A recent report published by the Centers for Disease Control and Prevention (CDC) confirmed what we already knew: this year’s flu is bad. Since October, widespread influenza activity has been reported in 49 states, resulting in 20 pediatric deaths and more than 6,000 influenza-related hospitalizations thus far. These rates surpass last year’s total numbers – and it’s only January.
One more way to see how bad the flu is this season: prescriptions for Tamiflu (oseltamivir), the most popular antiviral medication for treating the flu, are way up. According to a GoodRx analysis based on a significant sample of US pharmacy fills, Tamiflu fills are 640% above this time last year.
What’s more, it’s only January. As you can see below, fills for Tamiflu peaked in February of last year, indicating that the flu was the most widespread during that time. It’s possible that there is still more to come this year.
This is a stunning illustration of how bad the flu is – and how much worse it may still get.
If taken within the first 28 hours of getting the flu, Tamiflu can work to block the actions of influenza in your body, and shorten the duration of the virus. You can also take Tamiflu for up to six weeks to prevent you from getting the flu. Not surprisingly, Tamiflu is prescribed more often between the months of October and March, during flu season. Despite the surge of prescriptions, there are some doubts about whether Tamiflu is even effective for treatment or prevention – more on that below.
A shortage in Tamiflu
The high volume of Tamiflu prescriptions at this point in the season has resulted in a shortage of the medication. While the FDA has not yet confirmed this shortage, doctors and pharmacists in both urban and rural areas are reporting difficulty in accessing Tamiflu for their patients.
Those unable to access Tamiflu this year do have other options. Besides Tamiflu, there are two other influenza medications: Relenza and Rapivab. Both are considered just as effective as Tamiflu and may be easier to access this year. For more information on these medications, see our post here.
Over the counter medications can also help ease symptoms. Read here for more details on over the counter flu medications.
Is it effective?
Tamiflu is sometimes treated as a cure for all cases of the flu, but recent studies call this reputation into question. According to a study-of-studies, or meta-analysis, performed by Cochrane Research of 46 studies involving more than 24,000 people, Tamiflu may provide a much smaller benefit than expected. At best, the analysis found that Tamiflu may only help patients recover one day faster, and may not reduce the number of flu-related complications, like pneumonia. Additionally, it may only reduce the risk of getting sick by 55%. At over $50 per prescription for generic oseltamivir, for some, the benefits may not outweigh the cost.
While these findings don’t negate the use of Tamiflu, they may indicate that it is less protective than we had previously thought.
Tamiflu side effects
There has been recent concern about Tamiflu’s side effects, especially in younger children. Recently, a 6-year-old girl reportedly attempted to jump out of her bedroom window during a hallucination while taking Tamiflu. The FDA has warned of similar side effects previously, noting that:
“Children and teenagers with the flu may be at a higher risk for seizures, confusion, or abnormal behavior early during their illness. These serious side effects may happen shortly after beginning Tamiflu of may happen in people when the flu is not treated. These serious side effects are not common but may result in accidental injury to the patient. People who take Tamiflu should be watched for sins of unusual behavior and a healthcare provider should be contacted right away if the patient shows any unusual behavior while taking Tamiflu.”
More common side effects include nausea, vomiting, headache, and pain. Be sure to speak with your doctor if you or a loved one experience any of these side effects for a prolonged period of time.
Why is the flu so bad this year?
This year’s flu is different from past year’s. The reason? Around 80% of flu cases this year involved H3N2, a strain of the influenza A virus that is more dangerous and results in more complications. H3N2 is generally also harder to prevent with the flu vaccine, and this seems to be true this year. Experts say that this year’s flu vaccine may be only 10% effective.
How can you protect yourself?
- You can still get your flu vaccine. Even though the flu shot may only 10% effective against this year’s flu, you may still want to consider getting it. Even if you get sick, a flu vaccine can also help ease the severity and duration of the virus.
- Visit your doctor immediately. When true flu symptoms hit, go to the doctor. The sooner you visit, the sooner you can get your prescription for an antiviral medication.
- Wash your hands. This may go without saying, but washing your hands is your best weapon against the flu virus.
- Exercising may help. While heavy exercise may predispose you to the flu, a moderate amount may be protective.
If you’ve ever been afraid to show up at your doctor’s office because you’ve been “bad” then this post is for YOU! You may think your doctor is “pushing medications on you” especially if you aren’t experiencing any symptoms of the condition they are treating you for. However, their reasoning is not without sound medical and professional judgment.
