Hardwood Flooring Species

 

How to Install Laminate Flooring | Shaw Floors

Hardwood flooring is unmatched in beauty, durability, and time-to-market in modern homes. Hardwood flooring adds value to your home and creates a warm, inviting atmosphere in your indoor spaces. It also gives your home an authentic look that is unmatched by other types of flooring. My Affordable Floors is the local expert in hardwood flooring installation in Milwaukee Racine and Chicago. We would love to help you beautify your home using hardwood flooring.

My Affordable Flooring can help answer all your questions before you start with hardwood flooring installation. The most frequently asked question is about the types of hardwood that can be used for Floor mod. This information will help you make a decision and select the right species of wood to fit your home.

Red Oak, White Oak and Maple hardwood flooring have been used in American homes for years. These domestic hardwood species can be used in traditional settings, or to complement existing furniture or cabinets. Natural Red Oak remains one of the most popular wood species due to its hardiness, beautiful grain pattern and durability. The Janka hardness rating for Red Oak is used to compare the hardness of all wood species. Except for a few exceptions, domestic wood species tend to be lighter in color than other wood types, unless they are stained a specific color. My Affordable Floors can install many types of domestic wood species including engineered, clicklocking, hand-scraped, character grade and natural.

Even the most expensive wood flooring can react to moisture. Moisture can cause wood to shrink during dry winter heating. This can lead to unsightly gaps between planks. The wood expands and absorbs moisture when humidity is higher in the summer. Too much moisture can cause wood planks and other materials to buckle or cup, causing them to look distorted and affecting the floor’s smoothness. When installing a wood floor in your home, it is crucial to properly acclimate the wood materials. It is also important to allow adequate expansion space around perimeter and fixed objects. The manufacturer recommends that the relative humidity of the home be maintained between 30 and 50%. This will minimize movement in the wood flooring.

My Affordable Floors has over 20 years of experience in hardwood flooring installation. We know how to install any type of hardwood flooring in any home, to suit every style and lifestyle. Our extensive experience and skills will ensure you find the perfect floor for your home and help you maximize your investment.

 

Review of Apple iPod Touch

The initial school of applications to remember in regards to increasing your residing production is applications linked to driving and obtaining your path around. They are GPS applications, and they basically turn your smartphone in to a tiny portable GPS device. These purposes permit you to only put in your location and you will be able to see regional restaurants or even the addresses of your friends and family.

Google Maps Navigation is a great request that can help you attain only that. This is ostensibly an intelligent telephone version of the extremely popular internet site on the web that enables people put in directions and search for locations. Google’s Maps Application presents satellite and street views that other cellular applications do not provide.

Firm applications for the LG Enjoyment will also be essential because they can support us remain structured and produce life much easier for us. Organizational applications can include applications that assist you to with arrangement and conference visits and deadlines, in addition to applications at that support you place up calendars and even produce your own to accomplish provides through the touchscreen and writing performance of the phones. It is becoming harder to remain on top of points today in contemporary life, because so many folks have many obligations to tend to, so when you’re able to turn your smartphone in to an ally to help you remain attached and up to date with contemporary life, then it’s value using advantage of.

Mobile Searching has additionally become remarkably popular and that’s why there are many searching purposes for sale in the App Market. These kinds of applications can give you directions and addresses and results to the nearest centers, shops, food markets, and other aspects of contemporary life that you could be enthusiastic about locating in the actual world. You can also use such applications to learn all sorts of reviews of stores that can help you determine which keep you are enthusiastic about visiting or getting points from.  Shycocan

As you will see, you can find several features about the LG Enjoyment can be good for day-to-day coping with several applications, including applications for driving, searching, and work. Along the way, it would perhaps not be described as a bad idea to look in to some accessories such as a data wire, an incident, screen defender, and a Wireless headset. Using a data wire you will be able to transfer files from your PC to your telephone and the Wireless headset allows you speak hands-free as you get which is often really good for your safety.

their residence to examine if the garage door closed. Get some good bit of mind and don’t be concerned about turning everything down before you leave. You are able to turn everything down without even being there. Hook up to the user screen, shut garage door and always check any parts you may have forgotten. A good home may also support keep you on-time.

