We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
HAPPY NEW YEAR!!!! Have you quit smoking yet? Don’t stop reading because this will be yet another preachy person sticking their nose in my business about my decision to smoke. From the pharmacy business point of view, I want you to keep smoking. Smokers spend much more money in the pharmacy than non-smokers.
Smoking is the number 1 cause of premature death in North America. Now dead people aren’t good for business, but thankfully, smokers usually get sick before they die. A heart attack which kills the smoker is bad news, but if we are lucky, maybe the smoker will get a debilitating stroke. Stroked out smokers who can’t feed themselves, use the toilet by themselves, or walk by themselves get lots of health problems that need medications.
Even before something as drastic as a stroke, smokers are good for the pocket book.. Smoking decreases the blood flow to the skin, and this leads to leathery-looking skin and increased wrinkling. So, smokers are good for cosmetic sales. The more you smoke, the more likely you are to get cataracts -an eye problem that can lead to blindness. There will be eye drop sales to smokers with cataracts. Smoking is the main reason people get cancer in the mouth. If we are lucky, a doctor, a dentist and a pharmacist should all make mula on a mouth cancer smoker. Smoking makes it harder for your saliva to remove germs in your mouth. Smokers get stains, bad breath, and a higher chance of gum disease. Again, dentists and pharmacists should make more bucks on smokers. Smokers are twice as likely as non-smokers to develop psoriasis - a disfiguring red and silver rash that can occur anywhere on your body. We can sell smokers creams for that. Smokers are more prone to stomach ulcers. Smoker’s ulcers don't heal as fast, and they're more likely to recur. We have expensive stomach pills to sell smokers for those ulcers. Finally, guys, smoking causes impotence. Viagra sales are great to smokers.
Of course I am not serious about wanting to make money off of smokers. As a health care professional, I want you to have a healthy life. Smoking reduces the chances of a healthy life.
So, you have decided to quit, but you want something to reduce your cravings. Nicotine replacement is now available as a patch, gum, or an inhaler. There is also a prescription pill called Zyban. It doesn’t have nicotine in it and works on brain chemicals that have to do with addiction. Many people have already tried the nicotine patch, the nicotine gum and the prescription pill Zyban. Maybe its time to try something different. How about a Nicotine Lollipop? Nicotine Lolli’s are items that we can customize for people under the direction of their doctor.
At the moment we make 2mg and 4mg Nicotine Lollipops in about 6 different flavors, but again we can customize the flavor or the strength under the direction of your doctor. The idea behind the Nicotine Lollipop is the same as the nicotine gum or nicotine patch, we are putting some of the nicotine back into your system that the cigarette used to provide. This will help reduce (not eliminate) the cravings for cigarettes. The added bonus is psychological. People who have used the Lollipop say they like that they are still putting something in their mouth like they used to do with cigarettes.
How do you use the Nicotine Lollipop and how long does it last? This will vary person to person, but in general one Lollipop will last about 1/2 a pack of cigarettes. During your regular cigarette break you put the Lollipop in your mouth for about 5 minutes or until the craving passes (whichever is less) and then you reseal the Lollipop in our special child proof container and put it away until your next craving. What strength of Lollipop do I need? Your doctor will help you choose when they write the prescription, but usually the 2mg Lollipop is for 1 or less packs a day, and the 4 mg is for people who smoke more than a pack a day. Finally, the Lollipop can be used with the pill Zyban if your doctor chooses.
Dauphin has many people interested in helping you to quit. The Health Dauphin Tobacco Reduction Committee (629-3001) sent all the health care professionals the following list of quit smoking resources:
Manitoba Tobacco Reduction Alliance Inc. http://www.mantrainc.ca/
Booklets
· One Step at a time (Canadian Cancer Society) 1-888-532-6982
· Get On Track (Manitoba Lung Association) 1-888-566-5864
· On the Road to Quitting (Health Canada) 1-800-O-Canada
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, December 31, 2004
Tuesday, December 21, 2004
Insulin Basics
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at http://www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
What is diabetes? Well most people in Canada think of Fredrick Banting and Charles Best who found a substance called insulin inside the pancreas’s of dogs that stopped people from dying from a strange wasting disease called diabetes. (See Canadian’s can be pretty smart, eh?) If you look at the words diabetes mellitus (the full latin name), you can paraphrase it to mean “sweet tasting urine”. It was literally diagnosed by “water tasters” who drank the urine of those suspected of having diabetes; the urine of people with diabetes was thought to be sweet-tasting. The Latin word for honey (referring to its sweetness), 'mellitus', is added to the term diabetes as a result. Doctors today should be very happy they have lab tests to use. One of my favorite quotes during my readings though was by Aretaeus the Cappadocian in the second century AD when he called diabetes as “being a melting down of the flesh and limbs into urine.” It is not really accurate, but very dramatic.
Diabetes is when your body has trouble storing and using glucose. Glucose is a simple sugar that fuels many processes in the body. There are 3 types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes is when your pancreas doesn’t produce insulin. You must inject insulin or you will die. In Type 2 diabetes, your body may produce normal, or even above normal amounts of insulin. However, other parts of the body like your muscle and fat cells aren’t listening to the insulin signal. That means tissues like muscle and fat don’t suck the glucose out of the blood and use it. Type 2 diabetes can be treated with diet, exercise, pills or insulin, or often a combination of these. Gestational diabetes only occurs in pregnancy.
There are many types of insulin. The simplest is called R or Toronto insulin (Did I mention Banting and Best worked out of the University of Toronto?). It is produced by trained microbes and is identical to the insulin that the human body produces (and you thought trained seals were impressive). It is a short acting insulin. There are faster acting insulin in which the insulin molecule is changed a little to make it work faster. Other insulins with names like N, L and U are slow acting. They take R insulin and put it in a solution with other stuff to make the insulin release slowly. Insulin has to be injected because if it is taken orally, the stomach acid will destroy it.
Most people think of small syringes when they think of insulin. There also are insulin pens. Pens still have a needle, but many people find the fact you “dial up” the dose, instead of drawing up insulin into the syringe makes them easier to use. The pen needles also tend to be finer (in case you were interested, the finer the needle the bigger the gauge number) and shorter. Because of this, many people find the insulin pens more comfortable. The insulin pens give an audible “click” on each unit of insulin they dial up, so even those with visual impairments can use the insulin pens. Using a syringe with a visual impairment can be difficult.
There are also insulin pumps. These are expensive (in the thousands of dollars), they require a lot of training at first to learn how to use properly, but they are very interesting. Your pancreas releases a small amount of insulin into your body all the time (called basal insulin), and a pulse when you eat sugar (an insulin peak). Let’s say Jane is using an insulin pen and she uses short acting insulin at meal times (insulin peaks when they eat) and a long acting insulin at bedtime (this mimics the basal insulin). ( There are other ways of giving insulin. This was just an example. Don’t panic if you doctor has you doing something different.) So Jane’s injections are close to how a pancreas works but not exactly. With an insulin pump, the pump would release a small amount of short acting insulin all the time (basal insulin) and Jane could program the pump to release a pulse of insulin based on what she eats (an insulin peak). So insulin pumps more closely mimic what a pancreas does. They aren’t perfect, though. Jane would still have to poke her finger many times a day to check her sugar, and would have to become quite knowledgeable about how to use her pump in case of problems, clogs, etc.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
What is diabetes? Well most people in Canada think of Fredrick Banting and Charles Best who found a substance called insulin inside the pancreas’s of dogs that stopped people from dying from a strange wasting disease called diabetes. (See Canadian’s can be pretty smart, eh?) If you look at the words diabetes mellitus (the full latin name), you can paraphrase it to mean “sweet tasting urine”. It was literally diagnosed by “water tasters” who drank the urine of those suspected of having diabetes; the urine of people with diabetes was thought to be sweet-tasting. The Latin word for honey (referring to its sweetness), 'mellitus', is added to the term diabetes as a result. Doctors today should be very happy they have lab tests to use. One of my favorite quotes during my readings though was by Aretaeus the Cappadocian in the second century AD when he called diabetes as “being a melting down of the flesh and limbs into urine.” It is not really accurate, but very dramatic.
Diabetes is when your body has trouble storing and using glucose. Glucose is a simple sugar that fuels many processes in the body. There are 3 types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes is when your pancreas doesn’t produce insulin. You must inject insulin or you will die. In Type 2 diabetes, your body may produce normal, or even above normal amounts of insulin. However, other parts of the body like your muscle and fat cells aren’t listening to the insulin signal. That means tissues like muscle and fat don’t suck the glucose out of the blood and use it. Type 2 diabetes can be treated with diet, exercise, pills or insulin, or often a combination of these. Gestational diabetes only occurs in pregnancy.
There are many types of insulin. The simplest is called R or Toronto insulin (Did I mention Banting and Best worked out of the University of Toronto?). It is produced by trained microbes and is identical to the insulin that the human body produces (and you thought trained seals were impressive). It is a short acting insulin. There are faster acting insulin in which the insulin molecule is changed a little to make it work faster. Other insulins with names like N, L and U are slow acting. They take R insulin and put it in a solution with other stuff to make the insulin release slowly. Insulin has to be injected because if it is taken orally, the stomach acid will destroy it.
Most people think of small syringes when they think of insulin. There also are insulin pens. Pens still have a needle, but many people find the fact you “dial up” the dose, instead of drawing up insulin into the syringe makes them easier to use. The pen needles also tend to be finer (in case you were interested, the finer the needle the bigger the gauge number) and shorter. Because of this, many people find the insulin pens more comfortable. The insulin pens give an audible “click” on each unit of insulin they dial up, so even those with visual impairments can use the insulin pens. Using a syringe with a visual impairment can be difficult.
