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How to Prepare your Medicine Cabinet for Winter

How to Prepare your medicine cabinet for winter

Winter months bring the cold and flu season. Spending more time indoors and with more people at multiple holiday gatherings increases the risk of illness. How should you prepare your medicine cabinet for the winter months? Here are some winter medicine cabinet essentials.

Disclaimer: This post may contain affiliate links. I earn commission at no additional cost to you.

Start by disposing of expired medications

Go through your current stock of medications. Keep anything that is still in date, dispose of any expired medications responsibly.

Where should you dispose of expired medications?

Take your medications to a local take back program.

If a local take back program is not available then check to see if your medication is on the FDA flush list. Flush list items can be flushed down the toilet. If not, then follow the instructions on the FDA website for proper home disposal.

Winter Health Concerns:

Note: Not all of these concerns can be treated at home.

  • Viral illness is more common in winter months
  • Viral respiratory infections: Cold, Flu, RSV, COVID-19
  • Viral Gastroenteritis, commonly known as the “stomach flu”
  • Heartburn from over eating at Holiday parties
  • Chapped lips
  • Dry cracked skin
  • Slip and fall injuries
  • Frostbite
  • Seasonal affective disorder
  • Over exertion from snow shoveling
  • Vitamin D deficiency due to lack of sunlight

Why should you stock your medicine cabinet for Winter?

The main focus of this post is to prepare your medicine cabinet with winter essentials you may need in the middle of the night, on a holiday or a holiday weekend. Think of it like an insurance policy for not having to run out to buy something you might need. It might expire before you need it, but if you need it, you will be very happy to have planned ahead. Be prepared!

Note: Always keep medications in the original container and always read and follow all of the packaging safety and dosing information before taking.

Winter Medicine Cabinet Essentials:

Disclaimer: If you have any health conditions, are pregnant or breast feeding, have allergies or are taking any medications always check with your doctor or pharmacist before taking any of the over-the-counter medications listed.

Pain and Fever

  • Pain reliever and fever reducer medication: Acetaminophen (Tylenol) or Ibuprofen (Motrin). Always read the package directions and warnings.
  • Thermometer: Check out this link for selecting a home thermometer.
  • Batteries for your thermometer. Winter is a good time to check your batteries and obtain a spare if needed.
Which Thermometer is best for your home?

Nasal Congestion

  • Extra soft tissues
  • Oral nasal decongestant: Pseudoephedrine (Sudafed) is the only effective oral nasal decongestant available. In most states, you must obtain it from a pharmacist, but no prescription is required. It is nice to have a small amount on hand just incase you need it, since it can’t be obtained everywhere and you never know when those symptoms will start. Always read the package directions and warnings.
  • Nasal decongestant: Oxymetazoline (Afrin) -Use is limited to three days. I always keep an Afrin nasal spray on hand for each family member over the age of six. It is hands down the best nasal decongestant! Always read the package directions and warnings.
  • Nasal Suction device for babies – A Nose Frida is an awesome device for suctioning nasal congestion from babies unable to blow their own nose.

Cough

Cough is not usually the first symptom of a viral infection. You could wait to purchase a cough medicine until you end up having a cold. Hydration is the best first line treatment for cough especially for kids. Check out this link for some hydration tips.

  • Cough Suppressant: Dextromethorphan (Delsym) is an option for adults and teens. It is not recommended for kids. This medication cannot be purchased online and it is not universally available. Having a small stock on hand is not a bad idea, if you do not have any health conditions that prevent you from taking it. Always read the package directions and warnings.
  • Steamer: I prefer the warm mist humidifier for adults and teens because it is easier to keep clean. Kids can get burned by the warm mist so it is best to choose a cool mist humidifier for young children. A steamer is a great item to have on hand for the winter months.
  • Menthol Cough drops: A helpful and inexpensive item to keep on hand for help treating cough in adults and teens.

Sore Throat

Many people do not realize that mild sore throat pain can be treated with oral pain relievers like Tylenol or Motrin. Other options for sore throat include lozenges, sprays or warm or cold beverages.

If your sore throat worsens or does not improve after a few days, you may need to see a doctor.

Nausea and Vomiting

The best treatment for nausea and vomiting is avoiding dehydration by staying as hydrated as possible. There are not many options for treating nausea and vomiting over the counter. There is a product called Emetrol, but it is basically just sugar water. I usually just use cola or ginger ale.

The best thing to keep in your medicine cabinet for occasional vomiting are Pedialyte packets or liquid IV. These will help you rehydrate.

Heartburn

Occasional heartburn can be treated quickly with Tums or Gaviscon. If heartburn persists, it would be a good idea to talk to your doctor about it.

Diarrhea

The number one thing you will not want to have to leave the house for in the middle of the night is diarrhea relief! I always keep a small package of Imodium A-D in my medicine cabinet. It is usually good for a couple of years, if I don’t use it, I replace it. It’s a small price to pay to have the medication needed if anyone in my family ends up needing it. If you have diarrhea be sure to stay hydrated! Pedialyte packets or liquid IV will help you rehydrate. Always read the package directions and warnings.

Shopping List for Winter Medicine Cabinet

Note: Always keep medications in the original container and always read and follow all of the packaging safety and dosing information before taking. This list contains affiliate links.

Disclaimer: If you have any health conditions, are pregnant or breast feeding, have allergies or are taking any medications always check with your doctor or pharmacist before taking any of the over-the-counter medications listed.

Five Sneaky Tricks to Increase Your Hydration

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Which Thermometer is best for your home?

Which thermometer is best for your child

Whether you are expecting your first child or getting ready to send one off to college, it is important to have a home thermometer. A thermometer is the most basic health screening device you can have to determine if you or your child needs to see a doctor. What is the best thermometer for home use? Here are some tips from a pharmacist on how to choose the right thermometer for your home.

Disclaimer: This post may contain affiliate links. I earn commission at no additional cost to you.

Disclaimer: This article is intended to help you choose the right thermometer for home use, the intent is not to help you determine if your family member has a fever that needs medical attention. If you are looking for that information I’d recommend this site.

What are the different types of thermometers?

  • Digital temporal thermometer – These are available in contact and contactless.
  • Digital tympanic thermometer – Require some skill, but can be used in anyone over 6 months old.
  • Digital multi-use thermometer – Can be used for all ages, the rectal route is most accurate for infants. Can be used orally, rectally, or under the arm.
  • Mercury thermometer – Should be disposed of due to toxicity. For safe disposal check out this site.
  • Pacifier thermometer – Not recommended due to low accuracy.
  • Forehead strip thermometer – This is the type often found in first aid kits. Decent for screening, but also not recommended due to low accuracy.

