The Pharmacist Answers Podcast

Have a question for the pharmacist? Get your answers here! Clear explanations about complicated medical topics that anyone can understand. Disclaimer: The information contained in this blog and related podcast are not to be taken as medical advice, they are for informational and educational purposes only. If you resemble anything that is mentioned in this blog or related podcast, contact your doctor. The information contained in this blog and related podcasts is the opinion of the author and does not relfect the views of her employer, Walgreens. If you want to know what Walgreens thinks, ask Walgreens!
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Dec 31, 2015

Measuring - Episode 28

Medication for kids are usually in liquid form and require some kind of device to accurately measure the dose.

1 teaspoon = 5 ml

1 tablespoon = 3 teaspoons = 15 ml

1 fl oz = 30 ml

Milliliters = ml = cc = cubic centimeters --> all the same

Kitchen spoons and cooking teaspoons are not accurately calibrated to measure medication.


100 mg/5 ml = 20 mg/ml

Incorrect spoon #1:  4 ml < 5 ml (80 mg < 100 mg)

Incorrect spoon #2: 3.5 ml < 5 ml (75 mg < 100 mg)

Incorrect spoon #3: 6 ml > 5 ml (120 mg > 100 mg)

The cups that come with liquid OTC medications are calibrated accurately to measure medication.

Restaurant spoons are HUGE sometimes.

Maximum error when testing kitchen spoons is a 40% error (meaning it could be 40% below or 40% above the standard of 5 ml in a teaspoon).  For a 500 mg/5ml medication - a 40% error is equal to 200 mg too much or 200 mg too few.  That could mean the difference in not being treated adequately and leading to complications (i.e. infection resistance) or being over-treated and experiencing side effects.

It's a different story if you're taking an adult dose (i.e tablet, capsule - which is already pre-measured) and putting it into something more palatable.

A factoid about the history of pharmacy: the only way pharmacists got medicine to people was by mixing it up and making the pills themselves.  The process of taking bulk ingredients and making specialized forms of medications is called compounding.

A factoid about brand to generic conversion: generics are only allowed to have a 5% variation from the brand name, and some companies are even more strict on themselves and follow a 3% error standard.

3% << 40%!!

"Radio Martini" Kevin MacLeod (  Licensed under Creative Commons: By Attribution 3.0

Dec 31, 2015

A headache is an ambiguous side effect because there are so many different things that can cause headaches.  Hormones are a big culprit of this.  Blood pressure medications can too.

A factoid about blood pressure:  for someone with chronic high blood pressure, the higher pressure becomes the body's new "normal".  Once medication starts to bring it down, even though the pressures are within a normal range, the body will experience symptoms of low blood pressure.

2 lies people tell about allergies:

  1. No allergies - so then they take something they are allergic to and have an emergency
  2. Allergic to "everything" - because they experienced mild or moderate side effects.  Or in the case of pain pill seekers, they're "allergic" to the weak pain meds to get the doctor to prescribe stronger ones.

Irritability, nervousness, jitteriness, or moodiness can be a side effect of amphetamines (used for ADD) or cold medicines (i.e. pseudoephedrine).

A factoid about ADD/ADHD:  the focus and attention area of the brain are underactive, so a stimulant helps it be more active so improve focus.

The biggest complaint people have from any stimulant is the inability to sleep at night.  Just need to make sure it's taken early enough in the day so it wears off in time for bed.

Joint and bone pain - in this case, we rarely want you to keep taking the medication if these side effects happen.  For example, cholesterol medications (i.e. statins, and fibrates) and quinolone antibiotics (Levaquin, Cipro, Avelox).  The quinolones have a rare but serious side effect of tendon rupture; it is painful and permanent.

Tendons: the connective tissue that anchors muscles to the bones.

Osteoporosis medications can lead to bone pain - since their job is to cause changes in the way the bones are built and rebuilt, it's not uncommon to feel something.  But usually temporary. 


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Dec 28, 2015

3 drug intolerances that involve skin

  1. Itching and rash - even though they are a big sign of allergies, they also can be typical side effects of medications
    1. Narcotics - in hospitals, they give diphenhydramine (Benadryl) to calm an itching side effect
    2. Sulfa antibiotics and tetracyclines - sun hypersensitivity.  Not a sunburn, though.  May require pain reliever to get comfortable.
  2. Flushing - redness and hotness of the skin
    1. Niacin - used for cholesterol reduction.  Flushing is reduced by taking 81 mg of aspirin 30 minutes before taking niacin
    2. Hormones - natural or in medication (birth control or hormone replacement).  Can be reduced or eased by taking before bed or taking with food
    3. IV contrast - as the medication spreads through the body.
  3. Dryness - especially of skin surfaces that require moisture (i.e. mucous membranes)
    1. Antihistamines and cold medications - dry eyes, dry nose
    2. Overactive bladder medications - dry eyes, dry mouth, constipation
    3. IBS meds that control diarrhea - constipation

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Dec 14, 2015

Medication allergies - especially the dangerous, life-threatening kind - affect your entire body, multiple organ systems, and put you at serious risk of death.  They also require immediate medical attention.

