Are You Taking PIMs?

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Getting Off The Overmedication Train

The older we get, the more likely we are to be on more medications. It’s easy to assume that this is because, much like the ailments they treat, we accumulate them over time. And superficially at least, that’s what happens.

And yet, almost half of people over 65 in Canada are taking “potentially inappropriate medications”, or PIMs—in other words, medications that are not needed and perhaps harmful. This categorization includes medications where the iatrogenic harms (side effects, risks) outweigh the benefits, and/or there’s a safer more effective medication available to do the job.

See: The cost of potentially inappropriate medications for older adults in Canada: A comparative cross-sectional study

You may be wondering: what does this mean for the US?

Well, we don’t have the figures for the US because we’re working from Canadian research today, but given the differences between the two country’s healthcare systems (mostly socialized in Canada and mostly private in the US), it seems a fair hypothesis that if it’s almost half in Canada, it’s probably more than half in the US. Socialized healthcare systems are generally quite thrifty and seek to spend less on healthcare, while private healthcare systems are generally keen to upsell to new products/services.

The three top categories of PIMs according to the above study:

  1. Gabapentinoids (anticonvulsants also used to treat neuropathic pain)
  2. Proton pump inhibitors (PPIs)
  3. Antipsychotics (especially, to people without psychosis)

…but those are just the top of the list; there are many many more.

The list continues: opioids, anticholinergics, sulfonlyurea, NSAIDs, benzodiazepines and related rugs, and cholinesterase inhibitors. That’s where the Canadian study cuts off (although it also includes “others” just before NSAIDs), but still, you guessed it, there are more (we’re willing to bet statins weigh heavily in the “others” section, for a start).

There are two likely main causes of overmedication:

The side effect train

This is where a patient has a condition and is prescribed drug A, which has some undesired side effects, so the patient is prescribed drug B to treat those. However, that drug also has some unwanted side effects of its own, so the patient is prescribed drug C to treat those. And so on.

For a real-life rundown of how this can play out, check out the case study in:

The Hidden Complexities of Statins and Cardiovascular Disease (CVD)

The convenience factor

No, not convenient for you. Convenient for others. Convenient for the doctor if it gets you out of their office (socialized healthcare) or because it was easy to sell (private healthcare). Convenient for the staff in a hospital or other care facility.

This latter is what happens when, for example, a patient is being too much trouble, so the staff give them promazine “to help them settle down”, notwithstanding that promazine is, besides being a sedative, also an antipsychotic whose common side effects include amenorrhea, arrhythmias, constipation, drowsiness and dizziness, dry mouth, impotence, tiredness, galactorrhoea, gynecomastia, hyperglycemia, insomnia, hypotension, seizures, tremor, vomiting and weight gain.

This kind of thing (and worse) happens more often towards the end of a patient’s life; indeed, sometimes precipitating that end, whether you want it or not:

Mortality, Palliative Care, & Euthanasia

How to avoid it

Good practice is to be “open-mindedly skeptical” about any medication. By this we mean, don’t reject it out of hand, but do ask questions about it.

Ask your prescriber not only what it’s for and what it’ll do, but also what the side effects and risks are, and an important question that many people don’t think to ask, and for which doctors thus don’t often have a well-prepared smooth-selling reply, “what will happen if I don’t take this?”

And look up unbiased neutral information about it, from reliable sources (Drugs.com and The BNF are good reference guides for this—and if it’s important to you, check both, in case of any disagreement, as they function under completely different regulatory bodies, the former being American and the latter being British. So if they both agree, it’s surely accurate, according to best current science).

Also: when you are on a medication, keep a journal of your symptoms, as well as a log of your vitals (heart rate, blood pressure, weight, sleep etc) so you know what the medication seems to be helping or harming, and be sure to have a regular meds review with your doctor to check everything’s still right for you. And don’t be afraid to seek a second opinion if you still have doubts.

Want to know more?

For a more in-depth exploration than we have room for here, check out this book that we reviewed not long back:

To Medicate or Not? That is the Question! – by Dr. Asha Bohannon

Take care!

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  • How often should you wash your sheets and towels?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Everyone seems to have a different opinion when it comes to how often towels and bed sheets should be washed. While many people might wonder whether days or weeks is best, in one survey from the United Kingdom, almost half of single men reported not washing their sheets for up to four months at a time.

    It’s fairly clear that four months is too long to leave it, but what is the ideal frequency?

    Bed linen and towels are quite different and so should be washed at different intervals. While every week or two will generally suffice for sheets, towels are best washed every few days.

    Anyway, who doesn’t love the feeling of a fresh set of sheets or the smell of a newly laundered towel?

