by Carole Jackson>, Bottom Line Health

by Carole Jackson>, Bottom Line Health

by Carole Jackson>, Bottom Line Health

Have you ever bought a prescription medication online? If you have, you’re in good company. A recent FDA survey showed that almost one-quarter of Internet users have. The majority of these respondents used an online service associated with their health insurance.

It’s easy to see why many people go online—it’s convenient. You press a few buttons on your computer, and without having to leave your home, your prescription is delivered to your doorstep.

But if you’re thinking about purchasing prescription medications from an online source that isn’t affiliated with your health insurance or a local pharmacy, there are many unregulated, fraudulent, illegal companies that want you to think that they are legitimate, legal pharmacies—and they may even have Web sites that look very professional. But if you use one, you may not receive what you paid for. There’s no way to know for sure whether the product that you receive contains the right amount (or any) of the active ingredient. Plus, the medicine could be contaminated or expired. So I spoke to an expert for tips on how to safely buy prescription medications online…

RED FLAGS

Many people don’t realize how important it is to research an online pharmacy before using it. For example, the FDA survey showed that 15% of the respondents said that they would consider buying medication from an online pharmacy based outside the US. But the FDA doesn’t regulate pharmacies that are located outside the US. So the first rule of thumb is to make sure that an online pharmacy is licensed in the US state where it is operating, said Connie Jung, RPh, PhD, acting associate director for policy and communication at the FDA in the Office of Drug Security, Integrity and Recalls, who analyzed the survey results. This ensures that the pharmacy will be held to following state laws. To find out whether your Internet pharmacy is licensed by the state that it’s operating in, don’t just go by a statement on the site (because that could be fake). Check with your state’s licensing organization by clicking here.

Here are more questions to ask yourself before you commit to using a particular online pharmacy, from Dr. Jung…

• Does the pharmacy require that you send in your prescription? If it doesn’t, don’t use the pharmacy. Any legit pharmacy will require a prescription. Depending on the pharmacy, the pharmacist will either ask you to mail in the prescription or he or she might contact your doctor directly.
• Does the pharmacy send you spam? If you start getting spam or weird e-mails from the pharmacy that offer deep discounts and push you hard to buy medications, don’t use the pharmacy. That’s a sign that the “pharmacy” and its Web site may be a sham.
• Does the pharmacy offer prices that are too good to be true? There’s no way to know exactly what’s “too good to be true,” but if, say, one pharmacy typically charges $32 for a bottle of a brand-name (nongeneric) medication, and another charges $30, but an online pharmacy is charging just $5, that’s suspicious.
• Does the pharmacy have pharmacists who are available to talk to you? If the store doesn’t allow you to speak with any pharmacists over the phone, don’t use it. It may be an indication that real pharmacists aren’t running the pharmacy.

Source: Connie T. Jung, RPh, PhD, acting associate director for policy and communication, Office of Drug Security, Integrity and Recalls, Office of Compliance, Center for Drug Evaluation and Research, US Food and Drug Administration, Rockville, Maryland.

by Carole Jackson>, Bottom Line Health

Here’s an unusual New Year’s resolution that you probably have never made.

Become more flexible this year—literally!

For anyone who wants to have a fit, healthy body, building more endurance and strength are common goals, but you rarely hear someone say, “By the end of the year, I want to be able to touch my toes with the palms of my hands while standing—and do it smiling!”

But improving and/or maintaining flexibility is key to your health, because being loose and limber makes it easier to build strength and endurance…it makes everyday activities, such as tying your shoes or reaching behind the driver’s seat in a car, less painful…and it makes you less prone to injury.

And it just feels great.

So, how flexible are you?

Take our quick quiz to find out…and then, if you discover that you’re not exactly like Gumby, don’t worry—I’ll provide you with some easy tips from an expert that’ll make you flexible in no time.