Symptoms include:

  • Serious swelling
  • Not being able to breathe or swallow
  • Significant speeding or slowing of your heart rate or breathing
  • Blood leaking out of blood vessels into other regions of your body

Intolerances are usually related to regular side effects of the medications, but are so bad that you can't tolerate it.

At no time should you be asked to keep taking something that makes you feel worse than death.  And in most cases, avoid it at all costs.

Other times, the discomfort can be short-lived or fixed by altering how the medication is used.

Main point:  Intolerances to medication side effects are not true allergies (even though a lot of people will group them together when giving a medical history to a doctor or pharmacy).

  • Nausea can be caused by 
    1. Pain medications (narcotics)
    2. Antibiotics
    3. Any large, powdery elephant-sized tablet
    4. Multivitamins

Nausea is a side effect of almost everything that you swallow.  It's too vague and nondescript to be an allergy.  It is usually due to the increase in acid production by the stomach when it is trying to break down and dissolve the medication.

The main way to avoid nausea is to take the medication with food - and in some cases, a decent amount of food.

Some widespread advice is to take medications with milk because milk is a base to counteract the stomach acid.  Unfortunately, the calcium in milk and cause certain antibiotics to not work.  Also, some medications require acid to be activated, so making the stomach more basic, reduces the effectiveness of them.

Certain injectable medications for Type 2 Diabetes have a main side effect of nausea or indigestion.  With these medications, the patients are encouraged to keep taking them.  The logic behind this:  in most cases, someone with Type 2 Diabetes will be overweight.  And they may have been resistant to the lifestyle changes (i.e. diet and exercise) that would help improve their weight, thus also improving the diabetes outcomes.  So, if they take a medication that causes nausea thus reducing their appetite, it helps them limit their food intake, and the final results will most likely be weight loss.

  • Diarrhea can be caused by
    1. Antibiotics - they kill the bad bacteria that are making you sick, but also your good bacteria
      1. Take probiotics or eat live culture yogurt (the more diverse the better)
    2. Certain cholesterol medications - particularly, the ones that help trap up the fat in your intestines so it's not absorbed and add it to your waste that is about to exit.  Fat is an oil... oil is slippery... poo that is slippery.... you get the idea.
      1. The less fat you eat, the less slippery things will be.
    3. Metformin - causes diarrhea in the beginning while the body is adjusting to it.  Diarrhea that lasts a month sounds like forever, but is really not compared to the amount of time (aka the rest of your life) that someone may have to take this medication for Type 2 Diabetes.
      1. The best way to control this is to start this medication low and slow.

The best way to counteract long-term diarrhea issues from medications is to use bulking fiber.  They help absorb extra water and add solid substance to stool so it's firmer.

Dec 7, 2015

Who needs help falling asleep?  *raises hand*

WARNING: Do not mix any sleep aids with alcohol - compounded drowsiness, depressed breathing or depressed heart rate

  1.  Melatonin - the chemical your brain makes when it's dark.  Electronic light can interfere with your natural production of melatonin after the sun goes down.
  2. Valerian Root - claims to promote calming and relaxation
  3. 1st Generation Antihistamines - Diphenhydramine (Benadryl) or Doxylamine (Unisom; also in NyQuil).  They have natural drowsy side effect, so using for the purpose of that side effect is a common practice.
  4. Rozerem - stimulates melatonin production in your brain
  5. Hypnotics - Ambien (zolpidem), Lunesta (eszopiclone). They seduce your brain to sleep in an unnatural way, thus they have high risk side effects (vivid dreams, sleep driving/walking/eating) and a high risk of dependence.  The side effects are due to the fact that the medications may get you to a deeper level of sleep before the rest of your body is prepared.  Your body has a natural paralysis process to ensure you don't act out dreams in the REM cycle, but if your brain reaches REM before your body is paralyzed, you may do crazy things!
  6. Benzodiazepines - generic names end in -lam or -pam.  Also have a risk of dependence and side effects (mainly "hangover" effect).
  7. Tricyclic Antidepressants - a symptom of depression is sleeping too much, but insomnia can be a symptom of depression.  Also, insomnia can make you feel depressed - it's a vicious cycle.  In small doses, they work to help rebalance the brain chemicals and reset the sleep-wake cycle.

Use as natural a solution as possible that is effective.  Physiological and neurological issues can lead to chronic insomnia that is not corrected by the most natural solutions, thus pharmaceuticals are needed - and that's nothing to be ashamed of!

Sunlight stimulates your eyes and tells your brain to make serotonin.  When the light is gone, and that stimulation stops, serotonin stops and melatonin replaces it.  This is how we functioned and planned our days back in the "old days".

Summertime brings on long days and lots of sunlight.  Thus we may not sleep as long because the long daylight hours keep us awake.  But this can also be the issue in the winter and for people who experience SAD (Seasonal Affective Disorder) - the shorter daylight doesn't allow sufficient serotonin to be produced and we actually feel sad.

