Episode 165: OTC Pain Reliever Danger!

spk_0:   0:01
Hello, everybody.

spk_1:   0:01
Hello, everybody. And welcome to the show the big show that you were driving in a 45 mile our speed zone. So what? The big show? I said that already This is their three b y podcast, the most critically important. And you claimed. But I guess it is recorded in our moving vehicle. And today we're moving. Ghani's were heading east, heading towards the old homestead. After a day off, absolute frolicking.

spk_0:   0:37
I got in a bike ride and you don't do that every December day.

spk_1:   0:41
But to be fair, we we did that before I rocked my frog was going to the grocery store, walking from the parking lot to inside the store. Walking is good by myself, which recovering from a broken leg is kind of a big deal. Could I was actually walking on the leg sort of fourth help. I did have support, and, uh so, yeah, there we are.

spk_0:   1:08
And you didn't need any painkillers at all.

spk_1:   1:11
Did needy painkillers. Now, which is a big deal. You don't need to know. This is not what we're talking painkillers. A Segway sucking in ibuprofen like it's going out of style. It's over the counter, so it must be

spk_0:   1:25
safe, except for the part where it's the cause of 20% of liver transplants in the US except for that part. Yeah.

spk_1:   1:34
Wait, We're talking about how you were talking about.

spk_0:   1:38
We're talking about acetaminophen, which is

spk_1:   1:40
in effect. I'm sorry. Tylenol. Yes, Sita Min. If it You said every problem,

spk_0:   1:45
maybe I did, but I was watching traffic

spk_1:   1:47
again. Well, I guess she's driving today. I drove here, but she's better in the city. It's when I have won a boot on a foot. Not just a regular boot, but one of those broken foot boots, which takes up the sides like three pedals. So anyway, I've struggled in the city. Not that we're really in a city. You'd call it a small town, but we call it a sitting. So anyway, I'll start babbling now. A sea of benefit acetaminophen. Tylenol brand

spk_0:   2:17
Tylenol is one of the biggest causes of liver damage in the United States, not the biggest cause. There's those viruses, but still that

spk_1:   2:25
doesn't make any sense. It's a non prescription drugs so that it means it has to be safe, right?

spk_0:   2:31
It means it's safer. It either means that it's safer than drugs that are by prescription only and easier to select and use appropriately. Or they had a better lobby, depending on who you talk to.

spk_1:   2:47
This is one of the acetaminophen, and ibuprofen are very, very similar in effect, but they're quite different drugs, and they work on different pathways, even different mechanisms, so you can actually use them in rotational combination as a way to keep pain relief rolling in a person who's suffering from serious pain. Or like in my case, I was suffering from a significant pervasive swelling inside of a cast, and it was,

spk_0:   3:21
and also think,

spk_1:   3:21
frankly, excruciating at times. But what we did was we were put me on a strict rotational basis, which kept me well under the daily minimum for your average adult. For both of these drugs, which kept me from pickling my liver

spk_0:   3:40
by the Actually you were at the recommended daily maximum dosage for acetaminophen by we what we actually literally mean there is. His surgeon said, what was appropriate, and I helped implement that, and salty decided when he needed pain relief and when he did not, and we kind of worked together is a three person team in that way

spk_1:   4:08
right now, One of the first things that we're gonna go back Thio when I first had my entry. Because it's not that this is not all about me, of course, is all about me. Because everything's all about me and nothing else matters. Because mi mi mi mi mi mi may right.

spk_0:   4:23
We'll go with that for the moment. Go right ahead.

spk_1:   4:25
Okay. I was originally diagnosed with a broken, uh, tibia a couple months ago, and they sent me home from the hospital with some nuclear drugs. Or coz basically what it is, It's, um, Oxy cotton, with the additional agrees ingredient of acetaminophen. Oh, no. Was it might be broken. Acetaminophen. It was. Okay. Well, it had the over the counter type at a moderate dosage. So you get both of both of the effects. Okay, Well,

spk_0:   5:17
because the very effective combination there are several prescription medications that do this and bundle, including the incredibly popular oxycodone.

