My Blog
By Dr. Steven Miller
July 07, 2019
Category: Medicine

Unused and expired medicineThe preferred method for disposal of unused or expired medicine is a medicine take back option. The medicine can be brought to a registered collection site, such as a pharmacy, which safely and securely disposes them. A list of locations is available from the U.S. Drug Enforcement Administration (DEA).

The DEA also periodically hosts National Prescription Drug Take Back Day where temporary collection sites are set up for safe disposal.

The next best option for MOST medicines is to dispose of them in the household trash. First, mix the medicines (without crushing tablets or capsules) with an unpalatable substance such as dirt, cat litter, or used coffee grounds. Then place the mixture in a container such as a zip-top or sealable plastic bag; and throw this bag in your household trash.

A small number of medicines, most notably opioids (narcotics), should NOT be thrown in the trash, because this method may still provide an opportunity for a child or pet to accidentally take the medicine.  Instead, they should be flushed down the toilet when no longer needed and a take-back option is not readily available. The U.S. Food and Drug Administration (FDA) concluded that these medicines present negligible risk to the environment.

The majority of medicines currently found in water are believed to be the result of the body’s natural routes of drug elimination (in urine or feces).

Even a fentanyl skin patch that has been worn for three days still contains enough fentanyl to harm or cause death in a child, pet, or another household member. The patch should be folded in half so that the sticky sides meet, and then flushed down the toilet.

Here are two case summaries to illustrate how some medicines can result in death if they are accidentally taken by children. A 2 year old was seen drinking an unknown liquid from a stray plastic bottle. The next day she was unresponsive with labored breathing. Urine drug screen was positive.  She was determined to be brain dead after 10 days. A 15 month old was found with a buprenorphine/naloxone film wrapper in her mouth. Many hours later she suffered cardiac arrest and died.

One final note. Before throwing out an empty pill bottle or other packaging, remember to scratch out all personal information on the prescription label to make it unreadable (by someone else who may find it).

By Dr. Steven Miller
February 04, 2019
Category: Injury

Orthopedic walking bootOrthopedic boots, also known as removable short leg walking boots, are an effective alternative to casts for various injuries and after surgery of the ankle and foot. Obvious advantages of these boots include ease of application, ability to perform range of motion exercises, and hygienic reasons.

Driving with a boot is not recommended. I have warned many patients that the boot can get entrapped by the accelerator and/or brake pedal. One such episode occurred in Canada. The driver, recovering from foot surgery, collided with a tree and suffered a serious spinal cord injury.

There are no standardized guidelines indicating when a person can resume driving after an injury or surgery. Evaluations such as the brake response time are not perfect estimators of driving ability since there are many more obstacles and distractions on a road compared with a simulation.

The Clinician’s Guide to Assessing and Counseling Older Drivers, 3rd Edition, was published with support from the National Highway Traffic Safety Administration of the U.S. Department of Transportation. (The first two editions were titled The Physician’s Guide…) The main goal of this guide is to help health care practitioners prevent motor vehicle crashes and injury.

If you have think you need a walking boot or other treatment for your foot or ankle, please call our office at (847) 675-3400 or click here.

By Skokie Foot & Ankle Specialists
January 23, 2019
Category: Pain

What is CBD“She was experimenting with CBD oil to relieve the pain from wearing high heels.” This quote from the New York Times needs explanation.

THC (tetrahydrocannabinol) is the psychoactive chemical in marijuana (cannabis) that produces the feeling of being high. Cannabis and its derivatives without THC are now legal throughout the U.S., due to the Agriculture Improvement Act of 2018.

CBD (cannabidiol) is a different but related chemical in cannabis. CBD does not produce the feeling of being high but can produce other effects.  For example, Epidiolex is a CBD medication for the treatment of seizures associated with two rare and severe forms of epilepsy. The National Institutes of Health database lists hundreds of studies involving CBD.

Proponents claim that CBD treats ailments as diverse as inflammation, pain, acne, anxiety, insomnia, and depression. Among beauty products alone, CBD can be found in blemish creams, massage oils, soaps, lip balms and body creams. CBD’s popularity is similar to the radium craze a century ago.

The U.S. Food and Drug Administration (FDA) still has two legal concerns regarding over-the-counter CBD products:

   •  Because such products have not been proven in clinical studies to be safe and effective (uniform strength and consistent delivery), they may not be marketed or promoted in the diagnosis, cure, mitigation, treatment, or prevention of disease.

   •  Federal law prohibits all active medication ingredients, including CBD, from being added to food. And CBD cannot be classified as a dietary supplement because of a technicality – its use in medication came first.

By Dr. Steven Miller
December 02, 2018
Category: Swelling

Standing deskYou'd better taking this news sitting down: Standing desks are not as beneficial to health as some thought.

Workers have hoped standing would lead to weight loss, better heart health and better productivity because they are more alert.

Studies, however, contradict that expectation and suggest only a slightly higher calorie burn rate for standing. Standing for too long also compresses the spine and can cause swelling of the ankles, which can lead to varicose veins and greater strain on the heart.

If you use a standing desk, please adhere to the following advice:
  -  Set the desk at the correct height (read the instruction manual)
  -  When you stand, don’t stand still 
  -  Use an anti-fatigue mat 
  -  Don’t stand for too long, and gradually build up your endurance

Compared to using a standing desk, walking during the day is likely to provide greater benefits with less risk.

For a painful foot or ankle, you can schedule an appointment by calling (847) 675-3400 or clicking here.

By Skokie Foot & Ankle Specialists, Ltd.
November 15, 2018
Category: Education

Doctor holding cigarettePhysicians are to be the authority on promoting and restoring health.

This trust was exploited decades ago when actors appeared in magazines dressed as doctors to promote smoking. This marketing ploy stopped when the health hazards became more widely known.

There are many laws prohibiting deceptive practices. In one instance, the United States Federal Trade Commission required pomegranate products not be advertised to treat or prevent heart disease and prostate cancer without at least one randomized, well-controlled human clinical trial. 

So what about television personalities like Dr. Oz who promote undocumented therapies? One of the loopholes is that Dr. Oz doesn't have a financial stake in the remedies he endorses.

In podiatry, many over-the-counter products give the perception to eradicate toenail fungus but have never been proven to work. Some bone implants have long-term complications. Caveat emptor.

To find out if a treatment is effective and safe, contact Dr. Steven Miller by calling (847) 675-3400.





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