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.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 told you Waterhen was the center of the universe! The breaking edge of medical science is near the Waterhen River, just down from Taylor’s store at the Waterhen Health Unit! In case you missed my last article, let me get you caught up. A few weeks ago, I got to go to Waterhen for the first time. I was invited to speak to an infants, toddlers and parents group about cough and cold medications. The main question was: “Can you give over the counter cough and cold medications to infants and toddlers?” The easy answer is no. I did a little research, gave a presentation to the Waterhen group, then recycled that info for a Shopper’s article. It seems Health Canada is now trying to catch up to Waterhen. They changed the rules on infant and toddler cough and cold medication again.
On Dec 18, 2008 Health Canada said:
Health Canada is advising consumers of the outcome of its review of cough and cold medicines for children under the age of 12.
Health Canada is requiring manufacturers to relabel over-the-counter cough and cold medicines that have dosing information for children to indicate that these medicines should not be used in children under 6.
The relabelling of these medicines will be completed by fall 2009, in time for the next cough and cold season. During the current cough and cold season, medicines will remain on store shelves and in homes with the current labelling, which could include dosing information for children under 6, because many of these products also have dosing information for adults and older children on the same label. As a result, for this cough and cold season, parents or caregivers should consult a pharmacist or a health care practitioner when buying or using these products. These medicines can still be used in children 6 and older, and adults.
This decision is the result of a Health Canada review of these medicines, including the input of a Scientific Advisory Panel convened in March 2008. Health Canada has concluded that while cough and cold medicines have a long history of use in children, there is limited evidence supporting the effectiveness of these products in children. In addition, reports of misuse, overdose and rare side-effects have raised concerns about the use of these medicines in children under 6. The rare but serious potential side-effects include convulsions, increased heart rate, decreased level of consciousness, abnormal heart rhythms and hallucinations. The Scientific Advisory Panel's conclusions and details of the new Health Canada recommendations are posted on the Health Canada Web site.
Health Canada previously issued advice on the use of these medicines in an October 2007 Public Advisory. Based on a preliminary review, Health Canada at that time recommended not using over-the-counter cough and cold medicines in children under 2 years of age, unless instructed to do so by a health care practitioner. The current decision expands on those preliminary recommendations.
Until the relabelling of these products is completed, Health Canada advises parents and caregivers to follow these important guidelines:
□ Do not use these over-the-counter cough and cold medicines in children under 6 years of age.
□ With children older than 6, always follow all the instructions carefully, which includes the dosing and length-of-use directions, and use the dosing device if one is included.
□ Do not give children medications labelled only for adults.
□ Do not give more than one kind of cough and cold medicine to a child. Cough and cold medications often contain multiple ingredients. Combining products with the same ingredient(s) could cause an overdose that may result in harm to a child.
□ Talk to your health care practitioner (doctor, pharmacist, nurse, etc.) if you have questions about the proper use of over-the counter cough and cold medicines.
□ The common cold is a viral infection for which there is no cure. Cough and cold medicines offer only temporary relief of symptoms such as runny nose, cough, or nasal congestion Symptoms can also be managed using a variety of non-medicinal measures such as adequate rest, increased fluid intake and a comfortable environment with adequate humidity.
□ For babies and young children, it is important to rule out serious illnesses that have cold-like signs and symptoms (for example, pneumonia, ear ache or other infections). This is especially important if symptoms do not improve, or if the child's condition worsens.
□ If you are concerned about the child's health (such as if symptoms worsen, last for more than a week, or are accompanied by a fever higher than 38 C or the production of thick phlegm), consult a health care practitioner for a medical evaluation.
For more information please visit:
Health Canda at: www.hc-sc.gc.ca/dhp-mps/medeff/res/cough-toux-eng.php
Canadian Pharmacists Association- Common Colds and Influenza – What you need to know at : www.pharmacists.ca/content/hcp/Resource_Centre/Drug_Therapeutic_Info/pdf/CC-Influenza_InfoforPatients-Parents_CPhA.pdf
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, December 26, 2008
Friday, December 19, 2008
Infant Cough and Cold Medications
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.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
A few weeks ago, I got to go to Waterhen for the first time. I only got lost a few times between along the way, and it was a really nice drive. I found my way to the Health Unit, which is a very nice building. I was invited to speak to an infants, toddlers and parents group about cough and cold medications. The main question was: “Can you give over the counter cough and cold medications to infants and toddlers?” The easy answer is no. That would have made a rather short presentation, so I went through some of the background information with them. Now I’ll share that information with you.
So back in January 2008 the Food and Drug Administration (FDA) in the US said all cough and cold medications should be avoided in children under the age of two. A little later Health Canada made a similar recommendation. In October 2008 in the US manufacturers warnings said not to give cough and cold products to children under four and to not give any children antihistamines just to make them sleepy. Canadian changes are being considered.
So why all the fuss? Yes, my mom gave me Neo-Citran because it had an antihistamine in it which would make me sleepy. Yes, I gave my own children cough and cold medication before the age of four. But, the fuss boils down to safety and efficacy. For every medication we should ask: Is it Safe? Is it Effective? And What is the Risk versus Benefit of using it? For infant cough and cold medications, let’s start with are they safe?
It is safe to give over the counter cough and cold medication to infants and toddlers MOST of the time. The problem is the dose. Many parents have been giving their children the wrong dose. “No problem,” you say, “I can read. I’ll give my child the right dose!” Well, unfortunately, many parents have already given their children the wrong dose. Between 1969 and 2006 in the US there were 69 deaths in children from antihistamines and 54 deaths in children due to decongestants. Now, eventhough we assume the actual number of deaths are much higher than those reported, and these numbers don’t account for the number of injuries, not deaths that occurred, these are small numbers. When you consider the probable millions of doses of cough and cold medications given to children over the 37 years considered, cough and cold medications didn’t kill many children. But, they did kill and injure some children, so the risk isn’t zero.
So why do well meaning parents give the wrong dose to their kids? There are four main reasons: multiple ingredients, wrong formulations, kitchen spoons and small margin of error. Multiple ingredients means many cough and cold medications have more than one ingredient. For example if you bought a cough syrup, a anti-sneezing pill and Tylenol cold you could have a decongestant in all three of those products. If you were unaware of this you could give your child 3 times the dose of decongestant that they were supposed to get, and they could get a rapid heart rate or theoretically cause death. Wrong formulation means some products come in different strengths. Acetaminophen (or Tylenol) comes in 80 mg/ml and 160mg/5ml liquid. If a parent uses the 80mg/ml liquid (wrongly) and gives the child 1 tsp (5 mL), the child get 400 mg (not 160 mg) which is 2.5 times too much. Kitchen spoons means don’t use your kitchen spoons to measure your child’s medication. When a pharmacist says 1 teaspoon, we mean 5 mL. A kitchen teaspoon is not calibrated. Kitchen teaspoons vary from 2.5 to 10 mL. So if you use your kitchen teaspoon and I say give the child 1 teaspoon of medication you could be giving them anywhere from ½ the dose to twice the dose you were supposed to. Small margin of error refers to the fact children are small. Since children are small, their medication doses are small. Unfortunately that means even small errors in measuring a child’s medication can be harmful.
So we’ve seen that cough and cold medications have a small but real chance of harming children. We’ve talked about how : multiple ingredients, wrong formulations, kitchen spoons and small margin of error are the main reasons why parents make mistakes. So do cough and cold medications actually work? Are they effective? Probably not. What we need is to run some experiments where we give possibly dangerous chemicals to a bunch of babies….Any volunteers? For good ethical reasons, we don’t test cough/cold meds on babies. Even if we did, it is hard to ask them if they are feeling better or not. Cold medications have been tested on teenagers and adults. There is only a little proof that they improve symptoms like reducing the amount of cough and sneezing in teens and adults. If we assume infants and toddlers are just “little adults”, cold meds should help them a little too, right? The problem is infants and toddlers aren’t just little adults. Their lungs and immune systems are different. So we now think cold meds may not be effective in infants and toddlers at all (remember we can’t actually test meds on them). If cough and cold medications probably don’t help my child’s symptoms, and…If I give them the wrong amount I may harm them…Are Cough and Cold Medications in infants and toddlers worth the Risk? Probably not.
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.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
A few weeks ago, I got to go to Waterhen for the first time. I only got lost a few times between along the way, and it was a really nice drive. I found my way to the Health Unit, which is a very nice building. I was invited to speak to an infants, toddlers and parents group about cough and cold medications. The main question was: “Can you give over the counter cough and cold medications to infants and toddlers?” The easy answer is no. That would have made a rather short presentation, so I went through some of the background information with them. Now I’ll share that information with you.
So back in January 2008 the Food and Drug Administration (FDA) in the US said all cough and cold medications should be avoided in children under the age of two. A little later Health Canada made a similar recommendation. In October 2008 in the US manufacturers warnings said not to give cough and cold products to children under four and to not give any children antihistamines just to make them sleepy. Canadian changes are being considered.
So why all the fuss? Yes, my mom gave me Neo-Citran because it had an antihistamine in it which would make me sleepy. Yes, I gave my own children cough and cold medication before the age of four. But, the fuss boils down to safety and efficacy. For every medication we should ask: Is it Safe? Is it Effective? And What is the Risk versus Benefit of using it? For infant cough and cold medications, let’s start with are they safe?
It is safe to give over the counter cough and cold medication to infants and toddlers MOST of the time. The problem is the dose. Many parents have been giving their children the wrong dose. “No problem,” you say, “I can read. I’ll give my child the right dose!” Well, unfortunately, many parents have already given their children the wrong dose. Between 1969 and 2006 in the US there were 69 deaths in children from antihistamines and 54 deaths in children due to decongestants. Now, eventhough we assume the actual number of deaths are much higher than those reported, and these numbers don’t account for the number of injuries, not deaths that occurred, these are small numbers. When you consider the probable millions of doses of cough and cold medications given to children over the 37 years considered, cough and cold medications didn’t kill many children. But, they did kill and injure some children, so the risk isn’t zero.
So why do well meaning parents give the wrong dose to their kids? There are four main reasons: multiple ingredients, wrong formulations, kitchen spoons and small margin of error. Multiple ingredients means many cough and cold medications have more than one ingredient. For example if you bought a cough syrup, a anti-sneezing pill and Tylenol cold you could have a decongestant in all three of those products. If you were unaware of this you could give your child 3 times the dose of decongestant that they were supposed to get, and they could get a rapid heart rate or theoretically cause death. Wrong formulation means some products come in different strengths. Acetaminophen (or Tylenol) comes in 80 mg/ml and 160mg/5ml liquid. If a parent uses the 80mg/ml liquid (wrongly) and gives the child 1 tsp (5 mL), the child get 400 mg (not 160 mg) which is 2.5 times too much. Kitchen spoons means don’t use your kitchen spoons to measure your child’s medication. When a pharmacist says 1 teaspoon, we mean 5 mL. A kitchen teaspoon is not calibrated. Kitchen teaspoons vary from 2.5 to 10 mL. So if you use your kitchen teaspoon and I say give the child 1 teaspoon of medication you could be giving them anywhere from ½ the dose to twice the dose you were supposed to. Small margin of error refers to the fact children are small. Since children are small, their medication doses are small. Unfortunately that means even small errors in measuring a child’s medication can be harmful.
So we’ve seen that cough and cold medications have a small but real chance of harming children. We’ve talked about how : multiple ingredients, wrong formulations, kitchen spoons and small margin of error are the main reasons why parents make mistakes. So do cough and cold medications actually work? Are they effective? Probably not. What we need is to run some experiments where we give possibly dangerous chemicals to a bunch of babies….Any volunteers? For good ethical reasons, we don’t test cough/cold meds on babies. Even if we did, it is hard to ask them if they are feeling better or not. Cold medications have been tested on teenagers and adults. There is only a little proof that they improve symptoms like reducing the amount of cough and sneezing in teens and adults. If we assume infants and toddlers are just “little adults”, cold meds should help them a little too, right? The problem is infants and toddlers aren’t just little adults. Their lungs and immune systems are different. So we now think cold meds may not be effective in infants and toddlers at all (remember we can’t actually test meds on them). If cough and cold medications probably don’t help my child’s symptoms, and…If I give them the wrong amount I may harm them…Are Cough and Cold Medications in infants and toddlers worth the Risk? Probably not.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, December 05, 2008
The JUPITER Trial
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.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.
Back on November 20, 2008 we got to go to a very interesting talk sponsored by the pharmaceutical company AstraZeneca. It was a teleconference going on live across Canada at the same time. There were over 1200 family physicians (and a few pharmacists) listening to some very bright researchers out of Toronto talk about the JUPITER Trial.
The trial talked about a choleterol pill called crestor or rosuvastatin helping people reduce their hsCRP which means there is less inflammation in their blood vessels. None of that made any sense to you? No problem, let’s go through some background information.
Cholesterol medications called statins or HMG-CoA reductase inhibitors are very commonly used. They work very well at reducing cholesterol, especially LDL or bad cholesterol. Researchers have found over time that if we reduce a person’s LDL, they will be less likely to have a heart attack or stroke. So we put people on statins to reduce their chances of heart attacks or stroke.
Not surprisingly, it is not as simple as reduce cholesterol and you reduce the chance of heart attacks and stroke. Nothing with the body is ever that simple. There are people with high cholesterol who don’t have heart attacks and stroke. There are people with low cholesterol who do have heart attacks and stroke. There are even people with actual cholesterol laden partial blockages in their arteries (called plaques) that don’t go on to have a heart attack or stroke. It is only when these plaques become “unstable” that we get problems. The other thing that is going on may be inflammation in the blood vessels and statins might help that too.
We have known for a while that statins do other good things for preventing heart attacks and stroke than just lowering cholesterol. There have been studies that showed with the medication lipitor or atorvastatin there were benefits to reducing heart attack or stroke over and above how much the atorvastatin reduced the cholesterol. So was this because the atorvastatin reduced inflammation in the blood vessels?
This brings us to the JUPITER trial. They used the cholesterol pill rosuvastatin and measured both the LDL and the hsCRP. High sensitivity c-reactive protein (hsCRP) is a measurement of inflammation. One of the ways to look at people in general is to put them in 4 groups
Low LDL, low hsCRP – these people have very few heart problems. They weren’t in the trial.
Low LDL, high hsCRP – this is an interesting group. We wouldn’t normally give these people a statin, because their cholesterol isn’t high. But, this is the group that went into the JUPITER trial. They did give these people rosuvastatin and their hsCRP’s went down.
High LDL, low hsCRP - not in trial. We already know from previous trials that if we give these people a statin they will have less heart problems.
High LDL, high hsCRP - not in trial. We already know from previous trials that if we give these people a statin they will have less heart problems.
So the people in the JUPITER trial with low LDL and high hsCRP had their hsCRP go down with rosuvastatin. This means the inflammation in their blood vessels went down with rosuvastatin. They also had fewer heart problems with rosuvastatin. So reducing hsCRP with statins reduces heart problems, right? Maybe.
