health

Multiple Prescriptions May Have Negative Interactions

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | January 19th, 2017

Dear Doctor: Our elderly father is now seeing several specialists, all of whom have prescribed medications. My brothers and I are worried about how many pills Dad has been told to take, and the fact that these doctors don't seem to be consulting with one another. How do we make sure the drugs are safe and appropriate?

Dear Reader: You've hit on a problem that is both serious and widespread, particularly among the elderly. It's called polypharmacy, and it describes the simultaneous use of multiple drugs to treat one or more ailments or conditions. The risks of polypharmacy range from drug interactions that may make a person feel unwell, to those that are dangerous and may cause physical harm or even death.

It's estimated that more than 40 percent of men and close to 60 percent of women over the age of 65 now take five or more medications per week. This includes prescription medications from physicians; over-the-counter medications such as aspirin or antacids; vitamins, homeopathic or herbal remedies; and nutritional supplements. Any of these, in the wrong combination, can cause problems.

When it comes to medications, these are often prescribed by several different specialists who may not be familiar with a patient's medical history. When taken in combination, some of these drugs may cause problems such as dizziness, bleeding, confusion, low blood pressure or respiratory distress. In some cases, adverse drug interactions can send patients to the hospital.

So how do you make sure this doesn't happen to your dad? If you and your brothers are helping him keep track of things, these are tasks for you. If your father is handling his own health care, these are steps he should take:

-- Start by getting organized. Make a complete list of all medications, including any over-the-counter medications as well as herbal and dietary supplements. Write down the dose of each drug and how often and at what time he takes it.

-- If your father has a primary care physician, ask her or him to check the list. It can be run through a drug interactions database to identify potential problems. If a primary care physician is not part of your father's health care, you can get the same help from his pharmacist. To keep things simple, it's a good idea to have just a single pharmacy dispense all of your father's medications.

-- If any problems come to light, contact each of the prescribing physicians and explain the issue. By coordinating with all of the doctors, you can arrive at a list of drugs that are both necessary and safe for your father to take.

-- Going forward, your father should bring this new list of medications with him to every medical appointment. He should share it with each doctor he sees so future drug interactions can be avoided.

-- When a new drug is prescribed, your father should ask what the drug is for, what is the proper dosage, how long it should be taken for, how he will know it is working and whether there are any side effects or risks associated with the drug.

-- Always add any new drug, along with its dosage, to the medications list.

-- Periodically check with the prescribing physicians regarding the drugs they have recommended. Perhaps a dosage has changed, a drug can be eliminated, or it should be changed.

(Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.)

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)

health

Too Much Video-Gaming May Have Adverse Effects on Teens

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | January 18th, 2017

Dear Doctor: My son is obsessed with electronic gaming. He spends hours a day doing this. Is this unhealthy?

Dear Reader: I have a teenage son as well, so this is a question with which both you and I struggle. When I was younger, in the infancy of computer games, the games were of low resolution and the goal was simply to develop enough skill to master them. To me, this was a fun activity, often separating me from the mundane and stressful activities of everyday life.

Today's games are more complex, requiring a variety of skills in complex reasoning and hand-eye coordination. Proficient players record their techniques on YouTube, and the truly elite compete in auditoriums, watched online by hundreds of thousands of people. Is there a downside to this? Definitely -- if parents don't manage it properly.

The first potential problem with these games is the prolonged sitting required. This type of sedentary behavior can lead to obesity.

A 2004 study performed in Switzerland compared obesity rates and the hours that people spent either playing electronic games or watching television. Researchers found a significant correlation between playing electronic games and obesity, with a connection especially likely among people who spent more than two hours a day playing games. On the plus side, the obesity rates were not as high among game-players as among people who watched television, supposedly because of the passive nature of watching television and the greater amounts of unhealthy food consumed while watching it.

Other studies have not shown this obesity risk, but then they've only compared the risk of more than one hour of gaming per day versus less than one hour of gaming per day.