YOUR QUICK FLEXIBILITY TEST

To get an idea of how limber you are (or aren’t), take this simple test created by Diana Zotos, a physical therapist and yoga instructor at the Hospital for Special Surgery in New York City.

Shoulder Stretch. Standing, place your right forearm behind your waist and then raise your hand as far up as you comfortably can. Repeat this move with your left forearm. Can you…

a. Reach your shoulder blades with your fingertips?

b. Reach your middle back?

c. Reach your lower back?

Trunk Rotation. Sit up straight in a chair with your arms crossed lightly across your chest, hands touching opposite shoulders. Stare straight ahead. When you gently twist your upper body and head from side to side, can you…

a. Turn your torso to about the 3:00 position on your right side and 9:00 on your left?

b. Turn not quite as far—only to 2:00 and 10:00?

c. Turn only to 1:00 and 11:00, or not much further than your starting position?

Leg Reach. Stand up straight with feet hip-distance apart. When you bend forward and simultaneously slide both of your hands as far as you can down your legs (with your right hand on your right leg and your left hand on your left leg), can you…

a. Reach below the knee?

b. Reach the knee?

c. Reach mid-thigh?

Toe Touch. Sit on the floor with your back straight and your legs extended straight in front of you. When you bend over, can you…

a. Touch your toes?

b. Reach your ankles but no further?

c. Get only as far as your shins?

If you answered mostly As, good job—you’re lithe and limber. Just keep stretching a couple of times a week. If you fall into the B range, you’re getting a bit stiff and could benefit from stretching more often, three to five times a week. If you answered primarily Cs, watch out! You may not be moving around as much as you should, and as a result, you’re losing a lot of flexibility—but it’s never too late to reclaim it! Doing the following stretches can help you open up your muscles and start to see improvement in your flexibility in as little as one to two weeks.

LIMBER UP!

Marla Altberg, a certified personal trainer and Pilates mat instructor in New York City, assured me that even if you have spent the holidays (or longer) on the couch, you can easily loosen up again by performing this 10- to 15-minute stretching routine…

ON YOUR BACK: To perform the following stretches, lie on your back with your knees bent, feet slightly apart and flat on the floor and arms by your sides with palms facing downward.

Triangle Stretch (For hamstrings, quads, inner thighs and hips):

1. Make a triangle by crossing your left foot over your right knee.

2. Grasp your right leg behind your thigh, and inhale as you bring it in toward your chest.

3. Take your left elbow and press it gently against your left knee.

4. Breathe naturally as you hold the stretch for 20 seconds.

5. Return to your starting position and repeat on the other side.

Leg Raise (For hamstrings, quads and back):

1. Leaving your left leg where it is, bring your right knee to your chest as you inhale, and then slowly raise your right foot straight up to the ceiling as you exhale.

2. Using both hands, grab hold of your right leg behind your thigh, and climb up your leg, hand over hand, as far as you can toward your foot.

3. Keeping your hands as close as possible to your right foot, pull your right leg toward you, keeping it as straight as possible while your knee moves toward your face, gently but carefully—never to the point of pain. At the same time, push the leg against your hands in the opposite direction. Hold this pose for a count of 10, if possible.

4. Walk your hands back down, and repeat on the other side.

“T” Stretch (For back and side abdominals):

1. Join your knees together and tilt them both over to the left side until they touch the floor (or come as close to the floor as possible).

2. Spread your arms out to your sides, so your body forms the letter “T,” and turn your head and torso to the right.

3. Hold for 20 seconds, breathing naturally and deeply into the stretch. Repeat on the opposite side.

ON YOUR TUMMY: To perform the next set of stretches, roll over onto your stomach.

Ab Contraction (For abs and back):

1. Make a pillow with your hands, rest your forehead on it and position your feet hip-width apart.

2. Inhale deeply, and then exhale as you draw your abdominal muscles in and up. Hold for 5 to 10 seconds and release. Pause for just a few seconds and then repeat twice.