Dr. Hrabarchuk gave us a good commentary after the presentation in Dauphin and I have read some other people’s thoughts since about how good the JUPITER trial was. There are some criticisms.
The trial itself was well done, but the improvement is very small. Pharmacist’s letter did the math and to prevent one hard cardiac endpoint (heart attack, stroke or cardiovascular death) you would need to treat 120 people for 1.9 years. That is a lot of people buying and taking a lot of pills to prevent one event.
The hsCRP test is not free. It costs ~$70. Is it worth the money?
Are the good benefits, however small, from lowering LDL or lowering hsCRP or both?
Can we lower hsCRP (and inflammation) by a cheaper method like a low dose ASA?
So should everyone run out and get an hsCRP and then demand their docs lower them with rosuvastatin? Probably not. JUPITER was a very good trial, and had some interesting results, but hsCRP and heart problems needs more study. What is not under debate is that if you have high LDL you should be on a statin. It has been estimated that only about half the people prescribed a statin are still on it six months later. That is definitely bad for their health.
As always if you have any questions or concerns about these 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.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.
Back on November 20, 2008 we got to go to a very interesting talk sponsored by the pharmaceutical company AstraZeneca. It was a teleconference going on live across Canada at the same time. There were over 1200 family physicians (and a few pharmacists) listening to some very bright researchers out of Toronto talk about the JUPITER Trial.
The trial talked about a choleterol pill called crestor or rosuvastatin helping people reduce their hsCRP which means there is less inflammation in their blood vessels. None of that made any sense to you? No problem, let’s go through some background information.
Cholesterol medications called statins or HMG-CoA reductase inhibitors are very commonly used. They work very well at reducing cholesterol, especially LDL or bad cholesterol. Researchers have found over time that if we reduce a person’s LDL, they will be less likely to have a heart attack or stroke. So we put people on statins to reduce their chances of heart attacks or stroke.
Not surprisingly, it is not as simple as reduce cholesterol and you reduce the chance of heart attacks and stroke. Nothing with the body is ever that simple. There are people with high cholesterol who don’t have heart attacks and stroke. There are people with low cholesterol who do have heart attacks and stroke. There are even people with actual cholesterol laden partial blockages in their arteries (called plaques) that don’t go on to have a heart attack or stroke. It is only when these plaques become “unstable” that we get problems. The other thing that is going on may be inflammation in the blood vessels and statins might help that too.
We have known for a while that statins do other good things for preventing heart attacks and stroke than just lowering cholesterol. There have been studies that showed with the medication lipitor or atorvastatin there were benefits to reducing heart attack or stroke over and above how much the atorvastatin reduced the cholesterol. So was this because the atorvastatin reduced inflammation in the blood vessels?
This brings us to the JUPITER trial. They used the cholesterol pill rosuvastatin and measured both the LDL and the hsCRP. High sensitivity c-reactive protein (hsCRP) is a measurement of inflammation. One of the ways to look at people in general is to put them in 4 groups
Low LDL, low hsCRP – these people have very few heart problems. They weren’t in the trial.
Low LDL, high hsCRP – this is an interesting group. We wouldn’t normally give these people a statin, because their cholesterol isn’t high. But, this is the group that went into the JUPITER trial. They did give these people rosuvastatin and their hsCRP’s went down.
High LDL, low hsCRP - not in trial. We already know from previous trials that if we give these people a statin they will have less heart problems.
High LDL, high hsCRP - not in trial. We already know from previous trials that if we give these people a statin they will have less heart problems.
So the people in the JUPITER trial with low LDL and high hsCRP had their hsCRP go down with rosuvastatin. This means the inflammation in their blood vessels went down with rosuvastatin. They also had fewer heart problems with rosuvastatin. So reducing hsCRP with statins reduces heart problems, right? Maybe.
Dr. Hrabarchuk gave us a good commentary after the presentation in Dauphin and I have read some other people’s thoughts since about how good the JUPITER trial was. There are some criticisms.
The trial itself was well done, but the improvement is very small. Pharmacist’s letter did the math and to prevent one hard cardiac endpoint (heart attack, stroke or cardiovascular death) you would need to treat 120 people for 1.9 years. That is a lot of people buying and taking a lot of pills to prevent one event.
The hsCRP test is not free. It costs ~$70. Is it worth the money?
Are the good benefits, however small, from lowering LDL or lowering hsCRP or both?
Can we lower hsCRP (and inflammation) by a cheaper method like a low dose ASA?
So should everyone run out and get an hsCRP and then demand their docs lower them with rosuvastatin? Probably not. JUPITER was a very good trial, and had some interesting results, but hsCRP and heart problems needs more study. What is not under debate is that if you have high LDL you should be on a statin. It has been estimated that only about half the people prescribed a statin are still on it six months later. That is definitely bad for their health.
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, November 28, 2008
WARTS
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 http://www.dcp.ca/
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Be afraid. Be very afraid. There more than 100 different types of human papillomavirus (HPV) just waiting to cause warts on you! Okay, the viruses that cause warts aren’t all that scary, and warts are usually just annoying and not all that pretty bumps on the skin. Let’s look at what warts are.
Warts are a viral infection in the top layers of the skin. Children and young adults are most commonly affected. Handlers of meat, poultry and fish also have a high incidence of warts. It has been estimated that up to 25% of the population will have a wart at some time. Warts are usually spread from direct skin-to-skin contact with an infected person. It can also be spread with contact with surfaces like communal showers and swimming pool decks. It can take 2 to 6 months from time of infection until the wart appears. Although there is limited proof, some experts think it could take up to 3 years between exposure and wart development.
There are a wide variety of warts, but here’s a look at some of the most common types:
Common warts: These small, raised growths with a rough surface affect five to 10 percent of school-aged children, but adults may also be affected. They are most often found on the fingers, around the fingernails, on the back of the hands or on the face, knees and elbows.
Flat warts: Also known as plane or juvenile warts, these are seen mainly in children, often beginning where a skin break has occurred. The warts are small, slightly raised flat growths that are usually pink or brown and may appear in large numbers.
Genital warts: These are the most serious kind of warts and the most common of all sexually transmitted diseases. They can be smooth or flat, or more raised and rough. Genital warts found on the cervix are a major risk factor for developing cervical cancer. There is a vaccine called Gardasil available now to prevent genital warts. However, this subject will require a whole article itself.
Plantar warts: This less common wart is found on the sole of the foot and sometimes on the palm of the hand. It is fairly flat, mainly because the pressure of standing forces it to remain in that shape. Plantar warts look like large calluses and can be quite painful.
When should you see a doctor and when can you try to treat them yourself? If you have warts on the face or genitals, or if you have flat warts you should get them checked out by your family doctor. People with diabetes or circulatory problems should also not self treat because these people are more likely to have healing problems.
Non-prescription products-which contain salicyclic acid and lactic acid-are available to treat certain warts. Because most over-the-counter (OTC) products contain an acid, they can harm the skin around the wart if not used as instructed. For the salicyclic acid products, which are the most common type, here is how to use them. First soak the wart in warm water for 2-5 minutes. Dry off the wart and the area around it. Then gently remove the top layer of skin from the wart with an emery board, pumice stone or rough wash cloth. If you make the wart bleed, you rubbed too hard, and may actually cause the wart to spread. Apply the salicyclic acid product only to the wart and not to the healthy skin around it. If you are concerned you might not be able to apply the salicylic acid compound only to the wart, protect the health skin with some vaseline ahead of time. Every day you will have to repeat this wart removal process, so most people choose to soak, rub, and apply at bedtime. The wart will turn white and soft over time and you will rub off more and more of it until it goes away.
Recently, freezing products became available over the counter. Two common trade names are Wartner and Compound W Freeze Off. It is not liquid nitrogen like your doctor uses, but accomplishes the same thing. If you remember way back to highschool physics (and you thought you didn’t need physics anymore), and what happens to an expanding gas. When a gas expands, it cools. When a gas expands rapidly, it cools rapidly. These over the counter products allow liquids similar to lighter fluid exand into a gas within an applicator like a Q-tip end. So first warning is that these products are flammable. Second warning is the applicator gets cold. It can get below -55 C. Follow the instructions in the package carefully. Most importantly, don’t freeze the skin around the wart. It will damage your skin.
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 http://www.dcp.ca/
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Be afraid. Be very afraid. There more than 100 different types of human papillomavirus (HPV) just waiting to cause warts on you! Okay, the viruses that cause warts aren’t all that scary, and warts are usually just annoying and not all that pretty bumps on the skin. Let’s look at what warts are.
Warts are a viral infection in the top layers of the skin. Children and young adults are most commonly affected. Handlers of meat, poultry and fish also have a high incidence of warts. It has been estimated that up to 25% of the population will have a wart at some time. Warts are usually spread from direct skin-to-skin contact with an infected person. It can also be spread with contact with surfaces like communal showers and swimming pool decks. It can take 2 to 6 months from time of infection until the wart appears. Although there is limited proof, some experts think it could take up to 3 years between exposure and wart development.
There are a wide variety of warts, but here’s a look at some of the most common types:
Common warts: These small, raised growths with a rough surface affect five to 10 percent of school-aged children, but adults may also be affected. They are most often found on the fingers, around the fingernails, on the back of the hands or on the face, knees and elbows.
Flat warts: Also known as plane or juvenile warts, these are seen mainly in children, often beginning where a skin break has occurred. The warts are small, slightly raised flat growths that are usually pink or brown and may appear in large numbers.
Genital warts: These are the most serious kind of warts and the most common of all sexually transmitted diseases. They can be smooth or flat, or more raised and rough. Genital warts found on the cervix are a major risk factor for developing cervical cancer. There is a vaccine called Gardasil available now to prevent genital warts. However, this subject will require a whole article itself.
Plantar warts: This less common wart is found on the sole of the foot and sometimes on the palm of the hand. It is fairly flat, mainly because the pressure of standing forces it to remain in that shape. Plantar warts look like large calluses and can be quite painful.
When should you see a doctor and when can you try to treat them yourself? If you have warts on the face or genitals, or if you have flat warts you should get them checked out by your family doctor. People with diabetes or circulatory problems should also not self treat because these people are more likely to have healing problems.
Non-prescription products-which contain salicyclic acid and lactic acid-are available to treat certain warts. Because most over-the-counter (OTC) products contain an acid, they can harm the skin around the wart if not used as instructed. For the salicyclic acid products, which are the most common type, here is how to use them. First soak the wart in warm water for 2-5 minutes. Dry off the wart and the area around it. Then gently remove the top layer of skin from the wart with an emery board, pumice stone or rough wash cloth. If you make the wart bleed, you rubbed too hard, and may actually cause the wart to spread. Apply the salicyclic acid product only to the wart and not to the healthy skin around it. If you are concerned you might not be able to apply the salicylic acid compound only to the wart, protect the health skin with some vaseline ahead of time. Every day you will have to repeat this wart removal process, so most people choose to soak, rub, and apply at bedtime. The wart will turn white and soft over time and you will rub off more and more of it until it goes away.
Recently, freezing products became available over the counter. Two common trade names are Wartner and Compound W Freeze Off. It is not liquid nitrogen like your doctor uses, but accomplishes the same thing. If you remember way back to highschool physics (and you thought you didn’t need physics anymore), and what happens to an expanding gas. When a gas expands, it cools. When a gas expands rapidly, it cools rapidly. These over the counter products allow liquids similar to lighter fluid exand into a gas within an applicator like a Q-tip end. So first warning is that these products are flammable. Second warning is the applicator gets cold. It can get below -55 C. Follow the instructions in the package carefully. Most importantly, don’t freeze the skin around the wart. It will damage your skin.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Tuesday, November 18, 2008
Measles, Mumps and Rubella Vaccine
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.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 two children. Emily is six and Eric is three. I am very lucky that they are both healthy. Some parents, especially some celebrities, blame their children’s illness on childhood vaccines. The affliction that gets mentioned most often is autism. I don’t know what causes autism. From the reading I have done, though, I don’t think vaccines are to blame. Yes, you can start sending your hate mail now. I had my own children immunized. As a parent and a healthcare professional, I firmly come down on the side of vaccinating children, unless the child’s doctor has a valid medical reason not to do so such as an allergy to the vaccine. The evidence I’ve read comes down overwhelmingly on the side of vaccines having a great many benefits and very few risks. I’ll talk briefly about why I don’t think the MMR (measles, mumps, and rubella) vaccine causes autism, and then let’s talk about what the MMR vaccine actually does.
Back in 1998 there was a study published in the Lancet by Dr. AJ Wakefield and colleagues. They looked at 12 children that had lost acquired skills like language. These children ranged in age from 3 to 10 years old and 11 were boys. So these children could have had Autism Spectrum Disorder, depending on how that is defined. Of these 12 children, eight of them had developed symptoms after the MMR vaccine as determined by the parents. So the controversy began.
What was wrong with people questioning MMR vaccine after those reports? Nothing, but the media didn’t pick up on the answers to those questions. The answer is at least a dozen studies looked for a connection between MMR and autism and found none. I’m not saying looking for the cause of autism isn’t important, but MMR seems to be a dead-end and scientists should look elsewhere.
The MMR vaccine prevents three different diseases, which are all caused by viruses. These three diseases have no effective treatments once a patient has the disease, but can be prevented by getting a vaccine before exposure to the virus.
Measles is not a deadly disease in most people. It causes a rash, fever, runny nose and cough that lasts one to two weeks. Why vaccinate against it then? Because large outbreaks of the disease usually happen in children. In a small percentage of these children an inflammation of the brain and spinal cord can occur and cause headaches, seizures, coma and/or long term brain disorders. In rare cases it can even cause death.
Mumps is an uncomfortable condition. It can cause painful, swollen saliva glands (usually in the cheeks) and fever. Painful inflammation of the testicles can occur in about 1 out of 4 boys beyond puberty and painful inflammation of the ovaries in out 5% of girls beyond puberty. Inflammation of the lining around the brain can happen in 10-30% of cases. Again brain lining inflammation (or meningitis) is a rare but serious possibility.
Rubella is an important disease to avoid during pregnancy, as it can damage the unborn baby. Rubella can cause brain damage, an unusually small head, deafness, heart defects, blindness, small eyes, diabetes or death in the unborn child. About 90% of women infected with rubella during the first trimester will have babies with problems. So it is important to try to protect all children at a young age from rubella so they don’t contract the disease when they get pregnant later in life or give the disease to a pregnant mother.
The MMR vaccine is very effective. It protects 94% of those immunized verses rubella, 81% verses mumps and 88% verses measles. Measles protection goes up to 99% after two vaccinations. Protection is believed to be lifelong in most people for all three diseases.
Anyone with a weakened immune system or has an allergy to any of the components of the vaccines shouldn’t be given the shot. These concerns should be discussed with your doctor.
Common side effects from the MMR vaccine include local reactions where the shot is given like redness, and swelling which goes away on its own. Pain and fever are also possible, but if they are mild they can be treated with Tylenol.
