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Over-the-Counter Options for Osteoarthritis Pain. By Our September Student Pharmacist, MiKayla Matheny.

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It is estimated that more than 45 million Americans, over 17%, have some form of arthritis.

The most common form of arthritis is osteoarthritis which results from ‘wear and tear’ on the joints. About a third of adults over age 65 have osteoarthritis. This type of arthritis is due to the breakdown of cartilage, which normally serves as a cushion and shock absorber between the bones in joints. As the cartilage gradually decays, joints can become stiff and painful to move.

Arthritis tends to get worse gradually over time and the pain and stiffness associated with arthritis can have very significant impacts on a person’s daily activities and their ability to do things they enjoy. However, there are treatment options available, many of which are over-the-counter (OTC) and available without a prescription. Let’s discuss a few of the most common oral OTC options to help with pain due to osteoarthritis:

Acetaminophen (Tylenol) – – Tylenol is a household name for a reason. Acetaminophen (sometimes abbreviated as APAP) is usually one of the first things recommended as an OTC option for pain. It is safe for most people when taken correctly and can be very effective.

Because of the way acetaminophen is metabolized by the liver, people with a history of liver problems should not take acetaminophen without talking with a doctor first. Taking too much acetaminophen can damage your liver, so you should never take more than the maximum dose indicated on the bottle (usually less than 4000 mg), unless your doctor specifically tells you to do so. Also, it is important to be aware that acetaminophen is contained in many combination OTC products, such as medicines for cough or cold, allergies, migraines, and sleep.

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Ibuprofen (Advil, Motrin) – – Ibuprofen can often be more effective than acetaminophen for arthritis pain because it has greater anti-inflammatory activity. However, ibuprofen has many more side effects and safety concerns. Ibuprofen is generally better for short term or occasional use. Long term use of ibuprofen can cause stomach ulcers or bleeding, can increase high blood pressure, and can cause kidney damage. Ibuprofen also interferes with the heart protective and clot prevention effects of daily low dose aspirin. This risk is minimized with only occasional ibuprofen use and single doses of ibuprofen are generally okay with aspirin. However, it is best to take ibuprofen at least eight hours before or two hours after a low dose aspirin. People on long-term low dose aspirin therapy should consult a doctor before using ibuprofen regularly or often. Never take more ibuprofen than the dose recommended on the bottle label unless told to do so by a doctor.

Naproxen (Aleve) – – Naproxen is in many ways similar to ibuprofen and has most of the same safety considerations because they are in the same class of medications. Some people prefer naproxen to ibuprofen, or vice versa, but there is no evidence that either is really more effective. The main differences between the two are that naproxen can be a little easier on the stomach and does not need to be taken as frequently as ibuprofen because it lasts longer in the body.

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While these are the most common choices, there are many other options for arthritis pain available over the counter. There are several types of topical medications (which are applied to the skin rather than taken by mouth) which can also be very effective. Topicals can be more convenient or more effective for some people, but the choice of a topical medication is often very individualized. If you ever have questions about what OTC arthritis pain reliever would be best for you, ask your doctor or pharmacist to help you pick one out.

Autism Spectrum Disorder (ASD). By Our September Student Pharmacist, Rebecca Miller.

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Most people have heard the term autism before, but few have a good understanding of what it actually is. Autism is a diagnosis used to identify a group of neurodevelopmental disorders which range widely in symptoms and levels of disability. Nearly 1.7% of children in the US suffer from an autism spectrum disorder according to the Centers for Disease Control and Prevention (CDC) – that’s one kid out of every 59. Autism is not an intellectual disability; while some individuals on the spectrum may also suffer from intellectual disability, the majority do not.

The saying goes that ‘if you’ve met one person on the autism spectrum, then you’ve met one person on the autism spectrum’; that is to say that the characteristics of autism are so diverse that any two people on the spectrum are more likely to have nothing in common than to be similar. The severity of the disorder is, likewise, very individual. This is because severity is based on the resulting level of impairment in intellectual, social, educational, and occupational function. Even if two people have the same symptom, difficulty driving, for instance, if one of them lives in a city with public transportation while the other lives in a rural area, it would be much more difficult for the second person to find a job or attain a desired college degree than the first.

