RAVES

Bad Service

Last week I took my Tacoma to the new oil change place in [local town]. They offer a free state inspection. The next morning I noticed that one of my hubcaps was missing. I checked the inspection report and this hubcap belonged to one of the wheels they removed, When I checked the other wheel they removed, it was not installed properly. I returned to the location and was told "it sometimes happens" and that they "installed them properly.” If they cannot install hub caps properly I would not trust them to touch my engine. Tacoma hubcaps do not fall off if they are installed properly.

Cemeteries Need Money More Than Flowers

Community Spirit

Thank you to Mike and Luke and their employees and staff at Harding's Furniture Store in Mt. Morris for arranging to transport a donated and much needed lift chair to the Teresa House in Geneseo. Thank you for this generous and helpful action. Welcome to the Genesee Valley and for "jumping in" with your charitable community spirit.

Saved The Runaways!

A few days ago our 2 young dogs pushed their way out of the house and took off like a shot. Within seconds they were a few acres away and out of sight. The next thing we knew there were several vehicles stopped on the road including a contractor who was using their lights to alert other drivers. The dogs were with them and came when we called. I was so busy getting the dogs back to the house, I did not even acknowledge those who helped. So, whoever you are, thank you so much for your role in getting the "kids" back to us. That was a real kindness. Thank you, thank you, thank you and God Bless you!!

Go to WWW.GVPENNYSAVER.COM and submit your own Rants and Raves under the tab - SHARE WITH US

Regarding the rant about the maintenance at the local cemtery. Being a caretaker of one, I wondered when the last time they donated was. Most small town cemeteries are struggling to get the funds to mow, weed eat, and for maintenance. People spend big money on flowers. How good are they going to look if you can't see them with the grass taller than the headstones. Please donate to your local cemetery. Your loved ones are there along with veterans.

Annoying Dogs

Living in town can be a challenge during the summer months with loud lawn mowers, weed eaters, power washers, etc. But those sounds are to be expected. My complaint is people who tie their dogs outside for hours on end. The dogs literally bark nonstop. Is there no law against this? It is difficult to enjoy gardening or just simply relaxing and enjoying a conversation with a friend with a dog barking constantly. Why do people do this? It can't be good for the dog and it certainly is annoying to nearby neighbors. Please stop leaving dogs tied outside if they are going to bark all day!

To Your Good Health

By Keith Roach, M.D.

Prescription Costs

$500 for a Month’s Supply

DEAR DR. ROACH: What can you tell me about a prescription of 145 mcg of Linzess, and why a doctor would prescribe a pill over $500? What are the advantages to taking this? Surely, there must be something less expensive that will provide the same results. -- J.P.

ANSWER: Linaclotide (Linzess or Constella) is a medicine used for constipation, either in people with irritable bowel syndrome or in people with constipation for no particular reason. It works by activating a protein to allow chloride and bicarbonate (along with fluid) into the intestine. Since it is not absorbed into the body, it has few side effects. The major side effect is that it can work too well and cause diarrhea. This is enough of a concern that the medicine is not used in children under the age of 2. There are three different strengths: 72, 145 and 290 mcg.

If you are asking me to defend pharmaceutical pricing, I can’t do that. I very seldom use this medicine because there are so many other options for constipation -- starting with a different diet without using any medicine at all. But in people with occasional constipation despite having a good diet, I usually start with fiber supplements. If those don’t work, I recommend a surfactant such as docusate (Colace), which allows more water to enter the stool. Yet another option would be nonabsorbable substances like polyethylene glycol (MiraLAX and others), lactulose, sorbitol and magnesium. All of these are much less expensive. However, there are still people who don’t do well with any of these less-expensive (and also tried-andtrue) alternatives. Linzess has made a real difference in the lives of several of my patients. It is usually prescribed by an expert (a gastroenterologist) at least in the case of my patients.

Finally, Linzess is roughly $20 a pill or about $500 for a month’s supply in the U.S. without insurance. Some people only need it occasionally and are very willing to pay, even if insurance doesn’t cover it.

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Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.