The MMR vaccine is usually given to children at age 1 and again at age 5.
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.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 two children. Emily is six and Eric is three. I am very lucky that they are both healthy. Some parents, especially some celebrities, blame their children’s illness on childhood vaccines. The affliction that gets mentioned most often is autism. I don’t know what causes autism. From the reading I have done, though, I don’t think vaccines are to blame. Yes, you can start sending your hate mail now. I had my own children immunized. As a parent and a healthcare professional, I firmly come down on the side of vaccinating children, unless the child’s doctor has a valid medical reason not to do so such as an allergy to the vaccine. The evidence I’ve read comes down overwhelmingly on the side of vaccines having a great many benefits and very few risks. I’ll talk briefly about why I don’t think the MMR (measles, mumps, and rubella) vaccine causes autism, and then let’s talk about what the MMR vaccine actually does.
Back in 1998 there was a study published in the Lancet by Dr. AJ Wakefield and colleagues. They looked at 12 children that had lost acquired skills like language. These children ranged in age from 3 to 10 years old and 11 were boys. So these children could have had Autism Spectrum Disorder, depending on how that is defined. Of these 12 children, eight of them had developed symptoms after the MMR vaccine as determined by the parents. So the controversy began.
What was wrong with people questioning MMR vaccine after those reports? Nothing, but the media didn’t pick up on the answers to those questions. The answer is at least a dozen studies looked for a connection between MMR and autism and found none. I’m not saying looking for the cause of autism isn’t important, but MMR seems to be a dead-end and scientists should look elsewhere.
The MMR vaccine prevents three different diseases, which are all caused by viruses. These three diseases have no effective treatments once a patient has the disease, but can be prevented by getting a vaccine before exposure to the virus.
Measles is not a deadly disease in most people. It causes a rash, fever, runny nose and cough that lasts one to two weeks. Why vaccinate against it then? Because large outbreaks of the disease usually happen in children. In a small percentage of these children an inflammation of the brain and spinal cord can occur and cause headaches, seizures, coma and/or long term brain disorders. In rare cases it can even cause death.
Mumps is an uncomfortable condition. It can cause painful, swollen saliva glands (usually in the cheeks) and fever. Painful inflammation of the testicles can occur in about 1 out of 4 boys beyond puberty and painful inflammation of the ovaries in out 5% of girls beyond puberty. Inflammation of the lining around the brain can happen in 10-30% of cases. Again brain lining inflammation (or meningitis) is a rare but serious possibility.
Rubella is an important disease to avoid during pregnancy, as it can damage the unborn baby. Rubella can cause brain damage, an unusually small head, deafness, heart defects, blindness, small eyes, diabetes or death in the unborn child. About 90% of women infected with rubella during the first trimester will have babies with problems. So it is important to try to protect all children at a young age from rubella so they don’t contract the disease when they get pregnant later in life or give the disease to a pregnant mother.
The MMR vaccine is very effective. It protects 94% of those immunized verses rubella, 81% verses mumps and 88% verses measles. Measles protection goes up to 99% after two vaccinations. Protection is believed to be lifelong in most people for all three diseases.
Anyone with a weakened immune system or has an allergy to any of the components of the vaccines shouldn’t be given the shot. These concerns should be discussed with your doctor.
Common side effects from the MMR vaccine include local reactions where the shot is given like redness, and swelling which goes away on its own. Pain and fever are also possible, but if they are mild they can be treated with Tylenol.
The MMR vaccine is usually given to children at age 1 and again at age 5.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, November 07, 2008
Folic Acid
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.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.
Folic acid is a B vitamin. Like most vitamins and mineral, it is best to get it from the food we eat. Folic acid is in whole grain products, legumes and dark green vegetables. Folic acid is important for your blood, some people on an arthritis medication called methotrexate need extra, but maybe the most important group of people that should watch their folic acid intake are women of child bearing age. While planning a pregnancy, before becoming pregnant, it is important for women to start taking folic acid because it can prevent certain birth defects from occurring.
Birth defects, or congenital defects, can be defined as physical abnormalities that are present at birth. About 3 to 4 percent of babies are born with a major birth defect, and some may not be discovered until a child grows. By age five, 7.5 percent of all children are diagnosed with a birth defect, although many of these are minor. The type of birth defect that is associated with not enough folic acid is called a neural tube defect. Neural tube defects (NTD) include such conditions ancephaly and spina bifida. Ancephaly is when the child is born with most of its brain missing, or the brain does not develop at all. The infant cannot survive and is either stillborn or dies within a few days of birth. Spina bifida is where one or more of the vertebrae fail to develop completely leaving a portion of the spinal cord unprotected. Spina bifida is strongly linked with folic acid deficiency in the diet, especially early in pregnancy. Symptoms can vary, where some children have few or no symptoms, whereas others are weak and paralysed in all areas reached by nerves below the level of the defect.
To prevent neural tube defects, folic acid supplements should be taken before becoming pregnant, and continue throughout the first trimester. The neural tube forms and closes in the first four weeks of pregnancy. This is often before pregnancy tests can tell if you are pregnant, so that is why we want you to start before you are pregnant. A minimum of 0.4 mg of folic acid daily is recommended for women who are planning to become pregnant, and higher doses are recommended for women who already have a child with a neural tube defect. Prenatal vitamins, such as Materna, contain as much as 0.8 to 1 mg of folic acid, and these vitamins should be used in pregnancy rather than regular vitamin formulations.
A couple of years ago there was a lot of excitement about older people taking folic acid, vitamin b6 and vitamin b12 to reduce their homocysteine levels and reduce heart attacks. You see it was found that people with heart disease had high levels of homocysteine. So it was thought if you reduced their homocysteine, their heart disease would go away. So the researchers gave a bunch of people the folic acid, b6 and b12 and another bunch placebo. The folic acid, b6 and b12 group did have their homocysteine levels drop, but their heart disease levels stayed the same. So, unfortunately I can’t tell you that inexpensive B vitamins are an effective heart disease treatment. However, from the ashes of the heart disease trials, some researchers think that folic acid, b6 and b12 may reduce incidence of stroke. Stay tuned!
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.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.
Folic acid is a B vitamin. Like most vitamins and mineral, it is best to get it from the food we eat. Folic acid is in whole grain products, legumes and dark green vegetables. Folic acid is important for your blood, some people on an arthritis medication called methotrexate need extra, but maybe the most important group of people that should watch their folic acid intake are women of child bearing age. While planning a pregnancy, before becoming pregnant, it is important for women to start taking folic acid because it can prevent certain birth defects from occurring.
Birth defects, or congenital defects, can be defined as physical abnormalities that are present at birth. About 3 to 4 percent of babies are born with a major birth defect, and some may not be discovered until a child grows. By age five, 7.5 percent of all children are diagnosed with a birth defect, although many of these are minor. The type of birth defect that is associated with not enough folic acid is called a neural tube defect. Neural tube defects (NTD) include such conditions ancephaly and spina bifida. Ancephaly is when the child is born with most of its brain missing, or the brain does not develop at all. The infant cannot survive and is either stillborn or dies within a few days of birth. Spina bifida is where one or more of the vertebrae fail to develop completely leaving a portion of the spinal cord unprotected. Spina bifida is strongly linked with folic acid deficiency in the diet, especially early in pregnancy. Symptoms can vary, where some children have few or no symptoms, whereas others are weak and paralysed in all areas reached by nerves below the level of the defect.
To prevent neural tube defects, folic acid supplements should be taken before becoming pregnant, and continue throughout the first trimester. The neural tube forms and closes in the first four weeks of pregnancy. This is often before pregnancy tests can tell if you are pregnant, so that is why we want you to start before you are pregnant. A minimum of 0.4 mg of folic acid daily is recommended for women who are planning to become pregnant, and higher doses are recommended for women who already have a child with a neural tube defect. Prenatal vitamins, such as Materna, contain as much as 0.8 to 1 mg of folic acid, and these vitamins should be used in pregnancy rather than regular vitamin formulations.
A couple of years ago there was a lot of excitement about older people taking folic acid, vitamin b6 and vitamin b12 to reduce their homocysteine levels and reduce heart attacks. You see it was found that people with heart disease had high levels of homocysteine. So it was thought if you reduced their homocysteine, their heart disease would go away. So the researchers gave a bunch of people the folic acid, b6 and b12 and another bunch placebo. The folic acid, b6 and b12 group did have their homocysteine levels drop, but their heart disease levels stayed the same. So, unfortunately I can’t tell you that inexpensive B vitamins are an effective heart disease treatment. However, from the ashes of the heart disease trials, some researchers think that folic acid, b6 and b12 may reduce incidence of stroke. Stay tuned!
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, October 31, 2008
THE FLU SHOT
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.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.
In Ontario they have a universal flu vaccination program. Since 2000, anyone 6 months of age and older can get a flu shot free of charge. This means the province of Ontario spends $26.5 million dollars a year on flu shots. The good new is a study published by Dr. Jeffrey Kwong of the Institute for Clinical Evaluative Sciences in Toronto says the number of flu deaths and hospitalizations are down since the program started. The problem with the study is that the number of flu deaths and hospitalizations do go up and down periodically. But it is more positive news that flu shots help keep people healthy.
What is the flu? The flu (or influenza) is a viral illness spread from person to person by coughing or through contact with nasal fluids. Symptoms may include fever, headache, cough, muscle aches, runny nose, sore throat and exhaustion. The symptoms of the flu are usually more severe that a cold. Symptoms can be similar to other viral illnesses. However, onset of the flu is usually more sudden. Flu symptoms usually last from 7 to 10 days, but the cough and weakness can continue for 6 weeks. Influenza arrives in Manitoba every year in late fall or early winter.
“Can I get the flu from the flu shot?” No. The flu vaccine is made from dead virus parts. It cannot give you the flu. Unfortunately, some people can get sick, or can even get the flu immediately after the flu shot. That is because the flu shot doesn’t start working until 2 weeks after the shot. So you can catch the flu and get symptoms during that two week period. Also, people who seem to have gotten the flu within a day or two of the shot probably had the flu virus in them already at the time of the shot, and would have gotten sick anyway. Finally, the flu shot only protects against some very specific influenza virus. It doesn’t protect against the common cold virus or bacterial illnesses. The flu vaccine is effective in about 70% of healthy adults and children. In nursing homes, the flu vaccine stops 50%-60% of flu related hospitalizations, and 85% of flu related deaths. As said before immunity to the flu usually starts about 2 weeks after the shot and lasts less than 1 year. The elderly, unfortunately, can have their immunity fall off in as little as 4 months.
“Can the flu shot give me a bad reaction?” Rarely. The flu shot is made in chicken eggs. So people with serious egg allergies should not get the flu shot. You can get a local reaction at the injection site that turns red and is sore for up to two days. You may also get fever, headache, or muscle pain. If these symptoms get very bad or last for a long time, seek medical attention.
How well does the flu shot work? Well, that is difficult to say. The influenza virus mutates every year or so. The vaccine only protects against what the virus was like last year. If the virus only changed a little, the flu shot works well. If the virus changed a lot, the flu shot doesn’t work as well.
Who is at risk for influenza causing serious complications and should receive the vaccine?
· Residents of nursing homes and other chronic care facilities
· Anyone with chronic heart or lung disease
· Anyone with cancer, anemia, or a weakened immune system due to disease or medication
· Persons with other chronic conditions such as diabetes, kidney disease, inflammatory bowel disease, celiac disease, rheumatoid arthritis, lupus, alcoholism and multiple sclerosis may also benefit
· Anyone 65 years or older
· Children aged 6 months to 23 months
· Children and teenagers on long term aspirin therapy
· People living with "at risk" individuals who are likely to have a poor response to vaccine, such as frail elderly and those with a weakened immune system due to disease or medication
· Health care workers and other personnel in settings where care is provided for those at high risk
Who should not get the flu vaccine?
· Infants younger than six months of age
· Anyone who has a severe allergy to egg protein, formaldehyde or thiomerosal
· Anyone who has a serious acute illness, with or without fever, on the day they are to be immunized. A mild illness, with or without a low fever, is not a reason to avoid immunization.
· Persons known to have developed Guillain-Barre syndrome within six weeks of a previous influenza vaccination.
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.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.
In Ontario they have a universal flu vaccination program. Since 2000, anyone 6 months of age and older can get a flu shot free of charge. This means the province of Ontario spends $26.5 million dollars a year on flu shots. The good new is a study published by Dr. Jeffrey Kwong of the Institute for Clinical Evaluative Sciences in Toronto says the number of flu deaths and hospitalizations are down since the program started. The problem with the study is that the number of flu deaths and hospitalizations do go up and down periodically. But it is more positive news that flu shots help keep people healthy.
What is the flu? The flu (or influenza) is a viral illness spread from person to person by coughing or through contact with nasal fluids. Symptoms may include fever, headache, cough, muscle aches, runny nose, sore throat and exhaustion. The symptoms of the flu are usually more severe that a cold. Symptoms can be similar to other viral illnesses. However, onset of the flu is usually more sudden. Flu symptoms usually last from 7 to 10 days, but the cough and weakness can continue for 6 weeks. Influenza arrives in Manitoba every year in late fall or early winter.
“Can I get the flu from the flu shot?” No. The flu vaccine is made from dead virus parts. It cannot give you the flu. Unfortunately, some people can get sick, or can even get the flu immediately after the flu shot. That is because the flu shot doesn’t start working until 2 weeks after the shot. So you can catch the flu and get symptoms during that two week period. Also, people who seem to have gotten the flu within a day or two of the shot probably had the flu virus in them already at the time of the shot, and would have gotten sick anyway. Finally, the flu shot only protects against some very specific influenza virus. It doesn’t protect against the common cold virus or bacterial illnesses. The flu vaccine is effective in about 70% of healthy adults and children. In nursing homes, the flu vaccine stops 50%-60% of flu related hospitalizations, and 85% of flu related deaths. As said before immunity to the flu usually starts about 2 weeks after the shot and lasts less than 1 year. The elderly, unfortunately, can have their immunity fall off in as little as 4 months.
“Can the flu shot give me a bad reaction?” Rarely. The flu shot is made in chicken eggs. So people with serious egg allergies should not get the flu shot. You can get a local reaction at the injection site that turns red and is sore for up to two days. You may also get fever, headache, or muscle pain. If these symptoms get very bad or last for a long time, seek medical attention.
How well does the flu shot work? Well, that is difficult to say. The influenza virus mutates every year or so. The vaccine only protects against what the virus was like last year. If the virus only changed a little, the flu shot works well. If the virus changed a lot, the flu shot doesn’t work as well.
Who is at risk for influenza causing serious complications and should receive the vaccine?
· Residents of nursing homes and other chronic care facilities
· Anyone with chronic heart or lung disease
· Anyone with cancer, anemia, or a weakened immune system due to disease or medication
· Persons with other chronic conditions such as diabetes, kidney disease, inflammatory bowel disease, celiac disease, rheumatoid arthritis, lupus, alcoholism and multiple sclerosis may also benefit
· Anyone 65 years or older
· Children aged 6 months to 23 months
· Children and teenagers on long term aspirin therapy
· People living with "at risk" individuals who are likely to have a poor response to vaccine, such as frail elderly and those with a weakened immune system due to disease or medication
· Health care workers and other personnel in settings where care is provided for those at high risk
Who should not get the flu vaccine?
