Sunscreen, By the Numbers

Sunscreen numbers, what do they mean?

Sun Protection Factor , or SPF is a measure of how effectively a particular sunscreen limits
UVB ray exposure to the skin. This is the number printed on the front of your sun screen

The SPF number refers to how long you can stay in the sun, not how strong the product is.

SPF 30 is not twice as strong as SPF 15, it only means that you can stay in the sun twice as long, when applied appropriately.

For example, if your skin normally begins to burn in 10 minutes of mid-day sun, if you were
wearing an appropriate amount of SPF 15 you would be able to stay in the sun 10 min X 15, or 150 minutes before you begin to burn.

If you are wearing SPF 30, you are not twice as protected, it only means you can stay in the sun twice as long as you could with SPF 15.

Keep in mind that the SPF studies are done with generous amounts of sunscreen applied. As a general rule, one ounce (approximately one large handful of sunscreen) is necessary to cover the entire body.

Be aware that activities such as swimming, exercising, and taking clothes on and off may
decrease the effectiveness of your sunscreen and you many need to reapply for proper

An appropriate amount of SPF 15 will provide approximately 2 hours of protection from UVB rays while an appropriate amount of SPF 50 will provide approximately 8 hours of protection. Of course, if you are performing any activity in which the sunscreen may be compromised, please reapply for appropriate protection.


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Muscle Spasms

A muscle spasm is usually painful and comes from an involuntary contraction of a muscle.  Like so many situations, there are many different types of muscle spasms.  Most muscle spasms may easily be treated through diet, physical therapy and medications.  That said, there are also some muscle spasms which are much harder to treat and pin down the exact cause.

We have three different types of muscles in our body.
The first is our Heart Muscle which is used to pump blood to all of our tissues. 

The second is our Smooth Muscle which lines all of our intestines, stomach, esophagus, bladder etc…   These muscles are involuntary in action.  The brain tells them when to contract and when to relax. 

The third type of muscle is our Skeletal Muscle.  These are the muscles that we flex.  These muscles are anchored to our bones, and we consciously tell these muscles what to do.  For the purpose of this discussion, these are the muscles that we will be talking about.

Causes of muscle spasms include straining a muscle, muscle cell dehydration, muscle trauma, and central nervous system diseases like cerebral palsy or multiple sclerosis.  So, when a muscle spasm occurs, the brain is sending an involuntary message to the muscle to contract.  These mixed or involuntary signals being sent by the brain for the muscle to contract are directly related to the issue the muscle is facing such as dealing with the trauma or dehydration.

This is different than when we want a muscle to contract such as when we are exercising or basically doing anything that requires muscle coordination.  An involuntary contraction can last for a couple seconds, to a few minutes to even several hours and may be very painful.  When an involuntary message is sent to the muscle to contract, the muscle will stay contracted until the brain stops the message. 

Relaxation, stretching and breathing techniques will gradually help a muscle relax.  Proper hydration and nutrition are also key elements in appropriate muscle function.  These measures help when someone has exercised for an extended period of time and has fatigued the muscles which have led to cramping from dehydration and nutrient depletion. 

When someone incurs a muscle trauma or injury of some kind, proper hydration and nutrition may not be enough to calm a muscle spasm.   Proper evaluation by a physician may be necessary and they may prescribe medications such as anti-inflammatory or muscle relaxants for short-term pain relief.  The anti-inflammatory medication will help decrease the inflammation in an injured muscle while a skeletal muscle relaxant will help decrease the involuntary contraction signals being sent by the brain to the muscle. 

For more information on anti-inflammatory or muscle relaxant medications, visit and follow the link to the Medication Counseling Section.


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Spinal Pain (Back & Neck) Oral Medication Treatment Options

There are a variety of over the counter and prescription medications that are used to treat back and neck pain.  Which one should any particular patient take, how do they work, and what affect do they have on your body?  This blog will discuss the different oral medication  options and hopefully help you create some educated questions to take to your pharmacist or doctor.

Lets be clear, back and neck pain may have many different underlying causes, and quite often, the exact known cause of pain for any one particular patient may go unknown for quite some time.  Most people with chronic back or neck pain (pain that persists for more than three months) will treat them selves with over the counter therapies until the pain becomes unbearable and they find themselves at their doctors office or in an urgent care clinic of some kind looking for relief. 

There are different treatment alternatives that include diet, stretching,  physical therapy, exercise, chiropractic manipulation, surgical procedures,  topical medication, injectable medication and oral medication therapy.  It is important to discuss with your doctor which is the best combination of treatments for  you, however, my goal here is to help educate you about the different oral  medication treatment options.