There are also insulin pumps. These are expensive (in the thousands of dollars), they require a lot of training at first to learn how to use properly, but they are very interesting. Your pancreas releases a small amount of insulin into your body all the time (called basal insulin), and a pulse when you eat sugar (an insulin peak). Let’s say Jane is using an insulin pen and she uses short acting insulin at meal times (insulin peaks when they eat) and a long acting insulin at bedtime (this mimics the basal insulin). ( There are other ways of giving insulin. This was just an example. Don’t panic if you doctor has you doing something different.) So Jane’s injections are close to how a pancreas works but not exactly. With an insulin pump, the pump would release a small amount of short acting insulin all the time (basal insulin) and Jane could program the pump to release a pulse of insulin based on what she eats (an insulin peak). So insulin pumps more closely mimic what a pancreas does. They aren’t perfect, though. Jane would still have to poke her finger many times a day to check her sugar, and would have to become quite knowledgeable about how to use her pump in case of problems, clogs, etc.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Thursday, December 02, 2004
Depo-Provera
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
By now everyone has probably heard about the recall of the arthritis medication Vioxx off the market. Another drug that you may not have heard of, called Depo-Provera, is also causing some concern.
Depo-Provera is an injectable medication used to prevent pregnancy and to treat a condition where the lining of the uterus grows too much called endometriosis. It has been a popular method of birth control especially in younger women and adolescence because the injection only needs to be given every 3 months. As with other methods of hormonal birth control (e.g. the birth control pill) Depo-Provera was never intended to stop sexually transmitted diseases like HIV.
On Nov 18/04 Pfizer sent a letter to Health Care Professionals stating that “…we now have clinical data regarding the use of Depo-Provera and its associated effect on bone mineral density (BMD). The data suggest that women who use Depo-Provera may lose significant BMD. Bone loss is greater with increasing duration and may not be completely reversible.” So what does that mean? Women who use Depo-Provera may get weak bones. This may be a larger concern in adolescent women because they are still growing bone, so if that is interfered with, then that might lead to osteoporosis and broken bone when they are older.
Should all women who have ever taken a Depo-Provera injection panic? No. Depo-Provera may still be a reasonable choice for birth control and the treatment of endometriosis in some women. Remember, unwanted pregnancy is a health risk to the mother, and the child and can be a financial burden on the community. If you are a woman on Depo-Provera, however, you probably should discuss the risk of bone loss with your doctor.
There is some controversy about the timing of the warning about bone loss and Depo-Provera. A women’s health group in Winnipeg called the Canadian Women’s Health Network and another called the Canadian Coalition on Depo-Provera (both of which have the same spokesperson Madeline Boscoe out of the Women’s Health Clinic at the Health Sciences Center in Winnipeg) sent a letter to Health Canada in before Depo-Provera was approved in April 1997. Madeline Boscoe and others did not want Depo-Provera to be approved for birth control. They pointed to a 1991 study in New Zealand that was published in the British Medical Journal that said Depo-Provera increased risk of bone loss. Ms. Boscoe believes if Health Canada took their concerns seriously Depo-Provera would never have been given to Canadian women.
If you would like more information on the Canadian Coalition on Depo-Provera:
Contact Madeline Boscoe, Executive Director, Canadian Women’s Health Network and co-founder Canadian Coalition on Depo-Provera. Cell 204-295-2946
The Canadain Coalition on Depo-Provera c/o Women’s Health Clinic, 3rd Floor, 419 Graham Ave, Winnipeg, MB, R3C O3M
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
By now everyone has probably heard about the recall of the arthritis medication Vioxx off the market. Another drug that you may not have heard of, called Depo-Provera, is also causing some concern.
Depo-Provera is an injectable medication used to prevent pregnancy and to treat a condition where the lining of the uterus grows too much called endometriosis. It has been a popular method of birth control especially in younger women and adolescence because the injection only needs to be given every 3 months. As with other methods of hormonal birth control (e.g. the birth control pill) Depo-Provera was never intended to stop sexually transmitted diseases like HIV.
On Nov 18/04 Pfizer sent a letter to Health Care Professionals stating that “…we now have clinical data regarding the use of Depo-Provera and its associated effect on bone mineral density (BMD). The data suggest that women who use Depo-Provera may lose significant BMD. Bone loss is greater with increasing duration and may not be completely reversible.” So what does that mean? Women who use Depo-Provera may get weak bones. This may be a larger concern in adolescent women because they are still growing bone, so if that is interfered with, then that might lead to osteoporosis and broken bone when they are older.
Should all women who have ever taken a Depo-Provera injection panic? No. Depo-Provera may still be a reasonable choice for birth control and the treatment of endometriosis in some women. Remember, unwanted pregnancy is a health risk to the mother, and the child and can be a financial burden on the community. If you are a woman on Depo-Provera, however, you probably should discuss the risk of bone loss with your doctor.
There is some controversy about the timing of the warning about bone loss and Depo-Provera. A women’s health group in Winnipeg called the Canadian Women’s Health Network and another called the Canadian Coalition on Depo-Provera (both of which have the same spokesperson Madeline Boscoe out of the Women’s Health Clinic at the Health Sciences Center in Winnipeg) sent a letter to Health Canada in before Depo-Provera was approved in April 1997. Madeline Boscoe and others did not want Depo-Provera to be approved for birth control. They pointed to a 1991 study in New Zealand that was published in the British Medical Journal that said Depo-Provera increased risk of bone loss. Ms. Boscoe believes if Health Canada took their concerns seriously Depo-Provera would never have been given to Canadian women.
If you would like more information on the Canadian Coalition on Depo-Provera:
Contact Madeline Boscoe, Executive Director, Canadian Women’s Health Network and co-founder Canadian Coalition on Depo-Provera. Cell 204-295-2946
The Canadain Coalition on Depo-Provera c/o Women’s Health Clinic, 3rd Floor, 419 Graham Ave, Winnipeg, MB, R3C O3M
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Sunday, October 03, 2004
Dizziness
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Roller coasters and spinning fair rides can be thrilling. Sometimes after the ride the participants stagger a bit for a short time. They say they are dizzy. Dizziness refers to a variety of sensations such as lightheadedness, fainting, spinning and giddiness. Vertigo is the sensation of movement when there is none, or an exaggerated sense of movement to a give body motion. Dizziness can be caused by a number of non-ear related conditions like high or low blood pressure, diabetes, migraine or head injury. Dizziness can be caused by medications like blood pressure pills, anti-depressants, alcohol, anti-Parkinson medication and anti-seizure medications. We will talk mostly about ear related dizziness.
Firstly, though, all patients with dizziness and vertigo should be assessed by a physician. It is important to find the cases of dizziness and not just let them go untreated. If a person is dizzy and has numbness, tingling, or weakness in any part of the body, vision problems, confusion or has difficulty speaking call 911 or take them to an emergency room. The person may be having a stroke.
What can be done for dizziness? Well, there are drug and non-drug treatments. My sister is a physiotherapist in British Columbia. She tells me that sometimes she can help patients by having them do some specific movements. She tells me that these semi-circular cannels in the ear that control balance can get debris moving through the fluid and making the person dizzy. If a trained health care professional rotates the patient in a special way the debris can moved “out of the way” so the dizziness gets better.
There are a few medications that can be used to treat dizziness. Most people are probably familiar with dimenhydrinate (brand name gravol). It can help dizziness but often causes drowsiness and dry mouth. Meclizine (brand name bonamine) is available without a prescription now and it lasts longer than dimenhydrinate. There are also patches which contain scopolamine which can last for up to 3 days. These are popular to combat sea sickness for people going on boats. By prescription there is betahistine (brand name serc). It usually lasts about 8 hours and has less sedation than the other dizziness medications. All of these medications are called antihistamines. To differing degrees they can all treat nausea and vomiting as well as dizziness. Also to varying degrees they can all cause drowsiness, confusion, dry mouth, blurred vision, constipation and trouble urinating. They should be used with caution with people on antidepressants. They should be avoided in certain types of glaucoma (closed angle), certain prostate problems and if the person already has trouble with urinary retention.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Roller coasters and spinning fair rides can be thrilling. Sometimes after the ride the participants stagger a bit for a short time. They say they are dizzy. Dizziness refers to a variety of sensations such as lightheadedness, fainting, spinning and giddiness. Vertigo is the sensation of movement when there is none, or an exaggerated sense of movement to a give body motion. Dizziness can be caused by a number of non-ear related conditions like high or low blood pressure, diabetes, migraine or head injury. Dizziness can be caused by medications like blood pressure pills, anti-depressants, alcohol, anti-Parkinson medication and anti-seizure medications. We will talk mostly about ear related dizziness.
Firstly, though, all patients with dizziness and vertigo should be assessed by a physician. It is important to find the cases of dizziness and not just let them go untreated. If a person is dizzy and has numbness, tingling, or weakness in any part of the body, vision problems, confusion or has difficulty speaking call 911 or take them to an emergency room. The person may be having a stroke.
What can be done for dizziness? Well, there are drug and non-drug treatments. My sister is a physiotherapist in British Columbia. She tells me that sometimes she can help patients by having them do some specific movements. She tells me that these semi-circular cannels in the ear that control balance can get debris moving through the fluid and making the person dizzy. If a trained health care professional rotates the patient in a special way the debris can moved “out of the way” so the dizziness gets better.