Simplify your house and perform the House Movie audio, movie, and some other parts all from distant control. One handy remote control is an easy and easy solution to play music in virtually any room at anytime. If you prefer music, utilize the multi-room audio function and balance out the acoustics in your home. You can be green and appreciate the right feel in most room with lighting control. Dimming your lights uses less energy, thus helping you save money. Enjoy get a handle on from everywhere with an intelligent telephone or web connection. Get some good bit of mind and monitor your house security while on the road.

Betting High on Gambling

While all the items and solutions given by organizations worldwide are cyclical in nature, there are not many client groups offering expense possibility no real matter what business routine the economy is in. One particular market is gambling. Irrespective of the economic issue, there is always footfall in a casino or perhaps a betting hall. To be able to diversify a profile, gaming is among the fascinating groups to be invested in. The it self features a strong reception which may perhaps not let it fall. One do not need to use for a gambling licence or invest in a casino to raise a guess with this sector. Connect industry and stock areas offer various possibilities to achieve contact with gaming business.

Before going in to investing, let’s understand several standard reasons for having the industry. Gambling involves a host of betting activities such as for example betting on races and activities events, casinos, poker, and position machines login pkv games. These organizations could be among the two forms: American-styled gaming that will be modelled after the destination centered gambling and European-styled gaming which consists of retail betting shops. With the development of net a third kind of gaming organizations have surfaced which concentration only on line gaming. This calls for both manufacturers of application and operating platform and sponsor gambling organizations which offer gaming items to consumers online.

Historically, all types of gaming activities were considered illegal. Several illegal operators endured on local stage as a result of living of strong demand for the sector. This generated change in the belief of gambling activities and governments across world legitimised gambling labelling it to be leisure or recreational activity. This triggered popular development of casinos (mainly in US) and betting stores (in Europe). With the adjusting situations, new products were included such as for example position machines, off class betting, phone betting and finally to on line betting. While all the places are which allow gambling are quiet on on line gambling, American places have already been the leaders in the field. In 2000s, UK followed closely by Italy and Spain legalised on line gaming, giving way for new sort of players in the markets.

Nevertheless very regulated, equally land-based gambling and on line gambling have converted into lucrative business. Investors will to enter gaming market could spend money on a number of the organizations which have their shares shown in stock exchanges for example Bill Hill. Also, few of the gaming organizations have ties remarkable, giving great options for repaired revenue investors to achieve coverage to this sector. But, the market is very regulated, exposed to scientific improvements and has high detailed gearing. Investors are encouraged to hire economic advisors who will be able to get into these risks related to the bond, match it with chance appetite of customers and offer suggestions for investments.

Cheap Car Insurance Is Easy To Get Online

Can you ever question why various vehicles run you various amounts for vehicle insurance premiums? Why is it a new Corvette may run you $1,600 pounds a month in vehicle insurance and an older Buick Regal may only run you $90 each month? The brand new vehicle insurance price versus the previous vehicle insurance price is really a issue that you have to evaluation before you buy any car. Evaluation insurance expenses before you buy and you won’t get caught in an economic trap.

New vehicles price more to insure than previous vehicles for three reasons. First, a car robbery of a new and amazing vehicle expenses far more than the vehicle robbery of an older and average type car. That is because of the big price big difference of the new vehicle versus previous car. Like, a new Chevy Caprice is a lot more pricey to insure than an older Chevy Caprice. It really expenses more cash to displace a new, high priced vehicle than an older, more affordable car.

Second, the price to repair a new vehicle is a lot a lot more than the price to repair a classic car. Therefore, that fact will also raise your insurance premium price for a new car. Like, if your new Chevy Caprice is damaged in an incident, the vehicle mechanic shop can charge you much more cash for repairs than if the subject vehicle were a ten-year previous Chevy Caprice. Because of this, your insurer can charge you far more insurance premiums on a new vehicle than an older vehicle due to such restoration costs.

Third, the type and form of vehicle also will considerably influence the price of automobile insurance premiums that the Car insurance business can charge you. Insurance businesses use actuarial statistic platforms which demonstrate to them days gone by loss knowledge on unique styles and kinds of cars. They use these platforms, to help calculate what premiums to charge their consumers in the future. Mathematical platforms show these insurance firms that owners of certain styles and kinds of vehicles, such as for example sports vehicles, participate in more risky driving conduct than owners of vehicles which are of average type and style.

