Farewell

Ladies and gentlemen, it is my sad duty to inform you that your dedicated blogger and my devoted husband died in September from the awful disease which had ravaged him for over a year.  Thank you for reading his posts. He was a wise man whose last advice is "wear a hat."  Marcia O. Kaplan

THE AFTERMATH

A succession of highly competent nurses, physicians and technicians during the five days following my hospital admission for a massive, cancer-related pulmonary embolus, coupled with appropriate care and medication led to my discharge and return home on the fifth day for a slow recovery. Notwithstanding my grim prognosis, I am very slowly getting better, though shortness of breath, a distinct lack of strength and energy, and continuing unmistakeable stigmata of cardiopulmonary insult and aggressive malignant melanoma are clear indicators that all is not yet well and is unlikely to be.

Once again,  I must emphasize the importance of my supportive family, and friends throughout this  illness. Without their support I could not have made it.  To my family, friends, community and the kind and generous rabbis who  have visited and buttressed me, I offer a sincere "thank you."  It would have been impossible to have survived without your help, understanding and support.

FRIDAY NIGHT I DIED
It was a Friday night family "Shabbat" dinner, not initially notably different from Sabbath dinners and accompanying prayers we  enjoyed each week throughout our marriage. This night, I felt a call to the restroom, responded, and soon found myself unable to stand, as the room spun and the floor became unstable.  Recognizing that I was in serious difficulty, I used my hands to protect my head from hitting the cabinetwork and fell. I must have made enough noise because one of my sons recognized that something was wrong and with his brother entered the bathroom where they found me crumpled, not breathing, unresponsive, cold, clammy and without a  pulse. I recall sensing my two sons' strong arms enfolding me, followed shortly by the sounds of the competent paramedics who came to  my aid. Rapid emergency evaluation and transportation to El Camino Hospital's Emergency Department followed. There,  expert evaluation and care led to a confirmed diagnosis of a massive pulmonary embolism and a recommendation by the ER physician that family members be warned of my precarious situation.

This event occurred a little more than 48 hours ago. Luck, genetics, excellent medical and hospital care, modern technology, and advances in medicine have allowed me to survive this feared complication of malignant melanoma.

Stay well.

LET'S TALK ABOUT YOUR MONEY AND FAMILY

IF  AMERICA’S  AFFORDABLE CARE ACT IS GUTTED BY ONE POLITICAL PARTY,  AND YOUR YOUNG ADULT SON OR DAUGHTER BECOMES  SERIOUSLY ILL, WILL YOU HAVE TO CHOOSE BETWEEN SAVING YOUR CHILD’S LIFE AND  BANKRUPTCY?

Read this report, decide what's right for you and your family, and vote accordingly.

 TAILORING DIAGNOSIS AND TREATMENT OF DISEASE TO THE PATIENT GENETICS  - WHO WILL PAY?

"CONCLUSION. . . .
We have provided this information for CMS’s use in setting Medicare coverage and payment policies for genetic tests. Because State Medicaid programs and private health insurance plans closely monitor Medicare’s coverage and reimbursement decisions, CMS’s formulation of reimbursement rates for genetic tests may be useful to them. As one official from a State Medicaid program remarked, “Additional guidance from CMS on genetic testing would be very helpful. We have struggled with payment of such tests for the last couple of years ...."

HOUSTON DAYS

My Houston days have been busy, filled with appointments, consultations, radiographic procedures technical simulations for complex procedures, chemotherapy and a host of other activities which measure the scope and extent of my metastatic malignant melanoma and determines whether the disease has spread, notwithstanding vigorous efforts  to establish systemic control. From my perspective as a physician who, earlier in his career, worked with other "specialist" physicians to treat metastatic cancer of various types and stages, the team work and coordination that I observe here at MD Anderson Cancer Center, is highly reassuring.  Knowledge of, and adherence  to established professional standards is evident in each physician patient (or physician health care provider) contact,communication and discussion.


So far, I have been unable  to obtain access to one of the newest drugs which  stimulates the immune system to kill melanoma cells.  It is not clear when - and if - that access will be available. I will inform my readers of developments in this area.

MD ANDERSON
Last week, I went to Houston, Texas where I was seen by highly skilled, involved, competent physicians associated with MD Anderson's Cancer Center. Neither my time, resources or energy were wasted as I (with my spouse and a son)  saw thoughtful knowledgeable consultant after consultant, visited the laboratory for highly refined tests not generally available elsewhere and the radiologic service for a scan which had not been done before but which was important for the consultant's planning of future health care treatment and procedures for me.