There are a few medications that can be used to treat dizziness. Most people are probably familiar with dimenhydrinate (brand name gravol). It can help dizziness but often causes drowsiness and dry mouth. Meclizine (brand name bonamine) is available without a prescription now and it lasts longer than dimenhydrinate. There are also patches which contain scopolamine which can last for up to 3 days. These are popular to combat sea sickness for people going on boats. By prescription there is betahistine (brand name serc). It usually lasts about 8 hours and has less sedation than the other dizziness medications. All of these medications are called antihistamines. To differing degrees they can all treat nausea and vomiting as well as dizziness. Also to varying degrees they can all cause drowsiness, confusion, dry mouth, blurred vision, constipation and trouble urinating. They should be used with caution with people on antidepressants. They should be avoided in certain types of glaucoma (closed angle), certain prostate problems and if the person already has trouble with urinary retention.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, September 24, 2004
Rheumatoid Arthritis
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
September is arthritis awareness month. Last time we talked about the very common osteoarthritis. This time we will talk about the less common but sometimes more serious rheumatoid arthritis. But remember, arthritis has more than 100 different forms.
Rheumatoid arthritis (RA) is an autoimmune disease condition in which the body’s own immune system attacks the lining of the joints. The first thing someone might notice is pain in the hand or foot joints but can also affect other joints. Other symptoms a person might experience include fatigue, dry eyes, dry mouth, fever and/or chills. RA can cause the immune system to attack other internal organs like the eyes, lungs and heart.
How do I know if I might have RA? Symptoms can include: Pain, swelling, tenderness, heat or redness in a joint. The hands and feet are the joints most often affected. Unlike osteoarthritis, in rheumatoid arthritis morning stiffness usually lasts longer than 30 minutes. The pain of RA can be in 3 or more joints at the same time. (Often osteoarthritis effects only one joint like a knee.) The pain from RA can last all night long. The pain from RA can be symmetrical on both sides of the body. That means, for example, both your wrist are sore. RA can also cause non-joints symptoms like fatigue, fever and weight loss.
When a doctor is thinking about how to treat a patient’s RA, the doctor has to think about more than just how to relieve the pain. The doctor has to consider how to protect the joints from the inflammation which can eat away at the joints. Unlike osteoarthritis, which effects only the joint and takes many years to cause damage, in RA the disease attacks other parts of the body, and joint damage can occur within 2 years.
A doctor can start treating the pain of RA with pain relievers like acetaminophen (Tylenol), with or without codeine, or a stronger narcotic like oxycodone. These work within an hour on the pain, but they don’t effect the inflammation at all.
The next step (remember the doctor can skip steps, combine steps, etc, because each patient is unique) is a non-steroidal anti-inflammatory drug (NSAID). NSAID’s are drugs like ASA, ibuprofen and naproxen. They work well for pain and they reduce the inflammation that can cause the joint damage. NSAID’s can take 2-4 weeks of constant use to become fully effective. The problem with older NSAID’s like naproxen is that they can be hard on the stomach and cause problems like ulcers. So newer NSAID’s like celecoxib, and rofecoxib were developed that still reduce pain and inflammation, but are easier on the stomach.
Remember that the above medications don’t really do anything about the problem that the body’s own immune system is attacking the joints. This is done by medications called DMARD’s, disease modifying anti-rheumatic drugs (yes sometimes healthcare seems to have more acronyms than NASA), effect the immune system to stop it from attacking the joints. The most common DMARD in mild RA is hydroxychloroquine and is generally well tolerated. For moderate RA, methotrexate once a week is very common and seems to work very well. Depending on the DMARD, these drugs can take 6 weeks to 6 months to work.
Newer drugs call biologic response modifiers which more selectively block just the inflammation response and not the whole immune system have recently become available. These new medications are very expensive and generally only considered if a patient fails to respond to the standard DMARD combinations. They have names like etanercept (Enbrel), infliximab (Remicade), and anakinra (Keneret).
For more information visit www.arthritis.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
September is arthritis awareness month. Last time we talked about the very common osteoarthritis. This time we will talk about the less common but sometimes more serious rheumatoid arthritis. But remember, arthritis has more than 100 different forms.
Rheumatoid arthritis (RA) is an autoimmune disease condition in which the body’s own immune system attacks the lining of the joints. The first thing someone might notice is pain in the hand or foot joints but can also affect other joints. Other symptoms a person might experience include fatigue, dry eyes, dry mouth, fever and/or chills. RA can cause the immune system to attack other internal organs like the eyes, lungs and heart.
How do I know if I might have RA? Symptoms can include: Pain, swelling, tenderness, heat or redness in a joint. The hands and feet are the joints most often affected. Unlike osteoarthritis, in rheumatoid arthritis morning stiffness usually lasts longer than 30 minutes. The pain of RA can be in 3 or more joints at the same time. (Often osteoarthritis effects only one joint like a knee.) The pain from RA can last all night long. The pain from RA can be symmetrical on both sides of the body. That means, for example, both your wrist are sore. RA can also cause non-joints symptoms like fatigue, fever and weight loss.
When a doctor is thinking about how to treat a patient’s RA, the doctor has to think about more than just how to relieve the pain. The doctor has to consider how to protect the joints from the inflammation which can eat away at the joints. Unlike osteoarthritis, which effects only the joint and takes many years to cause damage, in RA the disease attacks other parts of the body, and joint damage can occur within 2 years.
A doctor can start treating the pain of RA with pain relievers like acetaminophen (Tylenol), with or without codeine, or a stronger narcotic like oxycodone. These work within an hour on the pain, but they don’t effect the inflammation at all.
The next step (remember the doctor can skip steps, combine steps, etc, because each patient is unique) is a non-steroidal anti-inflammatory drug (NSAID). NSAID’s are drugs like ASA, ibuprofen and naproxen. They work well for pain and they reduce the inflammation that can cause the joint damage. NSAID’s can take 2-4 weeks of constant use to become fully effective. The problem with older NSAID’s like naproxen is that they can be hard on the stomach and cause problems like ulcers. So newer NSAID’s like celecoxib, and rofecoxib were developed that still reduce pain and inflammation, but are easier on the stomach.
Remember that the above medications don’t really do anything about the problem that the body’s own immune system is attacking the joints. This is done by medications called DMARD’s, disease modifying anti-rheumatic drugs (yes sometimes healthcare seems to have more acronyms than NASA), effect the immune system to stop it from attacking the joints. The most common DMARD in mild RA is hydroxychloroquine and is generally well tolerated. For moderate RA, methotrexate once a week is very common and seems to work very well. Depending on the DMARD, these drugs can take 6 weeks to 6 months to work.
Newer drugs call biologic response modifiers which more selectively block just the inflammation response and not the whole immune system have recently become available. These new medications are very expensive and generally only considered if a patient fails to respond to the standard DMARD combinations. They have names like etanercept (Enbrel), infliximab (Remicade), and anakinra (Keneret).
For more information visit www.arthritis.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Tuesday, September 14, 2004
Osteoarthritis
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
September is Arthritis Month! The Arthritis Society would like Canadians to be more aware of Arthritis and its impact on Canadians. Osteoarthritis is the most common type of arthritis and it affects about 10% of the Canadian population. In fact, by age 75 nearly every one will have at least one joint that under X-Ray will have changes consistent with osteoarthritis.
First, let’s talk definitions. Arthritis literally means “inflammation of the joint”. As the Arthitis Society points out arthritis encompasses over 100 conditions ranging from tennis elbow, and gout on the mild end to severe crippling forms of rheumatoid arthritis and arthritis related disease like systemic lupus erythematosus. In the pharmacy, people seem to get the terms osteoarthritis and osteoporosis confused. Osteoporosis is NOT a form of arthritis. It can be debilitating and painful, but it does not directly effect the joints. Osteoporosis is when the bones get weak and break easily. We will leave osteoporosis for another article. Osteoarthritis (OA) is a complicated disease, but on its simplest level it is when the cartilage in a joint wears out and bone rubs on bone.
In a normal joint, a tough, smooth, elastic-like material called cartilage lets the two ends of the bones in the joint slide by each other with almost no friction. As cartilage wears down, bits can break off and go into the soft tissue around the joint and cause pain. The new thing I learned as I was researching this article, is that cartilage doesn’t have any nerve endings, so it doesn’t feel any pain. The pain from OA is from the cords that connect muscle to bone (tendons), bone to bone (ligaments) and the muscles which are forced to work in ways they weren’t designed to because of the cartilage break down. When the cartilage breaks down so much that bone rubs on bone, the bone can thicken and form spurs. A doctor may confirm the diagnosis of OA with X-rays.
What symptoms might I have if I had osteoporosis? Pain, stiffness and swelling around a joint that lasts longer than 2 weeks. Unlike rheumatoid arthritis, morning pain and stiffness usually lasts less than 30 minutes. Although there can be swelling around the joint in OA, it is usually less than that expected in rheumatoid arthritis. The joints usually affected are the hips, knees and spine. Finger and thumbs joints may also be affected.
How is OA treated? Osteoarthritis treatment is usually a combination of non-drug and drug treatments. Non-drug treatments can include physical therapy to strengthen the muscles around a joint, canes to remove stress from a joint or orthotics to correct problems like one leg being slightly longer that the other. Drug treatments can be roughly divided into pain killers, steroid injections, and synovial fluid replacements.
One of the least expensive, most safe medications for pain is acetaminophen (common brand name Tylenol). If that is not fully effective, the doctor may add an NSAID (non-steroidal antiinflammatory drug) like ibuprofen, diclofenac or naproxen. These medications can work better for the pain, but are more expensive than acetaminophen and have more side effects, like stomach upset, risk of ulcers, and risk of increasing blood pressure. Because of problems with stomach upset and ulcers, the COX-2 inhibitors were developed. They have names like rofecoxib (Vioxx) and celecoxib (Celebrex). The COX-2 inhibitors bother the stomach less, but still have a risk of increasing blood pressure. There are also topical or rub on forms of NSAIDS to try to get the NSAID to the joint without bothering the stomach. Although they can be effective, we have to assume they have the same side effects as oral NSAIDS.
