Rx for Readers: The great pill pile-up

While changes do not occur the day after the expiry date, the date on the package gives us a clear indication as to the accepted limits on such products.

I have a pile of out-of-date medicine – eye and ear drops, vitamins and creams – at home. I know that pharmacists warn the public to throw away anything that has gone beyond this time limitation, but perhaps this is to sell more products. Is observing the expiry date really all that important that I must throw out any medications and vitamins that have passed that date?

    – E.G., Haifa
Veteran pharmacist Howard Rice answers:
In the Western world, medicines and cosmetics have both the manufacturing date and expiry date printed or embossed usually on the container or blister pack. The date is important for two reasons:
The efficacy of the preparation may well diminish after a period of time (as would be the case of many vitamins) and can even become toxic (as with the antibiotic tetracycline). In addition, the product can become – as in the case of cosmetic creams or medications – infested with bacteria, making it unsuitable and often dangerous to use.
While these changes do not occur the day after the expiry date, the date on the package gives us a clear indication as to the accepted limits on such products.
Eye drops and other liquid preparations should be discarded after a maximum of one month only if stored in the refrigerator. If not kept cool, they are safely used for a much shorter time. Refrigeration ensures that bacteria entering the opened container will not multiply beyond an acceptable rate and harm the patient.
I have a very active and athletic 11-year-old son who was diagnosed recently as being severely lactose intolerant, which is unfortunate as he loves dairy food. Lactaid drops that are meant to neutralize the lactose in dairy products do not work for him. As a result, he has had to cut anything dairy out of his diet.

In addition, he’s become bothered by the idea of eating any meat product, and he’s never eaten fish. He now calls himself a parve-tarian (an eater of no meat and no dairy). On top of all this, he’s a very picky eater. He does eat eggs and gets protein from a limited amount of other things such as peanut butter, rice, beans and so on. But I am concerned for his overall growth and development and that on a diet heavily consisting of starches and carbohydrates, he is not getting anywhere near the nutrition that he needs, especially at his age and how physically active he is.

What’s a parent to do in a situation like this to be sure that he does not cause any long-term damage to his body and development?

    – F.J., Jerusalem
  Dorit Adler, head of the clinical dietitians’ unit at Hadassah-University Medical Center in Jerusalem’s Ein Kerem, replies:
Lactose for a lactose-intolerant person is not all or nothing. There is a dose response in lactose intolerance, which means that the larger the amount of dairy food one eats at once, the more likely a reaction such as stomachache, discomfort and gas. If he were to eat half a serving at a time, it is likely that he would not suffer from gastroenterological complaints. The condition can occur equally in boys and girls, but growth occurs at slightly different ages.
In addition, there are dairy foods that contain less lactose, which is a milk sugar produced by mammals; these include yogurt, cottage cheese, hard cheese and goat’s milk products. In addition, it is important to eat the servings of dairy products as part of a regular meal and not alone. There are also low-lactose products such as long-life milk.
I strongly advise you to take him to a clinical dietitian; every healthfund has several on staff. As he is 11, it is a critical age beforeyour son is due to begin his growth spurt. His being athletic alsomeans he needs nutrition for his muscles and more-intense physicalactivity. If he is not getting enough protein and the correct mix ofcalories and nutritional components, his growth and development couldsuffer at this critical age. The dietitian will help you and your sonconstruct an ongoing suitable diet for him that he can live with andenjoy without suffering the side effects of lactose intolerance andthat will promote his health.
Rx for Readers welcomes queries fromreaders about medical problems. Experts will answer those we find mostinteresting. Write Rx for Readers, The Jerusalem Post,POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at(02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials,age and residence.