MD Anderson is incorporated in a health care neighborhood, hospital next to hospital, clinic next to clinic and facilities readily accessible to patients and their families.  Patients' and their families' needs are carefully considered as clinics, labs, imaging centers, food services, and even transportation and social services are made accessible and appropriate.  Although the building are on a large scale, it seems as if every effort has been made to consider the patient  - and patients' families -  in the focus.  The environment feels large, but the patient remains the attention point of the physicians, house staff trainees, nurses and staff who provide the important human element of care.

Not everything could be concluded during my actual presence at MD Anderson in Houston.  But I felt satisfied that major steps towards understanding the complex issues I present as a patient were made, that attention had been paid by skilled physicians and staff, and that I would receive an appropriate set of recommendations when they had discussed and considered my medical issues.  Was I  guaranteed a cure? No.  Did I feel that I received proper medical care and consideration in this early stage of my MD Anderson experience? Yes.  Based on my experience would I recommend the MD Anderson Melanoma Center? Yes.

A LOT IS GOING ON

Melanoma is not a disease that stands still, and as it moves into its more aggressive phase, planting metastases hither, thither and yon, it is essential to have opinions from a variety of experienced physicians in different medical disciplines regarding treatment options, prognosis and expectations.

So, during the last several weeks, my physicians have been collecting scans and laboratory data and tissue samples and doing those things which help shape their professional opinions as to what's next.  I have been impressed by the strong advocacy positions expressed by my physicians, not in their interests, but in mine.  E-mails, telephone calls, and messages (including consultations) from my physicians, and their staffs, have been enlightening and valuable.

Family, close friends and the communities in which I function have been outstanding in their support and realistic encouragement which makes my days more meaningful and endurable. I hope that each person suffering from an aggressive malignancy experiences the types of  personal contact which I have gained. That support and contact is not a cure, but is an essential component of helping me to live with a bad disease.

I expect to have some new experiences in new venues shortly. I will share some of that information with my readers.

QUERY: Are you wearing a hat outdoors and applying sufficient sunscreen?

HIGH PRIESTS AND PHYSICIANS

The genetic patterns, Torah documentation, and experience, going back more than 3000 years, are consistent. Our family line was charged, not only with priestly functions, but with the ethical, moral, diagnostic and therapeutic functions of physicians.  Lepers were our responsibility, and in a sense, modern-day lepers remain our responsibility.

In the DeNardo lecture series, at Santa Clara University last night, Stanford's Abraham Verghese, MD, brought this long tradition into current practice.  His emphasis on the human values of focused concentrated listening to, and observation of, patients through touch, emotional contact, and allocation of time and attention were not in conflict with our electronic age. Verghese recognized electronics, computers and many other modern technologies as adjuncts (sometimes distractive) to care, rather than as the essence of care.  Patient care requires humanity, maturity, exquisite professional knowledge and a willingness to take the risks of professional closeness.

Verghese merged the priestly and physician function required to properly care for patients, continuing the tradition which has produced great doctors, comfort and healing, and appropriateness of care and resources.  The message is old and contemporary.

GIVE AWAY A HAT AS A FOLLOWUP TO EARTH DAY

No high cost, complicated medical procedure.  Just a simple gift to a family member or friend or someone you meet on the street.  Give that person a hat, a black hat a white hat, a red hat, a nice hat or an ugly hat. But be sure it has a wide brim and protects against ultraviolet radiation which causes melanoma, a disease which will strike 70,000 Americans this years.  Don't give away your baseball cap - throw it away because it doesn't protect the sides of the face from damaging environmental UV radiation (particularly against the sun that comes in through your side car windows). Your gift can protect against a serious fatal environmental disease, has no side effects, doesn't make people fat doesn't raise the cost of health care or taxes, and will protect someone you know and may love.  I just gave a hat to a family member.  Next, I'll put a tube of sunscreen aside as a followup gift.

Do it.  And put your own hat and sunscreen on!  It's an act of love!

