Joint pain from arthritis, an injury, or overuse often requires the use of anti-inflammatory medications. Many people hate taking pills by mouth because they can be hard on the stomach and kidneys. But do the topical options work? What are your options and which is the best?
Non-steroidal anti-inflammatory (NSAID) topical options:
In the United States, three topical NSAID products are approved to treat pain including Voltaren Gel (diclofenac sodium 1%), Pennsaid topical solution (diclofenac sodium 1.5%), and Flector patches (diclofenac epolamine 1.3%).
Do they work for arthritis pain?
Yes, several recent studies suggest topical NSAID options are effective for arthritis pain and some studies suggest pain relief is similar to that achieved by taking oral NSAIDs (e.g. naproxen, ibuprofen, Aleve, Advil).
Are the topical NSAIDs safer?
Yes, topical NSAIDs are likely safer than oral NSAIDs due to the low blood concentrations that occur when you use the topical NSAIDs (Voltaren Gel, Pennsaid and Flector patches). So in other words, using a topical won’t affect the GI tract or kidneys nearly as much as the oral medications.
What are the benefits of the topical NSAIDs over pills?
Oral NSAIDs work well, but concern over cardiovascular and GI side effects can potentially limit their use. The three topical options have been shown to provide effective pain relief with minimal side effects. Among the topical options, in one head to head comparison patients preferred Pennsaid over Voltaren gel.
What is the downside?
I’d say cost. Depending on what your insurance company will cover, know that Pennsaid comes in a generic diclofenac sodium spray, but it may still be more expensive than brand name Voltaren Gel. Flector patches come in a box of 30 and they are pricey, but if you can get it covered, worth a try.
With so many different insulin and insulin-like products out there these days it can be hard to keep track of when your vial should be tossed.
Depending on your dose, you may still have insulin left in your vial by the manufacturer-recommended time to throw it away. If this sounds like a familiar situation, know that it is important to throw away your vial regardless of whether you have any leftover.
You might think it is wasteful to throw out what you may consider “perfectly good insulin,” but using the medication past the recommended time can actually do you more harm than good.
You may notice that if you continue to use insulin from a vial past the manufacturers discard date, your blood glucose could be higher or a greater dose may be needed to achieve a normal blood glucose reading.
There are several different types of insulin and a variety of other injectable diabetes medications, and the recommendations for how long they keep varies.
For a quick overview, the different categories of insulin are:
- Short-acting (regular)
So how long can you hold on to your insulin after you start using a vial?
- Novolog: use within 28 days after puncturing vial
- Humalog: use within 28 days after puncturing vial
- Apidra: use within 28 days after puncturing vial
- Humulin R: use within 31 days after puncturing vial
- Humulin R U-500 concentrated: use within 31 days after puncturing vial
- Novolin R: use within 42 days after puncturing vial
- Humulin N: use within 1 month after puncturing vial
- Novolin N: use within 1 month after puncturing vial
Other injectable diabetes medications in vials
- Bydureon: use immediately once the vial has been punctured and the powder mixed
Patients often come in with small white (hypo-pigmented) patches on their upper arms wondering what to do about it. Ask for help, because you will need to see your doctor for diagnosis and treatment—most treatment options are prescription only. It’s easy to get rid of though, so here you go.
What is it?
Tinea versicolor is a common skin fungal infection. The white/hypopigmented areas occur most commonly on the upper arms and trunk. The organism that causes it is different from athlete’s foot or nail fungus, it is a lipid (fat) dependent yeast called Malassezia. Malassezia is normally found on skin and only causes a problem (tinea versicolor) when it transforms from a yeast form to a mycelial form (the vegetative or branching part of a fungus).
Why do some people get it?
We don’t really know. The use of oils on the skin, hot and humid weather and sweating are risk factors.
Is it contagious?
No. Tinea versicolor is not contagious.
What does it look like?
This may seem strange, but it can cause lighter areas (hypo-pigmented white areas) or darker areas. In light skinned people it can cause white or light brown small patches, in dark skinned folks it can be white, dark brown or gray-black. The most common appearance is lighter or white patches on the upper arms. In kids, for some reason, it most commonly involves the face.
Why the upper arms?
This is a cool and kind of gross fact at the same time. Malassezia is lipid (fat) dependent. There are more sebaceous glands on the upper arms—these glands secrete sebum (an oily substance that helps lubricate our skin) and the Malassezia likes that. Ewww.
Does it itch?
Nope, usually you feel no symptoms you will just notice the differently colored patches. In the summer when you are tan, you will notice them more because the affected patches will not tan, making them look more distinct.
What else could it be?
You will need to see your doctor for treatment so he or she can ensure it is tinea versicolor and not seborrheic dermatitis, vitiligo, or pityriasis rosea, among other things.
Can you treat it?
Yes, treatments work well, but recurrence is common. Remember that even when infection is treated it takes a couple months for the pigment to return to normal. Some folks need long-term maintenance therapy to prevent it from coming back.
So what might you be prescribed to treat tinea versicolor?
- The “Azole” antifungal creams. Clotrimazole 1%, ketoconazole 2%, econazole 1%, and miconazole 2% are examples that work well when used once or twice daily for one to four weeks. After an average of two weeks, 84% of people have been cured. Pick one of these based on price, as these are all generics and should be reasonable, though econazole can still be expensive.