· Infants younger than six months of age
· Anyone who has a severe allergy to egg protein, formaldehyde or thiomerosal
· Anyone who has a serious acute illness, with or without fever, on the day they are to be immunized. A mild illness, with or without a low fever, is not a reason to avoid immunization.
· Persons known to have developed Guillain-Barre syndrome within six weeks of a previous influenza vaccination.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, October 24, 2008
EAR WAX
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.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 periodically go deaf. It is usually only in one ear. Fortunately, there is nothing seriously wrong with me. I usually end up at the walk-in clinic. The doctor looks in my ear and usually says, “It is right full of wax.” Then a nurse takes some warm water in a syringe and clears it out. Voila! I can hear again. So I did some reading about ear wax. Here is what I found.
The skin lining the outer two thirds of the external auditory canal (EAC) has little hairs on it. The EAC also has two types of glands, ceruminous and sebaceous. Secretions from these glands mixed with sloughed off dead skin is ear wax, or more properly called cerumen. Cerumen (ear wax) helps to lubricate and protect the ear. It water-proofs the EAC and protects it from bacteria. Cerumen (ear wax) is normally produced in small amounts and moves out of the ear by the action of the little hairs we talked about earlier and by the motions produced in the EAC during talking and chewing. The ear is usually self cleaning. I am to discourage anyone from “Sticking anything smaller than their elbow” into them. Cotton swabs, match stick, pins, etc may just jam the wax in there real good and cause impaction.
What might too much wax in my ears do? It can: make it harder for a doctor to see my ear drum which they need to do to diagnose certain ear problems; I could get the wax impacted; my hearing could be impaired; or my ears could get infected. Why are my ears having problems getting the wax out? As we age the cerumen we produce gets drier and harder to move out, my EAC might be narrow or misshapen, my EAC might have too much hair in it, my hearing aids can cause problems, or I might have bony growths in my EAC.
What shoud you do if you think your ear is plugged with wax? See your doctor. Syringing with body temperature water works great in many cases. You should NOT try to syringe your own ears at home. If you do, more than likely one of the following will occur: pain, dizziness, ear infection, or perforated ear drum. There are things you can try at home first to soften the wax before syringing.
The most gentle treatments for ear warx are softening agents. These include olive oil, light mineral oil, 3% hydrogen peroxide mixed half and half with water, glycerin, and commercially available products like Cerumol (contains Chlorbutol 5%), and Murine Ear Drops (contains Carbamide peroxide 6.5%). You put these products in the ear 4-6 drops at a time, twice a day for 3-7 days. They are generally not irritating, but their effects take a few days to be noticed. The feeling of hearing loss and fullness may initially get worse as the ear wax swells. The wax may flow out naturally, but if it doesn’t, see your doctor in 3-7 days to get it syringed.
The commercially available product Cerumenex (contains triethanolamine poly peptide) works much faster than the softening agents, but don’t use it unless you are immediately going to have your ear syringed. If Cerumenex says in your ear longer 10-15 minutes it can cause irritation and allergic reactions.
The best ear wax disintegrator apparently is docusate sodium. This surprised me because there is no commercially available docusate sodium ear drop. What happened is some doctors tried the docusate sodium liquid stool softener for children in ears to soften wax. Apparently it works better than Cerumenex. The problem with the stool softener liquid is it has red dye and other stuff I don’t want in my ear. So I’m going to try to compound a docusate sodium ear drop, for the next time I go deaf. I’ll let you know how it goes.
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.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 periodically go deaf. It is usually only in one ear. Fortunately, there is nothing seriously wrong with me. I usually end up at the walk-in clinic. The doctor looks in my ear and usually says, “It is right full of wax.” Then a nurse takes some warm water in a syringe and clears it out. Voila! I can hear again. So I did some reading about ear wax. Here is what I found.
The skin lining the outer two thirds of the external auditory canal (EAC) has little hairs on it. The EAC also has two types of glands, ceruminous and sebaceous. Secretions from these glands mixed with sloughed off dead skin is ear wax, or more properly called cerumen. Cerumen (ear wax) helps to lubricate and protect the ear. It water-proofs the EAC and protects it from bacteria. Cerumen (ear wax) is normally produced in small amounts and moves out of the ear by the action of the little hairs we talked about earlier and by the motions produced in the EAC during talking and chewing. The ear is usually self cleaning. I am to discourage anyone from “Sticking anything smaller than their elbow” into them. Cotton swabs, match stick, pins, etc may just jam the wax in there real good and cause impaction.
What might too much wax in my ears do? It can: make it harder for a doctor to see my ear drum which they need to do to diagnose certain ear problems; I could get the wax impacted; my hearing could be impaired; or my ears could get infected. Why are my ears having problems getting the wax out? As we age the cerumen we produce gets drier and harder to move out, my EAC might be narrow or misshapen, my EAC might have too much hair in it, my hearing aids can cause problems, or I might have bony growths in my EAC.
What shoud you do if you think your ear is plugged with wax? See your doctor. Syringing with body temperature water works great in many cases. You should NOT try to syringe your own ears at home. If you do, more than likely one of the following will occur: pain, dizziness, ear infection, or perforated ear drum. There are things you can try at home first to soften the wax before syringing.
The most gentle treatments for ear warx are softening agents. These include olive oil, light mineral oil, 3% hydrogen peroxide mixed half and half with water, glycerin, and commercially available products like Cerumol (contains Chlorbutol 5%), and Murine Ear Drops (contains Carbamide peroxide 6.5%). You put these products in the ear 4-6 drops at a time, twice a day for 3-7 days. They are generally not irritating, but their effects take a few days to be noticed. The feeling of hearing loss and fullness may initially get worse as the ear wax swells. The wax may flow out naturally, but if it doesn’t, see your doctor in 3-7 days to get it syringed.
The commercially available product Cerumenex (contains triethanolamine poly peptide) works much faster than the softening agents, but don’t use it unless you are immediately going to have your ear syringed. If Cerumenex says in your ear longer 10-15 minutes it can cause irritation and allergic reactions.
The best ear wax disintegrator apparently is docusate sodium. This surprised me because there is no commercially available docusate sodium ear drop. What happened is some doctors tried the docusate sodium liquid stool softener for children in ears to soften wax. Apparently it works better than Cerumenex. The problem with the stool softener liquid is it has red dye and other stuff I don’t want in my ear. So I’m going to try to compound a docusate sodium ear drop, for the next time I go deaf. I’ll let you know how it goes.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, October 10, 2008
ARTIFICIAL SWEETNERS
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 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 professional.
“Is it true that aspartame causes Multiple Sclerosis?” “Isn’t aspartame a poison?” “Isn’t it true that airline pilots aren’t allowed to take aspartame before flying?” These are still common questions in our pharmacy. Are artificial sweetners evil? No, I don’t believe so. Is it possible that some people don’t react well to them? Absolutely. Some people get headaches, flushing, upset stomach, etc. when they use artifical sweetners. So we tell them not to use them. Should people without diabetes eat pounds of artifical sweetners every day? Probably not. However, are artifical sweetners a good tool for diabetics to use when they want something sweet, but don’t want their blood sugar to go up? Absolutely!
Diabetes educators now talk about CARB choices for diabetics when looking at their food. A person needs at least 9 CARB Choices per day and that should be spread over 3 meals. A female diabetic should aim for 3-4 CARB Choices per meal and a male diabetic should aim for 4-5 CARB Choices per meal. I scavenged the pharmacy staff fridge and found a no-name can of cola. In 355 mL it contains 42 g of carbohydrate, which is worth 3 CARB Choices. So if a female diabetic decided she wanted a can of cola, that would use up all her CARB Choices for one meal. Now if that same female diabetic craves 5-6 cans of cola per day, that would put her at 16 CARB Choices and that puts her way over budget for the whole day. So if she replaces regular cola with artificially sweetened cola she will be much better off.
The four common artificial sweetners are: aspartame (Equal, Nutrasweet), saccharin (Sweet ‘N Low), acesulfame (Sunette), and sucralose (Splenda). They have been blamed for everything from cancer to seizures to Multiple Sclerosis to chronic fatigue. There is no good evidence that they cause any of these. We will talk about the top two saccharin and aspartame.
Saccharin has been around for more than a century. It is 300 times sweeter than sugar. This means if you needed 42 grams of sugar to sweeten our can of cola, you would only need 0.14 grams of saccharin to sweeten it. Since so little saccharin sweetens so much stuff it was used a lot in the two World Wars because sugar was scarce. In the 1970’s the Food and Drug Administration in the US started looking at saccharin safety. Initially it was found that huge doses of saccharin (way more per body weight than people would eat) caused bladder cancer in rats. Since then, the data has been reviewed and saccharin is now considered safe. The National Cancer Institute, the National Toxicology Program, the American Diabetes Association, American Dietetic Association, American Cancer Society, and American Medical Association all support the use of saccharin and say it is safe.
Aspartame has been available in Canada since 1981. It is about 200 times sweeter than sugar. So if you needed 42 grams of sugar to sweeten our can of cola, you would only need 0.21 grams of aspartame to sweeten it. As a side note, have you ever noticed that diet soft drinks foam or froth or bubble much more that regular sugared ones? That is because you need so much more sugar to sweeten it than aspartame, the sugared soft drinks are more viscous and thus foam less. Aspartame has been accused of causing everything from seizures to cancer to hair loss. None of these claims has ever been proven in a clinical trial. Many of the claims of damage I have heard about aspartame are because as aspartame is being broken down in the body, formaldehyde is produced. Formaldehyde is a poison, so aspartame must be a poison, right? Wrong. Many fruits and vegetables break down into small amounts of formaldehyde as well. This formaldehyde will break down into formic acid and then to water and carbon dioxide. Want further proof your body can handle small amounts of formaldehyde? That last hang over you had was due in part to formaldehyde. Ethyl alcohol changes in part into formaldehyde. Some of the pain of the hang over was due to too much formaldehyde in your body. But your body eventually metabolized it and the hang over went away. You get much more formaldehyde in your body from a hang over than from aspartame.
In general aspartame has been thoroughly tested by the Canadian and American authorities and found to be safe. There is one group that must avoid aspartame. This condition is called phenylketonuria or PKU, a disorder of amino acid metabolism. Accumulation of phenylalanine can lead to neurological, behavioral and dermatologic problems in this population. Since aspartame contains phenylalanine, patients with PKU should not use aspartame.
So I have already said I think artificial sweetners are a good option for diabetics. Should non-diabetics use them? In moderation, saccharine, aspartame, acesulfame potassium and sucralose appear to be safe. The FDA in the US and Health Canada have set acceptable daily limits of these sweetners and studies show that normal diets contain far less sweetners than these limits. So yes, in moderation, these sweetners are safe to use. Do I use them? Yes I do. One last word about moderation, though. Almost anything can be toxic if used too much. A condition called water toxicity can happen if you drink too much water. I bring this up because one of the clinic physicians was talking about a patient of theirs that drank 8-12 liters of diet soft drinks per day. This patient didn’t mention this diet related quirk to their physician for years. When the patient’s enormous diet soft drink consumption finally came out, the doctor could finally successfully cure the patient’s chronic diarrhea.
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 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 professional.
“Is it true that aspartame causes Multiple Sclerosis?” “Isn’t aspartame a poison?” “Isn’t it true that airline pilots aren’t allowed to take aspartame before flying?” These are still common questions in our pharmacy. Are artificial sweetners evil? No, I don’t believe so. Is it possible that some people don’t react well to them? Absolutely. Some people get headaches, flushing, upset stomach, etc. when they use artifical sweetners. So we tell them not to use them. Should people without diabetes eat pounds of artifical sweetners every day? Probably not. However, are artifical sweetners a good tool for diabetics to use when they want something sweet, but don’t want their blood sugar to go up? Absolutely!
Diabetes educators now talk about CARB choices for diabetics when looking at their food. A person needs at least 9 CARB Choices per day and that should be spread over 3 meals. A female diabetic should aim for 3-4 CARB Choices per meal and a male diabetic should aim for 4-5 CARB Choices per meal. I scavenged the pharmacy staff fridge and found a no-name can of cola. In 355 mL it contains 42 g of carbohydrate, which is worth 3 CARB Choices. So if a female diabetic decided she wanted a can of cola, that would use up all her CARB Choices for one meal. Now if that same female diabetic craves 5-6 cans of cola per day, that would put her at 16 CARB Choices and that puts her way over budget for the whole day. So if she replaces regular cola with artificially sweetened cola she will be much better off.
The four common artificial sweetners are: aspartame (Equal, Nutrasweet), saccharin (Sweet ‘N Low), acesulfame (Sunette), and sucralose (Splenda). They have been blamed for everything from cancer to seizures to Multiple Sclerosis to chronic fatigue. There is no good evidence that they cause any of these. We will talk about the top two saccharin and aspartame.
Saccharin has been around for more than a century. It is 300 times sweeter than sugar. This means if you needed 42 grams of sugar to sweeten our can of cola, you would only need 0.14 grams of saccharin to sweeten it. Since so little saccharin sweetens so much stuff it was used a lot in the two World Wars because sugar was scarce. In the 1970’s the Food and Drug Administration in the US started looking at saccharin safety. Initially it was found that huge doses of saccharin (way more per body weight than people would eat) caused bladder cancer in rats. Since then, the data has been reviewed and saccharin is now considered safe. The National Cancer Institute, the National Toxicology Program, the American Diabetes Association, American Dietetic Association, American Cancer Society, and American Medical Association all support the use of saccharin and say it is safe.
Aspartame has been available in Canada since 1981. It is about 200 times sweeter than sugar. So if you needed 42 grams of sugar to sweeten our can of cola, you would only need 0.21 grams of aspartame to sweeten it. As a side note, have you ever noticed that diet soft drinks foam or froth or bubble much more that regular sugared ones? That is because you need so much more sugar to sweeten it than aspartame, the sugared soft drinks are more viscous and thus foam less. Aspartame has been accused of causing everything from seizures to cancer to hair loss. None of these claims has ever been proven in a clinical trial. Many of the claims of damage I have heard about aspartame are because as aspartame is being broken down in the body, formaldehyde is produced. Formaldehyde is a poison, so aspartame must be a poison, right? Wrong. Many fruits and vegetables break down into small amounts of formaldehyde as well. This formaldehyde will break down into formic acid and then to water and carbon dioxide. Want further proof your body can handle small amounts of formaldehyde? That last hang over you had was due in part to formaldehyde. Ethyl alcohol changes in part into formaldehyde. Some of the pain of the hang over was due to too much formaldehyde in your body. But your body eventually metabolized it and the hang over went away. You get much more formaldehyde in your body from a hang over than from aspartame.
