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T.J. Sharpe
My name is T.J. Sharpe. I’m a father, husband, brother, friend and fighter– of Stage 4 Melanoma.
You will be reading about a battle with cancer, but that is just the backdrop for this story - one that really focuses on life, health, family, and the challenges we all face every day to win our little battles. Ultimately the war on "Father Time" can never be won, but this is one man's tale on how I am fighting to keep that battle going for years.
I’m a South Jersey native and a 1993 graduate of Bishop Eustace. I parlayed an education and some success on the football field to gain admission to Carnegie Mellon, a Top 25 university in Pittsburgh – one that probably wouldn't accept me now, and likely would not have in 1993 either – without a little help from the athletic department. Regardless, a door was opened to another fantastic school, and four more years of football at the Division III level, where our biggest perks were the occasional travel meal money and some free grey t-shirts that I still wear today. At both schools, I was able to get a great education, play the sport I loved, and establish lasting relationships with more good people than I can easily count.
After college, I became an IT consultant, first based out of Hoboken, NJ, then Haverford, Pa., before relocating in 2004 to Fort Lauderdale, Florida, where I currently reside. There, I met a native Floridian (they do exist!) lawyer, married Jen in April of 2008, and now have two wonderful kids – 2-year-old Josie and 5-month-old Tommy. I love living in the Sunshine State, have met many great friends, and even have raised a little girl who is a Phillies and Flyers fan (Jen and I drafted teams for our children's allegiance; the Dolphins went first, followed by the two Philly teams, then the Heat. The top 3 picks have vastly underachieved). However, my roots are still in the Delaware Valley, and I will always call Philadelphia, South Jersey, and The Shore “home.”
Why does eating beets turn my pee and poop red? Are there any health concerns with this?
Mervyn D. Danilewitz, MD, FACG, AGAF, Chief of Gastroenterology, Mercy Philadelphia Hospital
The beetroot pigment called betanin is responsible for the red coloring in urine and feces and this should not cause any health concerns.
Some people cannot break the pigment down and this results in excretion of the pigment in urine and feces.The rest of the beetroot is digested and no nutrients should be lost. This usually lasts 48 hours, but it can vary in people who have a slow or faster rate of passing feces. It also depends on amount of fluids one drinks.
Michael R. Cohen, R.Ph.
By Mike Cohen
Could it be “Low T?”
By now you’ve probably heard this line or otherwise seen a multitude of TV or newspaper ads for testosterone gel products. Increasingly, drug manufacturers have been tapping into this billion dollar market aimed at men over 40, which is when men sometimes start to feel the signs of aging and decreased desire for sexual relations. The gel is easy to use. It’s applied once daily to the shoulders or upper arms. AndroGel can also be applied to the abdomen.
Testosterone of course is the male hormone in the body that is primarily responsible for the normal growth and development of male sexual and reproductive organs. It’s important in maintaining bone health, energy levels, mood, and sexual desire. If men have low testosterone levels, doctors may prescribe one of the widely advertised testosterone gel products such as AndroGel 1% and Testim 1% to restore normal levels of testosterone.
Michael R. Cohen, R.Ph.
By Michael R. Cohen, R.Ph.
A woman reported an error to us after her child’s doctor sent an electronic prescription to a community pharmacy for her 11-year-old daughter. The prescription was for the laxative Miralax powder (polyethylene glycol 3350). The woman was told by her doctor to give her daughter 3 teaspoonfuls by mouth mixed with 6 ounces of liquid. This was to be taken once a day for 30 days. However, when the woman picked up the prescription, the label on the bottle said take three tablespoonfuls mixedwith 6 ounces of liquid daily for 30 days. That might have led to a pretty serious error. Except for one thing – an important new type of back-up system came into play.