Like, insurance business statistical platforms reveal that the insurer has skilled more losses with sports vehicles than with average cars. It is because the owner of a Corvette will most likely get such vehicle quicker and riskier than the owner of a Toyota Camry. With such pace and risk also comes along more losses for the insurance companies. With such risk and loss increase, the insurance business must then increase their return and charge more for vehicle insurance premiums.

Another exemplory case of how the type and type of vehicle may present an insurance business with increased risk is the off-road type cars like the Hummer type of vehicles. These cars are designed to accomplish in the off-road type environment. They are increased up down the ground a lot more than standard automobiles for under carriage clearance. Moreover, there is also four-wheel get capability.

With such design abilities, the statistical platforms reveal that the insurance business has skilled more losses with these kinds of vehicles than standard cars. This is because the owners of such cars can participate in off-road driving that is both risky to the vehicle and driver. In reality, some insurance businesses may bar recovery for such damages, when the owner of the protected vehicle was damaged while any engaging in risky, off-road driving. Again, with increased risk, the insurance business increase return and therefore vehicle insurance premiums. Since you know that certain styles and kinds of vehicles price more to insure than others, you have to be wise about what type of vehicle you are going to buy.

As opposed to take a imagine at everything you feel a vehicle’s insurance expenses are, contact your car or truck insurance business and ask your insurance agent for a free vehicle insurance offer for the exact form of vehicle that you’re enthusiastic about buying. You will get a certain response to your issue of whether you can afford both the automobile and the insurance premiums necessary to cover your car or truck against protected losses.

Enough time to produce such analysis isn’t following you purchase a vehicle. When this occurs over time, it’s also late. Enough time to produce such analysis is way prior to your getting an automobile. You definitely desire to be able to produce both vehicle obligations in addition to insurance premium payments. Get a free vehicle insurance offer ahead of time and avoid financial problems.

Are You Really the Patient? Medical Identity Theft Facts You Didn’t Know

The public has become more armed against the threats of identity theft. While identity thieves can steal individuals’ money, ruin their good credit and cause years of aggravation and stress, an alternative form of identity theft, medical identity theft, can actually threaten lives.

Medical identity thieves steal and misuse other people’s personal information including their name and insurance card account numbers without the person’s consent and usually without their knowledge.

The Scary Truth about Medical Identity Theft

Your medical and insurance records follow you and when false information is added to your medical records, you can be at risk when you are treated in the future. Doctors may make decisions about your treatment and medications based on a fictitious medical history and this can put your health at risk. Not to mention that the insurance companies will have noted false “pre-existing conditions.”

As more and more medical communities rely on electronic records, the information is more likely to follow you on a larger scale and some believe this trend makes it easier more medical records to be compromised.

What can a thief do with your medical identity?

Medical identity thieves may use other people’s information to obtain medical care, prescription items or to make fraudulent medical claims.

A medical identity thief without insurance who wants a surgery or prescription drugs can use your information, get what they want and leave knowing you and your insurance company will get the bills.

Some medical identity thieves are motivated purely by money. Thieves can collect large amounts of money, even millions of dollars, by making these false medical claims.

Don’t Ignore a Medical Billing or Insurance Statements

Don’t assume a medical bill or insurance statement for services you didn’t get is just a mistake. It could be the first sign that someone has stolen your medical identity.

Joe Ryan, a Colorado resident, got a hospital bill for over $40,000 for surgeries and treatments he never received. This wasn’t a billing error. An ex-con had used Ryan’s medical identity to check into the hospital and obtain extensive medical care. Two years later, Ryan was still trying to undo the damage to his medical records.

You may not learn about a medical identity theft from a bill. Brandon Reagan, who stationed in California, learned that his medical identity had been stolen and used in South Carolina when his mother called and told him he was the lead suspect in a car theft. Reagan had lost his wallet in South Carolina and a thief used his military i.d. and license to test drive cars and then steal them. In addition to getting Ryan on a wanted list, the thief also used Ryan’s medical identity to go the hospital on several occasions to get treatment for injuries and kidney stones. The medical bills were close to $20,000.

Even though the identity thief was finally arrested, Reagan was left with a nightmare. His medical records in South Carolina were full of false information and his tax refund check was withheld due to the unpaid hospital bills still in his name.

Sketchy Law and Statistics on Medical Identity Theft:

Laws dealing with medical identity theft are still not thorough or consistent from state to state. Many Federal laws that were intended to protect confidentiality actually make it more difficult for you to access and correct your own medical records.

