Insect Repellants

Insect Repellants

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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. I was visiting a friend with my daughter Emily last night and just standing in his garage we were getting eaten alive. I guess water and warmth is just what the little vampires were waiting for. You gals and guys making a living in the bush/swamp/field every day have my respect and gratitude. I think I would lose my mind if I was bitten all working day long.

So how do us inside workers avoid getting eaten during our brief excursions outside? Try to reduce the amount of time you spend outdoors between sunset and sunrise. I know these are the only hours you aren’t working. I didn’t say avoiding being bit would be easy. The peak hours for mosquitoes are at sunrise and sunset. 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.

I won’t specifically give advice for pregnant women, because I don’t want to be sued. However, my wife is pregnant and we decided that we could accept the risk of spraying DEET repellent on her clothing only. You pregnant women out there may want to discuss the risks of this option with your health care provider.

Repellants with 30% DEET and higher will no longer be registered in Canada because of fears of the health risks with long term exposure. However, since there have been no actual reports of problems, products with 30% DEET in them already will be allowed to be sold still. Health Canada hopes to phase out the 30% DEET products eventually.

Insect repellants and sunscreens are an interesting challenge. Sunscreens should be put on liberally and often and insect repellants should be used only a little and not often. So this is why combination products with both sun screens and insect repellants were phased out Dec 31/03. Also there was evidence that the chemicals in the combo products counter-acted each other. So how do you apply when you need both? Apply the sunscreen first and work it in. Then apply the bug spray.

Although not as big a panic as last year, whenever you talk about mosquitos, someone asks about 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.

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.

As of June 21, 2005 there were no mosquitos caught of the type that spreads West Nile Virus in the Parkland. There were also no dead birds (Corvids like crows) reported in the Parkland.

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.gov.mb.ca/health/wnv

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Bio-identical Hormone Replacement Therapy Part 1

Bio-identical Hormone Replacement Therapy Part 1

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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.

I have been getting a lot of calls lately about Bio-Identical Hormone Replacement Therapy. People are reading books by Dr. John Lee, Dr. Christine Northrup, and Suzanne Sommers all talking about Bio-Identical Hormone Therapy (BHRT). What is it? Does it work? Aren’t all hormones going to kill me? This week we will talk about BHRT, and the Women’s Health Initiative Study from July 2002 that scared everyone about hormones. Next week, we’ll talk about saliva test for hormones and the new revelations from the WHI study.

Let’s go back to July 2002. A bunch of scientists went on TV, newspapers, radio etc and announced that there was a 26% increased risk in breast cancer and a 29% increased risk in heart attack for women on premarin and provera and their study was stopped because of such a terrible result. Women were scared. The media jumped all over this story. Many women threw their hormone replacement therapy (HRT) in the garbage. Now, almost 3 years later, women are having hot flashes, night sweats, and not sleeping, but are too scared and confused to get treated. What can be done?

First, let’s talk about the original study. It only looked at women on one specific kind of HRT. They were on premarin or conjugated equine estrogen (CEE) 0.625 mg and provera or medroxyprogesterone actetate (MPA) 2.5mg once daily. So these results do not apply to other types of HRT. Also, the risk in the media was blown way out of proportion. As you can see in the following table only 8 more women than normal out of 10,000 will develop breast cancer. That isn’t much when you consider that consuming alcohol 2 or more drinks a day or exercising less than 4 hours per week have each been reported to increase the risk of breast cancer by 60%.

Outcomes
If 10,000 women took placebo for 1 year how many would get the outcome?
If 10,000 women took premarin 0.625mg and provera 2.5 mg for 1 year how many would get the outcome?
How many more or less women in 10,000 would get the outcome.
Invasive Breast Cancer
30
38
8 more women with breast cancer
Coronary Heart Disease
30
37
7 more women with heart attacks
Stroke
21
29
8 more women with strokes
Blood Clots
16
34
18 more women with blood clots
Hip Fracture
15
10
5 fewer women with hip fracture
Colorectal Cancer
16
10
6 fewer women with colorectal cancer

So after you and your doctor have a discussion, the two of you may quite logically conclude that an 8 in 10,000 risk of breast cancer is acceptable weighed against the benefit of being able to sleep at night.

One of the alternatives to premarin and provera is called Bio-identical Hormone Replacement or BHRT. The ultimate goal of Bio-identical hormone replacement therapy is to imitate, as close as possible, the hormones that are naturally produced by the human body. Bio-identical hormone replacement uses molecules which are taken from yam or soy plants and are then modified so that their structure matches the hormone(s) which are produced by the human body. Bio-identical hormone replacement therapy has also been referred to as natural hormone replacement therapy or native hormone replacement therapy. This causes some confusion because people often associate different meanings with these different names. Bio-identical hormone replacement therapy does not refer to grinding up leaves and plants to make products, nor does it refer to using herbal/natural products such as soy supplements, black cohosh, or yam isoflavones. Bio-identical hormone replacement therapy products are made using pure chemicals purchased from an FDA approved chemical supplier. There are two major classes of hormones which are used in bio-identical hormone replacement therapy; estrogens and progesterone.
· Bio-identical Estrogens
There are three major estrogens that are produced by the human body namely estrone, estradiol, and estriol. Bio-identical forms of these estrogens can be made into products containing one estrogen alone or a combination of estrogens.
· Bio-identical Progesterone
The human body produces progesterone. Progesterone is used in bio-identical hormone replacement products. Some confusion arises because the words progesterone and progestin have sometimes been used interchangeably, but in fact they are different molecules and have some different effects in the body.

