Hack needed: Tiny pills, trembling hands

Top of a pill bottle reads "Close Tightly" Image by Are W on flickr

A friend writes:

I am sweeping the kitchen and just found one of my brother-in-law’s Parkinson’s pills [Ropinirole].

Every time he has to take it, he drops it. It is tiny and, well, he has Parkinson’s. I can’t tell you how many times the kids end up on the floor looking for the pill he just dropped.

Are there any hacks for a Parkinson’s patient to manage those tiny pills?

For those who aren’t familiar with the term “hack,” its original meaning is “an appropriate application of ingenuity.” I’ve written about home health hacks here and here and I’m actively seeking ways to connect health hackers/makers/inventors with the people who need them. I was thrilled when my friend texted me with this question and I’d love to help.

One idea I had: put a dab of honey on your finger and use that to pick up the pill.

Another idea: ask gardeners how they manage the sorting and handling of tiny seeds.

If you’ve got an idea, please share it in the comments below!

(Image courtesy of Are W on flickr.)

19 thoughts on “Hack needed: Tiny pills, trembling hands

  1. The Hermesetas brand of artificial sweeteners has a push-button dispenser package for their teeny weeny mini sweetener tablets. It’s a plastic box with a push-down top, which dispenses one teeny tablet at a time. It has a clear front so you can see how many are inside. I think the Hermesetas package is sealed or glued shut so it would be hard to hack using it for this, and the tablets are REALLY small, but I think the concept might work. See http://www.amazon.com/Hermesetas-Stevia-Sweet-Pack-Tablets/dp/B0076RI35Y

  2. Sounds gross but I lick the end of my finger and usually the pill will stick (pour a few pills out on something with an edge). Honey would work too. Also wonder if they could just capsule the tiny pill in soluble capsule at pharmacy to make it less tiny. Or pour on spoon, flick extras off and take it that way.

      • The universe works in mysterious ways. I posted this on Sunday morning and then, around 4pm, got an email from Eli Pollard, the executive director of the World Parkinson Coalition.

        See:
        http://www.worldpdcoalition.org/?page=Staff

        She is in town for the annual meeting of the American Academy of Neurology and wondered if I could meet for a drink at 8pm. We will be on a panel together at Stanford Medicine X in September but have never met in person.

        So there I was, less than 12 hours after posting this, talking about it with the person who organizes the largest meeting in the world of people living with, treating, and researching Parkinson’s.

        She agrees with you, Catherine, that licking your finger is the best mode. You don’t always have honey handy, she pointed out.

        More to come, of course, but I had to share this wonderful serendipitous moment.

  3. Try weighted wrist weight to dampen the tremor. (But evidence is mixed for this in non-essential tremors; it’s been more patient experiences.) Also using blister packs and pillboxes will save the hassle of opening separate bottles. Finally check to make sure Meds are not contributing to additional movement disorders. Best of luck getting a ‘handle on things’.

  4. I take 6 different prescription drugs for Parkinson’s, 6 times a day in five different combinations with 6 different time intervals… And I also am much more clumsy and stiff in my fingers when a dose is due, which is why I prepare my doses for a week or two in advance. I am also very careful not to drop any pills when I am about to take them. My biggest challenge when it comes to PD meds is finding a practical dispenser that’s not too big and not ugly-looking… I would love to see a good PD-med hack!

  5. I don’t have Parkinsons but I have CF and I take about 60 pills a day. Among these are steroids (prednisolone). I take 4 per day. They are tiny pills packaged in a way that almost guarantees some will fall on the floor. I have no shake and I have good dexterity. I have 20/20 vision and quick reflexes. I regularly drop them. I don’t have a hack. I wonder how older people with worse eyesight and maybe some arthritis cope with these pills. I know a lot of older people take steroids for respiratory problems.

    The other problem is the pills are so tiny that sometimes I think I have swallowed them all but one will still be in my mouth. They can nestle between teeth and gum. After a while it is obvious because they start to dissolve and the foul taste gives it away. I am very good at swallowing pills so it is not my technique.

    I have not found a good hack yet.

    The answer is bigger pills. Why are they so small?

    For a while I thought they were deliberately made tiny to make them more likely to be dropped so Pharma would sell more as the pills dropped on the floor would be discarded. I don’t think that’s true though. I guess people just pick them up and take them anyway but that’s not hygienic.

    I have tried to take it up with the company that makes the pills but they have zero interest.

    I think it is so difficult to get anywhere with things like this because the person who pays the product supplier is not the person using the product. As long as the supplier gets paid, they don’t care.

    I would love to see a mechanism that that ensured patient experience fed back into the their healthcare provider’s purchasing criteria, particularly where the issues impact on safety and adherence in the real world.

    Until that revolution happens, I will continue to hunt for a hack.

  6. Parkinson’s is a multi-faceted disability. It’s not only hand tremors that make pill taking such a challenge but it is also the compromised eye muscles causing distorted visions for the person coping with it all. Dropped pills are dangerous for children and also pets. Both are able to spot the fallen pills as it were shiny pennies. We resort to putting the pills in a little applesauce and if handling a utensil is not as problematic as fingering an object – it’s an alternative. The pills stick to the applesauce and they go down smoothly, as well.

    • Thank you, Marilyn!

      Another suggestion from a Twitter colleague: put the pills inside a Fig Newton. I’d be worried about accidentally biting into it but maybe that’s not a concern?

