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     A well-stocked medicine cabinet is like a well-stocked pantry in many ways.  First of all, it allows for rapid reaction time in moments of need, whether it is reaching for the nutmeg to complete a delicious apple crisp for your spouse (just in the nick of time!), or a syringe of baby acetaminophen (Tylenol) when your little one is crying and has a fever at two o'clock in the morning.  It also provides a sense of well-being because for most of the everyday situations you might encounter, you and your family will be ready.  And finally, like any good pantry, a well-stocked medicine cabinet requires preparation, planning and, of course, a list.

     Now, there are as many different concerns regarding health as there are people.  But, throughout that vast sea of diversity, there are a lot of similar complaints that we share.  We are, of course, only human.  I have made my list of medicines after observing several very common, and very uncomfortable, complaints shared by many patients and family members alike (including even myself, from time to time, unfortunately).  I have grouped the list around major symptomatic themes, such as aches and pain, fever, stomach upset (either going too much or not enough), and simple infections.

     Of course, as with everything medical, it is best to run medication choices by your primary care provider (PCP).  Based on your own medical history, medication allergies, and what medicines you are taking currently, your PCP will decide the safety and efficacy of the suggestions below.  For example, if you are the blood-thinning medicine Plavix (clopidogrel) for heart attack or stroke prevention, or if you have a history of recurrent gastrointestinal bleeding, then you should avoid taking aspirin, as it can thin your blood even further, and increase your risk of bleeding—perhaps uncontrollably.

     One other state of health should have you in constant contact with a medical professional also—pregnancy.  I do not presume to know what medications you might be on while you are pregnant, but every one of the medications listed below should be discussed with your healthcare provider before taking it.  Most of these medicines are taken by mouth and enter the bloodstream, affecting the developing baby as well as you.  So, please, if you are pregnant, evaluate this list and consider the risks and benefits.  But please also talk with your PCP about your situation, and whether or not it is safe for you to be on some of these medicines.    

     A word of caution as well: this list does not include prescription drugs.  These medicines are presumably prescribed for a reason—to treat or manage a particular diagnosis (for example, a blood pressure medicine like metoprolol for treating high blood pressure).  You are supposed to be on these medicines already, and they should occupy an important space in your medication cabinet.  Going back to the pantry analogy, prescription medicines are like that must-have ingredient your grandmother insists you keep on-hand for that special family dinner (i.e., kale in a special soup).  It is essential for your recipe and cooking style, but not necessary for the next person’s pantry down the hall (he has a weird allergy to kale).

     A special category of prescription medicines are ones that need to be refrigerated.  These are usually injectable, like insulin and medicines for diseases like rheumatoid arthritis or multiple sclerosis.  Please make sure that you have an adequate supply available, that your prescription is not going to run out soon, and, if it is, that you call your provider’s office at least two to three weeks in advance.  These medicines are very important to your health and well-being, and you should never be without them, or the appropriate supplies to administer them, like syringes, batteries for medical equipment like an insulin pump or glucometer (to test your blood sugar), and test strips.  Stock up on these supplementary supplies, follow your prescription and fill it religiously.  Know when it is time to get your refill, and when you need to have another script.  It is your health, and you need to be responsible for it, too.

     Finally, this list does not include emergency medications, like an epi-pen for allergic reactions, or rescue inhalers for asthma.  You need them to live.  Keep them in your cabinet, and check the expiration date regularly.  My father thought that he “out-grew” his allergy to bee stings, until he got stung.  Luckily, he still did have one epi-pen around, and was able to prevent disaster.

     Now, without further ado, here are eight drugs that I feel are worthy of your consideration:

     1. Aspirin:  A great, time-tested medicine that should be present in some form in your house (with a few notable exceptions, which I will explain below).  Aspirin, or acetylsalicylic acid, has proven very effective in reducing the risk of heart attack and stroke in millions of patients.  This medicine works by inhibiting the function of platelets—components of the blood that help us clot and form scabs.  Unfortunately, this process can also happen inside blood vessels, and if that clot completely blocks off blood flow, then, depending on where it is (the heart or the brain), the tissue cannot get nutrients and oxygen to live, and dies.   