    Why you should wash towels more often

    When you dry yourself, you deposit thousands of skin cells and millions of microbes onto the towel. And because you use your towel to dry yourself after a shower or bath, your towel is regularly damp.

    You also deposit a hefty amount of dead skin, microbes, sweat and oils onto your sheets every night. But unless you’re a prolific night sweater, your bedding doesn’t get wet after a night’s sleep.

    Towels are also made of a thicker material than sheets and therefore tend to stay damp for longer.

    So what is it about the dampness that causes a problem? Wet towels are a breeding ground for bacteria and moulds. Moulds especially love damp environments. Although mould won’t necessarily be visible (you would need significant growth to be able to see it) this can lead to an unpleasant smell.

    As well as odours, exposure to these microbes in your towels and sheets can cause asthma, allergic skin irritations, or other skin infections.

    A couple changing the sheets on their bed.
    People don’t always agree on how often to change the sheets.
    http://rawpixel.com/Shutterstock

    So what’s the ideal frequency?

    For bedding, it really depends on factors such as whether you have a bath or shower just before going to bed, or if you fall into bed after a long, sweaty day and have your shower in the morning. You will need to wash your sheets more regularly in the latter case. As a rule of thumb, once a week or every two weeks should be fine.

    Towels should ideally be washed more regularly – perhaps every few days – while your facecloth should be cleaned after every use. Because it gets completely wet, it will be wet for a longer time, and retain more skin cells and microbes.

    Wash your towels at a high temperature (for example, 65°C) as that will kill many microbes. If you are conscious of saving energy, you can use a lower temperature and add a cup of vinegar to the wash. The vinegar will kill microbes and prevent bad smells from developing.

    Clean your washing machine regularly and dry the fold in the rubber after every wash, as this is another place microbes like to grow.

    Smelly towels

    What if you regularly wash your towels, but they still smell bad? One of the reasons for this pong could be that you’ve left them in the washing machine too long after the wash. Especially if it was a warm wash cycle, the time they’re warm and damp will allow microbes to happily grow. Under lab conditions the number of these bacteria can double every 30 minutes.

    It’s important to hang your towel out to dry after use and not to leave towels in the washing machine after the cycle has finished. If possible, hang your towels and bedding out in the sun. That will dry them quickly and thoroughly and will foster that lovely fresh, clean cotton smell. Using a dryer is a good alternative if the weather is bad, but outdoors in the sun is always better if possible.

    Also, even if your towel is going to be washed, don’t throw a wet towel into the laundry basket, as the damp, dirty towel will be an ideal place for microbes to breed. By the time you get to doing your washing, the towel and the other laundry around it may have acquired a bad smell. And it can be difficult to get your towels smelling fresh again.

    A young woman loading a washing machine.
    Towels should be washed more often than sheets.
    New Africa/Shutterstock

    What about ‘self-cleaning’ sheets and towels?

    Some companies sell “quick-dry” towels or “self-cleaning” towels and bedding. Quick-dry towels are made from synthetic materials that are weaved in a way to allow them to dry quickly. This would help prevent the growth of microbes and the bad smells that develop when towels are damp for long periods of time.

    But the notion of self-cleaning products is more complicated. Most of these products contain nanosilver or copper, antibacterial metals that kill micro-organisms. The antibacterial compounds will stop the growth of bacteria and can be useful to limit smells and reduce the frequency with which you need to clean your sheets and towels.

    However, they’re not going to remove dirt like oils, skin flakes and sweat. So as much as I would love the idea of sheets and towels that clean themselves, that’s not exactly what happens.

    Also, excessive use of antimicrobials such as nanosilver can lead to microbes becoming resistant to them.The Conversation

    Rietie Venter, Associate professor, Clinical and Health Sciences, University of South Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • The End of Old Age – by Dr. Marc Agronin

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    First, what this book is not: a book about ending aging. For that, you would want to check out “Ending Aging”, by Dr. Aubrey de Grey.

    What this book actually is: a book about the purpose of aging. As in: “aging: to what end?”, and then the book answers that question.

    Rather than viewing aging as solely a source of decline, this book (while not shying away from that) resolutely examines the benefits of old age—from clinically defining wisdom, to exploring the many neurological trade-offs (e.g., “we lose this thing but we get this other thing in the process”), and the assorted ways in which changes in our brain change our role in society, without relegating us to uselessness—far from it!

    The style of the book is deep and meaningful prose throughout. Notwithstanding the author’s academic credentials and professional background in geriatric psychiatry, there’s no hard science here, just comprehensible explanations of psychiatry built into discussions that are often quite philosophical in nature (indeed, the author additionally has a degree in psychology and philosophy, and it shows).

