Worms infection

This is the question i always come across in my pharmacy?
1) My son/daughter is very thin? Can i give him Zentel?
2) My son stomach is very big? Can i give him Zentel?
3) It is already a month since i last gave him Zentel, can i give him again now?

Worms that infect humans can be divided into roundworm, whipworms, threadworms, hookworms, tapeworm, and fluke. Eating undercooked beef, pork, fish that friends with marine mammals, walking barefoot or swimming, playing with soil etc are some of the ways to invite them to stay inside your intestine.

Worms transmission -usually via direct anus to mouth transfer.What are the symptoms?
The most frequent symptom is irritating perianal itch that occurs at night as the female worms deposits it eggs.

Above pictures were taken during my visit to UPM Veterinary Department

Ask the pharmacist

Prevention
-Wash bed linens, towels, underwear in hot water. Remember not to shake it as it can disperse the eggs into air.
-The person should take daily morning showers to remove the eggs deposited outside the anal druing the night. Yes. The worms do not lay eggs inside.
-Use disinfectant on toilet seats and bathtube or anything that in contact with the butt.
-Wet mopping the floor.
-After the child uses the toilet, scrub the child's fingers with soap and brush.
-Trim the nails regularly.
-Wash hand regularly.

Take any one of these.
1) Zentel Suspension RM 8.55
2) Zentel Tablet Rm 6.40
3) Champs D-Worms Rm 5.60
4) Pharmalogik Worms Solution RM 4.50

All contains the same ingredient which is Albendazole. But diff price. Which one you choose?

Do u feel like want to take the medicine for worms after reading all these? I do as i write. Sometimes it is just physiological. But my butt feel itchy liao. Oh my god, do i have worms? Come to pharmalogik and buy your dose to kill that sh*t.

Kidney Failure; Acute Renal Failure

Kidney is one of the most important organ in the body. Without it, anything that we eat will end up poisoning our body.

Risk factors of kidney failure:
Chronic medical illness such as Diabetes and Hypertension
Systemic diseases such as SLE, etc.

If u ever wonder the cost of dialysis in Malaysia?
Recently i talked to my friendly customer who worked in a dialysis center. Kidney failure patient need to go for dialysis 3 times a week.

Cost (/month)
Private hospital
RM 250x13=RM3250

Charity funded dialysis center
RM 110x13= RM1430

If u apply for gov subsidy,
RM 110-RM 50=>RM 60x13=RM 780

I would say RM 780 /month still a very high figure, considering the gov only give RM 625/year one time for fuel rebate. Dialysis is a life long treatment. If a patient has kidney failure at age 40 years old, another 30 years of dialysis life will cost him RM 280,800.00. And this amount does not include cost from work loss, transport, medications etc.

So, now the question which many of my customers often ask is
Do ARBs (Angiotensin Receptor Blocker) and ACEI (Angiotensin Converting Enzyme Inhibitor) group of hypertension medicine protect the kidneys?
My doctor said this medicine is good for my kidney. ACEI group: Zestril, Coversyl, Renitec

ARBs group: Atacand, Cozaar, Fortzaar, Aprovel, Micardis, Diovan

Ask the pharmacist

Haha.. I would say yes if u are a diabetic or u have diabetic nepropathy.

But for patient with chronic kidney disease, the answer is BIG NO becoz it actually worsen the situation. That is why when u go for hospital treatment, they will take your blood sample to check for BUN, creatinine and potassium within 1 week after initiation of medicine from these groups. This is to detect early sign of kidney malfunction due to these group of medicine.

In elderly patients (kidney function often deteriorates with aging), we would like to advise to avoid NSAIDs/COX-2 I (pain killer) to be administered with ACEI, ARB and diuretics.

If u have the symptoms such as decrease urine production, dizziness or swelling of legs or ankle, pharmacists will advise u to see your dr, as all these is sign of acute kidney failure.

Prevention is better than cure, but in kidney failure, there is no cure, only prevention. Email me if u have further questions. Consult your pharmacist.

Treatment for Sore throat

What do we do when we have sore throat?
1) Go to supermarket/ grocery shop to buy Strepsils.2) Go to pharmacy and ask for advise.
3) Go to see Dr.
4) Drink more water?

