Rx Note

Introduction Most of us live in "disconnected boxes". We have a career box where we hustle for success, a financial box dominated by anxiety, and a spiritual box where we try to find peace on the weekends. We read productivity books to fix our work and investment guides to fix our money, yet we often feel a lingering sense of incompleteness. We are winning in one area but quietly losing in another - rich but anxious, or efficient but hollow. I have spent the last few years searching for the "invisible thread" that connects these boxes. This journey led me to write The Architecture of a Whole Life , a series of five books designed to mend these fractures and move us from fragmentation to wholeness. Bridging Two Worlds This collection is not a manual of "hacks". Instead, it is a living philosophy that bridges two cosmic forces: The "Yin" of Eastern Wisdom: Acceptance, flow, and the art of being. The "Yang" of Western Pragmatism: Action, s...

Introduction A sprain is an injury involving the overstretching or tearing of ligaments and/or the joint capsule. In contrast, a strain occurs when muscle fibers or tendons are damaged due to overstretching or tearing. PRICE Therapy Minor sprains and strains can usually be managed at home using PRICE therapy for the first 48 to 72 hours. The primary goal is to minimize swelling. If swelling is not controlled, the resulting pressure can limit mobility, lead to long-term muscle atrophy (wasting), and delay the overall recovery process. Protection Protect the affected area from further trauma, for example, by using a brace or support. Rest Avoid strenuous exercise and reduce daily physical activity. Use aids like crutches or a walking stick for lower limb injuries, or a sling for shoulder injuries, to offload weight. Ice Ice packs reduce the metabolic needs of the tissues, reduce blood flow and result in less tissue damage and swelling. Apply an ice pack to the affected area for 15-20 min...

Introduction A popliteal synovial cyst, commonly known as a Baker’s cyst, is a fluid-filled swelling that develops at the posterior aspect (back) of the knee. It typically occurs due to an underlying intra-articular pathology (e.g. osteoarthritis , rheumatoid arthritis ) or a meniscus (cartilage) tear, which causes the joint to produce excessive synovial fluid. Symptoms Patients often report increased discomfort during prolonged standing or when the knee is in hyperflexion. Common symptoms include: A visible or palpable lump behind the knee, which may extend into the calf. Knee pain Stiffness and an inability to fully flex or extend the knee. Rarely, a Baker’s cyst may rupture, causing synovial fluid to leak into the calf, and present with similar symptoms of a deep vein thrombosis. This results in sharp, sudden pain in the knee and significant swelling and redness in the calf, and require immediate medical evaluation. NOTE: Diagnosis is typically confirmed via physical examination a...

Introduction Vertigo is an illusion of rotational, liner or tilting movement of self or environment. It could be produced by peripheral (inner ear) or central (brainstem-cerebellum) stimulation. The most common motion illusion is a spinning sensation. Nausea and vomiting are typical with acute vertigo, unless it is mild or very brief, as with benign paroxysmal positional vertigo (BPPV). Vomiting can be severe, causing dehydration and electrolyte imbalance. Postural stability can be affected in patients with vertigo. NOTE: It is important to distinguish vertigo from other potential causes of "dizziness". Evaluation The clinical features of the most common disorders are summarized in the table below. NOTE: The time course of symptoms provides one the best clues to the underlying pathophysiology of vertigo. Symptomatic Treatment Medications to suppress vestibular symptoms are best used for alleviating acute episodes of vertigo that last at least a few hours or days. These dr...

Introduction Mal de Débarquement Syndrome (MdDS), which translates to "sickness of disembarkation", is a rare and often misunderstood neurological condition. It is characterized by a persistent phantom perception of self-motion, typically described as rocking, bobbing, or swaying. Essentially, the brain continues to feel as though it is in motion even after the person has returned to stable ground. While these sensations are common immediately following an ocean cruise, a long flight or a cross-country road trip, MdDS occurs when the symptoms fail to resolve. Current research suggests that MdDS results from the central nervous system’s inability to "re-adapt" to a stable environment after being habituated to rhythmic motion. Symptoms The primary symptom of MdDS is a constant feeling of being "at sea". Common experiences include: Persistent rocking, swaying or bobbing sensations Unsteadiness and impaired balance Cognitive symptoms: "Brain fog", co...

Introduction In a community pharmacy setting, almost on a daily basis, we recommend oral antihistamine to our customers, which could be for prevention and treatment of symptoms in allergic rhinitis , allergic conjunctivitis, urticaria , or a variety of other allergic diseases. 1st and 2nd Generation As an overview, antihistamines can be classified into 1st and 2nd generation. This dichotomy was introduced in 1983 to indicate a major pharmacological difference between terfenadine and astemizole. Being less lipid soluble, the second generation antihistamines is thus believed to be less readily penetrated the blood brain barrier, and hence does not cause drowsiness. However, second generation antihistamines are still able to penetrate the blood brain barrier and may cause drowsiness (thought it rarely occurs). In fact, there are textbooks using the terminology of "less sedating antihistamines" to describe the second generation antihistamines, instead of "non-sedating antih...

Indications Unlike its use for treatment of cancer, methotrexate is administered as long-term, low-dose therapy, usually 7.5 to 25 mg weekly in rheumatoid arthritis and other disorders. Sometimes, it might be a good idea to have a discussion with patients to select a day for them to take this medication. It could be a Monday, since methotrexate starts with a "M", or it could be a Sunday, since patient is going to church in the morning. Method of Administration In terms of prandial advice , methotrexate should be taken with an empty stomach. Milk-rich foods may decrease its absorption. However, under management, Lexicomp did suggest to administer without regards to food , which is interesting to be take note of. Being an antineoplastic agent, methotrexate is categorized under NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016 Group 1. The 2.5 mg methotrexate tablet should not be cut or crushed in an unprotected environment. If a weekly dose...