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With allergy season’s extended stay and cold and flu season having just begun, you may soon find yourself seeking relief through several different kinds of over-the-counter medications. Know what precautions you need to take when fighting multiple symptoms with multiple medications. When you’re too sick to go to work but not sick enough for a doctor’s visit, over-the-counter medicines are a welcome relief to help alleviate that fever, runny nose or allergies. But because those medicines aren’t signed off on or managed by your doctor and pharmacist, it’s crucial that you’re especially mindful of what you put into your body. Whenever you pop a pill, you want to make sure you’re taking the right dosage, waiting the right amount of time before taking another dose and not mixing certain medicines together. Recent stories like this one detail dangerous over-the-counter medicine combinations, and we’re following suit: Here is a quick go-to guide about potentially harmful over-the-counter combinations. Too Much Tylenol/Acetaminophen Tylenol — or acetaminophen — is a popular pain reliever for many, but too much can be bad for your liver. “Our bodies have a finite ability to metabolize Tylenol,” says Andy Wright, clinical pharmacist at Renown Rehabilitation Hospital. “When too much builds up in the liver, it becomes toxic. In patients with medical conditions like cirrhosis of the liver or hepatitis, this could be disastrous.” Remember, acetaminophen is in more than just Tylenol and generic pain relievers. You may also see acetaminophen in flu, cold and cough medicines, like Nyquil, and some prescription medications including Norco and Percocet. Keep a list of the medications you take, and limit daily acetaminophen use to 3,000 mg per day. When you’re scanning medicine bottle contents, remember acetaminophen is also referred to as APAP, AC, acetam or paracetamol. Mixing Painkillers When you’re dealing with pain and not getting any relief, taking a different medication may seem like the easy solution. Maybe you take some Aleve — a form of naproxen — for a headache, but it isn’t working, so you switch to Motrin, an over-the-counter form of ibuprofen. Not a smart idea. Ibuprofen and naproxen along with aspirin are known as nonsteroidal anti-inflammatory drugs (NSAIDS). Because these medicines work in similar ways, they should never be combined or used in larger doses or more frequently than directed. Otherwise your risk of side effects can increase, which range from mild nausea to severe gastrointestinal bleeding. It’s also important to consider your family history when taking NSAIDs because, “recent studies have shown NSAIDs may have greater cardiovascular risks for people taking blood thinners or those with hypertension,” explains Andy. “A good example is ibuprofen: It has a relatively low gastrointestinal bleed risk while it has a moderate to high cardiovascular risk. The opposite is true for naproxen.” Rather than experimenting with multiple medicines, figure out which drug works best for you. You may find muscle soreness improves with aspirin, whereas when a headache hits, naproxen is best. Keep in mind that these medications aren’t always best for everyone in the family. “Aspirin in children and teens is not recommended unless under the supervision of a doctor,” Andy says. And pregnant and lactating women should generally avoid NSAIDS due to risk of birth defects and bleeding. “In both of these cases, acetaminophen or Tylenol are preferred but only if approved by an OB/GYN.” Fighting Allergies Over-the-counter antihistamines like Claritin, Zyrtec and Allegra have made fighting itchy eyes and runny noses a little easier. But these daily medicines — when taken inappropriately or in the wrong combinations — can also have an adverse effect. Similar to acetaminophen, you need to watch for antihistamines in other products. Sleep aids — like Tylenol PM and Unisom — commonly use an antihistamine known as diphenhydramine, which may increase your risk of overdose. “Combining antihistamines, or overdosing, can cause many adverse effects including dry mouth, blurred vision — even arrhythmias,” Andy says. “Only take these medications on their own.” If you’re still struggling with symptoms, you can talk to your doctor about adding an over-the-counter nasal steroid. Andy confirms the importance of closely following the directions listed on antihistamine (and all medicine) bottles. He has seen extended release nasal decongestants cause significant arrhythmias requiring medical care after a patient took the medicine with warm fluids. “The decongestant in question is designed to slowly release, but it can dissolve suddenly in the presence of warm liquids like coffee,” Andy explains. “This can cause the pill to deliver 12 to 24 hours of medication all at once.” Taking an Antidiarrheal with Calcium Calcium supplements and antidiarrheal medicines are another harmful combination. Calcium firms up your stool, but if taken with an antidiarrheal, can cause severe constipation. If you need to take an antidiarrheal, take a break from your calcium for a few days until you’re back to normal. Another consideration when taking calcium supplements or calcium-based antacids is gas. “I’ve had several patients report cases of excessive gas using Tums or calcium carbonate-based supplements.” Andy suggests instead “trying Maalox or Mylanta for indigestion and Citracal as a supplement.” Talk with Your Doctor or Pharmacist About Your Medications If over-the-counter drugs aren’t providing the relief you need, it’s time to see your doctor. And remember, for your safety it is important to keep your doctor and pharmacist up-to-date with any medications — prescribed or over-the-counter — that you are taking.