Analyzing your sleep patterns and knowing your options will allow you to have a productive conversation with your doctor - different medications are used depending on if you have trouble falling asleep or waking up halfway through sleep or both.

*Melatonin in nursing:  your natural melatonin gets in breast milk and is thought to help baby's sleep cycle (especially early on when baby's sleep-wake cycle may be backwards because that's how they rolled in the womb).  Thus, if your natural melatonin gets into breast milk, then supplemented melatonin will get there too.  The rationale is that if you're not sleeping (despite the exhaustion of having a new baby), then you may not be making enough natural melatonin.  If you're going to take melatonin while breastfeeding, LOW dose is key to ensure the excess isn't deposited in the breast milk to pass on to baby - 3 mg seems to be the highest recommended, and I agree.  PLEASE do your own research and discuss it with a medical professional you trust rather than just taking my word for it!*

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Dec 1, 2015

Sleep Hygiene: how conducive your night time and bedtime habits are for restful sleep on a regular basis


Your body performs important processes while you sleep.


Risk of disease is increased when you don’t get enough sleep.  Heart disease, diabetes, and stroke, just to name a few.


4 areas of sleep hygiene

- environment

     - dark (all of our light-emiting toys are bad for our sleep) - your body makes serotonin stimulated by light, and then melatonin when the light is gone.

     - cool - kind of like hibernation, gotta get past REM sleep because REM sleep is not restful sleep


- habits

     - no naps - recovery processes can be inefficient

     - exercise (vigorous exercise during the day; slow & calming exercise late at night)

     - getting adequate natural light - so your brain isn’t confused about which chemical it needs to make

     - consistent routine - your brain likes predictable patterns


- what you consume

     - stimulants - caffeine, nicotine

     - alcohol - initially makes you sleepy, but can disrupt sleep when the liver finishes processing it into sugar

     - large meals - can cause indigestion which can disrupt sleep

     - drastic dietary changes - fluctuating amounts of sugar in the blood stream or digestive discomfort


- mindset

     - bed is for sleep - not a place for work or studying or eating

     - avoid emotional stress - positive (i.e. excitement) or negative (i.e. anger)


CPAP machine - helps in sleep apnea, which is wear the body doesn’t get enough oxygen during sleep.  Oxygen is needed for all sorts of processes.  If the body can’t get the oxygen, then it probably isn’t using the nutrients and energy sources available, and it can lead to feeling awful, even after a night of sleep.


Nothing good comes from a lack of sleep.

Nov 23, 2015

3 areas that thrive when you get enough sleep


1. Productivity 

     - Better memory

     - Better attention span

     - Better creativity


The cells in your brain (neurons) run on electricity (aka the flow of positive and negative charges).  Sleep allows the electricity to reset, so it’s really to flow quickly and efficiently the next morning.


2. Health - when you sleep, you live longer.

     - Risk for cardiac disease increase with lack of sleep.

     - Inflammatory chemicals are cleansed out during sleep

     - Weight management - certain metabolism processes only happen while you’re sleeping

     - Tissues heal and rebuild

     - Reaction time improves - less likely to be in an accident


3. Emotions

     - Stress hormones are removed from your system

     - Gives your serotonin production a break, so you get a fresh supply in the morning (Serotonin is your happy chemical)


"Radio Martini" Kevin MacLeod (

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Nov 16, 2015

#BoPoTribe stands for Body Positivity, where we believe all bodies are beautiful bodies.  Founded by Susie @BeautyWithPlus


You can find the supportive community on facebook at, follow them on Twitter and Periscope, @bopotribe.


Three ways to love yourself


1.  Know how your body works and how to know when something goes wrong

2.  If you have a chronic disease, know the ins and outs of it

2b.Finding friends or a community to support you

3.  Do research about the decisions that you make, don’t just trust ads and fads

4*. Choose a healthcare team that is willing to listen to you and work with you instead of just working on you.


Yes, and I brag on @RachelCMayo - again!  Because, well, she's AWESOME!

No matter what method you choose to enhance your health, my goal is for you to be empowered with knowledge and confidence to make a decision you’re happy with, and not be bullied into doing something you don’t want to do.


Just remember, we will not find you in a textbook!


"Radio Martini" Kevin MacLeod (

Licensed under Creative Commons: By Attribution 3.0

Nov 9, 2015

Hemoglobin A1c (HbA1c): measures the percentage of your hemoglobin (the protein in your red blood cells that carry oxygen) has been coated in glucose. When there’s a lot of extra sugar floating around, it tends to stick to the other things floating around with it.  Red blood cells live for 120 days*, so that’s a lot of time to let sugar hitch a ride.  And while a blood glucose measurement gives a snapshot of what the blood sugar level is right now, the A1c measurements gives us an idea of what the blood sugar level has been during all the times you’re not pricking your finger to measure over the last 3 months*.


*I do realize that 120 days equals 4 months and not 3 months, but the really old and decrepit RBC’s that are close to their expiration are exactly that - decrepit, so they’re not in good enough shape to give us a trustworthy measurement.


