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<v Speaker 2>Good day, I'm doctor Paul. Welcome.

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<v Speaker 1>Medicine and health in this series is called doctor pro Tips.

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<v Speaker 1>These are just little things that might make your either

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<v Speaker 1>interacting with doctor or doctors or healthcare providers and or

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<v Speaker 1>possibly following their instructions go a little bit more smoothly.

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<v Speaker 1>The first one is it's an area where a lot

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<v Speaker 1>of people have questions and it makes sense when we

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<v Speaker 1>look at the complexity and that's around pill taking. And

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<v Speaker 1>so in the world of pills, and this could be

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<v Speaker 1>prescription items or possibly supplements, et cetera, more and more

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<v Speaker 1>people are taking things that are both prescribed as well

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<v Speaker 1>as maybe over the counter, et cetera. So you really

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<v Speaker 1>need to think about your timing of pill taking and

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<v Speaker 1>certain other rules that go around with it. So the

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<v Speaker 1>first thing is is that pills, generally speaking, will digest

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<v Speaker 1>very similarly to whatever food item they are most similar to. So,

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<v Speaker 1>for example, if you take a pill that is a

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<v Speaker 1>fat based, say a capsule full of a fat based

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<v Speaker 1>medicine or something like that, or even a fat based nutrient, etc.

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<v Speaker 1>It's going to absorb in your digestive tract the same

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<v Speaker 1>way that other fats absorb, which means it's going to

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<v Speaker 1>go through a little bit different pathway than the water

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<v Speaker 1>soluble type things. If you take something that is say

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<v Speaker 1>an amino acid or an amino acid.

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<v Speaker 2>Based product or drug, it's going to.

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<v Speaker 1>Absorb the same way that amino acids that you eat

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<v Speaker 1>in protein will absorb. If you take other things.

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<v Speaker 2>Are going to absorb similarly.

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<v Speaker 1>So there are also some drugs that we don't normally

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<v Speaker 1>give orally because the digestive tract would break them down

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<v Speaker 1>too far and it wouldn't really be very useful or

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<v Speaker 1>there'd be just too much metabolism. So the next thing

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<v Speaker 1>is if it's prescribed or recommended by a healthcare provider,

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<v Speaker 1>and so what's that distinction. Well, generally speaking, we have

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<v Speaker 1>to prescribe to you something that would be say a

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<v Speaker 1>legend substance, and that means that in the state that

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<v Speaker 1>you're in, and usually this covers the whole country, it

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<v Speaker 1>is something that is on the order of prescription only,

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<v Speaker 1>and so that to be an antibiotic or whatever. So

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<v Speaker 1>there's a prescribed and then there might be a recommended

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<v Speaker 1>thing where it's not really a prescription, but your doctor

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<v Speaker 1>might say I want you to start taking calcium and

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<v Speaker 1>magnesium and vitamin D and K and here's the amounts.

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<v Speaker 1>So it's recommended as part of your chart usually, but

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<v Speaker 1>it's not really a prescription. So all of those together though,

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<v Speaker 1>will or should have some sort of instructions as far

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<v Speaker 1>as when and how you take them. So usually what

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<v Speaker 1>you have is either with food or before a meal,

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<v Speaker 1>or after a meal, or maybe between a meal, and

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<v Speaker 1>there's also bedtime posting. So the first thing is if

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<v Speaker 1>it's a bottle with a prescription information or sometimes you

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<v Speaker 1>got to walk out a receipt that will say take

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<v Speaker 1>this much of this at this time. That's your first

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<v Speaker 1>go to is, gee, what does the label say?

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<v Speaker 2>Now?

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<v Speaker 1>If the label is ambiguous, or if you have trouble

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<v Speaker 1>taking pills or you feel like you're going to get

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<v Speaker 1>nauseated from this pill, the next step is to talk

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<v Speaker 1>to the pharmacist when you're filling the prescription. There's always

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<v Speaker 1>a place where you can go and talk to the

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<v Speaker 1>pharmacist when you're picking up your medications and just say, look,

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<v Speaker 1>you know it doesn't really say it just says take

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<v Speaker 1>three times a day. Can I take this with food?