How Do I Get Started Using Bio-identical Hormone Replacement Therapy?
Bio-identical hormone replacement therapy products require consultation and a prescription from your family doctor who will prescribe a dose and combination that is right for you and your particular symptoms. As well, a pharmacist at the Dauphin Clinic Pharmacy can book an appointment with you to discuss bio-identical hormone replacement therapy. During this consultation the pharmacist will discuss a symptom checklist, a health questionnaire, and answer as many questions as possible that you may have about bio-identical hormone replacement therapy. A summary of what was discussed during the consultation, as well as any recommendations that the pharmacist may have regarding therapy, will be sent to your family doctor. Since most bio-identical hormone replacement therapy products are not available as commercial products, a compounding pharmacy must prepare these products. Dauphin Clinic Pharmacy is a compounding pharmacy and can prepare bio-identical hormone replacement products.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Asthma – Worse than Cancer?

Asthma – Worse than Cancer?
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.
Asthma kills more people than well spoken asthma researcher, pointed out an interesting fact. At the moment, asthma kills about 0.5 people per 100,000 people in the general population. That may not sound like a lot, but one serious type of cancer called non-solid lymphoma also kills 0.5 people per 100,000 in the general population. So why isn’t there a public out cry about asthma deaths.cancer. Now that I’ve got your attention, perhaps I should qualify that a little. I attended a conference in Winnipeg about asthma education in Manitoba and one of the presenters, Dr. Allan Becker, a pediatric allergist and
What is worse than 0.5 people per 100,000 people in the general population dying of asthma, is the fact that Dr. Becker says that 90% of all asthma deaths are preventable. So what is asthma and what can we do about it?
Asthma is "a chronic inflammatory disorder of the airways characterized by paroxysmal or recurrent symptoms (cough, wheeze, chest tightness, and shortness of breath), with variable airflow limitation and airway hyperresponsiveness to a variety of stimuli". Now if that isn't a mouthful, I don't know what is. Let's break that down into some manageable parts.
First, your lungs are not just big bags of air. Inside your lungs are lots and lots of air way tubes that branch into finer and finer tubes like the roots of a tree. Towards the ends of this branching airway system, the tubes get really small, so it doesn't take very much to block them. Now we'll talk about inflammation. If you took a piece of sandpaper and rubbed your hand with it, your hand would get red and swollen right? Well that is just what happens in the tiny tubes in the lungs during an asthma attack. They get red and swell shut. We call this inflammation. Finally, in asthma, having the airways swell shut doesn't happen all the time. It comes and goes, and usually we can identify and avoid triggers that cause the inflammation to happen.
There was a survey of Canadian asthmatics back in 1999. First they asked the asthmatics if they thought their asthma (or their child’s asthma) was under good control. Ninety percent said it was. Then they asked them six questions (which we will get to later). If they answered yes to 2 or more of the questions, the patients actually had poor asthma control. Sixty percent of the asthmatics interviewed actually had poor asthma control.
So what, you say? If the patient is happy with their asthma control, why should we care that some 6 question test says their control is bad? Because these asthmatics with poor control represent about 80% of asthmatics that end up in emergency rooms. These poorly controlled asthmatics also represent 99% of the asthmatics that miss school/work/social outings due to their asthma.
So what are these six magic questions?
1. Do you have problems with coughing, wheezing, breathlessness or chest tightness 3 or more times per week?
2. Do you need to use your fast acting inhaler (usually your blue puffer) 3 or more times per week?
3. Do symptoms like cough, wheeze, breathlessness or chest tightness wake you up more than once a week?
4. Have there been any physical activities that you were unable to do in the past 3 months due to your asthma?
5. Have you missed any school or work in the past 3 months due to asthma?
6. Have you had to go to the emergency room or hospital due to asthma in the past 6 months?
So what should you do if your asthma isn’t in good control? Contact your doctor. Also, read next week and we will discuss asthma treatments.
As always if you have any questions or concerns about these or other products, ask your pharmacist.

How to Treat Asthma

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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 signs that your asthma is not in good control like if you need your blue puffer more than 3 times per week. This time we will talk about what the different asthma medications do.

There does seem to be some confusion about what asthma medications do what. I have a story. There was this health care professional whose son ended up in the emergency room with asthma twice in one night. So the next day, the boy was seen by a doctor and prescribed an antibiotic, Prednisone pills for 5 days, an inhaled steroid puffer to use twice a day, and told the boy to continue using his salbutamol (blue) puffer as needed. The health care professional was very upset. This person didn’t know why the boy needed so much medication. This person felt the inhaled steroid did the same thing as the blue puffer, the prednisone was ridiculous, and that the boy was well controlled on his blue puffer anyway.

We will come back to the case in a minute, but two important points are that even us health care professionals can often use some education, and that you know already from last week that if a patient ends up in the emergency room because of asthma problems, that by definition they have poor asthma control.