3. Next, make the same muscle contraction but, as you do so, slightly raise your head (keeping your forehead glued to your hands) and chest off the floor. Hold for five seconds and release. Pause for just a few seconds and then repeat twice.

Fly Like Superman (For back, abs, butt and shoulders):

1. Still lying on your stomach, extend your arms above your head, shoulder-width apart, with the palms of your hands facing downward.

2. Inhale deeply. Exhaling, contract your abs and raise your right arm and left leg slightly off the floor simultaneously.

3. Hold for a count of 3 to 5 and then release. Repeat on the other side, and then do one more set.

Cat Stretch (For back and abs):

1. Get on your hands and knees.

2. Inhaling, pull your stomach in, tip your pelvis forward and arch your back like a cat. Hold for 3 to 5 seconds.

3. Exhaling, gradually relax back into your original position. Pause for just a few seconds and then repeat twice.

Note: If you have a health issue such as a bad back, joint problems or heart disease, consult your primary care provider before beginning any new exercise program.

Sources: Diana Zotos, physical therapist and advanced clinician, rehabilitation department, Hospital for Special Surgery, New York City. Marla Altberg, certified personal trainer and Pilates mat instructor, New York City.

by Carole Jackson>, Bottom Line Health

Ever step inside a hotel room and know instantly that someone recently smoked in it?

Or hop into a rental car and need to roll down the windows immediately to air out the stench of cigarettes?

Or maybe you occasionally get a “tobacco-y” whiff from the clothes or hair of a smoker who lives below you or in the condo next door.

So-called “thirdhand” smoke is the contamination that remains after a cigarette has been extinguished. And I’m sorry to tell you that it’s also dangerous, just like firsthand smoking and secondhand smoke—and why you need to avoid it…

OF MICE AND MEN

Believe it or not, the quintessential experiment proving the hazards of thirdhand smoke was published in Cancer Research way back in 1953. Researchers at the (then-called) Sloan-Kettering Institute of the Memorial Center for Cancer and Allied Diseases in New York collected cigarette smoke in a beaker and then gathered the residue that clung to the glass. They mixed the residue with a solvent and painted it on the backs of some mice…on other mice (the control group), they painted solvent alone. Researchers found that 59% of the mice exposed to tobacco residue developed skin lesions, and most of those mice went on to develop cancer. In contrast, none of the control mice developed skin lesions or cancer.

Now fast-forward to today. Sure, we’re living in a time when smoking is banned from most public places in the US, but, unfortunately, many homes, apartment buildings, hotel rooms and cars are still heavily contaminated, I learned recently from Jonathan Winickoff, MD, MPH, a pediatrician and professor of pediatrics at Harvard Medical School in Boston and one of the country’s top researchers on tobacco and health.

Some of these spaces are being smoked in still…others used to be smoked in…and all can hurt your health.

HOW WE’RE EXPOSED

Thirdhand cigarette smoke adheres to all surfaces and remains there even after a butt is stubbed out. “It’s surprisingly dangerous because it reacts with other compounds in the environment and with itself to create new tobacco-specific nitrosamines, compounds that are highly carcinogenic,” said Dr. Winickoff.

This thirdhand smoke is, unfortunately, almost impossible to clean off most surfaces, though you’ll have more luck with glass surfaces than with porous ones, such as wallboard. Usually, it just sticks around until someone comes into contact with it.

There are three ways that humans can come into contact with thirdhand smoke…

• Through breathing. The compounds can be reemitted into the air, so it’s possible to inhale them into your lungs.
• Through touch. Compounds can enter the body through the skin—just by touching a wall or lamp or using an armrest, for example.
• Through ingestion. The microscopic compounds can settle on everything from dishware to food, making it possible for us to unknowingly eat them.

HEALTH CONSEQUENCES OF TOBACCO TOXINS

People of any age can suffer various health consequences from any amount of exposure to thirdhand smoke, though children, in particular, are more likely to come into contact with the toxins and are more likely to be negatively affected by them.