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<v Speaker 1>I get sick from pills, etc. And they'll break that

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<v Speaker 1>down for you. Now, one of the important things about

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<v Speaker 1>when you take pills can be that there's different fates

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<v Speaker 1>of digestion of the pill that your healthcare provider may

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<v Speaker 1>have in mind. So there might be a substance, for example,

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<v Speaker 1>that really is best with no food, and that'd be

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<v Speaker 1>something like thyroid hormone. A lot of people take thyroid hormone,

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<v Speaker 1>and we try and have them take that when they

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<v Speaker 1>first get up before they eat anything, because it binds

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<v Speaker 1>to other things, especially minerals, really easily. So the worst

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<v Speaker 1>thing that you could do would be to take your

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<v Speaker 1>thyroid and then a mineral product and or food that

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<v Speaker 1>has minerals at the same time, because the amount of

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<v Speaker 1>thyroid you're gonnas are going to go weigh down. Then

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<v Speaker 1>there are some medications, some supplements where we'll say, well,

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<v Speaker 1>take it with a meal. Now in the case of

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<v Speaker 1>pills that really require food in your stomach to keep

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<v Speaker 1>you from getting nauseated, to help the pill break down,

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<v Speaker 1>whatever the reason is for with food, what I usually

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<v Speaker 1>try and tell people, especially with things that might be

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<v Speaker 1>a little more upsetting to the stomach, is take it

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<v Speaker 1>in the middle of your meal. And so the best

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<v Speaker 1>way I've figured out to do this is to just

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<v Speaker 1>set them by my plate, and then I see them

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<v Speaker 1>there and I eat literally half of the food, and

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<v Speaker 1>then I take the pills with a sufficient amount of water,

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<v Speaker 1>and then I eat.

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<v Speaker 2>The rest of my food.

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<v Speaker 1>Now why is that Because if you take the pill

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<v Speaker 1>at the beginning of your meal, it's with food, right,

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<v Speaker 1>but it's going to go in there. There's not a

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<v Speaker 1>lot of food or liquid in there, and it might

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<v Speaker 1>stick to your stomach lining and make you very nauseat

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<v Speaker 1>or even make you throw up. That happens with zinc

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<v Speaker 1>and other zinc based products that are used in a

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<v Speaker 1>number of drugs, like certain antibiotics, et cetera.

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<v Speaker 2>Will do that as well.

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<v Speaker 1>So if you imagine that your stomach, you know, it's

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<v Speaker 1>sort of this big oblique bag, sort of an organ,

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<v Speaker 1>and you got half your meal in there. Your stomach

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<v Speaker 1>is literally sort of churning the food around. So the

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<v Speaker 1>pill goes in with the water drink and it just

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<v Speaker 1>makes us in and then it's going to digest more easily.

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<v Speaker 1>It's not going to stick to the wall of your

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<v Speaker 1>stomach and make you sick, which is what we don't want.

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<v Speaker 1>Then you eat the rest of the food and it

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<v Speaker 1>helps to push any of the you know, any of

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<v Speaker 1>the pill down that didn't get there, et cetera. Now,

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<v Speaker 1>there were some medications there are that are better without food,

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<v Speaker 1>but still you don't want to get them stuck in

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<v Speaker 1>your esophagus the tube that you swallow through to your stomach.

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<v Speaker 1>So we would tell people then to take that pill

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<v Speaker 1>and drink a large glass, like a twelve ounce glass

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<v Speaker 1>of water with it, just to make through there was

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<v Speaker 1>enough fluid going down.

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<v Speaker 2>Because if you've ever tried and had.

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<v Speaker 1>This happen and felt like you had a pill stuck,

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<v Speaker 1>that's generally because the pills are you know, they're sticky,

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<v Speaker 1>they have different things on the outside, and they will

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<v Speaker 1>stick to the lining of your esophagus. So the more

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<v Speaker 1>fluid you can put down, if you can't eat with it,

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<v Speaker 1>eat food is better. But if you can't eat with it,

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<v Speaker 1>the more fluid you do the better. Now why would

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<v Speaker 1>and these are some of the hardest things to remember

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<v Speaker 1>as far as prescriptions or recommendations, why would your healthcare

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<v Speaker 1>provider recommend between meals? Well, one reason is to keep

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<v Speaker 1>it away from foods. So like with thyroid, we usually

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<v Speaker 1>say first thing in the morning before eating. But there

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<v Speaker 1>are some medications and other things that we want between meals,

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<v Speaker 1>and again you may have to set an alarm for yourself,

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<v Speaker 1>or having a little pill container if you work at

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<v Speaker 1>a desk and just have it there and remember when

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<v Speaker 1>the alarm goes off to take that and it kind

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<v Speaker 1>of goes back to that same thing. These are probably

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<v Speaker 1>things that are better to move through your system and

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<v Speaker 1>not have a lot of food going with them so

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<v Speaker 1>that we get maximum absorption, etc. Now the other thing

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<v Speaker 1>is if you have a reaction to anything but a medication,

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<v Speaker 1>a recommended supplement of whatever you're doing with your health

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<v Speaker 1>care provider, you want to get a hold of the clinic.