     The most important reason to have aspirin in your cabinet is that, if you think that you are having a heart attack and have called 911, then the operator might tell you to take aspirin tablets (325mg, or four baby (81mg) tablets), and chew them.  That’s right—chew them.  Studies have shown that the chemical gets into the bloodstream quicker if you chew the tablets than if you swallow the pills and let them dissolve in the stomach.  But, aspirin is a powerful medicine, and I do not think that anyone should start taking it without the direction and supervision of their primary care provider.  I say this for a couple of reasons.

     First of all, aspirin can interact with a lot of other medicines.  As I mentioned before, aspirin and Plavix are both medicines that thin the blood, and taking both medicines can cause someone to bleed excessively.  Aspirin is also filtered out of the body by the kidneys, so any medicines that are also filtered by the kidneys (such as ibuprofen and other non-steroidal anti-inflammatories, or NSAIDs), can make the kidneys work very hard, and can actually damage them, potentially causing kidney failure.

     Besides its interactions with other medicines, aspirin should also be used very cautiously with certain medical conditions.  These are mainly chronic diseases that predispose someone to bleeding a lot.  Some examples are stomach ulcers and other gastrointestinal bleeding problems, like a colon polyp, or clotting disorders like hemophilia (a rare genetic disorder).  It may still be safe to take aspirin, if you also suffer from heart disease or are at risk for a stroke, but you need to be monitored routinely by a medical professional and checked regularly for any signs or symptoms of bleeding.  People with kidney disease should also use aspirin under a doctor’s supervision, as it can worsen kidney function in high doses.

     Another VERY important point about aspirin is not to give it to children to treat fevers (except in very rare circumstances, and only approved and followed, and probably even given, by a doctor).  This is because of a rare, but very serious, association between viral infections and aspirin use known as Reye’s syndrome, a condition which causes liver failure and brain damage.  It is VERY serious – potentially fatal – so don’t do it!  There are also people who have a known allergy to aspirin, and they also should absolutely avoid the medicine.  In fact, they should have a medical-alert bracelet stating that information, in the event of an emergency.  So, while aspirin has the power to potentially save your life in the case of an emergency, it can also be very dangerous and must be used and monitored with the care and cooperation of a trained professional.

     2. Acetaminophen:  The active ingredient in Tylenol, this is another old, but very effective medicine.  Interestingly, Tylenol works on the same proteins as aspirin, but does so mainly in the central nervous system (which is the brain and spinal cord).  Both of these medicines are known as anti-inflammatories—they work to reduce pain, warmth, and chemical changes that are produced in response to an injury or illness.  Tylenol is very effective at quieting pain signals as well as reducing fevers.  But since it works in the brain, it doesn’t have the anti-clotting properties.  Because of this fact, Tylenol is considered safe in treating pain and fevers in patients who cannot take aspirin (as listed previously).

     But like any medicine, there are important and potentially dangerous side effects that you need to know about to avoid.  The main ones with acetaminophen arise from the fact that it is filtered out of the body by the liver.  There is a set amount that the liver can filter daily.  If it gets more than it can handle, toxic by-products of the degradation process can build up and poison the liver, causing it to fail, and making someone very sick, or even be fatal.  Therefore, people who have liver disease (like cirrhosis) or hepatitis C (a chronic viral liver infection), really should try to avoid acetaminophen.  For healthy individuals, research has shown that the upper safe limit for daily acetaminophen use (which you should try to be well below, if possible) is about four grams.  If you are taking a 650mg tablet of Tylenol, that means your daily maximum limit is six (650mg x 6 tablets = 3900mg).  Of course, a lot of other medicines can have acetaminophen also, especially doctor-prescribed pain medicines (like Lortab, Percocet, and Vicodin, for example).  So, if you are taking these medicines, and Tylenol as well, you need to sit down with your healthcare provider and figure out what your daily maximum dose is, in order to be safe.