Ask the pharmacist
1) First we have to differentiate whether the cause of sore throat caused by virus or bacteria.
Viral/Virus pharyngitis- Mild redness, slight inflamation, prominent lymphoid patches.

Streptococcal (bacteria) pharyngitis- Erythema, inflammation, and white patches of the tonsils.

2) If it is caused by virus, there is nothing much u can do, taking antibiotics wont help. It will heal by itself after about 7 days. Taking pain killer and certain medicine will help to reduce the pain and inflammations. So look in the mirror for yourself and don't always ask for antibiotics whenever u see a Dr! Taking too much antibiotics is no good.

3)If it is caused by bacteria, u can either take antibiotics or lozenges or use a mouthwash.

Sore throat lozenges

Mouth Wash (See it only said it protects against oral bacterial and fungal infections, NOT VIRUS)

Maybe taking vitamin C will helps.

4) Lastly always consult your Dr and pharmacist.

Choosing a cholesterol drug or statins? LDL cholesterol high?

ScenarioWe go for our annual blood test. Then we notice on lipid studies section stated our LDL-cholesterol is high. Then what we usually do? Go to see a Dr, Dr start us on statins, then asked to come and check for our cholesterol lelvel after 4 months?

We was told that LDL will clog our artery and cause heart attack. So we have to take statins to lower the LDL.

But which one?

Ask the pharmacist

1) How to choose between the statins which is most suitable?

Statin of Choice	Average LDL reduction
Lipitor 10mg	36%
Lipitor 20mg	44%
Lipitor 40mg	49%
Lipitor 80mg	50%
Vytorin 10/20	52%
Lescol 20mg	22%
Lescol 40mg	25%
Lescol 80mg XL	35%
Lovastatin 20mg	25%
Lovastatin 40mg	31%
Pravachol 10mg	21%
Pravachol 20mg	26%
Pravachol 40mg	30%
Crestor 10mg	43%
Zocor 10mg	30%
Zocor 20mg	35%
Zocor 40mg	40%

Lets say the
Case 1
Patient's LDL is 4.11, and the target is 2.6 so we have to reduce by 35%. We can choose to take Zocor 20mg or Lipitor 10mg.

Case 2
Patient 's LDL is 4.91, and the target is 2.6, so we have to reduce by 48%. We can choose to take Lipitor 40mg or Vytorin 10/20mg.

By now, u should roughly know if the statins u r taking is suitable for u or not. Actually to start a cholesterol medication on a patient, we need to take many things into considerations.
Such as whether the statins taken will reduces the risk of heart attack and death rate. This is becoz even the medicine lower the LDL cholesterol, it does not mean u will have less risk of getting heart attack.
Then they also take into considerations your age, race, gender, muscle tissue damage, liver damage, kidney patients, HIV patient, warfarin patients.
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2) But is taking statins good for u?

Interesting extract from BusinessWeek
Statins drugs are the best-selling medicines in history, used by more than 13 million Americans and an additional 12 million patients around the world, producing $27.8 billion in sales in 2006. Half of that went to Pfizer for its leading statin, Lipitor.

The drugs can be life-saving in patients who already have suffered heart attacks, somewhat reducing the chances of a recurrence that could lead to an early death. But for the majority of patients, who don't have heart disease. No benefit has been found in people over the age of 65, no matter how much their cholesterol declines, and no benefit in women of any age. There is a small reduction in the number of heart attacks for middle-aged men taking statins in clinical trials. But even for these men, there was no overall reduction in total deaths or illnesses requiring hospitalization—despite big reductions in "bad" cholesterol.

A current TV and newspaper campaign by Pfizer, for instance, stars artificial heart inventor and Lipitor user Dr. Robert Jarvik. The printed ad proclaims that "Lipitor reduces the risk of heart attack by 36%...in patients with multiple risk factors for heart disease."
The dramatic 36% figure has an asterisk. Read the smaller type. It says: "That means in a large clinical study, 3% of patients taking a sugar pill or placebo had a heart attack compared to 2% of patients taking Lipitor."