Although the doctor sent the prescription to the pharmacy electronically, he gave the woman a hard copy of the prescription in case there was a problem. Smart move! In the past, you got a hand written prescription, where at least you could usually make out the drug name. But with e-prescribing, you may not be given anything in writing and you may not know what to expect at the pharmacy. If the pharmacist hands you something that doesn’t seem right based on your expectations, then it might just be that an error has happened. In this case though, the woman told us that the hard copy saved an error. She said she would not have remembered the correct dose if she had not received the copy of the prescription. So she would have given her daughter more than the required dose for her age and weight.
You should always receive verbal instructions from your doctor about how to take your medicines. This will give you an opportunity to ask questions. But if the prescription is sent electronically to the pharmacy, you should also be provided with a clearly marked copy or corresponding “voucher.” Insist on it. This voucher should list the medicine that was ordered, the dose, and the directions for use. You can use the voucher to check the prescription by matching it to what you actually receive in the pharmacy to assure it is the correct medicine and instructions.
My husband, in his 40s, recently began snoring every night. Is there anything we can do? Can a doctor help?
Ajay Pillai, MD, Director of Sleep Disorders Center, Mercy Fitzgerald Hospital & Mercy Suburban Hospital
Snoring is very common, particularly in males. Habitual snoring is present in 44 percent of males and 28 percent of females between the ages of 30 and 60. Occasional snoring is almost universal.
Snoring is a sound produced by vibration of the soft tissue in the throat during sleep. It suggests some narrowing of the upper airway.
Daniel R. Hoffman, Ph.D.
By Daniel R. Hoffman, Ph.D.
Last month the pharma columnist at Forbes, Matthew Herper, wrote that after "talking to executives around the drug industry," most are pursuing one of the following three alternative scenarios: The blockbuster model, the expanded orphan strategy and the access model. Here, I offer up some insight into each of these "visions" of the future:
1) The blockbuster model. Three or four years after it became conventional wisdom in pharma that the blockbuster model was dead, Herper now claims that "many executives still hold to basically this model." He's probably correct and, as much as anything, that fact reveals the dearth of innovative thinking and the CYA behavior in pharma's C-suites.
Basically any intent on pharma's part to persist with the blockbuster model would require deploying several elements that no longer exist or are rapidly fading.
My crotch gets super sweaty when I exercise. Is there anything I can do?
Bradley Smith, MD, is a sports medicine physician at Lankenau Medical Center of Main Line Health System.
Like every other part of your body, your groin can also be affected by excessive perspiration, especially during exercise. You should know that you are not alone. This condition, called hyperhidrosis, causes excessive sweating. It usually presents during exercise, in extreme heat, or in stressful situations and can often cause those who are affected by it to sweat through their clothing. It typically affects the hands, feet, underarms, and face, but it can affect other areas of the body, too, including the groin.
While this is natural and usually nothing to be concerned about, it can be embarrassing for those who exercise often and deal with it on a regular basis. Fortunately, by taking some preventative measures and choosing the appropriate workout gear, you should be able to lessen or avoid the problem.
One of the most effective ways to cut down on the amount of perspiration during your workout is paying attention to what you wear. Not only will this affect the amount of perspiration in your groin, but other areas of your body, as well. Thicker fabrics in sweatshirts and sweatpants will hold onto moisture, so choose materials like light cotton or linen that will wick away sweat and keep air circulating during your workout.
In addition, pay attention to the fit of your clothing. Workout clothing should fit well, but try and keep them loose fitting. Look for wide-legged pants and capris or athletic shorts, which are preferable to tight leggings. For your workout, opt for undergarments with an absorbent cotton crotch that can help to decrease the amount of perspiration.
Much like applying anti-perspirant to your underarms to avoid odor and perspiration, there are also products available that can be applied to other areas of the body. Check your local pharmacy or grocery store for spray deodorant, which can be applied to the groin or other affected areas to decrease sweating.
Finally, don’t forget to cool yourself down during and after your workout with a fan or water bottle. While this won’t target the groin specifically, cooling down your whole body can be helpful.
If you are still dealing with excessive perspiration after trying these tactics, consult with your doctor, who may be able to suggest other treatment options.
Michael R. Cohen, R.Ph.