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<v Speaker 1>Leave a message. Nowadays, with electronic medical records, you can

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<v Speaker 1>just send a message electronically and just say, Okay, I

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<v Speaker 1>started this new prescription and here's what's happening. It could

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<v Speaker 1>be any number of things. It makes me nauseated, it

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<v Speaker 1>makes me get flushed, it makes me feel dizzy when

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<v Speaker 1>I take it, It does this, that or the other thing.

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<v Speaker 1>Let them know soon and then often they can tell you, okay,

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<v Speaker 1>if that's happening, try this okay. So, for example, in

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<v Speaker 1>our clinic, in most people's clinics, if you're getting nauseated,

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<v Speaker 1>from it will reiterate the idea of eating half of

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<v Speaker 1>your food and a meal, taking the pill with no fluid,

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<v Speaker 1>and eat the other half of the meal of the food.

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<v Speaker 1>That usually does take care of a lot of those problems. Now,

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<v Speaker 1>sometimes there's other things like you're asking me to take

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<v Speaker 1>this at bedtime, and I'm taking these other pills at bedtime.

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<v Speaker 1>Can we just double check, you know, check with a

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<v Speaker 1>practitioner who's adding on the new pill, and can we

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<v Speaker 1>just double check and take a look at, you know,

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<v Speaker 1>making sure everything goes together that we're taking at night.

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<v Speaker 1>And this is very important, especially with certain medications and

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<v Speaker 1>a lot of supplement recommendations, because let's say, for example,

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<v Speaker 1>there's some nighttime medication you're taking that's fairly critical for

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<v Speaker 1>a function. Let's it helps you with a dysrhythmia, a arrhythmia,

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<v Speaker 1>or it helps you with some other thing. And then

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<v Speaker 1>let's say somebody adds on another thing to take that

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<v Speaker 1>may actually bind to the other medication.

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<v Speaker 2>And I've actually seen this with.

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<v Speaker 1>Patients where all of a sudden they start having you know,

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<v Speaker 1>arrhythmias again, or their blood pressure went up or something,

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<v Speaker 1>and there was no reason for it, and you go

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<v Speaker 1>back and you look, and it turns out that there's

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<v Speaker 1>two things going in at the same time with say

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<v Speaker 1>their heart medication or something else, and one is inhibiting

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<v Speaker 1>the other, so you get those symptoms from that. I've

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<v Speaker 1>also seen this with neuropsychiatric meds and other things, So

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<v Speaker 1>you just want to make sure you get a good

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<v Speaker 1>top down look at that. And in another section we're

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<v Speaker 1>going to talk about doctors disagreeing and stuff like that.

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<v Speaker 1>But generally speaking, whomever the healthcare provider is that's adding

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<v Speaker 1>this new thing for your regimen, you should be able

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<v Speaker 1>to say, Okay, look at my med profile or my

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<v Speaker 1>supplement profile, is there any reason I shouldn't be able

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<v Speaker 1>to take this at that time? And so for some people,

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<v Speaker 1>for example, there would be things that we would prefer

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<v Speaker 1>were at bedtime, but there were other medications that were

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<v Speaker 1>a little bit more critical that they'd be taken at

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<v Speaker 1>that time, and so we would have them back up

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<v Speaker 1>and take it right before dinner or some other time,

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<v Speaker 1>just to make it work out a little bit better

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<v Speaker 1>for them. Now, one thing that comes up as far

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<v Speaker 1>as tolerance of pills, et cetera, is sometimes you'll have

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<v Speaker 1>a pharmacy and one of their jobs is to make

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<v Speaker 1>sure you're not going to have drug interactions and things

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<v Speaker 1>like that, and so drug interactions generally, there's pretty decent

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<v Speaker 1>data on most drugs. It's like, don't take this with that, etc.

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<v Speaker 1>We get into the world of some supplements and some

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<v Speaker 1>botanical or herbal medicines, et cetera. Sometimes the interaction checkers

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<v Speaker 1>are very theoretical, so it's a good place to start

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<v Speaker 1>because there's maybe a paper that showed, you know, in

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<v Speaker 1>a Petri dish that this reaction happened, but there's no

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<v Speaker 1>papers showing was that a problem or not when we

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<v Speaker 1>put it into people. Okay, there's a big difference between

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<v Speaker 1>a Petrie dish reaction and people reaction. So again, if

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<v Speaker 1>you are working with healthcare provider in adding something like that,

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<v Speaker 1>the things that they should be looking for to help

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<v Speaker 1>you out. Number one are is there anything we're adding

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<v Speaker 1>in here that's going to create a problem for anything

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<v Speaker 1>else you're taking. The next thing is are the things

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<v Speaker 1>that we're adding in going to pharmacologically play well with

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<v Speaker 1>the other stuff that you're taking. We do this constantly

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<v Speaker 1>and well all the types of patients I see, but

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<v Speaker 1>especially on ecology patients because there are a lot of

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<v Speaker 1>critical drag metabolism things, which thankfully most of them work

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<v Speaker 1>out pretty well, but there's some that are a little

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<v Speaker 1>more dicey than others. So as you're going through communicate, communicate, communicate.