For those with diabetes, the goal is to have an A1c >7%.  For the average non-diabetic, A1c is ~ 5% (though with the American lifestyle, that “normal” number is creeping up - but that has more to do with Type 2 Diabetes).


Rachel received lots of support through the people she met through the Juvenile Diabetes Research Foundation (JDRF) and continues to support their cause and actively helps other T1D’s get connected.  She also participates in her local chapter of JDRF and participates in the Annual One Walk in Nashville (that’s where I got to hang out with Rachel for this interview!) You can find out what JDRF is all about by visiting and


++Time Sensitive ++ —> Follow Rachel on social media during the month of November to catch her Diabetes education Periscopes: @RachelCMayo


Music Credits:                                                                                                                 

"Radio Martini" Kevin MacLeod (

Licensed under Creative Commons: By Attribution 3.0

Pharmacist Answers Facebook Page

Nov 2, 2015

Without insulin, you would die!


Sugar scrub = sugar + water (+/- essential oils)

- a good exfoliant to remove dead skin


Fact:  Your tiniest capillaries are so small that red blood cells can barely squeeze through one at a time.  So, if the fluid around the red blood cell is full of sugar, it’s like that sugar scrub on your skin.


And that extra sugar can damage the capillaries in your eyes, finger tips, toes, and organs.


The cells in your body require glucose to do their jobs.  Insulin is the only key that will let the glucose in.  No key means no glucose.  No glucose means no energy.  And no energy eventually means death.


Insulin is also responsible for fat storage.


If you don’t eat the sugars, the body will use the fat stores on your body for energy.  But if you don’t consume energy sources (by being on a specific diet) AND your energy stores are depleted, your body will break down the proteins (aka muscles of your body) to make energy.  Your brain (and other organs in your body don’t want you to die).


Sugars and fats you eat gets turned into glucose.  Insulin lets opens the doors to allow the cells to use the glucose.  If there’s extra glucose around, insulin tells the liver to link it together to form glycogen and store it for later.  If the glycogen storage is full, insulin tells the liver to turn the glucose into triglycerides (think clogged arteries and growing fat deposits).


Free glucose is the easiest and fastest to use.  But during times that you’re not actively consuming sugars (like when you’re sleeping), your body is still working and that’s when glycogen can be used to provide glucose.


How much sugar in a day?  It’s always different for different people.  The goal is having a level blood sugar as much of the day as possible.  The rule of complex carbs being better than simple carbs is true, because it takes your body longer to break down and use complex carbs.  While simple carbs usually dump a whole log of glucose in your blood stream at one time.  And natural sugars are better than processed sugars because processed sugars tend to be more concentrated.


Your body has an easier time utilizing nutrients and supplements that look more like itself over ones that are synthesized in lab.


Rachel Mayo is my diabetes hero!


Find her at:


T1D vs T2D:

Oct 26, 2015

Yeast infection = fungal infection

Miconazole = -azole antifungal

Miconazole = Monistat

Yeast, or fungus, can affect any part of your skin.

The medicine in the tube doesn’t care what body part you put it on, but the product manufacturer’s try to convince you that it does by changing the labeling on the package.

Oct 19, 2015

Let’s Review!


Liver contributes to:


1. Digesting your food

2. Metabolizing the energy from your food

3. Storage of Vitamins

4. Detoxing waste and toxins from your blood

5. Production of factors involved in blood clotting


Lastly, your liver keeps your healthy by aiding your immune system.


This is the last time we get to see this guy! *sad*


The last part of the lobule to be discussed is the sinusoids.  Sinuses and sinusoids describe the space between (think about the sinuses in your your face - they are actually just holes and tubes through the bones of your face and skull that allow for empty space).


Sinusoids are lined with Kupffer cells (actually pronounced “Coop-fur”; I said it wrong on the broadcast - blame it on the accent).  Kupffer cells are a part of your immune system (remember that your immune cells flow through the lymph system that parallels your blood vessels).  Some of the cells involved in your immune system are called macrophages (big eater).  When they find something that’s not supposed to be there, they gobble it up and carry it off to be disposed of or dissolve it into it’s basic parts and makes it safe.


To summarize: Kupffer cells are macrophages that are stationed in the sinusoids of your lobules of your liver.


So, if you’ve had an infection and you start to get better, where do all the dead bacteria go?  They end up floating around in your blood and the Kupffer cells will gobble them up.  They will do this for bacteria, fungi, and micro-parasites that they encounter.  They also gobble up dead red blood cells and get them out of circulation.  Other types of cells in your body die periodically and they, too, get gobbled up by Kupffer cells and have their parts recycled.


Dying cells and bacteria can release toxins if you had to wait on them to break down and dissolve on your own.


The liver is very efficient at all the things it does. Without your liver, processes that help your body thrive would take too long for you to reap the benefits.

Oct 12, 2015

Most of the liver’s jobs have to do with taking things away from your blood supply or taking them apart.


