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[hedgie]

I have never seen a school (or indeed a shoal) of fish drinking, so I can't tell you whether we do so similarly or not

I drink very rarely, and could quite happily never drink again. In fact I might easily not do. I didn't realise British people particularly had a reputation for drinking a lot?

Well, IME, most folks from the UK I know tend to put down enough to get labelled an alcoholic in the US, and most days their routine consisted of going to work, then heading to the pub until one was pissed enough to head home (and possibly have more).  Kinda like Shaun of the Dead sans zombies.

[LTK]

Eh, I usually end up just calling it tylenol (it's a genericized brand name like aspirin, right?)

Whether a brand name is genericized or not can always be disputed but there's already an existing nonproprietary name (paracetamol), which is as genericized as you can get as Tylenol is only a brand in the US.

Wow: Wikipedia informs me that some people were poisoned and killed with cyanide-laced Tylenol in 1982. What the hell happened then?

[cesium133]

Yeah, but nobody in the U.S. calls it paracetamol.

[hedgie]

*cough* I generally do.

[Papersatan]

Even *Tylenol* calls it acetaminophen in the US.
 


 I had never heard the term paracetamol until I encountered a conversation on the drug with non-americans.  Most people here would not know what that was if you asked for it.

[Carl-E]

Guys, guys - Tylenol / Acetaminophen / paracetamol is ridiculously dangerous.  The maximum recommended dosage, if surpassed even for a brief amount of time, can devastate your liver.  We're talking failure in a relatively short period of time (a couple of months). 

And what's that maximum dosage? 

1 gram, 4 times a day.  Two of those extra strength tabs pictured above.  Take a third at serious risk to your health.  The regular strength is 325 mg, so three of them is still a safe dose. 

Ibuprofin (Advil) will cause stomach upset, yes, but it takes massive amounts to do serious damage.  Same with Naproxen Sodium (Aleve).  All three (along with plain aspirin) are anti-inflammatories, which is how they reduce pain, and why they're mixed with codeine (you can get codeine mixed with any of the three, but Tylenol is most common) because codeine isn't an anti-inflammatory, it just kills pain by deadening nerves temporarily. 

I learned some of this through my wife, a PA student, and the rest from an extensive report on the radio - here's the report, and a transcript.  Warning: it's an hour-long program, but the bsics are laid out early. 

No matter what you call it, be careful.  "Some is good" rarely means "more is better". 

[GarandMarine]

I switched to naproxen sodium for my daily pain relief.

[Carl-E]

I use it for the collapsing discs in my back - one in the morning, an occasional one in the evening.  Ibuprofin works well for me for muscular aches and pains, and I only use Tylenol for my very rare headaches.  It seems to do best on those for me, better than aspirin.  None of them bother my stomach. 

[Aimless]

Saying that paracetamol is ridiculously dangerous because it will fuck you up if you take more than the maximum recommended dose every day for two months is like saying alcohol is ridiculously dangerous because it will fuck you up if you drink a bottle of wine every day for a couple of months. It's true, but, if you're overconsuming a substance for a long period of time, maybe the danger shouldn't be attributed entirely to the substance.

There are a few rare individuals that metabolize drugs differently from most other people to the point where they may be at significant risk of harm when using even normal or low doses of various drugs. Apart from these people, paracetamol is very safe for most people if you don't exceed the maximum recommended dosage of 1g x3-4/d. There is little to be gained from taking higher doses. If it works for you, but doesn't cover the whole day, you may consider slow-release formulations. If it doesn't work for you, maybe some other intervention is in order.

Every single class of painkillers is associated with a more-or-less significant risk of adverse effects. Ibuprofen, naproxen and other similar antiinflammatory drugs are generally well-tolerated by healthy youngish individuals, but we regularly get people in the ER with gastrointestinal bleeds most likely caused by these kinds of drugs. We also see the occasional hospitalisation due to interactions between these drugs and other more dangerous drugs. Tramadol is relatively safe for short periods when used appropriately (right regimen and for the right kind of pain), but we regularly get people in the ER who've had seizures from moderate-to-high doses of tramadol, and never mind the growing number of people who've become literally addicted to tramadol and can't kick it even after its efficacy has been drastically reduced. Codeine and similar drugs are extremely effective for many kinds of pain, esp. in combination with paracetamol, but lose their efficacy over time while the side-effects become increasingly prominent.

