By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
Rubber duckies are evil. Erectile dysfunction is bad in more ways than you would think. All this and much more were released in the new 2009 Dyslipidemia guidelines! These are what your doctor reads to see how the experts in the field recommend that he or she treats your high cholesterol. The Guidelines are a big document, so I’m going to focus on two parts. Who should get their cholesterol tested and something called Apo-B.
Who should get their cholesterol levels tested? The first group includes any male over 40 (I’m getting close), and any female over 50 or who is in menopause. It is nice the guideslines were more specific about exactly who should get tested, but these recommendations weren’t surprising. Us guys probably start getting fatty streaks in our arteries in our teens or twenties due to poor diets and lack of exercise. By the time we hit 40, our doctors should start testing our cholesterol because those fatty streaks in our arteries may have started to partially block them. You women have estrogen in you to protect the lining of your blood vessels for a decade longer than us guys.
The next group of people that should be screened might be a little more surprising. This is not the complete list, but cholesterol testing is recommended in any adult who: has diabetes, is a current smoker, has high blood pressure, has obesity, or has erectile dysfunction. All of these conditions, yes even erectile dysfunction, can be signs of damage to the lining of your arteries or to the very small blood vessels in your body. Any of the above conditions increases your risk of a heart attack or stroke. This is why your doctor should keep an eye on your cholesterol.
This year the Guidelines talked a lot about Apo-B. Now I don’t want to confuse you. The Guidelines still says the number one indicator we should follow is LDL. LDL is the famous “bad cholesterol”. HDL is the famous “good cholesterol”. These are still the most important markers. But they are still markers. Remember we don’t really care about your cholesterol. What we want to do is reduce your chance of heart attack and stroke. Cholesterol is just a surrogate marker of your cardiovascular risk.
Another marker you will probably hear more about soon is called Apo-B. Apo-B’s full name is Apolipoprotein B. Remember LDL or bad cholesterol and HDL or good cholesterol? Well LDL’s full name is low density lipoprotein and HDL’s is high density lipoprotein. Although we talk about cholesterol floating around in your blood, that isn’t really how it works. Just like oil doesn’t mix with water, cholesterol alone doesn’t mix with blood. Cholesterol (a lipid) must be attached to a protein to form a lipoprotein for it to stay in your blood. There are a lot of different lipoproteins like chylomicrons, very-low density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), low density lipoprotein (LDL), or high-density lipoprotein (HDL). All lipoproteins except HDL (remember the good cholesterol) have a particle of Apolipoprotein B in them. So counting the number of particles of Apo-B in someone’s blood sample is another way to access cardiovascular risk.
Traditional measurements of LDL actually weighs the amount of LDL cholesterol in a blood sample. This is still the gold standard for assessing risk in someone who isn’t on any cholesterol medications. LDL levels of less than 2.0 mmol/L is still the goal the doctors are trying to reach when they put you on a cholesterol medication. But, the guidelines say doctors could look at your Apo-B levels too when they are trying to figure out if they have you on the right dose of your cholesterol medication. The Apo-B level to shoot for is less than 0.8 g/L.
In some cases, Apo-B may be more useful to see how someone on a cholesterol treatment is doing than LDL. First remember that rubber duckies are evil. So, LDL is measured by weight. Let’s pretend low density lipoproteins are evil rubber duckies filled to bursting with oil. The doctor orders an LDL test and we weigh the evil oil filled rubber duckies and we get a number. Then, the doctor puts you on a cholesterol pill and in 6 months measures your LDL again. The number is lower. That is good, right? Well, since we just weighed the evil rubber duckies, we don’t know if we have less evil rubber duckies, or if each evil rubber ducky just dumped some oil out. To keep track of the evil rubber duckies, it would be better to count them. So in our world, Apo-B is the bill on the rubber ducky. To do an Apo-B test we draw out some blood, put all the evil rubber duckies in a blender and count the number of duck bills that come out. This way we can count how many evil rubber duckies we have.
So count your evil rubber duckies. Remember erectile dysfunction puts you at higher risk for heart attacks and stroke. And have a Merry Christmas.
For more info on Cholesterol Guideline visit:
www.ccs.ca/download/consensus_conference/consensus_conference_archives/2009_Dyslipidemia-Guidelines.pdf
As always if you have any questions or concerns about these products, ask your pharmacist.
Thursday, December 24, 2009
Friday, December 18, 2009
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.
I have kids. Emily is seven and Eric is four. I am sure this won’t be the first or last time Eric thinks this, but apparently I favor his sister. If both my kids got a cough at the same time, I can help seven year old Emily, but I have to let four year old Eric suffer. You will now notice most over the counter cough and cold medications say don’t used in children under 6 years old. Why is this?
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 labeling changes came into effect in the fall of 2009 and now say most cough and cold medications shouldn’t be given to children under 6.
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. 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. There have been documented cases of parents giving their children the wrong dose. “No problem,” you say, “I can read. I’ll give my child the right dose!” Well, between 1969 and 2006 in the US there were 69 deaths in children from antihistamines and 54 deaths in children due to decongestants. Now, these are small numbers. Even if we assume the actual number of deaths are much higher than those reported, and we stipulate that the number of injuries is not counted at all, not many children were harmed. 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 let’s assume you bought a cough syrup, a anti-sneezing pill and Tylenol cold for your child. There is a decongestant in all three of those products. If you were unaware of this you could give your child 3 times the recommended dose of decongestant. That dose could cause a rapid heart rate or theoretically it could 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 when they meant to use the 160mg/5ml and gives their child 1 tsp (5 mL), the child get 400 mg (not 160 mg) of acetaminophen 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. 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. And that is why Health Canada says I can treat my 7 year old but not my 4 year old.
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 kids. Emily is seven and Eric is four. I am sure this won’t be the first or last time Eric thinks this, but apparently I favor his sister. If both my kids got a cough at the same time, I can help seven year old Emily, but I have to let four year old Eric suffer. You will now notice most over the counter cough and cold medications say don’t used in children under 6 years old. Why is this?
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 labeling changes came into effect in the fall of 2009 and now say most cough and cold medications shouldn’t be given to children under 6.
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. 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. There have been documented cases of parents giving their children the wrong dose. “No problem,” you say, “I can read. I’ll give my child the right dose!” Well, between 1969 and 2006 in the US there were 69 deaths in children from antihistamines and 54 deaths in children due to decongestants. Now, these are small numbers. Even if we assume the actual number of deaths are much higher than those reported, and we stipulate that the number of injuries is not counted at all, not many children were harmed. 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 let’s assume you bought a cough syrup, a anti-sneezing pill and Tylenol cold for your child. There is a decongestant in all three of those products. If you were unaware of this you could give your child 3 times the recommended dose of decongestant. That dose could cause a rapid heart rate or theoretically it could 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 when they meant to use the 160mg/5ml and gives their child 1 tsp (5 mL), the child get 400 mg (not 160 mg) of acetaminophen 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. 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. And that is why Health Canada says I can treat my 7 year old but not my 4 year old.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, December 11, 2009
Lower Back Pain
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
You are pretty weak. And you’re slow. Your teeth are dull, your claws are non-existent, your hide is very thin and you have no fur to keep you warm. How on Earth have you lived this long? This is how I imagine an average wolf, coyote, cougar, bear or for that matter elk or moose looks at us humans. Even if you look closer on our family tree, picture a human next to a chimpanzee. If you put a human and a chimp in hand to hand combat, the chimp could literally pull the human’s arms off. It is odd when you think that humans with no natural weapons or effective defenses now live in nearly every corner of the planet.
So how have we become so dominant on the planet? Big brains, opposable thumbs, tools and fire undoubtedly all helped. But arguably one of the first things we did right as a species was to start walking on our back legs. Walking up right helped us do simple things like collect stuff in one place and bring it back to another. It helped us do more complicated things like use tools and run while poking things with sharp sticks. As helpful as standing upright has been, it puts a lot of stress on our lower backs.
