Doctors Orders: Take as Prescribed?

Last time you were prescribed an antibiotic, did you take every pill in the bottle or packet as directed, or take them for the recommended number of consecutive days? Or, like millions of medical consumers, did you take them the first few days and then stop when you were feeling better?

Do you remember to take your blood pressure pills, cholesterol meds, or other prescriptions every day? Are you eating what you need to eat or avoiding what you shouldn’t be eating, again per your physician’s recommendations? Did you stop smoking yet, or cut back on caffeine and alcohol?  Do you visit a doctor annually for a full physical or for recommended preventive screenings based on your age and gender?

This isn’t a lecture, it’s pointing out a dangerous reality shared by many of us – the failure to comply with pharmaceutical or medical recommendations…or to even understand them.

Truth is, more than one in four Americans don’t follow their physicians’ guidance. That’s a huge problem, and in the case of medications – where the number of non-compliers is even higher – failing to take prescriptions as prescribed is common, costly, and can be deadly. Medicines are an important part of treatment for serious infections. They can help relieve pain and lift depression. They also can help combat some of the nation’s leading causes of death and disability by helping control many common chronic diseases and lower the complications associated with them.

Consider these statistics on just Rx non-compliance alone:

  • 75 percent of patients sometimes fail to take their medications as directed.
  • 33 percent of prescriptions are never filled.
  • 50 to 60 percent of the time, patients with chronic conditions do not take their medications.
  • 33 to 69 percent of medication-related hospitalizations are linked to drug noncompliance.
  • 125,000 patient deaths each year are linked to drug noncompliance.
  • $290 billion is spent annually on care needed because of medication noncompliance.
  • Why we don’t comply and how to improve our odds

    There are dozens of reasons for why we don’t take our medications as prescribed. We forget to take them. We leave them at home. They upset our stomachs or make us drowsy. They cost too much. They taste lousy. They’re hard to swallow. Or, we don’t understand why we’re taking them or how they help us, so we don’t take it seriously. It also could be because of cultural issues, language problems, or literacy challenges.

    Taking medications on time and correctly is extremely important. When we don’t take medications as prescribed, they may not work as well as they should, or we may have a greater risk for side effects. Also, many drugs work over a longer period and in less obvious ways. People who don’t take their blood pressure or cholesterol medications may feel well, but their blood pressure or cholesterol numbers may be rising. That can increase their risk for heart attack or stroke.

    Here are tips to help medications work safely and effectively:

    • Gather information. Request brochures and pamphlets from your doctor’s office about a condition and medication. Ask your doctor to recommend reliable websites that may help. Your nurse-information service is another good resource, if you have access to one.
    • Make a list of your medications. Include all medicines, vitamins, supplements, and herbal remedies that you use. Share this list with all your doctors and your pharmacist, and keep it up-to-date. This makes it easier for medical professionals to spot – and hopefully prevent – potentially dangerous drug interactions.
    • Don’t rely on your memory. Buy a special pill case that’s divided into the days of the week. Then keep it somewhere in plain sight but safe from children. Newer boxes have built-in alarms. Also, take your medication at the same time every day, like when you brush your teeth or feed the dog. Set your watch or cell phone alarm to go off when you need to take a dose. Even a note on the refrigerator may help you remember.
    • Talk with your doctor. Before you stop taking a medication or start taking fewer doses to save money or simplify your schedule, call your doctor – even if symptoms disappear or you don’t think the medicine is working. Suddenly stopping some medications can be dangerous.
    • Ask about a simpler schedule. If you just can’t keep track of all your medications and when to take them, ask your doctor for help. With some medications, you may be able to switch to a different dose that doesn’t need to be taken as often.
    • Explore more affordable options. Prescriptions can take a big bite out of your budget, even if your health benefits include drug coverage. But, taking less medication or skipping doses isn’t a safe way to save money. If you’ve been prescribed a brand-name medication, ask your doctor about using a generic instead. It will have the same active ingredients as its brand-name version but may cost less. Some pharmacies and drug companies offer discount cards. Additionally, you may be able to buy a larger dose and split it to save money. It may be cheaper, for instance, to buy 200 mg tablets and break them in half if you only need 100 mg. But ask your pharmacist because selected medications are not safe to split apart.

