insomnia

insomnia is dreadful. and children can compound that for their parents when the children themselves can’t sleep. i’ve experienced both. as a young adult before having kids, i had insomnia from??? anxiety, stress, i never did figure it out. as a mother with a sleepless infant (and still somewhat sleepless pre-teen), my insomnia disappeared (presumably due to sheer exhaustion). but when i could finally sleep, my baby couldn’t. he didn’t even nap for his caregivers at day care. i was absolutely desperate and tried everything…that is everything BUT melatonin.

considerations BEFORE deciding whether to give your child melatonin

1. supplements are unregulated making it hard to know if they are what they say they are. one of the main reasons i am, generally, reluctant to use ANY supplements is that they are largely unregulated. that being the case, the label can say “melatonin” but the pills in the bottle can contain nothing resembling melatonin. they could contain anything from relatively harmless sugar; to relatively dangerous prescription-only benzodiazepenes (BZD) or BZD-like imposters; to contaminants resulting from a lack of proper manufacturing controls. and it’s only in the more dangerous scenarios and only when those cases HAPPEN to be discovered, that these supplements are recalled.

2. making medicines palatable to children is a double-edged sword. on one hand, they are more likely to take good tasting medicine (a blessing for any parent who has tried to give their child Augmentin® or any child who has to take it). on the other hand, children love sweets and will seek (and sneek) them. this is part of what underlies the recent sharp increase in ER visits attributable to melatonin overdoses in children.

considerations if you decide to give your child melatonin

1. only buy USP-verified supplements. i do use some supplements. personally, i need vitamins D and B -12. so when i purchase supplements, i look for the letters “USP” on the label. these stand for United States Pharmacopeia, an entity that establishes reference standards for drug entities. USP operates a voluntary certification program; most manufacturers do NOT participate in this certification (because it’s an additional cost). supplements that are USP-verified contain the stated ingredients in the stated amounts reflected on the label. ONLY Nature Made and Natrol market USP-verified melatonin products as per the USP-verified product finder. ergo (that’s an oldie but seemed fitting), if you purchase melatonin, only purchase these.

2. keep medicines away from children. out of sight, out of reach, preferably locked up. supplements often do NOT come with child-resistant caps or packaging. with the penchant my child has for treats, i can almost guarantee he would’ve helped himself to any tasty gummies i made relatively accessible in my home. fortunately, i don’t like gummies and my husband doesn’t like sweets, so our risk in that area is low. if you do use melatonin gummies to help your child sleep, take some simple precautions to make sure you and your child don’t end up in the ER, a night that will surely be filled with no sleep!

be informed, keep safe <3!

acne

Many products which used to be prescription only are now available over-the-counter (OTC). Adapalene - a retinoid and benzoyl peroxide - an antibacterial are two such acne products.

• Adapalene 0.1% gel is OTC (the 0.3% gel is prescription) - retinoids work by dissolving blackheads, preventing blackheads from forming, and reducing inflammation. Bonus, they are also used to treat wrinkles, a two-fer.

• Benzoyl peroxide (BPO) is available in various strengths (0.25% to 10%) and formulations (gel, lotion, wash, etc.) - this antibacterial works by killing acne-causing bacteria and dissolving excess skin cells.

DO: A reasonable strategy would be an initial trial of BPO. It can be harsh particularly on sensitive skin or if left on too long. Avoid using around the eyes, mouth, and folds of the nose. If tolerated and additional control is required, adapalene could be added. If BPO is not working, you could switch to adapalene. Adapalene can also be harsh; avoid the same sensitive areas. Adapalene is labeled for daily use, but if you have sensitive skin, you may want to “work up” to this frequency by starting less frequently (ex. every other day).

DON’T: start both products at the same time. This could cause double the side effects and you won’t know which product is (or is not) working.

OTHER: I don’t recommend any particular brand, but, as will all OTCs, I recommend looking at the “Active Ingredients” section to make sure you are getting the ingredient you are looking for. Many brands will sell different ingredients under, essentially, the same name. For example, Galderma makes both adapalene and BPO products as well as other “acne” products (ex. moisturizers, toners) - all branded as Differin®.

RANDOM: Anti-bacterials are drugs that kill or inhibit the growth of bacteria. Anti-biotics are antibacterials that are “naturally”-sourced (ex. from bacteria or molds).

cough season

of all the cold symptoms, cough is, in my opinion, the worst of them. how it lingers. how it interrupts sleep - yours and your bedmate’s. how it can be so severe and so persistent that you end up with muscle spasms or - and this happened to my husband - tearing your vocal cords. and the underlying causes can be many. so it’s important to know what kind of cough and the underlying cause of it. in this post, i discuss OTC treatments for “dry: and “wet” cough. importantly, there is coughing related to other causes (e.g., asthma) that cannot be treated by OTC medicines and requires a prescription medication.

there are two OTC medications for cough:

• dextromethorphan - for adults i recommend the liqugels; for kids i like the 12-hour suspension* (DO NOT USE BRAND NAME DELSYM(R) - SEE NOTE)

  this is a cough suppressant. it works by suppressing the cough reflex. it works well for a nagging dry cough, in the beginning. dextromethorphan is chemically related to opioids, but it is not an opioid. like individuals using opioids develop tolerance, tolerance to the cough suppressant effects quickly develops, after which it effectively stops working. (note: dextromethorphan is increasingly abused by consuming large doses. this is dangerous and any doses in excess of the labeled dose are NOT recommended.)