- Ketoconazole 2% shampoo works better with a shorter duration of therapy. The shampoo applied to the areas affected is left on for 5 minutes once daily for 3 days cures 80% of people.
- Terbinafine (Lamisil) 1% cream or gel is used twice daily for one week.
- Ciclopirox 0.77% cream is effective when used twice a day for 14 days. It’s generic and reasonably priced.
- Selenium sulfide shampoo 2.5% works well when used as one 10 minute application daily for one week. Of note, the over the counter 1% shampoo has not been studied so we don’t know if it works for treatment.
- Zinc pyrithione 1% or 2% shampoo is used on areas affected every day for 2 weeks and you leave it on for 5 minutes.
Pills—used only when the topicals don’t work. Two anti-fungal pills have been shown to be effective:
- Fluconazole (Diflucan) 300 mg once a week for two weeks cures 87% of people.
- Itraconazole (Spectazole) 200 mg per day for 5 days also works well.
Hope this helps
Hidden ingredients or substances not listed on the labels of unregulated muscle-building supplements can be risky. A new study in the British Journal of Cancer found out how risky, and turns out, for testicular cancer it’s impressive. This matters because use of muscle-building supplements is increasing among younger men and rakes in billions of dollars.
What did we learn?
Men, especially 25 and younger, who use muscle-building supplements that contain creatine or androstenedione may have up to 65% increased risk of developing testicular cancer. If you used them longer, your risk was higher.
Why should we care?
Testicular cancer is the most common solid cancer in men aged 15 to 39 years. In 2014, the National Cancer Surveillance Program reported a substantial increase in testicular cancer among Hispanic adolescents and young adults in the United States. So far, we can’t explain this increase . . . that’s what makes this study on muscle building supplements so compelling.
What part of muscle-building supplements is bad?
Remember that these supplements are unregulated so we don’t really know what you are getting. Some ingredients in these supplements cause testis damage and some “natural components” could act like artificial hormones. Analysis in the British Journal of Cancer study found that using supplements containing creatine and proteins significantly increased the risk.
Haven’t we been warned about muscle-building supplements before?
Many many times. In 2013, thirty-two cases of liver failure were reported in Hawaii due to Oxy Elite Pro muscle building supplement. Again on April 13th of this year the FDA raised concerns about the use of Tri-Methyl Xtreme, which contains anabolic steroids that can cause serious liver injury. There are many more.
How did this study work?
This study included 356 men diagnosed with testicular cancer between 2006 and 2010 and 513 men without testicular cancer. Among other things, the interviewers asked about lifetime muscle-building supplement use (powders or pills). The interviews revealed that almost 20% of participants with testicular cancer had used muscle-building supplements, either pill or powder.
What were the risks of testicular cancer?
Men who had taken muscle-building supplements had significantly increased odds of developing testicular cancer. The risk was higher if you started using them before age 25 or used two or more types. Using them longer than 36 months also raised your risk even higher.
I’ve taken care of a 23 year old with liver failure from these supplements, who then survived only because of a liver transplant. Now, testicular cancer? Not worth it, not even close.
You may already know that, like many pharmacies, Sam’s Club offers a selection of generic medications at $4 for a 30-day supply and $10 for a 90-day supply—the same savings available at Walmart pharmacies. And you don’t need to be a member to take advantage of the savings or to fill a prescription at a Sam’s Club pharmacy.
But what if you’re a current Sam’s Club member, or looking for more savings? Sam’s has just introduced a new pharmacy savings program exclusively for their Plus Members.
Now, a regular membership ($40 per year) still won’t get you access to these savings. You’ll need the Sam’s Plus Membership, which currently runs $100 per year. That’s pretty steep, and possibly not worth it if you’re just looking at some prescription savings. However, there are a few cases where it may actually still be worthwhile.
First, if you’re already a regular member, it may be easier to make back the cost of the upgrade than the full Plus Membership in savings, both at the pharmacy and in the store. If you would be purchasing a yearly membership anyway, compare and consider the cost of each membership and the savings available.
If you already have a Plus Membership through work or your business is willing to upgrade to the Plus level, there may be some good values for you in the new savings on offer. Prices on the discounted list tend to be as good or better than most pharmacy discount programs as long as you aren’t taking the cost of membership into consideration. They cover a fairly wide range of generics, brands, and supplies like test strips. Blood glucose monitors are also free.
Another factor to keep in mind: the 5 free medications. Donepezil (Aricept), pioglitazone (Actos), escitalopram (Lexapro), finasteride 5 mg (Proscar), and Vitamin D2 50,0000 IU are all available for $0 for a 30-day supply to Plus Members. These drugs can be normally be found in the $10 – $20 cash price range if you’re a smart shopper or use a GoodRx discount. Insurance co-pays should be the same or less for these typically-tier-1 generics.
For the free medications, you could be looking at a $20 – $140 per year savings as a Plus Member after the $100 membership fee. Again, if you already shop at Sam’s or if you think you might use the membership to save on other prescriptions or products in the store, it may not be a bad choice. However, this may not be worth going out of your way for.
Take a look at their list to see for yourself—there are also 200 generic meds listed at $4 for 30 days and another 400 at $10 for 30 days, along with an estimated 10% – 30% savings on some brand name drugs.