Wide scale investigations into medical identity theft are just beginning but in 2005 there were over 8 million victims of identity theft and three percent, 249,000 of those involved medical identity theft.

Pam Dixon, executive director of the World Privacy Forum warns, “Medical identity theft causes terrible harm, both financial and physical.”

How can you protect yourself from medical identity theft?

-Get a copy of your medical records for comparison in case they are compromised in the future.

– Annually request a list of payments made for your medical services from your insurance company.

-Review your Explanation of Benefits (EOB) as they are provided by your insurance carrier to determine their accuracy.

-Check your credit report at least once a year for any unusual unpaid charges.

-Research and report any suspicious medical bill or insurance statements.

Why You Need to Understand Medication Management

Early in my mom’s tenure in assisted living, I noticed her monthly bill had a significant expense labeled as “medication management.” As someone who rarely takes any medication, I realized I needed to understand the process better.  I’ll be dedicating several posts in near future to this topic, as I believe family involvement in medication management is critical.

Medication is a Major Issue According to a 2006 study by the three leading non-profits – ACHA, NCAL and MEFC, medication is often a major component of an older person’s life, making it a major issue for assisted living facilities. The role of medication and medication assistance (called “medication management” by assisted living administrators) is surprising:

 

  • 77.5% of residents needed assistance with medications
  • Residents were taking an average of 13 medications

 

In an assisted living setting, residents rely heavily on staff to assist with the timely and correct delivery of medication.  But in the United States alone, nearly two million Americans experience adverse drug reactions from prescription medication each year.

What can you do to protect your loved one? A better understanding of medication management can help.

Where to Get Medications Families have several options for filling prescriptions on behalf of loved ones.  They are:

 

  • Mail order. Most health insurance and Medicare plans provide options for mail order delivery of medications.  Prescriptions are usually filled in 90-day quantities. Price discounts are usually offered over that of pick-up or local pharmacies. Unfortunately, mail order makes urgent medications challenging.
  • Pick-up. You guessed it?!  You or a family member pick up prescriptions and deliver them to the facility. For a small number of medications, this may be feasible.  But it doesn’t work for multiple prescriptions on multiple delivery schedules.
  • Local pharmacy delivery. Prescriptions are filled and delivered by a local pharmacy 1-2 times daily. Since assisted living facilities usually contract with a single pharmacy, rush orders and other conveniences are widely available. I recommend this option for all but the most hands-on families.

 

Introducing the Med Room So where do they store all that stuff? It’s called a “med room.”  The med room is a restricted-entry office that holds all resident medication, dosage records and prescription histories.

If you’re looking into assisted living for the first time, you should ask to see the med room.  From an audit perspective, if you already have a loved on in assisted living, you should periodically ask to see the med room.

Your goal in visiting the med room is to validate the following:

 

  • Medication is stored in a well-organized manner like that seen in hospitals
  • Files are well-organized and clutter is at a minimum
  • The staff can quickly share with you your loved one’s medication and prescription history
  • There is a supply of pudding or apple sauce for those residents that have trouble swallowing pills
  • Contact information for your loved one’s doctors is readily available
  • The door is kept locked (verified by staff unlocking the door when they let you in)

 

Who Administers Medication Medications are provided to residents by a medical aide (called “med techs” by administrators).  Med techs are responsible for the maintenance of the med room and for administering medications correctly and in a timely manner.

Med techs typically lay out all medications on a labeled delivery tray and deliver medication to each room. Their role is to ensure residents take their medications, although they will often leave medications with caregivers, if they are present.

In the unfortunate event of hospitalization, the med tech will also provide a copy of all current medications to paramedics or the individual taking your loved one to the hospital.

Keeping Track of It All As a family member, you should stay well informed of the medications your loved one is taking. The dosage record is the easiest way to do this.

A dosage record is kept for each patient and resembles the graph paper we all used in grade school.  Along the left side of the page is a list of medications. Across the top are days of the month. Every time a medication is given, the med tech is required to sign the box corresponding to that medication and date.

The best way to spot-check medication management is to randomly request copies of the dosage report.  Secondarily, ask the staff to notify you when medications are added or discontinued, so that you have a real-time understand of the medications being consumed.