Your liver produces 3 important components found in your blood.  Two of them are involved in helping your blood clot.  The third is involved in keeping your blood watery.


1. Prothrombin


The prefix “pro-“ means “starter” or “before”.  Like “prologue” or “prodrugs”.  In medicine, it usually means that it’s the starter piece but something has to happen to it (metabolism) for it to become useable.

Not Prozac…brand names of medications are developed by highly paid branding and marketing professionals.


Prothrombin gets activated into Thrombin when your body gets hurt and sends a signal that it needs help to stop the bleeding.


2. Fibrinogen


The suffix “-gen” means “creating” or “starter”.  Fibrinogen gets activated into Fibrin.


So…. you get cut…. *ouch*

“I’m bleeding!”

The clotting cascade starts (way too complicated for this discussion).

When it gets to clotting factor X (ten).

CF X activates Prothrombin into Thrombin

Thrombin activates Fibrinogen into Fibrin


Fibrin - sounds like “fiber”.  Fibrin is a protein.  Some proteins are globular proteins - they are balled up in globs.  Fibrous proteins are nice and stringy like fibers.  So, Fibrin is fibrous.


Fibrin lays down a matrix over the wound and then the platelets that are floating around in your blood collect on the Fibrin and plugs the hole.


You want the blood in your body to stay liquid. You need the blood flowing out of your body to harden and stop.


3.  Albumin (also found in the white parts of eggs).


It helps maintain the watery-ness of your blood.  They maintain the osmotic pressure of your blood (there’s a big enough difference from the inside of a cell and the outside of the cell to allow the fluid to push through the membrane without needing a portal).  If the pressure on both sides is the same, nutrients and chemicals will not transfer.


Albumin also helps the blood stay isotonic (same saltiness).  You don’t want the fluid in your blood to be more salty than the fluid in your cells because the water will flow out of the cells into the blood to try and dilute it.  But you don’t want the cells to be more salty either because the water will flow the other way and you won’t have enough liquid in your blood.


So, your liver takes the building blocks (amino acids) and puts them together to build these proteins.

Oct 5, 2015

100,000 lobules - get counting!


The hepatocytes contains enzymes.  Enzymes are catalysts.  While a lot of processes would probably happen naturally, they would be too slow to do us any good.  Enzymes make those natural changes happen faster.

Think of an assembly line worker that does they same action over and over again on each piece being made.  That’s how enzymes work.


Things that have floated around your body and done their job (i.e. drugs, hormones), the liver brings them back in and breaks them apart into inactive parts so they can be disposed of in one of your waste systems (urine or poo).


A lot of drugs to through the liver to become active and sent out to do a job, or to be deactivated after the job is done.  You don’t want those things to stay around forever because they can become toxic.


Your liver also detoxes your body of used up hormones.  Your body produces fresh ones as you need them, so the old ones need to be gotten rid of.


The most popular job that your liver does is filtering out alcohol.  Science says an average liver can process 1 standard alcoholic drink per hour (for some people that’s longer - up to 4 hours).


Thus you have to be careful with cocktails and mixed drinks due to the different types of alcohol that get added together.  1 drink DOES NOT equal 1 glass!



Liver cleanses your blood of:

1. Drugs

2. Hormones

     - Sex hormones

     - Adrenaline

     - Cortisol

3. Alcohol


Thank your liver!!

Sep 28, 2015


Digestion - bile breaks down fat to be absorbed by intestines

Metabolism - breaking down food into useful pieces


Your liver helps you store those energy sources until you need them - like times when you’re not eating.

Your body does a lot of processes for you while you’re sleeping.


Glucose is a main source of energy for your body.

Insulin tells your cells to let glucose in the door so it can be used immediately.  It also tells the liver to put extra glucose in long chains called Glycogen to store for future use.


Another energy source is fat or fatty acids.  When the liver doesn’t have enough space for fat, it sends it to other areas of the body.

Certain vitamins (A, D, E, K) like to hang out in fat more than water, so it goes with the fat wherever it goes.


The liver stores Vitamin B12.  B12 is usually promoted for energy boosting.  A vitamin B12 deficiency can lead to a certain type of anemia (pernicious anemia). This means not enough red blood cells are being made, thus not enough oxygen is being delivered to all the parts of your body.  Therefore your body doesn’t have the resources to utilize and create energy.  End result: you feel tired.


Iron and copper are also stored by your liver until you need them.  Low iron is another culprit of anemia.

Interesting fact:  This is why liver tastes more metallic than other red meats.


Sep 21, 2015

Liver - have one. 


Lobule - yep! 


Recap: Liver makes bile, helps digest fat in the intestines. Gallbladder? Holds bile until your intestines need bile. 


3 main energy sources:  Carbohydrates, Fats, Proteins 


Inestines absorb them into the blood and send them to the liver. 


Metabolism = change 


Metabolism happens for 2 reasons: 

1. To make something useful 

2. To make something safe 


What’s water got to do with it? 