Which thermometer is most accurate?

The digital rectal thermometer is most accurate for infants and toddlers.

A digital oral thermometer and the digital tympanic thermometer are also accurate if used properly. The digital oral thermometer must be kept under the tongue inside a closed mouth until it beeps. This is why itis not recommended for younger children who may not keep it under their tongue and may not be able to follow directions to keep their mouth closed.

The digital temporal thermometer is considered an acceptable alternative for screening for fever. Some studies have shown that it could be off by 1 degree F.

Which thermometer is best for home use?

Digital Temporal thermometer

The Digital temporal thermometer is recommended for all ages.

Pros:

  • Easy to use – always follow manufacturer specific instructions for where to point it and how far away from the forehead you should hold it.
  • Non-invasive – Some models even have a quiet mode, so you can use it while your child is sleeping.
  • Other uses – You can use some models to measure the temperature of bath water and food.

Cons:

  • May not be as accurate as the rectal, tympanic or oral route depending on the age of the child. It is still a great screening tool. You could always repeat with another more accurate method.
  • Outside weather conditions can affect the reading, so you should wait at least 15 minutes after being outside in hot or cold conditions before taking a temperature.
  • Anything on the forehead, including sweat can affect the reading.
  • Cost – Although the price has come down quite a bit, these thermometers are more expensive than the digital multi-use thermometers.
  • User error – Make sure you follow the manufacturer specific instructions.

Digital Tympanic thermometer

The Digital tympanic thermometer is recommended for anyone over 6 months of age.

Pros:

  • More accurate than a temporal thermometer if used properly
  • Recommended in infants as young as 6 months
  • Less invasive than a rectal thermometer

Cons:

  • Cost – This is the most expensive digital thermometer.
  • Requires a disposable plastic probe cover for each use.
  • Ear wax can interfere with the reading.
  • Outside weather conditions can affect the reading, so you should wait at least 15 minutes after being outside in hot or cold conditions before taking a temperature.
  • Not recommended for babies under 6 months old.
  • User error is possible. Make sure to read the instructions that come with thermometer.

Digital Multi-Use Thermometer

The Digital multi-use thermometer is recommended for all ages depending on route.

Pros:

  • Cost: It is the least expensive option.
  • Can be used orally, rectally or under the arm (axillary).
  • It is the most accurate option for infants when used rectally. If you have an infant it is best to purchase one with a short probe to prevent over insertion.

Cons:

  • Although inexpensive, you may need to purchase two if you plan to use one rectally. You should not use the same thermometer rectally and orally. If you use the thermometer rectally, it should remain a rectal use only thermometer. Label it, “for rectal use only”.
  • The oral route is only accurate over age 4.
  • You could get an inaccurate reading orally if the person is so congested they have to breath through their mouth. The mouth must remain closed.
  • You should wait at least 15 minutes after consuming hot or cold beverages before taking an oral temperature.
  • The axillary route is not as accurate.
  • The rectal route requires a lubricant such as petroleum jelly

What thermometer is best based on age of family members?

Birth to 6 months: A digital rectal thermometer. The rectal route is the most accurate in this age group. This thermometer has a stopper to ensure you will not insert it too deep. A Digital temporal thermometer is reasonable to use for screening in this age group. It is less accurate, but it is great for determining if you should take a rectal temperature. Some models can also be used to help parents measure safe food and bath water temperatures.

6 months to 3 years: A digital rectal thermometer. The rectal route is the most accurate in this age group. The second most accurate thermometer in this age group is the Digital tympanic thermometer. A Digital temporal thermometer is reasonable to use for screening in this age group.

Kids 4 and up: A Digital multi-use thermometer is really all you need if everyone in your family is over four years old. It would be nice to have an alternative for the younger children, since they may not be able to keep their mouth closed for an accurate reading if they are really congested. The Digital tympanic thermometer, is the next most accurate for this age group. A Digital temporal thermometer is reasonable to use for screening in this age group.

Adults: A Digital multi-use thermometer is really all you need if everyone in your family is an adult. Therefore, it is a great one to get when your teen leaves for college.

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Colonoscopy Prep Tips: Easy and Comfortable

Fancy Clear Liquid dinner
Apple Juice, Beef Consommé and Lemon Jell-O, a fancy clear liquid dinner.

Congratulations for choosing to get the only cancer screening exam that is actually preventative! Here you will learn some tips and tricks from a pharmacist, who has been through it. I hope to help you make your colonoscopy prep as easy and comfortable as possible. This information is not intended to replace your doctors instructions. These colonoscopy prep tips are merely a supplement to your doctor’s instructions. If we differ in any way, please follow your doctor’s instructions first.

Disclaimer: This post may contain affiliate links. I earn commission at no additional cost to you. Always follow your doctor’s advice first. This information is intended to be a helpful supplement.

Colonoscopy Prep Timeline

This post contains valuable colonoscopy prep timeline tips for all of the following colonoscopy prep steps:

  • Make your colonoscopy appointment
  • Choose your prep
  • Pick up your prep
  • Read you doctor’s instructions
  • Pick up other needed items
  • Find out what to do about your current medications
  • Eat a low fiber diet
  • Transition to a liquid diet
  • Transition to a clear liquid diet
  • Confirm appointment time and prep instructions
  • Start your prep
  • Go to your appointment
  • Post colonoscopy tips

Tips for making your colonoscopy appointment

Things to consider before making you appointment:

Who will drive you to your appointment?

You will need to have a driver for your appointment. Make sure you have both your schedule and your driver’s schedule available when you make your appointment. You will need to start your prep the night before your appointment, so make sure you do not have any plans for the evening before your appointment. After your appointment you will not be able to stay home alone, so make sure you have someone available to stay with you after your test. You should be able to return to work the following day, as long as your doctor says you are able to.

Insurance coverage

Before you make your appointment you should check with your health insurance company to find out where your should go for your test. Also, ask which prep they will cover. There are multiple preps available, best to find out which one is covered by your insurance before you make the appointment. When you make the appointment you may be offered more than one prep option. Be prepared!

Timing of your appointment

Colonoscopy appointment timing tips based on when you have to start your prep.