I’ve read stats that say up to 85% of us will get lower back pain during our lifetime. It is very common. And it can start with what seem to be minor injuries. People have come into the pharmacy saying they hurt themselves tying their shoes or just sleeping funny. So what should you do? Let’s start with non-drug measures.
The physiotherapists and chiropractors will remind you to prevent lower back pain. You should remain active, lift with you legs, work on keeping your stomach muscle strong and avoid twisting and lifting. After your back is already sore, physios and chiros can recommend different exercises, stretches and/or manipulations to help you. As for exercise in general after your back is sore, the 2007 guidelines from the American College of Physicians and the American Pain Society say you should keep moving. In general, bed rest is not recommended for lower back pain.
Another non-drug measure you can use is heat. Whether it is a warming blanket, a gel pack you put in the microwave or a hot water bottle, heat can help lower back pain. An interesting category of products in the pharmacy are the 8 heat hour patches. These have iron in them that slowly oxide or burn for 8 to 12 hours. They can be put over the sore area and worn all day.
Once we more into the medication zone we always recommend acetaminophen first. This is because acetaminophen is generally the safest pain medication. However, acetaminophen only treats pain. It doesn’t reduce inflammation. A lot of the discomfort in lower back pain is due to inflammation in the muscles or possibly even the nerves. So I usually point people towards ibuprofen. It is a good pain killer and antiiflammatory. Naproxen sodium or aleve would work as well.
The problems with over the counter antiinflammatory pain killers like ibuprofen are stomach, blood, and kidneys. Now I don’t want to scare you. Medications like ibuprofen are safe for most people, most of the time. However, if you have problems with ulcers in your stomach, are on blood thinners, or have kidney problems let your pharmacist know before taking them. Between you and your pharmacist you can decide if the ibuprofen like drug will have a benefit that will out weigh the risk in your case.
The other over the counter medication that is often used for back pain is a muscle relaxant. Some common brand names are Robaxacet, Robaxasol, and Robax Platinum. These all have the same muscle relaxant in them, but one has acetaminophen, one has ASA and the last has ibuprofen. The over the counter muscle relaxants can work very well, but they can make you sleepy. I usually suggest that a patient take the first dose at home when they don’t have to do anything that requires a lot of attention. That way they can see how it effects them. And definitely don’t mix muscle relaxants with alcohol.
When should you see the doctor? Well if your lower back pain is very severe, go immediately. In general, though, we expect lower back pain to go away in 4-6 weeks. If yours lasts longer, stop treating it with over the counter medications and it is probably time to see your family doctor.
So as we evolved to stand up right. This has allowed us to hold a beverage and popcorn and still walk to our seats at a Kings game. However our evolutionary advantage can be a pain in the back.
As always if you have any questions or concerns about these products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
You are pretty weak. And you’re slow. Your teeth are dull, your claws are non-existent, your hide is very thin and you have no fur to keep you warm. How on Earth have you lived this long? This is how I imagine an average wolf, coyote, cougar, bear or for that matter elk or moose looks at us humans. Even if you look closer on our family tree, picture a human next to a chimpanzee. If you put a human and a chimp in hand to hand combat, the chimp could literally pull the human’s arms off. It is odd when you think that humans with no natural weapons or effective defenses now live in nearly every corner of the planet.
So how have we become so dominant on the planet? Big brains, opposable thumbs, tools and fire undoubtedly all helped. But arguably one of the first things we did right as a species was to start walking on our back legs. Walking up right helped us do simple things like collect stuff in one place and bring it back to another. It helped us do more complicated things like use tools and run while poking things with sharp sticks. As helpful as standing upright has been, it puts a lot of stress on our lower backs.
I’ve read stats that say up to 85% of us will get lower back pain during our lifetime. It is very common. And it can start with what seem to be minor injuries. People have come into the pharmacy saying they hurt themselves tying their shoes or just sleeping funny. So what should you do? Let’s start with non-drug measures.
The physiotherapists and chiropractors will remind you to prevent lower back pain. You should remain active, lift with you legs, work on keeping your stomach muscle strong and avoid twisting and lifting. After your back is already sore, physios and chiros can recommend different exercises, stretches and/or manipulations to help you. As for exercise in general after your back is sore, the 2007 guidelines from the American College of Physicians and the American Pain Society say you should keep moving. In general, bed rest is not recommended for lower back pain.
Another non-drug measure you can use is heat. Whether it is a warming blanket, a gel pack you put in the microwave or a hot water bottle, heat can help lower back pain. An interesting category of products in the pharmacy are the 8 heat hour patches. These have iron in them that slowly oxide or burn for 8 to 12 hours. They can be put over the sore area and worn all day.
Once we more into the medication zone we always recommend acetaminophen first. This is because acetaminophen is generally the safest pain medication. However, acetaminophen only treats pain. It doesn’t reduce inflammation. A lot of the discomfort in lower back pain is due to inflammation in the muscles or possibly even the nerves. So I usually point people towards ibuprofen. It is a good pain killer and antiiflammatory. Naproxen sodium or aleve would work as well.
The problems with over the counter antiinflammatory pain killers like ibuprofen are stomach, blood, and kidneys. Now I don’t want to scare you. Medications like ibuprofen are safe for most people, most of the time. However, if you have problems with ulcers in your stomach, are on blood thinners, or have kidney problems let your pharmacist know before taking them. Between you and your pharmacist you can decide if the ibuprofen like drug will have a benefit that will out weigh the risk in your case.
The other over the counter medication that is often used for back pain is a muscle relaxant. Some common brand names are Robaxacet, Robaxasol, and Robax Platinum. These all have the same muscle relaxant in them, but one has acetaminophen, one has ASA and the last has ibuprofen. The over the counter muscle relaxants can work very well, but they can make you sleepy. I usually suggest that a patient take the first dose at home when they don’t have to do anything that requires a lot of attention. That way they can see how it effects them. And definitely don’t mix muscle relaxants with alcohol.
When should you see the doctor? Well if your lower back pain is very severe, go immediately. In general, though, we expect lower back pain to go away in 4-6 weeks. If yours lasts longer, stop treating it with over the counter medications and it is probably time to see your family doctor.
So as we evolved to stand up right. This has allowed us to hold a beverage and popcorn and still walk to our seats at a Kings game. However our evolutionary advantage can be a pain in the back.
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, December 04, 2009
MS Surgery
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
Now remember I’m not a surgeon, neurologist, or multiple sclerosis specialist of any sort. I’m just a pharmacist who thinks MS and its treatment is interesting. But I have to tell you about a possible MS treatment that has been getting a lot of buzz lately.
For me it started with a documentary on CTV’s W5. They were interviewing an Italian vascular surgeon named Paolo Zamboni. They told a compelling tale. You could see from his hands that Dr. Zamboni could no longer perform operations. He had developed a neurological condition that wouldn’t allow him to hold a scalpel. He continued to work as a doctor and professor and then his wife developed MS. So, Dr. Zamboni started doing lots of reading about Mutiple Sclerosis.
During his research, Dr. Zamboni read about iron deposits in the brains of MS patients. Others had noted them before, but no one had attributed much significance to them. Have you heard the saying, “To a carpenter, the whole world looks like a nail”? Well that’s what I thought of when Dr. Zamboni explained what he thought when he read about these iron deposits. Dr. Zamboni, the former vascular surgeon, thought the iron deposits were due to improper drainage of blood from the brain. So took some ultra sound images of the necks of some MS patients and found many of them had strictures or narrowing of the veins that drain the brain.
Dr. Zamboni’s team then went the next step and used little balloons to open the narrow veins and let the blood drain properly from MS patient’s brains. Low and behold, many had improvement in their MS symptoms! Dr. Zamboni calls the condition of narrow veins draining the brain CCSVI or Chronic Cerebrospinal Venous Insufficiency.