    Bottom line: if you’d like your own aging to be something you understand better and can actively work with rather than just having it happen to you, then this is an excellent book for you.

    Click here to check out The End Of Old Age, and live it!

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  • What pathogen might spark the next pandemic? How scientists are preparing for ‘disease X’

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Before the COVID pandemic, the World Health Organization (WHO) had made a list of priority infectious diseases. These were felt to pose a threat to international public health, but where research was still needed to improve their surveillance and diagnosis. In 2018, “disease X” was included, which signified that a pathogen previously not on our radar could cause a pandemic.

    While it’s one thing to acknowledge the limits to our knowledge of the microbial soup we live in, more recent attention has focused on how we might systematically approach future pandemic risks.

    Former US Secretary of Defense Donald Rumsfeld famously talked about “known knowns” (things we know we know), “known unknowns” (things we know we don’t know), and “unknown unknowns” (the things we don’t know we don’t know).

    Although this may have been controversial in its original context of weapons of mass destruction, it provides a way to think about how we might approach future pandemic threats.

    Anna Shvets/Pexels

    Influenza: a ‘known known’

    Influenza is largely a known entity; we essentially have a minor pandemic every winter with small changes in the virus each year. But more major changes can also occur, resulting in spread through populations with little pre-existing immunity. We saw this most recently in 2009 with the swine flu pandemic.

    However, there’s a lot we don’t understand about what drives influenza mutations, how these interact with population-level immunity, and how best to make predictions about transmission, severity and impact each year.

    The current H5N1 subtype of avian influenza (“bird flu”) has spread widely around the world. It has led to the deaths of many millions of birds and spread to several mammalian species including cows in the United States and marine mammals in South America.

    Human cases have been reported in people who have had close contact with infected animals, but fortunately there’s currently no sustained spread between people.

    While detecting influenza in animals is a huge task in a large country such as Australia, there are systems in place to detect and respond to bird flu in wildlife and production animals.

    Scientists in a lab.
    Scientists are continually monitoring a range of pathogens with pandemic potential. Edward Jenner/Pexels

    It’s inevitable there will be more influenza pandemics in the future. But it isn’t always the one we are worried about.

    Attention had been focused on avian influenza since 1997, when an outbreak in birds in Hong Kong caused severe disease in humans. But the subsequent pandemic in 2009 originated in pigs in central Mexico.

    Coronaviruses: an ‘unknown known’

    Although Rumsfeld didn’t talk about “unknown knowns”, coronaviruses would be appropriate for this category. We knew more about coronaviruses than most people might have thought before the COVID pandemic.

    We’d had experience with severe acute respiratory syndrome (SARS) and Middle Eastern respiratory syndrome (MERS) causing large outbreaks. Both are caused by viruses closely related to SARS-CoV-2, the coronavirus that causes COVID. While these might have faded from public consciousness before COVID, coronaviruses were listed in the 2015 WHO list of diseases with pandemic potential.

    Previous research into the earlier coronaviruses proved vital in allowing COVID vaccines to be developed rapidly. For example, the Oxford group’s initial work on a MERS vaccine was key to the development of AstraZeneca’s COVID vaccine.

    Similarly, previous research into the structure of the spike protein – a protein on the surface of coronaviruses that allows it to attach to our cells – was helpful in developing mRNA vaccines for COVID.

    It would seem likely there will be further coronavirus pandemics in the future. And even if they don’t occur at the scale of COVID, the impacts can be significant. For example, when MERS spread to South Korea in 2015, it only caused 186 cases over two months, but the cost of controlling it was estimated at US$8 billion (A$11.6 billion).

    Coronavirus statistics on a screen.
    COVID could be regarded as an ‘unknown known’. Markus Spiske/Pexels

    The 25 viral families: an approach to ‘known unknowns’

    Attention has now turned to the known unknowns. There are about 120 viruses from 25 families that are known to cause human disease. Members of each viral family share common properties and our immune systems respond to them in similar ways.

    An example is the flavivirus family, of which the best-known members are yellow fever virus and dengue fever virus. This family also includes several other important viruses, such as Zika virus (which can cause birth defects when pregnant women are infected) and West Nile virus (which causes encephalitis, or inflammation of the brain).

    The WHO’s blueprint for epidemics aims to consider threats from different classes of viruses and bacteria. It looks at individual pathogens as examples from each category to expand our understanding systematically.

    The US National Institute of Allergy and Infectious Diseases has taken this a step further, preparing vaccines and therapies for a list of prototype pathogens from key virus families. The goal is to be able to adapt this knowledge to new vaccines and treatments if a pandemic were to arise from a closely related virus.