Steroid injections directly into arthritic joints can be an option your doctor may consider if other treatments aren’t working. They are mostly done on knees, and should be limited to 3 injections per year.
Synovial fluid replacements or hyaluronans can also be injected directly into the joint and help lubricate it. It can be effective. It is used most often on knees and it is expensive.
Glucosamine and chondroitin are natural products that are generally well tolerated and have side effects similar to placebo. It is difficult to determine if they actually work because of the limited study on them, but it does seem that even the proponents say you need to use them for at least 1 month for there to be any good effects.
For more information: see the Arthritis Society’s website : www.arthritis.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
September is Arthritis Month! The Arthritis Society would like Canadians to be more aware of Arthritis and its impact on Canadians. Osteoarthritis is the most common type of arthritis and it affects about 10% of the Canadian population. In fact, by age 75 nearly every one will have at least one joint that under X-Ray will have changes consistent with osteoarthritis.
First, let’s talk definitions. Arthritis literally means “inflammation of the joint”. As the Arthitis Society points out arthritis encompasses over 100 conditions ranging from tennis elbow, and gout on the mild end to severe crippling forms of rheumatoid arthritis and arthritis related disease like systemic lupus erythematosus. In the pharmacy, people seem to get the terms osteoarthritis and osteoporosis confused. Osteoporosis is NOT a form of arthritis. It can be debilitating and painful, but it does not directly effect the joints. Osteoporosis is when the bones get weak and break easily. We will leave osteoporosis for another article. Osteoarthritis (OA) is a complicated disease, but on its simplest level it is when the cartilage in a joint wears out and bone rubs on bone.
In a normal joint, a tough, smooth, elastic-like material called cartilage lets the two ends of the bones in the joint slide by each other with almost no friction. As cartilage wears down, bits can break off and go into the soft tissue around the joint and cause pain. The new thing I learned as I was researching this article, is that cartilage doesn’t have any nerve endings, so it doesn’t feel any pain. The pain from OA is from the cords that connect muscle to bone (tendons), bone to bone (ligaments) and the muscles which are forced to work in ways they weren’t designed to because of the cartilage break down. When the cartilage breaks down so much that bone rubs on bone, the bone can thicken and form spurs. A doctor may confirm the diagnosis of OA with X-rays.
What symptoms might I have if I had osteoporosis? Pain, stiffness and swelling around a joint that lasts longer than 2 weeks. Unlike rheumatoid arthritis, morning pain and stiffness usually lasts less than 30 minutes. Although there can be swelling around the joint in OA, it is usually less than that expected in rheumatoid arthritis. The joints usually affected are the hips, knees and spine. Finger and thumbs joints may also be affected.
How is OA treated? Osteoarthritis treatment is usually a combination of non-drug and drug treatments. Non-drug treatments can include physical therapy to strengthen the muscles around a joint, canes to remove stress from a joint or orthotics to correct problems like one leg being slightly longer that the other. Drug treatments can be roughly divided into pain killers, steroid injections, and synovial fluid replacements.
One of the least expensive, most safe medications for pain is acetaminophen (common brand name Tylenol). If that is not fully effective, the doctor may add an NSAID (non-steroidal antiinflammatory drug) like ibuprofen, diclofenac or naproxen. These medications can work better for the pain, but are more expensive than acetaminophen and have more side effects, like stomach upset, risk of ulcers, and risk of increasing blood pressure. Because of problems with stomach upset and ulcers, the COX-2 inhibitors were developed. They have names like rofecoxib (Vioxx) and celecoxib (Celebrex). The COX-2 inhibitors bother the stomach less, but still have a risk of increasing blood pressure. There are also topical or rub on forms of NSAIDS to try to get the NSAID to the joint without bothering the stomach. Although they can be effective, we have to assume they have the same side effects as oral NSAIDS.
Steroid injections directly into arthritic joints can be an option your doctor may consider if other treatments aren’t working. They are mostly done on knees, and should be limited to 3 injections per year.
Synovial fluid replacements or hyaluronans can also be injected directly into the joint and help lubricate it. It can be effective. It is used most often on knees and it is expensive.
Glucosamine and chondroitin are natural products that are generally well tolerated and have side effects similar to placebo. It is difficult to determine if they actually work because of the limited study on them, but it does seem that even the proponents say you need to use them for at least 1 month for there to be any good effects.
For more information: see the Arthritis Society’s website : www.arthritis.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Wednesday, August 11, 2004
Irritable Bowel Syndrome
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Irritable bowel syndrome (IBS) is the most common form of bowel disorder, affecting about 10% of the population in Western countries. Symptoms that patients experience vary and may include abdominal pain and discomfort, bloating, cramping, and altered bowel function with either cramping or diarrhea. IBS is not life-threatening, but it definitely can be life-style altering and can reduce a patient’s quality of life.
Irritable bowel syndrome can be difficult for doctors to diagnose, because there is no one test or symptom to look for. Usually IBS is diagnosed after doctors rule out other diseases through a complete medical examination and history. IBS can be suspected if as abdominal pain or discomfort for at least 12 weeks (they don’t need to be all in a row) in the past 12 months that has two of the three following features: the pain is relieved by passing a stool, the pain is associated with a change in how often a patient passes their stool, or the pain is associated with a change to either diarrhea or constipation. Symptoms of IBS not related to the stomach include tiredness, insomnia, painful urination, and back pain. IBS sufferers are sometimes divided up into diarrhea or constipation predominant subtypes. Up to three quarters of people with IBS never seek medical attention.
The cause of IBS is not known. Research has shown that emotional conflict in stress do worsen IBS symptoms, but the same research has shown other factors also play a role. Scientists have found that the colon muscles of people with IBS are far more sensitive and reactive than normal. The colon begins to spasm after only mild simulations so to respond strongly to stimuli that would not affect most people. Hence, ordinary event such as eating cause the colon to over react. Certain foods and medicines can trigger spasms. Sometimes the spasms can delay the passage of stool which can lead to constipation, or the spasms can induce diarrhea. Frequent offenders include chocolate, dairy products, caffeine, and alcohol. Psychiatric illnesses like depression and anxiety seem to be more common in people with IBS than in the general population.
There's no standard approach to the treatment of IBS. Treatment should start with education and reassurance, life-style modifications, changing diet, and psychological assessment in some patients. Triggers (e.g.,alcohol, caffeine) should be identified and avoided. Doctors frequently recommend an increase in dietary fiber. Medications are sometimes used to help alleviate specific symptoms (e.g., anti-diarrheal agents such as loperamide in patients with diarrhea predominant IBS). Anti-spasmodic agents such as scopolamine and hyoscine (buscopan) are used to help reduce painful spasms. Relaxation therapy and anxiolytics (e.g. diazepam) have been prescribed in patients with anxiety related IBS. Depending on the patient, antidepressants have also been tried with some success. There is a newer medication tegaserod (Zelnorm) that has worked with moderate success in women with constipation predominant IBS.
For more info visit: American Gastroenterology Association at www.gastro.org/clinicalRes/brochures/ibs.html
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Irritable bowel syndrome (IBS) is the most common form of bowel disorder, affecting about 10% of the population in Western countries. Symptoms that patients experience vary and may include abdominal pain and discomfort, bloating, cramping, and altered bowel function with either cramping or diarrhea. IBS is not life-threatening, but it definitely can be life-style altering and can reduce a patient’s quality of life.
Irritable bowel syndrome can be difficult for doctors to diagnose, because there is no one test or symptom to look for. Usually IBS is diagnosed after doctors rule out other diseases through a complete medical examination and history. IBS can be suspected if as abdominal pain or discomfort for at least 12 weeks (they don’t need to be all in a row) in the past 12 months that has two of the three following features: the pain is relieved by passing a stool, the pain is associated with a change in how often a patient passes their stool, or the pain is associated with a change to either diarrhea or constipation. Symptoms of IBS not related to the stomach include tiredness, insomnia, painful urination, and back pain. IBS sufferers are sometimes divided up into diarrhea or constipation predominant subtypes. Up to three quarters of people with IBS never seek medical attention.
The cause of IBS is not known. Research has shown that emotional conflict in stress do worsen IBS symptoms, but the same research has shown other factors also play a role. Scientists have found that the colon muscles of people with IBS are far more sensitive and reactive than normal. The colon begins to spasm after only mild simulations so to respond strongly to stimuli that would not affect most people. Hence, ordinary event such as eating cause the colon to over react. Certain foods and medicines can trigger spasms. Sometimes the spasms can delay the passage of stool which can lead to constipation, or the spasms can induce diarrhea. Frequent offenders include chocolate, dairy products, caffeine, and alcohol. Psychiatric illnesses like depression and anxiety seem to be more common in people with IBS than in the general population.
There's no standard approach to the treatment of IBS. Treatment should start with education and reassurance, life-style modifications, changing diet, and psychological assessment in some patients. Triggers (e.g.,alcohol, caffeine) should be identified and avoided. Doctors frequently recommend an increase in dietary fiber. Medications are sometimes used to help alleviate specific symptoms (e.g., anti-diarrheal agents such as loperamide in patients with diarrhea predominant IBS). Anti-spasmodic agents such as scopolamine and hyoscine (buscopan) are used to help reduce painful spasms. Relaxation therapy and anxiolytics (e.g. diazepam) have been prescribed in patients with anxiety related IBS. Depending on the patient, antidepressants have also been tried with some success. There is a newer medication tegaserod (Zelnorm) that has worked with moderate success in women with constipation predominant IBS.