At the moment Dr. Zamboni and colleagues in the US are testing more MS patients to see how many have CCSVI. They will be doing more opening of the veins with balloons to see how many people’s symptoms improve. Even the Canadian Multiple Sclerosis Society is now offering research money to the best candidates to research CCSVI. It is very exciting.
Now I am going to be a wet blanket. The odds are CCSVI and its treatment is not a cure for MS. I’d love to be wrong, but that is not usually how these things turn out. Five years from now, probably the best we can hope for is CCSVI diagnosis and treatment is one more tool in the toolbox for MS treatment. The worst case is that when we look back five years from now we will see that some people were hurt or worse from a surgery that was eventually proven to have more risks than benefits.
Two MS treatments from the past that come to mind are substance P and massive chemotherapy. Several years ago a Canadian researcher was convinced a dysfunction in a brain chemical called substance P was involved in MS. Substance P is usually involved in pain transmission. Since in MS there is a problem with nerve transmission, this theory seemed plausible. However, I haven’t heard any more about substance P and MS in the last few years. I don’t know if it was disproven or just fell out of favor, but substance P is no longer the next big thing in MS treatment. A more troubling treatment involved massive chemotherapy. Despite Dr. Zamboni’s work, the current belief is that in MS the body’s own immune system attacks the myelin sheaths around nerve fibres. This makes nerve transmission not work as well. A fascinating presentation I went to a few years ago talked about a trial in which they destroyed the immune systems of some severely ill MS patients. They used chemotherapy drugs to kill off the bone marrow which produces immune cells that fight disease. Then they regrew “normal” bone marrow in these patients to give them “normal” immune systems. They did have some success. Some of these MS patients no longer had attacks. That is wonderful, but a few of the test subjects died from the massive chemotherapy. In my mind the risk of that treatment surely out weighed the benefit.
So has Dr. Zamboni found a cure for MS? No one really knows. I’ll definitely be watching for his papers to be published as he tests more and more people. It is great that he is bringing a whole new type of thinking to the problem of MS. If I had MS would I run out and get the surgery? Not yet. I would wait and see what happens with the ongoing trials. But if you haven’t seen it yet, go to the W5 website and watch the documentary. I found it fascinating.
http://www.ctv.ca/w5 CTV's W%
As always if you have any questions or concerns about these products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
Now remember I’m not a surgeon, neurologist, or multiple sclerosis specialist of any sort. I’m just a pharmacist who thinks MS and its treatment is interesting. But I have to tell you about a possible MS treatment that has been getting a lot of buzz lately.
For me it started with a documentary on CTV’s W5. They were interviewing an Italian vascular surgeon named Paolo Zamboni. They told a compelling tale. You could see from his hands that Dr. Zamboni could no longer perform operations. He had developed a neurological condition that wouldn’t allow him to hold a scalpel. He continued to work as a doctor and professor and then his wife developed MS. So, Dr. Zamboni started doing lots of reading about Mutiple Sclerosis.
During his research, Dr. Zamboni read about iron deposits in the brains of MS patients. Others had noted them before, but no one had attributed much significance to them. Have you heard the saying, “To a carpenter, the whole world looks like a nail”? Well that’s what I thought of when Dr. Zamboni explained what he thought when he read about these iron deposits. Dr. Zamboni, the former vascular surgeon, thought the iron deposits were due to improper drainage of blood from the brain. So took some ultra sound images of the necks of some MS patients and found many of them had strictures or narrowing of the veins that drain the brain.
Dr. Zamboni’s team then went the next step and used little balloons to open the narrow veins and let the blood drain properly from MS patient’s brains. Low and behold, many had improvement in their MS symptoms! Dr. Zamboni calls the condition of narrow veins draining the brain CCSVI or Chronic Cerebrospinal Venous Insufficiency.
At the moment Dr. Zamboni and colleagues in the US are testing more MS patients to see how many have CCSVI. They will be doing more opening of the veins with balloons to see how many people’s symptoms improve. Even the Canadian Multiple Sclerosis Society is now offering research money to the best candidates to research CCSVI. It is very exciting.
Now I am going to be a wet blanket. The odds are CCSVI and its treatment is not a cure for MS. I’d love to be wrong, but that is not usually how these things turn out. Five years from now, probably the best we can hope for is CCSVI diagnosis and treatment is one more tool in the toolbox for MS treatment. The worst case is that when we look back five years from now we will see that some people were hurt or worse from a surgery that was eventually proven to have more risks than benefits.
Two MS treatments from the past that come to mind are substance P and massive chemotherapy. Several years ago a Canadian researcher was convinced a dysfunction in a brain chemical called substance P was involved in MS. Substance P is usually involved in pain transmission. Since in MS there is a problem with nerve transmission, this theory seemed plausible. However, I haven’t heard any more about substance P and MS in the last few years. I don’t know if it was disproven or just fell out of favor, but substance P is no longer the next big thing in MS treatment. A more troubling treatment involved massive chemotherapy. Despite Dr. Zamboni’s work, the current belief is that in MS the body’s own immune system attacks the myelin sheaths around nerve fibres. This makes nerve transmission not work as well. A fascinating presentation I went to a few years ago talked about a trial in which they destroyed the immune systems of some severely ill MS patients. They used chemotherapy drugs to kill off the bone marrow which produces immune cells that fight disease. Then they regrew “normal” bone marrow in these patients to give them “normal” immune systems. They did have some success. Some of these MS patients no longer had attacks. That is wonderful, but a few of the test subjects died from the massive chemotherapy. In my mind the risk of that treatment surely out weighed the benefit.
So has Dr. Zamboni found a cure for MS? No one really knows. I’ll definitely be watching for his papers to be published as he tests more and more people. It is great that he is bringing a whole new type of thinking to the problem of MS. If I had MS would I run out and get the surgery? Not yet. I would wait and see what happens with the ongoing trials. But if you haven’t seen it yet, go to the W5 website and watch the documentary. I found it fascinating.
http://www.ctv.ca/w5 CTV's W%
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, November 27, 2009
Vitamin D
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 was at a Multiple Sclerosis Society conference several years ago, when I went to a talk by an epidemiologist. He was showing how the further north you went in the world, the more likely it was that you would get MS. In other words MS is relatively common in places like Manitoba, Canada, but almost unheard of near the equator. I thought that was very interesting because I also have an interest in asthma and asthma has a similar distribution around the world. Asthma is more common the further you get from the equator. Now what else changes the further you get from the equator? The amount of sunshine does. Is that related? Maybe.
Researchers are making more links between Vitamin D and health all the time. Although not a direct cause and effect, some researchers think that the increased sunshine in the lower latitudes may be a reason there is less Multiple Sclerosis and less asthma the further south you live. More sunshine means your body produces more Vitamin D. Vitamin D effects many things in the body. One thing Vitamin D does is to reduce inflammation. Both MS and asthma involve inflammation. So maybe Vitamin D deficiency is involved in asthma and MS.
Another interesting theory that came out was Vitamin D and the flu. If you ignore the current H1N1 scare, influenza is a group of viruses that move around the world. They move between humans, birds and pigs and they mutate a bit every year. The interesting part for our Vitamin D story is when people get sick. Flu season in North America is in the winter months, when sunshine is in short supply. However flu season in Australia is about 6 months before us, in their winter months, when sunshine there is the least abundant. In countries around the equator, when the hours of sunshine are the same all year round, flu season happens in the rainy season when there is less sun. So there is research into whether Vitamin D deficiency makes you less able to fight off the flu.