Now do some simple math. The numbers in that sentence mean that for every 100 people in the trial, which lasted 3 1/3 years, three people on placebos and two people on Lipitor had heart attacks. The difference credited to the drug? One fewer heart attack per 100 people. So to spare one person a heart attack, 100 people had to take Lipitor for more than three years. The other 99 got no measurable benefit. Or to put it in terms of a little-known but useful statistic, the number needed to treat (or NNT) for one person to benefit is 100.

In an eagerly awaited trial completed in 2006, the companies compared Vytorin, ezetimibe plus a statin with a statin alone in patients with genetically high cholesterol. But the drugmakers delayed announcing the results, prompting scientific outrage and the threat of a congressional investigation. The results, finally revealed on Jan. 14, showed the combination reduced LDL levels more than the statin alone. But that didn't bring added benefits. In fact, the patients' arteries thickened more when taking the combination than with the statin alone.

IRRELEVANT LDL?

If cholesterol lowering itself isn't a panacea, why is it that statins do work for people with existing heart disease? In his laboratory at the Vascular Medicine unit of Brigham & Women's Hospital in Cambridge, Mass., Dr. James K. Liao began pondering this question more than a decade ago. The answer, he suspected, was that statins have other biological effects.

Since then, Liao and his team have proved this theory. First, a bit of biochemistry. Statin drugs work by bollixing up the production of a substance that gets turned into cholesterol in the liver, thus reducing levels in the blood. But the same substance turns out to be a building block for other key chemicals as well. Think of a toy factory in which the same plastic is fashioned into toy cars, trucks, and trains. Reducing production of the plastic cuts not only the output of toy cars (cholesterol) but also trucks and trains. In the body, these additional products are signaling molecules that tell genes to turn on or off, causing both side effects and benefits.

Liao has charted some of these biochemical pathways. His recent work shows that one of the trucks, as it were—a molecule called Rho-kinase—is key. By reducing the amount of this enzyme, statins dial back damaging inflammation in arteries. When Liao knocks down the level of Rho-kinase in rats, they don't get heart disease. "Cholesterol lowering is not the reason for the benefit of statins," he concludes.

The work also offers a possible explanation of why that benefit is mainly seen in people with existing heart disease and not in those who only have elevated cholesterol. Being relatively healthy, their Rho-kinase levels are normal, so there is little inflammation. But when people smoke or get high blood pressure, their Rho-kinase levels rise. Statins would return those levels closer to normal, counteracting the bad stuff.

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3)Conclusion of above article: In my opinion, I think those who have had a heart attack or heart disease should take statins, but for normal people which have high LDL, ask your dr's advice.
For more reading, pls refer to the article by John Carey (BusinessWeek)

We pharmacist cannot recommend statins as in Malaysia (not like UK), only Dr can. Here, we can just give counseling on how to reduce risk and check for drug-drug interactions and dispense what your Dr prescribed.

4) According to Dr Daniel Stienberg, LDL is not bad, it is the modified oxidized LDL cholesterol that is truly bad as it cause damage and hardening to the artery. So he and Dr Ray recommend to take antioxidants such as Vitamin E, C, Bioflavonoids to reduce oxidation of the LDL. So i think Exercise, eat healthily and taking supplements to lead a healthy lifestyle is the utmost important.
Suggested reading:5)So, always follow your Dr recommendations. But of course, u always can get a second opinions from another Dr if u think the Dr does not put your health in your best positions. U also can consult your pharmacist for advise on how to take the prescribed medications and also the supplements which can help u. Hehe....

Comparing Vitamin B Complex

Which one is the best?

	Vitamin B Complexs	B1	B2	B6	B12
1	Surbex X-Zinc	15mg	15mg	10mg	12mcg
2	Berocca	15mg	15mg	10mg	10mcg
3	Enervon C	50mg	20mg	5mg	5mcg
4	Blackmores Executive B	7.5mg	8.5mg	10mg	10mcg
5	Blackmores B+C	7.5mg	8.5mg	10mg	10mcg
6	Blackmores Multivitamins	7.5mg	8.5mg	10mg	10mcg
7	Centrum	2.25mg	3.2mg	5mg	20mcg
8	Pharmaton	1.4mg	1.6mg	2mcg	1mcg
9	Vita Mega B+C	5mg	5mg	5mg	2.5mcg
10	Iberet Folic	6mg	6mg		25mcg
11	Neurorubine Forte	200mg		50mg	1000mcg
12	Neurobion	100mg		200mg	200mcg
13	Neurovit	97mg		50mg	100mcg