Children breathe at faster rates than adults, so when thirdhand smoke is present, the little ones’ respiratory exposure is much higher. Also, they tend to touch everything and move around surfaces like mops, which increases their skin exposure. Plus, they ingest twice the amount of house dust as the average adult, said Dr. Winickoff.

Since a child usually weighs less than what an adult weighs, exposure will impact a kid’s body more. And because their bodies and brains are still developing, the exposure can have measurable effects. Studies have found that children exposed to thirdhand smoke have much higher blood levels of cotinine, which is a breakdown product of nicotine, compared with children who are not exposed to contaminated environments. “High cotinine levels have been associated with developmental delays and lower reading and math scores,” said Dr. Winickoff. “Plus tobacco smoke exposure—it can be hard to tease out the effects of secondhand and thirdhand smoke—is now a leading cause of Sudden Infant Death Syndrome.”

SMOKE-FREE LIVING

So if you or someone around you still smokes, this is obviously another good reason to quit—and another good reminder that smoking doesn’t just harm the person who has the cigarette in his or her mouth. For more information on how to quit, click here.

If you’re not a smoker, do everything you can to avoid thirdhand smoke. Try to live in a building that is smoke-free, because even if there is just one smoker around—even in another apartment—smoke moves freely in the air through ductwork or out one window and into another and can affect everyone. Reject a stinky-smelling hotel room or rental car, and ask the company for a replacement. And if a smoker (even one who is not smoking at the moment) steps into an elevator with you, step out of the elevator and take the next one. Is this inconvenient? Sure, but your good health is worth the extra hassle.

Source: Jonathan Winickoff, MD, MPH, pediatrician and associate professor, department of pediatrics, Harvard Medical School, Boston, and immediate past chair of the American Academy of Pediatrics Tobacco Consortium. He has drafted tobacco control policies for the American Medical Association and other organizations.

by Carole Jackson>, Bottom Line Health

It’s January, which means that it’s time for warm gloves, furry coats and…antibiotics.

Yep, antibiotics.

A new study shows that adults in the US are prescribed antibiotics most often right now, during the first three months of the year.

Now, you might argue, Well, that’s because more people get bacterial infections during the winter.

But check out what else these researchers found, and you’ll see that there may be another reason for it…and, frankly, it’s a reason that outrages me—the findings suggest that many doctors may be behaving badly and putting people at risk.

DOCS PRESCRIBE AT THEIR DISCRETION

Scientists examined the national Medicare records of about 1 million seniors annually over three years. They tracked antibiotic prescriptions month by month to see when the most antibiotics were prescribed. They also analyzed the prevalence of the following conditions…

• Category 1: Bacterial pneumonia. This disease almost always requires antibiotics, according to the study authors.
• Category 2: Acute nasopharyngitis (the common cold) and nonspecific upper respiratory tract infections. These diseases are usually viral infections, so antibiotics are almost never necessary, according to the study authors.
• Category 3: Sinusitis, pharyngitis, tonsillitis and bronchitis. These diseases sometimes require antibiotics, but often they don’t, according to the study authors.

In addition, they compared disease prevalence and antibiotic prescription rates in the four main US regions—the Northeast, South, Midwest and West.

Results: As I mentioned earlier, antibiotics were prescribed most often during the first three months of the year. And the rate of bacterial pneumonia (category one), which almost always requires antibiotics, also spiked during those months. So upon first glance, you might think that solely explains the spike in antibiotic prescriptions.

But take a close look at this next finding. When the researchers compared the four regions, they found that the areas that had the highest prevalence of bacterial pneumonia, on average, did not have the highest rate of antibiotic prescriptions, on average, as you would expect. For example, the Northeast had the highest prevalence of bacterial pneumonia, but it didn’t have the highest antibiotic prescription rate—it had the second lowest, after the South and the Midwest. Very peculiar, isn’t it?