Acetaminophen (Tylenoltm) is an effective non-prescription medication for back/neck pain and generally has very few side effects.  Acetaminophen does not have any anti-inflammatory effects, rather, it blocks the perception of the pain.  Acetaminophen has the benefit that there is no chance of addiction, it rarely causes stomach upset and you do not develop a tolerance to the medication.  The risk with acetaminophen is that it is easy to take too much of it, which may cause serious liver problems.  Please read the packaging and do not take more acetaminophen than is directed on the label.  Also, please be aware, many prescription medications contain acetaminophen in combination with another medication.  Be sure to keep track of your daily acetaminophen dose to be sure you do not get more than 3000-4000mg daily. 

Ibuprofen (Motrin IBtm, Adviltm) and Naproxen (Alevetm) are two non-prescription non steroidal anti-inflammatory medications available.  Ibuprofen and naproxen work differently than acetaminophen to relieve pain, so, a patient in significant pain may take the recommended dose of acetaminophen alternating with the recommended dose of ibuprofen or naproxen and repeat this pattern as appropriate to treat the pain. 
Prescription Oral Medications options.

Non-Steroidal Anti-Inflammatory Medications:  Celecoxib (Celebrextm), Diclofenac (Voltarentm), Edotolac (Lodinetm), Ibuprofen (Motrintm), Meloxicam (Mobictm), Nabumatone (Relafentm), Naproxen (Naprosyntm Anaproxtm), Piroxicam (Feldenetm)
These medications work best when taken on a regular basis.  The idea is that the medication build up in the system and work to block the inflammatory process.  A muscle may be inflamed and pressing against a nerve in the spine causing the pain.  This decrease in inflammation creates a better environment for healing.  There are a number of potential risks and side effects associated with each specific non-steroidal anti-inflammatory agent such as gastrointestinal irritation or cardiovascular side effects.  Please talk with your doctor to decide which medication would be best for your specific condition. 

Nerve Pain Medications:  Pregabalin (Lyricatm), Gabapentin (Neurontintm), Duloxetine (Cymbaltatm)
These medications work to interfere with specific signals in nerve pathways that have to do with the transmission of pain impulse recognition.  These medications are usually not addictive and may be taken safely for long periods of time.  That said, this category of medications is sometimes difficult for people to start.  The dose of any of the three will most likely be titrated up slowly over a course of 1-4 weeks to minimize the side effects.  It helps to know that the body will usually acclimate to the medication over the course of a few weeks and the side effects will diminish as the pain control increases. 

Narcotic Pain Medications:  Oxycodone/Acetaminophen (Percocettm
), Hydrocodone/Acetaminophen (Vicodintm, Norcotm, Lorcettm), Oxycodone Extended-Release (Oxycontintm), Fentanyl Patch (Duragesictm), Morphine Extended Release (MS Contintm, Avinzatm, Kadiantm) Narcotic pain medications(opiates)  work very well at treating back and neck pain for short term therapy like you might need after a surgery or an acute injury of some kind.   The opiates block the perception of the pain in the central nervous system.  They don't actually do anything to where the pain is coming from, they just block your perception of it so you have a decreased sensation of the pain.  One of the big issues with opiate pain therapy is that after 2-3 weeks of treatment, the body slowly begins to build up a tolerance to the medication.  This may sometimes be perceived  as an increase in pain, rather than a decrease in effectiveness and the dosage may be increased.   If not monitored and talked about regularly, this can lead to a self-defeating addiction to opiates  with an escalating need for pain control.  That said, there are some physicians who use low dose, long-acting opiates to treat chronic back and neck pain effectively for long periods of time.  Please discuss all aspects of narcotic pain control with your doctor or pharmacist before beginning chronic opiate pain control. 

Corticosteroid Medications: Dexamethasone, Methylprednisolone, Prednisone
Corticosteroids are sometimes used for short term therapy(7-14 days)  to decrease inflammation in an acute situation.  There are generally only a few complications associated with short term use of corticosteroids such as upset stomach, restlessness and agitation.  Long term use of corticosteroids may be associated with osteoporosis, compromised immune system, stomach ulcers and possible other complications.  Please note that caution should be used when someone with diabetes is prescribed a corticosteroid beause this medication increases blood sugar.  Also, if steroids are used in someone with an acute infection, the infectious condition may worsen.  Please make sure your doctor and pharmacist are aware of your current medical conditions and other medications before you begin a course of oral corticosteroids.  

