beta-carotene; calcium; antioxidants) are harmful or unhelpful or unknown; Vitamin D3 and Omega 3s are unknown (future tests are around the corner); CoQ10 & Glucomsamine don't appear beneficial, but are yet unknown.
It is worth noting that his examples are referring to synthetic supplements only, since these make up such a large portion of North American consumption.
According to Dr. Tice, according to the evidence, a diet containing a variety of "real" foods full of naturally occurring nutrients is always better (notwithstanding individuals with specific health concerns requiring a supplemental nutrient dose unattainable through diet alone, where the risks of non-supplementation outweigh the risks of supplementation) for long-term health than one supplemented by synthetic drugs. They don't know why, but for some reason, humans appear to be generally more healthy when getting somewhat less-than-"optimal" daily nutrition from raw sources, compared to "optimal" daily nutrition from artificial or processed sources.
I've never seen/heard evidence for such claims before, but his arguments a fairly compelling. Despite the strange breach in logic (why wouldn't the identical synthetic supplement act the same way in the body as its natural counterpart?), there is actually a modicum of intuition here, I think.
It's certainly simpler (and debatably cheaper; though not necessarily easier) to stick to eating real food and forgetting about supplements all together... if this research holds weight.
Thoughts?
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Bacterial pink eye is actually quite rare in healthy adults. Most cases are viral in nature or CL induced inflammatory conditions.
Secondary to a swab is there any definitive way to determine if it is bacterial or viral. I know that I had bilateral conjunctivitis that I picked up from a military base a few years back and the amount of purulent discharge that I had was significant and I got a prescription for an antibiotic from a GP for an antibiotic and it cleared up within a day or two if memory serves me correct however now I am wondering if this would be the natural healing process?
We didn't see any point in finding out if he is. My kids are weird. 