One of the many reasons you might receive a lecture about the importance of taking your medications is due to the progressive nature of many diseases if not properly treated. The following are common disease states that are often “silent” and can be deadly if not properly managed.
Diabetes is a disease that occurs when your blood sugar is too high. Blood sugar is your main source of energy and comes from the food you eat. There are several different types of diabetes, with the most common being type 1 and type 2 diabetes.
Signs and symptoms of uncontrolled high blood sugar can oftentimes be overlooked, as you may not be able to tell. Some signs that are associated with low blood sugar include increased thirst and urination, blurry vision, lethargy, and frequent headaches.
Some people will stop taking their medication or take them inconsistently due to not “feeling” any different whether they take them or not. This is a more common occurrence with type 2 diabetics but has happened in type 1 diabetics who forgo their insulin.
Diabetes is one of many diseases that is often referred to as a “silent killer” as it can lead to amputations, vision loss, heart attack, stroke, sexual dysfunction, bladder problems, and kidney disease if poorly controlled.
Patients with diabetes may control their diabetes with injectable medications like Humalog, Novolog, Humulin, Lantus, and Tresiba, or oral medications like metformin, glipizide, glimepiride, and invokana.
High blood pressure
High blood pressure occurs when the force of your blood pushing against the walls of your blood vessels is consistently too high and can damage or weaken your blood vessels. However, it can’t physically be felt, as there are no obvious symptoms indicating something is wrong. You will need to visit your doctor to determine if you have high blood pressure.
Also referred to as a ‘silent killer,’ consequences of poorly controlled high blood pressure may include heart attack, stroke, vision loss, heart or kidney failure, and sexual dysfunction.
Cholesterol is a substance your body needs to build cells. However, there is bad cholesterol (LDL, and triglycerides) and good cholesterol (HDL).
Too much of the bad kind and not enough of the good kind increases the chances that cholesterol will begin to build up in the inner walls of arteries. Over time, this buildup can narrow or completely block the arteries leading to a variety of serious, life-threatening problems.
You can’t physically feel if you have high cholesterol and usually don’t know unless something bad happens or through routine blood work called a lipid panel. If not treated properly, high cholesterol can lead to heart attack, stroke, and chest pain.
Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall, or, in serious cases, from sneezing or minor bumps. Osteoporosis affects both men and women, and as our bodies age the likelihood of developing osteoporosis increases.
Breaking a bone is often one of the first indications that you may have osteoporosis. People with osteoporosis most often break bones in the hip, spine, and wrist. You may also notice that you are getting shorter, or your upper back is beginning to curve forward. These symptoms may also indicate that you may have osteoporosis.
Consequences of untreated osteoporosis include one fracture, broken bones, pain, and limited mobility.
One of the most popular drugs in the country, levothyroxine – also known as the brand name Synthroid – is in short supply, making prices higher and even leaving some patients without the drug. The shortage is a result of hurricanes Irma and Maria, which hit Puerto Rico nearly four months ago, and knocked out manufacturing facilities for many drugs and medical supplies, including levothyroxine.
Walmart, for instance, has more than doubled their cash prices for levothyroxine. Before the shortage, Walmart offered 30 tablets of all dosages of levothyroxine for $4 and 90 tablets for $10. Now, 30 tablets is $9, and 90 tablets is $24.
Walmart issued a statement informing the public of their price increase:
“Effective December 8th, 2017, your price will increase temporarily to $9 per 30-day supply or $24 per 90-day supply. We value your loyalty and business and are committed to offering you affordable pharmacy products and services. We’ll return to regular pricing as soon as this shortage has been resolved.”
In other places, the shortage means that patients are leaving their pharmacy without the medicine altogether. Many consumers are turning to Twitter to share their stories:
At present, the FDA has not added levothyroxine to their official shortage list, even as some patients are being blindsided at the pharmacy over levothyroxine’s cost and availability.
Levothyroxine is among the most prescribed medications in the United States; it is a lifesaving maintenance drug used to treat hypothyroidism. Simply skipping a dose, or waiting till you can afford it it is a dangerous option. Patients who suddenly stop taking levothyroxine may go into withdrawal and may experience symptoms like debilitating weight loss, panic attacks, fatigue, muscle weakness, and nausea.
If you have found it difficult to fill your levothyroxine prescription, or you’re experiencing sticker shock at the pharmacy, here are a couple of alternatives you can try.
Armour Thyroid is considered the natural alternative to levothyroxine. While it is not the first-choice treatment for those with a thyroid condition, according to our friends at Iodine, many people actually prefer Armour Thyroid over levothyroxine. Why? Let’s get into the differences between levothyroxine and Armour Thyroid to explain that.