You will likely have to start your prep 4 hours before you appointment time. If you schedule an early morning appointment, you will have to wake up 4 hours before that time to begin your prep. Keep that in mind when choosing a time.

You will be on a clear liquid diet on the day of your appointment. If you choose an afternoon appointment you will be able to sleep in, but you will be very hungry. Keep this in mind when choosing a time. I think the best time for a colonoscopy appointment is between 10:00 and 12:00. That way you wake up between 6:00 and 8:00, and you will only be on the clear liquid diet in the morning.

Choose your prep

This decision is ultimately made by your doctor, although your doctor may give you some options. Here are some things to consider if you are given an option:

Cost of the prep

If cost is a concern, contact your insurance provider to determine which prep they will cover. There is a very big difference in cost of the available preps.

Volume and flavor of the prep

Four common colonoscopy preps:

NOTE: Follow the directions provided by your doctor. These directions are just sample directions to give you an idea of what to expect. The goal here is to help you make a decision about the prep you want to try.

Gatorade (not red or purple)+ MiraLAX prep

MiraLAX generic
MiraLAX generic

This prep is very tasty. Patients love it. If you like Gatorade the prep will be tasty. This prep may not be allowed by your doctor. It also may not be covered by insurance since MiraLAX is over-the-counter. It is not very expensive so that may not be a concern. Find the MiraLAX generic here. You will likely be required to consume 32 ounces of the prep (MiraLAX mixed with Gatorade) followed by 32 ounces of any clear liquid. This will be repeated again in the morning.

GoLytely or GaviLye-G

GaviLyte-G
GaviLyte-G

This is the least expensive option because it is most likely to be covered in full by your insurance. It will require you to consume 4 liters (~1 gallon of gross tasting liquid) likely in two 2 liter servings. You may also have to follow this with more clear liquid of your choice. Don’t worry, I have some tips to help. Remember, it’s worth it for your health.

Suprep

SuPrep Generic
SuPrep Generic

This prep requires a reduced volume of gross tasting liquid when compared to the GoLytely. You will be required to consume 16 ounces of the prep, followed by 32 ounces of water. This process will be repeated in the morning. This prep is covered by most insurance companies, if not covered by yours you can use this coupon.

SuTab

SuTab
SuTab

This prep does not require any gross tasting liquid. Instead you have to swallow 12 tablets with 16 ounces of water, then another 16 ounces of water 60 min later and another 16 ounces 30 min after that. Much more tolerable if you can swallow tablets. The only problem is that it is very expensive and not covered by many insurance companies. If you still want this option you can check out this offer to see if you qualify for a coupon.

Other Medications you may need

Your doctor may also want you to pick up other medications for your prep. The most common are Dulcolax (a laxative) and simethicone (anti-gas medication). You will likely need only 4 tablets of each. You may be able to find a pharmacy that will sell you only the 4 tabs you need. I suggest you call first. This could save you some money. I suggest you look into this option ahead of time. If you can’t find a pharmacy to sell you only 4 tabs, you can find the generic Dulcolax tablets here, and simethicone tablets here. Make sure the simethicone tablets you buy do not have red color, and do not take with food as the package directions suggest, instead follow the directions provided by your doctor.

Read your doctor’s instructions

Once you make your appointment and choose your prep, your doctor should send you some instructions. Make sure you read through them when you get them. Note the timeline. It is very important to read over these instructions to make sure you stop any supplements you make be taking and make arrangements for any medications you doctor wants you to stop taking.

When to pick-up your prep

You should plan to pick up your prep at least 2 weeks before your appointment. This will give you time to troubleshoot any problems that could happen. Maybe you were wrong about the amount your insurance will cover and want to choose a different prep. If you plan to pick up your prep 2 weeks in advance you will be able to contact your doctor for a new prescription and still have your prep in time for your procedure. This will also help if for some reason your pharmacy is out of your prep or maybe the prep you chose will end up being backordered, you never know. Just take my advice, pick it up early and be prepared!

Items to pick up 2 weeks before your colonoscopy

  • Your prep, as discussed in the previous section.
  • Other meds required for your prep, check your instructions. Most likely you will need Dulcolax and Simethicone
  • Ointment to protect your sore bottom from excessive wiping. The least expensive options are: generic Vaseline, or zinc oxide ointment. Zinc oxide is the active ingredient in many diaper rash ointments, like Desitin and Boudreaux’s Butt Paste which are also great options. If you do not have this near your toilet when you start your prep, you will be sorry!
  • Premium Toilet Paper -Now is not the time for cheap toilet paper. You should be prepared to pamper you bottom with the best. Try Cottonelle Premium Comfort, this should make you more comfortable.
  • Flushable wipes – There will be a lot of mess to clean up. So why not make your life easier with some flushable wipes. You can can even use Preparation H medicated wipes to help sooth your sore bottom. Dude wipes also come in medicated and regular options. Both are great options for colonoscopy prep clean up, even if you are not a dude. Honestly I preferred the regular Dude wipes, and I’m not a dude!
  • Boost or other protein shakes, with no added fiber. More on this later.
  • Clear liquids: You will need to go on a clear liquid diet the day before your colonoscopy. So stock up on Jell-O, chicken broth or bone broth, hard candy/popsicles (not red or purple), and clear juice like apple, white grape and white cranberry.
  • Cough Drops with menthol, also not red. If you end up having to prep with GoLytely, SuPrep, or any other gross tasting prep, menthol cough drops can help mask the flavor, making the prep easier and more palatable. Try lemon, ginger or honey flavor.
  • Low fiber foods. More on this later.

Find out which medications need to be discontinued or stopped prior to your colonoscopy

Once again: READ THE INSTRUCTIONS FROM YOUR DOCTOR. This is very important especially if you are taking blood thinners or you are diabetic. It could also be important if you have a seizure disorder. It may be important even if you are just taking a multiple vitamin. Find out which medications your doctor wants you to take and which ones will need to be held during your prep. If you are diabetic you may require adjustments to your usual medications due to changes in your diet.