    Taking your medication as directed is just one part of a comprehensive strategy for staying healthy. Ask questions if you’re not sure what you’re taking and why you’re taking it, and especially if you’re in doubt about instructions.

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    Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

    Drink Up!

    Whether we’re running, playing sports, riding a bike, exercising, hiking on a trail or working outdoors, paying careful attention to proper hydration — especially in the warmer months — is critical to our health. When it’s warm, our bodies perspire more to help cool us down. Proper fluid levels are important for ensuring a good flow of oxygen and red blood cells to our muscles and organs. During exercise and activity, we also lose valuable nutrients and minerals. These include sodium, magnesium and potassium, which help keep our muscles working properly, reduce fatigue and prevent dehydration.

    Thirst alone shouldn’t be our barometer for measuring fluid loss. The rule of thumb should be to drink plenty of liquids before, during and after each activity.

    A good guideline to use when preparing for an outdoor workout is to drink about two cups of fluid two hours before the activity. That helps make sure we are well-hydrated before we even go outdoors. Then, during the activity, we should drink four to six ounces every 15 to 20 minutes to keep our muscles well-hydrated. If planning an hour-long walk or gym workout, take a water bottle with about 16 ounces (two cups). Then, after exercise, drink again.

    Fluids are vital to help our muscles function throughout our activity, but so is our blood sugar. Eat a light meal or snack of at least 100 calories about an hour or so before an activity. The nutrients from the snack will help keep hunger from interfering. The best snacks combine healthy carbohydrates, protein, and a small amount of fat. Fruit, yogurt, nuts, and granola bars are all good examples.

    Water or sports drinks?

    For most outdoor activities, regular tap or bottled water does the trick. If activity lasts an hour or more, either fruit juice diluted with water or a sports drink will provide carbohydrates for energy, plus minerals to replace electrolytes lost from sweating.

    Sports drinks like Gatorade, Powerade, and All Sport can provide a needed energy boost during activity. They are designed to rapidly replace fluids and to increase the sugar (glucose) circulating in our blood. However, read the label to determine which sports drinks are most effective. Ideally, it will provide around 14 grams of carbohydrates, 28 mg of potassium, and 100 mg of sodium per eight-ounce serving. The drink’s carbohydrates should come from glucose, sucrose, and/or fructose, rather than from processed sugar or corn syrup. These are more easily and quickly absorbed. It shouldn’t be carbonated, as the bubbles can lead to an upset stomach.

    Most sports beverages are well-diluted and contain relatively few calories. If the flavor of a sports drink helps you maintain hydration, diluting it with water or pouring it into a thermos packed with ice will cut down even more on excess calories.

    “Fitness waters” such as Propel are lightly flavored and have added vitamins and minerals. The additional nutrients are meant to supplement a healthy diet — not replace losses from exercise.

    Fitness waters fall somewhere between the sports drinks and plain water in terms of being effective hydrators. They contain fewer calories and electrolytes than sports drinks, but offer more taste than plain water. Additionally, the so-called “designer, or super waters” are advertised as being enhanced with everything from vitamins, oxygen and glucose, to alleged fat-burning minerals. The FDA does not require proof of this kind of claim, but whatever helps keep you hydrated is worth considering…as long as you keep drinking!

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    Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

    Scratch Weeks of Discomfort, Not Outdoor Fun

    As the summer approaches we’re back outdoors enjoying hiking, camping, and picnicking. We’re working in our yards, attending sporting events and barbeques, and loving the warm weather and beautiful flowers. However, there’s a serious side to outdoor play. We don’t want to sound like a teaser for a Steven King novel, but there are certain dangers lurking in the trees and among the bushes, trails and woods that we need to know about. These aren’t necessarily all life threatening, but certainly can be annoying and, in some cases, can lead to serious illness or even death. We’re not talking lions, tigers, and bears (oh my), but about poisonous plants.