For more info visit: American Gastroenterology Association at www.gastro.org/clinicalRes/brochures/ibs.html
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Thursday, July 22, 2004
West Nile Virus - 2004
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Mosquitoes are out in full force. My wife has set up our dining tent in the backyard so we can sit outside in the evening and not get eaten. Enthusiastic environmentalists (I’d get in trouble if I called them rabid environmentalists, right? I’m just kidding, don’t sue me.) are getting up at 2 am in Winnipeg to stop mosquito fogging trucks. Residents in Winnipeg that want to be fogged are forming neighborhood action groups to sue the environmentalists. Ahhh, summer in Manitoba, can’t beat it!
Mosquito fogging, bug spray and dining tents are a hot topic of conversation because of something called West Nile Virus. West Nile Virus was first identified in Africa in 1937. It spread to Europe and it was first reported in North America in New York City in 1999. Since then it has spread to most parts of the US and Canada. The first known human case of West Nile Virus (WNV) in Manitoba was in July of 2003.
West Nile Virus is carried by mosquitoes. That means that the mosquito bites an infected animal (often a bird), picks up WNV and then bites the human and gives them WNV.
Although WNV is carried by mosquitoes, most mosquitoes do not carry WNV. I am not an insect expert, but Manitoba Health says in this province the main carrier of WNV is the Culex mosquito, which is usually less common type of mosquito. Manitoba Health reports that for the week of July 11 the average one night catch of the WNV carrying type of mosquito in the Parkland in a U.S. Centers for Disease Control (CDC) trap was 5.
What are the symptoms of WNV? Most people who become infected with WNV do not become ill, and so won’t report an illness to their doctor. According to Manitoba Health in 2003 141 people saw their doctor and were confirmed to be infected with WNV. Of those 1 had no symptoms, 105 had West Nile Fever, and 35 had the more serious neurological symptoms. West Nile Fever has flu like symptoms such as fever, headache, fatigue and body aches. West Nile Fever is usually considered mild and resolves on its own. The much more rare West Nile neurological syndrome is more serious. The neurological syndrome can include encephalitis, an inflammation of the lining of the brain. Encephalitis can have serious complications including paralysis, confusion, coma or death. Anyone experiencing symptoms like persistent high fever, muscle weakness and headache should seek medical attention.
How can you protect yourself from WNV? Try to reduce the amount of time you spend outdoors between sunset and sunrise. The peak hours for mosquitoes are at sunrise and sunset, but the WNV Culex mosquitoes do also bite at night. Make sure your screens on your doors and windows don’t have rips or tears. Remove standing water like childrens wading pools from your property. Use bug repellant with DEET. Remember that DEET is NOT recommended for children under 6 months of age.
There have been a lot of DEET questions at the pharmacy lately. Here is what Health Canada says: repellents with concentration of DEET of 30% will protect you for approximately 6 hours, DEET 15% for ~5 hours, DEET 10% for ~3 hours, and DEET 5% for ~2 hours. Health Canada says that you should not use DEET on infants under 6 months of age. You can use DEET of 10% or less on children aged 6 months to 2 years if it is absolutely necessary. You can use DEET of 10% or less on children aged 2 to 12 years not more than 3 times per day.
For more information visit:
Health Canada’s Insect Repellent Page: www.hc-sc.gc.ca/pmra-arla/english/consum/insectrepellents-e.html
Manitoba Health’s WNV page: www.hc-sc.gc.ca/pmra-arla/english/consum/insectrepellents-e.html
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Mosquitoes are out in full force. My wife has set up our dining tent in the backyard so we can sit outside in the evening and not get eaten. Enthusiastic environmentalists (I’d get in trouble if I called them rabid environmentalists, right? I’m just kidding, don’t sue me.) are getting up at 2 am in Winnipeg to stop mosquito fogging trucks. Residents in Winnipeg that want to be fogged are forming neighborhood action groups to sue the environmentalists. Ahhh, summer in Manitoba, can’t beat it!
Mosquito fogging, bug spray and dining tents are a hot topic of conversation because of something called West Nile Virus. West Nile Virus was first identified in Africa in 1937. It spread to Europe and it was first reported in North America in New York City in 1999. Since then it has spread to most parts of the US and Canada. The first known human case of West Nile Virus (WNV) in Manitoba was in July of 2003.
West Nile Virus is carried by mosquitoes. That means that the mosquito bites an infected animal (often a bird), picks up WNV and then bites the human and gives them WNV.
Although WNV is carried by mosquitoes, most mosquitoes do not carry WNV. I am not an insect expert, but Manitoba Health says in this province the main carrier of WNV is the Culex mosquito, which is usually less common type of mosquito. Manitoba Health reports that for the week of July 11 the average one night catch of the WNV carrying type of mosquito in the Parkland in a U.S. Centers for Disease Control (CDC) trap was 5.
What are the symptoms of WNV? Most people who become infected with WNV do not become ill, and so won’t report an illness to their doctor. According to Manitoba Health in 2003 141 people saw their doctor and were confirmed to be infected with WNV. Of those 1 had no symptoms, 105 had West Nile Fever, and 35 had the more serious neurological symptoms. West Nile Fever has flu like symptoms such as fever, headache, fatigue and body aches. West Nile Fever is usually considered mild and resolves on its own. The much more rare West Nile neurological syndrome is more serious. The neurological syndrome can include encephalitis, an inflammation of the lining of the brain. Encephalitis can have serious complications including paralysis, confusion, coma or death. Anyone experiencing symptoms like persistent high fever, muscle weakness and headache should seek medical attention.
How can you protect yourself from WNV? Try to reduce the amount of time you spend outdoors between sunset and sunrise. The peak hours for mosquitoes are at sunrise and sunset, but the WNV Culex mosquitoes do also bite at night. Make sure your screens on your doors and windows don’t have rips or tears. Remove standing water like childrens wading pools from your property. Use bug repellant with DEET. Remember that DEET is NOT recommended for children under 6 months of age.
There have been a lot of DEET questions at the pharmacy lately. Here is what Health Canada says: repellents with concentration of DEET of 30% will protect you for approximately 6 hours, DEET 15% for ~5 hours, DEET 10% for ~3 hours, and DEET 5% for ~2 hours. Health Canada says that you should not use DEET on infants under 6 months of age. You can use DEET of 10% or less on children aged 6 months to 2 years if it is absolutely necessary. You can use DEET of 10% or less on children aged 2 to 12 years not more than 3 times per day.
For more information visit:
Health Canada’s Insect Repellent Page: www.hc-sc.gc.ca/pmra-arla/english/consum/insectrepellents-e.html
Manitoba Health’s WNV page: www.hc-sc.gc.ca/pmra-arla/english/consum/insectrepellents-e.html
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Wednesday, July 14, 2004
Sun Screens
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Were you up at the 15th Anniversary of Dauphin’s Country Fest over the July long week-end? The music was great. The parties were hopping. The people were friendly. The weather, well, let’s say raincoats were more of an issue than sunscreen. However, the weather channel says summer isn’t cancelled. It will still show up…sometime. Because I have faith in warm weather returning, let’s talk about sunscreen.
Skin cancer is the most commonly occurring cancer in Canada, and the fastest growing cancer in the world. In 2000 68,000 Canadians were diagnosed with non-melanoma skin cancer, and 3,700 with malignant melanoma, the more aggressive form of the disease. In 2003 the estimates are 75,000 Canadians with non-melanoma skin cancer and 3,900 with malignant melanoma. Since 1988 the death rate from malignant melanoma is up 41% for men and 23% in women. The Canadian Cancer Society says that anyone born today has a one in seven chance of getting skin cancer in their lifetime.
What are those UV Indexes that are reported in weather reports?
UV Index Range Exposure Category Action Required
0-2 Low Minimal Sun Protection
3-5 Moderate Take precaution
6-7 High Protection Required
8-10 Very High Extra Precautions Required
11+ Extreme Take full precautions
The UV index is a measure of the intensity of the sun’s UV rays on the earth’s surface. It predicts the maximum value expected on that day, taking into account many of the factors that effect UV radiation strength. The sun emits radiation across the entire spectrum, from radio waves to X-rays. The part of the spectrum we are most interested in for skin health are the Ultra-violet wavelenghts. Ultra-violet wavelengths are not visible to us, they are too short. And there are 2 types of UV radiation we talk about, UVA and UVB. It is an over-simplication, because both UVA and UVB can cause aging, cancer etc, but you can think of UVA causing the skin to age (wrinkles, lose elasticity, etc.), and UVB causing cancer. There is a UVC which is even more energetic and thus even more dangerous than UVB, but its wavelengths are so short it is completely absorbed by the atmosphere.
The Canadian Cancer Society estimates that 60-70% of skin cancer cases in Canada could be prevented if Canadians adopted safer lifestyles. So what are these safer lifestyle choices?
Here are some more practical suggestions.
· Avoid the sun when it is most intense. These are between the hours of 10 am and 4 pm.
· Wear a sunscreen of sun protection factor (SPF) of 15 and that protects against both UVA and UVB radiation.
· For an adult use at least ½ teaspoon (2.5ml) for face and neck, ½ teaspoon (2.5ml) for each arm and shoulder , ½ to 1 teaspoon (2.5 to 5 ml) for on your chest and back, and 1 teaspoon (5 ml) for each leg.
· Reapply sunscreen every 2 hours when outdoors, especially after swimming or sweating heavily. Waterproof sun screens will stick better.