Implementing the AMA’s Guidelines For Medical Tourism

In June 2007, the American Medical Association (“AMA”) released a report entitled “Medical Travel Outside the U.S.,” that tried to explain why people are going abroad for medical care. According to the AMA, the primary reasons that Americans are traveling for treatment are the ever escalating-cost of healthcare and the lack of affordable health insurance.

On June 16, 2008 the AMA re-entered the conversation with Guidelines on Medical Tourism. These guidelines address important issues of patient safety, transparency, financial incentives, after care, and legal liability. The AMA’s contributions to the medical travel industry at such an early stage is notable and important. Many American doctors strongly disapprove of patients who seek care abroad and few will agree to provide follow-up care for returning medical travelers. Those doctors are understandably concerned about incurring liability for another physician’s malpractice.

Widespread resistance in the medical community led many to believe that the AMA would either ignore or actively oppose the development of the medical travel industry. Instead, most were surprised by the AMA’s desire to get out in front of the issue and announce guidelines that some view as a traveling patient’s bill or rights.

As the health insurance industry and employers begin to explore the cost savings and benefits of medical travel, the AMA’s contributions promote patient safety and protection. The AMA has legitimized a nascent industry with only limited support from mainstream healthcare networks. Since the AMA entered the discourse, more and more health insurers are evaluating whether medical travel makes sense today, tomorrow or sometime soon.

At this stage, AMA does not seem intent to stamp out medical travel. This may be due in part to the movement’s consumer-driven nature and the reality of restricted resources at home. Instead, the organization of medical professionals will propose model legislation to all states that protects patients who go abroad for treatment.

2. The Guidelines and Who Will be Impacted

The AMA’s Guidelines on Medical Tourism are enumerated below. Each addresses important components of patient decision-making, safety, protection and recovery.

a. Medical care outside of the U.S. must be voluntary.

b. Financial incentives to travel outside the U.S. for medical care should not inappropriately limit the diagnostic and therapeutic alternatives that are offered to patients, or restrict treatment or referral options.

c. Patients should only be referred for medical care to institutions that have been accredited by recognized international accrediting bodies (e.g., the Joint Commission International or the International Society for Quality in Health Care).

d. Prior to travel, local follow-up care should be coordinated and financing should be arranged to ensure continuity of care when patients return from medical care outside the US.

e. Coverage for travel outside the U.S. for medical care must include the costs of necessary follow-up care upon return to the U.S.

f. Patients should be informed of their rights and legal recourse prior to agreeing to travel outside the U.S. for medical care.

g. Access to physician licensing and outcome data, as well as facility accreditation and outcomes data, should be arranged for patients seeking medical care outside the U.S.

h. The transfer of patient medical records to and from facilities outside the U.S. should be consistent with HIPAA guidelines.

i. Patients choosing to travel outside the U.S. for medical care should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activities.

Generally, these guidelines appear to be directed to health insurers and employers incorporating foreign providers into healthcare plans and to a lesser extent medical travel experts coordinating the patient travel experience. The Guidelines seek to protect patients from being pressured by healthcare payers to accept lower quality care without recourse in the event of a bad outcome. The AMA repeatedly stresses the importance of informing patients of their rights and recourse, the hospital and doctor’s credentials, and potential risks associated with combining travel activities with surgical procedures.

3. Implementing Key Guidelines

a. Patient Safety

The majority of the AMA’s Guidelines are aimed and ensuring patient safety. The Guidelines call for treatment abroad to be voluntary and for financial incentives to not restrict treatment options. This measure is meant to avoid patient coercion and withholding important information about available alternatives. The AMA also requires that institutions treating patients be accredited by recognized international accreditation bodies. This rule tries to ensure that patients are treated in safe and clean facilities that meet international standards of patient care, infection control and hygiene. The AMA also requires that patients be informed of the risks of combining surgical procedures with travel activities. The Guideline’s proscription against transferring patient medical records in violation of HIPAA aims to reassure patients that their privacy rights will continue to be safeguarded abroad.

Medical Terminology – First Step on a New Career Path

In these days of economic uncertainty, career change is a hot button issue. As baby boomers retire and leave the work force, employers are concerned about the shortage of skilled workers. In addition, corporate cost cutting, off-shoring, layoffs, and forced career changes leave many workers with difficult choices. Gone are the days of one job and one employer for life. Following a career path today can mean maneuvering many twists and turns, setbacks, side roads, and blind alleys. Where is the roadmap to a new career that provides enrichment, stability and growth potential?