Muscle Relaxants: Diazepam (Valiumtm), Cyclobenzaprine (Flexeriltm), Carisoprodol (Somatm), Tizanidine (Zanaflextm),  Methocarbamol (Robaxintm)
Muscle relaxants may be prescribed for an acute flare up of back or neck pain when the pain is associated with a spasming muscle.  This type of medication may help relax a muscle that is spasming around a nerve thereby decreasing the pressure that the muscle is placing on the nerve and decrease the pain.  The trouble with this approach is that the muscle relaxant is not specific for the muscle that is spasming.  All of the muscles will be relaxed and may significantly decrease your reflex response capability.  In other words, don't drive and don't drink any alcohol while taking these medications.  Quite often this category is prescribed for back or neck pain to help relax a muscle so someone may sleep at night.   Please discuss with your doctor or pharmacist how long you should take your muscle relaxant for and to make sure you are aware of the important information associated with your specific muscle relaxant. 

Other:  Tramadol (Ultramtm)
Tramadol is an alternative to opiate pain medications for treatment of moderate to moderately severe acute pain such as you might have post-operatively or after an acute injury.  Tramadol is not a narcotic; however, it works by stimulating the same opioid receptors in the central nervous system that opiates do.  It also has decreases pain by increasing the levels of specific neurotransmitters, similar to how the nerve pain medications work.  This medication has a much less chance of addictive behavior associated with it; however, because it does work in the central nervous system, you still need to be aware of the potential of side effects such as light headedness, dizziness and drowsiness.  It is important to note that someone would usually not take Tramadol and an opiate at the same time because one may block the effects of the other.   Please discuss this option with your doctor as an alternative to taking short acting narcotic pain medications.

This is meant as a general over view of the oral medications commonly used for treatment of back and neck pain.  Please discuss with your doctor what the best course of treatment is for your situation.  If you have any questions about any of the medications listed here, I encourage you to contact your community pharmacist and engage them in a discussion

Please visit the Membership Area of AudibleRx for full access to all of the currently available Medication Counseling Sessions.

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Grapefruit and Medications

Grapefruit and medications:

I will help you take the mystery out of the question of whether you can have grapefruit with your medications. This is a topic that we hear regularly in the pharmacy, the discussion of whether you can have a grapefruit or drink some grapefruit juice with your medications.

Grapefruit inhibits a portion of the liver metabolizing system and also inhibits a specific protein in the gut that the body uses for metabolizing medications. If the medication you are taking needs one or both of these metabolizing systems to break it down, than you can not have grapefruit.

The medication will not be metabolized completely, and will then build up to potentially toxic levels and you could experience significant side effects from the medication.

Quite a few medications from many different therapeutic categories are included in the list of medications that interact with grapefruit. Please ask your pharmacist or doctor if any of your medications are on the list.

It is important to realize that just one grapefruit, or even just one glass of grapefruit juice is too much. The grapefruit has the potential to affect the metabolizing system for up to 3 full days, so it doesn't help to separate the grapefruit from your medication by a couple of hours.

The interaction is a little different for each person. It is not a good idea to try and adjust the dose of the medication to allow for grapefruit because it is very difficult to guess how much interaction any particular individual will have.

If you take one of the medications on the grapefruit interaction list, then you can not have grapefruit, regardless whether you drink it or eat it. It is interesting to note that most other citrus fruits, including most oranges, lemons and tangerines do not interact with this enzyme system and are OK to eat or drink.

If giving up grapefruit is not an option, than talk with your pharmacist or doctor about switching to an alternative medication that is not on the grapefruit interaction list.


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Generalized Anxiety Disorder vs. Stressful Situation

Anti-Anxiety Medications

In simple terms, this category of medications helps promote calming and soothing.  They enhance a particular chemical in the brain that helps inhibit excitability.  These benzodiazepine anti-anxiety medications are effective at lessening anxiety, regardless of the cause.

This effect is very helpful with generalized anxiety which can come on quite suddenly and without apparent cause.  The issue here is these medications also work very well at decreasing anxiety felt under normal stress of daily life, stress that we know what the cause is from. 

Sometimes it is difficult to distinguish the difference between acute general anxieties from the stress brought on by normal life.  Here, it is important that your doctor take the time to help you distinguish the difference between the two so that you don't end up taking this type of anti-anxiety medication to help relax everyday stressful situations.

Benzodiazepine medications do not cure generalized anxiety; however, when prescribed appropriately they have a place at helping relieve the symptoms of generalized anxiety.  When this category of medications is used to help relax everyday stressful situations, your body may become dependent upon the medication which may lead to addictive behavior.

If this is confusing, join the crowd.  Many people have difficulty separating generalized anxiety disorder from the stress of daily life.  Please, if you use one of these medications, talk about this with your doctor or pharmacist.  If you would like more information on any of the medications in this class, please register to become a member of AudibleRx, then have full access to all of the Medication Specific Counseling Sessions. 

Alprazolam (Xanax-TM), Clonazepam(Klonopin-TM), Diazepam (Valium-TM), Lorazepam (Ativan-TM)

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