What is Vitamin D? As usual, there isn’t a simple answer. There are different forms of Vitamin D. The type of Vitamin D your body makes is called Vitamin D3 (or cholecalciferol). The formation is complicated, but it goes like this. A precusor chemcial is converted to Vitamin D3 in the skin with the help of sunlight (UV Radiation). Vitamin D3 is converted in the liver to a second form called calcidiol. The calcidiol is converted to calcitriol by the kidney. Calcitriol is the most active form of Vitamin D. So you can get Vitamin D3 from taking pills, you can go outside and have your skin make it from sunshine or you can eat 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? Despite the interesting, but speculative research into other good things Vitamin D does, it is still mostly about the bones. Vitamin D helps your gut absorb calcium. This was originally discovered by people who studied Rickets. Rickets is most common in children and is a characterized by bone deformaties and “soft bones” which don’t have enough calcium. However if we gave these children Vitamin D, we could reverse and prevent rickets. Moving back to the present, current research shows that if adults get between 400-800 IU of Vitamin D per day their bones break less often. Research also shows these adults fall less often if they get enough Vitamin D. Some of the newer research is talking about people taking up to 2000 and more IU per day.
How much Vitamin D do we need? The easy answer is that most of us adults should get 1000 IU of Vitamin D3 per day. The dose is still being debated among groups like the Osteoporosis Society and the Canadian Cancer Society, but 1000 IU seems to be a safe middle road. Although Vitamin D is a fat soluable vitamin and can build up in your tissues, the toxic dose of Vitamin D is probably above 10,000 IU per day.
We live in a Northern Country. Most of us probably get Vitamin D deficient in the winter as the days get shorter and we put on more clothes. A Vitamin D supplement may be an inexpensive health booster most of us should look at.
As always if you have any questions or concerns about these products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 was at a Multiple Sclerosis Society conference several years ago, when I went to a talk by an epidemiologist. He was showing how the further north you went in the world, the more likely it was that you would get MS. In other words MS is relatively common in places like Manitoba, Canada, but almost unheard of near the equator. I thought that was very interesting because I also have an interest in asthma and asthma has a similar distribution around the world. Asthma is more common the further you get from the equator. Now what else changes the further you get from the equator? The amount of sunshine does. Is that related? Maybe.
Researchers are making more links between Vitamin D and health all the time. Although not a direct cause and effect, some researchers think that the increased sunshine in the lower latitudes may be a reason there is less Multiple Sclerosis and less asthma the further south you live. More sunshine means your body produces more Vitamin D. Vitamin D effects many things in the body. One thing Vitamin D does is to reduce inflammation. Both MS and asthma involve inflammation. So maybe Vitamin D deficiency is involved in asthma and MS.
Another interesting theory that came out was Vitamin D and the flu. If you ignore the current H1N1 scare, influenza is a group of viruses that move around the world. They move between humans, birds and pigs and they mutate a bit every year. The interesting part for our Vitamin D story is when people get sick. Flu season in North America is in the winter months, when sunshine is in short supply. However flu season in Australia is about 6 months before us, in their winter months, when sunshine there is the least abundant. In countries around the equator, when the hours of sunshine are the same all year round, flu season happens in the rainy season when there is less sun. So there is research into whether Vitamin D deficiency makes you less able to fight off the flu.
What is Vitamin D? As usual, there isn’t a simple answer. There are different forms of Vitamin D. The type of Vitamin D your body makes is called Vitamin D3 (or cholecalciferol). The formation is complicated, but it goes like this. A precusor chemcial is converted to Vitamin D3 in the skin with the help of sunlight (UV Radiation). Vitamin D3 is converted in the liver to a second form called calcidiol. The calcidiol is converted to calcitriol by the kidney. Calcitriol is the most active form of Vitamin D. So you can get Vitamin D3 from taking pills, you can go outside and have your skin make it from sunshine or you can eat 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? Despite the interesting, but speculative research into other good things Vitamin D does, it is still mostly about the bones. Vitamin D helps your gut absorb calcium. This was originally discovered by people who studied Rickets. Rickets is most common in children and is a characterized by bone deformaties and “soft bones” which don’t have enough calcium. However if we gave these children Vitamin D, we could reverse and prevent rickets. Moving back to the present, current research shows that if adults get between 400-800 IU of Vitamin D per day their bones break less often. Research also shows these adults fall less often if they get enough Vitamin D. Some of the newer research is talking about people taking up to 2000 and more IU per day.
How much Vitamin D do we need? The easy answer is that most of us adults should get 1000 IU of Vitamin D3 per day. The dose is still being debated among groups like the Osteoporosis Society and the Canadian Cancer Society, but 1000 IU seems to be a safe middle road. Although Vitamin D is a fat soluable vitamin and can build up in your tissues, the toxic dose of Vitamin D is probably above 10,000 IU per day.
We live in a Northern Country. Most of us probably get Vitamin D deficient in the winter as the days get shorter and we put on more clothes. A Vitamin D supplement may be an inexpensive health booster most of us should look at.
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, November 20, 2009
Ear Infections in Children
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
Today you are a family doctor. Congratulations on making it through 7 plus years of education and a bunch of on the job experience in about 15 seconds. Your patient is this little kid I know called Eric. He is 4 years old. Eric complains to his mom that his ear hurts. His mom takes him to see you. You examine Eric and determine that he has acute otitis media or a middle ear infection. What should you do? Should Eric get an antibiotic? Recent guidelines from the Canadian Pediatric Society say maybe not.
Acute otitis media or a middle ear infection is very common in children. It is estimated that 75% of children will have an ear infection by the time they are one year old. Why do so many children get ear infections? Well, just being young gives children a shorter and more horizontal eustachian tubes as compared to adults. The eustachian tubes, among other things, helps fluid from behind the ear drum drain out. If these eustachian tubes become blocked or squeezed shut by inflammation, fluid behind the ear drum can become trapped. Allergies and viral infections are also common in young children. These can cause the eustachian tubes to become inflamed and blocked. There is even the suggestion that children who get many ear infections have less of a certain antibody called secretory immunoglobulin A. Since this antibody makes it harder for bacteria to stick in the nose and throat, if children have less of it, they may have more bacteria hanging around ready to cause ear infections.
As you talk to Eric’s mom, you find out he had an upper respiratory tract infection for a few days before his ears started to hurt. You figure that the virus from this infection inflamed his eustachian tubes and caused his adenoids to swell. Eric’s eustachian tubes got blocked eustachian tubes and fluid got trapped behind his ear drum. The blocked tube also created a bit of a vacuum and pulled bacteria from Eric’s nose and throat back into his middle ear space. The bacteria grew in the trapped fluid and voila, Eric got an ear infection!
An interesting thing about middle ear infections is we don’t know exactly what is going on behind the ear drum. The only way to find out what is causing an ear infection is to push a big needle through Eric’s ear drum, draw out some fluid and test it. I don’t think he’d like that much. However some brave, unfortunate children have had their ear drums poked for science, so we know that most ear infections have bacteria in the fluid behind the ear drum. As you are a doctor, you know that antibiotics can kill bacteria. So every ear infection should get an antibiotic, right? That brings us back to the Canadian Pediatric Society.
So what are the experts at the Canadian Pediatric Society recommending you do with Eric? Nothing. If the child is older than 6 months, doesn’t have other under-lying complicating diseases, and doesn’t have a fever over 39 C or severe ear pain, then parents should just watch the child. The reason is that about two thirds of children will have their ear infection symptoms just go away in 48 to 72 hours without antibiotics. If the child doesn’t get better in 48 to 72 hours, then the parents should take them back to the doctor to get an antibiotic.
So you are a good family doctor and follow the guidelines. You tell Eric’s mom that although she has taken time off work, and she has a cranky four year old with a sore ear that she should just go home with no antibiotic prescription. Do you think she will be very happy? Probably not. So you make a deal with her. First you explain to her that only about 1 in 15 kids with ear infections get better faster on antibiotics than without. Then you tell Eric’s mom that antibiotics aren’t without risk. About 20% of kids on antibiotics get diarrhea. A smaller number of children on antibiotics can get things like rashes, trouble breathing or antibiotic resistance. Eric’s mom calms down. Eric has gotten a rash before on a certain antibiotic, so his mom starts to see the risk.