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<v Speaker 1>Remember if it comes to pills, the person who's recommended

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<v Speaker 1>or prescribed whatever it is in question should be able

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<v Speaker 1>to answer questions about is it okay to take the

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<v Speaker 1>new stuff you're giving me with these old drugs or

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<v Speaker 1>supplements I'm taking. Sometimes there's a replacement where one of

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<v Speaker 1>the new things will take over for the new thing

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<v Speaker 1>and one of the old things and they'll take you

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<v Speaker 1>off of it. But again that's a communication thing. If

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<v Speaker 1>you start having a problem and you can't trouble shoot

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<v Speaker 1>it yourself. For example, I've got a lot of people

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<v Speaker 1>who got sick from certain pills and they looked and

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<v Speaker 1>it said don't take with dairy products, and they took

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<v Speaker 1>that to me, don't take with any food, And indeed

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<v Speaker 1>it was just saying don't take with dairy products or

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<v Speaker 1>calcium containing things. So they were able to eat a meal,

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<v Speaker 1>they just couldn't have dairy products with it. And then

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<v Speaker 1>that took care of some of the problems. But if

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<v Speaker 1>you're not getting a resolution, then ask your healthcare provider

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<v Speaker 1>what to do about it. Because one of the things

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<v Speaker 1>that's not going to help you medically speaking, and we're

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<v Speaker 1>just about a time here, but I'll get into this

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<v Speaker 1>real quick. It's not going to help you medically speaking

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<v Speaker 1>or for your medical management is if you stop taking

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<v Speaker 1>a person decribed or recommended therapy and you don't see

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<v Speaker 1>your doctor for two, four, six, eight weeks and then

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<v Speaker 1>you get back and they're like, well, are you better

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<v Speaker 1>or what has changed? And they don't realize that you've

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<v Speaker 1>been off of things that they recommended for that whole time,

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<v Speaker 1>and so you know, they're not mind readers. So you

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<v Speaker 1>can go back and you know, just communicate with their office,

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<v Speaker 1>let them know. Usually it's something fairly simple. If you're

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<v Speaker 1>really having a bad reaction, you have an allergy or

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<v Speaker 1>something like that, they also need to know about that

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<v Speaker 1>because they're going to have you stop taking it and

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<v Speaker 1>look for an alternative v and do, or if there's

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<v Speaker 1>a bat allergic reaction, they're going to have you go

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<v Speaker 1>to the emergency room. And so that pretty much goes

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<v Speaker 1>through everything on the basics around pill taking, how to

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<v Speaker 1>optimize them how to help out your pill taking journey

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<v Speaker 1>and experience. And then there are other things that can

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<v Speaker 1>be helped or done. Sometimes these are things that the

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<v Speaker 1>pharmacy can do. For example, in our patients that have

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<v Speaker 1>a little trouble keeping track of things, or there's a

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<v Speaker 1>lot of different pills at different.

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<v Speaker 2>Times, they can be packaged by.

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<v Speaker 1>Different pharmacy services into bubble packs that will allow and

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<v Speaker 1>it will say, you know, mourning, you know, lunchtime, bedtime,

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<v Speaker 1>something like that, and that really helps us sort of

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<v Speaker 1>keeping track of things. The other thing is we've had

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<v Speaker 1>people sometimes where they because of various reasons, due to digestion,

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<v Speaker 1>absorption and all of the other things that go on,

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<v Speaker 1>they were unable to really swallow the pills or it

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<v Speaker 1>was really really difficult. And so in some cases what

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<v Speaker 1>was done is either through the pharmacy or somebody who's

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<v Speaker 1>competent to do it, they got you knowed versions of

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<v Speaker 1>a medication or powdered versions of supplement, etc. And they

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<v Speaker 1>can mix it into a smoothie or other things like that.

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<v Speaker 1>So as we kind of wind down here in the

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<v Speaker 1>pill taking discussion, we'll just go back through the first

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<v Speaker 1>thing is communicate with your provider as they're recommending the

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<v Speaker 1>new things. It doesn't hurt ever to just double check

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<v Speaker 1>that everything is copasetic together, read the labels, and communicate

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<v Speaker 1>back if you're having any trouble at all. All right,

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<v Speaker 1>well we're going to go on to the next session

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<v Speaker 1>and we'll take a little break here