Not all Maalox are Equal

Not all Maalox products are interchangeable. Most parents think of antacids (for heartburn) when they hear the name Maalox, but Maalox Total Relief contains an anti-diarrheal agent. Recently, the FDA warned consumers to avoid Maalox mix-ups because the active ingredient in Maalox Total Relief, bismuth subsalicylate (related to aspirin), can cause serious side effects if it is taken by children and adults who are at risk for bleeding excessively. One such risk factor is having a history of gastrointestinal ulcers or bleeds. Another risk is taking anti-diabetic medicines, blood-thinning medicines (warfarin, aspirin), and nonsteroidal anti-inflammatory agents (ibuprofen, naproxen). Children and teenagers who are recovering from viral illnesses (chicken pox or flu-like illnesses) should also steer clear of aspirin-containing products to avoid Reye's Syndrome. Finally, patients allergic to aspirin should not take anything containing bismuth subsalicylate.

Novartis, the manufacturer, has agreed to rename Maalox Total Relief to remove the name Maalox and change the graphics to make it clearer that these are different products. You won't see these new packages until later in September. Until then, ask your pharmacist to make sure you're buying the right product for your child or yourself. Ask yourself: what is it that's bothering your child?

• Is it just gas? You can just get plain simethicone (Gas X, Mylicon, or generic equivalents) for gas relief.
• If your child has heartburn, acid indigestion, sour stomach, or upset stomach from these symptoms, but no gas, then Maalox Children's Relief will be appropriate.
  
• If your child is 6 and older and also needs gas relief, then choose Maalox Junior Plus.
  
• For children 12 and older with diarrhea and upset stomach and not recovering from a viral illness, try Maalox Total Relief. For heartburn, sour stomach, and acid indigestion relief without gas, try Maalox Regular Strength Chewable.
  
• Gas is also the problem? Then try either Maalox Advanced Maximum Strength Chewable Tablets or Maalox Advanced Regular Strength Liquid. Note that the Advanced Maximum Strength (as compared to Regular Strength) chewable tablets and the Advanced Regular Strength liquid both have simethicone, but they have different antacids. Here it becomes a preference of dosage form, as both will be effective against heartburn, acid indigestion, sour stomach, and upset stomach from these symptoms.
  

To identify which active ingredients each product contains, read the label under "Drug Facts." Below is a table that lists the active ingredients and the products that contain them. Please visit the manufacturer's web site for more detailed information. Report and side effects to the Medwatch program (that's how the FDA picked up that there is a potential danger when these products are confused).

	Active Ingredients	Indications
Maalox Children’s Junior Relief Chewable	Calcium carbonate	Acid indigestion, heartburn, sour stomach, upset stomach due to these symptoms
Maalox Junior Plus	Calcium carbonate, simethicone	Acid indigestion, heartburn, sour stomach, upset stomach due to these symptoms, bloating and pressure (gas)
Maalox Regular Strength Chewable Tablets	Calcium carbonate	Acid indigestion, heartburn, sour stomach, upset stomach due to these symptoms
Maalox Advanced Maximum Strength Chewable Tablets	Calcium carbonate, simethicone	Acid indigestion, heartburn, sour stomach, upset stomach due to these symptoms, bloating and pressure (gas)
Maalox Advanced Regular Strength Liquid	Aluminum hydroxide, magnesium hydroxide, simethicone	Acid indigestion, heartburn, sour stomach, upset stomach due to these symptoms, pressure and bloating (gas)
Maalox Total Relief	Bismuth subsalicylate	Diarrhea, upset stomach associated with nausea, heartburn, and gas from overeating

Nose bubbles

My 21-month son had a cold for about 2 weeks. I know my mother-in-law wagged her finger at me (even over the phone) when I told her we didn't visit our pediatrician. I didn't even call him. No, no medications either for his runny nose or cough (I presumed from postnasal drip). Yes, we did have a few rough nights, but I wasn't worried because he was drooling so much. Teething. It really wasn't fun changing his outfits 3-5 times a day. My fingers also became his teething ring. Ah, the joy of parenthood; my shirts also became his snot rags. In any case, I watched the mucus from his nose change from runny and clear to thick and green. He also made big nose bubbles. Still I did not worry, since he never had a fever and his activity level was normal. He even tolerated physical therapy. I did, however, use a bulb syringe to help clear his nose and petroleum jelly to soothe the chafing from all the wiping with tissues.

The bulb syringe we have is one that allows you to run water right through it with its removable flap at the other end. Just rinse with mild soapy water and air dry without worrying whether it's been thoroughly cleaned.

\My son's nose eventually dried up and his cough and drooling stopped, too. Until the next teeth erupt...

Timing is Everything - Scheduling Your Child's Physicals for Insurance Purposes

Something I never thought about until I had to appeal to the health insurance company: schedule annual physicals at least 366 days after your last one if you want to avoid insurance claim nuisances. My daughter had her physical on 12/16/08 and her next one exactly a year later on 12/16/09. Maybe I should have taken it as a sign when it turned out that the appointment was never actually placed on their schedule and I never got a reminder call. I called on the day of the appointment to confirm and was told that there must have been a mix-up, but she was able to fit us in. Well, we received statements from the insurance company that the claims for the visit, including the vaccines that she endured, were denied because we reached the maximum allowed. I thought, how could that be? We were there in 2008, the visit was in 2009. Then we got the bill from the pediatrician's office. When I called the insurance company, the only thing that the associate was able to come up with is that the computer was counting days and it's exactly 365 days. "I always tell people to wait 367 days." That doesn't make sense to me, but when I schedule her next physical, I'll be sure to make it on 12/17 or after. The claims have been resubmitted, and we'll see in a week if the humans are more practical than the computer.