Ringing in the New Year is an exciting event. “Out with the old, and in with the new,” people say. It’s a time to throw off bad habits and take on better, healthier ones that will precipitate true change. You can take this same adage and apply it to many aspects of your health such as your medicine cabinet. The New Year may be a perfect time to go through all those old medications and throw out the expired vitamins, aspirin, prescription and over-the-counter medications.

While it is easy to tell when food has gone bad in your refrigerator, it is not as easy to determine whether you medication and vitamins are due for replacement. Drug expiration dates exist on most medication labels, including prescription, over-the-counter (OTC) and dietary (herbal) supplements. But can medications be taken past their expiration date?

What does expiration date mean?
The expiration date on a medication is the final day that the manufacturer guarantees the full potency and safety of a medication. Since 1979, U.S. pharmaceutical manufacturers are required to post expiration dates on prescription products prior to marketing. For legal and liability reasons, drug companies will not make recommendations about the potency of drugs past the original expiration date. Taking medication past the expiration date may not do you any harm, but it may not be as effective after the date has passed. For some medications, you may see the expiration date as a “best used by” date.

Pills and solid forms of medication
In 2001, the American Medical Association (AMA) concluded that the actual shelf life of some medications extends past the expiration date. A study called the Shelf Life Extension Program (SLEP) found that 88 percent of 122 drug products were still potent past their expiration date for an average of 66 months. That is five and a half years! Solid dosage forms, such as tablets and capsules, appear to be most stable past their expiration date (compared to liquid medication).

Antibiotics
Some medications, such as antibiotics, however, should be consumed within the specified number of days on the label. You may be tempted to keep those extra few antibiotic pills or additional milliliters in the bottle, but you shouldn’t, and this is why: if the antibiotic has lost its potency, you are putting yourself at risk. The bacteria that caused the infection will continue to spread, and it could likely develop an antibiotic-resistant strain. Using expired medication could have very dire consequences when it comes to serious infections.

Liquid drugs
Drugs in liquid form such as Epi-Pen auto-injectors should not be used after the expiration date because epinephrine can lose its potency. Anaphylaxis can be a life-and-death situation, so discard Epi-Pens that have passed their expiration date. Ophthalmic eye drops for conditions such as pink eye should be discarded after the expiration date because eye drops often contain preservatives. These preservatives break down over time and may allow bacterial growth that could result in eye damage.
Insulin, oral nitroglycerin, and other liquid vaccines should be discarded after the expiration date. If the liquid has become cloudy, powdery, crusty, or has a strong smell (even if the expiration date has not passed), throw it out. You can always take your medication to your local pharmacist if you are unsure of its potency.

Proton Pump Inhibitors
Proton pump inhibitors (PPIs) are the most commonly prescribed class of medication for the treatment of heartburn and acid-related disorders. PPIs reduce the amount of acid in your stomach by blocking its acid-producing glands. Reduced acid production gives damaged esophageal tissue time to heal, and cures most cases of esophagitis.

If you are taking PPIs, make sure you are using them as directed on the Drug Facts label. PPIs should only be used as directed for 14 days for the treatment of frequent heartburn. Studies show that long-term usage of PPIs can have some very dangerous side effects. Beyond the common side effects of prolonged PPI use, such as headaches, nausea, diarrhea, abdominal pain, and bloating, you can experience vitamin deficiency, poor absorption of nutrients, hypocalcemia, pneumonia, and increased risk of dementia. If you take PPIs, you should only take a 14-day treatment before visiting your doctor. If you have been taking PPIs, toss out those over-the-counter pills and make an appointment with your doctor.

Make a fresh start this New Year by tossing out old medication and replenishing your medicine cabinet. If you have some medications that are expensive to replace but you are unsure of its potency, talk to your doctor or pharmacist so you can make an informed decision. For all other medications, use your best judgement. If in doubt, don’t take any risks. Your health and well-being is worth a new bottle of medication, vitamins or supplements.