Which one is the best? Decide yourself

Public Questions: Vitamins in Pregnancy

Hi there...
Found your blog to be very informative! If you don't mind got a few questions need answering...
Vit A is teratogenic but beta carotene form is ok? Been taking pramilet for the last 4 months. Which form of Vit A is it in Pramilet? Thought the rec dose during pregnancy is 770mcg (~2400IU) but Pramilet v high. Is that ok? If Obimin is best should I change?
How about taking essential fatty acids while pregnant? Is it beneficial and what are the side effects? Heard DHA and Omega 3 particularly good for brain development but has it got any teratogenic effects. Like fish oil ..is it because of the vit A in it?

Ask the pharmacist

1) Beta carotene is metabolized to vitamin A, but the proportion converted to vit A decreases as beta carotene intake increases.So therefore no toxicity of Vit A. But u have to limit your daily beta carotene consumptions to 7mg max/day.
Studies have shown that supplying 20mg daily for 5-8 years to smokers will increase the risk of lung cancer, prostate cancer, stroke, heart attack etc. This is becoz smoking produce carcinogenic beta carotene oxidation metabolites. So for smokers out there, if u want to die faster, remember to take beta carotene. If want to live longer, pls stop smoking right now.

2) Vitamin A in obimin is higher than pramilet. Recommended daily allowance of vitamin A during pregnancy is 2700IU, although it shall be ok if u r not taking more than the max daily doses of 10,000 units.
Pls aware that this 10K units will include vitamin A from dietary units, esp animal liver, and even some breakfast cereal. Be extra careful in first trimester. Remember never to take 2 tablet of Obimin or Pramilet in one day. Always consult your pharmacist b4 choosing any supplements. As i say b4, if u r a healthy mother, there r no reason for u to take any extra supplementations also except folic acid.

3) Follow your dr recommendations would be the best choice in choosing supplementations becoz dr is the one who checked u. Of course u can always consult your pharmacist.

4) Essential Fatty acids is not necessarily to take during pregnancy. Insufficient evidence for its use.
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Hopes it help. Let me know if u want to know more.
Previous post Comparing Vitamins in Pregnancy

How to take Postinor 2? Morning After pills

How do u take postinor-2?
According to,
1)Manufacturer leaflet: one Postinor-2 within 72 hours following intercourse and another 12 hours after taking the first pill.2) Martindale reference: levonorgestrel may be given alone by mouth in a single dose of 1.5 mg (2 tablets) within 72 hours of coitus (preferably as soon as possible).
Alternatively, a dose of 750 micrograms (1 tablet) is given within 72 hours of coitus (preferably as soon as possible), and repeated after 12 hours.

3) BNF 53rd Ed Sept 2007: 1.5mg as a single dose as soon as possible (preferably within 12hours but no later than after 72 hours.

Ask the PharmacistDue to popular search, I have decided to answer most of the questions posted by my reader here

1) I would advise them to take as single dose, ie 2 tab at once as soon as possible for increased compliance and to follow the latest advise from British National Formulary. Actually the pills can be taken up to 120 hours after sex, without regard to menstrual cycle, but the efficay reduced as the time pass. The pregnancy rate if taken after one day is 0.4%, 2 days is 1.2% and 3 days is 2.7%.

After u have taken the 2 pills, u may experience menstrual bleeding within one week of the expected time. If u took the pills late into the cycle, your next menses will be prolonged.

2) After u have taken postinor, if u have unprotected sex again, u may become pregnant. So u can take another 2 pills again as the max doses is 4 pills /month.
If u vomited within one hour, take a vomiting pills together with postinor again.

3) The safest unprotected sex is few days before your menses come.
Just use the other methods if u r not sure, ok? Dont understand? Use barrier. DONT UNDERSTAND? USE CONDOM lar ...hehe....

4) Consult a pharmacist if u take any anti convulsant or epileptic medicine such as phenytoin, carbamazepine, and valproic acid etc. Sorry as i wont be replying to the comments here anymore. If you have further questions, pls click like on my facebook account and message me there.