    Pathogen X, the ‘unknown unknown’

    There are also the unknown unknowns, or “disease X” – an unknown pathogen with the potential to trigger a severe global epidemic. To prepare for this, we need to adopt new forms of surveillance specifically looking at where new pathogens could emerge.

    In recent years, there’s been an increasing recognition that we need to take a broader view of health beyond only thinking about human health, but also animals and the environment. This concept is known as “One Health” and considers issues such as climate change, intensive agricultural practices, trade in exotic animals, increased human encroachment into wildlife habitats, changing international travel, and urbanisation.

    This has implications not only for where to look for new infectious diseases, but also how we can reduce the risk of “spillover” from animals to humans. This might include targeted testing of animals and people who work closely with animals. Currently, testing is mainly directed towards known viruses, but new technologies can look for as yet unknown viruses in patients with symptoms consistent with new infections.

    We live in a vast world of potential microbiological threats. While influenza and coronaviruses have a track record of causing past pandemics, a longer list of new pathogens could still cause outbreaks with significant consequences.

    Continued surveillance for new pathogens, improving our understanding of important virus families, and developing policies to reduce the risk of spillover will all be important for reducing the risk of future pandemics.

    This article is part of a series on the next pandemic.

    Allen Cheng, Professor of Infectious Diseases, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • The Salt Fix – by Dr. James DiNicolantonio

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    This book has a bold premise: high salt consumption is not, as global scientific consensus holds, a serious health risk, but rather, as the title suggests, a health fix.

    Dr. DiNicolantonio, a pharmacist, explains how “our ancestors crawled out of the sea millions of years ago and we still crave that salt”, giving this as a reason why we should consume salt ad libitum, aiming for 8–10g per day, and thereafter a fair portion of the book is given over to discussing how many health conditions are caused/exacerbated by sugar, and that therefore we have demonized the wrong white crystal (scientific consensus is that there are many white crystals that can cause us harm).

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    A lot of the studies the author cites to support the idea of healthy higher salt consumption rates were on non-human animals, and it’s always a lottery as to whether those results translate to humans or not. Also, many of the studies he’s citing are old and have methodological flaws, while others we could not find when we looked them up.

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    Click here to check out The Salt Fix for yourself! It’s a fascinating book.

    (Usually, if we do not approve of a book, we simply do not review it. We like to keep things positive. However, this one came up in Q&A, so it seemed appropriate to share our review. Also, the occasional negative review may reassure you, dear readers, that when we praise a book, we mean it)

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    Here are some key things to consider:

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  • Relieve GERD and Acid Reflux with Stretches and Exercises

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Looking for relief from GERD or acid reflux? Today we’re featuring an amazing video by Dr. Jo, packed with stretches and exercises designed to ease those symptoms.

    Here’s a quick rundown, in case you don’t have time to watch the whole video.

    If you’re not familiar with GERD, you can find our simple explanation of GERD here. Or, if you’re on the other end of the spectrum and want to do a deeper dive on the topic, we reviewed a great book on the topic).

    1. Mobilize Your SEM Muscle

    The sternocleidomastoid (SEM) muscle, if tight, can aggravate acid reflux. Dr. Jo shows how to gently mobilize this muscle by turning your head while holding the SEM in place. It’s simple but effective.

    2. Portrait Pose Stretch

    Stretch out that SEM with the Portrait Pose. Place your hand on your collarbone, turn your head away, side bend, and look up. Hold for 30 seconds. You’ll feel the tension melting away.

    3. Seated Cat-Cow Motion

    Open up your stomach area with this easy exercise. Sit down, roll your body forward, arch your back (Cow), then curl your spine and tuck your chin (Cat). Alternate for 30 seconds and feel the difference.

    4. Quadruped Cat-Cow with Breathing

    Similar to the seated cat-cow, the quadruped cat-cow focuses on flexing the lower spine whilst on all fours. Bonus tip: focus on deep belly breathing during the exercise. This helps improve digestion and ease reflux symptoms.

    5. Exaggerated Pelvic Tilt

    Lie on your back and tilt your pelvis back and forth. This loosens up the abdominal area and helps everything flow better.

    6. Trunk Rotation

    Lie down, bend your knees, and rotate them to one side. Hold for 30 seconds, then switch sides. It’s a great way to relax and stretch your abdominal muscles.

    We know this is a quick overview (sorry if it seems rushed!), but if you have a few more minutes on your hand you can watch the whole video below.

    Feel better soon! And if you have any favorite tips or videos to share, email us at 10almonds.

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