As the third-leading cause of cancer death among men and women in the United States, colon cancer is a prevalent disease that affects 1 in 20 Americans. It is estimated that about 134,490 people will be diagnosed with colon cancer or rectal cancer this year, and 49,190 people will die of the disease in 2016.

Role of family history
Family history is one of many colon cancer risk factors you cannot change. If you have a first-degree relative such as a parent, sibling or child who has colon cancer, you are at increased risk for developing the disease. Your risk is even higher if the relative was younger than 45 at diagnosis or if you have multiple relatives with colon cancer. Having a family history of colon cancer can be linked to genetics, shared environmental factors or both, but it is estimated that as many as 1 in 5 people who develop colon cancer have another family member who is affected as well.

Inherited syndromes
Between 5 and 10 percent of people who develop colon cancer have inherited gene defects that can potentially cause family cancer syndromes which lead to colon cancer. There are two common inherited syndromes:

• Familial adenomatous polyposis (FAP), which is initiated by a mutation in the APC gene that a person inherits from a parent. In the most common type of FAP, hundreds of polyps develop in the colon and rectum before early adulthood. By the age of 40, almost every affected person develops colon cancer if the colon is not removed to prevent it. FAP accounts for about 1 percent of all colon cancers.
• Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC) increases the risk for polyps (although not nearly as severe as FAP) and accounts for about 2 to 4 percent of all colon cancers. Caused by an inherited abnormality in the MLH1 or MLH2 gene, Lynch syndrome increases the risk for colon cancer by as high as 80 percent. Lynch syndrome is also linked to other cancers of the stomach, small intestine, pancreas, kidney, brain, ureters (tubes that carry urine from the kidneys to the bladder), and bile duct.

The need for earlier screening
It is easy to see that colon cancers, especially those that are linked to Lynch syndrome and FAP, are time-intensive to treat. If you have a family history of polyps or colon cancer, you should be screened before the age of 50, and you need to be screened much more often than someone who is only at average risk for colon cancer. How soon should you be screened? If you have a first-degree relative (or relatives) with colon cancer, subtract 10 years from the age your relative was at diagnosis, and that is the age you should begin screening. After receiving the results of your screening, your doctor will advise you on a timeline for your next screening.

The expense of colon cancer
Colon cancer is much easier and less expensive to treat when it is in the early stages. For individuals who are at average risk for colon cancer, the disease is largely preventable by staying up-to-date with screening colonoscopies. The U.S. Preventative Services Task Force recommends that adults who are at average risk for colon cancer get a colon screening beginning at age 50 and continuing until age 75.

Having a family history of colon cancer can make surveillance more costly because you need to visit your primary care physician and gastroenterologist more often. Being at higher risk for colon cancer does not mean that you will develop colon cancer, but it does mean that you need to focus on prevention. A colonoscopy is one of the more expensive preventative services covered under the Affordable Care Act, but it is the best screening available for colon cancer.

It is understandable that you may be concerned about unexpected medical expenses, but preventative care is always less expensive than chronic disease treatment. According to Fight Colorectal Cancer, the estimated annual national expenditure for colorectal cancer treatment is $14 billion, and inpatient hospital care accounts for 80 percent of this cost. This statistic is proof that prevention is always easier on your pocketbook. Unfortunately, the fear of unexpected cost-sharing deters patients from getting screened earlier when treatment is more affordable. Staying current with visits to your primary care physician and gastroenterologist is the best way reduce medical costs and offer early detection and treatment for colon cancer.

Colonoscopy is best
Although the U.S. Preventative Task Force recommendations for colon screening include fecal occult blood testing, flexible sigmoidoscopy and colonoscopy, the colonoscopy is the gold standard for colon screening because of its unique therapeutic and preventative properties. During a colonoscopy, precancerous polyps can be removed so that they will not have the opportunity to progress to cancer. This offers the best defense against colon cancer, whether or not the disease runs in your family.