spk_1:   5:29
Yeah. Sounds like you could use him. She just had to have a big coughing fit, like we sometimes do. When we start talking on a podcast, there's nothing with podcast. Makes you wanna cough? So yeah, these air, the combination drugs and but one of things we had to we had to start paying attention to this of just giving me a standard stand alone narcotic. They gave me one of these combinations, and you have to count in the over the counter pain reliever part of the combination in the daily total. So you don't fry your liver. Okay, so there's that. And then because I'm a big guy, they were absolutely convinced I have sleep apnea, which I don't

spk_0:   6:26
he doesn't

spk_1:   6:27
never have. And I'm just a big fella and I but I've never had sleep apnea Monitor has sleeping problems like that at all. But apparently it's a new thing in the anti of the anesthesiologists have really

spk_0:   6:49
in the cover your assets department.

spk_1:   6:51
Yeah. They really started covering their own personal assets and not allowing prescription

spk_0:   7:00
your counter

spk_1:   7:00
narcotics. Two people who they suspect need to have a sleep apnea test without first getting the test done

spk_0:   7:08
and lefts. They are going to stand the hospital under observation overnight. And the surgery didn't otherwise require that. So

spk_1:   7:14
which I had no intent

spk_0:   7:16
five or $8000 that we just kind of didn't want to drop on that,

spk_1:   7:21
right? So long story short, they gave me a spinal block.

spk_0:   7:28
Andr. Bloch

spk_1:   7:28
under block, Hamner blag spinal. But it was a nerve block which did absolutely nothing or did such a limited job anyway. Sometimes they work. Sometimes they don't. Well, this one did so like a bitter or anything, but it was kind of uncomfortable. The game is this. And then I had to sign off on the fact that I would not take narcotics before bedtime, especially that first night when I was coming off the anesthesia. So I didn't take these. My leg. My ankle was in a cast. It was in this horrible, terrible cast and there was no way to ice it. So anyway, I struggled through. So getting coming up with the rotation of the maximum amount of anti swelling pain relief over the counter medications was a big deal,

spk_0:   8:33
and what his surgeon recommended was a total of four grams of acetaminophen a day divided up into four doses, so each was every six hours. But every three hours he could also have 600 milligrams of ibuprofen. So there was no point time when he was really low on every painkilling end, anti inflammatory drugs. He was taking a different one three hours on three hours off. So everything was it a safe dose. But since they work on different pathways, you could have both acting at the same time.

spk_1:   9:10
That rotation is kind of a kind of a really nice deal, especially if you convey vary it a little bit. You can vary your timing, too. If you're feeling pretty good, you can take a a longer release version, just the tablet version, or if you're starting to be in a whole lot of pain. Now, this is assuming you have everything on hand. You can go with the Joe version or even the acetaminophen. They make a liquid version of it, and so that you know that takes 30 minutes off of the pain relief. Wait time

spk_0:   9:42
I play a full contact sport, in which case injuries sometimes happen. And the word there from one of my teammates, who is a registered nurse is that it's common in cases of acute pain to give both the ibuprofen dose and the acetaminophen does at the same time. And that's considered safe. The idea is you'll be icing it or doing something else for pain control by the time the concentrations of those things drop. So you don't have that desert of no relief before the next dose is conceivably be taken,

spk_1:   10:16
and we've seen a lot of broken bottles in that sport. So yeah, it's a very common thing now. Why we're bringing this up is I think it was a lot of people they like to think. Okay, I took this money and I'm still hurting is 10 minutes later I still hurt is better, so I'll take a couple more of these acetaminophen. It's