Comparing Vitamins in Pregnancy

Best vitamins to take pre and post pregnancy

	Iberet Folic	Obimin	Pramilet
Elemental Iron	105mg	30mg	5mg
Vitamin C	500mg	100mg	60mg
Niacinamide	30mg	20mg	10mg
Calcium Pantothenate	10mg	7.5mg	1mg
Vitamin B1	6mg	10mg	3mg
Vitamin B2	6mg	2.5mg	2mg
Vitamin B6	5mg	15mg	3mg
Vitamin B12	25mcg	4mg	3mg
Folic Acid	800mcg	250mcg	500mcg
Vitamin A		6000USP	4000IU
Vitamin D		400USP	400IU
Calcium Lactate		250mg
Copper		0.1mg	0.15mg
Iodine		0.1mg	0.1mg
Dimethyl polysiloxane		20mg
Ca			250mg
Mg			10mg
Zinc			0.85mg

Ask the pharmacist

1)Vitamins to be taken during pregnancy are:
a)B12 >5mcg
Especially for vegetarian women, because they may give birth to infants who suffer early and serious signs of megaloblastic anemia and failure to thrive due to low B12.
b)Folic acid > 400mcg will reduce the incidence of neural tube defects by 50%
c) Elemental iron 30-65mg/day
d) Calcium: Milk, cheese and yogurt should be taken.
2)Energy requirement: 300 more kcal/day (less in first trimester, more during 3rd trimester)
Protein: 10g/day increase to support fetal and placental growth.
Weight: Average women gain 25-30pounds during pregnancy.

4)Which vitamin better to take?
After comparing these 3, Obimin seems the winner for normal pregnancy without complications. I like the high doses of B6 in Obimin, which can reduce complications of nausea and vomiting happens during the first 4-8 weeks. Furthermore it is the cheapest vitamin in the market. Due to lower folic acid, we would usually recommend Obimin+folic acid supplementation from milk.

Iberet Folic seems to be the taikor as it has high doses of iron, folic acid and B12, vitamin C (to enhance absorption of iron). So it is the most useful in anemic pregnant lady.

Just remember do not take several prenatal vitamins as it may expose mother and baby to the toxicity and teratogenic dose of vitamin A.

5)Remember, each individual is different. Always ask your Dr or pharmacist if u r not clear.

6) Want to know expected date of confinement?
Rough calculation:
Last menstrual period+ 7days -3months+ 1 year.
(assumes ovulation on day 14 of 28 day cycle)

Hope u will get a healthy baby!

Skin whitening for Melasma

Many of us may suffer from a skin condition called melasma due to the overexposure of sun. Here we will discuss how does it looks like and the usual pharmaceutical treatment for it. Below is the pictures of my customer having this problem of hyperpigmentation (melasma) due to sun exposure.

She allowed me to take her picture .Rx treatment (pls note that all these creams are only available in the pharmacy):

Hydroquinone 2%-4%
Action: Inhibit tyrosinase(enzymatic oxidation of tyrosine to 3,4-dihydroxyphenylamine , decreased production of melanin. Lighten both healthy and hyperpigmented skin.
Usage: Apply 2 times a day. Discontinue use if no effect after 2 months.

Tretenoin 0.1% cream
Action: Works by increasing keratinocyte turnover and limiting the transfer if melanosomes to keratinocytes.
Usage: Apply in the evening. Response to treatment can be slow, improvement may take 6 months or longer.
Adverse Reaction: Skin irritation, temporary photosensitivity and paradoxial hyperpigmentation can occur.

Azelaic acid 20%
Action: Reduce DNA synthesis, target only hyperactive melanocytes, No phototoxic or photoallergic.
Usage: 2 times daily

Soap
Soap containing salicylic acid 3% (keratolytic) may help to exfoliate the hyperpigmented skin.

Ask the pharmacist!

1)Regardless of the treatments used, all will fail if sunlight is not strictly avoided.
2)Avoid sunlight, use hats, use sunscreen at least with SPF 15 eg. titanium dioxide, zinc oxide.
3)Always check with your dermatologist.
4)Do not buy those products sold in pasar malam. Buy from your reputable pharmacy.
5) Test your skin sensitivity before using any product by applying to small area of unbroken skin- (minor redness is ok, but if itching, vesicle formation or excessive inflammatory response, not it is not ok).
6)Email me for more info.