We think that the majority of problems in asthma are from inflammation of the lining of the tubes in your lungs. Since most of us have never seen the inside of our lungs, let’s talk about the back of your hand. Normally, if you rub a feather or sprinkle some sand on the back of your hand, it doesn’t hurt, right? Now let’s pretend the back of your hand has poison ivy. It is red, and inflamed. Now if we rub a feather or sprinkle some sand on your hand, the muscles in your arm will twitch, pull your hand away, and spill your coffee. So to prevent you from spilling your coffee, we could treat your hand and arm in two ways. We could inject some muscle relaxants into the muscles in your arm. This would mean that although rubbing the feather on your hand hurts, the muscles in your arm are too relaxed to spill your coffee. We could also rub some steroid cream onto the red, inflamed rash. This would slowly, over time (like weeks) reduce the rash so that rubbing the feather on your hand wouldn’t hurt and so you wouldn’t spill your coffee.

This is how we treat asthma in the lungs. When you are having an asthma attack (like coughing, wheezing, having trouble breathing, etc.), we should give you something that will immediately relax the bands of muscles around the tubes in your lungs. Often (but not always) this is an inhaled medication like salbutamol (the brand name is Ventolin) and the inhaler is blue. Just like with your inflamed hand, if a little bit of dust, cold air, or some other irritant gets into your inflamed lungs, the muscles over-react and you cough, and wheeze. So the salbutamol (or short acting beta-agonist) relaxes the twitchy muscles in your lungs and stops the coughing and wheezing. The short acting beta-agonist does NOT fix the underlying problem of inflammation in your lungs. As an extra problem, short acting beta-agonists like salbutamol or Ventolin, speed up the heart. So if you use too much salbutamol or Ventolin it can be hard on the heart.

So how do we fix the inflammation in the lungs and not speed up the heart too much? Just like with your inflamed hand, we use a steroid. In the lungs we use a steroid puffer, not a cream, but if we use it every day, over weeks and months the inflammation in the lungs will go down. So after the inflammation goes down, if you inhale a little dust or cold air you won’t cough and wheeze. This is just like after the inflammation on your hand goes down, if you rub a feather on it you won’t jerk your hand away and spill your coffee.

This is why we say that ideally we want an asthma patient to use an inhaled steroid regularly everyday to keep the inflammation down and only need there short acting beta-agonist (like salbutamol or Ventolin) three or fewer times a week.

So back to our case study. The medications the doctor prescribed were appropriate. The antibiotic will kill the bugs in the lungs that caused the problem in the first place. Prednisone pills are the strongest antiinflammatories for the lungs that we have. The prednisone will quickly reduce the swelling in the lungs caused by the infection. The problem is that prednisone is too strong to be used for more than about a week in asthma. So we use the inhaled steroid to keep helping the inflammation in the lungs heal. Remember, just like the poison ivy on your hand, it may take weeks or longer for the inflammation in the lungs to go away. After the inflammation in the lungs has healed, we think the patient should remain on the inhaled steroid so the next irritation (infection, etc) doesn’t make the lungs swell up again. Finally we hope that if the boy continues to use his inhaled steroid regularly he will end up needing his blue puffer 3 or less times a week and stay out of the emergency room.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Sun Awareness

SUN AWARENESS

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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.

As I write this, it is raining outside. It is supposed to rain tomorrow as well. I am sure that summer will show up soon and that when you read this, you will be sweating. Remember though: Summer is great. The outdoors are great. Skin cancer is not so great.

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.

The Canadian Dermatology Association has proclaimed May 30-June 5, 2005 “Sun Awareness Week” but it is something we should be careful with all summer. Here are some of the CDA’s recommendations:
Reduce sun exposure between 11 a.m. and 4 p.m. The sun's rays are at their strongest between these hours. It's easy to remember - during these hours your shadow is shorter than you are. If you can, plan your outdoor activities before 11 a.m. or after 4 p.m.
Seek shade or create your own shade. When you are outside - especially between 11 a.m. and 4 p.m. - try to stay in the shade. Be prepared for places without any shade by taking along an umbrella. With an umbrella you can create shade wherever you need it.
SLIP! on clothing to cover your arms and legs. Covering your skin will protect it from the sun. Choose clothing that is: loose fitting; tightly woven; and lightweight.
SLAP! on a wide-brimmed hat. Most skin cancers occur on the face and neck. This area needs extra protection. Wear a hat with a wide brim that covers your head, face, ears and neck. Hats without a wide brim, like baseball caps, do not give you enough protection.
SLOP! on a sunscreen with SPF (Sun Protection Factor) 15 or higher - SPF 30 if you work outdoors or if you will be outside for most of the day. Look for "broad spectrum" on the label. This means that the sunscreen offers protection against two types of ultraviolet rays, UVA and UVB.
Apply sunscreen generously, 20 minutes before outdoor activities. Reapply often - at least every 2 hours (and after swimming or exercise that makes you perspire). No sunscreen can absorb all of the sun's rays. Use sunscreen along with shade, clothing and hats - not instead of them. Use sunscreen as a backup in your sun protection plan.
Keep babies under one year out of the direct sun. Babies need extra protection because their skin is very sensitive. Keep your child's stroller, playpen or carriage in the shade.
Tanning salons and sunlamps are not a safe way to tan. Tanning salons do not give you a "safe tan without burning". No tan is a safe tan. A tan is evidence of sun damage.
For More Information visit:
The Canadian Cancer Society: www.cancer.ca
The Canadian Dermatology Association www.dermatology.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.