The main difference lies in how these drugs are manufactured. Levothyroxine is a synthetic T4 hormone, while Armour Thyroid is a natural thyroid hormone. What does this mean? Levothyroxine’s hormone, T4, is not active in the body and has to be processed into a different hormone, called T3, to work its magic. Levothyroxine is also synthetic, meaning that all of the hormones it contains are man-made in a laboratory. In contrast, Armour Thyroid is a natural thyroid, so it comes from animal sources and includes both the T3 and T4 hormones.
Because levothyroxine only includes the T4 hormone, some argue that it might not work for everyone. While studies haven’t shown that Armour Thyroid’s combination T3-T4 therapy is superior to levothyroxine’s T4 therapy, it might account for the high ratings from patients.
Thinking of switching? Here are some things you need to be aware of.
- Birth controls and estrogens have been shown to decrease the effectiveness of Armour Thyroid. Be sure to speak with your doctor if you are taking a birth control.
- Try to avoid antacids within four hours of taking Armour Thyroid, as they can make it harder to absorb the hormones.
- Armour Thyroid and levothyroxine are not interchangeable, so 1 mg of Armour Thyroid is not the same as 1 mg of levothyroxine. It may take some time to determine what dose of Armour Thyroid will work best for you, so as always, consult with your doctor.
- There are no generic versions of Armour Thyroid, and it isn’t covered by many insurance plans, but you can pay as little as $25 with a GoodRx coupon, depending on your location.
- You cannot substitute Armour Thyroid for levothyroxine and will need to get a new prescription from your doctor.
Just like levothyroxine, Cytomel (liothyronine) is another synthetic thyroid medication. But there is a difference. While levothyroxine is a synthetic version of the T4 hormone, Cytomel is a synthetic version of the T3 hormone. Remember how levothyroxine’s T4 hormone has to be processed into the T3 hormone in the body? Since Cytomel contains the T3 hormone, there is no processing needed.
But there is a downside to this. The T3 hormone is absorbed rapidly in the body, which can lead to thyroid hormone toxicity (hyperthyroidism) in some cases. Don’t let this scare you though, Cytomel is safe if used correctly. Be sure to work with your doctor to keep your thyroid hormone levels healthy.
Another downside? According to our friends at Iodine, 13% of people rated that Cytomel was ineffective for them. This side-effect can be common with many thyroid medications, but this is still important to keep in mind.
Thinking of switching? Here are some things you need to be aware of.
- Cytomel has a generic, liothyronine, that is affordable. The average retail price for liothyronine is $33.24 and can be reduced to as little as $12.77 with a GoodRx coupon.
- You may need to work with your doctor to find the right dosage for you.
- Periodic blood tests are a must.
- Cytomel also has many food and drug interactions you should be aware of. For instance, birth control pills, estrogen, anticoagulants, ketamine, antidepressants, and vasopressor medications may interact negatively with Cytomel. Be sure to speak with your doctor if you are taking any of these medications.
- Common side effects include chest pain, diarrhea, weight change, fatigue, headache, insomnia, dizziness, and depression. Be sure to speak with your doctor if you experience any of these for a prolonged period of time.
- You cannot substitute Cytomel for levothyroxine and will need to get a new prescription from your doctor.
Levoxyl (levothyroxine) is a brand name only medication used to treat hypothyroidism and has the same active ingredient as Synthroid – levothyroxine. Just like Synthroid, Levoxyl is also a synthetic T4 hormone. Overall, Synthroid and Levoxyl are quite similar, so why isn’t Levoxyl as well known?
Pfizer, the manufacturer of Levoxyl, lost their market share for levothyroxine products a couple of years back. In 2013, Pfizer pulled Levoxyl from the market because of a suspicious odor emitted from the packaging. After this recall, Levoxyl was off the market for about a year, causing many consumers to switch to alternatives, and they never looked back. Pfizer officially lost their market share. Out of sight, out of mind.
Despite this recall, after Levoxyl’s return to the market, there has been little concern over the safety of the medication, making it an adequate alternative to Synthroid.
Thinking of switching? Here are some things you need to be aware of.
- Levoxyl has a patient savings program that can help you save $5 off your monthly prescription. For more information see Pfizer’s website here.
- While there is no generic available, the brand is still quite affordable, with an average retail price of $33.29.
- Even though they contain the same active ingredient, you cannot substitute Levoxyl for levothyroxine and will need to get a new prescription from your doctor.