By Michael R. Cohen, R.Ph.
Few caregivers are more devoted than parents when caring for a child. Yet, even the most cautious and educated parents will make mistakes when giving medicine to children or fail to protect children from accidental poisonings. Dangerous mistakes with medicines are three times more likely with children than adults and more than half of all accidental poisonings—mostly with medicines—occur in children less than 5 years old. The list that follows, although not all inclusive, covers ten important safety tips for parents.
Ten Steps Parents Should Take to Prevent Medicine Mishaps
- Discard older (concentrated strength) infant’s acetaminophendrops. Acetaminophen is a common medicine for infants and children to treat pain and fever. There used to be two strengths of acetaminophen liquid—a higher strength (80 mgper 0.8 mL) of concentrated drops for infants and a lower strength of elixir for children (160 mg per 5mL). After years of serious mix-ups between these two strengths, companies are now making just the lower strength (160 mg per 5 mL)of acetaminophen. But the older concentrated drops may still be in your medicine cabinet. A dosing error can happen if your child’sdoctor gives you directions for using the new lower strength acetaminophen, but you are still using the old higher strength concentrated drops. Acetaminophen overdoses can lead to serious liver damage. To avoid errors, toss out acetaminophen drops in the higher strength (80 mgper 0.8 mL) and use only the newl ower acetaminophen strength (160mg per 5 mL).
- Avoid giving cough and cold medicines to infants and young children. In 2008, drug companies voluntarily removed over-the-counter (OTC) cough and cold products for infants and children less than 2 years old due to safety concerns. The safety concerns were based on reports of seizures, rapid heart rates, loss of consciousness, and death. These products contain decongestants (ephedrine, pseudoephedrine, orphenylephrine) and antihistamines(diphenhydramine, brompheniramine, or chlorpheniramine). Laterin 2008, companies re-labeledcough and cold medicines to say that the products should not be used in children less than 4 years of age. For children 4 years and older, do not give more than the recommended dosages and stop the medicine if it makes the child sleepy.
- Store medicines in a single location. Select a single, secure area to keep all medicines, rather than having them scattered in different bathrooms, medicine cabinets, bedrooms, and closets. Bathrooms and cabinets above the stove are not good because of the heat and humidity. In a 2010 study that used home visits to understand medication errors in children, homes that did not have a centralized location for medicines were more likely to experience medication errors. Thus, all medicines should be kept in one location that is up and away and out of reach of children (www.upandaway.org).
- Know how to measure liquid doses. Three out of four parents make mistakes when measuring doses of liquid medicines, particularly when using dosing cups that come with OTC medicines. More than one-thirdof the mistakes are large overdoses, which are serious in children.The errors are most often due to: 1) confusing teaspoon with tablespoon, especially since the markings “tsp” and “tbsp” look similar; 2) confusing mL (milliliters) with teaspoons; and 3) assuming that the entire dosing cup is the correct dose. If your child’s medicine does not come with a measuring device, or if it comeswith a dosing cup, ask your pharmacist to recommend an oral syringe to use. Before leaving the pharmacy with a prescription or OTC liquid medicine, verify with your pharmacist that you know how to measure the correct dose. Never use a household teaspoon or tablespoon to measure the dose—both are inaccurate.
- Don’t repeat a dose unless directed. While giving a liquid medicine to a squirming child, the parent and child might both end up wearing part of the dose. Or, the child may vomit shortly after taking the medicine. Although you may doubt the child has swallowed and kept down enough of the medicine, giving another full dose could be dangerous. It is best to call your child’s doctor or your community pharmacist, who can let you know whether you should give your child anothe rdose of that medicine.