One of the best ways to ease some of the uncertainty and increase your marketability quotient is to broaden your skill set. Since continuing education is often required to maintain licenses and certifications, make those education hours do double duty. The right training can mean more opportunities in your current field, and serve as a stepping stone to a new career. But which industries offer the best chance for job stability and advancement?

It is predicted that expanding healthcare and healthcare-related industries will require many additional skilled workers in the coming decade. According to Forbes Magazine, “As well-heeled baby boomers age, look to the health care industry… (B)etween 2004 and 2014, seven of the 10 fastest-growing jobs in the U.S. will be in health care.” In addition to careers directly involved in patient care, demand for support professionals such as medical records and health information technicians, therapists, counselors, and medical transcriptionists will increase.

A basic requirement for entry into almost any healthcare-related career is a command of medical terminology. The ability to recognize, understand, spell, and pronounce basic medical terms, identify medical abbreviations, and decipher unfamiliar words using roots, suffixes and prefixes is a necessary tool to perform well in any medical setting. Medical terminology courses are widely available in online, home study and instructor-led formats. Because medical technology advances rapidly, medical terminology evolves to keep pace. To stay on top of new terminology, consider taking the course again if you’ve taken it in the past.

The Department of Labor database lists seven nontraditional careers that require medical terminology:

Medical Transcriptionists – To understand and accurately transcribe dictated reports, medical transcriptionists must understand medical terminology, anatomy and physiology, diagnostic procedures, pharmacology, and treatment assessments. They also must be able to translate medical jargon and abbreviations into their expanded forms.

Medical Records and Health Information Technicians – In addition to general education, coursework requirements for medical records and health information technicians includes medical terminology, anatomy and physiology, legal aspects of health information, health data standards, coding and abstraction of data, statistics, database management, quality improvement methods, and computer science.

Surgical Technologists – Surgical technologists receive their training in formal programs offered by community and junior colleges, vocational schools, universities, hospitals, and the military. In 2006, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) recognized more than 400 accredited training programs. Programs last from 9 to 24 months and lead to a certificate, diploma, or associate degree. Programs provide classroom education and supervised clinical experience. Students take courses in anatomy, physiology, microbiology, pharmacology, professional ethics, and medical terminology. Other topics covered include the care and safety of patients during surgery, sterile techniques, and surgical procedures. Students also learn to sterilize instruments; prevent and control infection; and handle special drugs, solutions, supplies, and equipment. Most employers prefer to hire certified technologists.

Occupational Therapist Assistants and Aides – There were 126 accredited occupational therapist assistant programs in 2007. The first year of study typically involves an introduction to health care, basic medical terminology, anatomy, and physiology. In the second year, courses are more rigorous and usually include occupational therapist courses in areas such as mental health, adult physical disabilities, gerontology, and pediatrics. Students also must complete 16 weeks of supervised fieldwork in a clinic or community setting.

The Dangers of Expired Medications

Expired medications are commonplace and inertia notwithstanding, many of us tend to rely on an intuitive sense of their value in continuing to store and use them. Such drugs can be harmful to health in several ways; they can be unpredictable in effectiveness, simply ineffective, or even toxic.

The formal way of classifying a medication as having expired is through it’s labeled expiry date. This date is often set based on a combination of the common properties of the dosage form as well as the stability and expiration studies of the product that have been conducted by the manufacturer. Importantly, this expiry date is contingent on specific storage conditions of the product. Although a medication may pass it’s labeled expiry date, it may not necessarily be any less effective or dangerous to consume depending on the product itself, the storage conditions and the circumstances leading up to expiry.

When most medications pass their expiry date under appropriate storage conditions, they are generally taken to have become so variable in effectiveness as to have become unsuitable for use. This often comes about as a result of the degradation of the active ingredients of the medication with exposure to physical, chemical or microbiological variables like temperature, pressure, humidity, light, bacteria as well as other components of the product known as excipients.