Fevers – can’t live with them, can’t live without them. Or at least, that’s the case once you start coming down with one. Understanding what happens inside your body when you have a fever may help you determine whether to treat yours or not.
How a fever works
It seems counterintuitive that you get the shivers when you’re feeling feverish. You’re hot, but you’re also cold? But it all starts to make sense if you take a look at what’s really going on inside.
Our bodies come with a built-in thermostat in the brain’s hypothalamus. Normally, this thermostat is set to around 98 degrees Fahrenheit. If your body dips below this “set point” – say, from wearing short sleeves during a snowstorm – your brain will turn on processes to create and retain heat. Shivering is the most obvious one; its rapid muscle micro-movements generate heat all over your body. On the other hand, if you get too warm, you’ll start sweating. Sweat evaporating off of your skin cools you down. This happens involuntarily, and your brain is really good at keeping your body’s temperature stable.
What’s going on when you get a fever? Fever is a sign of inflammation in your body. An inflammatory response can be triggered by infection, such as a flu virus, or by immune-related diseases, cancer, or even drugs and alcohol. Certain chemicals released during inflammation turn your body’s thermostat up past 98 degrees.
So now your body is 98 degrees, but your thermostat is at (for example) 102. Your brain thinks your body is too cold, so you shiver to warm up. This is how you can have a fever and feel warm on the outside but get the chills and feel cold inside. Once you warm all the way up to your body’s new set point, you’ll feel warm to the touch, but internally your body will feel just right, so you’ll stop shivering.
A fever “breaks” when your body fights off the bug and the inflammation starts calming down. Your thermostat gets reset back to 98 degrees, but your body is still up at 102. Your brain turns on sweating and sends blood near the surface of your skin to release heat, and you cool back down to your normal body temperature.
The thermostat hypothesis explains how fever medications work. Acetaminophen, aspirin, and NSAIDs such as ibuprofen are fever reducers. Among other effects on the body, they inhibit production of prostaglandins, the chemicals that turn up the thermostat in your brain. During a fever, taking one of these medications will turn your thermostat down a notch.
The benefit of fevers
It’s true that fevers wear you down in a number of ways. They put stress on your body, your heart beats faster, you consume oxygen more quickly, and your cells consume more energy than usual. Very high temperatures (above 105 degrees) can directly damage cells.
However, fevers show up consistently across species as a response to infection, indicating an evolutionary advantage. Even cold-blooded animals that can’t internally regulate their temperature move to a warm rock when they get sick.
A higher body temperature creates an inhospitable environment for many invading bugs to grow and replicate. For example, high temperatures reduce iron levels in the blood, and bacteria have trouble reproducing. Fevers also appear to boost the immune system to fight off infection. So you feel terrible, but you’re actually in a stronger position to beat the bug.
On a population level, there’s even evidence that suppressing fevers with antipyretics leads to increased transmission of the flu virus and, therefore, more cases of the flu and more flu-related deaths.
So should you treat a fever?
While a fever is a sign of infection, it may also be part of the cure. The idea that any fever must be treated immediately with a reducer could be wrong in many cases. Fever reducers treat a symptom, not the cause of an illness, and lowering your temperature may get in the way of your body’s normal defenses and actually prolong the sickness.
Generally, a fever on its own isn’t dangerous and there’s no real need to treat it. You should, however, seek treatment for the following reasons:
- Infants under 3 months with a fever above 100.4 degrees
- Infants 3–12 months with a fever above 102.2 degrees
- Very high fever (above 105 degrees)
- Persistent fever (longer than 48–72 hours – more guidelines here)
- Your child is unvaccinated
- You have other serious symptoms such as shortness of breath, abdominal pain, headache that doesn’t go away with over-the-counter pain medication, neck stiffness, redness or swelling in joints or extremities, coughing up blood, bloody diarrhea, recent unexplained weight loss, or unusual fatigue that doesn’t go away
- You are an IV drug user
- You have a known serious illness or are immunosuppressed
Fevers also cause dehydration, especially if it’s associated with vomiting or diarrhea. The most important thing to remember with a fever is to stay hydrated. It’s okay if you don’t feel much like eating (that’s a normal response), but keep drinking water. Kids can drink Pedialyte. If a child urinates less than 3 times or an infant has fewer than 3 wet diapers in 24 hours, they’re already dehydrated and should be seen by a doctor right away.