You tell Eric’s mom to go to the pharmacy and ask the pharmacist for the appropriate doses of acetaminophen and ibuprofen for Eric based on his weight. This should make Eric’s ear feel better for the next 48 to 72 hours. You also give Eric’s mom a prescription for an antibiotic, but you tell her not to fill it. She will leave the prescription at the pharmacy. That way if he doesn’t get better in 48 to 72 hours, Eric’s mom can get him a prescription without having to get back into see you. Good job, doc!
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
Today you are a family doctor. Congratulations on making it through 7 plus years of education and a bunch of on the job experience in about 15 seconds. Your patient is this little kid I know called Eric. He is 4 years old. Eric complains to his mom that his ear hurts. His mom takes him to see you. You examine Eric and determine that he has acute otitis media or a middle ear infection. What should you do? Should Eric get an antibiotic? Recent guidelines from the Canadian Pediatric Society say maybe not.
Acute otitis media or a middle ear infection is very common in children. It is estimated that 75% of children will have an ear infection by the time they are one year old. Why do so many children get ear infections? Well, just being young gives children a shorter and more horizontal eustachian tubes as compared to adults. The eustachian tubes, among other things, helps fluid from behind the ear drum drain out. If these eustachian tubes become blocked or squeezed shut by inflammation, fluid behind the ear drum can become trapped. Allergies and viral infections are also common in young children. These can cause the eustachian tubes to become inflamed and blocked. There is even the suggestion that children who get many ear infections have less of a certain antibody called secretory immunoglobulin A. Since this antibody makes it harder for bacteria to stick in the nose and throat, if children have less of it, they may have more bacteria hanging around ready to cause ear infections.
As you talk to Eric’s mom, you find out he had an upper respiratory tract infection for a few days before his ears started to hurt. You figure that the virus from this infection inflamed his eustachian tubes and caused his adenoids to swell. Eric’s eustachian tubes got blocked eustachian tubes and fluid got trapped behind his ear drum. The blocked tube also created a bit of a vacuum and pulled bacteria from Eric’s nose and throat back into his middle ear space. The bacteria grew in the trapped fluid and voila, Eric got an ear infection!
An interesting thing about middle ear infections is we don’t know exactly what is going on behind the ear drum. The only way to find out what is causing an ear infection is to push a big needle through Eric’s ear drum, draw out some fluid and test it. I don’t think he’d like that much. However some brave, unfortunate children have had their ear drums poked for science, so we know that most ear infections have bacteria in the fluid behind the ear drum. As you are a doctor, you know that antibiotics can kill bacteria. So every ear infection should get an antibiotic, right? That brings us back to the Canadian Pediatric Society.
So what are the experts at the Canadian Pediatric Society recommending you do with Eric? Nothing. If the child is older than 6 months, doesn’t have other under-lying complicating diseases, and doesn’t have a fever over 39 C or severe ear pain, then parents should just watch the child. The reason is that about two thirds of children will have their ear infection symptoms just go away in 48 to 72 hours without antibiotics. If the child doesn’t get better in 48 to 72 hours, then the parents should take them back to the doctor to get an antibiotic.
So you are a good family doctor and follow the guidelines. You tell Eric’s mom that although she has taken time off work, and she has a cranky four year old with a sore ear that she should just go home with no antibiotic prescription. Do you think she will be very happy? Probably not. So you make a deal with her. First you explain to her that only about 1 in 15 kids with ear infections get better faster on antibiotics than without. Then you tell Eric’s mom that antibiotics aren’t without risk. About 20% of kids on antibiotics get diarrhea. A smaller number of children on antibiotics can get things like rashes, trouble breathing or antibiotic resistance. Eric’s mom calms down. Eric has gotten a rash before on a certain antibiotic, so his mom starts to see the risk.
You tell Eric’s mom to go to the pharmacy and ask the pharmacist for the appropriate doses of acetaminophen and ibuprofen for Eric based on his weight. This should make Eric’s ear feel better for the next 48 to 72 hours. You also give Eric’s mom a prescription for an antibiotic, but you tell her not to fill it. She will leave the prescription at the pharmacy. That way if he doesn’t get better in 48 to 72 hours, Eric’s mom can get him a prescription without having to get back into see you. Good job, doc!
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, November 13, 2009
Angina Meds
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 good idea can go a long way. Did you know that an ingredient in TNT or dynamite can helped chest pain?
A long time ago, I thought I was going to be a physicist. That turned out not to be the case, but I did get to go to one physics conference. I forget most of what I learned at that conference. However I remember I saw two Nobel Prize winners. The Nobel Prize is an international award administered by the Nobel Foundation in Stockholm, Sweden. It was started by Alfred Nobel. Alfred Nobel was a great scientist and inventor in 1800’s. One of his greatest inventions was dynamite. His inventions made him very wealthy, but at some point he grew very concerned about all the war around him in the 1800’s and how his inventions were being used to kill people. So in his will he left money to be given out the person who accomplished "the most or the best work for fraternity among nations, for the abolition or reduction of standing armies and for the promotion of peace congresses." This turned in to the Nobel Peace Prize. Every year since 1901 the Nobel Prize has been awarded for achievements in physics, chemistry, physiology or medicine, literature and for peace.
In places like Alfred Nobel’s dynamite factories, people worked with nitroglycerin. The workers noticed they got awful headaches every Monday morning after being away from the factory for a few days. These headaches went away in a few hours. It was eventually determined that the headaches were caused by the nitroglycerin opening blood vessels in the brains of the workers. Opening up blood vessels in the brain can hurt, but if we open up blood vessels in the heart, we can actually make pain go away. This type of pain is called angina.
You may hear your doctor call chest pain angina pectoris, but many people simple call it angina. If suddenly start experiencing chest pain, get to your doctor or the hospital as soon as possible. For those people that the doctor has diagnosed as having angina, he/she may have given them a nitro-spray, or a nitro-patch. Both of these medications contain nitroglycerin, which helps open the blood vessels to the heart. Opening up blood vessels to the heart gets more blood and oxygen to the heart muscle and helps the pain go away. Even though both nitro-spray, and the nitro-patch contain nitroglycerin, they are used in different ways, and are used under different circumstances.
The nitro-spray is used at the first sign of angina, and should help the chest pain immediately. At the first sign of chest pain, sit down or recline, because the nitro-spray will probably make you dizzy. Don’t shake the canister. Hold it in an upright position, and remove the plastic cover. Open your mouth, bring the canister as close as possible, and spray the nitro under or onto your tongue. Don’t inhale the spray. If the pain persists, you can spray again in 5 minutes. If you need more than 3 doses in 15 minutes, seek medical attention immediately. Finally, if your doctor has prescribed nitro-spray for you, you should always carry it with you.
The nitro-patch works differently than the spray. With the nitro-patch, the nitroglycerin is absorbed slowly through the skin instead of through the mouth. It is designed to be used every day to prevent angina, where the spray is used to treat angina that is occurring now. To apply the patch, first wash your hands, then tear open the package. Hold the patch so that both brown lines are vertical and facing you. Bend the patch forward and back until you hear a light “SNAP”. Twist the patch to peel off its plastic backing, and avoid touching the backing. Apply the patch to a hairless area, such as the shoulders, back or hip. Unless your doctor tells you differently, you should only have the patch on for 12 hours, then it should be off for 12 hours. You should also rotate the various places you put the patch each day, to avoid irritating the skin.
So Alfred Nobel’s prizes still motivate and reward those who push forward the boundaries of science and medicine. Alfred Nobel’s own great invention, dynamite is still in use today. And nitroglycerin, one of the main ingredients in dynamite is still helping people’s hearts. One good idea can go a long way.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 good idea can go a long way. Did you know that an ingredient in TNT or dynamite can helped chest pain?