  7. I don’t have an answer to the hack question (and thank you for re-posting the proper, original meaning) but I want to point to another dimension of the issue: it’s what I’ll call the utter disrespect for, disregard for, and ignoring of the practical needs of “the ultimate stakeholder,” the patient.

    Please say double-hi to Eli for me. Because of Sara Rigarre, I got invited to speak at the Word Parkinson Congress in late 2013, and it was astounding, because a large proportion (what, Sara, 30%??) of the audience was patients. One palpable difference compared to most speeches is that these people laughed and applauded in places where doctors and researchers don’t, as the video shows. (Free registration required; my 24 minute talk starts at 1 hr 2 minutes in.) (The slides are not synchronized properly – a production problem.)

    Next point: do you know the wonderful book Periipatetic Pursuit of Parkinson, conceived and written and produced by patients? I’ll dig out my copy and see if it has anything about pill handling.

    Lots more later – gotta get on a call.

    • The other thing I want to add is how useful it would be for medicine (drug developers as well as the FDA) to study and adopt the discipline called usability. In Let Patients Help I express this as “Make it easy to do the right thing.”

      Could we start a discussion about “pill usability”?

      In every other industry if it’s hard for the end user to use your product in its intended way, you go out of business or a competitor eventually kicks your butt, so eventually all survivors have learned to make it usable or suffer the consequence. In medicine(s), entry of new competitors is far tougher, so this tends not to surface – instead people write scholarly articles about patients not being “compliant.”

      Wouldn’t it be great if developers and the FDA could look at whether the product can readily be used as intended, by the people it’s intended to be used by?

      The retail pharmacy industry has figured this out, with the introduction of caps that are child-safe and/or far more usable by arthritic hands. Why not apply exactly the same thinking to the physical “package” that carries the active ingredient from bottle to body?

      (Victor Montori at Mayo talks about “minimally disruptive medicine,” i.e. the physician prescribing things that actually work in the patient’s actual life with all its complications. This “pill usability” issue seems to be an expression of that thinking.)

      • Thanks, Dave!! Some of the replies on Twitter have been from people who imply that the FDA *does* look at delivery mechanism (pill, patch, etc) during the approval process, but clearly we could use a refresh.

        I’m reminded of my favorite story about patient-centered design: a redesign of the auto-injector for epinephrine. (Not only is it a great story, it’s had such a significant effect on my own #1 worry: treatment of anaphylaxis).

        The original cigar-shaped design was a Cold War design and a huge step forward from the old vial-syringe-needle kit.

        People who carry an Epi-pen are grateful for it — but guess what? Its awkward size means that not everyone carries it as often as they are supposed to. But it was the only choice. A whole industry grew up around ankle holsters and fanny packs that are fashion crimes of the first order.

        Beyond the awkward shape, the non-intuitive design meant that bystanders often didn’t know what to do with it — or accidentally stabbed themselves instead of the person having an allergic reaction.

        Eric and Evan Edwards grew up with life-threatening allergies vowed to design a better auto-injector — and they did. It’s the Auvi-Q — designed to fit into a jeans or shirt pocket AND the usability is much more intuitive AND it talks you through the injection. They were empowered to say no to the poor design that hadn’t changed since the 1940s and 50s.

        Read Joyce Lee’s post if you’re interested in learning more about the Auvi-Q.

        I truly don’t know if there is a reason why these pills have to be so tiny. Maybe this has all been discussed and we just have to live with it — and create hacks to handle it. But I’m grateful for everyone contributing to the conversation!

        • Well, if they do consider usability, evidently they’re failing bigtime for Parkinson’s, eh?

          I wonder if any of those tweeps know of a way to report “Yo, this is not working here.”

  8. Dave, thanks for alerting me to this thread and for the plug for our book. There isn’t anything specifically on the topic of tiny pills although we do mention pill rolling (a very different issue.)

    I have no tremor with PD but do have the general clumsiness that can come with the rigid form. My solution for tiny pills and motor challenged hands is to use a larger box, like the flat metal box mints and some fruit candies come in (approximately 2 x 21/2 inches). I transfer my daily mix from my weekly pill organizer into it). The hinged lid is easy to open and reasonably secure in a pocket or purse. It is much easier to fish out one small pill using this system and I have less fear of dropping the whole bunch in the process of opening a smaller, less cooperative box.

    Of course getting it to your mouth is another issue. A friend and I spent 10 minutes yesterday looking for a dropped pill while keeping the dog (who was very willing to help) out of range.

  9. I’m a product design student at university looking for a way to improve the lives of those with chronic diseases, primarily focused on hand tremors. I stumbled across this post whilst researching and wondered if anyone had found the perfect solution yet?

    I’ve found the “Zuup Pill Dispenser” and believe this might be a suitable product to aid administering pills with shaking hands – just thought I’d post in case someone took a fancy!

    • Hi Tory, thanks for the comment — so glad you found this post. I don’t think anyone has concluded anything except to note that this issue is a problem for some — not all — people with hand tremor.

      Since I wrote this, I had the honor of being the moderator of a panel at Stanford Medicine X that included two patients who are involved in designing better products (both real and virtual) and a leader in the patient advocacy/research world.

      Here’s the panel description, just fyi:
      http://medicinex.stanford.edu/conf/conference/event/101

      And here’s the conference YouTube channel — you might be interested since it’s a very design-friendly (even design-happy) medical conference:
      https://www.youtube.com/channel/UCK1chhgXNHf7iB5mlqzXODA

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