spk_0:   10:48
people assume since they're over the counter, they don't have to worry so much about safety. Yeah, and they'll come up with justifications for themselves like, Well, you know, this is the average dose, but I'm a bigger than average person, so I'll take more or they built in a safety margin. Not I'm really hurting, so I'll take more. But a lot of people really poison themselves with acetaminophen, and there's one more thing that really bites people with acetaminophen. Is those combination drugs because, for example, I had not known that the Norco had acetaminophen on it. I knew AQSIQ. Odo did, but he didn't have Oxy code. And he had Norco,

spk_1:   11:26
right? So I looked it up on the on the Internet. And, of course, the first thing they told me. I looked it up on. I went on WebMD and looked it up. If you're taking this, you're going to be dead within 24 hours because everything is going to

spk_0:   11:39
give ibuprofen cancer.

spk_1:   11:41
Everything is going to kill you on WebMD. You're just dead. You open it, you click on the website. You're gone.

spk_0:   11:48
This is the site I try and keep salty away from. Be honest with you. It's not the best of the places out there for information anyway. Mayo Clinic. Much better, for example. But

spk_1:   12:00
I like it personally. Like live strong.

spk_0:   12:03
Strong is nice. T o do a good job. I've got a more professional background. I like Mayo Clinic better, but I got nothing against live strong. They're generally reliable. So that's a deal. Is that if you don't check on these things, you don't know. They've got a seat, him in enough acetaminophen in them. And there's a lot of company medications pop quiz. Salty. Do you happen to know any of the other comin over the counter medications, but also have acetaminophen of them?

spk_1:   12:37
Um, I am sure of several, and I'm gonna guess here, I'm sure. So I'm gassing here. Yeah, you noticed that. I'm guessing that a lot of the, um a lot of the Sinus multi drugs dio like the pain relieving Sinus decongestant.

spk_0:   13:04
Some do some don't

spk_1:   13:06
a lot of them do

spk_0:   13:06
Day Coyle A NyQuil do Excedrin does, uh, you know who else was on the list? Suit A Fed does. There's a bunch of others. I just didn't memorize them

spk_1:   13:20
all. I know that some of these nighttime PM so you can sleep once have it in there, too.

spk_0:   13:27
Yeah. Pain Relief PM Formulas are often a cinnamon with acetaminophen with diphenhydramine, which is an anti histamine. It's the one that song's people. It makes me sleepy. And

spk_1:   13:40
I would suspect that another one ah, might be combo for like, um, arthritis. I know

spk_0:   13:53
Excedrin is often used for arthritis, and that's one of them.

spk_1:   13:59
So yeah, you really kind of need to look at the drugs you're taking. It's exactly what's in them.

spk_0:   14:03
Just by seeing that cold and allergy relief medicine, you don't necessarily trigger that. Hey, maybe this has acetaminophen. So you take that stuff for your your cough and stuffy head, and then you take something else for your headache, and that's acetaminophen. And now you've overdosed. Congratulations.

spk_1:   14:20
And sometimes you use, uh, drugs that you don't even realize you're using. I know this Benadryl. Are they? What was been a Joel? What is that stuff?

spk_0:   14:33
I don't re a Benadryl is the diphenhydramine. Thank you.

spk_1:   14:38
Dive in hydra Mean isn't so much stuff that you wouldn't realize and you could end up with way too much time on hydra mean in your system if you take it. Because that's one of the other

spk_0:   14:47
cold remedies. And it's also in sweep EDS And it's also an anti itch medications.

spk_1:   14:54
Yes, they really help speed for itching, but it knocks me out. I'm like that. I take one of those

spk_0:   15:01
That is, by the way, another approach that sometimes works for over the counter pain relief. We use that sometimes when the thing is just so painful that it's hard to sleep. Kid, take a diphenhydramine, too. That would knock him out it was probably hurting, but I was sleeping through it, so But

spk_1:   15:22
I was end up with really weird dreams that way.

spk_0:   15:25
Yeah, it's kind of like having hot flashes when you're asleep and you wake up dreaming that you're trapped in a burning building.