- Your blood is made of water 

- Liver preforms hydrolysis on carbohydrates (using water to dissolve it into tiny bits of sugar = glucose) 


Glucose is the main form of sugar that your body uses for energy. 


The liver breaks down the fatty acids to make cholesterol (which is not always bad). Cholesterol is used in your cells walls to keep them fluid and slippery.  Cholesterol is also used to make bile (think “like dissolves like”).  If there’s any extra fatty acids the liver performs gluconeogenesis (gluco = glucose, neo = new, genesis = creation). It basically creating glucose out of anything that contains Carbon. 


This is why fats are bad for Type 2 Diabetics as well as sugar. 


Sugars are the easiest to turn into energy so that gets used first.  So low carb diets force the body to go after fats, which are the next easiest.  If you’re eating low fat as well, then the body will burn the fat deposits on the body.  Weight loss! 


Protein is the hardest, but can still provide energy.  Proteins are made up of amino acids.  Amino = Nitrogen, acid = carbon.  The nitrogen is relatively useless, so the liver turns it into urea, that gets sent out and filtered by the kidneys.  The part with the carbon can be turned into glucose (gluconeogenesis again). 


One of the intermediate steps of the urea production is ammonia.  There is actually a blood test that can be done to test the ammonia-urea balance.  And if this is out of balance, it indicates a problem.  The BUN (Blood Urea Nitrogen).  One thing this indicates is that your body is metabolizing your own muscles.  This can be a sign of starvation or other nutritional imbalance.  You need your muscles, you don’t want to metabolize your muscles. 


Your body generally needs fully intact amino acids to build, rebuild, and heal muscles.  Proteins and amino acids have a life span, so your body is constantly rebuilding and replacing with fresh supply.  Athletes require higher protein diets than most because of this process. 


Glucose and fats aren’t inherently bad, it’s more about the amounts of each that get consumed and float around your body. 


Your liver can be very efficient and metabolizing the foods you eat. 



Your body gets fat deposits because the body is saturated with enough fatty acids that it needs, so any extra gets packed up and shipped around the body to be stored until later. 

Sep 14, 2015

Liver shaped like a triangle - check!


Lobule, hepatocytes, vessels - check!  Hundreds of thousands - got it!  



Hepatocytes make bile. 

It’s colors green due to red blood cell waste (bilirubin). 

Bile consists of water, salt, cholesterol, bilirubin. 


Bile moves from hepatocytes in liver to the gallbladder. 

When you eat fats, the intestines triggers the gallbladder to send bile to help digest fat. 


The fats are used in the energy-making process. 


Bilirubin makes bile green.  It also makes the skin yellow in jaundice.  Makes poop brown. 

For babies, it’s because baby hangs on to extra red blood cells from mommy after birth, and the liver has to learn what to do with all of them after they die (RBC’s only liver 120 days!).  For adults with hepatitis, it’s because their liver is damaged and can’t work as efficiently as it used to.  If your poop is the wrong color, it can indicate there is a major liver problem. 


If you are gallbladderless, there is no where for the bile to be stored.  So, it gets send to the intestines continuously.  Also, if you have a meal heavy in fats, the intestines will just dump the food it can’t process faster towards the exit. 



High levels of bilirubin in infants can lead to cerebral palsy.  If the liver can’t handle all the bilirubin in a timely manner, the only other way to get it to breakdown is UV light. 

Sep 7, 2015

Your liver is shaped like a lumpy triangle.  


The liver is part of the digestive system, so having it close to the organs that carry your food means that blood doesn’t have to travel very far to get things to and from your liver. 


During a physical exam, your doctor finds the location and size of your liver by percussing (aka tapping on it - just like a percussion instrument). 


Ignore the big words -


Hepatocytes (liver cells) build together in Lobules.  Lobules build together in Lobes. 



6 Functions of your liver: 

1. Digestion 

2. Metabolism 

3. Storage 

4. Detoxification 

5. Production 


6. Immunity 

Aug 31, 2015

Muscle contractions depend on the muscle cells trading Potassium (K+) and Calcium (Ca2+).


As your muscle uses up energy to do work, the by-product is Lactic Acid. 


Muscle fibers are “woven” together - kinda like fabric. 


Contracting and relaxing a muscle causes the fibers to grip together and then spread back out.  



Stretching a muscle causes the muscle fibers to extend.  



Over-extending a muscle can lead to a strain or pull/torn muscle.  



Inflammation happens in the tiny fibers of your muscles. 




Anti-inflammatory medications work great for strained muscles. 

- Ibuprofen (Advil, Motrin) 

- Naproxen (Aleve) 


When an injury first happens: R.I.C.E. (Rest.Ice.Compression.Elevation) 

Rest - stop using it, or at least give it a little break with only light use 

Ice - yep, that cold, frozen water stuff 

Compression - for smaller muscles, they can be wrapped to help limit inflammation and hold muscle fibers in a unoffensive position 

Elevation - not as important (or possible) for larger muscles, but smaller muscles that can be affected by gravity pulling blood to it, can benefit from being elevated and allowing gravity to pull blood away from it for a short time. 