· Wear a hat and long-sleeved garment.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Were you up at the 15th Anniversary of Dauphin’s Country Fest over the July long week-end? The music was great. The parties were hopping. The people were friendly. The weather, well, let’s say raincoats were more of an issue than sunscreen. However, the weather channel says summer isn’t cancelled. It will still show up…sometime. Because I have faith in warm weather returning, let’s talk about sunscreen.
Skin cancer is the most commonly occurring cancer in Canada, and the fastest growing cancer in the world. In 2000 68,000 Canadians were diagnosed with non-melanoma skin cancer, and 3,700 with malignant melanoma, the more aggressive form of the disease. In 2003 the estimates are 75,000 Canadians with non-melanoma skin cancer and 3,900 with malignant melanoma. Since 1988 the death rate from malignant melanoma is up 41% for men and 23% in women. The Canadian Cancer Society says that anyone born today has a one in seven chance of getting skin cancer in their lifetime.
What are those UV Indexes that are reported in weather reports?
UV Index Range Exposure Category Action Required
0-2 Low Minimal Sun Protection
3-5 Moderate Take precaution
6-7 High Protection Required
8-10 Very High Extra Precautions Required
11+ Extreme Take full precautions
The UV index is a measure of the intensity of the sun’s UV rays on the earth’s surface. It predicts the maximum value expected on that day, taking into account many of the factors that effect UV radiation strength. The sun emits radiation across the entire spectrum, from radio waves to X-rays. The part of the spectrum we are most interested in for skin health are the Ultra-violet wavelenghts. Ultra-violet wavelengths are not visible to us, they are too short. And there are 2 types of UV radiation we talk about, UVA and UVB. It is an over-simplication, because both UVA and UVB can cause aging, cancer etc, but you can think of UVA causing the skin to age (wrinkles, lose elasticity, etc.), and UVB causing cancer. There is a UVC which is even more energetic and thus even more dangerous than UVB, but its wavelengths are so short it is completely absorbed by the atmosphere.
The Canadian Cancer Society estimates that 60-70% of skin cancer cases in Canada could be prevented if Canadians adopted safer lifestyles. So what are these safer lifestyle choices?
Here are some more practical suggestions.
· Avoid the sun when it is most intense. These are between the hours of 10 am and 4 pm.
· Wear a sunscreen of sun protection factor (SPF) of 15 and that protects against both UVA and UVB radiation.
· For an adult use at least ½ teaspoon (2.5ml) for face and neck, ½ teaspoon (2.5ml) for each arm and shoulder , ½ to 1 teaspoon (2.5 to 5 ml) for on your chest and back, and 1 teaspoon (5 ml) for each leg.
· Reapply sunscreen every 2 hours when outdoors, especially after swimming or sweating heavily. Waterproof sun screens will stick better.
· Wear a hat and long-sleeved garment.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Tuesday, June 29, 2004
WHAT’S GOOD ABOUT CHOLESTEROL? Part 2 of 2
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Last time we talked about what cholesterol was, what HDL, and LDL were and how statin medications were very helpful for many people. This time we will talk about raising HDL.
If you remember, cholesterol is a kind of fat, so it doesn’t mix with blood, which is mostly water, very well. The liver has to mix the cholesterol with proteins and other stuff to get it to stay in the blood. This mixture of cholesterol (a lipid or fat) and protein is called a lipoprotein. If you take a blood sample and spin it really fast, it separates based on density. So different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called “bad” cholesterol because it transports cholesterol and other lipids from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called “good” cholesterol because it transports cholesterol and other fats from the cells lining the blood vessels to the liver. This can decrease the chance of blockages.
Medications like the statins are good at reducing the LDL, but what about increasing the HDL or “good” cholesterol? Weigh reduction and physical activity can each increase HDL up to ~25%, stopping smoking can increase HDL by ~5%, statins can increase HDL up to ~15%, and niacin can increase HDL up to ~35%.
If niacin is so good at increasing HDL, why isn’t it used more? There is a lot of confusion about types of niacin, side effects and how it should be used.
Vitamin B3 has two chemical names: niacin or nicotinic acid. There is a different form of niacin called nicotinamide. Both niacin and nicotinamide can be used to prevent niacin deficiency and to treat pellagra. Pellagra is a condition of niacin deficiency that includes rash, diarrhea and dementia. However, only niacin is useful to treat cholesterol problems.
If niacin is just a vitamin and is good at raising HDL, why don’t we all take it just in case? Although you can buy niacin without a prescription, I recommend anyone considering using it to consult their doctor first. Niacin has side effects. The most noticeable one is flushing of the skin and feeling very warm. Although this effect is not harmful, it makes many people uncomfortable enough that they quit niacin. Other common, nontoxic, reversible effects of large doses of niacin are dizziness, nausea, low blood pressure, fast heart beat, headache, and blurred vision. Of more concern is that niacin can raise blood sugar, cause gout, and like other cholesterol pills, niacin has rarely been associated with liver problems. Niacin should be avoided in people with chronic liver disease, severe gout, active stomach ulcers, and certain bleeding problems. It can be used with caution in people with diabetes and mild gout.
If your doctor wants to start you on niacin, they will probably want to do blood tests on your liver, uric acid and blood sugar before they start the niacin and periodically after that.
There are also different niacin preparations. The fast acting niacin tends to give people more flushing, but the slow acting tends to cause more liver problems. There is also a vitamin commonly called no-flush niacin that contains inositol hexaniacinate. Although it may have other beneficial properties, it will not help cholesterol levels.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Last time we talked about what cholesterol was, what HDL, and LDL were and how statin medications were very helpful for many people. This time we will talk about raising HDL.
If you remember, cholesterol is a kind of fat, so it doesn’t mix with blood, which is mostly water, very well. The liver has to mix the cholesterol with proteins and other stuff to get it to stay in the blood. This mixture of cholesterol (a lipid or fat) and protein is called a lipoprotein. If you take a blood sample and spin it really fast, it separates based on density. So different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called “bad” cholesterol because it transports cholesterol and other lipids from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called “good” cholesterol because it transports cholesterol and other fats from the cells lining the blood vessels to the liver. This can decrease the chance of blockages.
Medications like the statins are good at reducing the LDL, but what about increasing the HDL or “good” cholesterol? Weigh reduction and physical activity can each increase HDL up to ~25%, stopping smoking can increase HDL by ~5%, statins can increase HDL up to ~15%, and niacin can increase HDL up to ~35%.
If niacin is so good at increasing HDL, why isn’t it used more? There is a lot of confusion about types of niacin, side effects and how it should be used.
Vitamin B3 has two chemical names: niacin or nicotinic acid. There is a different form of niacin called nicotinamide. Both niacin and nicotinamide can be used to prevent niacin deficiency and to treat pellagra. Pellagra is a condition of niacin deficiency that includes rash, diarrhea and dementia. However, only niacin is useful to treat cholesterol problems.
If niacin is just a vitamin and is good at raising HDL, why don’t we all take it just in case? Although you can buy niacin without a prescription, I recommend anyone considering using it to consult their doctor first. Niacin has side effects. The most noticeable one is flushing of the skin and feeling very warm. Although this effect is not harmful, it makes many people uncomfortable enough that they quit niacin. Other common, nontoxic, reversible effects of large doses of niacin are dizziness, nausea, low blood pressure, fast heart beat, headache, and blurred vision. Of more concern is that niacin can raise blood sugar, cause gout, and like other cholesterol pills, niacin has rarely been associated with liver problems. Niacin should be avoided in people with chronic liver disease, severe gout, active stomach ulcers, and certain bleeding problems. It can be used with caution in people with diabetes and mild gout.
If your doctor wants to start you on niacin, they will probably want to do blood tests on your liver, uric acid and blood sugar before they start the niacin and periodically after that.
There are also different niacin preparations. The fast acting niacin tends to give people more flushing, but the slow acting tends to cause more liver problems. There is also a vitamin commonly called no-flush niacin that contains inositol hexaniacinate. Although it may have other beneficial properties, it will not help cholesterol levels.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Wednesday, June 09, 2004
What's Good About Cholesterol? Part 1 of 2
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Cholesterol. You’ve read about it. It scared you away from eggs. Then Aitken’s diet and the other low-carb, high protein diets said eat eggs. Starchy snack foods are labeled “Cholesterol Free”. Does that make them good for you? A few years ago a popular prescription chosterol medication called Baycol was pulled off the shelves. Does that make all cholesterol medications bad for you? And what is this good cholesterol, bad cholesterol stuff mean anyway?
Let’s start with, what is cholesterol? Cholesterol is a naturally occurring substance in the body that is essential for life. If you had no cholesterol in you, you would die. It is used to make bile acids which help your digestive system work, hormones which help regulate different body functions and it is also found as an important part of the cell membrane which is located around every cell in your body. Although cholesterol is essential for life, you don’t have to eat any. Your body, mostly your liver, can make all the cholesterol you need.
So what does all this LDL, HDL, VLDL stuff mean? When your liver makes cholesterol, it puts it into the blood stream. Cholesterol is a kind of fat, so it doesn’t mix with blood, which is mostly water, very well. The liver has to mix the cholesterol with proteins and other stuff to get it to stay in the blood. This mixture of cholesterol (a lipid or fat) and protein is called a lipoprotein. If you take a blood sample and spin it really fast, it separates based on density. So different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called “bad” cholesterol because it transports cholesterol and other lipids from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called “good” cholesterol because it transports cholesterol and other fats from the cells lining the blood vessels to the liver. This can decrease the chance of blockages.