     3. Ibuprofen:  Ibuprofen is very effective at treating a majority of everyday aches and pains.  It is the active ingredient in many arthritis and pain relief medicines, like Advil and Aleve, for example.  As with aspirin and Tylenol, it is an anti-inflammatory medication, a member of the NSAID family.  It works by a mechanism very similar to aspirin, but again has less (but not completely absent) effect on platelets and bleeding.  But it is a very potent anti-inflammatory drug, which makes it ideal for treating many of the muscle strains and sprains that we all suffer around the farm (we all know how I should have lifted that hay bale, but that twinge in my back lets me know that I used the wrong technique again).

     The main concerns for ibuprofen are very similar to aspirin, namely bleeding and kidney problems.  However, there is one big contraindication for ibuprofens (and other NSAIDs, like motrin and celebrex)—and that is a history of heart disease or stroke.  Research has shown that people who take NSAIDs are at greater risk for having a heart attack or stroke.  So I would talk to a medical professional about your health problems and current medicines before taking ibuprofen.  But once it is approved, and if you use it sparingly (no more than two or three days in a row—if the pain has not improved by then, it’s time to go see a doctor), ibuprofen can be a very powerful ally in treating those occasional muscle aches and joint pains.

     4. Muscle rub ointments:  Along the same lines as aspirin, acetaminophen and ibuprofen, external analgesic salves and ointments (translation: pain meds that are absorbed through the skin) can help relieve muscle aches and pains, and are very useful to have on-hand.  Most of these formulations, including common trade names like Bengay, have a compound in the same family as aspirin (methyl salicylate, also known as oil of wintergreen).  Some others, like capsaicin cream, have compounds derived from hot peppers that over-stimulate and inactivate pain receptors.  Both are very good medications for relief of localized pain like that found in arthritis or back aches.

     The major benefit of taking medicated compounds in an ointment, compared to by mouth, is that the ointment works right where it is placed.  When you take a medicine like aspirin, however, it goes throughout your body, and interacts with nearly all of your tissues.  Besides keeping the therapeutic action right where you need it, external analgesics also help reduce the chances of medication side effects and drug interactions.  So with methyl salicylate, for example, you don’t need to worry about bleeding disorders or kidney problems, like you do with aspirin.  However, people who are allergic to aspirin, or peppers, should still be very careful when using these ointments, since they could also react to these ointments as well.  It is also important to use common sense, and not to ingest these medicines by mouth.  They are toxic when taken internally!  So please use common sense, and use them as effective local pain relief as directed.

     5. Triple antibiotic ointment:  Another great weapon in the medicine arsenal is a topical antibiotic. (I know, I just went from the pantry metaphor to the war metaphor.  But with antibiotics, it’s convention I think.)  These are medicines that help reduce the risk of serious secondary infection, especially for those minor cuts and scrapes we all suffer on the homestead.  Antibiotics help slow bacterial growth, but do not cure the infection alone.  That is left to the body’s natural defenses (antibodies, white blood cells, and the like).

     Topical antibiotics, therefore, allow people to safely and judiciously apply a potent and powerful medicine in a relatively safe manner in order to prevent a more dangerous infection or illness, and allow our body to help heal itself a little bit faster.  But as with all medicines, and especially for antibiotics, it is important to know what you are using, and how to use it.  The application is very straightforward—clean wound under running water to get rid of dirt, grime, and other yuckiness that might harbor pathogens, then take tube, squeeze ointment on cut, place bandage over medicine, and proceed with daily chores, repeating daily until cut is scabbed over or healed.  The medicines themselves, however, are a little more complex.

     Most triple antibiotic ointments have three medicines: polymyxin B, neomycin, and bacitracin.  Huh?  Okay, so all of these medicines are pretty strong antibiotics that attack bacteria in different ways.  They work in a combined fashion on the bacterial cell wall and internal cellular proteins.  The important things to know is that these are very strong antibiotics, and are very poisonous if ingested.  So don’t eat them!  People who have allergic reactions to medications that contain sulfa compounds should also avoid using this medication.  Finally, after using the medicine, you still need to monitor the wound closely.  You need to call your doctor if the cut continues to look infected after several days (signs include redness, pus, or increased leakage of fluid from wound), or immediately if you have a new onset of fever, chills, weakness or dizziness with a worsening wound.  At that point, you might have a serious body-wide infection that requires intravenous antibiotics and hospital care.