In general aspartame has been thoroughly tested by the Canadian and American authorities and found to be safe. There is one group that must avoid aspartame. This condition is called phenylketonuria or PKU, a disorder of amino acid metabolism. Accumulation of phenylalanine can lead to neurological, behavioral and dermatologic problems in this population. Since aspartame contains phenylalanine, patients with PKU should not use aspartame.
So I have already said I think artificial sweetners are a good option for diabetics. Should non-diabetics use them? In moderation, saccharine, aspartame, acesulfame potassium and sucralose appear to be safe. The FDA in the US and Health Canada have set acceptable daily limits of these sweetners and studies show that normal diets contain far less sweetners than these limits. So yes, in moderation, these sweetners are safe to use. Do I use them? Yes I do. One last word about moderation, though. Almost anything can be toxic if used too much. A condition called water toxicity can happen if you drink too much water. I bring this up because one of the clinic physicians was talking about a patient of theirs that drank 8-12 liters of diet soft drinks per day. This patient didn’t mention this diet related quirk to their physician for years. When the patient’s enormous diet soft drink consumption finally came out, the doctor could finally successfully cure the patient’s chronic diarrhea.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Sunday, October 05, 2008
Finish Your Antibiotics
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.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.
One beautiful, warm summer Saturday morning I went for breakfast at CC’s Restaurant in the Boulevard Hotel. I was there to meet some friends and catch up. The conversation was good. The food was great. However, sometimes even on a Saturday morning I have to put the pharmacist hat back on. The conversation eventually turned to old antibiotics. “Why shouldn’t I keep those antibiotics I didn’t finish last winter?” I was asked. I wanted to say, “Antibiotic resistance and the end of the world.” Now that might be a small exageration, but not as much as you might think. Let’s go back to that Flemming dude and his messy lab.
Sir Alexander Fleming discovered penicillin in 1928. He was doing research on bacteria and was already known as a good researcher, but a messy lab technician. Coming back to his lab after a few days off, he found some cultures of his bacteria that he’d forgotten had been spoiled by mold. Instead of just throwing out all the culture plates, he noticed a zone around some of the mold was completely free of bacteria. The mold (later named Penicillium notatum) produced a substance (now called penicillin) that killed the bacteria. Penicillin was eventually isolated and made in large quantities. When it was given to people, certain infections were cured!
Penicillin was a miraculous discovery. Bacterial infections can kill people. Before antibiotics strept throat, sexually transmitted diseases and child birth often killed people. In fact bacterial infections remain still one of the only maladies that drugs can “cure”. Yes insulin treats diabetes, celebrex treats arthritis and Viagra treats erectile dysfunction, but the malady doesn’t go away. If you take away the insulin, the celebrex or the Viagra the diabetes, arthritis and erectile dysfunction and their symptoms come back. However, if I have strept throat and the doctor gives me a 10 day course of penicillin, I am cured. The bacteria are dead and that infection is over. Unlike insulin, which type 1 diabetics need to be on for life, I can take antibiotics for a short time and be cured.
As miraculous as antibiotics are, they aren’t perfect. Several decades after penicillin was discovered, people started talking about antibiotic resistance. You see mold can’t move. It can’t run away from other microbes competing for the same food. It has no claws or teeth to defend its territory. So it has been engaging in chemical warfare with bacteria and other microbes for a long time. Evolution says that if you throw a poisonous chemical at a bunch of bacteria some will die quickly and some will die slowly. The ones that die slowly are more likely to reproduce and pass that chemical resistance to their offspring. As bacteria reproduce quickly, resistance can develop quickly. So, in the wild, molds produce chemical warfare against bacteria, then bacteria get resistant to the molds’ chemical warfare, then the bacteria get resistant and on it goes. We humans threw a monkey wrench into the works by making tons of mold chemical warfare (penicillin) and wiping out the bacteria for a few decades. The bacteria have finally caught up, and now they are getting resistant to some antibiotics.
How is the best way to make bacteria resistant to antibiotics? First, insist you get an antibiotic from your doctor whether you have a bacterial infection or not. Then, only take 2 or 3 days worth of the antibiotics and “save the rest for next time”. This will kill off the most susceptible bacteria, but it will leave some. The ones that are left will have a natural immunity to the antibiotic. Those bacteria will reproduce and all their offspring will have a resistance to that antibiotic. If your immune system doesn’t finish off those bacteria with antibiotic resistance, they will start up the infection again. Now that original antibiotic won’t work anymore. You now have an antibiotic resistant infection!
So how do you avoid antibiotic resistance?
□ Wash your hands regularly with soap and water for at least 20 seconds. It is the most effective way of preventing many types of infections.
□ Have your doctor vaccinate you and your children and keep vaccinations up to date.
□ Store, handle and prepare food safely. When preparing food, be sure to wash cutting boards and knives with detergent and water. Thoroughly wash all fruits and vegetables that will be eaten raw.
□ Don’t demand antibiotics from your doctor for a viral infection. Antibiotics don’t kill viruses. Putting antibiotics in your body when you don’t need them can lead to antibiotic resistance.
□ Do not share prescriptions with anyone else. Taking an inappropriate drug makes the resistance problem worse.
And finish your antibiotics! Do not stop taking a prescription part way through the course of treatment (unless you are having a serious adverse reaction) without first discussing it with your doctor. Even if you feel better, use the entire prescription as directed to make sure that all of the bacteria are destroyed. Dead bacteria don’t cause resistance.
As always if you have any questions or concerns about these 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.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.
One beautiful, warm summer Saturday morning I went for breakfast at CC’s Restaurant in the Boulevard Hotel. I was there to meet some friends and catch up. The conversation was good. The food was great. However, sometimes even on a Saturday morning I have to put the pharmacist hat back on. The conversation eventually turned to old antibiotics. “Why shouldn’t I keep those antibiotics I didn’t finish last winter?” I was asked. I wanted to say, “Antibiotic resistance and the end of the world.” Now that might be a small exageration, but not as much as you might think. Let’s go back to that Flemming dude and his messy lab.
Sir Alexander Fleming discovered penicillin in 1928. He was doing research on bacteria and was already known as a good researcher, but a messy lab technician. Coming back to his lab after a few days off, he found some cultures of his bacteria that he’d forgotten had been spoiled by mold. Instead of just throwing out all the culture plates, he noticed a zone around some of the mold was completely free of bacteria. The mold (later named Penicillium notatum) produced a substance (now called penicillin) that killed the bacteria. Penicillin was eventually isolated and made in large quantities. When it was given to people, certain infections were cured!
Penicillin was a miraculous discovery. Bacterial infections can kill people. Before antibiotics strept throat, sexually transmitted diseases and child birth often killed people. In fact bacterial infections remain still one of the only maladies that drugs can “cure”. Yes insulin treats diabetes, celebrex treats arthritis and Viagra treats erectile dysfunction, but the malady doesn’t go away. If you take away the insulin, the celebrex or the Viagra the diabetes, arthritis and erectile dysfunction and their symptoms come back. However, if I have strept throat and the doctor gives me a 10 day course of penicillin, I am cured. The bacteria are dead and that infection is over. Unlike insulin, which type 1 diabetics need to be on for life, I can take antibiotics for a short time and be cured.
As miraculous as antibiotics are, they aren’t perfect. Several decades after penicillin was discovered, people started talking about antibiotic resistance. You see mold can’t move. It can’t run away from other microbes competing for the same food. It has no claws or teeth to defend its territory. So it has been engaging in chemical warfare with bacteria and other microbes for a long time. Evolution says that if you throw a poisonous chemical at a bunch of bacteria some will die quickly and some will die slowly. The ones that die slowly are more likely to reproduce and pass that chemical resistance to their offspring. As bacteria reproduce quickly, resistance can develop quickly. So, in the wild, molds produce chemical warfare against bacteria, then bacteria get resistant to the molds’ chemical warfare, then the bacteria get resistant and on it goes. We humans threw a monkey wrench into the works by making tons of mold chemical warfare (penicillin) and wiping out the bacteria for a few decades. The bacteria have finally caught up, and now they are getting resistant to some antibiotics.
How is the best way to make bacteria resistant to antibiotics? First, insist you get an antibiotic from your doctor whether you have a bacterial infection or not. Then, only take 2 or 3 days worth of the antibiotics and “save the rest for next time”. This will kill off the most susceptible bacteria, but it will leave some. The ones that are left will have a natural immunity to the antibiotic. Those bacteria will reproduce and all their offspring will have a resistance to that antibiotic. If your immune system doesn’t finish off those bacteria with antibiotic resistance, they will start up the infection again. Now that original antibiotic won’t work anymore. You now have an antibiotic resistant infection!
So how do you avoid antibiotic resistance?
□ Wash your hands regularly with soap and water for at least 20 seconds. It is the most effective way of preventing many types of infections.
□ Have your doctor vaccinate you and your children and keep vaccinations up to date.
□ Store, handle and prepare food safely. When preparing food, be sure to wash cutting boards and knives with detergent and water. Thoroughly wash all fruits and vegetables that will be eaten raw.
□ Don’t demand antibiotics from your doctor for a viral infection. Antibiotics don’t kill viruses. Putting antibiotics in your body when you don’t need them can lead to antibiotic resistance.
□ Do not share prescriptions with anyone else. Taking an inappropriate drug makes the resistance problem worse.
And finish your antibiotics! Do not stop taking a prescription part way through the course of treatment (unless you are having a serious adverse reaction) without first discussing it with your doctor. Even if you feel better, use the entire prescription as directed to make sure that all of the bacteria are destroyed. Dead bacteria don’t cause resistance.
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, September 26, 2008
The September Asthma Epidemic? Part 2 of 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.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 discussed the timeing and the causes of the September Asthma Epidemic. Two bright researchers from Hamilton, Ontario, Malcom Sears and Neil Johston described how in many countries around the world, including Canada had an increase in the number of children hospitalized with asthma problems 2-3 weeks after the beginning of the new school year. We talked about how it was probably due to rhinoviruses and return to school stress. Rhinovirus infections increase in September. Suddenly cramming kids onto school buses and classrooms is a great way to spread these infections. But if it was just rhinovirus the timing of the hospitalization shouldn’t be as consistent as it has been from 1990 through 2004. So the researchers think that back to school stress may add to the problem. The last piece of the puzzle might be asthma medication usage.
When the researchers look in the Ottawa area, there were fewer fills of children’s asthma medications during the summer months. So the use of asthma controller medication may be at its lowest point just before school starts. Why does this matter? Let’s look at the two broad types of asthma medications.
Asthma medications are broadly classified as relievers or controllers. Relievers are medications like ventolin or salbutamol. These medications rapidly open airways when a patient has asthma symptoms. They work well during an asthma attack, but they don’t reduce inflammation in the lungs, so they don’t prevent future attacks. Controller medications have names like flovent, singulair, and pulmicort. These medications don’t work quickly enough to help someone if they are having an attack now. However, if controller medications are taken every day (even if the asthmatic is feeling well), they reduce inflammation in the lungs and prevent future attacks. So, if patients aren’t taking their controller medications over the summer, their lungs are going to be inflammed. So they will be primed and ready to have a full fledge, hospital-requiring asthma problem in September when they encounter the rhinoviruses and school stress.
So can we prevent the September Asthma Epidemic? Let’s look at the proposed causes: rhinovirus, school stress, and lack of controller medication at the beginning of school. Can we reduce rhinovirus exposure? There is no practical way to put all the kids in bubbles or filter the air on school buses. There might be a rhinovirus vaccine some time in the future. However, short of developing a vaccine, we can’t control rhinovirus. Can we get rid of school stress? Maybe brighter people than I can figure out how to teach children to handle the stress better, but I see no practical way. Also, as much as my daughter Emily might like it, we can’t banish school all together. Can we convince asthmatics to take their medications regularily? Asthmatic patient should keep taking controller medications in August to keep the inflammation down in September. The problem is that we have been telling patient that forever, and obviously in the years 1990 through 2004 (the years the researcher looked at in Canada), patient’s weren’t listening. So the researchers looked at another option. What if everyone took singulair for 6 weeks starting at the beginning of September?
The researchers ran an experiment. From September 1 to October 15, 2005 194 children aged 2 to 14 years took part in a randomized, placebo controlled trial with singulair (aka montelukast). They took the singulair in addition to whatever asthma medication they were regularily on. Guess what? The children who took the singulair had fewer days with worse asthma symptoms and fewer unscheduled doctor visits than those on the sugar pill! It didn’t matter if the children were regularily on other controller medications or not. It didn’t matter if the children had colds during the test period or not. Singulair seemed to help everyone in the first six weeks of school.
So should every school-aged asthmatic child go on Singulair from September 1st to October 15th every year? I’m not quite ready to say that yet. However, it is an intriguing option for my parents to consider. Do you buy less asthma medication over the summer? Does you child go on a drug-holiday in August? Have you every taken your asthmatic child to the emergency room in the third week of school? If you answered yes, ask you pharmacist which is your child’s controller medication. Talk to your doctor or pharmacist about having you child use his/her controller medication regularily in the summer. Ask your doctor if your child is a good candidate for being on Singulair for the first six week of school.
As always if you have any questions or concerns about these 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.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 discussed the timeing and the causes of the September Asthma Epidemic. Two bright researchers from Hamilton, Ontario, Malcom Sears and Neil Johston described how in many countries around the world, including Canada had an increase in the number of children hospitalized with asthma problems 2-3 weeks after the beginning of the new school year. We talked about how it was probably due to rhinoviruses and return to school stress. Rhinovirus infections increase in September. Suddenly cramming kids onto school buses and classrooms is a great way to spread these infections. But if it was just rhinovirus the timing of the hospitalization shouldn’t be as consistent as it has been from 1990 through 2004. So the researchers think that back to school stress may add to the problem. The last piece of the puzzle might be asthma medication usage.
When the researchers look in the Ottawa area, there were fewer fills of children’s asthma medications during the summer months. So the use of asthma controller medication may be at its lowest point just before school starts. Why does this matter? Let’s look at the two broad types of asthma medications.
Asthma medications are broadly classified as relievers or controllers. Relievers are medications like ventolin or salbutamol. These medications rapidly open airways when a patient has asthma symptoms. They work well during an asthma attack, but they don’t reduce inflammation in the lungs, so they don’t prevent future attacks. Controller medications have names like flovent, singulair, and pulmicort. These medications don’t work quickly enough to help someone if they are having an attack now. However, if controller medications are taken every day (even if the asthmatic is feeling well), they reduce inflammation in the lungs and prevent future attacks. So, if patients aren’t taking their controller medications over the summer, their lungs are going to be inflammed. So they will be primed and ready to have a full fledge, hospital-requiring asthma problem in September when they encounter the rhinoviruses and school stress.