We tend to be concerned with fevers because of how disastrous we look and feel with one. It’s more productive for you to stay home and rest, avoiding spreading germs to the rest of the office anyway. If your child has a fever and is lethargic (so sleepy that you can’t wake them) or inconsolable (can’t stop crying), you should take them to a doctor immediately.
Doctors typically won’t worry if your child (older than 3 months) has a fever of 101 degrees but is behaving normally (playing, eating, and drinking). If your child has a fever and seems fussy, they’re probably uncomfortable, just as many of us are when we’re sick – but they’re probably not seriously ill. It’s your choice to treat a fever in yourself or your child to alleviate discomfort, but again, there’s no medical need to treat the fever itself. (For kids, use children’s acetaminophen or ibuprofen. Don’t give aspirin to children.)
With increasing life expectancy comes an increase in age-related complaints. Understandably folks want to know: is this normal with aging? This list is not meant to be depressing or hopeless, but instead, shed light on some of the areas of our body that, frankly, don’t age well.
“Can I get a light with that menu?” Presbyopia will hit you after the age of 40, and in fact, studies show it becomes most noticeable at 43 ½. What you may find more difficult is focusing on objects up close—that’s presbyopia.
Why does it happen? These are normal age-related eye changes that occur due to hardening of the lens inside your eye. In the beginning, you may be able to compensate by holding your reading material farther away or holding a light to it. Eventually, you will need reading glasses, multifocal contact lenses, or multifocal eyeglasses.
Age-related hearing loss, presbycusis, is the slow loss of hearing that occurs as people get older.
Why does it happen? Tiny hairs inside your ear help you hear. When these hairs are damaged or die, hearing loss occurs. Half of folks 75 and older have some degree of age-related hearing loss. High-frequency hearing goes first so women’s voices become harder to hear than men’s voices (how convenient).
Memory, specifically visual short-term memory
While this may differ widely among people, a hallmark of aging is a decline in visual short-term memory.
What does that mean? Visual short-term memory is the ability to maintain a visual representation in mind after the sensory input (object) has been removed. This matters for memory and thinking because deficits in visual short-term memory have been proposed to cause problems in higher-order (more complicated) cognitive tasks.
The big joints: knees and hips
Osteoarthritis (OA) of the hip and knee is a leading cause of suffering and disability. Age is the primary risk factor for OA or “wear and tear” arthritis.
Why does this happen? The cells that make cartilage decline in quality and number as you age, so the older joint has a lower reserve to deal with impact. While there is no way to completely prevent osteoarthritis, some people who have knee and hip arthritis won’t have any symptoms. Oh, and there is also the option of knee and hip replacement.
The purple bruises that fade to brown over several months and occur most commonly on the back of your hands, that’s aging.
Why does this happen? Age-related thinning of the skin, atrophy of subcutaneous tissue, and weakened capillaries cause bruising in older people. This bruising is commonly seen on the back of the hands, forearms, and shins without any known trauma.
The valve at the end of your esophagus
“Why can’t I eat spicy food now that I’m older?” Reflux disease (GERD) is more common as we get older and causes heartburn with spicy foods.
Why does this happen? Lower pressures in the valve at the lower end of the esophagus occur which is designed to keep acid in the stomach, this allows acid to reflux, or flow backward.
The Achilles: the largest tendon in the body
Aging alone increases the chance of injury to the Achilles tendon leading to Achilles tendonitis. Pain in the tendon, heel pain and stiffness are common complaints from patients.
Why does this happen? The Achilles tendon doesn’t age well due to stiffness, lack of blood supply, and the combination of forces placed on it. Luckily you can get rid of Achilles tendonitis with ice, rest, and nonsteroidal anti-inflammatory drugs but physical therapy, orthotics, and surgery may be necessary for total relief.
Wrinkles on the neck show your age, no matter how many creams you put on it.
Why does this happen? The neck contains thinner skin, more sensitive to sun damage and other factors that wrinkle the skin. The muscles and skin tissue supporting the neck area are weaker than that of the face so neck skin is more vulnerable to gravity over time.
The pelvic floor
Ladies, do your Kegels. The pelvic floor is the hammock of muscles and ligaments that support the bladder, uterus, vagina, and rectum which starts to fail as we get older. Symptoms include urinary incontinence and prolapse (sagging) of the bladder or uterus. Twenty seven percent of women ages 40 to 59 and 37 percent of women ages 60 to 79 will experience pelvic floor dysfunction.
The whites, or “off whites” of your eyes
The color of the sclera, the white part of your eye, changes with age from bluish (in babies) to yellowish.
Why? This is because of accumulation of fat in the scleral tissue.