A COST SHIFT DOESN'T MEAN A SAVING

Today's New York Times repeats the crowing claims by Medicare of how much money it will save by reducing "waste" related to diabetic testing strips through competitive bidding.  An hour after reading the Times article I received a call from my supplier of diabetic testing strips telling me how many hundreds of dollars it would cost me, under the rules now laid out by Medicare, to fill my supply and allow me to perform the testing that keeps me from succumbing to the complications of rapidly shifting blood glucose values which mark my day in this time of my serious illness.  I have spent countless hours filling out Medicare appeals and requests for reconsideration, entreating my physician to provide data (a costly process in a medical office) but the costs I, my physicians, and the medical system incur are not acknowledged in the bureaucratic self-hyping Medicare release.  It is the little folk, the vulnerable folk, who are now bearing the cost of the "saving" which our government is so gleeful about.  It's a cost shift - not a saving!

A few months ago I wrote about the diabetic test control solution provided by a large company which was clearly defective.  The government sent me no inquiry about this potentially injurious product for which it was paying more than $10 per defective container. I received no notice that the company had self-reported its defective product distributed to diabetics. Strange disconnects 

Perhaps our government needs to pay more attention to the business of government and less to Columbian prostitutes and Las Vegas parties. And the question - when taxpayer money is involved - is whether anyone in the system is being paid a bonus or incentive, directly or or indirectly - for savings incurred by cost shifting from Medicare to our sick taxpayers?

THE DEATH TEAM
A few months ago, one of the political parties characterized participants in end-of-life discussions with patients as death teams.  In my service, for years, in various biomedical ethical roles, I never found that characterization to be accurate: the discussion among patients and physicians and nurses were always done carefully, with a full sensitivity to the needs of all concerned, and without pressure on patients and their families to take steps which would inflict harm.

But there are death teams.  They are the bureaucrats who, without having taken an oath to do no harm, sit in their cubicles administering the financial and utilization protocols their superiors have provided to them which may result in a denial of services or equipment or - ultimately - of life.  This is not an issue of the content of the Affordable Care Act: it is an issue of arrogance, contempt and a lack of humanity.

This morning I received a call from the company which has recently provided me with diabetic testing equipment. They said they were sorry, but that  government organization has placed a moratorium on the company's ability to provide diabetic testing supplies for type 2 diabetic and now strictly requires extensive paperwork from physicians and institutions to justify continuing to supply. Physicians who have had their incomes cut by Medicare are being asked to supply more time and paperwork. Patients suffer,the  costs of hospitalization, dialysis, wound treatment, neurologic disorders and other diabetic conditions suffer.  But the bureaucracy grinds on. 

This is not an issue of one party or the other.  It is an issue of governmental inadequacy, in which financial control and power have replaced common sense, medical ethics and judgment. 

I'M TOO SICK, BUT ....

Sometimes, illness becomes an additive affair. The original serious problem becomes complicated by another serious problem- or problems) which confounds doctors and patient, alike.  A difficult practice issue is whether one problem's complexities makes it difficult - or unwise - to use the potent therapeutic firepower which might ordinarily be invoked. So that's my situation.  I will see my doctor in a few days because his advice is given with integrity and competence.

In the meantime, life is made more complicated by messages from a Medicare review agency which has decided that I don't qualify for the blood sugar frequency that my doctor has prescribed through the years.I guess that the money Medicare is saved because the testing allows my doctor and me to carefully control my sugar levels, avoid hospital emergency room treatments, hospitalizations for heart attacks and strokes, loss of vision, loss of kidney function (then dialysis) and bodily  injury from auto accidents doesn't count. What does count more and more these days is a bureaucratic review system, administered by anonymous people in far off places, in which arbitrary decisions seem to be issued (appeal is allowed, but physicians who have had their Medicare reimbursement cut may be grudging participants in the bureaucratic paperwork process of their patients and hiring an attorney seems cost-ineffective).  Sick people don't have the strength or resources to fight this impenetrable system.

If you have never read Kafka's "The Trial" click for a link.  Kafka described your brave new world.

THE AFFORDABLE CARE ACT - MY OPINION

In my careers, as a  health care attorney and as an hematologist caring for very sick people of all ages (I am retired from both) , and as a board member of large powerful health care and health-care related corporations,  I was keenly aware of  the inequities in our health care system. I welcomed the underlying spirit of the Affordable Care Act and read it through carefully, more than once, concluding that the ACA was carefully and skilfully crafted by people who knew what they were doing, understood our system and created needed improvements.  I believed - and publicly stated -  that the ACA improved the long-term potential for  American health care and safety and extended its quality, availability and affordability to all Americans.  I have not changed those opinions.