College Dorm Medications – Pharmacist Recommended

Pre-Colonoscopy Low Fiber Diet Tips

Your doctor may request that you go on a low fiber diet 3-5 days prior to your test. This is important to follow for two reasons: The low fiber diet will make the prep easier and more comfortable for you, because there will be less bulk to pass. Also, the low fiber foods will clear easier making it less likely that food residue will block your doctor from seeing a polyp. Both good reasons for following your doctor’s advice. Please read your doctor’s specific instructions for your low fiber diet. Most doctor’s will want you to avoid whole grains, oats, most fruits and vegetables, beans, tough meat with gristle, nuts and seeds. Here are some meal suggestions for low fiber meals and snacks:

Low fiber meal ideas infographic

Pre-colonoscopy Low fiber breakfast ideas:

  • Hard boiled eggs
  • Plain bagel with cream cheese
  • Yogurt-avoid berry flavors or any fruit with seeds -choose vanilla, honey, plain or peach.
  • Pancakes or French toast with maple syrup, honey or seedless jelly
  • White toast with peanut butter or seedless jelly
  • Scrambled eggs with hashbrowns
  • Rice Krispies

Low Fiber pre-colonoscopy Lunch ideas:

  • Macaroni and cheese
  • Tomato soup with a grilled cheese sandwich on white bread
  • Cheese or chicken quesadilla made with flour tortillas
  • Chicken noodle soup with saltine crackers
  • Peanut butter and jelly on white bread

Low Fiber pre-colonoscopy Dinner ideas:

  • Baked boneless skinless chicken breast with mashed potatoes
  • Sloppy Joes
  • Spaghetti and meatballs
  • Cheese Pizza
  • Shrimp with white rice
  • Miso soup with tofu

Pre-colonoscopy Low Fiber Snack ideas:

  • Applesauce
  • Cheese sticks
  • Jello
  • Ice cream or sorbet without seeds or nuts
  • Cookies and cakes with no seeds, nuts or fruits
  • Ripe Honeydew melon or cantaloupe

Liquid vs. Clear Liquid Diet Pre-Colonoscopy

Read the instructions from your doctor. You may have to go on a liquid or clear liquid diet when you wake up the day before your appointment. There is a difference.

If you are placed on a liquid diet you may be able to have Boost or other protein shakes, with no added fiber, in addition to any clear liquid. The reason I suggest Boost is because I did small taste test with some co-workers. It was blinded, so we did not know which one was which. We tested Ensure, Boost, Premier, Kate Farms and Fair life. All chocolate flavors. Boost was the clear favorite, find it here!

Boost

Clear liquids are any liquid that you can see through, and have no pulp or other solids at room temperature. However, Jell-O and popsicles are also allowed as long as they are not red or purple. Your doctor may also limit orange and/or blue. Here are some examples of clear liquids:

  • Chicken, vegetable or beef broth or bouillon
  • Bone broth
  • Beef Consommé
  • Apple, white grape, or white cranberry juice
  • Jell-O
  • Popsicles
  • Sports drinks: Gatorade or Power aid
  • Coke, Pepsi, 7-Up, Sprite or other sodas
  • Water
  • Pedialyte, Prime, or liquid IV
  • Hard candy
  • Coffee black or with sugar-no milk or cream
  • Tea-except red herbal teas
  • Coconut water
Fancy Clear Liquid dinner
Apple Juice, Beef Consommé and Lemon Jell-O, a fancy clear liquid dinner.

Tips for starting your colonoscopy prep:

Make sure you have the following items within reach of your toilet if possible. Listed in order of importance!

  • generic Vaseline or alternative suggested above.
  • Dude Wipes and soft TP.
  • Water or another clear liquid- both would be preferred.
  • Something to keep you occupied, e.g.: a book to read, smart phone games or activities. Plan to be on the toilet for 30 to 60 min.

Tips to help with colonoscopy prep flavor and nausea: Prepare your prep early if possible and refrigerate it. A cold prep will taste better. Each prep has specific instructions for when it will expire after mixing. Read the instructions for your prep. If your prep has a gross taste I recommend Cough Drops with menthol to mask the taste and using a straw to help you consume it faster. If the prep makes you nauseous drinking a few sips of regular cola can help.

Make sure you stay hydrated during your prep. You will lose a lot of fluid during your prep, so the more clear liquid you can consume, the better!

Benefits of staying hydrated during your colonoscopy prep:

  • You will need to have an IV placed to administer your sedation for the prep. It is much easier to place an IV in a hydrated patient. Use this to motive you to drink more fluids. More fluids = Less pokes!
  • Hydration will make you feel better. Check out this post for some hydration tips.
  • Women of childbearing age: your doctor will ask you to provide a urine sample for a pregnancy test before your procedure. This will be much easier if you are hydrated. Bottoms up!

Tips for appointment day

  • Read your doctor’s instructions again
  • Confirm your driver. Make sure your driver has some activities to keep them busy in the waiting room.
  • Set your alarm to start your second round of prep
  • Only take the medications approved by your doctor
  • Stop all fluids at the time designated by your doctor
  • Leave home in time to make it to your appointment

Post Colonoscopy Tips

  • Have someone stay home with you
  • Do not drive, operate heavy machinery, or make any legal decisions for the rest of the day or until your doctor suggests. You may not even remember the drive home.
  • Eat small light meals, however, try to incorporate some fiber into your diet. This is not the best time for a Big Mac or a Big salad.
  • Continue to stay hydrated.
  • Thank your driver and pat yourself on the back. You did it! Congrats!

Colonoscopy Prep Shopping list

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Health Tips Healthy Home Save Money

How to save money on over the counter medications

save money on non prescription medications

I suppose it’s time to help my readers save on over the counter medications. As a pharmacist, I do have plenty of secrets to share with you.

Recently, I was checking out at the grocery store. The cashier told me she was sleepy because she accidently took her night time cough medicine instead of her day time cough medicine. I cringed because there should be no difference. Read on to find out why.

Common symptoms that can be treated at home

  • Pain/fever
  • Cough
  • Sore throat
  • Nasal congestion
  • Allergies
  • Insomnia
  • Heartburn
  • Constipation
  • Diarrhea

How to save money on Cold and Flu medications

Here I will share some secret tips that most consumers do not know about the over the counter cold and flu medications. Pharmacists are always a great reference to help you choose a medication for your symptoms. There are thousands of cold and flu products on the market sold under many brand names, although all of these products are just combinations of very few ingredients.

Disclaimer: Always read the safety information on all over the counter medications. Follow the manufacturer recommended dosing. Ask a doctor or pharmacist before using any over the counter medication if you are pregnant or breastfeeding or have any health conditions, allergies or are taking and medications.