A long time ago, I thought I was going to be a physicist. That turned out not to be the case, but I did get to go to one physics conference. I forget most of what I learned at that conference. However I remember I saw two Nobel Prize winners. The Nobel Prize is an international award administered by the Nobel Foundation in Stockholm, Sweden. It was started by Alfred Nobel. Alfred Nobel was a great scientist and inventor in 1800’s. One of his greatest inventions was dynamite. His inventions made him very wealthy, but at some point he grew very concerned about all the war around him in the 1800’s and how his inventions were being used to kill people. So in his will he left money to be given out the person who accomplished "the most or the best work for fraternity among nations, for the abolition or reduction of standing armies and for the promotion of peace congresses." This turned in to the Nobel Peace Prize. Every year since 1901 the Nobel Prize has been awarded for achievements in physics, chemistry, physiology or medicine, literature and for peace.
In places like Alfred Nobel’s dynamite factories, people worked with nitroglycerin. The workers noticed they got awful headaches every Monday morning after being away from the factory for a few days. These headaches went away in a few hours. It was eventually determined that the headaches were caused by the nitroglycerin opening blood vessels in the brains of the workers. Opening up blood vessels in the brain can hurt, but if we open up blood vessels in the heart, we can actually make pain go away. This type of pain is called angina.
You may hear your doctor call chest pain angina pectoris, but many people simple call it angina. If suddenly start experiencing chest pain, get to your doctor or the hospital as soon as possible. For those people that the doctor has diagnosed as having angina, he/she may have given them a nitro-spray, or a nitro-patch. Both of these medications contain nitroglycerin, which helps open the blood vessels to the heart. Opening up blood vessels to the heart gets more blood and oxygen to the heart muscle and helps the pain go away. Even though both nitro-spray, and the nitro-patch contain nitroglycerin, they are used in different ways, and are used under different circumstances.
The nitro-spray is used at the first sign of angina, and should help the chest pain immediately. At the first sign of chest pain, sit down or recline, because the nitro-spray will probably make you dizzy. Don’t shake the canister. Hold it in an upright position, and remove the plastic cover. Open your mouth, bring the canister as close as possible, and spray the nitro under or onto your tongue. Don’t inhale the spray. If the pain persists, you can spray again in 5 minutes. If you need more than 3 doses in 15 minutes, seek medical attention immediately. Finally, if your doctor has prescribed nitro-spray for you, you should always carry it with you.
The nitro-patch works differently than the spray. With the nitro-patch, the nitroglycerin is absorbed slowly through the skin instead of through the mouth. It is designed to be used every day to prevent angina, where the spray is used to treat angina that is occurring now. To apply the patch, first wash your hands, then tear open the package. Hold the patch so that both brown lines are vertical and facing you. Bend the patch forward and back until you hear a light “SNAP”. Twist the patch to peel off its plastic backing, and avoid touching the backing. Apply the patch to a hairless area, such as the shoulders, back or hip. Unless your doctor tells you differently, you should only have the patch on for 12 hours, then it should be off for 12 hours. You should also rotate the various places you put the patch each day, to avoid irritating the skin.
So Alfred Nobel’s prizes still motivate and reward those who push forward the boundaries of science and medicine. Alfred Nobel’s own great invention, dynamite is still in use today. And nitroglycerin, one of the main ingredients in dynamite is still helping people’s hearts. One good idea can go a long way.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, November 06, 2009
Tamiflu Liquid
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.
Sometimes I get asked if I like being a pharmacist. I do. Very much. I have to keep learning new things all the time. Every day on the job is different, and I never know what to expect when I show up to work. Let me walk you through a couple exciting days last week.
A few weeks before our story begins, a father had taken his children to the Children’s Hospital in Winnipeg with flu like symptoms. Fearing they might have H1N1, the doctor gave the children a prescription for tamiflu liquid. The father had to go to three different Winnipeg pharmacies before he could get the tamiflu filled. The first two pharmacies didn’t have the liquid. It is not really the pharmacies’ fault as there is a shortage of liquid tamiflu. The third pharmacy mixed the adult dose of tamiflu in some syrup for the children. The father was understandably upset and called CBC.
What is tamiflu, and why is liquid tamiflu in short supply? Tamiflu (or oseltamivir) and Relenza (or zanamivir) are called neuramidnase inhibitors. They can stop or slow viruses from reproducing. If tamiflu is given within the first 48 hours of the onset of symptoms, it can decrease the amount and severity of flu symptoms. Even during this current flu scare, most people will not get flu symptoms. Those that do get symptoms, most will get very mild symptoms. Only a small number of people will get very sick and need to be hospitalized. Tamiflu can reduce the chance the patient will end up in the hospital or die from influenza. The adult capsule of Tamiflu is 75 mg. That is too strong for little children. The company, Roche, makes a liquid form for kids, but it is not always available. Roche says it takes 20 times as long to make the liquid form as the capsule form. So, especially during a flu scare, liquid Tamiflu is hard to come by.
So now the first two pharmacies were being blamed for delaying treatment of the children. The Federal Minister of Health was on CBC saying pharmacies should just compound the liquid tamiflu when required. Our regulator in Manitoba, the Manitoba Pharmaceutical Association or MPhA, sent all Manitoba pharmacies a fax with instructions how to compound liquid tamiflu for children.
The story gets better. The specific liquid we are supposed to use to compound the liquid tamiflu with is now in short supply. I guess that’s what happens when MPhA tells every pharmacy in the province to order the same thing. In fact, the company that makes tamiflu recommended pharmacies compound liquid tamiflu with that specific liquid also. So pharmacies all over North America are trying to order that specific liquid.
So what is a pharmacist to do when handed a prescription for liquid tamiflu? Do a little homework. We went to a very good talk by Dr. Blair Seifert. He is a pharmacist who specializes in pediatrics at Children’s Hospital in Winnipeg. He had a few good ideas about how to make the liquid tamiflu. We also used our contacts at PCCA Canada and did some research in the International Journal of Pharmaceutical Compounding. We made a liquid tamiflu a formula. We have flavored it so it is not so bitter. We are ready to fill a liquid tamiflu prescription.
So on top of the usual crisises of computers not working, student doctor questions, reports due for nursing homes and of course my main job of checking prescriptions and talking to patients, the challenge of that day was liquid tamiflu. We got that one figured out and are ready for the next challenge. And I still really like being a pharmacist.
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.
Sometimes I get asked if I like being a pharmacist. I do. Very much. I have to keep learning new things all the time. Every day on the job is different, and I never know what to expect when I show up to work. Let me walk you through a couple exciting days last week.
A few weeks before our story begins, a father had taken his children to the Children’s Hospital in Winnipeg with flu like symptoms. Fearing they might have H1N1, the doctor gave the children a prescription for tamiflu liquid. The father had to go to three different Winnipeg pharmacies before he could get the tamiflu filled. The first two pharmacies didn’t have the liquid. It is not really the pharmacies’ fault as there is a shortage of liquid tamiflu. The third pharmacy mixed the adult dose of tamiflu in some syrup for the children. The father was understandably upset and called CBC.
What is tamiflu, and why is liquid tamiflu in short supply? Tamiflu (or oseltamivir) and Relenza (or zanamivir) are called neuramidnase inhibitors. They can stop or slow viruses from reproducing. If tamiflu is given within the first 48 hours of the onset of symptoms, it can decrease the amount and severity of flu symptoms. Even during this current flu scare, most people will not get flu symptoms. Those that do get symptoms, most will get very mild symptoms. Only a small number of people will get very sick and need to be hospitalized. Tamiflu can reduce the chance the patient will end up in the hospital or die from influenza. The adult capsule of Tamiflu is 75 mg. That is too strong for little children. The company, Roche, makes a liquid form for kids, but it is not always available. Roche says it takes 20 times as long to make the liquid form as the capsule form. So, especially during a flu scare, liquid Tamiflu is hard to come by.
So now the first two pharmacies were being blamed for delaying treatment of the children. The Federal Minister of Health was on CBC saying pharmacies should just compound the liquid tamiflu when required. Our regulator in Manitoba, the Manitoba Pharmaceutical Association or MPhA, sent all Manitoba pharmacies a fax with instructions how to compound liquid tamiflu for children.