Diet and exercise are very important to prevent and treat cholesterol problems, but I’m going to talk about medications. The most common LDL lowering medications are a group of medications called the statins. The statins stop an important step in the liver’s synthesis of cholesterol, so the liver makes less cholesterol. So the statins do a good job of reducing LDL. They are also generally well tolerated. They can cause some stomach upset which can usually be fixed by taking them with food. Much more rarely they can cause muscle pain and/or liver damage. Your doctor will check for liver problems with blood tests, and if you get body aches all over see your doctor. The prescription drug Baycol was pulled off the market because it caused liver problems more often than other statins.
There is a lot of good news about statins. If you take your statin as prescribed and get your LDL, HDL and Triglyceride numbers where your doctor wants you can reduce your risk of having a heart problem or dying of a heart problem by 14-40%. Besides lowering LDL cholesterol they seem to protect the heart in other ways. There are theories that the statins have a good effect on the lining of the blood vessels called the endothelium. There has been some study of statin drugs reducing the risk of breast cancer in women. The results are not conclusive but are interesting and promising. There have been other reports that statin drugs reduce the incidence of prostate and kidney cancer. Again there is not enough evidence for everyone to take statins to prevent cancer, but more research should be done.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Cholesterol. You’ve read about it. It scared you away from eggs. Then Aitken’s diet and the other low-carb, high protein diets said eat eggs. Starchy snack foods are labeled “Cholesterol Free”. Does that make them good for you? A few years ago a popular prescription chosterol medication called Baycol was pulled off the shelves. Does that make all cholesterol medications bad for you? And what is this good cholesterol, bad cholesterol stuff mean anyway?
Let’s start with, what is cholesterol? Cholesterol is a naturally occurring substance in the body that is essential for life. If you had no cholesterol in you, you would die. It is used to make bile acids which help your digestive system work, hormones which help regulate different body functions and it is also found as an important part of the cell membrane which is located around every cell in your body. Although cholesterol is essential for life, you don’t have to eat any. Your body, mostly your liver, can make all the cholesterol you need.
So what does all this LDL, HDL, VLDL stuff mean? When your liver makes cholesterol, it puts it into the blood stream. Cholesterol is a kind of fat, so it doesn’t mix with blood, which is mostly water, very well. The liver has to mix the cholesterol with proteins and other stuff to get it to stay in the blood. This mixture of cholesterol (a lipid or fat) and protein is called a lipoprotein. If you take a blood sample and spin it really fast, it separates based on density. So different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called “bad” cholesterol because it transports cholesterol and other lipids from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called “good” cholesterol because it transports cholesterol and other fats from the cells lining the blood vessels to the liver. This can decrease the chance of blockages.
Diet and exercise are very important to prevent and treat cholesterol problems, but I’m going to talk about medications. The most common LDL lowering medications are a group of medications called the statins. The statins stop an important step in the liver’s synthesis of cholesterol, so the liver makes less cholesterol. So the statins do a good job of reducing LDL. They are also generally well tolerated. They can cause some stomach upset which can usually be fixed by taking them with food. Much more rarely they can cause muscle pain and/or liver damage. Your doctor will check for liver problems with blood tests, and if you get body aches all over see your doctor. The prescription drug Baycol was pulled off the market because it caused liver problems more often than other statins.
There is a lot of good news about statins. If you take your statin as prescribed and get your LDL, HDL and Triglyceride numbers where your doctor wants you can reduce your risk of having a heart problem or dying of a heart problem by 14-40%. Besides lowering LDL cholesterol they seem to protect the heart in other ways. There are theories that the statins have a good effect on the lining of the blood vessels called the endothelium. There has been some study of statin drugs reducing the risk of breast cancer in women. The results are not conclusive but are interesting and promising. There have been other reports that statin drugs reduce the incidence of prostate and kidney cancer. Again there is not enough evidence for everyone to take statins to prevent cancer, but more research should be done.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Thursday, June 03, 2004
Vitamins and Your Eyes
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
A couple of years ago, people kept coming into the pharmacy looking for vitamins with lutein in them. I, frankly, had no idea what they were talking about. Then vitamins like Icaps, Ocuvite and Vitalux among others started appearing with lutein in them. Lately, I’ve seen patients come in with recommendations from their optometrists for Vitalux AREDS for macular degeneration. So can vitamins help you eyes? Should you just eat lots of carrots? Do carrots help you see better anyway?
Let’s start with carrots. Carrots contain carotenoids. Carotenoids are yellow to red pigments found in a variety of plants. Carotenoids are a group of chemicals that include beta-carotene, lycophene, and lutein. I am over simplifying the chemistry here, but for this article we will consider beta-carotene as a water soluble version of vitamin A and the other carotenoids as antioxidants that are good for your eyes and other things. Not enough vitamin A can cause night blindness, so eating carrots and getting beta-carotene can prevent nightblindness. So, yes in that way carrots are good for your eyes. In an odd twist, though, people who smoke or have a history of asbestos exposure should not use beta-carotene supplements. There is some evidence to suggest this increases their risk of lung and prostate cancer.
It is less clear what lutein does for you. Lutein is believed to work in two ways. First it filters blue light. If you remember back to high school physics, blue light has the shortest wavelength of the visible light spectrum, so it has the highest energy. So lutein filters high energy blue light which is protective for the eye. The second thing lutein does is act as an antioxidant. Lutein finds and destroys “bad” oxygen molecules. Oxygen can be turned into a oxygen radical by things like being hit with light. Free oxygen radicals are “bad” because they are just dying to react chemically with anything they touch. If they react chemically with certain parts of your body’s cells they can damage or kill the cell. So it is a good thing that lutein gets rid of these reactive oxygen species. Researchers also believe that the more people consume lutein, the less they get eye problems like age-related macular degeneration (AMD) and cataracts.
The lutein data is promising but not conclusive yet. There was a small study of 90 patients called the LAST (Lutein Antioxidant Supplement Trial) in the journal Optometry in 2004 that showed that lutein alone or in combination with other nutrients improved visual functions in patients with AMD. But because the study was so small and had mostly men in it and didn’t go on for very long (1 year), it is not the final word yet.
Well what is this age-related macular degeneration anyway? AMD is the leading cause of blindness in people 65 and over in the Western world. People with AMD may notice such things as the center of their vision getting blurry. Lines on graph paper may appear wavy, and the squares may appear distorted.
So what about Vitalux AREDS for macular degeneration? Well, the National Eye Institute in the US sponsored the Age-Related Eye Disease Study (AREDS). The AREDS study concludes that zinc plus antioxidants can slow the progression of intermediate or advanced AMD in high risk patients. At the moment, it has not been showed that these vitamins help people with early AMD. The patients in the AREDS study used a vitamin C 500mg, vitamin E 400 IU, zinc 80 mg, and beta-carotene 15 mg. This is the dose you get with 2 tabs of Vitalux AREDS.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
A couple of years ago, people kept coming into the pharmacy looking for vitamins with lutein in them. I, frankly, had no idea what they were talking about. Then vitamins like Icaps, Ocuvite and Vitalux among others started appearing with lutein in them. Lately, I’ve seen patients come in with recommendations from their optometrists for Vitalux AREDS for macular degeneration. So can vitamins help you eyes? Should you just eat lots of carrots? Do carrots help you see better anyway?
Let’s start with carrots. Carrots contain carotenoids. Carotenoids are yellow to red pigments found in a variety of plants. Carotenoids are a group of chemicals that include beta-carotene, lycophene, and lutein. I am over simplifying the chemistry here, but for this article we will consider beta-carotene as a water soluble version of vitamin A and the other carotenoids as antioxidants that are good for your eyes and other things. Not enough vitamin A can cause night blindness, so eating carrots and getting beta-carotene can prevent nightblindness. So, yes in that way carrots are good for your eyes. In an odd twist, though, people who smoke or have a history of asbestos exposure should not use beta-carotene supplements. There is some evidence to suggest this increases their risk of lung and prostate cancer.
It is less clear what lutein does for you. Lutein is believed to work in two ways. First it filters blue light. If you remember back to high school physics, blue light has the shortest wavelength of the visible light spectrum, so it has the highest energy. So lutein filters high energy blue light which is protective for the eye. The second thing lutein does is act as an antioxidant. Lutein finds and destroys “bad” oxygen molecules. Oxygen can be turned into a oxygen radical by things like being hit with light. Free oxygen radicals are “bad” because they are just dying to react chemically with anything they touch. If they react chemically with certain parts of your body’s cells they can damage or kill the cell. So it is a good thing that lutein gets rid of these reactive oxygen species. Researchers also believe that the more people consume lutein, the less they get eye problems like age-related macular degeneration (AMD) and cataracts.
The lutein data is promising but not conclusive yet. There was a small study of 90 patients called the LAST (Lutein Antioxidant Supplement Trial) in the journal Optometry in 2004 that showed that lutein alone or in combination with other nutrients improved visual functions in patients with AMD. But because the study was so small and had mostly men in it and didn’t go on for very long (1 year), it is not the final word yet.
Well what is this age-related macular degeneration anyway? AMD is the leading cause of blindness in people 65 and over in the Western world. People with AMD may notice such things as the center of their vision getting blurry. Lines on graph paper may appear wavy, and the squares may appear distorted.
So what about Vitalux AREDS for macular degeneration? Well, the National Eye Institute in the US sponsored the Age-Related Eye Disease Study (AREDS). The AREDS study concludes that zinc plus antioxidants can slow the progression of intermediate or advanced AMD in high risk patients. At the moment, it has not been showed that these vitamins help people with early AMD. The patients in the AREDS study used a vitamin C 500mg, vitamin E 400 IU, zinc 80 mg, and beta-carotene 15 mg. This is the dose you get with 2 tabs of Vitalux AREDS.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Pregnancy Testing at Home
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
There is nothing quite so scary/exciting/bewildering/overwhelming as looking at a small chunk of plastic in your wife’s hand and having that little chunk of plastic tell you that you are going to have your first child. It was two years ago that happened to me now, but I still remember the stomach churning feeling. So what about these tests? Do they work? Do they make mistakes? When can you use them?