Creams may “crack” once their expiry date is passed, leading to a separation of the components and hence provide a non-uniform delivery of active ingredients. This can lead to the poor control of conditions like eczema or acne. Tablet medications can mechanically “powder” off, change in consistency with exposure to water vapor or even experience the contained drug itself becoming ineffective on prolonged exposure to air as occurs with glyceryl trinitrate, an emergency medicine that can easily become ineffective in relieving acute symptoms of chest pain. With common injections, should the acidity change to fall outside a fairly narrow range, significant pain and tissue damage can result from use. With most eye drops, an expiry date of one month after opening is accepted to minimize the potential for dangerous bacterial contamination.

With any medication, once a specific threshold of remaining active ingredient is passed, the medication can no longer be relied upon to deliver accurate doses. This loss of reliability is often exacerbated by the fact that the active ingredients can degrade into various combinations of active, inactive or toxic breakdown products. The common aspirin is for instance, known to react with moisture to breakdown into salicylic acid, which is active, and acetic acid, which is inactive and can lead to toxicity in excess.

While the expiry date provides a useful gauge of when to stop using a medication, there are also many other factors that can informally accelerate the expiry of a medication and make it dangerous to use, chief among which is how the medication is stored. It is oftentimes not just the medication that is affected by storage conditions but also the storage container. Under inappropriate storage conditions, certain containers can leech material into liquid medication preparations, or medication particles can stick to the container rather than remain separated. On average, a 10 degree rise in temperature doubles the rate of chemical reactions that occur to a medication product and can accelerate the rate of bacterial contamination several fold. Just like an ice cream can simply melt or a loaf of bread becomes mouldy much quicker if not refrigerated, many medication products can easily expire much faster when not stored appropriately.

With oral liquid and topical medications, potentially dangerous changes associated with expiry can at times be detected by color or consistency changes, component separations, altered smell or taste (oral preparations). Should a suspicion of expiry arise, a medication expert should be consulted regardless of whether or not the labeled expiry date has been passed.

“Expiry” should also be understood to occur once a supply of medications is no longer used appropriately for it’s intended purpose. Consultation with a medication expert is always advised to prevent the inappropriate use of existing medication supplies. Inappropriate use can often occur with self-medication and is harmful. An unfinished supply of a previously used antibiotic may be tried to treat a new infection that is actually untreatable by or resistant to that antibiotic. This practice may not only delay recovery but can also encourage the proliferation of “super bugs” that have resistance to many antibiotics. Another incorrect purpose involves sharing medications and this can be especially harmful if another is allergic to the shared medication or a child or pet is medicated with an adult’s medication. Children often require dose adjustments to accommodate their size while many human drugs are often unsuitable for pets. Even a simple food like chocolate that we may enjoy can easily be toxic to a pet dog.

Another mechanism whereby medication expiry is dangerous occurs when an unfinished supply is used despite new information that points to increased precautions associated with the medication or that has led to it’s recall. An example is obtaining pain relief from a previous supply of a painkiller like Vioxx (rofecoxib) or Celebrex (celecoxib) in spite of an existing heart condition that is now known to relate to an increased risk of fatality under those circumstances of consumption.

Expired medications that are kept instead of discarded not only take up space but can actually discourage the appropriate use of new supplies in the treatment of illness. A medication cabinet, if not tended to regularly, could eventually contain more expired medications than viable ones and this can lead to the accidental consumption of an expired medication in place of a viable one. It is definitely advisable to clear the medication cabinet of expired medicaitons at least annually if not more often.

A further danger however, lies in how expired medications are disposed of. Expired medications and pharmaceutical byproducts can be harmful to the environment especially when they end up in our rivers and drinking water supply. Hormonal compounds like estrogen from birth control pills and patches as well as antibiotics have been linked to being flushed by individuals and institutions into sewage, draining largely unchanged and collecting in rivers and streams, then returning in tiny amounts into drinking water. Traces of antibiotics could worsen bacterial resistance while estrogens and other steroids are known to change the reproductive characteristics of fish. Even trace amounts of chemotherapy medications have emerged in tap water and this could be severely detrimental to the unborn babies of pregnant women who drink such water. The long-term impact on human health of medications in our rivers and drinking water is as yet unknown but no one would want to wait to find out. We can all play our part by inquiring on and using pharmacy or state-run programs for the disposal of expired medications instead of sending them down the sink or the toilet bowl.

A pharmacist is the expert of choice to approach in handling medication expiry and should be consulted if in doubt. As a general rule, it is always best to safeguard your own health and that of those around you by expeditiously and appropriately discarding all expired medications.