7)Lastly do not simply use unknown and unregistered products.

Fever: To treat or not to treat?

Fever is defined as a body temperature higher than 37C. Many of my patients suffer from what we called "fever phobia", the irrational fear that body temperatures from 37.8-40C will cause severe harm eg brain damage to their children, themselves or loved one and they quickly find solution to their fever.Actually, the decision to treat fever is based on patient because fever is not associated with many harmful effects unless temperature exceeds 39.4-41.1C. In fact, many microbs or bacteria is thermolabile, therefore, their growth is impaired by higher than normal temperatures.

Clinical reports already suggest treating conditions like chicken pox may increase the duration of the symptoms compared with no treatment. Also, treatment of rhinovirus with aspirin may increase viral shedding. This is because fever increases oxygen consumption, production of carbon dioxide, and cardiac output. Specifically, fever increases the release of interferons, neutrophil release and improve chemotaxis, thus boosting up the activity of the immune system, helping patient to combat viral and bacterial infections.

So to treat or not to treat fever, and when to treat? Buy a thermometer and monitor your fever.
How do we choose which type to buy? How many types of thermometer available in the market?
Glass/plastic thermometer
Advantages
1)Low cost
2)Light weight
3)Compact size

Cons
1) Extra care in rectal measurement as it can break
2) Glass or plastic may break
3) Proper storage ie cool location, out of sunlight

Electronic thermometer
Advantages
1) Register reading quickly
2) Not subject to glass breakage and risk of cuts
3) Can used with disposable covers to eliminates the need to disinfection after use
4) Easier to read

Tympanic thermometer
Advantages
1) Most accurate as it measure tympanic membrane(close to the hypothalamus)
2) Measurement takes only 1 second, appropriate for baby and small children

Cons
1)Slightly expensive

Skin thermometer
Advantages
1) Easy to use
2) Relatively cheap

Cons
1) Only measure skin temperature (which can be influenced by environment and skin perfusion
2)Only useful in noting temperature trends but not absolute temperature

Ask the pharmacist!
1)Do you think you know how to measure body temperature correctly?

0-3 months old-Rectal method is preferred because due to the size and shape of infant's ear canal, the tympanic thermometer is not indicated.
3 months to 5 years old- Axillary or tympanic method is preferred. Rectal may cause discomfort.
More than 5 years old- Oral or tympanic method is preferred.

2)When the body temperature exceed 40C, sponge the body with lukewarm water(not cold) water. Usually the person must wait 1 hour after a dose of fever medicine before sponging the body.
3)Wear light clothing, remove blanket, and maintain room temperature about 25-26C.
4)Drink sufficient fluids to replenish body fluid losses.5) But still, remember to seek medical attention if the fever persists after 3 days of treatment or fever continues to increase during treatment (>39.4C, or history of febrile seizures) because you need to treat the underlying cause of the fever.
6) Email me if you want to know more or want to buy a thermometer for your family...

Diarrhea

How does your stools looks like?
According to Wikipedia, Type 1 and Type 2 indicates constipation, 3 and 4 are the easiest to pass and types 5-6 are the more symptomatic of diarrhea, while type 7 may be a sign of cholera, food poisoning, etc.

If you are having type 7 stools?
Sign and symptoms
Loose liquid stools +/- blood or mucus, fever, abdominal pain and distension, headache, anorexia, malaise, vomiting, myalgia, cramping.

Treatment
Oral Rehydration Salt: The main treatment.
Loperamide: 4mg followed by 2mg capsule after each unformed stool
Diphenoxylate/Atropine: 2.5mg/25ug every 4 hours until symptoms resolved.

If the pathogens identified (after consulting your doctor or pharmacist)
Giardia: Metronidazole 250mg tds for 5 days.
E.histolytica: Metronidazole 750mg tds for 10 days.
Shigella: Trimethoprim-sulfamethoxazole 160mg and 800mg 2bd for 5 days, or Ciprofloxacin 500mg bid for 3 days.
C.difficile (associated with antibiotic uses): Metronidazole 500mg tds for 10-14days.
Travellers diarrhea: Ciprofloxacin 750mg one dose or, if severe 500mg bid for 3 days.