    Poisonous plants adorn trails, parks, yards, golf courses and ballfields across the Northeastern United States. While it goes without saying that we should never pick and eat a wild berry we don’t know and recognize distinctly (like wild blueberries or blackberries), there are dozens of inviting berries growing in bushes along paths that can sicken or kill us if ingested. Same goes for toadstools (mushrooms) growing in the wild. Don’t even touch them, unless you are trained and know what you’re doing.

    Plants poison people in two ways – contact with the skin and contact with the mouth, including swallowing. Reactions range from mild skin irritation to much more serious effects. It is common that one part of a plant is poisonous while other parts are not.

    Different types of poisonous plants affect the body differently. Stomach upset, including vomiting and diarrhea, and skin rash are the most common problems. Some examples of plants that can cause stomach upset include pokeweed, ivy, Jerusalem cherry, and the bulbs of the daffodil, and iris. Poinsettia can be a mild irritant, but only in very large quantities, and is not considered to be very poisonous.

    Almost any plant can cause a skin rash (dermatitis) in sensitive people. Daisy, black-eyed-susan, and hyacinth are some common examples of plants that can cause dermatitis. Additionally, some plants have calcium oxalate crystals, which cause burning and swelling of the throat, tongue, and mouth. Jack-in-the-pulpit, philodendron, and dieffenbachia are among the many plants that have this needle-like irritant. Rhubarb contains another type of oxalate. Eating large amounts of rhubarb leaves may damage the kidneys and other organs.

    Foxglove, lily-of-the-valley, and oleander are very toxic. They are examples of cardiac glycosides. Cardiac glycosides can affect the heart rate and rhythm. Symptoms may include nausea and vomiting, belly pain, slowed heart rate, irregular heart rhythm, dropping blood pressure, and lethargy. Death may occur in severe cases.

    Avoiding the most common intruders — poisonous ivies

    The most common poisonous plants we typically see in Connecticut include Poison Ivy, Poison Oak, and Poison Sumac. Each of these can produce a topical reaction that includes a rash, itching, and weepy open sores and blisters that easily spread when scratched or touched. People who are highly allergic can be affected by spores carried in the air, or when the poisonous leaves are burned, but most people react after touching or brushing up against the plants or items that have been in contact with the plants’ oils. In more serious cases, the reaction can spread across the body, and even get into your bloodstream.

    • Poison Ivy usually has three broad, spoon-shaped leaves or leaflets (“Leaves of three? Let it be!”), but it can have more. It may grow as a climbing or low-spreading vine that sprawls through or as a shrub. It’s common to see it along fences and stone walls, and throughout wooded areas. Most people are allergic to the oily resin or sap of poison ivy. You can get a rash by touching any part of the poison ivy plant, or anything that has come in contact with poison ivy and still has the oily resin on it (for example, gardening equipment and tools, toys, pets, clothing, shoes, gardening gloves, camping equipment and sports gear).
    • Poison Sumac has seven to 13 leaflets per leaf stem. The leaves have smooth edges and pointed tips. Poison sumac grows as a shrub or small tree. It is found in wooded, swampy areas and in wet, wooded areas.
    • Poison Oak has leaves that look like oak leaves, usually with three leaflets but sometimes up to seven leaflets per leaf group. It grows as a vine or a shrub. Poison oak is more common in the western United States, but is also found in the eastern United States.

    Plants may look different depending on the season and the area where they are growing. But all of these plants have small white, tan, cream, or yellow berries in the fall. Their berries can help distinguish them from harmless but similar plants. Also, after the leaves have fallen off, these plants can sometimes be identified by the black color on areas where the oil in the plant has been exposed to air.

    The best approach for beating any allergic reaction is to avoid the source that triggers it. Here are some tips to help you steer clear of poison ivy, poison oak, and poison sumac:

    • Avoid areas where you know poisonous plants grow, whenever possible.
    • Cover up with closed shoes, socks, long pants, long sleeves, and gloves. Wash any clothes that come in contact with poisonous plants as soon as you can.
    • If you do get exposed, wash your skin with soap and water, or rubbing alcohol. Though the timeframe varies by person, you have about 10 minutes to wash a poisonous plant’s oil off your skin before the stage is set for a rash.
    • Scrub under your nails. You can spread poison ivy to other parts of your body by having the oil on your fingers.
    • If you suspect your pet has rolled around in a poisonous plant, give him a bath with pet shampoo and water — before you hug or touch him. Wear rubber gloves while you give your pet a bath.
    • Oil from poison ivy and other poisonous plants can get on golf clubs, balls, bats, and any other objects, and can remain potent for as long as five years. Make it a habit to wash sports equipment, gardening tools, and other outdoor items with soap and water.