In a study by the American Academy of Pediatrics in 2009, children and teens who said they played more than 45 minutes of video games per day were more likely to report poorer health and increased psychological distress than those who played less than that amount. Those gamers also were found to have more behavior problems.

And consider this: In an Australian survey study of 3,000 adolescents ages 11 through 17, those who had the highest levels of psychological distress were those who spent the most time playing electronic games or roaming the internet. It may be that gaming itself is not the full problem. Rather, the gaming may be an outlet for children with emotional issues.

However, the biggest problem with gaming is that it can be addictive. The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) identifies Internet Gaming Disorder as a condition that warrants further studies.

My feeling is that electronic games can have benefits for children and adolescents, but exposure to them must be limited.

I recommend that you watch for addictive behavior from your son in connection to these games and that you limit the amount of time he spends with them each day. The American Academy of Pediatrics recommends no more than two hours of screen time per day. If your son is playing these games and in addition watches television, he may have an increased risk of obesity, poorer health and behavior problems.

When it comes to activity, keep two other pieces of advice in mind. One, encourage your son to substitute more active video games over the more passive variety and, even better, encourage him to pursue sports and other forms of exercise.

(Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.)

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)

health

Talk to Family's Doctor Before Moving Kids to Vegan Diet

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | January 17th, 2017

Dear Doctor: My sister has decided to switch her entire family to a vegan diet, including her 2-year-old twins. But I'm really worried -- is it possible for young children to stay healthy and get all of the nutrients that a growing body requires?

Dear Reader: Unlike a vegetarian diet, which cuts out meat, poultry and fish, the vegan approach eliminates all animal-based products. It centers instead on whole grains, legumes, nuts, seeds, fruits, vegetables and leafy greens.

Some people choose a vegan diet for health reasons, others for ethical ones. But because not all nutrients essential to human health are present in plants, vegans face special challenges to ensure that their diet is well-rounded.

A vegan diet for young children has gotten a lot of bad press recently. A mother in Pennsylvania, who fed her infant only nuts and berries in an effort to go vegan, was recently charged with child endangerment. In Italy, where a number of vegan babies wound up in the hospital with malnutrition, some lawmakers want to make a plant-based diet illegal for anyone under 16.

But these are extreme cases. Proponents of plant-based diets say the real culprit is ignorance of proper nutritional principles, not veganism itself. With care and vigilance, and with the guidance of a pediatrician or registered dietitian, a well-balanced vegan diet can provide the nutritional needs of children and adolescents.

One of the most important parts of childcare is proper nutrition and feeding. Due to their more intensive nutritional requirements, children and adolescents are more susceptible to malnutrition when following an atypical diet. With a relatively short window in childhood during which critical growth in the brain, body, skeleton and internal organs takes place, it's all too easy for a child's diet to adversely affect future growth and development.

Vitamin B-12, vitamin D, iron, zinc, calcium and essential fatty acids are key nutrients for proper development in babies and children. Getting an adequate amount of B-12, which is provided by milk and eggs in a traditional diet, and meeting the minimum requirement for iron, which is present in red meat, is of particular concern in the vegan diet.

As there are no known plant sources for vitamin B-12, and without meat to provide essential fatty acids and other nutrients, providing a nutritional supplement, such as a multivitamin, is essential to normal growth and good health.

Another concern is that the plant-based diet is less nutrient-dense and more difficult to digest than the traditional diet. It not only takes more food to meet caloric and nutritional needs in a plant-based diet, it requires a greater amount of energy for the body to extract nutrients. Including concentrated sources of energy such as nuts and nut butters, soy products and legumes will help support appropriate growth.

If your sister does her homework, works in partnership with her primary care physician or a dietitian, makes sure the children get the full range of nutrients they need and are hitting their growth milestones, having a healthy vegan family is indeed possible.

A final thought -- going vegan is a radical change. Perhaps suggest to your sister that the family do a dry run, for instance Vegan Wednesdays for a month or two? If that works, then they can expand slowly until veganism becomes a family lifestyle.

(Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.)

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)

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