Often patients take medicines by themselves for simple ailments such as fever, headache, cough, cold and backache. The symptom may be relieved but the underlying illness remains. Fever may be due to urinary infection, upper respiratory tract infection, pneumonia, typhoid, sinusitis, liver disease, dengue, leptospirosis or it might be a simple viral fever. The treatment of each condition is different. So it is better to get evaluated for the cause of the fever and then take medicine. Even high-end antibiotics are available over the counter (that is without doctor's prescription). This can lead to inappropriate use of the drug, inadequate or wrong treatment; and it can lead to drug resistance. Painkillers for headache and backache taken for long can cause serious kidney and liver damage. And the underlying cause of the pain still remains! The disease has to be treated; not just the symptom.
Oral Medication
Patients with diabetes mellitus, hypertension, chronic kidney disease, chronic liver disease and cardiac disease have to take medication long term; maybe even lifelong. They should know names (including brand name) of medicines they take. This will enable the physician to adjust the dose or change the medicine appropriately. Often when asked about present medication, the patient will say that he is taking a "small, round, white tablet". It is important for patients on long-term medication not to change the brand of medicine they use.
Although medicines are supposed to contain the same molecule in the same strength, it is often seen that the different brands have different efficacy. This can significantly alter the control of blood sugar or blood pressure in a patient. If more than one person in a household takes medicines for the same illness, store them differently to avoid mix-up. Close the bottle lid as soon as the medicine is taken out. Moisture and dirt can enter the bottle and contaminate remaining tablets. Do not remove the label on the bottle. This will prevent wrong intake of medicines.
Syrups
Many antacids as well as cough medication are syrups. The amount of medicine consumed depends on the concentration of the medicine in the syrup as well as the volume ingested. This is crucial, especially for children. Often patients take "one spoon" of syrup. The volume of a spoon can vary from 3ml to 15ml. Use calibrated containers to dispense syrups. Many syrups are available in "dry powder" form that needs to be reconstituted before use. Use the exact amount of water to reconstitute or the concentration may vary and wrong dose of medicine will be ingested.
Gently shake bottles prior to use to prevent sedimentation and clumping of the drug. Store medicines in separate places, medicines for external application must not be mixed up with medicines for oral ingestion. Do not store chemicals like nail polish remover, spirit and ether near medicines; or store them in used medicine bottles. Many times young children accidently take these, especially if they are sleepy.
Listen, insulin users!
Various types of insulin are available and different types are required for different clinical conditions. Insulin is available in different concentrations - both 100 units/ml as well as 40 units/ml. Similarly different insulin syringes are available- U-100 and U-40 insulin syringes. In many countries, insulin is only available to humans as U100 insulin. This means that there are 100 units per 1ml of insulin. U-40 syringes are intended for use with U40 (40 units per ml) insulin. In India it is the U-40 insulin & syringes that are more commonly available. Very often in clinical practice we see relatives of patients from abroad bring U-100 syringes as "gift". These patients might have been using U-40 syringes and U-40 insulin. When they use the same volume of insulin in a differently calibrated syringe, they inject a wrong quantity of insulin and sugars go out of control.
In addition to the concentration, there are different types of insulin - short acting, intermediate acting, long acting, premixed insulin (which is a combination of short acting as well as long acting insulin in various ratios - 30/70 or 50/50). It is very important that the patient knows the name of the insulin he or she takes. Insulin pens are very convenient. Once insulin gets over in the cartridge, it can be removed and a new cartridge be inserted. Use the same brand of insulin for a particular type of pen. If a different brand is used, the cartridge might not fit properly; it might leak; it might deliver wrong amount of insulin.
Insulin is very sensitive to sunlight, indoor lights, and to extremely hot or cold temperature. Insulin is not OK to use if exposed to very hot or cold weather. Unopened insulin is best stored inside the fridge (2° to 8°Celcius). Storing it at room temperature or in the freezer can damage it. If stored wrongly, insulin can lose its efficacy and again blood sugars can go out of control. Mistakes with insulin can happen at home. People using insulin for years may be more likely to err. The more often you perform a task, the more you may do so without acting carefully.
Tips to avoid insulin mix-up at home:
After opening an insulin vial, throw out the carton: Storing insulin vials in the original carton after the packages have been opened can lead to a mix-up. This happens if you replace the vial into the wrong carton. By eliminating storage of vials in their cartons, the chance of error is eliminated. If you are using more than one type of insulin, consider using two different insulin devices to inject your insulin. Use a vial and a needle/syringe for your long-acting insulin and an insulin pen for your rapid-acting insulin. If you are unable to use different devices, then consider making each vial, pen, or cartridge look different by putting a rubber band around one type of insulin. You can also use colored stickers to help differentiate the insulin.
Do not ever assume you are using the correct insulin based solely on what it looks like or where it is stored. Some may think that fast-acting insulin is the only insulin that's a clear liquid. But that's not true. For example, insulin glargine is a clear, 24-hour insulin. Likewise, not all intermediate- or long-acting insulin is cloudy. Some pre-mixed combinations of intermediate and rapid-acting insulin are cloudy.
Never rely only on the container or label color to identify your insulin. The label color can be used as a guide to identify insulin but should never be used by itself.
Place all needles and other sharps in a sharps disposal container immediately after they have been used. This will reduce the risk of needle sticks, cuts, and punctures from loose sharps. Overfilling a sharps disposal container increases the risk of accidental needle-stick injury.
DO’s and Don’ts of hospital visits
Do not import/export infections
Visitors to patients with airborne infections (tuberculosis, chickenpox, severe acute respiratory syndrome [SARS]), should wear surgical masks. Avoid contact with dressings, tubes, bed sheets and other items the patient may touch. Don't go if you are sick. If you have a fever, cough, or any other sign of sickness stay home. You don't need to spread your germs in hospital where people's immune systems are weak. Wash your hands before and after you visit, you don't want to take germs into or out of hospital.
You don't need to stay for hours unless you are the spouse, parent, or child of the patient. Most of the time, 15 or 20 minutes is an adequate amount of time to allow. Keep your hands off all medical equipment. The hospital is not a good place for loud voices, booming laughter, or ringing cell phones. Put your cell phone on silent or vibrate and plan to visit in a quiet tone.
Let family go first
Let the family go first. If the hospital policy states that only so many people are allowed in the room at one time, family members should go first. After all, this isn't a party. Don't wear perfume or heavily scented toiletries to hospital. Some of the patients may have allergies, or worse, be on ventilators. In hospital, be as positive as you can and smile if it is appropriate. Don't share negative past experiences in hospital, lest you may frighten your friend or family member.
Avoid the urge to diagnose the patient. Your relative might have had similar symptoms, but this is not the time to share them with the person in hospital bed. Never tell the person how bad she looks, and if you are shocked by tubes and beeping machines, don't show it. Keep conversation light. Before you visit the patient, think about a few conversation starters to help prevent letting the conversation get too intense.
Avoid discussing business, politics, or anything that may hinder the patient's recovery. Things you can talk about to brighten the patient's day include the weather, anecdotes about work that aren't stressful, and something funny. Remember that people can still hear when their eyes are closed. Whether the person is in a coma or simply resting, don't say anything that you wouldn't say if he were looking at you. He might be listening.
Don’t sit on the bed
Don't sit on the bed, unless the patient asks you to sit beside him. Honor medical professionals. When the doctor or nurse comes in, offer to leave. Step out of the room with a positive attitude and either wait by the door or in the waiting room. It is always a good idea to thank the people at the nursing station.
(The writer is Professor and Head of Nephrology at Amala Medical College, Thrissur)