    Ultimately, if you do come in contact with and react to one of these common poisonous plants, there are a variety of over-the-counter remedies, lotions and drugs (such as strong antihistamines like Benadryl, and topical treatments such as hydrocortisone) available. The best advice always is to seek professional assistance from your physician or pharmacist to see what’s recommended, how to care for yourself, and how it might react with other drugs or medicine you may be taking. In serious cases where the rash is spreading quickly and leaving blisters or sores, you should seek immediate medical attention from a physician or medical center. You may require a stronger medicine administered by injection, or other care to prevent the infection from entering your bloodstream and potentially causing internal damage.

    Being outdoors is healthy and fun, but you still have to be careful. We’ll save common biting insects and snakes for another day!

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    Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

    Reducing Stress at Work

    Last month was National Stress Awareness Month and we examined the impact of stress on employee wellness. This month we’ll address how to set up a roadmap for decreased stress in the workplace.

    According to the 2013 Work and Well-Being Survey released in March by the American Psychological Association’s (APA) Center for Organizational Excellence, more than one-third (35%) of American workers experience chronic work stress. The APA’s most recent Stress in America survey (released in February 2013) also found high levels of employee stress, with 65 percent of working Americans citing work as a significant source of stress, and 35 percent  reporting that they typically feel stressed during the workday.

    According to the Work and WellBeing Survey, fewer than half of working Americans report that they receive adequate monetary compensation (46%). Of course, employers can’t be expected to arbitrarily increase employee compensation across the board and stay in business. But it’s critical to note that almost half of the employees surveyed (46%) talked about non-monetary compensation. Additionally, just 43 percent of employees say that recognition is based on fair and useful performance evaluation, and just over half (51%) say they feel valued at work. Besides feeling undervalued, employees also report feeling unheard: Less than half (47%) say their employer regularly seeks input from employees, and even fewer (37%) say the organization makes changes based on that feedback.

    These numbers help put into perspective what organizational development experts see as an epidemic-level wave of unhappy employees. If you’re wondering what the impact of this unhappiness may be on your workplace, consider that stress at work manifests itself in increased absenteeism and presenteeism, lower productivity and increased service errors, and has a negative impact on safety, quality and teamwork.

    Yet despite growing awareness of the importance of a healthy workplace, few employees say their organizations provide sufficient resources to help them manage stress (36%) and meet their mental health needs (44%). Just 42 percent of employees say that their organizations promote and support a healthy lifestyle, and only 36 percent report regularly participating in workplace health and wellness programs.

    That sounds like a boatload of opportunity for savvy employers who want to do more to address workplace stress, but don’t want to spend a fortune.  People want to be heard and feel that their opinions count. They want to see an employer show an interest in them as human beings, and want to be recognized for their hard work, dedication and value. And since health is important to all of us, investing in health and wellness planning, and involving your workforce in both the planning and execution can result in a significant return on investment.

    Taking time to ask employees what they think is important. That can be done informally at lunches, team meetings, small-group interactions, and one-on-one. There are a variety of inexpensive online tools available for surveying attitudes and communication, as well. But the easy steps, like building employees into planning and decision making is invaluable for improved execution and buy-in. And recognizing performance, personally and in front of the team, pays back in spades. Small gestures like gift certificates, comp time, and team lunches go a long way toward improving morale.

    You can sponsor team walks and charity events, supplement fitness center fees, host on-site health screenings, and many other activities – the list of potential steps is long, as are the benefits. Additionally, if you haven’t yet, consider establishing a wellness champion and having your employees participate in a free, online health assessment. You can do this by joining CBIA Healthy Connections at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!