Let’s start with how these tests work. All the tests are looking for a hormone in the woman’s urine called human chorionic gonadotropin. Since that is a mouthful, let’s just call it HCG. If an egg (ovum) is fertilized by a sperm, it floats down the fallopian tube, gets to the uterus (womb) and attaches itself to the uterus wall (endometrial wall). The connection to the endometrial wall is called the placenta. The placenta produces HCG. So in healthy women HCG is a good thing to look for because it is only produced by the placenta.
With lab equipment, it is possible to detect HCG as little as six days after conception, but all the information I read on the home urine tests said the earliest they could detect HCG was the day of the first missed period. The amount of HCG in a woman’s body varies during the day. It is highest between 9 am and noon (so this is usually the best time of day to do the test). The amount of HCG increases exponentially in the woman’s body and peaks at about 60 days from conception. Then the HCG level drops. So it is possible that if you do a home pregnancy test too late in the pregnancy, it might give you a false negative (same you are not pregnant when you actually are).
Most tests on the market now can be done one the first day of the missed period. They all give results within one to three minutes. They all have a control indicator. This shows you that a test was actually done. For example if you did the test and the symbol for not pregnant appeared and the control symbol also appeared, you should be relatively confident you are not pregnant. If you did the test, got a not pregnant symbol, but no control symbol appeared, the test is meaningless and should be disregarded. Most tests don’t require you to collect urine in a cup. They can be put directly into the urine stream. Most test claim it doesn’t matter what time of day the test is done, but remember HCG should be highest in the morning.
Eventhough today’s tests are quick and easy, mistakes are possible. Human error is still the most common problem, such as holding the wrong end of the device in the urine stream. The control is your best friend for this kind of error. Remember that if the control symbol does not appear, some part of the test wasn’t done properly and the results should be discarded.
There are other things that can give false results on a home pregnancy test, including:
· Testing before missing your period (i.e. testing too soon)
· Testing after 60 days of conception (i.e. testing too late)
· Contaminating the device with soap, dirt etc.
· Urine with blood or protein in it
· Use of fertility drugs
· Something else in the body producing HCG like a tumor (rare)
· Doing test after a missed or incomplete abortion
If you do have a positive pregnancy test, see your family doctor. They will want to confirm the test, and if you are pregnant, early pre-natal care is important.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
There is nothing quite so scary/exciting/bewildering/overwhelming as looking at a small chunk of plastic in your wife’s hand and having that little chunk of plastic tell you that you are going to have your first child. It was two years ago that happened to me now, but I still remember the stomach churning feeling. So what about these tests? Do they work? Do they make mistakes? When can you use them?
Let’s start with how these tests work. All the tests are looking for a hormone in the woman’s urine called human chorionic gonadotropin. Since that is a mouthful, let’s just call it HCG. If an egg (ovum) is fertilized by a sperm, it floats down the fallopian tube, gets to the uterus (womb) and attaches itself to the uterus wall (endometrial wall). The connection to the endometrial wall is called the placenta. The placenta produces HCG. So in healthy women HCG is a good thing to look for because it is only produced by the placenta.
With lab equipment, it is possible to detect HCG as little as six days after conception, but all the information I read on the home urine tests said the earliest they could detect HCG was the day of the first missed period. The amount of HCG in a woman’s body varies during the day. It is highest between 9 am and noon (so this is usually the best time of day to do the test). The amount of HCG increases exponentially in the woman’s body and peaks at about 60 days from conception. Then the HCG level drops. So it is possible that if you do a home pregnancy test too late in the pregnancy, it might give you a false negative (same you are not pregnant when you actually are).
Most tests on the market now can be done one the first day of the missed period. They all give results within one to three minutes. They all have a control indicator. This shows you that a test was actually done. For example if you did the test and the symbol for not pregnant appeared and the control symbol also appeared, you should be relatively confident you are not pregnant. If you did the test, got a not pregnant symbol, but no control symbol appeared, the test is meaningless and should be disregarded. Most tests don’t require you to collect urine in a cup. They can be put directly into the urine stream. Most test claim it doesn’t matter what time of day the test is done, but remember HCG should be highest in the morning.
Eventhough today’s tests are quick and easy, mistakes are possible. Human error is still the most common problem, such as holding the wrong end of the device in the urine stream. The control is your best friend for this kind of error. Remember that if the control symbol does not appear, some part of the test wasn’t done properly and the results should be discarded.
There are other things that can give false results on a home pregnancy test, including:
· Testing before missing your period (i.e. testing too soon)
· Testing after 60 days of conception (i.e. testing too late)
· Contaminating the device with soap, dirt etc.
· Urine with blood or protein in it
· Use of fertility drugs
· Something else in the body producing HCG like a tumor (rare)
· Doing test after a missed or incomplete abortion
If you do have a positive pregnancy test, see your family doctor. They will want to confirm the test, and if you are pregnant, early pre-natal care is important.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Wednesday, May 12, 2004
DOES IBUPROFEN EFFECT THE BLOOD THINNING EFFECTS OF ASA?
We now have this and most other articles published on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Questions. Lots and lots of questions. People call the pharmacy with all sorts of questions all the time. One came in the other day that gave me pause. “Is it true that ibuprofen will make low dose ASA not thin the blood as well as before?” I had no idea. It was time to do some reading. Here is what I found.
There was a study published in the New England Journal of Medicine in 2001 in which the researchers tried to see if ibuprofen, acetaminophen (the medication in Tylenol), diclofenac or rofecoxib (the medication in the prescription medication Vioxx) effected the blood thinning properties of 81 mg of ASA. It turned out that the ibuprofen effected the blood thinning properties of ASA if the ibuprofen was taken first. The diclofenac and rofecoxib did not effect the blood thinning properties of ASA. If the ASA was taken first by 2 hours, the ibuprofen didn’t effect the blood thinning properties.
Another study in the Lancet in 2003 looked at Scottish patient with heart disease. These patients were divided into 4 groups: ASA alone, ASA plus ibuprofen, ASA plus diclofenac, and ASA plus any other NSAID. More people died from any cause who were on ASA plus ibuprofen than ones who were on ASA alone. There was no difference in mortality between the ASA alone group and ASA plus diclofenac and ASA and any other NSAID groups.
Well, what does this all mean? First, the question needs more study. There are more studies that support the idea that ibuprofen might counter-act the heart protecting effects of ASA. These studies aren’t the final word. There might be something else going on. So what should we do?
If you are on low dose ASA to protect your heart, it might be wise to avoid ibuprofen altogether. We know that ASA plus another NSAID like ibuprofen can increase the chance of stomach problems like ulcers. Now it looks like ibuprofen may reduce ASA’s heart protective effects. What should you use if you are on low dose ASA and need a pain killer? Acetaminophen (Tylenol) is a good choice for most people. The problem is acetaminophen doesn’t help with inflammation. So if acetaminophen doesn’t help, ask your doctor if one of the prescription NSAID’s like rofecoxib or diclofenac is right for you. What if you absolutely feel you want to take ibuprofen? It is probably okay if ibuprofen is taken once in a while, if it is taken 2 hours after the ASA.
Hopefully this will help make sense of the new Tylenol ads on TV bashing ibuprofen.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Questions. Lots and lots of questions. People call the pharmacy with all sorts of questions all the time. One came in the other day that gave me pause. “Is it true that ibuprofen will make low dose ASA not thin the blood as well as before?” I had no idea. It was time to do some reading. Here is what I found.
There was a study published in the New England Journal of Medicine in 2001 in which the researchers tried to see if ibuprofen, acetaminophen (the medication in Tylenol), diclofenac or rofecoxib (the medication in the prescription medication Vioxx) effected the blood thinning properties of 81 mg of ASA. It turned out that the ibuprofen effected the blood thinning properties of ASA if the ibuprofen was taken first. The diclofenac and rofecoxib did not effect the blood thinning properties of ASA. If the ASA was taken first by 2 hours, the ibuprofen didn’t effect the blood thinning properties.
Another study in the Lancet in 2003 looked at Scottish patient with heart disease. These patients were divided into 4 groups: ASA alone, ASA plus ibuprofen, ASA plus diclofenac, and ASA plus any other NSAID. More people died from any cause who were on ASA plus ibuprofen than ones who were on ASA alone. There was no difference in mortality between the ASA alone group and ASA plus diclofenac and ASA and any other NSAID groups.
Well, what does this all mean? First, the question needs more study. There are more studies that support the idea that ibuprofen might counter-act the heart protecting effects of ASA. These studies aren’t the final word. There might be something else going on. So what should we do?
If you are on low dose ASA to protect your heart, it might be wise to avoid ibuprofen altogether. We know that ASA plus another NSAID like ibuprofen can increase the chance of stomach problems like ulcers. Now it looks like ibuprofen may reduce ASA’s heart protective effects. What should you use if you are on low dose ASA and need a pain killer? Acetaminophen (Tylenol) is a good choice for most people. The problem is acetaminophen doesn’t help with inflammation. So if acetaminophen doesn’t help, ask your doctor if one of the prescription NSAID’s like rofecoxib or diclofenac is right for you. What if you absolutely feel you want to take ibuprofen? It is probably okay if ibuprofen is taken once in a while, if it is taken 2 hours after the ASA.
Hopefully this will help make sense of the new Tylenol ads on TV bashing ibuprofen.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
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