Vitamin E – Is it Bad for You?

Vitamin E – Is it Bad for You?

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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.

Dr. Hrabarchuk came into the pharmacy the other day and said that if Vitamin E was a prescription drug it would be pulled off the market. When Dauphin’s Internist makes such statements, it catches our attention. So he left us some reading about a study on Vitamin E. The following is what got him so excited.

There was a big trial run between 1993 and 1999 called the Heart Outcomes Prevention Evaluation (HOPE) trial. It told us things like the blood pressure pill ramipril is very good for the heart. It also looked at Vitamin E 400 IU’s per day in the hope that Vitamin E would prevent heart problems. The HOPE trial did not show improvement in heart outcomes due to Vitamin E.

The original HOPE trial involved patients at least 55 years old with vascular disease or diabetes. There was an extension of the HOPE trial, called HOPE-TOO. Of the 9541 patients in the HOPE trial, 7030 agreed to continue to be followed from April 1999 to May 2003. Again these people were on Vitamin E 400 IU and the researchers were looking to see if they got cancer, died from cancer, or got heart problems like heart attack, stroke or death from heart problems more often than people on sugar pill (placebo).

So the answer was…. there was no difference in the rates of cancer, cancer deaths, heart attacks, strokes or death from heart problems. The HOPE trial did find that people on Vitamin E were more likely than the sugar pill group to get a heart disease called heart failure. The trial found that those taking Vitamin E were more likely to be hospitalized due to heart failure.

So if Vitamin E is a natural anti-oxidant, why are more people getting heart failure, and why are more people going to the hospital? We don’t know for sure. Some expert think that too much Vitamin E (and 400 IU may be too much) might not be an anti-oxidant anymore. Or may too much Vitamin E does bad things to your good cholesterol (HDL).

So should I throw my Vitamin E away? We don’t know for certain on that either. If a patient already has had a heart problem like a heart attack, Vitamin E could do them harm. If a patient has never had any heart problems, we don’t know what Vitamin E will do.

Five or six years ago, Vitamin E was very popular. People were taking it for everything from protecting their heart to helping with Alzheimers. Now, studies seem to be saying that the best case is that Vitamin E supplements do no good, and worst case is that they do people harm.


As always if you have any questions or concerns about these or other products, ask your pharmacist.

Bio-identical Hormone Replacement Therapy Part 2

Bio-identical Hormone Replacement Therapy Part 2

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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 week we talked about the Women’s Health Initiative Study from 2002 and Bio-identical Hormone Replacement therapy. This week we will talk about the WHI results from March 2004, depot provera and saliva tests for hormones.

On March 1, 2004 the National Institutes of Health (NIH) in the US informed study participants that they should stop study medications in the trial of conjugated equine estrogens (Premarin) versus placebo in the Women’s Health Initiative (WHI).

NIH informed participants, who now have an average age of almost 70 years and have been followed for approximately 7 years, that the current results show that estrogen alone does not appear to affect (either increase or decrease) coronary heart disease. At the same time, estrogen alone appears to increase the risk of stroke and decrease the risk of hip fracture, and does not increase the risk of breast cancer during the time period of this study. The current results indicate that the increased risk of stroke is similar to the found in the trial of Premarin and Provera (remember from last week that was an extra 8 women in 10,000 got strokes).

So why was the trial stopped early? This study was a primary prevention trial which means that they took otherwise healthy women and gave them premarin in the hope that they could find out how much improvement premarin could produce on things like heart disease. So, since after 7 years there was no improvement in heart disease and there was a slight increase in stroke, NIH believed the increase in stroke was not acceptable in a prevention trial.

If you remember the chart from last week, that there were small increases in risk of breast cancer, heart disease, and blood clots in the premarin and provera trial, but these reports of the premarin alone trial don’t show those increased risks. Is provera the real bad guy? Is there something else going on? The jury is still out.

To add further fuel to the fire that provera might be the bad guy, there was a Health Canada warning about the injectable form of provera (medroxyprogesterone acetate) recently. Depo-Provera is most often used as an injectable form of birth control. In November 2004 a warning was released that Depo-Provera may reduce women’s bone mineral density and thus increase their chance of broken bones due to osteoporosis. It is not proven, but it make you wonder about using medroxyprosterone acetate in older women for menopausal symptoms if the injection weakens bones of younger women.

Saliva testing for hormone levels is controversial. Not all doctors think they are worthwhile or give any useful information. Manitoba Health doesn’t pay for them. A five hormone test will cost about $200 if a woman wants to spit an special test tube and send it to Calgary based Rocky Mountain Analytical labs.

There are blood test for hormone levels that family doctors have access to, but some experts argue the levels that you get don’t co-relate very well with the symptoms very well. So, for example, a woman may have swollen and tender breasts – usually a sign of too much estrogen, but the blood hormone level is normal.

A bio-chemist, David Zava, in the US was using saliva testing to test for different herbal products and found saliva was a better fluid to check for hormone levels than blood. A medical doctor and bio-chemist, George Gillson, worked with Dr. Zava and then opened his own lab in Calgary, Rocky Mountain Analytical. He is the main promoter of saliva testing in Canada. The people who believe in saliva hormone testing are also usually quite pro bio-identical hormone replacement. The idea is that BHRT can be customized to just boost the hormones you need.