As I read of the attacks on the Affordable Care Act by partisans of one party, I wonder about Congress peoples', and national political candidates',  undisclosed conflicts of interest which influence their  political activities and public statements concerning the health coverage which our nation, communities, neighbors and families depend upon.  As I watch the run up to the Supreme court  hearing  on the constitutionality of contended provisions of the Affordable Care Act, I wonder about the legal and social objectiveness of the Court's process.

My concern reflects the insightful statement by the biblical king, David, to the prophet, Gad  in which he expresses his distress, concluding  that it is better to fall into the hand of God, for God's mercy is great, rather than fall into the hand of man. With respect to our health care, the decisions will be those of men and women.

In my opinion, all Americans will benefit from the Affordable Care Act. That means my community, family, neighbors and friends. And that includes you, my reader.

AN ISSUE OF JUDGMENT

Since my initial diagnosis of malignant melanoma, I have met a number of new doctors, representing various fields of medicine (specialists in melanoma, oncologic dermatologists, surgeons, radiation oncologists, and others) who work at different types of medical facilities (i.e., medical groups, hospitals), and as solo practitioners.  At the same time, I am well grounded in care provided by highly skilled practitioners, who have been my physicians for years.

I do not accept all of the advice I receive from this population of competent practitioners and I think that I can share with my readers, how I sort through my interaction with reputable physicians and institutions in planning and carrying out treatment of malignant melanoma, a condition which is a major killer of men.  As I interact with physicians (and, to some extent, non-physician health care professionals), to determine basic competence. I ask myself  whether the physician has demonstrated the basic history-taking and physical examination skills that physicians should have.  I ask about physicians' formulation of diagnoses, the additional steps necessary to support the diagnosis, and the treatment plan. I listen for high quality peer-reviewed scientific evidence to support their comments and recommendations.

But during our interactions, I listen for something which is harder to recognize, measure and evaluate, which is evidence that the physician, or other health care provider, has good judgment.  For I learned as a practicing physician, the chair of a large hospital department of medicine,a chief of staff, a member of hospital boards, and an educator of physicians,  no matter what the doctors' skill sets and education may be, without good judgment, that doctor is dangerous.

I recall that one of my partners, a surgeon who practiced at several San Jose area hospitals, once described another surgeon as a person who had an encyclopedic knowledge of surgical literature, but had poor judgment and poor outcomes in his cases.  Through the years, as I represented hospital medical staffs as their attorney in disciplinary cases, and physicians who were the objects of those disciplinary measures, I came to appreciate that partner's observation: I encountered physicians who knew what the books said, but made flawed decisions because of poor judgment.

In a sense, medicine has some similarities to current politics. If the physician - or politician - exhibits behavior, conversation, or conduct which seems to be at significant variance from other physicians or health care providers (or other politicians or the electorate), pay attention. Ask yourself whether you have reason to mistrust the physician's judgment. If so, find another physician or candidate.

FOOTBALL SEASON IS OVER - BUT THE DAMAGE LINGERS ON.

My Stanford medical postgraduate training was physically, intellectually and emotionally grueling as we spent 90+ to 120+ hours each week, caring for terribly sick patients. But one of my most difficult days involved high school football, coaches and the failure of adults to protect kids entrusted to their supervision.

Offered the opportunity to earn a few dollars as the "doc" at a local high school football game, I accepted.  I was told when and where to appear, where to sit at the field, and other administrative details.  Some of the orthopedic residents with whom I trained told me to immediately call an ambulance for any player who was seriously injured and to abstain from any significant medical contact because the players had their own sports doctors who were willing and ready to respond when called.

On a warm sunny afternoon, I showed up as instructed and was greeted by a grumpy home team coach who complained that I was not there when the game started minutes earlier.  I took my field seat and watched the game.  Several of the teenage players took hard hits and I went on the field and sent them to the sidelines to recover.  But by the time I had walked back to my seat, the coaches had returned those injured players to the game.   This was not an isolated event: shaken students were put back in the game repeatedly, before they were steady on their feet.  

I complained to the coaches who were uninterested in my comments, leading me to believe  they were more concerned about their teams' scores and wins than the well-being of the students entrusted to their care and supervision. 

Today, we know that teenagers' brain may be permanently susceptible to damage by the trauma inflicted in sports, including high school football.   We have seen news reports of retired professional football players who suffer severe dementia from cumulative blows to their brains, beginning early in the careers.