Every drug has its risks, but paracetamol is the only in the list above that is reasonably safe for almost everyone to use every single day as long as you stick to a reasonable dose, and reasonably effective for most kinds of mild-to-moderate pain, in combination with another class of drugs if necessary.

That being said, pain-treatment should be guided not only by concerns about safety but also--and primarily--by the type of pain. In many cases of acute and clearly inflammatory musculoskeletal pain, a short course of antiinflammatory drugs, ranging from ibuprofen to high-dose naproxen or the like, is the way to go. In many cases of chronic back-/neck-pain, I've had much greater success from referring patients to multimodal pain-rehabilitation, an experienced physiotherapist, a warm swimming pool or sauna, steroid-injections or nerve blocks, etc. In many of those cases, a drug directed towards a neuropathic component of the pain, can be a far more valuable supplement than any antiinflammatory or opioid drug. However, there's also a need for rescue-meds. For some people, nothing but opioid drugs seem to help, and those people end up at least having to switch drugs from time to time. And, with chronic headaches of various kinds, there's a large arsenal of more-or-less effective pharmacological and non-pharmacological treatments.

I realise I work in a country where people have greater and more affordable access to these measures, so all this is very easy for me to say. I also don't mean to offend anyone--you know your body and your pain better than I do, and you know what works for you and what doesn't. I speak only from my own experiences with patients who have been done a great disservice by the healthcare-system's sometimes irrational or uninformed approach to treating pain, and from my experience of what can be gained from taking a different approach. peace

[Akima]

Interesting. Doctors here frequently recommend 2x665mg three times a day for chronic pain associated with osteoarthritis, in a specific formulation available as Panadol Osteo. It is supposed to be a layered "slow release" medication to provide eight hours of pain relief, but I don't know anything about the pharmokinetics beyond that. It is on the Pharmaceutical Benefits Scheme, but you can buy it without a prescription as a "behind the counter" medication, which is to say that you have to buy it through a pharmacist and they will warn you that you should take no additional paracetamol-based medicines at all. An alternative is 2x500mg four times a day. Doctors seem to be much more comfortable with this regime than, for example, meloxicam (Mobic), where they fret constantly about ulcers and intestinal bleeding, sometimes prescribing pantoprazole (Somac) as a sort of prophylactic.

I don't think paracetamol/acetaminophen is ridiculously dangerous. Exceeding the recommended dose of any medication is a bad idea, and I don't think that overdosing continuously for two months really counts as a "brief amount of time". It is probably a bad idea to self-medicate continuously with any pain-killer for two months without consulting your doctor, even if you don't exceed the recommended dose on the packet. There is a reason there is usually a warning to "See your doctor if pain persists" in the small print.

Disclaimer: I work at a hospital, but in IT. I have no medical training, I just have a grandmother who suffers from fairly serious arthritis.

[LTK]

Even *Tylenol* calls it acetaminophen in the US.

Well of course they do, being associated with the nonproprietary name is bad for their business!

[Aimless]

Interesting. Doctors here frequently recommend 2x665mg three times a day for chronic pain associated with osteoarthritis, in a specific formulation available as Panadol Osteo. 

It's my go-to prescription for long-term use I don't think we have that OTC, but I haven't checked in a while.

[Loki]

Side note, but I am really surprised at how... flashy the package of those drugs is.

See, in Germany, most drug packages look really bland, like most in this picture:



The preferred colors are white and blue and occasionally a pastel orange. Whether that is due to cost or for making it look more clinical, I don't know.

The Tylenol picture shown earlier, with its bright colors and the "trendy" font is literally something I would have expected from chewing gum or the like:

[Aimless]

Only to be expected from those vain Caplets

[Carl-E]

Aimless, Akima, the ridiculousness I referenced isn't a matter of intentional overdosing. 

I know what I cited was really long, but as put out in that report the problem is that, as a brand, Tylenol was touted as "the safest pain reliever you could buy", and so people think a little more won't hurt!  It's so easy for someone with chronic pain to go a little further without even realizing it - taking it 5 or six times a day instead of four, taking an extra tablet or two each time "just for a little while" (and then it becomes months). 