- Verify all vaccines. Vaccines are made in different strengths for children and adults. But all too often, children receive an adult strength vaccine and adults receive a children’s strength vaccine. This mistake is common with vaccines used to prevent diphtheria, tetanus, and pertussis (whooping cough): Tdap is an adolescent/adult strength vaccine while DTaP is a vaccine for children less than 7 years old. The letters in eac hvaccine abbreviation signify diphtheria, tetanus, and pertussis. If most of these letters are uppercase (DTaP), it signifies a stronger form of the vaccine, which is necessary for young children to establish immunity. If most letters are lowercase (Tdap), it signifies a weaker form of the vaccine for adolescents/adults to boost existing immunity. Thus, if a young child receives the adolescent/adult vaccine, he or she will not be adequately immunized. Before your child receives a vaccine, ask your doctor or nurse for a Vaccine Information Statement (VIS)—a printed sheet that explains the purpose of the vaccine. These sheets, which physicians are required to give to parents, list age groups that should receive the vaccine so you can check that the right strength has been chosen for your child.
- Don’t give acetaminophen prior to vaccines. Vaccines can cause mild pain at the needle injection site and fever. In anticipation, parents may want to give their child a dose of acetaminophen before they get vaccinated. However, vaccines are less effective in children who havebeen given acetaminophen prior to vaccination. Only give children acetaminophen, as recommended by your child’s doctor after receivinga vaccine, if they develop a high fever (100.4 degrees in infants 3 months or younger, 102 degrees in children older than 3 months).Contact the doctor if the child’s fever does not go down after receiving acetaminophen. Use a cold compress on the needle injection site as needed to reduce pain. If pain worsens or the injection site becomes red or swollen, contact your child’s doctor.
- Child-resistant does not mean child-proof. If you have young children or grandchildren, you are probably used to being on the look out for danger in your home and the child’s play areas. But don’t let your guard down with OTC and prescription medicines that come with a child-resistant cap. Sometimes it’s tough for adults to open these caps, but children as young as 1 year have opened them in seconds. In 2011, a 13-month-old boy died after ingesting Suboxone (buprenorphine and naloxone) tablets. His parents allowed the child to use the bottle as a rattle, believing he could not open the child-resistant cap. According to the Consumer Product Safety Commission, child-resistant caps have to keep out only 80% of children under the age of 5. More than a million children are poisoned each year, many by household products and medicines that were in child-resistant containers.
- Be alert to the countless ways in which children can access medicines. A 2-year-old child died after putting a used patch containing a powerful pain reliever, fentanyl, in his mouth. The patch was picked up on the tires of the boy’s toy truck while playing on the floor i nhis grandmother’s room in a nursing home. He found the patch the next day and put it in his mouth, which caused him to stop breathing. A 4-year-old child died after finding a used fentanyl patch in a trashcan and placing it on his body. A toddler sat on a patch that fell off a family member and it stuck to her upper thigh. Another child removed a patch while his grandmother was sleeping and put it on himself like a Band-Aid. Also, children have been exposed to hormone medicines after skin-to-skin contact with a person using a topical product such as AndroGel (testosterone). This hormone causes children ,ranging from 9 months to 5 years, to have such symptoms as enlarged reproductive organs, increased sexual feelings, growth of pubic hair, advanced bone age, and aggressive behavior. In another case, a young child found a bottle of Tambocor (flecainide) in the refrigerator and drank most of its contents through a twist-on bottle adaptor used to help his parents measure each dose. Bottle adapters should be replaced with a child-resistan tcap after each dose is prepared. Two in every ten medicine poisonings in children involve grandparent’s medicines, oftenf ound on a shelf or table top at the grandparent’s house, or in a suitcase, a weekly or daily pill holder, or in grandmother’s purse.
- Take care with “yummy” medicine. Never tell your child that liquid medicine is a special drinkor juice, or that solid medicine is candy. Most children’s medicines are made to taste good so children will take them—a tactic that can work too well. However, even if the medicine tastes bad, don’t let your guard down. Childre nhave been known to drink a whole bottle of medicine that tastes just awful! Always mark the level of liquid medicines after each use by drawing a line on the label. Then, if a child drinks the contents, you’ll know how much is missing. This information will help determine if emergency care is needed.
Daniel R. Hoffman, Ph.D.