Generally, there are two core characteristic types which are shared by all autism-spectrum disorders: difficulty with social interaction and restrictive or repetitive behaviors. How these characteristics manifest, however, can take a multitude of forms, such as:

  • Difficulty understanding when it is their turn to speak in conversation
  • Poor eye contact or lack of friendly smile
  • Difficulty with relationships
  • Snapping fingers, lining up objects, repeating a phrase or sound
  • Distress in response to small changes in routine
  • ‘Special interests’ or topics about which the person is especially knowledgeable or passionate
  • Indifference to pain or temperature
  • Inability to wear clothing with tags
  • Visual fascination with lights or motions

Examples are varying and exhaustive, can change as a person grows, and there is no set list.

autism genetics

The exact causes of autism are unknown. There are many theories and it is likely that there are multiple possible causes. Because a first degree relative with an ASD diagnosis is a risk factor for developing the disorder, there has long been the theory that autism is a genetic condition. While there is no single gene which causes autism (as is the case for sickle cell disease, hemophilia, and cystic fibrosis), researchers have recently identified 18 different genes which contribute to the development of ASDs.

Treating autism is a difficult proposition. There is no actual treatment for autism, only treatments for some of the symptoms, such as speech therapy to improve verbal communication, medication for anxiety, and counseling/coaching on appropriate skills. There has been a large push in recent years to diagnose children with ASD as early as possible because the earlier these treatments begin, the better their quality of life and the more independent and productive they will be.

Autism and Vaccines

Although there has been a large movement against vaccination of children based on the argument that children who are vaccinated are more likely to develop autism, there have been no reputable studies that back this up. There have, in fact, been numerous studies to the contrary. Autism is a neurodevelopmental disorder that begins before birth and, therefore, before a child is vaccinated.

A note from the author…

I was not diagnosed with ASD until I was 27. I cannot tell you how many difficulties that I encountered in my life because I did not know about my condition and the difference that it would have made if I had received treatment as a child, teen, or even young adult. Luckily, I eventually learned the skills that I needed to succeed and am living happily with a husband and daughter, about to graduate with a doctoral degree. My story turned out well, but not all of them do. If you see signs of autism in your child, please, please, please talk to your child’s pediatrician. It cannot hurt to talk to them and it could make all the difference.

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Concussions are Serious. By Our September Student Pharmacist, MiKayla Matheny.

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Concussion in Introduction to Sports Medicine, wikidot.com

About one million children go to the emergency room or are seen by a doctor for a concussion in the United States each year.

A concussion, which doctors consider a mild form of traumatic brain injury, usually results from a bump or jolt to the head. When an impact causes the brain to bounce or twist inside the skull, it can potentially cause damage to brain cells. This type of injury is common with falls and car accidents, but is also increasingly a concern with sports injuries. Children and teens are at higher risk of concussions and, while concussions are dangerous at any age, they can have more serious effects on young, developing brains. It is important that anyone with signs or symptoms of a concussion gets medical help as soon as possible.

Symptoms of a concussion can begin right after the injury, but sometimes may not appear or be noticed until several hours to days later. The majority of concussions do not involve being ‘knocked out’ or losing consciousness. Even a seemingly mild or harmless bump to the head can result in a concussion. In fact, many concussions occur without immediately noticeable signs or symptoms and therefore go undiagnosed. An undiagnosed concussion is particularly dangerous in young athletes because it increases the risk of a subsequent concussion occurring on the field, extends the time required for recovery, and increases the risk of lasting brain damage. Parents, teachers, and coaches should always know to watch for the visible signs of a concussion and should encourage their kids to speak up about any symptoms. Young athletes should never return to play on the same day an injury occurs, even if they initially feel able.

After an injury, medical attention is necessary if the person experiences any of the following symptoms of a concussion:

  • Headache or ‘pressure’ in the head
  • Nausea or vomiting
  • Dizziness
  • Blurry or double vision
  • Sensitivity to light or sound
  • Numbness or tingling

Sometimes children cannot easily describe these symptoms or may simply say they do not feel ‘right’. This should be taken seriously even if complaints are not specific. Someone with a concussion may have difficulty thinking clearly, concentrating on or remembering things, or feel sluggish, hazy or foggy.

Parents, teachers, and coaches should seek medical help for their kids if they notice any of the following:

  • Dazed or stunned appearance
  • Confusion about events
  • Answering questions slowly
  • Behavior or personality changes
  • Loss of consciousness (even briefly)
  • Inability to recall events before or after the hit, bump, or fall
Signs and symptoms of a concussion. Ivan Chow for Queensland Brain Institute.

Signs and symptoms of a concussion. Ivan Chow for Queensland Brain Institute.

Even with proper medical attention, it can be difficult to recover from a concussion. For the first several days after a concussion, rest is the best course of action. Physical and mental activity should be restricted in order to give the brain time to heal. Parents, teachers, and coaches may need to help make sure their kids are excused from school and/or practice initially. Concussion symptoms usually resolve within a month or two, but may persist longer in some cases. Kids should resume normal activities gradually to avoid aggravating concussion symptoms and their activity level should increase only if no symptoms occur.

