Dr James Schaller
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Creative and Special Medical Creams to Treat Child and Adult Nausea, Diarhea, Fever, and Arthritis Joint Pain.

From: Schaller JL. Treating pain and nausea in children and adolescents. RxTriad 2002;October:1, 2. Reprinted with permission.

"Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an underground dictatorship ... To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un-American and despotic and have no place in a republic ... The Constitution of this republic should make special privilege for medical freedom as well as religious freedom."

Dr. Benjamin Rush, signer of the Declaration of Independence

James L. Schaller, MD, MAR, is a psychiatrist in private practice in a suburb of Philadelphia. He is also the president of the Chester County Research Center in Chester County, Pennsylvania, for which he oversees research on preventive medicine, antiaging therapies, bioidentical hormone replacement, and analyses of the purity of nutritional products. In addition to child, adolescent, and adult psychiatry, his clinical specialties include bioidentical hormone replacement therapy for adolescents and adults, as well as pediatric health care and nutrition. Dr. Schaller's patients range in age from birth to 85 years; approximately one third are children. Because effective hormone therapy for adolescents and pharmacologic treatment for pediatric patients often require delicate adjustments in dosage, compounded medications are an essential part of his practice. In the interview below, Dr. Schaller discusses the use of compounded medications to treat nausea and pain in children and adolescents.

Which types of illnesses do you treat?

My practice is now very broad based. Initially, I treated a variety of neurologic diseases, learning difficulties such as attention-deficit disorder with hyperactivity (which is often misdiagnosed in children), and psychiatric disorders such as depression, anxiety, oppositionality, and obsessive-compulsive disorder. I now also prescribe bioidentical hormone replacement therapy for premenopausal conditions and premenstrual tension in adolescents, and I provide family-medicine care for patients of all ages.

Why do you prescribe compounded medications?

About 25% of the medications that I prescribe are compounded, and many of those are for children. Most children are fragile; they should not be given the standard doses or artificial dyes found in many commercially manufactured medications. They require treatment tailored to their size and medical requirements, and working with a compounding pharmacist enables us as physicians to provide those customized therapies. I have found compounded formulations to be especially effective in treating nausea, diarrhea, and pain in children.

Which compounded medications do you prescribe to treat nausea?

When you're nauseous, you don't want to be swallowing pills. I usually prescribe a compounded promethazine cream (for small children, I start with 6.25 mg of promethazine in a cream base) to relieve nausea. That cream also relieves motion sickness. Commercially available promethazine is available only in oral or rectal forms, but in compounded form the penetrating transdermal cream has an extremely rapid onset of action. The dose must be adjusted to the patient's size, and if the preparation is overused or the dose is significantly excessive, arrhythmia can occur, but that is very rare. In some gastrointestinal illnesses, nausea is followed by diarrhea, for which I prescribe transdermal loperamide (2 mg/0.5 mL) in the pharmacist's choice of base. For a small child with diarrhea, I recommend 0.5 mg of loperamide in a cream. To treat the fever that often accompanies such illnesses, I prescribe acetaminophen in a cream or rectal suppository so that it's not necessary for the child to swallow pills when he or she is nauseous.

Which preparations are the most effective analgesics?

I have had success in treating sports-related injuries to the hand, wrist, ankle, finger, knee, or elbow with a transdermal cream for localized use. The cream is applied to the point of pain and does not necessarily need to exert a systemic effect. It also prevents the microinflammation of the gastrointestinal tract that often results from treatment with oral nonsteroidal anti-inflammatory drugs. The addition of low-dose ketamine is optional if severe pain must be relieved. To treat lesser pain or localized trauma like an ankle injury caused by a skateboard, I prescribe a combination of ketamine, ketoprofen (which is better absorbed than ibuprofen), amitriptyline, gabapentin, and a tiny amount of clonidine in a transdermal cream. The dose can be adjusted to the patient's size, and the cream can be applied once every 12 hours. Relief may occur as rapidly as 15 minutes after the first application.

Sore throat pain in children can be just as debilitating as pain from an injury. I use a mist delivery system to treat a severe sore throat. The compounded mist that I prescribe, which disperses pain medication to the entire throat area, usually contains lidocaine 10% and tetracaine at a 0.5% strength. Even severe sore throat pain is immediately relieved by 1 or 2 sprays.

Which other benefits do compounded preparations offer?

Compounded medications are loved by patients; they are very effective. Compounding pharmacists are the best pharmacists in the world because they understand drugs and have an excellent command of the effects of medications on the body. Compounding is more than pill counting. It is a superspecialization. For people who are tired of the impersonal hassle of dealing with an HMO, a compounding pharmacist is pure gold!

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