By Daniel R. Hoffman, Ph.D.
The Right's reflexes on matters of drug therapy are consistent with the way they feel about everything else. Trumping even considerations of whether or not the bible offers specific guidance, the Right claims that an unregulated market represents the best way, in fact the only way, of obtaining broader access to care, high quality and more affordable costs.
This reference to biblical fundamentalism is appropriate, but not just because the oligopoly corporations and the top 1% operate in unholy alliance with the repressive segments of evangelical Protestantism. (A former partner at Bain Capital let that point slip out on television this month while he was trying to argue that enormous disparities of income and wealth are good!) No, the point here is that the very idea of a completely unfettered market creating optimal benefits for everyone is as much a matter of non-empirical faith for the Right as anything to be found in a religious tract.
Now the positive results from markets that function the way they should are often highly beneficial. That in itself is not an argument for doing away with regulatory oversight, but it does explain why both developed and emerging nations generally try to make commercial markets the cornerstone of their mixed economies. Top-tier pharmaceutical companies, for their part, all give public lip service to the benefits of "free" markets. In reality, however, Big Pharmas seek a truly unencumbered market about as much as they want root canal procedures.
Michael R. Cohen, R.Ph.
By Michael R. Cohen, R.Ph.
There are more than 600 different prescription and over-the-counter (OTC) medicines that contain acetaminophen (Tylenol). The drug is often found in pain relievers, fever reducers, and sleep aids as well as cough, cold, and allergy medicines. These medicines are safe and effective when used as directed. However, severe liver damage can occur from taking too much acetaminophen (if you continue to take more than 3,000 to 4,000 mg per day). In most cases, this can happen if you take more than the prescribed or recommended dose of acetaminophen or if you take more than one product containing acetaminophen.
In January 2011, the US Food and Drug Administration (FDA) asked drug companies to limit the amount of acetaminophen in all prescription medicines to 325 mg per tablet. This would help reduce the risk of taking too much acetaminophen, particularly if the medicine is taken every 4 to 6 hours around the clock.
Abbott, the company that makes the prescription pain medicine Vicodin (hydrocodone and acetaminophen), will be decreasing the amount of acetaminophen in all of its Vicodin products to 300 mg per tablet. The amount of hydrocodone will remain the same based on the prescribed strength - 5 mg, 7.5 mg (called Vicodin ES), and 10 mg (called Vicodin HP). It is unclear at this point regarding the many generic versions of Vicodin and whether they are complying with these changes in the acetaminophen strength. So, use caution when adding up the amount of acetaminophen. Generic versions of Vicodin may not be exactly the same as the “new” Vicodin because of different amounts. When you drop off or pick up your prescriptions, ask your pharmacist how much hydrocodone and acetaminophen are in each tablet.
- Abington Memorial Hospital
- Agency for Healthcare Research and Quality
- American Medical Association
- Aria Health
- Centers for Disease Control and Prevention
- Centers for Medicare & Medicaid Services
- Consumer Medication Safety site from ISMP
- Cooper University Hospital
- Crozer-Keystone Health System
- ECRI Institute
- Inquirer Health & Science
- Institute for Safe Medication Practices
- Jefferson Health System
- Kaiser Health News
- Kennedy Health System
- Lourdes Health System
- Medical Society of New Jersey
- Mercy Health System
- New Jersey Department of Health and Senior Services
- New Jersey Hospital Association
- NPR.org Shots
- NYTimes.com: Well
- Penn Medicine
- Pennsylvania Department of Health
- Pennsylvania Health Care Cost Containment Council
- Pennsylvania Medical Society
- Pennsylvania Patient Safety Authority
- St. Mary Medical Center
- Temple University Health System
- Tenet Healthcare
- The ACP Advocate Blog by Bob Doherty
- The Chester County Hospital
- The Hospital & Healthsystem Association of Pennsylvania
- U.S. Department of Health and Human Services
- U.S. Food and Drug Administration
- Virtua
- WSJ.com Health