So can we prevent the September Asthma Epidemic? Let’s look at the proposed causes: rhinovirus, school stress, and lack of controller medication at the beginning of school. Can we reduce rhinovirus exposure? There is no practical way to put all the kids in bubbles or filter the air on school buses. There might be a rhinovirus vaccine some time in the future. However, short of developing a vaccine, we can’t control rhinovirus. Can we get rid of school stress? Maybe brighter people than I can figure out how to teach children to handle the stress better, but I see no practical way. Also, as much as my daughter Emily might like it, we can’t banish school all together. Can we convince asthmatics to take their medications regularily? Asthmatic patient should keep taking controller medications in August to keep the inflammation down in September. The problem is that we have been telling patient that forever, and obviously in the years 1990 through 2004 (the years the researcher looked at in Canada), patient’s weren’t listening. So the researchers looked at another option. What if everyone took singulair for 6 weeks starting at the beginning of September?
The researchers ran an experiment. From September 1 to October 15, 2005 194 children aged 2 to 14 years took part in a randomized, placebo controlled trial with singulair (aka montelukast). They took the singulair in addition to whatever asthma medication they were regularily on. Guess what? The children who took the singulair had fewer days with worse asthma symptoms and fewer unscheduled doctor visits than those on the sugar pill! It didn’t matter if the children were regularily on other controller medications or not. It didn’t matter if the children had colds during the test period or not. Singulair seemed to help everyone in the first six weeks of school.
So should every school-aged asthmatic child go on Singulair from September 1st to October 15th every year? I’m not quite ready to say that yet. However, it is an intriguing option for my parents to consider. Do you buy less asthma medication over the summer? Does you child go on a drug-holiday in August? Have you every taken your asthmatic child to the emergency room in the third week of school? If you answered yes, ask you pharmacist which is your child’s controller medication. Talk to your doctor or pharmacist about having you child use his/her controller medication regularily in the summer. Ask your doctor if your child is a good candidate for being on Singulair for the first six week of school.
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, September 19, 2008
The September Asthma Epidemic? Part 1 of 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 http://www.dcp.ca/
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Every few years someone tells us pharmacists that a drug is so good, it should go into the water supply. When I graduated from pharmacy school, it was prozac. We were told that prozac was such a good antidepressant that if it was put in the water supply, not only would we cure depressed patients, the rest of us would be happier too. It was true that prozac was a lot better (and safer) than the existing antidepressants on the market at the time. However, it wasn’t for everyone, and like all medications it did have side effects in some people. The next miracle drug was a type of blood pressure pill called ACE inhibitors. I remember being at a talk by a kidney specialist when he said that ACE inhibitors were so good they should be in the drinking water. Now don’t get me wrong, ACE inhibitors are very good. Aside from treating blood pressure, they help some aspects of diabetes, some types of heart problems and some kidney conditions. But, as good as ACE inhibitors are, they aren’t perfect either. So you can understand why I was skeptical when I heard a drug rep suggesting that all asthmatic children go on singulair. It turns out he wasn’t talking about all asthmatic children going on singulair (montelukast) all the time. He was talking about a study that showed maybe they should be on it during the first 6 weeks of school. The study said it would help treat the “September Asthma Epidemic”.
So what is this “September Asthma Epidemic”? I was given a couple of medical articles when I asked. It seems that two bright researchers from Hamilton, Ontario, Malcom Sears and Neil Johston wrote “Understanding the September asthma epidemic” in the Journal of Allergy and Clinical Immunology in August 2007 and Neil Johnston and his team wrote “Attenuatin of the September Epidemic of Asthma Exacerbations in Children: A Randomized, Controlled Trial of Montelukact Added to Usual Therapy” in Pediatrics in September 2007. Long titles, but interesting reading. Don’t tell my six year old daughter, but the gist is that school makes kids sick.
The researchers first looked at health data from across Canada, and from around the world. They were specially looking at the number and timing of asthma related hospitalizations. The most childhood asthma hospitalizations happen in September every year. This happens in many Northern Hemisphere countries including the United States, Mexico, Israel, Finland, Trinidad, the United Kingdom and Canada. In Canada 20 to 25% of all childhood asthma hospitalizations happen in September.
It gets more interesting when you break down the numbers into age groups and apply it to a family, say mine. We’ll call me the adult (my wife would probably disagree), my daughter Emily is school aged (she’d six), and my son Eric is pre-school (he is three). Now give all of us asthma. Emily should be in the hospital first and have the worst asthma symptoms. Emily would go to the hospital September 19th. Eric (the pre-schooler) would have a less serious attack but would still end up in hospital September 21st. I would have an attack that wasn’t as serious as the kids but I should be admitted September 25th. It seems whatever causes this epidemic hits the school aged kids hardest and first. Then the school aged kids spread it to the pre-schoolers and the adults. (Again, don’t tell Emily she could literately be the cause of all my problems).
So what causes this increase in asthma in September? Well, it probably isn’t allergens or pollution in the air, or least not by themselves. Although amount of allergens in the air like pollens, does increase in the late summer/early fall, they should hit all asthmatics at the same time. School aged children shouldn’t have problems at a different time than adults. Viruses could be another possible culprit. Going back to school is a great time to get a virus. During the summer kids probably play with 3-4 other children at a time. Suddenly, they are in classrooms, school buses, etc with 30 or more other children. It doesn’t take long for that one sick kid to share his or her viruses. There is one virus that interested the researchers in particular. Rhinovirus infections have been associated with up to 80% of asthma attacks in school aged children. School aged children pass rhinovirus infections to their families 3 times more often than working adults do. Finally, rhinovirus infections do go up around September. When the researchers looked, they did seem to find more rhinovirus in the kids with asthma attacks in September. So rhinovirus is the culprit, right? Maybe the timing is too perfect.
The timing of the increase in hospital visits due to asthma is always 2 to 3 weeks after the start of school. The researchers looked at every September in Canada from 1990 to 2004. The peak number of hospitalizations was always at the same time. Rhinovirus infections go up in September, but the timing can easily change by a few weeks either way. There is another piece to the puzzle. That puzzle piece is school. As a bit of proof, the researchers checked other countries. In Canada and England most children go back to school the first week of September. In Scotland and Sweden, they go back in the third week of August. Large peaks in asthma hospitalization occur 2 to 3 weeks after the return to school in all four countries despite their different school start dates.
Next week we will look at why school is the missing link and what can be done about it.
As always if you have any questions or concerns about these products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at http://www.dcp.ca/
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Every few years someone tells us pharmacists that a drug is so good, it should go into the water supply. When I graduated from pharmacy school, it was prozac. We were told that prozac was such a good antidepressant that if it was put in the water supply, not only would we cure depressed patients, the rest of us would be happier too. It was true that prozac was a lot better (and safer) than the existing antidepressants on the market at the time. However, it wasn’t for everyone, and like all medications it did have side effects in some people. The next miracle drug was a type of blood pressure pill called ACE inhibitors. I remember being at a talk by a kidney specialist when he said that ACE inhibitors were so good they should be in the drinking water. Now don’t get me wrong, ACE inhibitors are very good. Aside from treating blood pressure, they help some aspects of diabetes, some types of heart problems and some kidney conditions. But, as good as ACE inhibitors are, they aren’t perfect either. So you can understand why I was skeptical when I heard a drug rep suggesting that all asthmatic children go on singulair. It turns out he wasn’t talking about all asthmatic children going on singulair (montelukast) all the time. He was talking about a study that showed maybe they should be on it during the first 6 weeks of school. The study said it would help treat the “September Asthma Epidemic”.
So what is this “September Asthma Epidemic”? I was given a couple of medical articles when I asked. It seems that two bright researchers from Hamilton, Ontario, Malcom Sears and Neil Johston wrote “Understanding the September asthma epidemic” in the Journal of Allergy and Clinical Immunology in August 2007 and Neil Johnston and his team wrote “Attenuatin of the September Epidemic of Asthma Exacerbations in Children: A Randomized, Controlled Trial of Montelukact Added to Usual Therapy” in Pediatrics in September 2007. Long titles, but interesting reading. Don’t tell my six year old daughter, but the gist is that school makes kids sick.
The researchers first looked at health data from across Canada, and from around the world. They were specially looking at the number and timing of asthma related hospitalizations. The most childhood asthma hospitalizations happen in September every year. This happens in many Northern Hemisphere countries including the United States, Mexico, Israel, Finland, Trinidad, the United Kingdom and Canada. In Canada 20 to 25% of all childhood asthma hospitalizations happen in September.
It gets more interesting when you break down the numbers into age groups and apply it to a family, say mine. We’ll call me the adult (my wife would probably disagree), my daughter Emily is school aged (she’d six), and my son Eric is pre-school (he is three). Now give all of us asthma. Emily should be in the hospital first and have the worst asthma symptoms. Emily would go to the hospital September 19th. Eric (the pre-schooler) would have a less serious attack but would still end up in hospital September 21st. I would have an attack that wasn’t as serious as the kids but I should be admitted September 25th. It seems whatever causes this epidemic hits the school aged kids hardest and first. Then the school aged kids spread it to the pre-schoolers and the adults. (Again, don’t tell Emily she could literately be the cause of all my problems).
So what causes this increase in asthma in September? Well, it probably isn’t allergens or pollution in the air, or least not by themselves. Although amount of allergens in the air like pollens, does increase in the late summer/early fall, they should hit all asthmatics at the same time. School aged children shouldn’t have problems at a different time than adults. Viruses could be another possible culprit. Going back to school is a great time to get a virus. During the summer kids probably play with 3-4 other children at a time. Suddenly, they are in classrooms, school buses, etc with 30 or more other children. It doesn’t take long for that one sick kid to share his or her viruses. There is one virus that interested the researchers in particular. Rhinovirus infections have been associated with up to 80% of asthma attacks in school aged children. School aged children pass rhinovirus infections to their families 3 times more often than working adults do. Finally, rhinovirus infections do go up around September. When the researchers looked, they did seem to find more rhinovirus in the kids with asthma attacks in September. So rhinovirus is the culprit, right? Maybe the timing is too perfect.
The timing of the increase in hospital visits due to asthma is always 2 to 3 weeks after the start of school. The researchers looked at every September in Canada from 1990 to 2004. The peak number of hospitalizations was always at the same time. Rhinovirus infections go up in September, but the timing can easily change by a few weeks either way. There is another piece to the puzzle. That puzzle piece is school. As a bit of proof, the researchers checked other countries. In Canada and England most children go back to school the first week of September. In Scotland and Sweden, they go back in the third week of August. Large peaks in asthma hospitalization occur 2 to 3 weeks after the return to school in all four countries despite their different school start dates.
Next week we will look at why school is the missing link and what can be done about it.
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, August 01, 2008
Vitamin D
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 http://www.dcp.ca/
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
My dad remembers getting his dose of “liquid sunshine” everyday from my grandmother. They were in Wawa, Ontario and like many places in Canada, there wasn’t a lot of sun in the winter. My dad hated, but took his spoonful of Cod Liver Oil daily. That was more than half a century ago, and maybe my grandmother was ahead of her time. Cod live oil has lots of good things in it including Omega-3 fatty acids and Vitamin A. We think people should try to eat cold water fish like cod or salmon twice a week. But today we are going to talk about the wonders another cod liver oil ingredient. Today we will tackle Vitamin D.
What is Vitamin D? As usual, there isn’t a simple answer. There are different forms of Vitamin D, but the most potent form is called calcitriol. The type of Vitamin D your body makes is called Vitamin D3 (or cholecalciferol). The formation is complicated, but it goes like this. A Pre- Vitamin D3 is converted Vitamin D3 in the skin with the help of sunlight (UV Radiation). This is why my grandmother called it “liquid sunshine”. Vitamin D3 is converted to a second form in the liver called calcidiol. The calcidiol is converted to calcitriol by the kidney. Again calcitriol is the most active form. So you can get Vitamin D3 from taking pills, having your skin make it from sunshine or eating things like fish. Then you hope your kidneys are healthy enough to convert the Vitamin D3 to calcitriol. There is another form of Vitamin D called Vitamin D2 . It is formed by plants and it can be converted to calcitriol in your body as well. There are those that argue that Vitamin D2 doesn’t form calcitriol as well at Vitamin D3.
Why do we care about Vitamin D? The most important thing about Vitamin D is still that it helps your gut absorb calcium. We know this because young children who don’t get enough Vitamin D develop rickets. Rickets is a condition characterized by bone deformaties and “soft bones” which don’t have enough calcium. If we treat these children with Vitamin D and/or sunlight, their bones get better. This is why we give breast fed babies a Vitamin D supplement called D-Vi-Sol. We assume that the newborns aren’t put in the sun (mostly because we told the mothers not too) and the mothers aren’t in the sun either. Once the babies go onto formula or milk, they will be consuming Vitamin D.
So we need Vitamin D to absorb calcium. That isn’t a new recommendation. Why is Vitamin D in the news? Well, a few things have changed lately. First, we are all probably getting less Vitamin D than we did before. We are using more sunscreen which is good for preventing skin cancer, but it reduces the Vitamin D our skin can produce. We spend less and less time outdoors, and as people age their bodies are less good at absorbing Vitamin D from their diet. The second thing is the recommendations for how much Vitamin D we need keeps going up. It used to be 400 IU of Vitamin D was fine. Now we don’t think 400 IU of Vitamin D will prevent fractures in adults. The recommendations are for at least 400 IU if you are healthy and less than 50. If you are over 50, you should consider 800 to 1000 IU. Vitamin D is generally considered safe up to 2000 IU, and some of the cancer trials are recommending that much.
Another reason that Vitamin D seems to be in the news more is that it is inexpensive, relatively safe and everytime we turn around it seems to do another good thing for us. Let’s look at some of the new health claims Vitamin D has.
· I was at care home meeting the other day and a patient’s daughter if her mom could be put on more Vitamin D. “It has been proven to reduce falls,” she said. I had no idea, so I looked it up. Sure enough in the February 2008 issue of the Journal of the American Geriatric Society there was a study that said nursing home patients on 800 IU of Vitamin D fell less than one on 600 IU, 400 IU, 200 IU or placebo.
· Dr. Philippe Autier, MD from the International Agency for Research on Cancer in France did a meta-analysis that was published in the September 10, 2008 issue of Archives of Internal Medicine. A meta-analysis lumps a bunch of other studies together to look for trends. It isn’t considered as reliable as a randomized placebo controlled trial, but they often give us interesting information for further study. This meta-analysis showed Vitamin D supplementation seemed to make you less likely to die from all causes (including cancer, diabetes and heart problems). The problem is that a meta-analysis can’t draw any conclusions about which dose of Vitamin D is best or why Vitamin D does go things.
· The Canadian Cancer Society now recommends 1000 IU ( in consultation with your doctor) during the fall and winter.
· Low blood levels of Vitamin D seem to make men more likely to have heart attacks. In the June 9, 2008 Archives of Internal Medicine they looked at a lot of men who hadn’t had heart problems and followed them for 6 years. Then they counted who had heart attacks. Even after they eliminated the differences due to smoking, diabetes, high blood pressure, cholesterol levels and other factors, the men with higher blood levels of Vitamin D had few heart attacks.