Here’s a link with a concise explanation of when to use ice vs when to use heat.


Bilateral muscles = symmetrical muscles.  They look the same on each side of your body and work together to move your body in both directions from your center (left and right). 


Prescription steroids (prednisone, methylprednisone) help relieve inflammation. 

Prescription muscle relaxers keep the muscle from knotting up. 


@_KevinBuchanan used 800 mg ibuprofen for his injury.  800 mg should be taken every 8-12 hours, no sooner, or GI side effects may occur. 



1. Stop the offending activity. 

2. Ice it (24-72 hours after injury) 

3. Take anti-inflammatory pain relievers. 

4. Apply heat to keep muscle relaxed 

5. Gentle use or stretches 


Show photo is my 32 lb toddler that likes to ride in the “backpack” (which is actually a woven wrap by "Form by Pavo Textiles" and is called Fruit Stripes). 



Aug 24, 2015

MIC = Minimum Inhibitory Concentration = the lowest amount of antibiotic required to kill the bacteria.


Antibiotics either kill the bacteria or slow it down enough that your own immune system can get rid of it. 


Antibiotics are designed to maintain a certain amount of medicine in your body over a certain number of days to ensure the infection is completely gone. 


Do not take antibiotics that you have left over from previous treatments, because you most likely do not have enough medicine for a full course of treatment. 


Think about a spot of dirt on the floor: 

Dirt + a few drops of water = mud 

Dirt + a whole pitcher of water = a watery mess 

Dirt + a wet rag = clean floor 


Relate it to an infection: 

Infection + too little antibiotic = resistance 

Infection + too much antibiotic = side effects or toxicity 

Infection + the right dose of antibiotic = you get better 


The gap between the lowest effective dose and the highest, non-toxic dose is called the Therapeutic Index. 



That is why you should always take antibiotics exactly as prescribed and until they are all gone. 

Aug 17, 2015

Ear wax is produced by your ear to keep junk out and away from your ear drum - like a slime booby-trap.


Allergies and other things that go in your ears (like water, especially dirty water, like lake water) causes the production of ear wax to increase to the point it becomes a problem. 


When you swim under water, the deeper you go, the harder the pressure of that water pushing down on you get, including the pressure of the water pushing in your ear.  This pressure can smoosh wax up against your eardrum. 


A quick tip to get water out of your ear - use a capful of rubbing alcohol.  Alcohol evaporates quickly at room temperature, so when it mixes with the tiny amount of water in your ear, it helps that water evaporate faster. 


Three step process for earwax removal (or maybe four) 

1. Debrox (Carbamide Peroxide) - OTC drops that helps dissolve ear wax if you have earwax buildup. It can also soften an impaction (glob of wax smooshed against ear drum) 

2. Take a hot shower.  Ear wax - just like other waxes - when it gets warm, it will soften. 

3. Irrigation - with an ear bulb 

     1. Fill sink up with comfortably warm water 

     2. Fill bulb with water 

     3. Point affected ear down towards sink 

     4. Put tip of bulb in your ear 

     5. Squeeze water into ear and let water and wax drain back out 

4. Use a capful of alcohol to dry water droplets left over (optional) 




Aug 10, 2015

Seasonal allergies can lead to nasal congestion and throat irritation, eye irritation with itchiness or watery eyes, or asthma-like symptoms.


If you can’t breathe or swallow or see, call 911. 

At first sign of allergic reaction, take Benadryl (diphenhydramine).  It’s an antihistamine to counteract the histamines that are part of an allergic reaction. 


Benadryl also comes as a topical.  The other option is Cortisone (hydrocortisone) - a steroid.  This can’t be used all over your body because it can soak all the way through your skin and get in your bloodstream, which would lead to systemic effects of steroids.  If you need systemic effects, it’s best to get a steroid prescribed by a doctor. 



1st Generation: Benadryl - drowsy side effects, works fast but wears off fast. 

2nd Generation: Claritin, Zyrtec, Allegra - all have generics, all OTC, just take 1 time a day. 


Steroid nasal sprays are newly OTC - Flonase and Nasacort.  Localized steroids in your sinus passages can help block the other chemicals involved in allergic reactions, not just histamines. 


The only medication that requires a doctor’s prescription is Singulair - it works best for asthma-like reactions that is produced in the lungs. 

Also, Albuterol inhalers can be used for people who have asthma-like symptoms to open the airways back up quickly. 



Is poison ivy cumulative in your body? (from @stevetessler) 


When you come in contact with an allergen (poison ivy leaves), you body recognizes it as a “bad guy”.  Once your body deals with the offender, it “remembers” poison ivy, so the next time you come in contact with it, your body’s systems can be more efficient at taking care of it (antibodies).  A problem arises if your body does “too good” of a job or gets overzealous.  This can lead to a more serious reaction or possibly anaphylaxis. 


Poison ivy is typically a topical offender.  It would require an unusual type of exposure  (i.e. burning it and inhaling the smoke) for it to affect other systems of you body than just your skin. 