And through the usual american litigation system, the package warnings didn't even mention liver damage until just recently, and for quite a while there was no warning label at all. 

While in a perfect world, no one would exceed the recommended dose, in reality there are many, many people who don't even know what the recommended dosage is - two or three at a time, whenever you feel pain, right?  "Whatever works" is the American way, after all. 

It's a genuine problem, and overdosng with other anti-inflammatories in a similar way is nowhere near as dangerous!  I'm not trying to fear-monger, just point out that it's not the same across the board.  Ignorance prompted this (especially the attitude that they "cut" codeine with this stuff - they can prescribe pure codeine, that's not the issue), and the fact that I was surprised to see 1g pills mentioned by Barmy.  I know she'd not take an extra - she was not even taking one - but that's just too easy an overdose setup, taking an extra one a couple of times a day for someone in extreme pain would really be a problem! 

OK, I just wanted to educate a little, it's a little known issue, and more of a problem here than outside the US where doctors are listened to and labels are probably read.  Happy to drop it now. 

[Barmymoo]

Oh not 1g pills, two 0.5g pills. The leaflet says take one or two pills every three to four hours, not exceeding more than 8 pills.

[bainidhe_dub]

Even *Tylenol* calls it acetaminophen in the US.

Well of course they do, being associated with the nonproprietary name is bad for their business!

Acetaminophen is the nonproprietary name here, that's what we're saying.

[jwhouk]

For you young'ns who weren't around in 1982: when Tylenol first came out as an alternative pain reliever to aspirin, it came in capsules. In 1982, some sicko in the greater Chicago area discovered he could inject the capsules with potassium cyanide. There were a ton of reported deaths, and Tylenol maker McNeil Laboratories had a huge PR problem with the safety of their brand.

What they did was twofold: they first put seals and tamper-resistant bands on their products; then, they changed the capsules to what they called "caplets" - the solid-bodied medications we see today.

Johnson & Johnson, who owned the Tylenol brand, went out of their way to promote the safety of the medication. That is what led (many years later) to the issues with OD'ing and liver shutdown side-effects.

[Barmymoo]

Any medication is dangerous if taken in too large a quantity over too long a time. It's hardly the fault of the medication if people don't bother reading the leaflet that comes with it before taking any. I doubt there are many adults in the UK who don't know the correct dose for paracetamol.

[BeoPuppy]

I plucked apples today. Due to a russian boycot apple growers can't get rid of them. Apple growers are advised to let the fruit rot on the tree. One grower decided to just open his doors for the public and let them pick at fifty cents a kilo.

I got twenty three kilo.

We were not alone, though. Couple of thousand people showed up.

It was amazing fun. Go pluck some apples!

[Masterpiece]

Any medication Everything is dangerous if taken in too large a quantity over too long a time.

Fixed that for you, dear.

[Active Madness]

I plucked apples today. Due to a russian boycot apple growers can't get rid of them. Apple growers are advised to let the fruit rot on the tree. One grower decided to just open his doors for the public and let them pick at fifty cents a kilo.

I got twenty three kilo.

We were not alone, though. Couple of thousand people showed up.

It was amazing fun. Go pluck some apples!

I believe in situations like that you should. Nay, you are honour bound to make cider!

[Grognard]

nearly 50 lbs. of apples?!!

I see a lot of apple cobbler in someone's future.

so send me some. 

[Akima]

Due to a russian boycot apple growers can't get rid of them.

Are the Russians boycotting apples (constipated comrades?), or the growers boycotting Russia?

[hedgie]

Russian food boycott was caused by Putin (or is it Puto?) retaliating for EU sanctions.

[BeoPuppy]

Sorry that I was unclear. Yes, the russians have stopped importing foods from ... certain countries. Imagine that.

Made apple sauce. Yummie. Fresh apple sauce ...

[Pilchard123]

I have recipe for a fantastic apple cake somewhere. I'll have to see if I can find it and put it up in the cooking thread.

[BeoPuppy]

That would come in so handy ... because I have a few apples left over still.