1. Don’t buy oral phenylephrine or any oral product containing phenylephrine

Phenylephrine has been found to be ineffective at treating nasal congestion in oral form. It has no value, but is still on the market to give manufacturers time to reformulate their products. The reason it has been allowed to remain on the market is because it is still considered safe, but not effective. Even though it is not effective you will still have drug interactions and side effects associated with it’s use, but no benefit.

Update: The FDA has moved to remove phenylephrine from the market. All the more reason to find a great alternative soon.

What should you use instead of phenylephrine to treat nasal congestion?

Note: Always follow the product information for dosage, warnings, and contraindications.

If you want an oral medication for nasal congestion your only option is pseudoephedrine, which you do not need a prescription for. You will have to ask a pharmacist for it. It can be found at most local pharmacies for as low as $2.49 for 24 tablets ~ 21 cents/dose, max of 4 doses/day = 84 cents/day.

Another great option for treating nasal congestion is Afrin nasal spray. Afrin can only be used for 3 days. It is dosed 1-2 sprays in each nostril every 12 hours for 3 days. After 3 days, you will need to use something else to treat your nasal congestion.

what to use instead of phenylephrine

2. Save on Cold and Flu medications by choosing single ingredient medications

Brand name manufacturers try to simplify your purchase by listing symptoms in the name of their product. You could get the same benefit from taking the individual ingredients for less cost, and you could take only the ingredients you need. Usually a cold starts with fever, body aches and sore throat, then nasal congestion, ending with a lingering cough. It would be better to purchase the individual ingredients and treat only the symptoms you currently have.

Lower cost options for “day time” non- sedating cold and flu medications

Instead of using a combination product like these:

Tylenol Cold & Flu Severe -Current cost is $7.67 for 24 caplets ~64 cents a dose, max of 5 doses per day = $3.20/day

Vicks DayQuil Cold and Flu – Current cost is $16.57 for 48 liquicaps ~ 69 cents/dose, max of 4 doses per day = $2.76/day

Treat only the symptoms you have with the single ingredients in these products:

Acetaminophen – This ingredient is effective for treating pain and fever. If you have body aches, sore throat, other pain or fever, then this ingredient will help. Current cost for 325mg tablets = $2.12 for 100 tablets ~ 4 cents/dose, max of 6 doses 3900mg/day = 24 cents/day (note-this is adult dosing)

Dextromethorphan – This ingredient is a cough suppressant. It is used in adults and children 12 years and older to suppress a cough. It is not always good to suppress a cough. If your cough is productive then an expectorant may be a better choice. Current cost for 15mg soft gels = $8.99 for 100 soft gels ~ 18 cents/dose, max of 4 doses/day = 72 cents/day (note-this is adult dosing)

Guaifenesin – This ingredient is only in the Tylenol Cold & Flu severe, not in Vicks DayQuil Cold and Flu. Guaifenesin is an expectorant that helps thin mucus in the bronchial passages to make it easier to cough up mucus. It is most effective if you drink plenty of water. If you drink plenty of water you will help to thin the mucus anyway. This medication is best used to treat a productive cough. It will not help a dry cough at all. It does not suppress a cough. Current cost for 400mg tablets = $8.79 for 200 caplets ~4 cents/dose, max dose of 6 doses/day = 24 cents/day (note-this is adult dosing)

Phenylephrine – Is found in both Vicks DayQuil and Tylenol Cold & Flu Severe. Phenylephrine has been found to be ineffective at treating nasal congestion. If you do have nasal congestion-use one of my phenylephrine alternative suggestions above.

Lower cost options for “night time” sedating cold and flu medications

Instead of using a combination product like these:

NyQuil Cold & Flu – Current cost $17.88 for 48 liquicaps ~ 75 cents/dose, max of 4 doses/day = $3.00/day (note-adult dosing)

Tylenol Cold + Flu + Cough Night liquid – Current cost $10.67 for 8 ounces ~ $1.33/dose, max of 5 doses/day = $6.65/day

Treat only the symptoms you have with the single ingredients in these products:

Acetaminophen – This ingredient is effective for treating pain and fever. If you have body aches, sore throat, other pain or fever, then this ingredient will help. Current cost for 325mg tablets = $2.12 for 100 tablets ~ 4 cents/dose, max of 6 doses 3900mg/day = 24 cents/day (note-this is adult dosing)

Dextromethorphan – This ingredient is a cough suppressant. It is used in adults and children 12 years and older to suppress a cough. It is not always good to suppress a cough. If your cough is productive then an expectorant may be a better choice. Current cost for 15mg soft gels = $8.99 for 100 soft gels ~ 18 cents/dose, max of 4 doses/day = 72 cents/day (note-this is adult dosing)

Doxylamine – This ingredient is an antihistamine. It is used mostly as a sleep aid because it is very sedating, but also has a drying effect that can help with congestion. If you are taking either of the above combination products to help you sleep, you could save a lot by using the single ingredient. Current cost for 96 – 25mg tablets = $7.17 ~4 cents for a half a tablet dose (12.5mg is the amount in a dose of the 2 combination products above). (Note-this is adult dosing.)

Phenylephrine – Is found in Tylenol Cold + Flu + Cough, but not NyQuil. phenylephrine has been found to be ineffective at treating nasal congestion. If you do have nasal congestion-see my phenylephrine alternative suggestions above.

3. Buy generic cold and flu medications

I am a pharmacist and I almost always buy generic medications. They work just as well as brand name medications for a fraction of the cost. There are a couple of exceptions. I prefer brand name for flavored medications. Liquid or chewable medications often taste better if you buy brand name. The other exception is nasal sprays. I have found brand name Afrin to sting less than the generic.

4. Non-drug options for helping with cold and flu symptoms

  • Stay hydrated, this will help with cough, congestion and fever.
  • Use a humidifier, this will help with cough and congestion.

How to save money on seasonal allergy medications

Disclaimer: These recommendations are for mild seasonal allergy symptoms, not severe life threatening allergy symptoms like shortness of breath, hives or severe swelling.

There are many over the counter medications to treat allergy symptoms. Read on for some tips on allergy treatment savings.

1. Avoid combination products

Same as my advice on cold and flu medications, there are plenty of allergy products on the market with more than one ingredient. Watch out for phenylephrine on any product promoted for allergy and sinus relief. Do not buy any product with phenylephrine listed as an ingredient.