Where Can I Find Out More Information About Bio-identical Hormone Replacement?
To find out more about bio-identical hormone replacement therapy and the products that are available, talk to your family doctor or speak to one of the pharmacists at the Dauphin Clinic Pharmacy. One of the pharmacists can arrange an appointment with you (which we will charge for) to discuss your hormone questions.

Some places for more information:
http://www.sogc.medical.org/ The Society of Obstetricians and Gynaecologists of Canada
http://www.whi.org/ The Women’s Health Initiative
http://www.menopause.org/ The North American Menopause Society
http://www.rmalab.com/ Rocky Mountain Analytical Labs

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Head Lice

HEAD LICE

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.

We seem to be getting a lot of lice questions again. We are selling more lice treatments again. We are getting phone calls from schools with treatment questions. I thought is was time for another lice review.

What are lice? Head lice are parasites that live in humans’ hair. The scientific name for them is Pediculus Humanus, and they are wingless insects with six legs. They are tiny grey insects that are the size of a pinhead and can barely be seen with the naked eye. They multiply very quickly. Females lay 7 to 10 oval and whitish eggs called nits every day. Seven to ten days later, the nits hatch and are called nymphs. The nymphs mature in 10-14 days and lay more eggs. So the whole life-cycle is about 30 days.

So how is head lice transmitted? Lice are transmitted directly by close contact from one infested scalp to another and indirectly by sharing personal articles that come in contact with the head, i.e. brushes, hats, etc. Children from 3 to 10 years old are the most affected age group. However, anyone can get lice, regardless of sex, race, age, hair length or socio-economic status.

There are a lot of myths and misconceptions about head lice. Lice is not a sign that your child’s hair isn’t clean. Lice actually prefer clean hair. Lice cannot fly and lice cannot jump. Lice can only survive on humans; therefore you cannot get lice simply by being in contact with pets, sand, grass, trees or plants.

What are the symptoms of having lice? Persistent itching, especially around the ears and back of the scalp. There can be small sores, or small scabs on the person’s scalp or neck. If these sores get infected, there can be pus.

How do you recognized head lice? First you should see nits (the eggs) attached to the base of the hair shafts on the warmer parts of the scalp (the back and sides). The egg or nit is oval and glued to the hair. Nits are laid close to the scalp for warmth, usually around the ears and the nape of the neck. Live nits are brownish in color, and dead ones are whitish. Dandruff, hair casts, and hair spray globules are sometimes mistaken for nits. You can tell that they are not nits because they can be easily removed, while nits are firmly cemented to the hair and can only be removed with the fingernails or a fine toothed nit comb. Nits found more than 1.0 cm from the scalp have grown out with the hair and have either hatched or are dead. The nymph is a miniature replica of the adult louse, but it cannot reproduce. It goes through three stages before becoming an adult. And then there is the adult. It is approximately 1-2 mm in length. It is elongated in shape, greyish, has six claw like legs, and no wings. It avoids light by staying away from the top of the head and is usually found around the ears and nape of the neck.

The main product used to treat head lice is permethrin (one of the brand names is Nix). It actually sticks around for up to ten days after use to kill any more lice that hatch. It is generally the product of first choice because is very good at killing the eggs, it has low toxicity and it sticks around for about 10 days. Although it is not absolutely necessary to do a repeat application, it is often recommended that one uses the permethrin again in 7 to 10 days. There is a similar product to permethrin on the market and it contains natural pyrethrins (one of the brand names is R&C Shampoo). It is not as good as permethrin at killing the eggs. It doesn’t hang around after application. It must be reapplied in 7 to 10 days for it to be effective. Both permethrin and pyrthrins can cause allergic reactions in ragweed or chrysanthemum sensitive individuals. There are older products that contain lindane available as well. Lindane is not as good as permethrin at killing eggs. It doesn’t stick around so you must do a second application in 7-10 days for it to be effective. About 10% of the lindane actually goes into the rest of your body and it can accumulate with repeated exposure. It can cause seizures and other neurologic disorders so lindane is not my favorite product.

Because of the perceived lack of effectiveness of some of the commercially available products, the Dauphin Clinic Pharmacy has developed an all natural oil lice treatment. It coats the hair and suffocates the lice. It can be used as an alternative to the commercially available products.

Some non-medication measures should be taken when a family member gets lice. Combs and brushes should be soaked in alcohol or Lysol for one hour; or they can be soaked in water 65oC or hotter for 10 minutes. Bedding, towels, and clothing should be washed in hot water and dried in a dryer for 20 minutes to an hour. It is actually the heat from the dryer that kills the lice. Other items may be dry-cleaned or stored in a sealed plastic bag for 2 weeks. Lice can’t live away from human contact for very long, so the two weeks allows the eggs to hatch and the new lice to die. Some people have even stored these plastic bags full of teddy-bears etc. in the freezer. Vacuuming of carpets and furniture is also a good idea.

The eggs, or nits, are very difficult and tedious to remove because they are cemented onto hairs. Hold the hair at its end and comb towards the scalp with a fine toothed comb or tweezers. Vinegar and water in a 1:1 ratio can be used to help dissolve the cement that holds the nits onto the hair.