In addition, the rates of the diseases that fell into categories two and three (which don’t usually require antibiotics) also spiked during the first three months of the year—not just bacterial pneumonia. “These findings imply that it’s likely that some antibiotics were prescribed inappropriately to older adults to treat diseases that don’t typically require those drugs,” explained lead study author Yuting Zhang, PhD.

A QUESTIONING ATTITUDE

You, of course, know that overusing antibiotics can cause bacteria to become drug-resistant, leading to disease strains that can’t be wiped out with standard antibiotics. And taking antibiotics can be pretty hard on your body, too. This knowledge, coupled with the finding above, means that you may want to be extra inquisitive if and when you visit a doctor—especially in the winter.

If your doctor prescribes an antibiotic, should you automatically accept it? That’s a personal decision, but if you ask me, I make sure that my doctor has a darn good reason to give me one before I take it.

In fact, you may want to consider the following advice from regular Daily Health Newscontributor Andrew Rubman, ND, founder and medical director of the Southbury Clinic for Traditional Medicines in Southbury, Connecticut. He told me that when your doctor prescribes an antibiotic, always ask, “How confident are you that bacteria are causing my illness?” Physicians can rarely be 100% certain that bacteria are the root cause of health problems, Dr, Rubman said—but you should expect at least a fair degree of confidence from your doctor before swallowing antibiotics. Here are more of Dr. Rubman’s tips, below…

• If bacteria are definitely the cause…Ask these two follow-up questions—are antibiotics absolutely necessary? And what do recent studies show about the effectiveness of the antibiotic you’re suggesting?Some bacterial diseases, such as bacterial pneumonia, which was mentioned earlier, almost always require an antibiotic. But others, such as the diseases in categories two and three above, can often be resolved with over-the-counter remedies. “The OTC antihistamine drug diphenhydramine (Benadryl) is a good decongestant for occasional use, and your naturopath may consider prescribing you natural treatments such as nettle, echinacea, horehound, cajaput seed oil and/or henbane to shorten the duration and symptom intensity of your condition,” said Dr. Rubman. So find out from your doctor whether you can try an OTC product first. Keep in mind that all supplements have potential side effects and contraindications based on certain medical conditions that you may have and drugs that you may take, so take them under a doctor’s care.

  If your doctor insists that an antibiotic is necessary and explains that there is scientific evidence that it’s shown to be effective in relieving or curing your particular health problem, then ask whether you need a “broad-spectrum” type or whether a “narrow-spectrum” type will do, because a broad-spectrum type may be overkill for the problem at hand.

• If your doctor isn’t sure whether the cause is bacterial or viral…You’re faced with a more difficult decision. Ask what your options are besides antibiotics and how likely they are to help, and then, after weighing all the benefits and risks with your doctor, make a judgment call.

• If a virus is definitely the cause…Skip the antibiotics and ask your doctor what sort of treatment might help. If you’re interested in using a natural treatment, specifically, it’s best to consult a naturopathic doctor. Supplements containing the herbs lobelia (Indian tobacco), Ligusticum porteri (called osha by Native Americans) or larch tree bark (Larix occidentalis) can help clear mucus from the respiratory tract, for instance, if you have a respiratory infection.

Now, your doctor may say, “the cause of the illness is viral, but I want to give you an antibiotic to prevent any secondary bacterial infections.” Dr. Rubman said that in this type of situation, it’s best to consult a naturopathic doctor for a second opinion. And if you do eventually get a secondary infection, first ask your doctor to try to confirm that it’s bacterial through symptom examination and/or lab tests before considering an antibiotic.

Sources: Yuting Zhang, PhD, associate professor, health economics, and director, Pharmaceutical Economics Research Group, University of Pittsburgh. Her study was published in Archives of Internal Medicine.

Andrew Rubman, ND, founder and medical director of Southbury Clinic for Traditional Medicines, Southbury, Connecticut. He is contributing medical editor to Daily Health News. www.SouthburyClinic.com