2. Choose the right allergy product for your symptoms

Allergy symptoms and treatment options include:

  • Runny/Itchy nose – Oral or nasal antihistamine, nasal steroid
  • Sneezing – Oral or nasal antihistamine, nasal steroid
  • Itchy watery eyes – Oral antihistamine, antihistamine eye drop

Disclaimer: Always read the safety information on all over the counter medications. Follow the manufacturer recommended dosing. Ask a doctor or pharmacist before using any over the counter medication if you are pregnant or breastfeeding or have any health conditions, allergies or are taking and medications.

The first step is to try the lowest cost option of the non sedating oral antihistamine options: (take only one)

If you still have nasal symptoms, then the next step is to add one nasal steroid . Start with the lowest cost option: (these will take a week or two of daily use to show a benefit)

If you still have nasal symptoms then you can add a nasal antihistamine.

If you still have itchy watery eyes, add an antihistamine eye drop.

3. Buy generic allergy medications

I always choose generic medications for tablets and capsules. It’s okay to try generic flavored oral liquids and chew tabs, but sometimes I choose brands in those cases due to better flavor. Generic nasal sprays are worth a try, but sometimes I opt for brand name if the generic stings more.

4. Use your HSA account if possible to pay for allergy medications.

You may be able to use your HSA to pay for chronic medications for allergy symptoms, but you may need a prescription from your doctor even though these meds due not require a prescription. Just in case, ask your doctor for a prescription at your annual check-up. It will save you money if you can use tax free dollars in your HSA account to pay for OTC medications.

How to save money on OTC insomnia medications

Disclaimer: Always read the safety information on all over the counter medications. Follow the manufacturer recommended dosing. Ask a doctor or pharmacist before using any over the counter medication if you are pregnant or breastfeeding or have any health conditions, allergies or are taking and medications.

There are plenty of over the counter options to help with occasional insomnia. The marketing for this indication is very effective in persuading consumers to overspend on very inexpensive medications.

1. Avoid combination products for insomnia

I probably sound like a broken record by now, but there is nothing more frustrating than watching people get sucked into spending more money just to get an advertised brand name medication with extra ingredients they don’t need.

Example:

Advil PM – Current price ~ 52 cents per dose – or take the individual similar ingredients: diphenhydramine 25mg tablets ~4 cents/dose + ibuprofen (if you have pain or fever in addition to your insomnia) ~4 cents/dose.

2. Buy generic medications for insomnia.

Cost saving examples:

ZzzQuil 25mg tablets – Current price ~ 55 cents/dose or you could choose generic (same ingredient) diphenhydramine 25mg tablets ~4 cents/dose.

ZzzQuil Ultra 25mg tablets – Current price ~ 35 cents/dose or you could choose generic (same ingredient) Doxylamine 25mg tablets ~ 7 cents/dose.

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College Dorm Medications – Pharmacist Recommended

Dorm medication box
Dorm medication box
Pharmacist recommended College Dorm Medications

Are you are getting ready to send your teen off to their college dorm? Look no further for some practical pharmacist recommended college dorm medications. These items will make a very helpful medicine and first aid kit. I am a pediatric pharmacist with over 2 decades of experience and I am also a mother of three teens. Obviously I need to caution that I cannot just give blanket recommendations because all medications have some contraindications and potential drug interactions. Always read the product safety information and/or speak directly with your doctor or pharmacist if you are taking other medications or have any health conditions or medication allergies.

Make sure your teen is up to date on immunizations and has a copy of their immunization record and health insurance card. Here is a link to the vaccine recommendations for 19-26 year-olds.

Always send all college dorm medications prescription and non-prescription in the original containers so your teen can read the instructions.

As a pharmacist I usually recommend single ingredient medications. It might save space to include multi-symptom cough and cold medications, but it is not worth the saved space to have you teen taking medications that are not needed. It is also easier to overdose on acetaminophen or ibuprofen with multi-symptom medications. Which is why my pharmacist recommended college dorm medications are nearly all single ingredient medications. I usually buy generic medications because they work just as well as brand name medications. Sometimes I prefer brand name medications due to better flavor.

Which medications should you bring to your college dorm?

Prescribed Medications

Please make sure your teen has all of their prescribed medications and knows how and where to obtain refills. If your teen is going out of state make sure they are still able to obtain refills in that state. All state laws are different, so make sure you have a plan in place ahead of time. Please also make sure your teen is aware of their medication allergies and what their reaction was to the medication. If your teen is taking any prescribed medications or has any medication allergies or health conditions, check with their doctor or pharmacist if any of the other medication listed are still safe to include in their kit.

Pain/Fever medication

Include a small bottle of Ibuprofen (MOTRIN, ADVIL) and/or acetaminophen (TYLENOL). The bottle size depends on how much how much you expect your teen will need. Ibuprofen and acetaminophen are both good choices for pain or fever. They can both provide relief from a sore throat or headache. Ibuprofen is better for menstural cramps, tooth or bone pain, and is also an anti-inflammatory. It would also be a good idea to include a digital thermometer.

Gastrointestinal medications

Heartburn medication. A small bottle of Tums. Even if your teen does not have trouble with heartburn now, they may start to have problems when they get to choose all of their own food for the first time. College meal plans are sometimes all you can eat, including many dessert options. If they use up their supply and request more, that would be a good time to discuss better food choices and smaller meal sizes.

Diarrhea/Constipation medicine. Travel size Imodium. If they make poor food choices or get sick from close living quarters they will love you forever for including medication for diarrhea. This would not be the medication they will want to walk to the nearest pharmacy to obtain. For constipation I recommend better food choices and exercise as first line treatment for occasional constipation. Fruits, veggies, All-bran, prunes, prune juice, more water, and nice walk. If that doesn’t work, and it’s a new problem, it’s probably due to lack of fiber in their diet. Most college students to do not eat enough fiber in their diet. It would not hurt to include a fiber supplement in the medication kit. If they take the fiber supplement, make sure they are staying hydrated.

Hydration. Diarrhea and vomiting can cause dehydration. Including a few packs of Pedialyte or Liquid IV will help if your teen is dehydrated. Staying hydrated can also reduce the risk of constipation. Check out my other post on how to increase your fluid intake.