Adults have a responsibility to protect young people from the exorbitant price that high school sports may exact.  Training, proper equipment and sensible rules will help. But vigorous protection of players, by those who are there oversee their safety, is the key line of defense.

EPIGENETICS, CANCER & MENTAL ILLNESS: LIKE SWITCHES AND HOUSE LIGHTS?

EPIGENETICS, CANCER & MENTAL ILLNESS:  LIKE SWITCHES AND HOUSE LIGHTS?

You may never have heard the word "epigenetics" though it describes a process which has been with you since your conception.  The genes, you inherited from generations of ancestors,  which now make you the individual you are, are turned on and off by chemical switches in your body.  Cancers and other conditions may be caused by genes which are switched on and off by those chemical switches. And now, we have learned that even mental illness may be related to chemical switches which are activated, or inactivated, causing genes to produce proteins which produce normal growth and development, or produce serious disease.

Epigenetics is the science underlying those switches and their roles in causing appropriate development and disease. Scientific/medical breakthroughs may flow from an understanding of epigenetics and the development of tools which  can turn some genes on and some genes off, fostering normal development or treating disease. I have attended American Society of Hematology conferences in which German researchers reported their use of epigenetic techniques to treat lymphomas, which are cancers of the lymphatic system. 

A National Institutes of Health release tracks gene regulation in the brain's executive hub  across the lifespan and reports that mental illness suspect genes are among the most environmentally responsive. Perhaps some of our political figures should pay more attention to environmental issues - which play potent roles in causing disease, aggravating our national deficit because of escalating health care costs, and bringing misery to Americans subjected to potent toxins in our air, water, food and environment.

CSI-MIAMI: NOT A CHOICE SOURCE OF WILSON'S DISEASE INFORMATION

The critical issue in this week's CSI-Miami was Wilson's Disease, which caused the severe illness and death of several young show characters.  Unfortunately, if that program's viewers depended on the information conveyed  in that one hour show, they would have been seriously misled.

While Wilson disease does affect young people, it is inherited from both parents (not just one parent) who carry a genetic mutation, which causes this disease of copper metabolism involving liver function, neurologic disorder, movement disorder, speech disorder and conditions such as personality changes and depression.  While the disease may be fatal, competent medical evaluation at a center of excellence should lead to a proper diagnosis and treatment and a normal life expectancy.

Need information about Wilson disease?  Check out these links [1], [2] and [3] which will provide reliable current data about this uncommon condition which may be life-saving.  If someone in the family has Wilson's Disease, share the information you obtain from these links and other expert sources with the appropriate family health care providers and join the Wilson's Disease Association.

THE SPIRIT SUSTAINING HEALTH CARE REFORM
 

As my television showed a drove of national political candidates belittling each other, proclaiming their consultant-generated views on what Americans want and "need," calling for changes in  national governance, and voicing harsh criticism (coupled with parroting of their contributors' demands for destruction of President Obama's championed Affordable Care Act),  I thought of a different era in which a successful American political leadership understood that all individuals are people, created in a holy image, not subservient chattels whose major purpose in life is to make their owners rich. 

Reflect on these words (italics - below) from a humble, brave, ethical, heroic American. Take a moment and consider the difference between the spirit conveyed in these words and that  which come to us from the recent presidential primary debates, uttered in a small mean way.  The American president understood and transmitted the true meaning of freedom and died defending it, as did Rev. King whose memory Americans celebrated yesterday.  

Read on and click on the link----

"And upon this act, sincerely believed to be an act of justice, warranted by the Constitution, upon military necessity, I invoke the considerate judgment of mankind, and the gracious favor of Almighty God."

[The Emancipation Proclamation

January 1, 1863

A Transcription
By the President of the United States of America:
A Proclamation.
Whereas, on the twenty-second day of September, in the year of our Lord one thousand eight hundred and sixty-two, a proclamation was issued by the President of the United States, containing, among other things, the following, to wit:

"That on the first day of January, in the year of our Lord one thousand eight hundred....]

HOW DO LIONS CHOOSE DINNER?

If you have watched television nature programs, you may have seen videos of lions attacking relatively easy  game: animals which are very young, very old, sick or separated from the pack.  Defenseless against the predatory lion, the young, old, sick and socially isolated are easy prey.