     6. Hydrogen peroxide:  I just want to say a brief word about hydrogen peroxide, since most of us know what it is and what it’s used for.  It is a compound that is unstable and readily forms oxygen free radicals—compounds that are poisonous to cells.  And that is ALL cells—yours, mine, bacteria, fungi, everything.  So it is nonselective in how it works.  My family likes to use it on our calves after we cut off their horns, to help prevent infection.  The secret with hydrogen peroxide is to use it immediately after the cut or injury happens.  You want to kill any potential bugs or threats from entering the wound, but then you need to give your own cells time to grow and divide, and heal the wound.  If you keep using it, though, it will kill those cells that are trying to heal the cut.  So, when I use hydrogen peroxide, I like to use it in combination with a triple antibiotic ointment.  I use it first to clean out the cut, then I apply the antibiotic to act as a barrier, with a bandage covering it all.  And, as always, use common sense—please do not drink hydrogen peroxide (it hurts the lining of your digestive tract).  People do brush their teeth with it, but just remember to spit it out.

     7. Stool softener:  Now I would like to transition to some medicines, that, at first glance, might not seem as fancy as the pain relievers or antibiotics above.  But what they might lack in style, they more than make up for in substance, helping many people through some difficult situations.  The first, and most useful, are stool softeners. These include medicines like docusate and senna, and come with brand names like Colace and Dulcolax.  Many hospitals include them on their admission check lists, in order to save the patient (and frankly, a lot of the hospital staff) difficulties later on down the line.  All of these substances are types of fiber, and work by drawing water into the small intestine and colon, in order to lubricate and soften the stool and help keep the bowels moving.    

     There are not a lot of side effects with these medicines, and not many people have reported allergies to them (since they are inert fiber, and are passed out of the body anyways).  One main concern with these medicines is the possibility of worsening small bowel distention, or bloating, if someone has been constipated for a while, and the stool is starting to act like a plug.  The usual recommendation for stool softeners is to use them for two to three days as a trial.  If you are able to move your bowels while taking the medicine and relieve the constipation, then the trial is successful and you can go on enjoying life.  If there is no movement in the two or three days, however, then you might have constipation that requires an enema (using water or soapy water, mineral oil, or another marketed product, under some moderate pressure to the area), to try and relieve the blockage.  But for mild symptoms of constipation, stool softeners can be very effective, and save a lot of time, money, and discomfort.

     8. Pepto-Bismol:  Then there is the other side of the equation.  We have all had those nights, when we’ve had one too many slices of pizza (or the entire thing, unfortunately), and your stomach is churning and rumbling.  I like having some bismuth subsalicylate (the active ingredient in Pepto-Bismol and similar digestive aids) handy, in order to calm things down.  It works by helping to slow the increased muscle activity of the stomach, as well as reducing irritation in the stomach lining by coating it, and acting as a mild anti-inflammatory.  The subsalicylate in the compound is actually a weaker formulation of acetylsalicylic acid (also known as aspirin, described above).

     The main side effect of Pepto-Bismol is constipation, if taken in excess.  It should be avoided in children who are dehydrated, since this increases the chance of causing constipation.  It should also be avoided in children and teenagers who are suffering, or recovering, from a fever or known viral illness, because, as discussed above, there is the potential danger of developing Reye’s disease.  But I know that there are a lot of people out there (myself included), who have used and benefited greatly from using Pepto-Bismol or something similar, in order to enjoy a good night’s rest.

     Well, there they are.  My eight must-have medicines.  I realize, however, like I said earlier, that there is going to be a lot of discussion and variation out there, and I think that is a good thing.  I had a lot of trouble paring down the list to these eight, since I did want to add a couple more, like antacids, and antihistamines like Benadryl, especially as an ointment (wonderful stuff!).  In fact, now that I think about it, there might be a couple of additions in potential future writings.  But, for right now, this is a good starting point.  I feel it is an important foundation for any homestead medicine cabinet, and will help treat a wide variety of mild to moderate medical conditions that we run in to on the farm.  By knowing how these medications work, how powerful some of them are, and when to stop taking them and consult a medical professional, we gain an understanding and respect that serves us well and helps us live more healthily and independently. 

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