Other studies have hinted that Vitamin D may make you less likely to get Multiple Sclerosis, colorectal cancer and/or be more likely to survive breast cancer.
As always if you have any questions or concerns about these products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at http://www.dcp.ca/
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
My dad remembers getting his dose of “liquid sunshine” everyday from my grandmother. They were in Wawa, Ontario and like many places in Canada, there wasn’t a lot of sun in the winter. My dad hated, but took his spoonful of Cod Liver Oil daily. That was more than half a century ago, and maybe my grandmother was ahead of her time. Cod live oil has lots of good things in it including Omega-3 fatty acids and Vitamin A. We think people should try to eat cold water fish like cod or salmon twice a week. But today we are going to talk about the wonders another cod liver oil ingredient. Today we will tackle Vitamin D.
What is Vitamin D? As usual, there isn’t a simple answer. There are different forms of Vitamin D, but the most potent form is called calcitriol. The type of Vitamin D your body makes is called Vitamin D3 (or cholecalciferol). The formation is complicated, but it goes like this. A Pre- Vitamin D3 is converted Vitamin D3 in the skin with the help of sunlight (UV Radiation). This is why my grandmother called it “liquid sunshine”. Vitamin D3 is converted to a second form in the liver called calcidiol. The calcidiol is converted to calcitriol by the kidney. Again calcitriol is the most active form. So you can get Vitamin D3 from taking pills, having your skin make it from sunshine or eating things like fish. Then you hope your kidneys are healthy enough to convert the Vitamin D3 to calcitriol. There is another form of Vitamin D called Vitamin D2 . It is formed by plants and it can be converted to calcitriol in your body as well. There are those that argue that Vitamin D2 doesn’t form calcitriol as well at Vitamin D3.
Why do we care about Vitamin D? The most important thing about Vitamin D is still that it helps your gut absorb calcium. We know this because young children who don’t get enough Vitamin D develop rickets. Rickets is a condition characterized by bone deformaties and “soft bones” which don’t have enough calcium. If we treat these children with Vitamin D and/or sunlight, their bones get better. This is why we give breast fed babies a Vitamin D supplement called D-Vi-Sol. We assume that the newborns aren’t put in the sun (mostly because we told the mothers not too) and the mothers aren’t in the sun either. Once the babies go onto formula or milk, they will be consuming Vitamin D.
So we need Vitamin D to absorb calcium. That isn’t a new recommendation. Why is Vitamin D in the news? Well, a few things have changed lately. First, we are all probably getting less Vitamin D than we did before. We are using more sunscreen which is good for preventing skin cancer, but it reduces the Vitamin D our skin can produce. We spend less and less time outdoors, and as people age their bodies are less good at absorbing Vitamin D from their diet. The second thing is the recommendations for how much Vitamin D we need keeps going up. It used to be 400 IU of Vitamin D was fine. Now we don’t think 400 IU of Vitamin D will prevent fractures in adults. The recommendations are for at least 400 IU if you are healthy and less than 50. If you are over 50, you should consider 800 to 1000 IU. Vitamin D is generally considered safe up to 2000 IU, and some of the cancer trials are recommending that much.
Another reason that Vitamin D seems to be in the news more is that it is inexpensive, relatively safe and everytime we turn around it seems to do another good thing for us. Let’s look at some of the new health claims Vitamin D has.
· I was at care home meeting the other day and a patient’s daughter if her mom could be put on more Vitamin D. “It has been proven to reduce falls,” she said. I had no idea, so I looked it up. Sure enough in the February 2008 issue of the Journal of the American Geriatric Society there was a study that said nursing home patients on 800 IU of Vitamin D fell less than one on 600 IU, 400 IU, 200 IU or placebo.
· Dr. Philippe Autier, MD from the International Agency for Research on Cancer in France did a meta-analysis that was published in the September 10, 2008 issue of Archives of Internal Medicine. A meta-analysis lumps a bunch of other studies together to look for trends. It isn’t considered as reliable as a randomized placebo controlled trial, but they often give us interesting information for further study. This meta-analysis showed Vitamin D supplementation seemed to make you less likely to die from all causes (including cancer, diabetes and heart problems). The problem is that a meta-analysis can’t draw any conclusions about which dose of Vitamin D is best or why Vitamin D does go things.
· The Canadian Cancer Society now recommends 1000 IU ( in consultation with your doctor) during the fall and winter.
· Low blood levels of Vitamin D seem to make men more likely to have heart attacks. In the June 9, 2008 Archives of Internal Medicine they looked at a lot of men who hadn’t had heart problems and followed them for 6 years. Then they counted who had heart attacks. Even after they eliminated the differences due to smoking, diabetes, high blood pressure, cholesterol levels and other factors, the men with higher blood levels of Vitamin D had few heart attacks.
Other studies have hinted that Vitamin D may make you less likely to get Multiple Sclerosis, colorectal cancer and/or be more likely to survive breast cancer.
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, July 25, 2008
SUN SCREENS
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.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.
Dauphin used to be the “City of Sunshine”. Now we are “Everything You Deserve”. I’m not sure what our current slogan means, but it does sound nice. The “City of Sunshine” is quite literally from an article in Canadian Geographic (Mar/Apr 2000). Apparently Dauphin ranks first among the sunniest cities in Canada. So we all use lots and lots of sunscreen, right? Well, we should. As The Fair, Countryfest, Jesus Manifest, Urkranian Festival and all those other wonderful summer Parkland activities come and go, don’t forget the sunscreen.
Skin cancer is the most commonly occurring cancer in Canada, and the fastest growing cancer in the world. In 2000 68,000 Canadians were diagnosed with non-melanoma skin cancer, and 3,700 with malignant melanoma, the more aggressive form of the disease. In 2003 the estimates are 75,000 Canadians with non-melanoma skin cancer and 3,900 with malignant melanoma. Since 1988 the death rate from malignant melanoma is up 41% for men and 23% in women. The Canadian Cancer Society says that anyone born today has a one in seven chance of getting skin cancer in their lifetime.
The Canadian Dermatology Association recommends:
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.
Dauphin used to be the “City of Sunshine”. Now we are “Everything You Deserve”. I’m not sure what our current slogan means, but it does sound nice. The “City of Sunshine” is quite literally from an article in Canadian Geographic (Mar/Apr 2000). Apparently Dauphin ranks first among the sunniest cities in Canada. So we all use lots and lots of sunscreen, right? Well, we should. As The Fair, Countryfest, Jesus Manifest, Urkranian Festival and all those other wonderful summer Parkland activities come and go, don’t forget the sunscreen.
Skin cancer is the most commonly occurring cancer in Canada, and the fastest growing cancer in the world. In 2000 68,000 Canadians were diagnosed with non-melanoma skin cancer, and 3,700 with malignant melanoma, the more aggressive form of the disease. In 2003 the estimates are 75,000 Canadians with non-melanoma skin cancer and 3,900 with malignant melanoma. Since 1988 the death rate from malignant melanoma is up 41% for men and 23% in women. The Canadian Cancer Society says that anyone born today has a one in seven chance of getting skin cancer in their lifetime.
The Canadian Dermatology Association recommends:
- 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.
- GOLFERS: Choose a high SPF product – 30 – 60 – that offers greater protection as you will be out for more than four hours if playing 18 holes. Use a golf umbrella or golf cart for personal shade. If possible, wait for play in shaded, treed areas.
- Cover your arms and legs. Covering your skin will protect it from the sun. Choose clothing that is: loose fitting; tightly woven; and lightweight.
- Wear a wide-brimmed hat (3 inches or 7.5 cm). 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.
- Use a sunscreen with SPF (Sun Protection Factor) SPF 30 or higher. Look for "broad spectrum" on the label. This means that the sunscreen offers protection against two types of ultraviolet rays, UVA and UVB. Don’t forget to use SPF 30, broad spectrum lip balm.
- 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.
For More Information visit:
The Canadian Cancer Society: http://www.cancer.ca/
The Canadian Dermatology Association http://www.dermatology.ca/
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Sunday, February 24, 2008
HEAD LICE
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.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.
My then five year old daughter came home from kintergarten in the fall with a pamphlet about head lice. My wife and I asked if her teacher was trying to tell her something. She said no that everyone in her class got the pamphlet. So we felt better as parents, and that is one of the reasons we usually start getting lice questions at the pharmacy in September and October. Head lice doesn’t just happen at the beginning of the school year, though. It can happen at any time.
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 two main ways. Lice can be transmitted directly by close contact from one infested scalp to another (i.e. touching heads together). They can be transmitted indirectly by sharing personal articles that come in contact with the head (e. brushes, hats, etc). Louse transfer has been found to be optimal when hairs are relatively stationary and parallel, suggesting that louse transmission is more likely to occur while children are at rest (e.g. taking a nap together), than during periods of vigorous play (e.g. wrestling on the ground). 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. Head lice is not a sign that your child’s hair is dirty. 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? The most common symptom is 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 recognize 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.
There is a new product on the market now for lice called Resultz. It contains isopropyl myristate. This is different that the Nix like products. The permethrin in Nix attacks the nervous system of the louse. Isopropyl myristate is more like a soap. It dissolves the waxy outer coating on the louse and the louse dehydrates. The down side to Resultz is it does not kill the nits or eggs in the hair. So you absolutely need to do the second treatment in one week. On the positive side, there is no documented resistance to Resultz. Back in the 1980’s permethrin like products killed 100% of lice. I have seen estimates now that in places it kills more like 28% of the lice. It can be hard to tell if these treatment failures are due to poor application technique, but resistance to permetherin is probably real. There were small studies where Resultz killed more lice than permetherin. I don’t know if I am ready to say it is definitely better than permetherin yet, but it is nice to have another tool against lice.
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. Although tedious, nit removal is very important because even permetherin only kills about 70% of the eggs.
As always if you have any questions or concerns about these 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.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.
My then five year old daughter came home from kintergarten in the fall with a pamphlet about head lice. My wife and I asked if her teacher was trying to tell her something. She said no that everyone in her class got the pamphlet. So we felt better as parents, and that is one of the reasons we usually start getting lice questions at the pharmacy in September and October. Head lice doesn’t just happen at the beginning of the school year, though. It can happen at any time.
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 two main ways. Lice can be transmitted directly by close contact from one infested scalp to another (i.e. touching heads together). They can be transmitted indirectly by sharing personal articles that come in contact with the head (e. brushes, hats, etc). Louse transfer has been found to be optimal when hairs are relatively stationary and parallel, suggesting that louse transmission is more likely to occur while children are at rest (e.g. taking a nap together), than during periods of vigorous play (e.g. wrestling on the ground). 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. Head lice is not a sign that your child’s hair is dirty. 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? The most common symptom is 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 recognize 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.
There is a new product on the market now for lice called Resultz. It contains isopropyl myristate. This is different that the Nix like products. The permethrin in Nix attacks the nervous system of the louse. Isopropyl myristate is more like a soap. It dissolves the waxy outer coating on the louse and the louse dehydrates. The down side to Resultz is it does not kill the nits or eggs in the hair. So you absolutely need to do the second treatment in one week. On the positive side, there is no documented resistance to Resultz. Back in the 1980’s permethrin like products killed 100% of lice. I have seen estimates now that in places it kills more like 28% of the lice. It can be hard to tell if these treatment failures are due to poor application technique, but resistance to permetherin is probably real. There were small studies where Resultz killed more lice than permetherin. I don’t know if I am ready to say it is definitely better than permetherin yet, but it is nice to have another tool against lice.
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. Although tedious, nit removal is very important because even permetherin only kills about 70% of the eggs.
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, February 15, 2008
QUITTING SMOKING –SOMETHING OLD AND SOMETHING NEW 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.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.
The experts who study how people make decisions say there are 5 stages of change: precontemplation, contemplation, preparation, action and maintenance. Last time we were talking about the 5 stages of change and how they apply to quitting smoking. We left off with Stage 3 – Preparation or “I’ve made up my mind to do it, but now I need a plan.”
Stage 4 – Action – I’m actually doing it!
You have quit smoking! That’s amazing! Now, not to rain on your parade, but there are going to be bumps on the road. Also, if you have gone cold turkey, you may be now wishing you had a little help. Let’s review the products out there to help you stay quit.
Smoking Cessation products fall into three categories: nicotine replacement, antidepressants and nicotine receptor modifiers.
Nicotine replacement is still the most common smoking cessation aid. Whether it is a gum, lozenge, lollipop, patch, inhaler, etc. we are actually giving you back nicotine. It works like this. You quit smoking. Although there are thousands of compounds in the cigarette smoke that you inhale, we think the one that causes addiction is nicotine. So, after your last cigarette, the amount of nicotine in your body falls. Your body says, “I WANT MORE NICOTINE. SMOKE! NOW!” So if you give your body nicotine in the form of a patch, lollipop, etc. the craving goes away, or at least gets less intense.
People do ask about if the various nicotine replacements are safe. This is understandable as nicotine is a dangerous toxin. It raises blood pressure, increases heart rate and other nasty things. My standard answer is if you aren’t sure, ask your doctor. If your doctor gives says nicotine replacement is okay for you, I feel comfortable saying nicotine replacement is safer that smoking. If the various nicotine replacements are used properly, they give you less nicotine than cigarettes and they don’t give you the tar, cyanide, arsenic, and many, many other chemicals in cigarette smoke.
So what about buproprion? Its brand name is Zyban. Ideally, you should start using Zyban about 2 weeks before you quit smoking. That gives it time to build up in your system. However, if you have already quit, and ask your doctor about Zyban now, it still could help. It was originally marketed as an antidepressant, and an interesting thing happened, less of the depressed patients taking buproprion in the trials smoked than those taking sugar pills. So it was re-branded for smoking cessation. (FYI the brand name of the antidepressant is Wellbutrin). We don’t know exactly how it helps people stop smoking, but we do know that as an antidepressant, one of the brain chemicals it effects is dopamine. We know dopamine is involved with the reward center in your brain and that the reward center is involved with addiction. So my favorite theory says that through dopamine, Zyban effects the reward center in your brain and that slowly makes you want to smoke less and less. Under doctor’s supervision, Zyban can be used with nicotine replacement as well. The mostly commonly reported side effects with Zyban are dry mouth and insomnia. There is a rare but serious side effect with Zyban that makes a patient more likely to have a seizure.
The newest product is called varenicline or Champix. Again, Champix should be started one to two weeks before quitting smoking. Champix is interesting because it is what is called a partial nicotine agonist. It attaches to nicotine receptors in the body and stimulates them a little, but not as much as nicotine. So this should take the edge off of nicotine withdrawal. Champix also blocks the nicotine receptors, so patients get fewer pleasurable effects from smoking. It is not a good idea to use champix with nicotine replacement. There is no evidence it works any better and increases the chance of nausea. Speaking of nausea, 30% of the trial patients experienced mild to moderate nausea, compared to only 10% on placebo.
So what is the best product? Whichever one gets you to quit. Champix might be more effective than Zyban. One study found it more effective at 12 weeks, but that advantage seems to have disappeared by 1 year.