[Thrillho]

Wait, you're from the UK and *don't* drink like a school of fish.  I am now officially bewildered.

Not sure how I feel about this, joke or otherwise.

[Aimless]

No no no make apple-butter. Flavour with cinnamon and the like and cook it until it's thick and brown and delicious.

[ev4n]

Yeah, the painkillers they gave me after my wisdom tooth extraction was cut with tylenol. I quit taking it as soon as I could and switched to ibuprofen. The downside of ibuprofen, though, is if you take it for more than a couple days it gives you an upset stomach. I'd rather have that, though, than liver damage.

NSAIDs go a bit further than upset stomachs....   

[ankhtahr]

I need to get used to the term NSAID, the German abbreviation is NSAR.
I'm not supposed to take NSAIDs anymore due to another medication I'm taking. I still don't know what other painkillers I should take, the painkillers one can get over the counter here are very limited. So far I haven't needed any, but I do have a tendency to get migraines every few months, and then I wouldn't know what to do.

[bainidhe_dub]

So apparently, despite the fact that Tylenol and Sudafed are basically the only medicines I'm allowed to take right now, if I actually read the packaging I would have realized that I can take a fuckton more of it than I thought. As in, every 4 hours, not every 12 hours. Which explains why I felt like crap for 8 hours yesterday.

[Akima]

I do have a tendency to get migraines every few months, and then I wouldn't know what to do.

That is what doctors are for. Go and see one. Pretty please?

[Masterpiece]

My doctor gave me metamizole when I told her about my chronic headaches. That shit is something - my headache was gone pretty fast but it has so many toxicities that I only use it in worst cases (and have only used it thrice so far).

In Germany it is known as Novalgin-Tropfen. It is prescribed to almost every senior with chronic pain (a fact I learned during my Civic duty).

[ankhtahr]

Hoo. Novalgin is pretty strong.

Akima: I sincerely doubt they'll do anything besides giving me a prescription for painkillers. Both of my parents have those migraines, luckily I get them relatively rarely. My mother had them at least every two weeks. My father around monthly. For me it's every three months if I'm lucky. With my mother it has been reduced to the same frequency as with me, when she was given a NARI, a noradrenaline reuptake inhibitor. Sadly that was an off-label use for that medication, and since it has been found ineffective for it's original purpose the health insurance won't pay for it anymore and she can't afford to buy it herself.

For migraines I usually relied on "Aspirin Migräne", in which the acetylsalicylic acid is buffered, because it would otherwise lead to stomach aches. The normal dose (also according to the leaflet) is 1 gram. If I take that early enough I'll manage to avoid the whole migraine. If I don't take it early enough it'll just help with the pain, which will then hold on for around two or three days. But Aspirin is a NSAID, and I'm not supposed to take those now. From what I've read basically my only option now is Paracetamol, and I know that at least on my mother's side of the family allergies against it are common. I never tried Paracetamol because of that.

[hedgie]

Wait, you're from the UK and *don't* drink like a school of fish.  I am now officially bewildered.

Not sure how I feel about this, joke or otherwise.

Okay, I'll start off by apologising to all the UK crowd, for implying that the whole country is filled with drunkards.  I don't think that's actually the case, but I think that there is a cultural difference, that is totally *my* fault for typing what I did.  The US doesn't generally (I've actually spent time in more places out of this country than in it, and some of the places I have lived in the US are different than what's common.  I plead ignorance, your honour).  Where I live, at least right now, most people walk quickly past the bar/pub/club, and there's a frequent reaction of people passing very quickly by, if they see anyone standing outside, and that people who frequent such places are either drunks, or, in the last case, kids partying away all their parents' money.

Depending on where one lives, IME, much of Europe has a much stronger pub culture, where it's basically the place where you want to see your mates, or meet strangers, but don't have plans to go anywhere more interesting.  Much of the US is more puritanical, since we have counties that don't even really allow booze, to places where there are strict "Blue Laws", where people are discouraged from having any fun because of religious fundamentalism.  There is also a stereotype of pubs here being full of violent people (bikers, sailors on shore-leave, etc), and even casual drinking isn't as culturally accepted.  I've, via some osmosis, seen my fair share of the bad shite that many people think goes along with drinking culture. 