Concussions are quite common and can be easily overlooked. Concussions can be serious and have long-term consequences. It is important that parents, teachers, coaches and their children, students, and players all be aware of what to watch for and how to react if a head injury occurs.

For more information check out the CDC “Heads Up on Concussion” Campaign: https://www.cdc.gov/HEADSUP/

Meet Meghan Nestleroth, the Assistant Manager of Plain City Druggist and Manager of Midwestern Compounding Pharmacy: The Woman Who Can Do It All, Including Making Balloon Animals!!

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There have been some changes brewing at Plain City Druggist, but the faces stepping in to keep the pharmacy running like clockwork are familiar–only the position titles have changed. Tayler, as we reported last week, is becoming the pharmacist manager and Meghan Nestleroth, who has been with us since she was a student also, will be filling in as assistant manager for Plain City Druggist and manager for the compounding pharmacy.

Here is Meghan’s bio so you can learn a bit more about her.

My name is Meghan and I’m the new manager of Midwestern Compounding Pharmacy and the assistant manager of Plain City Druggist. I graduated from The Ohio State University’s College of Pharmacy in 2017 and started working with Plain City Druggist in October of 2017. If you’ve been in the pharmacy lately you have probably seen me behind the counter–if you can see me over my computer that is.

I grew up in Westerville, Ohio and made my parents very happy when I decided to stay in the Columbus area. I have a little bit of a commute to get to Plain City every day, but you can’t beat driving down country roads on a beautiful summer morning!

I decided I wanted to become a pharmacist when I was about 13 years old. I always knew I wanted to take after my mom and go into some sort of medical profession, I just wasn’t sure what. My mom suggested pharmacy and set up a shadowing experience with a pharmacist she worked with at OSU. After that day, I knew pharmacy was the career for me. My love for independent pharmacy was discovered while I was in pharmacy school at OSU. I started working at Joe’s second store, Happy Druggist Karl Road, as an intern and found my passion. I am beyond thrilled that I now get to continue that passion here in Plain City.

In my spare time I enjoy hiking, playing in an adult kickball league, and going to local theater shows. My hidden talents include baking over-the-top cupcakes and making balloon animals.

I’m looking forward to getting to know all our customers better and learning more about Plain City. Who knows, if you stop by the pharmacy you might even get a balloon dog!

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Meet Our Second Student Pharmacist for September, MiKayla Matheny.

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We introduced you to Rebecca Miller in a previous post. Rebecca and MiKayla are both rotating with us for the month of September in the pharmacy. MiKayla is also a fourth year student at The Ohio State University’s College of Pharmacy and will graduate in May 2019 with her PharmD degree.

Here is what MiKayla tells us about herself:

Although I am originally from a small community in West Virginia, I moved to Ohio after deciding to pursue pharmacy school and Columbus has become my second home. I completed my BS in Pharmaceutical Science at The Ohio State University in 2015 and I am currently in my fourth and final year of the PharmD program.

I don’t know exactly when I decided I wanted to be a pharmacist. The interest developed gradually (sometime after I realized that growing up to be a marine biologist would be slightly impractical for someone who lived so far from the ocean). I largely credit my mother, a registered nurse, for helping develop my interest in the health professions. She encouraged me to explore pharmacy even before I decided I didn’t have the tolerance of bodily fluids required for medical school.

My most recent pharmacy work experience was with the OSU Medication Management Program, providing medication therapy management (MTM) services and counseling by phone to Medicare patients all over the country. It was fulfilling to speak with so many very different people every day and offer help with their complex medication regimens. And I can now offer myself as proof that not everyone who calls from a different time zone is necessarily a telemarketer or a scam artist.

I also enjoy volunteering in the pharmacy at Physicians CareConnection, a free clinic for uninsured patients in the Columbus area. The challenge of explaining medication regimens through an interpreter to patients who do not speak English often makes me wish to learn another language. Yet, I am always grateful when I can answer their questions which might not get addressed anywhere else.

Outside of pharmacy school, I try to find time for my other interests. I have something of a crochet addiction and I am recently teaching myself to sew and quilt–this in spite of the fact that both my younger siblings are convinced it makes me seem like an ‘old lady’. I always appreciate a good fantasy novel (or several), but sometimes I like science fiction for a change of pace. I have a very enthusiastic Australian cattle dog who loves to swim and can always wear me out with her playful energy.

I am excited to spend the month of September on rotation with all the wonderful people at Plain City Druggist and Midwestern Compounding Pharmacy.

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