Avoid poison ivy, poison oak, poison sumac, and any other poisons if you can help it. 


Note:  I told a story on the live broadcast. Afterwards, I checked my facts and found out I told it wrong, so I cut it out.  Here is the real story (to the best of my knowledge - I reserve the right to add or correct details as I learn the full story)… 

True Story: 


My husband’s grandfather burned a pile of brush that included some poison ivy or poison oak.  He ended up breathing in some of the smoke which allowed it to go through his lungs and even into his bloodstream.  It obviously caused a terrible, widespread reaction.  And he would have an allergic reaction every year after that at about the same time as the original reaction. 

Aug 3, 2015

Rule of Thumb:  If total burned area is larger than a softball, get medical attention.


A quick physics lesson:  Heat is a result of increased energy.  Energy likes to flow from places of high energy to places of low energy until it’s equaled out.  So heat will flow from the hot thing to the cool thing until they are the same temperature.  Because the temperature difference between the hot thing and your skin is so large, the heat transfers really quickly, to the point that the water in the cells evaporates and causes cell injury. 



Burns can lead to dehydration due to the loss of moisture from that area.  Burns can also lead to infection due to cell injury and possible broken skin from blisters. 

Jul 27, 2015

Drink water - lots of water.  Eight 8 oz glasses of water a day - at least. 


Your body is mostly water.  If you end up in a deficit, heat sickness or heat stroke may ensue. 


Drink room temperature water to be able to drink more and absorb more.  Here’s a website that explains different situations in which you should drink water at different temperatures.


If you feel thirsty, you’re already at a deficit and needs to be corrected ASAP. 


Make sure kids are drinking water and staying hydrated.  And your pets too! 


Temperature Reference

Water freezes at 32o F (0o F)

Refrigerated water is between 35-45o F (1-7o F)

Room temperature is between 68-78o F (20-25 o F)

Body temperature is 98.6o F (37o F)

Your hot water heater is probably set somewhere between 110-140o F (43-60o F)


Water boils at 212o F (100o F)

Jul 20, 2015

Stomach acid causes  heartburn.


Long-term reflux problems leads to a GERD diagnosis. 


Stomach acid has a pH of 2.  


Low pH = acid; High pH = base 


Stomach acid is Hydrochloric acid (HCl) 


The molecules of the acid like to spend their time joining together and breaking apart.  So by attaching to something else instead of each other is how it can be dangerous but also how it helps digest food quickly. 


Your stomach is designed to hold this strong acid safely. 


There are pumps in the cells of the lining of your stomach that produce the acid. 


Proton pumps work kind of like a water wheel - they move protons from inside the cell to outside to the stomach cavity. 


Hydrogen atoms are made up of 1 proton (positive charge) and 1 electron (negative charge).  So if you take the electron away from hydrogen, you are left with a proton with a positive charge. 


That is why there is a class of medications for reflux called Proton Pump Inhibitors (PPI).  These medications turn off these pumps so they pump less protons into the stomach. 


Another process that helps create acid in the stomach relies on histamines. 


They are not quite the same as the histamines that you hear about in relation to allergies.  But there is a particular type of histamine that is only in your stomach. 


The medications for the histamine process are called Histamine 2 Receptor Blocker (H2RB). 


H2RB’s work faster than PPI’s.  Just like you can take an antihistamine and it block histamines causing allergies in just a dose or two, H2RB’s can work as fast as one or two doses.  That is why they are advertised to treat heartburn after you eat or to help prevent heartburn before you eat. 


PPI’s take up to 2 weeks to reach maximum effect. 


The third option for heartburn are your antacids.  They are bases that go into your stomach acid and help neutralize it. 


Atnacids: Tums, Rolaids, Maalox, Mylanta - fastest 


H2RB’s: Pepcid, Zantac, Tagamet  - all have generics, all OTC 

Tagamet can have drug-drug interactions with other prescription medications, so caution is advised.


PPI’s: Prilosec, Prevacid, Nexium - some generic, newly OTC - slowest 


The downside to having reflux medications available OTC and people having the opportunity to self-treat is if there are any cellular changes in your esophagus. 


Your esophagus is not designed to be in contact with that level of acid.  As those cells are injured, they eventually change and can become cancer. 


Fun tidbit:  Just like the cells of your skin are epithelial cells and their job is to keep the inside things in and the outside things out.  Your digestive tract is also lined with epithelial cells.  So technically the food you eat doesn’t go inside your body, it just moves through this tract that is “outside turned in”. 


@steve_tessler question:  After he eats, he coughs for 30 minutes, and sometimes sneezes.  Is this considered GERD?  Cannot eat nuts or seeds due to diverticulosis.  If he sits and rests it doesn’t get so bad, but if he has to be active right after a meal, it is. 



Recommendation:  try a H2RB morning and night and see if it contains the acid after meals.  The next option could be a slight food allergy, possibly gluten, so cutting out certain foods would be necessary. 

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