As always if you have any questions or concerns about these products, ask your pharmacist.

Bowl of Hygeia

Bowl of Hygeia

By Dauphin Clinic Pharmacy Staff

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.

We have received quite a few questions at the pharmacy about the award Myles won. In case you missed the ads in the paper, Myles Haverluck, owner of the Dauphin Clinic Pharmacy was awarded the Bowl of Hygeia award on April 16, 2005. The Staff at the Dauphin Clinic Pharmacy would like to congratulate Myles on this prestigious award.

The Bowl of Hygeia symbol comes from Greek mythology and is the most widely recognized international symbol of pharmacy. Hygeia was the daughter and assistant of Aesculapius (sometimes spelled Asklepios), the god of medicine and healing. Hygeia’s classical symbol was a bowl containing a medicinal potion with the serpent of wisdom (or guardianship) partaking it. This is the same serpent of wisdom that appears on the caduceus, the staff of Aesculapius, which is the symbol of medicine.

The Bowl of Hygeia award is given each year to one pharmacists in each Canadian province, each US State, the District of Columbia (i.e. Washington, DC), and Puerto Rico. The Award is given to a pharmacist to recognize their outstanding community service. The Bowl of Hygeia has been awarded since 1958 and is generally recognized as the most prestigious award a community pharmacist can receive.

Myles is well recognized as a community lead in Dauphin. The staff at the pharmacy have imperfect memories, so this list is incomplete, but here is our best effort to list some of Mr. Haverluck’s community service:
- Strategic Planning for Dauphin Medical Group and Dauphin Clinic Pharmacy
- Chairman of Parkland Mental Health Advisory Council
- Member of Provincial Mental Health Council to Minister of Health (Don Orchard)
- Public speaking and interactive seminars with: High School Career Days, Senior Citizen Groups, Church Groups, Addictions Foundation of Manitoba, Mental Health, Diabetic Groups, Canadian Diabetes Association, Fibromialgia, LPN associations, Arthritis Self Help, Second Year Family Medicine Residents
- Written articles for the local paper
- Canadian Red Cross board
- Handivan Board
- Economic Development Board
- Annual Golf Tournament with proceeds going to local charities
- Dauphin Clinic Pharmacy Cash Spiel Title sponsor
- Countryfest Corporate Sponsor
- Jeus Manifest Sponsor
- Dauphin Kings major sponsor
- Figure skating competition donations
- At one time or other supported all the schools in the Parkland Area – e.g. Speakers for career day, donations for sports teams
- Sponsor of Dauphin Agricultural Society Fair
- Contribution to Dauphin Festival of the Arts – trophies and awards
- Spring Lunch Tour – pharmacy staff travels to several Dauphin Seniors complexes, and community centers in communities up to an hour away. We cater and serve lunch to the seniors who come to enjoy the socialization and health issues discussions.
- Member of the Kinsmen Club of Dauphin – motto “Serving the community’s greatest needs.”
- Member of the K-40’s Club of Dauphin

So again, congratulations to Myles Haverluck for his award.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Pharmacy Awareness Week

PHARMACY AWARENESS WEEK

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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.

Pharmacy awareness week is March 7-13, 2005. The theme this year is “You and Your Pharmacist – A Healthy Partnership”. One of the main activities we would like the public to help us with is a Medicine Cabinet Clean-Up! So grab those unused antibiotics from last spring, Uncle Joe’s ointment that he left at your house last year and that expired cough syrup and bring them back to your pharmacy for disposal. Old and expired medication can cause a number of problems if left in your house:
- Expired medications don’t work as well as in date ones
- Expired medications such as tetracycline can actually harm you instead of help you
- If your doctor has switched you from one medication to another, if you leave the old medication in your house you run the risk of accidentally taking the wrong one

As this week is called “Pharmacy Awareness Week” I think I should blow a horn for the profession! I think that we are one of the most accessible health care professionals. For instance, did you know that -

1) We detect and solve any problems with your medication.
Before filling any new prescription, we check your records to make sure you are not allergic to the medication, the dose is correct for you, and to spot possible interactions with other drugs you may be taking. If you experience difficulties after you start taking your medication, such as unpleasant side effects, we can help by suggesting ways to overcome the problem.

2) We answer your questions with expert information.
We have spent more years learning about medications than any other health care professional. Even after we leave school, it is part of our job to stay up to date on new drugs and treatments. Please feel free to ask us anything you would like to know about your medicine or other health-related concerns.

3) We teach you how to use your medicine effectively.
Even the best medicine will not help if it is not taken properly. Sometimes small things - like what time of day you take your medication or what you take with it can make a big difference in the effectiveness. We advise you on how and when to take your medication to make certain you get the greatest benefit from it.

4) We consult your doctor concerning your care.
As partners in your health care, we communicate with your doctor whenever necessary to ensure your drug therapy is going according to plan. We are always available to discuss your medications with your doctor.

5) We give you advice on staying healthy.
We give personalized counselling on topics such as vitamins and nutritional supplements, and how to use products designed to help you stop smoking. We also offer a wide range of educational materials to teach you good health habits.