  *IMPORTANT: i have found brand name Delsym to have the incorrect markings on the dosing cup where what is marked 2.5 mL is actually 3.75 mL - this is 1.5 times the recommended dose for a child ages 4 to 6 years (READ: OVERDOSE). i have reported this issue to the FDA and the manufacturer, without adequate remediation. this product should have been recalled but has not been.

• guaifenesin - if someone wants this ingredient, i recommend the high-dose, extended-release product (i.e., Mucinex(R) or the generic).

  this is an expectorant. it (theoretcially) works by breaking up mucus making it easier to cough up. in my learnings, it does not work. anecdotally, many individuals report Mucinex (high-dose, extended-release guaifenesin) does work. i’ve even heard these reports from other pharmacists who are admittedly skeptical about the effectiveness of guaifenesin. i have to wonder if the effectiveness is attributable to marketing. Mucinex has been heavily marketed since its introduction to the market. it’s worth noting that Mucinex is quite expensive.

TAKEAWAYS

i like dextromethorphan. it works, but i use it SPARINGLY to prevent tolerance/to ensure it continues to work. if i give it to my children, i try to avoid giving it during the day and reserve it for night so they can sleep. DO NOT USE BRAND NAME DELSYM; THE MARKINGS ON THE DOSE CUPS HAVE BEEN FOUND TO BE INCORRECT.

i do not like or use guaifenesin. i do not think it works. personally, i especially do not use Mucinex(R) due to the high cost. however, if an individual strongly desires a guaifenesin product and has a “wet” cough, i recommend high-dose, extended-release guaifenesin (i.e., Mucinex) based on anecdotal evidence.

Naloxone - for opioid overdose

you’re going to want naloxone, a medication that reverses the effects of opioids and saves lives. i hope you never need it. i hope you never need a fire extinguisher either. but you have one of those. and so too you should have naloxone. but the hard part isn’t convincing you that you should have this on hand. there’s no one in this country who is unaware of the increasingly deadly and expansive opioid crisis…

the harder part is getting it. it used to be prescription only, but it’s now available over the counter. a fire extinguisher might run you $25. i just bought a fire blanket for about that (they’re supposed to be a lot less messy).

option 1: OTC naloxone is ~$50 for 2 doses (2 in case 1 isn’t enough). i personally would save $2 and get the generic. go and buy it here.

option 2: in many states, there is what’s called a “standing order” issued by the public health department which is used in lieu of a prescription and, unlike a typical prescription, can be dispensed to anyone including an individual who is NOT the patient. this took the cost down to $10 for me. call your pharmacy, ask them to fill a prescription for naloxone using the standing order. that’s a worthwhile use of $10 in my opinion.

option 3: you may be able to find it for free through a program near you. check here.

at a time when literally one pill can kill, there is every reason to have naloxone on hand. fake prescription medicines are rampant and they often contain deadly fentanyl not to mention other poisons. do yourself and your loved ones a favor and keep naloxone on hand, like you do a fire extinguisher. there’s no good reason not to.

macy’s

I don’t shop at macy’s anymore. Haven’t for 20 years. I used to. They always had a lot of product and great clearance pricing. But there were just too many choices, too much product. Just walking through the door made me feel overwhelmed to the point of fatigue…decision fatigue.

And I don’t have to shop at macy’s. There are so many other options. Sometimes I prefer Target; they always have stylish finds at low price points. I like the Gap companies because they have options at various price points to suit my entire family (including two young boys known for ceaslessly blowing out the knees of their pants). More recently I’ve started shopping on-line consignment stores like PoshMark and Mercari for the ease of narrowing search results to my size and style as well as the deals. Plus they get bonus points for their role in reducing retail waste.

I think of my experience shopping at macy’s whenever I walk into the local pharmacy. The sheer volume of over-the-counter (OTC) products is enough to overwhelm even a seasoned pharmacist. Anyone without healthcare background is sure to feel like they’ve been dropped into the middle of a labyrinth. And, while many others occupy the labyrinth, they really can’t help anyone find their way through. The pharmacist, just feet away behind the counter, is so inundated with filling prescriptions and, now, giving immunizations, that they are effectively unavailable. The customer who walked in with eye allergies, looking for a fever reducer for their toddler, for a cough medicine so they can sleep through the night, they are all but on their own.

My goal is to fill that void, to provide reliable content to those seeking it, to support self-healthcare. No matter the time of day or day of week, access to a healthcare provider or lack thereof, the information shared here is available. I’ll lessen the fatigue of decision-making when it comes to self-healthcare and provide tips to navigate the OTC labyrinth.