The story gets better. The specific liquid we are supposed to use to compound the liquid tamiflu with is now in short supply. I guess that’s what happens when MPhA tells every pharmacy in the province to order the same thing. In fact, the company that makes tamiflu recommended pharmacies compound liquid tamiflu with that specific liquid also. So pharmacies all over North America are trying to order that specific liquid.
So what is a pharmacist to do when handed a prescription for liquid tamiflu? Do a little homework. We went to a very good talk by Dr. Blair Seifert. He is a pharmacist who specializes in pediatrics at Children’s Hospital in Winnipeg. He had a few good ideas about how to make the liquid tamiflu. We also used our contacts at PCCA Canada and did some research in the International Journal of Pharmaceutical Compounding. We made a liquid tamiflu a formula. We have flavored it so it is not so bitter. We are ready to fill a liquid tamiflu prescription.
So on top of the usual crisises of computers not working, student doctor questions, reports due for nursing homes and of course my main job of checking prescriptions and talking to patients, the challenge of that day was liquid tamiflu. We got that one figured out and are ready for the next challenge. And I still really like being a pharmacist.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, October 30, 2009
HEARTBURN
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.
One of the pharmacy’s technicians grew a huge patch of jalapeno peppers. I love hot, spicy food. Hot food doesn’t always love me. Some times it gives me heart burn. You know that uncomfortable burning feeling behind your breast bone. What can be done to quench the fire?
Firstly, symptoms of heartburn happen to virtually everyone at some point in their life. If heart burn symptoms are infrequent and don’t last long they are not associated with an increase risk of serious disease. There are some warning flags for when you should see your doctor: severe abdominal pain, pain on the side of your abdomen that persists in one spot, unexplained weight loss of more than 7 lbs in the past six months, new feelings of shortness of breath or chronic tiredness, difficult or painful swallowing, persistent vomiting, coughing up blood, or black tarry stools.
So how can we prevent heartburn. Big meals can lead to heart burn, so let’s cancel Christmas! Well, cancelling Christmas would work, but wouldn’t be very unpopular. So instead try eating smaller more frequent meals, eat low fat foods with lots of fiber, reduce alcohol consumption, avoid lying down right after meals, and lose some weight. Well, if you’re like me over Christmas I eat huge meals with lots of fat, drink alcohol and coffee and then immediately lie down on the couch (and just forget about losing weight over the holidays). Okay, maybe prevention is harder than we thought. What about treating the heartburn once it has started?
Without a prescription, we have antacids and H2 receptor blockers. Antacids with names like Tums, Maalox, Mylanta, Rolaids, Diovan etc all work on mild heart burn. They go into your stomach and neutralize stomach acid. So you feel relief quite quickly, but the relief may not last very long. If you find one you like, use it. There are a couple of cautions, though. If you need antacids more than 3 times a week, or have been using them longer than 6 months in a row, see your doctor. The other problem can be different medications. Antacids bind up other medications that are in the stomach at the same time. If you are on prescription medications, ask you pharmacist if they are safe to take with antacids.
H2 receptor blockers have names like cimetidine, ranitidine, or famotidine. H2 receptor blockers go to a special histamine receptor and prevent them from getting turned on. This stops the stomach from making as much acid. They are reasonably fast and last a long time. They are quite safe and you can usually get relief from 1 or 2 pills in a day. In fact, until recently 150 mg of ranitidine used to be available only by prescription. Now you can buy it over the counter.
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.
One of the pharmacy’s technicians grew a huge patch of jalapeno peppers. I love hot, spicy food. Hot food doesn’t always love me. Some times it gives me heart burn. You know that uncomfortable burning feeling behind your breast bone. What can be done to quench the fire?
Firstly, symptoms of heartburn happen to virtually everyone at some point in their life. If heart burn symptoms are infrequent and don’t last long they are not associated with an increase risk of serious disease. There are some warning flags for when you should see your doctor: severe abdominal pain, pain on the side of your abdomen that persists in one spot, unexplained weight loss of more than 7 lbs in the past six months, new feelings of shortness of breath or chronic tiredness, difficult or painful swallowing, persistent vomiting, coughing up blood, or black tarry stools.
So how can we prevent heartburn. Big meals can lead to heart burn, so let’s cancel Christmas! Well, cancelling Christmas would work, but wouldn’t be very unpopular. So instead try eating smaller more frequent meals, eat low fat foods with lots of fiber, reduce alcohol consumption, avoid lying down right after meals, and lose some weight. Well, if you’re like me over Christmas I eat huge meals with lots of fat, drink alcohol and coffee and then immediately lie down on the couch (and just forget about losing weight over the holidays). Okay, maybe prevention is harder than we thought. What about treating the heartburn once it has started?
Without a prescription, we have antacids and H2 receptor blockers. Antacids with names like Tums, Maalox, Mylanta, Rolaids, Diovan etc all work on mild heart burn. They go into your stomach and neutralize stomach acid. So you feel relief quite quickly, but the relief may not last very long. If you find one you like, use it. There are a couple of cautions, though. If you need antacids more than 3 times a week, or have been using them longer than 6 months in a row, see your doctor. The other problem can be different medications. Antacids bind up other medications that are in the stomach at the same time. If you are on prescription medications, ask you pharmacist if they are safe to take with antacids.
H2 receptor blockers have names like cimetidine, ranitidine, or famotidine. H2 receptor blockers go to a special histamine receptor and prevent them from getting turned on. This stops the stomach from making as much acid. They are reasonably fast and last a long time. They are quite safe and you can usually get relief from 1 or 2 pills in a day. In fact, until recently 150 mg of ranitidine used to be available only by prescription. Now you can buy it over the counter.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Tuesday, October 20, 2009
Antibiotic Resistance
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 like Pink Floyd. Yes that psychedelic British rock band from the 1960’s. Although I don’t think I’ve played their album “The Wall” from end to end in a decade, I used to listen to it a lot in University. One of the many themes on The Wall is the difficulty of losing a father in World War 2 and how hard it was to grow up in post war Britain. And in a couple of places they mentioned Vera Lynn.
I honestly had no idea who Vera Lynn was when I heard her name in the Pink Floyd songs. However, on September 13, 2009, Dame Vera Lynn had a Number 1 record in Britain at the very young age of 92. After that I heard an interview with her. She described her career entertaining the troops with hits like “We’ll Meet Again” and “There’ll Be Blue Birds Over the White Cliffs of Dover”. For us on this side of the Atlantic, picture her as a British Bob Hope. She described visiting field hospitals in Burma to see wounded soldiers. She actually saw a new drug being used. She saw penicillin powder poured onto open wounds to help them heal. For the record, she said it was a yellow powder.
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 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.
As miraculous as antibiotics are, they aren’t perfect. Several decades after penicillin was discovered, people started talking about antibiotic resistance. Antibiotic resistance is when bacteria aren’t killed by a certain antibiotic anymore.
How do bacteria become resistant to an antibiotic? There are a few ways including complicated things like sharing plasmids, but often it is when the bacteria are exposed to a small dose of the antibiotic. This dose is either too small to kill them or given for too short a time to kill them. For example, let’s say you go to the doctor and insist that she give you an antibiotic for your “cough”. Then, you only take 2 or 3 days worth of the antibiotics and “save the rest for next time”. This will kill off the most of the bacteria, but it will leave some alive. 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. Now that original antibiotic won’t work anymore. You now have an antibiotic resistant infection!
So finish your antibiotics! I want you to be like my new Pink Floyd inspired hero Vera Lynn. Be working and productive for seven decades. Get that number 1 album on the British charts when you are 92. Do not stop taking an antibiotic part way through the course of treatment 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.
And like Vera Lynn says, “We’ll meet again….Some sunny day”.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 like Pink Floyd. Yes that psychedelic British rock band from the 1960’s. Although I don’t think I’ve played their album “The Wall” from end to end in a decade, I used to listen to it a lot in University. One of the many themes on The Wall is the difficulty of losing a father in World War 2 and how hard it was to grow up in post war Britain. And in a couple of places they mentioned Vera Lynn.