Cold and flu medications

Nasal Congestion medicine. I recommend including something for allergies and at least one decongestant. Maybe your teen does not suffer from allergies, but could if they move to a new area. I prefer Zyrtec for allergy symptoms, but Claritin and Allegra are also good choices for a non-sedating antihistamine. I would also include a decongestant incase the congestion is from a cold or flu. In this case pseudoephedrine is my first choice. In some states it can only be purchased from a pharmacist. I would also include a bottle of Afrin nasal spray. This can only be used for three days, six doses. It is dosed 1-2 sprays each nostril every 12 hours. It cannot be used for more than 3 days, but it will be three glorious days of breathing through your nose during the worst of any cold or flu.

Cough medicine. For cough in teens and adults it is okay to use Delsym. There are age restrictions on the purchase of Delsym in some states due to abuse potential. This should not be a problem for most college students because the age to purchase is 18. I still think it is the best over the counter option for cough for teens and adults and I am sending a bottle to college with my teen. I would also include cough drops that have menthol as the main ingredient and some that are just soothing throat drops with pectin as the main ingredient. The menthol drops are best for cough suppression. The pectin drops are better for sore or irritated throat, but can also help a bit with cough.

Topical medications

For cuts and scrapes I recommend triple antibiotic ointment and a package of a variety of sizes of Band-Aids.

For itchy rashes a tube of 1% hydrocortisone cream will be a helpful medication to bring to your dorm room.

Canker sores can be brought on by stress, which is why I recommend including Kanka, a topical anesthetic for mouth sores.

Sleep Aids

I prefer non pharmacological treatment as first line for insomnia. I can understand how sleeping in a new place might be a problem due to noise, stress, or just a new environment. Honestly, I used a box fan to block out the noise when I stayed in a dorm. Earplugs are an inexpensive option that might be helpful. A sleep mask might help if your teen is sensitive to light. Good sleep hygiene would be ideal, but if all else fails it wouldn’t hurt to have a small supply of melatonin. I’d recommend 2.5mg or less as a starting dose.

College dorm medication checklist

Disclaimer: Always check with your teen’s doctor or pharmacist if they have any allergies, medical conditions, or are taking any prescribed medications before including these medications in your college dorm medication kit. This section contains affiliate links.

  1. Prescribed medications
  2. Acetaminophen (Tylenol)
  3. Ibuprofen (Motrin, Advil)
  4. Cough drops (menthol)
  5. Throat Drops (pectin)
  6. Tums
  7. Imodium (loperamide)
  8. Fiber
  9. Pedialyte packets
  10. Non sedating antihistamine (Zyrtec, Claritin or Allegra)
  11. pseudoephedrine
  12. Brand name Afrin nasal spray (oxymetazoline)
  13. Delsym (grape flavor)
  14. Triple antibiotic ointment
  15. 1% hydrocortisone cream
  16. Kanka
  17. Lubricating eye drops (Artificial Tears – not Visine)
  18. Melatonin
  19. Multiple vitamin
  20. ChapStick
  21. Sunscreen
  22. Insect repellant

Basic First Aid Supplies for College Dorm Checklist

  1. digital thermometer
  2. Variety of Band-Aids
  3. Ice Pack
  4. Scissors
  5. Tweezers
  6. Cotton balls/swabs
  7. Gauze pads
  8. Medical tape
  9. Ace bandage
  10. Tick Key
  11. Alcohol swabs
  12. Gloves

Other College Dorm Needs

Check out our other post for what you need to make your dorm your home. This post includes many items we forgot to pack. Be prepared!

What do you need to make your dorm your home?
Prime Student 6-month Trial

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Five Sneaky Tricks to Increase Your Hydration

How to increase you water intake

According to the CDC the average American adult drinks about 39 ounces of water per day. This is below the recommended amount. If you are like many adults who wish to increase your water intake, read on for five sneaky tricks to increase your fluid intake.

Why should I drink more water?

Water is essential for life. Your body is about 60% water. You need water for temperature regulation, clear thinking, eliminating waste, and proper circulation.

Drinking adequate amounts of water prevents dehydration, keeps your skin healthy, reduces fatigue, prevents constipation, and reduces the risk of kidney stones.

How much water do I need?

The Institute of Medicine of the National Academies recommends that healthy men consume 3.7 Liters ( 125 ounces) and healthy women consume 2.7 Liters or 91 ounces of water each day.

These are just guidelines for adults with average activity. There are other factors that could change your water needs such as physical activity, climate, age, sex, pregnancy and breastfeeding.

Warm climate could increase your fluid intake needs.
Warm climate could increase your fluid intake needs.

How can I increase my hydration?

Increasing your daily fluid intake could be as easy as just setting a goal and finding ways to stick to it. If you don’t really care for drinking plain water than finding ways to flavor it could help. Maybe you just need to find ways to fit drinking more fluids into your daily routine. Read on for some great ways to increase your daily fluid intake.

How to increase your hydration infographic

1.Set a goal to increase your fluid intake

Use an app to keep track of your water consumption goals.

If you already enjoy drinking water you may just need to set a goal and find a way to stick to it. Believe it or not there are plenty of apps out there to help you keep track of your water consumption goals. These apps will be best used with a water bottle with measurement marks on it to help you keep track of your consumption.

2. Flavor your water to help increase your fluid consumption

Tea is a great way to flavor water
Tea is a great way to flavor your water.

If you struggle to drink plain water it may really help if you flavor your water. I like to infuse fruit flavor into my water. My favorite is lemon, but there are plenty of fruits and vegetables that can give your water a pleasant flavor without adding too may calories. I like to use a water pitcher with infuser to add fruit to my water because it keeps the seeds out of my water. It is also easy to clean out and refresh the fruit. If you prefer you could drink iced or hot tea as an alternative to plain water or fruit infused water. It’s best to try decaffeinated teas if possible. I’d recommend trying several teas before you rule this out. There are so many different teas you could try; there has to be at least one you would like.

3. Make drinking water a habit to help increase your hydration.

You can easily increase your fluid intake by making drinking water part of your daily routine. Jim Kwik, author of Limitless has a great example of this in his morning brain enhancing routine. He drinks a tall glass of water every morning to help replace overnight losses from breathing. You could also make it a habit to drink a tall glass of water before each meal. This can also help you to eat less and could improve your weight loss goals.