spk_1:   15:31
Yeah, I was actually that I was I had a whole bunch of dreams where my leg, which wasn't The cast was caught in like an animal trap. I couldn't get away. It was just really made subconscious telling me that. Well, my leg swelling in this cast and it really hurts.

spk_0:   15:49
I just tried to move my leg and it wouldn't. So we wanted to do this podcast version of an article I just wrote here this morning to help raise awareness of over the counter does not mean safe, necessarily. You still got to be careful about what you're taking and what it interferes with and everything else. For example, the other ibuprofen and things like that make you believe more. They inhibit coagulation. And so it's enhances bleeding salty. Got a tiny little scrape on his arm when he was wandering around in the rial wheelchair. I didn't know why he was just bleeding like a complete stuck pig just kept flowing from this ridiculous tiny little wound. And that evening, he was telling I don't know why it bled like that. And I'm like,

spk_1:   16:50
Well, I

spk_0:   16:51
do. I'm giving you an X amount of aspirin every day, and you're taking ibuprofen on top of that. All of the doctor's recommendation

spk_1:   16:59
and this wound, but we're talking about scratched the surface of the skin took off a couple of years of skin, just enough to make it bleed. You're talking to something that's about the third of the size of my pinky nail. I mean, it's really small, shallow, shallow, just a few layers of skin. And it just was like bleeding like I cut an artery.

spk_0:   17:22
No, it's courts when you pull it, cut an artery.

spk_1:   17:24
It was almost courting. You saw them the amount of blood on that bandage.

spk_0:   17:31
I I saw the amount of blood have seen cut arteries and no scrapes. Hated it.

spk_1:   17:39
Maybe not a cutter.

spk_0:   17:40
You wouldn't have to clean it off the ceiling. It wasn't an artery.

spk_1:   17:43
That was the frustrating part of pleading on. It didn't even hurt, but it was bleeding all over everywhere. Not that I really wanted it to her, but

spk_0:   17:51
But that's something you ought to know if you're taking that over the counter medication,

spk_1:   17:54
right? Especially like he had me on four baby accidental calling about anywhere because they were baby aspirin, headman of these four baby aspirin. And, you know, in addition to acetaminophen, ibuprofen, You know, that's a lot of anti bleeding.

spk_0:   18:10
Acetaminophen doesn't have that action, but I'd be Prophet does.

spk_1:   18:13
Okay, Well, ibuprofen two, my limit. And for baby aspirin, im a bleed.

spk_0:   18:21
He was pretty anti coagulated.

spk_1:   18:24
I was pretty anti sea and tickle. What a word that is anti.

spk_0:   18:28
Yes. Scientists do make up these words cause Really, where do we have another one that fits that job? E get accused of making up words. And yes, we do that

spk_1:   18:39
she once the wee comes out way for our eyes to start rolling way, make up this and we make up that

spk_0:   18:54
I made up that one. So there you go.

spk_1:   18:57
We may have made a scientific fact up, were discovered it. Let's just be nice way have discovered that size fact 200 years before we were born, but we discovered it

spk_0:   19:11
That's right. All right, just pay attention to the over the counter stuff

spk_1:   19:18
that you want to go with it. I guess we can go

spk_0:   19:21
e. The secondary message here is is that's not the only health provider I've heard that story from. I myself am not a physician and do not make recommendations. But that is not the first health provider. I have heard that advice from Tau alternate the ibuprofen based and the acetaminophen based so that each one is kept within the standard dozing requirements. But they're staggered by half a dose each to get continuous pain and anti inflammatory relief. That is a common approach and probably one of the most effective ways to deal with pain it with over the counter medications. So I want to know what you know.

spk_1:   20:03
And tertiary point we want to make your is. You can argue with your wife about everything, but we've been married for 31 years that we argued over everything off 31 years. Sometimes you just have to say, OK, what ends? What ever's honey, I mean really seriously What? Mm. All right, All right. Sure. Whatevs structure Later