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.
Tuesday, June 28, 2005
Thursday, June 16, 2005
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.
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.
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.
Tuesday, June 14, 2005
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.
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.
Wednesday, June 01, 2005
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.
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.
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