Stage 5 – Maintenance – Staying Quit
Okay you have quit. You have battled through the cravings, mood swings and other nastiness of the first 7 to 14 days. Now you have to focus on changing habits. If you used to smoke after supper, now you should schedule a walk. If you used to smoke with a group of ladies over coffee, you should tell them you won’t be seeing them for a while. You will keep running into triggers that will make you want to smoke. You will need to be creative in avoiding them, or doing something else instead of smoking. The reason most smoking cessation products say you should take them for 12 weeks is that we think that is how long it takes to change a habit. The actual withdrawal is probably over in the first week. It takes much longer to change your lifestyle.
Relapse – Oops I smoked again.
Don’t panic, and don’t beat yourself up. Just because you smoked one, two or a pack of cigarettes doesn’t mean you have failed and should start smoking again. Figure out what the trigger was. Figure out what you are going to do differently next time that trigger happens. There will be bumps in the road. But, if you stay smoke free, it will be good for your health.
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.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.
The experts who study how people make decisions say there are 5 stages of change: precontemplation, contemplation, preparation, action and maintenance. Last time we were talking about the 5 stages of change and how they apply to quitting smoking. We left off with Stage 3 – Preparation or “I’ve made up my mind to do it, but now I need a plan.”
Stage 4 – Action – I’m actually doing it!
You have quit smoking! That’s amazing! Now, not to rain on your parade, but there are going to be bumps on the road. Also, if you have gone cold turkey, you may be now wishing you had a little help. Let’s review the products out there to help you stay quit.
Smoking Cessation products fall into three categories: nicotine replacement, antidepressants and nicotine receptor modifiers.
Nicotine replacement is still the most common smoking cessation aid. Whether it is a gum, lozenge, lollipop, patch, inhaler, etc. we are actually giving you back nicotine. It works like this. You quit smoking. Although there are thousands of compounds in the cigarette smoke that you inhale, we think the one that causes addiction is nicotine. So, after your last cigarette, the amount of nicotine in your body falls. Your body says, “I WANT MORE NICOTINE. SMOKE! NOW!” So if you give your body nicotine in the form of a patch, lollipop, etc. the craving goes away, or at least gets less intense.
People do ask about if the various nicotine replacements are safe. This is understandable as nicotine is a dangerous toxin. It raises blood pressure, increases heart rate and other nasty things. My standard answer is if you aren’t sure, ask your doctor. If your doctor gives says nicotine replacement is okay for you, I feel comfortable saying nicotine replacement is safer that smoking. If the various nicotine replacements are used properly, they give you less nicotine than cigarettes and they don’t give you the tar, cyanide, arsenic, and many, many other chemicals in cigarette smoke.
So what about buproprion? Its brand name is Zyban. Ideally, you should start using Zyban about 2 weeks before you quit smoking. That gives it time to build up in your system. However, if you have already quit, and ask your doctor about Zyban now, it still could help. It was originally marketed as an antidepressant, and an interesting thing happened, less of the depressed patients taking buproprion in the trials smoked than those taking sugar pills. So it was re-branded for smoking cessation. (FYI the brand name of the antidepressant is Wellbutrin). We don’t know exactly how it helps people stop smoking, but we do know that as an antidepressant, one of the brain chemicals it effects is dopamine. We know dopamine is involved with the reward center in your brain and that the reward center is involved with addiction. So my favorite theory says that through dopamine, Zyban effects the reward center in your brain and that slowly makes you want to smoke less and less. Under doctor’s supervision, Zyban can be used with nicotine replacement as well. The mostly commonly reported side effects with Zyban are dry mouth and insomnia. There is a rare but serious side effect with Zyban that makes a patient more likely to have a seizure.
The newest product is called varenicline or Champix. Again, Champix should be started one to two weeks before quitting smoking. Champix is interesting because it is what is called a partial nicotine agonist. It attaches to nicotine receptors in the body and stimulates them a little, but not as much as nicotine. So this should take the edge off of nicotine withdrawal. Champix also blocks the nicotine receptors, so patients get fewer pleasurable effects from smoking. It is not a good idea to use champix with nicotine replacement. There is no evidence it works any better and increases the chance of nausea. Speaking of nausea, 30% of the trial patients experienced mild to moderate nausea, compared to only 10% on placebo.
So what is the best product? Whichever one gets you to quit. Champix might be more effective than Zyban. One study found it more effective at 12 weeks, but that advantage seems to have disappeared by 1 year.
Stage 5 – Maintenance – Staying Quit
Okay you have quit. You have battled through the cravings, mood swings and other nastiness of the first 7 to 14 days. Now you have to focus on changing habits. If you used to smoke after supper, now you should schedule a walk. If you used to smoke with a group of ladies over coffee, you should tell them you won’t be seeing them for a while. You will keep running into triggers that will make you want to smoke. You will need to be creative in avoiding them, or doing something else instead of smoking. The reason most smoking cessation products say you should take them for 12 weeks is that we think that is how long it takes to change a habit. The actual withdrawal is probably over in the first week. It takes much longer to change your lifestyle.
Relapse – Oops I smoked again.
Don’t panic, and don’t beat yourself up. Just because you smoked one, two or a pack of cigarettes doesn’t mean you have failed and should start smoking again. Figure out what the trigger was. Figure out what you are going to do differently next time that trigger happens. There will be bumps in the road. But, if you stay smoke free, it will be good for your health.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, February 08, 2008
QUITTING SMOKING –SOMETHING OLD AND SOMETHING NEW 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 http://www.dcp.ca/
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
HAPPY NEW YEAR!!!! Have you quit smoking yet?
There has been a Manitoba wide smoking ban since October 1, 2004. It is hard to believe that is now over 3 years ago. Across the pond in the European Union, Ireland was first to institute smoking ban in March 2004. Bans now exist in Italy, Spain, Belgium and Britain. On January 1, 2008, the smoking ban in France was extended to bars, discotheques, restaurants, hotels and cafes. Those romantic images of people in Paris discussing the issues of the day in a Parisian café over a cigarette and café au lait are a thing of the past. Who says the world doesn’t follow Manitoba’s lead?
The big brained people who study how people make decisions say there are 5 stages of change: precontemplation, contemplation, preparation, action and maintenance. Let’s look at them in regards to smoking.
Stage 1: Precontemplation – Not thinking seriously about it yet.
So you are not planning on quitting smoking in the next 6 months? That is okay. Here is your home work: Write down three things you like about smoking. Yes I said like. For example, “Smoking relaxes me.” Bring these 3 points with you the next time you see your doctor or pharmacist or health nurse or any other health care professional. Have a quick conversation about your smoking. That isn’t too intimidating/annoying is it?
Stage 2: Contemplation – Starting to think about it.
What if you would like to quit smoking before June 15, 2008? That is good. Write down three things you don’t like about smoking. For example, “I am afraid my smoking hurts my grandchildren.” Bring these 3 points with you the next time you see your doctor or pharmacist or health nurse or any other health care professional. Are you afraid you have smoked too long to make any difference now if you quit? It is never too late. Within 8 hours of quitting your carbon monoxide level drops and your oxygen level returns to normal. After 48 hours your chances of having a heart attack start to go down and your sense of smell and taste start to improve. Let’s go to the other extreme. Let’s say you had an advanced smoking related lung disease called COPD and were on death’s door. If you quit smoking the COPD won’t go away, but it won’t get worse as fast.
Smoking is the number 1 cause of premature death in North America. The Health Canada says smoking causes 47,581 deaths annually. That is more than the total number of deaths from AIDS, car accidents, suicide, murder, fires and accidental poisonings combined. Of those 47,581 deaths, Health Canada estimates that 30,230 of the deaths were men, and 17,351 were women including 55 boys an 41 girls under the age of 1. You women are also working hard to close that gender gap. There were 9224 more smoking related deaths in 1998 than in 1989 with females accounting for more than 6531 of these increased deaths.
Death doesn’t scare, you? We all gotta die of something, you say? Well how about stopping smoking to reduce your chance of a debilitating stroke that leaves you unable to walk, talk or feed yourself. Even before something as drastic as a stroke, smokers start to suffer. Smoking decreases the blood flow to the skin, and this leads to leathery-looking skin and increased wrinkling. The more you smoke, the more likely you are to get cataracts -an eye problem that can lead to blindness. Smoking is the main reason people get cancer in the mouth. Smoking makes it harder for your saliva to remove germs in your mouth. Smokers get stains, bad breath, and a higher chance of gum disease. Smokers are twice as likely as non-smokers to develop psoriasis - a disfiguring red and silver rash that can occur anywhere on your body. Smokers are more prone to stomach ulcers. Smoker’s ulcers don't heal as fast as non-smokers, and they're more likely to recur. Finally, guys, smoking causes impotence.
Stage 3:Preparation – I am going to do it, but I need a plan
You have set the goal of quitting by Feb 18, 2008. That is very good. So, you have decided to quit, but you want something to reduce your cravings. Nicotine replacement is now available as a patch, gum, or an inhaler. There is a prescription pill called Zyban, and a new pill called Champix. They don’t have nicotine in them and works on brain chemicals that have to do with addiction. I will compare and contrast them pills next week. Maybe its time to try something different. How about a Nicotine Lollipop? Nicotine Lolli’s are items that we can customize for people under the direction of their doctor.
At the moment we make 2mg and 4mg Nicotine Lollipops in strawberry flavor, but we can customize the flavor or the strength under the direction of your doctor. The idea behind the Nicotine Lollipop is the same as the nicotine gum or nicotine patch, we are putting some of the nicotine back into your system that the cigarette used to provide. This will help reduce (not eliminate) the cravings for cigarettes. The added bonus is psychological. People who have used the Lollipop say they like that they are still putting something in their mouth like they used to do with cigarettes.
How do you use the Nicotine Lollipop and how long does it last? This will vary person to person, but in general one Lollipop will last about 1/2 a pack of cigarettes. During your regular cigarette break you put the Lollipop in your mouth for about 5 minutes or until the craving passes (whichever is less) and then you reseal the Lollipop in our special child proof container and put it away until your next craving. What strength of Lollipop do I need? Your doctor will help you choose when they write the prescription, but usually the 2mg Lollipop is for 1 or less packs a day, and the 4 mg is for people who smoke more than a pack a day.
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 http://www.dcp.ca/
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
HAPPY NEW YEAR!!!! Have you quit smoking yet?
There has been a Manitoba wide smoking ban since October 1, 2004. It is hard to believe that is now over 3 years ago. Across the pond in the European Union, Ireland was first to institute smoking ban in March 2004. Bans now exist in Italy, Spain, Belgium and Britain. On January 1, 2008, the smoking ban in France was extended to bars, discotheques, restaurants, hotels and cafes. Those romantic images of people in Paris discussing the issues of the day in a Parisian café over a cigarette and café au lait are a thing of the past. Who says the world doesn’t follow Manitoba’s lead?
The big brained people who study how people make decisions say there are 5 stages of change: precontemplation, contemplation, preparation, action and maintenance. Let’s look at them in regards to smoking.
Stage 1: Precontemplation – Not thinking seriously about it yet.
So you are not planning on quitting smoking in the next 6 months? That is okay. Here is your home work: Write down three things you like about smoking. Yes I said like. For example, “Smoking relaxes me.” Bring these 3 points with you the next time you see your doctor or pharmacist or health nurse or any other health care professional. Have a quick conversation about your smoking. That isn’t too intimidating/annoying is it?
Stage 2: Contemplation – Starting to think about it.
What if you would like to quit smoking before June 15, 2008? That is good. Write down three things you don’t like about smoking. For example, “I am afraid my smoking hurts my grandchildren.” Bring these 3 points with you the next time you see your doctor or pharmacist or health nurse or any other health care professional. Are you afraid you have smoked too long to make any difference now if you quit? It is never too late. Within 8 hours of quitting your carbon monoxide level drops and your oxygen level returns to normal. After 48 hours your chances of having a heart attack start to go down and your sense of smell and taste start to improve. Let’s go to the other extreme. Let’s say you had an advanced smoking related lung disease called COPD and were on death’s door. If you quit smoking the COPD won’t go away, but it won’t get worse as fast.
Smoking is the number 1 cause of premature death in North America. The Health Canada says smoking causes 47,581 deaths annually. That is more than the total number of deaths from AIDS, car accidents, suicide, murder, fires and accidental poisonings combined. Of those 47,581 deaths, Health Canada estimates that 30,230 of the deaths were men, and 17,351 were women including 55 boys an 41 girls under the age of 1. You women are also working hard to close that gender gap. There were 9224 more smoking related deaths in 1998 than in 1989 with females accounting for more than 6531 of these increased deaths.
Death doesn’t scare, you? We all gotta die of something, you say? Well how about stopping smoking to reduce your chance of a debilitating stroke that leaves you unable to walk, talk or feed yourself. Even before something as drastic as a stroke, smokers start to suffer. Smoking decreases the blood flow to the skin, and this leads to leathery-looking skin and increased wrinkling. The more you smoke, the more likely you are to get cataracts -an eye problem that can lead to blindness. Smoking is the main reason people get cancer in the mouth. Smoking makes it harder for your saliva to remove germs in your mouth. Smokers get stains, bad breath, and a higher chance of gum disease. Smokers are twice as likely as non-smokers to develop psoriasis - a disfiguring red and silver rash that can occur anywhere on your body. Smokers are more prone to stomach ulcers. Smoker’s ulcers don't heal as fast as non-smokers, and they're more likely to recur. Finally, guys, smoking causes impotence.
Stage 3:Preparation – I am going to do it, but I need a plan
You have set the goal of quitting by Feb 18, 2008. That is very good. So, you have decided to quit, but you want something to reduce your cravings. Nicotine replacement is now available as a patch, gum, or an inhaler. There is a prescription pill called Zyban, and a new pill called Champix. They don’t have nicotine in them and works on brain chemicals that have to do with addiction. I will compare and contrast them pills next week. Maybe its time to try something different. How about a Nicotine Lollipop? Nicotine Lolli’s are items that we can customize for people under the direction of their doctor.
At the moment we make 2mg and 4mg Nicotine Lollipops in strawberry flavor, but we can customize the flavor or the strength under the direction of your doctor. The idea behind the Nicotine Lollipop is the same as the nicotine gum or nicotine patch, we are putting some of the nicotine back into your system that the cigarette used to provide. This will help reduce (not eliminate) the cravings for cigarettes. The added bonus is psychological. People who have used the Lollipop say they like that they are still putting something in their mouth like they used to do with cigarettes.
How do you use the Nicotine Lollipop and how long does it last? This will vary person to person, but in general one Lollipop will last about 1/2 a pack of cigarettes. During your regular cigarette break you put the Lollipop in your mouth for about 5 minutes or until the craving passes (whichever is less) and then you reseal the Lollipop in our special child proof container and put it away until your next craving. What strength of Lollipop do I need? Your doctor will help you choose when they write the prescription, but usually the 2mg Lollipop is for 1 or less packs a day, and the 4 mg is for people who smoke more than a pack a day.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
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