I honestly prefer the way it was when I was in the UK, and nobody would judge you for ordering a couple of pints (real pints, mind you, not those shitty American ones) with lunch.

[Aimless]

Akima: I sincerely doubt they'll do anything besides giving me a prescription for painkillers.

Your doctor may potentially be able to do at least two useful things for you in this situation.

1. Assess whether or not it might be okay for you to take some form of NSAID in the event of a migraine attack anyway by looking at your other meds to see why they may be inappropriate to combine with NSAIDs. If, for example, the combination may lead to a dramatic change in the concentrations of your other medicines, an NSAID may be very inappropriate. If, on the other hand, the risk consists of a marginally increased risk of getting a bleeding ulcer, one or two doses of eg. aspirin or some other NSAID may be perfectly acceptable, esp. in combination with something to protect the stomach. Your doctor may help you clear this up.

2. Assess whether or not you may be a candidate for some other form of migraine-specific emergency meds such as a triptan (many different kinds and formulations, eg. spray). If your headaches have been determined to be pure migraines (rather than some other form of headache) and your blood-pressure's okay and you don't have an extremely high dose of any meds that may theoretically interact with triptans then it may be worth asking your doctor. It's a reasonable request: you need to know what you can do in the event of a severe migraine attack.

If your migraines aren't too severe and come infrequently to boot, or if you know that they have a strong musculoskeletal component, then you could probably do without the above. I can't say any more, not least because half the drugs regularly prescribed in Germany are banned in Sweden due to our patients' weaker constitutions Novalgin being one example of many.

[ankhtahr]

I am pretty sure that it's a real migraine. It has the classical symptoms of a migraine. First Aura, then headache with nausea, light and sound sensitivity. My mother had it diagnosed, and I know that even my great grandmother had very strong migraine attacks. She used to lock herself into a darkened room with a bucket for vomiting.

[Aimless]

In that case it def. wouldn't hurt to ask your doctor about migraine-specific meds such as a triptan spray or one of those tablets that just melt in your mouth and may or may not taste horrible

[Barmymoo]

Ankh, it's always sensible to see a medical professional rather than self-diagnosing, even if you're pretty sure that you're right. All of those factors are relevant information to give to the doctor, but they don't mean there isn't something else playing a part in your personal situation.

[Welu]

While getting an official diagnosis from the appropriate people is preferable, it's bloody hard to get one and sucks in the mean time when you're unable to do anything with your ailment because of lack of an official diagnosis and seeing the people who could help you means being on a list for at least nine fucking months.

That mini-rant isn't really constructive. I'm a bit pissed off with the local health system right now.

[Lines]

hedgie, that's not my experience at all. I don't know where you live, and I can't speak for the whole country, but I don't think that all places view drinking as bad. Especially not in my beer-centric city.

[Barmymoo]

I agree that it sucks how long you have to wait for a diagnosis. Months-long waiting lists are completely ridiculous; I fully sympathise.

I got a new lamp! It is pretty and purple and a very simple shape but I like it. I needed a bedside light and finally got round to ordering one. By some miracle I was home when they delivered it (I've been trying to get a delivery of some business cards for the last week and they have still utterly failed to deliver it when I've been here, despite my ringing up several times and specifying "Monday afternoon" or "just leave it in the porch").

Also I applied for a couple more jobs, or rather more accurately a couple more schemes within the job of student ambassador which I already got. One is to give presentations at local schools to encourage students to apply for my course, and another is to be an ambassador for the whole university, not just my campus. That in turn can lead onto another job, which also sounded interesting. Gainful employment!

[Welu]

Sounds exciting, May! Hope good job things happen for you!

[Masterpiece]

I have headaches so bad that I puked. I'm not feeling very well.

[BeoPuppy]

Been there. Sympathies. Try a long, hot shower. Preferably in the dark.

[Masterpiece]

oh. Oh no. I'm getting SICK. NOOOOOOOO.

[Masterpiece]

Now my head is pulsating and my feet shivering. Using voice over commands cut I can not type anymore I think I should medication

[Lines]

Oh noes! I hope you feel better. :c  I hope it's not a really bad flu or something.