4. Eat your water to help increase your fluid consumption.

Celery is 95% water.
Celery is 95% water

Simply increasing you consumption of fruits and vegetables could help to increase your overall fluid consumption. Some fruits and vegetables are very high in water. Examples of fruits and vegetables with the high water content are cabbage, celery, watermelon, peaches, bell peppers, cucumbers, lettuce, tomatoes, oranges, cantaloupe, and strawberries. Other foods with high fluid content are yogurt, cottage cheese, and soup. Try adding some of these foods to your diet. You could swap French fries for coleslaw, or swap a sandwich for a salad or soup. Have a breakfast smoothie or try my Immune Boosting granola with yogurt.

Immune-boosting-granola-served-with-yogurt
Immune boosting-granola served with yogurt.
Nutrient Packed Smoothie vs. Smoothie Bowls

5. Keep water convenient to help increase consumption.

Find a water bottle you love and make sure to take it with you. Make sure it fits into the cup holder in your car. Find one with a handle that is easy to carry, or invest in a water bottle carrier.

Leave a glass of water on your night stand at night. Keep a glass near you at work. Fill a pitcher with plain or fruit infused water and keep it in the refrigerator. Keep a tray of fresh sliced fruit or veggies in your refrigerator.

Prepared veggie tray
Grab and Go veggie tray to keep in your fridge.

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Breakfast recipes Health Tips Healthy Recipes Recipes

Pharmacist Shares Immune Boosting Granola Recipe

Immune boosting granola pharmacist recommended

Customers are flooding into local pharmacies in search of immune boosting supplements. Many of these immune boosting ingredients can easily be included in your diet. It’s much less expensive to eat your vitamins than to purchase supplements. I’m a pharmacist and I would love to share my recipe for Immune Boosting Granola. Granola is a quick and easy breakfast or snack that can easily be added to any daily meal plan. Add some to you favorite yogurt or just pack it for a quick and easy snack.

Disclaimer: The statements made regarding this recipe have not been evaluated by the Food and Drug Administration. The efficacy of this recipe has not been confirmed by FDA-approved research. This recipe is not intended to diagnose, treat, cure or prevent any disease.

Immune Boosting Nutrients

In order to make an immune boosting recipe, one first needs to know which nutrients are known to boost immunity. I have compiled a list of immune boosting vitamins and minerals, because adding more to your diet can help boost your immunity.

Vitamin C- There is research to support Vitamin C supplementation in reducing the length and severity of respiratory infections.1 Vitamin C plays an important role in immune response.

Zinc – Plenty of research is certainly available supporting zinc supplementation in reducing the length and severity of infections.1 Zinc is an important player in immune response.

Vitamin D – There is some evidence that vitamin D could reduce the risk of Influenza and COVID-19 infections and death.2

Vitamin B6- A deficiency in Vitamin B6 reduces your ability to make antibodies to fight off infection. Vitamin B6 could help strengthen immunity.3

Vitamin E- Immune response is enhanced by Vitamin E. It can provide protection against infections.4

Selenium- The immune system relies on adequate dietary selenium.5

Immune Boosting Ingredients

I selected my granola ingredients to include as many immune boosting vitamins and minerals as possible so they can help boost immunity. Here is a list of my ingredients because it is important to understand why they were included in my recipe.

  1. Elderberry syrup (find it here): Elderberry syrup is also used to enhance immunity. Elderberries are high in flavonoids, Vitamin A and Vitamin C. It may also help reduce symptoms of viral infections by stimulating immune response.6
  2. Matcha (find it here): Another natural superfood, matcha is green tea powder. It is made by grinding green tea leaves into a fine powder. Regular consumption of green tea could decrease influenza infection rates and cold symptoms.7
  3. Hemp hearts(find them here), pumpkin seeds and Flax Seeds: I included all of these mostly for the zinc and omega 3 and 6. These polyunsaturated fats also have been extensively studied for their role in immune health.8
  4. Nuts: These serve as a good source of selenium and zinc. I also chose Brazil nuts because they have the highest amount of selenium. Cashews are also high in zinc.
  5. Sunflower seeds: These seeds also have some healthy fats, but I chose them mostly because they are an excellent source of vitamin E. They are also a good source of selenium and vitamin B6.
  6. Ginger: Can also help reduce the severity of respiratory infections.9
  7. Blueberries: Another natural superfood. Blueberries are a good source of Vitamin C. I included them because they are one of the best sources of antioxidants, mostly flavonoids.

Immune Boosting Granola Recipe

Ingredients:

4 Cups Oats

1 Cup mixed nuts (cashews, almonds, and Brazil nuts)

1/4 Cup sunflower seeds

1 Cup shelled pumpkin seeds

1/4 Cup hemp hearts

1 Tablespoon matcha powder

2 Tablespoons cinnamon

1 teaspoon ground ginger

1/2 teaspoon Himalayan pink salt

2 Tablespoons flax seed

1/3 Cup dried cranberries

1/2 Cup shredded dry coconut

1/3 Cup dried blueberries

1/2 Cup honey

1/3 Cup Peanut butter

2 Tablespoons Elderberry Syrup

1/3 Cup coconut oil

Directions:

First preheat oven to 350 degrees F. Mix together the oats, nuts, sunflower seeds, pumpkin seeds, hemp hearts, matcha, cinnamon, ginger, salt, and flax seed. Meanwhile, in a separate bowl mix the peanut butter, coconut oil, honey, elderberry syrup. Once mixed, pour the wet ingredients over the dry ingredients and mix until evenly coated.

Cover a Jelly Roll Pan with parchment paper. Spread the granola over the paper. Bake for 15 min. Remove from the oven and mix in the dried coconut. Bake for 10 more minutes. Remove and mix again. If the coconut is not completely toasted, bake for 2 more minutes or until most of the coconut is toasted but not burnt. Lastly, remove from the oven and stir in the dried fruit while the granola is still warm. Finally, allow the granola to cool to room temperature. Although it is difficult not to finish it all in one sitting, you may have some leftover. If so, you can store in an air tight container at room temperature for up to 2 weeks.

Immune Boosting Granola Served with Yogurt
Immune-Boosting-GranolaPrintable recipe

Granola makes a great gift!

References:

  1. https://www.karger.com/Article/Abstract/90495
  2. https://www.mdpi.com/2072-6643/12/4/988
  3. https://pubmed.ncbi.nlm.nih.gov/28367454/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266234/
  5. https://pubmed.ncbi.nlm.nih.gov/30200430/
  6. https://www.tandfonline.com/doi/abs/10.1271/bbb.120112
  7. https://www.mdpi.com/1420-3049/23/7/1795
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6834330/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019938/

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