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Everyday, Renown salutes its more than 150 active military and veterans on staff. Becca Gilbert, a Renown trauma nurse, is an example of the many outstanding service members at Renown who are serving both their country and their community. Becca Gilbert, BSN, RN, wears many uniforms. When she’s not wearing scrubs in her role as a trauma nurse in the intensive care unit of Renown Regional Medical Center, she’s wearing fatigues as a first lieutenant in the Nevada Air National Guard. “Service is huge,” says Becca Gilbert, RN, of her role in the Air Guard. “It’s something that is ingrained in me and a big part of who I am as a person. I find a lot of pride in being a part of something that is bigger than what is going on in my world.” Renown Health was named one of 15 recipients across the nation — and the only health system in the U.S. — for the Department of Defense’s highest employer award, the Secretary of Defense Employer Support Freedom Award, for exceptional support of its military employees. The Employer Support of the Guard and Reserves and Renown held a ceremony June 29 to recognize the award and to honor representatives of Renown who currently serve in the Guard and Reserves. With her Air Guard background, Gilbert is preassigned veteran patients at the Renown ICU. She says she’s able to relate to the veterans and their families and create a quick bond with them. “I’ve been assigned patients who are guard members with traumatic injuries — it’s good but hard,” Gilbert explains. “But I really love working with patients who are veterans.” Gilbert’s first career was as a veterinarian technician. Then enlisted in the Nevada Air National Guard in August 2008 — following in her father’s footsteps — and trained to serve as an EMT. While she was a medic, she went to nursing school for her second bachelor’s degree and was able to commission as an officer after graduation. Serving Our Community Gilbert says her work in the guard offers benefits that help with her job responsibilities at Renown, where she’s worked for four years. “At Renown, we are really a team and rely on each other to make sure there are good outcomes,” she says. “In the guard, officers are often put in charge, which teaches you a lot of things — organization, decision making and thinking of others. I think all of those things go hand-in-hand with my role as a nurse, especially in the ICU. People in the guard count on you as an officer and leader, and that is really important in the ICU when patients are counting on you for a positive outcome.” Gilbert’s responsibilities in the guard vary, including training for disaster relief missions and ensuring service members are fit and healthy enough to perform their jobs. “Training is a large part of the military — trauma training, physical fitness training and staying current on certifications,” she says. Locally she also leads the Self Aid Buddy Care program, a United States Air Force program that encompasses basic life support and limb-saving techniques to help wounded or injured personnel survive in medical emergencies until medical help is available. With the guard, Gilbert has also been involved in a bleeding-control program for volunteers in the community. She teaches community groups how to stop bleeding if they are a bystander to a car accident or other type of event, and is working with Renown trauma surgeon Marty Bain, M.D. to implement the program at Renown as well. Making a Difference Abroad In January, Gilbert was presented with an opportunity through the Nevada Guard State Partnership Program to travel outside the United States to the Kingdom of Tonga in the South Pacific and work at the Women and Children Crisis Centre, which assists families who are dealing with domestic violence. Gilbert praised the women who work at the center for their efforts towards change, as she says domestic violence is common in Tonga. “The women who work at the Women and Children Crisis Centre are pioneers,” she says. “They are trying to make changes by documenting what is going on and providing statistics to the lords and kings of Tonga. Some of it still isn’t accepted, but they continue to help the women and children of Tonga. They are helping so many people.” Renown Health salutes Gilbert for her tireless service to her country and her community here at home.

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