6) We guide you in managing your illness.
Are you living with a chronic illness such as diabetes, asthma or heart disease? We are here to help you monitor your condition, provide advice about the safe use of non-prescription drugs and answer any questions about your medications or your illness. We work with you to keep you on track and feeling the best you can be.

Adderall XR Recall

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.

On February 9, 2005 Health Canada instructed Shire BioChem Inc. to pull Adderall XR off the market. Adderall XR contains mixed salts of amphetamine in a long acting format and is used to treat Attention Deficit Hyperactivity Disorder (ADHD). There is concern that the drug is linked to sudden deaths, heart-related deaths, and strokes in children and adults taking usual doses of Adderall XR (long acting) and Adderall (short acting). The short acting Adderall was never available in Canada.

The concern is that 20 people worldwide have died while taking usual doses of Adderall and Adderall XR. Fourteen of the deaths occurred in children, and six of the deaths occurred in adults. There were 12 reports of strokes, two of which were in children. None of the reported deaths or strokes occurred in Canada.

Health Canada’s decision is not without its opponents. The manufacturer, Shire, points out that approximately 30 million prescriptions of Adderall products were written between 1999 and 2003 (the period of time that the deaths occurred), and that, although unfortunate, the reported number of deaths and strokes in a population that size is to be expected whether they were taking Adderall or not. They state that at least 5 of the cases were in patients with pre-existing heart defects like abnormal arteries, valves or heart walls. This is why in the US the regulating body there, the Food and Drug Administration (FDA) did not pull Adderall off the market. Instead the FDA changed the labeling for Adderall XR to emphasize to doctors not to prescribe Adderall XR to patients with pre-existing heart problems.

So what should you do if you or your child is taking Adderall XR? Contact your doctor about whether to continue the drug in the short term and about getting an alternative medication. After you have got an alternative medication, do not flush the rest of your Adderall XR down the sink or toilet. Return any unused portion of the medication to your pharmacy. The company, Shire, says it will reimburse your money if you return it to the pharmacy on or before March 4, 2005.

So what should you do if you or your child is on a medication in the same class as Adderall XR? Nothing different, yet. Health Canada is reviewing the other ADHD medications and will release information as it becomes available. Until we know different, we will assume the other ADHD medications are safe if used appropriately.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Asthma Part 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.

Asthma is " a chronic inflammatory disorder of the airways characterized by paroxysmal or recurrent symptoms (cough, wheeze, chest tightness, and shortness of breath), with variable airflow limitation and airway hyperresponsiveness to a variety of stimuli". Now if that isn't a mouthful, I don't know what is. Let's break that down into some manageable parts.

First, your lungs are not just big bags of air. Inside your lungs are lots and lots of air way tubes that branch into finer and finer tubes like the roots of a tree. Towards the ends of this branching airway system, the tubes get really small, so it doesn't take very much to block them. Now we'll talk about inflammation. If you took a piece of sandpaper and rubbed it on your hand for a minute, that spot on your had would get sore, red and swollen. Well that is just what the tiny tubes in the lungs do in an asthma attack. They get red and swell shut. We call this inflammation. Finally, in asthma, having the airways swell shut doesn't happen all the time. It comes and goes, and usually we can identify and avoid triggers that cause the inflammation to happen.

Some people with asthma don’t realize that their asthma is not as well controlled as it could be and that if it was better controlled they could be more comfortable and do more things. Here are six questions to check asthma control.

· Do you have problems with coughing, wheezing, breathlessness or chest tightness 3 or more times per week?
· Do you need to use your fast acting inhaler (usually your “blue” puffer) 3 or more times per week?
If an asthmatic needs his/her fast acting inhaler, or coughs most days, often that means if we removed some asthma triggers from the environment and used a controller medication daily we could get the patient to breath better.
· Do symptoms like cough, wheeze, breathlessness or chest tightness wake you up more than once a week?
Symptoms at night are usually a sign that bedding or bedroom triggers need to be looked at and a controller medication used consistently.
· Have there been any physical activities that you were unable to do in the past 3 months due to your asthma?
· Have you missed any school or work in the past 3 months due to asthma?
If asthma is well controlled, a person should be able to do any physical activity they desire and should not miss any school or work due to asthma symptoms.
· Have you had to go to the emergency room or hospital due to asthma in the past 6 months?
Visiting the ER due to asthma is a definite sign that a person’s asthma care plan should be examined

Do you or someone you know have any of the previous 6 problems? The Dauphin Clinic Pharmacy is running asthma check-ups. Call us at 638-4602 and book an appointment. Bring in all your asthma medication and one of our pharmacists will check to see if you are using them properly and see if there are any changes that could be made to help you breathe better.

Next time we will talk about some different asthma medications.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Asthma Part 1

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.

Asthma is " a chronic inflammatory disorder of the airways characterized by paroxysmal or recurrent symptoms (cough, wheeze, chest tightness, and shortness of breath), with variable airflow limitation and airway hyperresponsiveness to a variety of stimuli". Now if that isn't a mouthful, I don't know what is. Let's break that down into some manageable parts.