Ask the pharmacist!
1)If you are given antibiotic by your doctor, make sure you ask for what type of antibiotic you are taking.
2)If you are given antibiotics others than above, maybe you can ask what is your actual diagnosis.
3)Photosensitivity is the common side effect when taking above antibiotics, so you may need to reduce your sun exposure during treatment.
4)Let the pharmacist know what other medication you are taking, eg. Ciprofloxacin increase theophylline levels and cost toxicity.
5)There is no evidence that bowel rest speeds recovery, and food may enhance the efficacy of oral rehydration therapy. I would encourage you to follow your normal diet or this (dry toast or bread, baked potato, chicken soup with rice or noodles, poultry, bananas) but you still need to avoid coffee, alcohol, diary products, most fruits, vegetables, red meats, and heavily seasoned foods.
6) Taking probiotics can reduce the duration of acute infectious diarrhea (Systemic review of 23 randomized trials of probiotics in 1,917 patients with acute diarrhea; probiotics reduced risk of diarrhea at 3 days(15 trials) and mean duration of diarrhea by 30.5 hours (12 trials)
7) Taking zinc supplementation at 3x RDA reduce duration of diarrhea (Pediatrics 2002 May;109(5):898), reduced diarrheal duration and volume (J Paediatr Gastroenteral Nutr), and reduce morbidity and mortality(BMJ 2002 Nov 9;325(7372):1059)

Do you know? (1) You can choose when to menstruate!

Do you know that US women with heavy menstrual flows work 3.6 fewer weeks yearly compared with women without mentrual problems and lose an estimated $1692 in wages per woman annually?

Actually, menstruation or not, does not pose any health advantages. In 2005, the Association of Reproductive Health Professionals (ARHP) surveyed 1018 women aged 18-40 revealed that women harbour many misconceptions about their period, including what is "natural" and have an incomplete understanding of menstruation.

What are the usual symptoms of mentruation?
According to the study, 84% of them will experience bloating, 84% moodiness, 84% irritability, 81% cramps, 80% pimples or acne, 76% less energy, 70% food cravings, 69% breast tenderness, and 59% headaches,64% often or sometimes experience heavy bleeding and 63% have "really bad cramps".

So, what can we do about it?

SUPPRESS IT!
Women who wish to suppress their menstruation, are mostly women with menstrual-related medical or gynecologic problems, adolescents, perimenopausal women, athletes, females in the military, athletes, females with mental disabilities. Women who choose to menstruate less frequently are also candidates.

Since 1977, numerous randomized clinical trial have evaluated the safety and efficacy of extended use regimens of combination oral contraceptives. Extended contraception regimens eliminate the placebo week from the standard 21/7 day cycle.

Are there any side effects?
The major side effect of extended use hormonal contraceptives is unscheduled bleeding and spotting during the first few cycles of use. This side effect typically abates within a few months as the body adjusts to the new hormonal balance. No worry, as no endometrial hyperplasia or significant pathology has been observed in trials and the endometrium quickly reverts to normal cyclic changes after discontinuation.How about benefits?
Nonmenstrual benefits of extended regimens OCs
medical conditions include iron-deficiency anemia, mentrual related migraines or seizures, dysmenorrhea, prementrual syndrome and premenstrual dysphoric disorder, and menorrhagia.

Is it safe?
A lot of women may not aware that it is not medically necessary to bleed while taking hormonal contraceptives. No ovulation occurs and menstrual blood does not build up with hormonal methods. Monthly bleeding episodes are false periods designed to make cycles with the pill seem more "natural".

No serious side effects have been detected across dozens of studies involving thousand of women. There are no harmful effects on the uterine lining. Data on conventional pills use are reassuring regarding breast cancer risk. One study showed no increase of breast cancer related to OC dose, duration of use, young age at initiation, or family history. Return to fertility after discontinuation is expected to be the same as for conventional OCs.

Ask the pharmacist! He would counsel u on how to
1) Carefully select your hormone free days and create a full pharmaceutical care plan for you.
2)Expect unscheduled spotting and bleeding initially.
3)Stick to your schedule given by your pharmacist.

The author can be contacted by email: pharmalogik@gmail.com or msn: leems123@hotmail.com

(Sources: Epocrates CME)