If you have a family history of adenomatous polyps or colon cancer, talk with your doctor about the possible need to begin screening before age 50. It is also important to tell your close relatives so that they can pass along that information to their doctors and start screening at the right age. Finally, make sure that you have a primary care physician and GI specialist with whom you feel comfortable and schedule regular visits to ensure that you are getting the care your condition requires. Prevention is always better than treatment, so give yourself the gift of quality care and good colon health.

Do you need a little motivation to stay on track with your New Year’s weight loss goals? Healthy Weight Week is January 16-20! This nationwide public health and awareness campaign highlights the importance of healthy changes that can lead to long-term weight loss.

Diet and exercise are the two main components for weight loss, but sometimes they just aren’t enough. If you have a significant amount of weight to lose and have been unsuccessful with diet, exercise and medications, it may be time to consider bariatric surgery.

Bariatric surgery is a safe and effective weight loss procedure for those affected by severe obesity. This type of surgery promotes weight loss by making changes to the digestive system. Some types of bariatric surgery decrease the overall size of the stomach to limit caloric intake and help you feel fuller faster. Other types make changes to the small intestine where calories and nutrients are absorbed. Most weight loss surgeries are performed using minimally invasive techniques which increase safety and reduce recovery time.

Not everyone is a candidate for bariatric surgery, so it is important to talk to your doctor if you are considering this route (Source: American Society for Metabolic and Bariatric Surgery). Common criteria for weight loss surgery include:

• A body mass index (BMI) of 40 or higher or be 100 pounds overweight
• A BMI of 35 or higher and have at least two obesity-related comorbidities such as hypertension, sleep apnea, type 2 diabetes, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease
• Inability to achieve long-term weight loss with traditional methods such as lifestyle modifications and exercise

Weight loss is the most obvious benefit of bariatric surgery, but many patients experience other health benefits as well (Source: National Institute of Diabetes and Digestive and Kidney Diseases). After surgery, patients may see improvement in obesity-related health issues such as:

• type 2 diabetes
• hypertension (high blood pressure)
• unhealthy cholesterol levels
• sleep apnea
• urinary incontinence
• body aches
• joint pain in the hips and knees

Bariatric surgery can produce amazing results, but long-term success depends largely upon your commitment to healthy lifestyle changes. Following a well-balanced diet and committing to an exercise routine is crucial to achieving optimum results. For more information on how bariatric surgery can benefit you, schedule an appointment with your doctor today!

When you’re looking for a new doctor, what criteria go into making your decision? You probably start by checking your insurance for an in-network provider. Next, you might narrow down the list by location, office hours, convenience of scheduling, and personal recommendations. All of these are great items to consider, and they should play a role in your decision. But when it comes to choosing a qualified gastroenterologist to perform your colonoscopy, there’s one item that matters most: adenoma detection rate.

Adenoma detection rate, or ADR, is a numeric value that represents the percentage of times your gastroenterologist detects a precancerous polyp during screening colonoscopies. This number is considered a benchmark of quality and care, as it indicates how thorough your doctor will be during your examination.

Although gastroenterologists undergo the most extensive training in performing colonoscopies, their rates of polyp detection can vary significantly. When interviewing gastroenterologists to perform your procedure, look for a physician with an ADR of at least 25 percent in men and 15 percent in women. The higher the ADR, the better. Research shows that for every 1 percent increase in a physician’s ADR, your risk of developing colon cancer over the next year decreases by 3 percent.

You may feel a little uneasy asking your potential doctor about providing an ADR, but rest assured that this is a reasonable request. Qualified gastroenterologists take pride in their hard-earned ADRs, and they will be happy to share this information with you. You should also inquire about your physician’s average withdrawal time, which is the amount of time it takes to remove the scope from the colon. You want a gastroenterologist with an average withdrawal time of at least six minutes.

Finding the right gastroenterologist may require a bit of courage and assertiveness, but it is well worth the effort. Make a list of questions to ask when interviewing potential physicians, and be sure include ADR and average withdrawal time. A high-quality physician is the key to a thorough examination and a future without colon cancer.