First, your lungs are not just big bags of air. Inside your lungs are lots and lots of air way tubes that branch into finer and finer tubes like the roots of a tree. Towards the ends of this branching airway system, the tubes get really small, so it doesn't take very much to block them. Now we'll talk about inflammation. If you took a piece of sandpaper and rubbed it on your hand for a minute, that spot on your had would get sore, red and swollen. Well that is just what the tiny tubes in the lungs do in an asthma attack. They get red and swell shut. We call this inflammation. Finally, in asthma, having the airways swell shut doesn't happen all the time. It comes and goes, and usually we can identify and avoid triggers that cause the inflammation to happen.

Some people with asthma don’t realize that their asthma is not as well controlled as it could be and that if it was better controlled they could be more comfortable and do more things. Here are six questions to check asthma control.

· Do you have problems with coughing, wheezing, breathlessness or chest tightness 3 or more times per week?
· Do you need to use your fast acting inhaler (usually your “blue” puffer) 3 or more times per week?
If an asthmatic needs his/her fast acting inhaler, or coughs most days, often that means if we removed some asthma triggers from the environment and used a controller medication daily we could get the patient to breath better.
· Do symptoms like cough, wheeze, breathlessness or chest tightness wake you up more than once a week?
Symptoms at night are usually a sign that bedding or bedroom triggers need to be looked at and a controller medication used consistently.
· Have there been any physical activities that you were unable to do in the past 3 months due to your asthma?
· Have you missed any school or work in the past 3 months due to asthma?
If asthma is well controlled, a person should be able to do any physical activity they desire and should not miss any school or work due to asthma symptoms.
· Have you had to go to the emergency room or hospital due to asthma in the past 6 months?
Visiting the ER due to asthma is a definite sign that a person’s asthma care plan should be examined

Do you or someone you know have any of the previous 6 problems? The Dauphin Clinic Pharmacy is running asthma check-ups. Call us at 638-4602 and book an appointment. Bring in all your asthma medication and one of our pharmacists will check to see if you are using them properly and see if there are any changes that could be made to help you breathe better.

Next time we will talk about some different asthma medications.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Stop Smoking - Nic-Stix

We have the rest of these articles 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.

Last time we talked about the nicotine lolly pop to stop smoking. There is a pill to stop smoking called Zyban or the generic name is bupropion. It is available by prescription only. What should you know about it? First it is a pill, not a patch or a gum. It works on a part of your brain and reduces your craving for smoking. It does not have any nicotine in it. In fact, under the supervision of your doctor, you can be on Zyban and a nicotine gum or patch at the same time. With your doctor's supervision, you would start taking Zyban about a week before you quit smoking. This is to build up enough of the drug in your system, that by quit day you should have less cravings to smoke.

There are some side effects from Zyban. The most common include dry mouth and difficulty sleeping. These are often mild and disappear after a few weeks. The most common reason for people to stop taking Zyban are shakiness and skin rash. There is also a 1 in 1000 chance that Zyban may cause seizures in people taking it.

What about smoking cessation planning and behavior modification? These are very useful add-ons to the medications to quit smoking. These plans focus on things like what events in your life trigger you to smoke and how to avoid or manage those triggers. Sometimes the public doesn't realize when the drug companies talk about the success rates of their products being 20-25% of users remain non-smokers after 1 year, they are talking about people who have used the product PLUS had a smoking cessation plan drawn up for them. For example, studies have found that the quit rate with the patch is about 20% with a plan, and about 10% without one. Ten percent success rate is the same as someone trying to quit cold turkey.

Speaking of triggers and cravings, sometimes smokers have a craving and sticking something like a lollipop or gum in their mouth is inappropriate. What should they do? Well the nicotine patch is too slow for an immediate craving and so is the pill Zyban. What if you had a discreet little applicator which you could rub on your wrist and get nicotine immediately? Well at the Dauphin Clinic Pharmacy, we are compounding such a device for patients at the request of their doctors. We call it a Nic-Stix and with a prescription from a patient's doctor, we compound a device that looks like a chap stick tube. The Nic-Stix has 30mg of nicotine in it so is will last 1-4 weeks depending on use, but it also must be kept away from children because it would be toxic if ingested. The Nic-Stix will melt easily, so it should be kept in a cool place, but is small enough to be carried almost anywhere.

The tobacco industry today seems to be targeting youth. It needs new customers as old ones die off and it is financially most advantageous to target young teens and pre-teens to get them hooked early. There are some people who believe the tobacco industry pays large sums of money for cigarettes to be smoked strategically in movies, music videos, etc. to subtly encourage teens to try smoking.

“Too bad today wasn’t like the good old days, when everyone smoked and no one minded.” I’ve heard people say that and reminisce about when all the chairs in the doctors office had ash-trays built in and all the doctors, the pharmacists and the patients seemed to be smoking. But even then, not everyone liked cigarette smoke. Even 400 years ago, not everyone liked smoking. “The habit of smoking is disgusting to sight, repulsive to smell, dangerous to the brain, noxious to the lung, spreading its fumes around the smoker as foul as those that come from Hell.” - King James I, 1604. Smoking kills 5 million people annually worldwide. Smoking kills three times more people than alcohol, AIDS, illicit drugs, car accidents, suicide and murder all combined. Quitting smoking is very difficult, and it takes the average ex-smoker six serious quit attempts before one sticks, but the results are worth it.

Some places for more info:

Butt Out (designed for youth) Manitoba Lung Association 1-888-566-5864
e-Quit Health Canada online www.gosmokefree.ca
Youth target: www.quit4life.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.