In my experience negotiating health care contracts- and studying the practices of health insurers -  I observed similar corporate behaviors. Individual underwriting of pregnant women, in states such as Texas, resulted in their inability to obtain maternity coverage at a point when they needed it the most.  Newborns with congenital diseases, which might cost millions of dollars in health care services, led to cost-shifting. Underwriting made those with significant (and sometimes insignificant) health histories unable to obtain insurance or to afford the insurance offered to them (one insurer representative claimed that the company represented had very few HMO members who were over the age of 24). And those, seeking individual health insurance policies, were offered coverage which only the very rich could afford.

Take a look at the article from Kaiser Health News, "Health Law's Individual Mandate, Essential Benefits Draw Headlines."  You may find that my metaphor - of predation - is not far off base. The difference is that the insurers, their lobbyists and those in our government, whom their political contributions support, tread our nearby streets, state capitol hallways, and Congressional venues not far off jungles. 

MEDICALLY NONCOMPLIANT: ANYONE YOU KNOW?

Medconditions.net supplies a definition of noncompliance: "Patient or client refusal of or resistance to medical, psychological, or psychiatric treatment. (APA, Thesaurus of Psychological Index Terms, 8th ed.)" 

Any experienced physician will tell you that noncompliant patients present serious problems. It is difficult to tell whether a recommendation or prescription is helping the patient because the physician doesn't really know whether the patient is following the recommendation or has filled (or is taking the prescription or treatment in a manner consistent the doctor's instructions).  Is the patient's heart function deteriorating because the medicine is not working or is the patient not taking the medicine?  Is the patient getting sicker because of the medicine or in spite of it?  Is the patient's back pain worsening because there is increasing structural damage to the spine or back muscles or because the patient is not performing the exercise program that, if he or she had gone to the physical therapist, would normally have improved the discomfort?


Ten questions:
1. Are you a patient who doesn't follow the doctor's advice because you have good reasons not to trust the doctor's competence?
2. When the doctor gives you a prescription, do you go to the internet to research the drug or program before filling it?
3. When the doctor gives you a prescription for a generic drug, do you insist that the pharmacist provide the branded version because your insurance will pay for it and the branded drug is better?
4. Do you ask the pharmacist (or has the pharmacist been found) to give you less than the amount of the drug prescribed (i.e., fewer pills) to save money?
5. Do you cut non-scored pills into two or more pieces so that, by taking half a pill daily they will last longer,to save money?
6. Do you take the prescription drug every day as prescribed, or do you skip days?
7. Do you borrow pills from friends, or give some of your supply to friends who are running short?
8. Do you store your pills in the bathroom medicine cabinet (warm, well-lighted and moist) or in a cool dark place which may be a little out of your way?
9. Do you ask the pharmacist for pill bottle caps which are not child resistant because you keep the bottle in your purse or nightstand (including when you visit grandchildren) and find it a nuisance to open the child resistant bottles?
10. Do you put all your pills for the next week in one bottle (such as an old unlabeled medicine container) and take them out as needed?

Note: some of the links which follow are to opinions which may conflict with mine, which also follow.


Comment: 1. If you don't trust the doctor's competence, find another doctor quickly. 2. If you research the drug on the internet (at a reputable site which provides verifiable authoritative evidence for its opinions and information) you may qualify as a patient who pays attention, not a non-compliant patient. 3. The doctor's generic prescription is equivalent in effectiveness and you are wasting money and driving up the nation's health bill. 4. The pharmacist should fill the prescription as written or call the doctor to verify that the doctor agrees with your request. 5. Not only are non-scored pills not suitable for breaking or cutting (the active ingredients may not be distributed evenly throughout the pill and you may get more or less drug than you expect) but your total dose may not be correct. See link above for a conflicting opinion. 6. Skipping days needs to be discussed honestly with your doctor because you are not getting the treatment program the doctor expects. 7, Giving or taking pills may harm yourself or someone near and dear to you because the pills may be out of date, another strength, or perhaps inactive pills bought on the internet. 8. Some medicines seriously degrade in warm moist well-lighted environments and may actually damage you (i.e., your kidneys). 9. Kids experiment by taking grandparents' pills and get sick. Get child resistant caps and always use them. Don't be responsible for the illness or death of a child. 10. The unlabeled or incorrectly labeled bottle full of pills is the bane of emergency department doctors: they have to figure out what the pills are, whether you have taken them, and how they were prescribed. Keep pills in clearly marked original containers.


HAPPY SAFE HEALTHY NEW YEAR.