I honestly had no idea who Vera Lynn was when I heard her name in the Pink Floyd songs. However, on September 13, 2009, Dame Vera Lynn had a Number 1 record in Britain at the very young age of 92. After that I heard an interview with her. She described her career entertaining the troops with hits like “We’ll Meet Again” and “There’ll Be Blue Birds Over the White Cliffs of Dover”. For us on this side of the Atlantic, picture her as a British Bob Hope. She described visiting field hospitals in Burma to see wounded soldiers. She actually saw a new drug being used. She saw penicillin powder poured onto open wounds to help them heal. For the record, she said it was a yellow powder.
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 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.
As miraculous as antibiotics are, they aren’t perfect. Several decades after penicillin was discovered, people started talking about antibiotic resistance. Antibiotic resistance is when bacteria aren’t killed by a certain antibiotic anymore.
How do bacteria become resistant to an antibiotic? There are a few ways including complicated things like sharing plasmids, but often it is when the bacteria are exposed to a small dose of the antibiotic. This dose is either too small to kill them or given for too short a time to kill them. For example, let’s say you go to the doctor and insist that she give you an antibiotic for your “cough”. Then, you only take 2 or 3 days worth of the antibiotics and “save the rest for next time”. This will kill off the most of the bacteria, but it will leave some alive. 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. Now that original antibiotic won’t work anymore. You now have an antibiotic resistant infection!
So finish your antibiotics! I want you to be like my new Pink Floyd inspired hero Vera Lynn. Be working and productive for seven decades. Get that number 1 album on the British charts when you are 92. Do not stop taking an antibiotic part way through the course of treatment 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.
And like Vera Lynn says, “We’ll meet again….Some sunny day”.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, October 02, 2009
OSTEOPOROSIS
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 Pharmacy world, we have a problem. We call it look alike, sound alike drugs. For example losec looks like lasix when a doctor writes it on a prescription pad and they sound similar when a doctor phones it into the pharmacy. Losec or omeprazole reduces stomach acid and is often used to treat stomach ulcers. Lasix or furosemide causes the body to pass out extra fluid and is used to treat swelling and heart failure. As a pharmacist if I get confused by a doctor’s order and give someone the wrong medication, bad things can happen. So we are very careful to catch the differences between look alike sound alike drugs when the doctor orders them. So I understand when people get confused between look alike sound alike conditions such as osteoporosis and osteoarthritis.
Osteoarthritis is when the joints between the bones wear out. Moving those joints hurt. Osteoporosis may not hurt at all. It is when the bones themselves lose calcium and become less dense and more brittle. Do you want to learn more about these two conditions? Call Linda Watt at the Arthritis Society 638-8107. She is putting on a talk Oct 7, 7-9 pm at the Senior’s Center where Bonnie Hopps will discuss the differences between the two conditions and even lead you through some helpful exercises.
Osteoporosis is a disease of the skeleton that can have many contributing factors. It’s most important characteristic is the loss of bone strength. If you look at a bone under a microscope, bones look like a honey comb. It isn’t solid. When a person has osteoporosis, the microscopic structure changes, and the holes in the honey comb get bigger. The bone also gets weaker. Osteoporosis is called a silent disease. Sometimes the first sign of the disease is when a person breaks a bone unexpectedly. For example, someone with osteoporosis can break ribs by coughing. Other bones that can break in osteoporosis are the vertebrae in the spine (they usually compress and the person gets shorter), the upper thigh bone, the wrist, and the hip.
What factors put someone at risk of osteoporosis? Being female, being Caucasian or Asian, being over 65, having a small frame, having relatives with osteoporosis, being inactive, low calcium intake, smoking and high caffeine intake.
What can you do to help reduce the risk of osteoporosis? Depending on your age, you should be getting 1000 to 1500 mg of calcium per day either from your diet or supplements and you should be getting 800-1000 IU of Vitamin D per day. Calcium helps build bone and maintain it, and Vitamin D helps your body absorb calcium from the gut. Regular weight-bearing exercise will also help building bone. So regular walks with the dog 4-5 times a week for about 20 minutes each will help strengthen your bones. Also, quit smoking and reduce your caffeine intake.
How can you tell if your bones are thinning before you break one? The gold standard is special X-ray called a DEXA. The problem is the DEXA machine is in Winnipeg and it can take a while to get in and get your bones tested. In fact, you have to meet some pretty specific criteria to qualify for a DEXA scan. Some criteria are being over 65, having been on prednisone for more than 3 months, or having an existing compression fracture in your spine. The reason for the strict conditions is that having thin bones on a DEXA scan doesn’t necessarily mean you are at a high risk for fracture.
I know it is a bit confusing, but having thin bones, or a low Bone Mineral Density (BMD), is just one risk factor for getting fractures. This risk should always be viewed in the context of the person’s age and other risk factors. For example a 25 year old with a low BMD has a very low 10-year risk of fracture that is not much different than a 25 year old with a high BMD. However, a person with a low BMD at age 65 has a much higher 10-year risk of fracture.
So what do you do if you are curious about how thin your bones are but you don’t qualify for a DEXA? Come to the Dauphin Clinic Pharmacy’s Heel Scanning Clinic. We will be using a special ultrasound machine to see how dense the bone in your heel is on October 7 and 8th. Please call us at 638-4602 to book your appointment soon as spots are limited! The test is fast, easy, and painless!
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 Pharmacy world, we have a problem. We call it look alike, sound alike drugs. For example losec looks like lasix when a doctor writes it on a prescription pad and they sound similar when a doctor phones it into the pharmacy. Losec or omeprazole reduces stomach acid and is often used to treat stomach ulcers. Lasix or furosemide causes the body to pass out extra fluid and is used to treat swelling and heart failure. As a pharmacist if I get confused by a doctor’s order and give someone the wrong medication, bad things can happen. So we are very careful to catch the differences between look alike sound alike drugs when the doctor orders them. So I understand when people get confused between look alike sound alike conditions such as osteoporosis and osteoarthritis.
Osteoarthritis is when the joints between the bones wear out. Moving those joints hurt. Osteoporosis may not hurt at all. It is when the bones themselves lose calcium and become less dense and more brittle. Do you want to learn more about these two conditions? Call Linda Watt at the Arthritis Society 638-8107. She is putting on a talk Oct 7, 7-9 pm at the Senior’s Center where Bonnie Hopps will discuss the differences between the two conditions and even lead you through some helpful exercises.
Osteoporosis is a disease of the skeleton that can have many contributing factors. It’s most important characteristic is the loss of bone strength. If you look at a bone under a microscope, bones look like a honey comb. It isn’t solid. When a person has osteoporosis, the microscopic structure changes, and the holes in the honey comb get bigger. The bone also gets weaker. Osteoporosis is called a silent disease. Sometimes the first sign of the disease is when a person breaks a bone unexpectedly. For example, someone with osteoporosis can break ribs by coughing. Other bones that can break in osteoporosis are the vertebrae in the spine (they usually compress and the person gets shorter), the upper thigh bone, the wrist, and the hip.
What factors put someone at risk of osteoporosis? Being female, being Caucasian or Asian, being over 65, having a small frame, having relatives with osteoporosis, being inactive, low calcium intake, smoking and high caffeine intake.
What can you do to help reduce the risk of osteoporosis? Depending on your age, you should be getting 1000 to 1500 mg of calcium per day either from your diet or supplements and you should be getting 800-1000 IU of Vitamin D per day. Calcium helps build bone and maintain it, and Vitamin D helps your body absorb calcium from the gut. Regular weight-bearing exercise will also help building bone. So regular walks with the dog 4-5 times a week for about 20 minutes each will help strengthen your bones. Also, quit smoking and reduce your caffeine intake.
How can you tell if your bones are thinning before you break one? The gold standard is special X-ray called a DEXA. The problem is the DEXA machine is in Winnipeg and it can take a while to get in and get your bones tested. In fact, you have to meet some pretty specific criteria to qualify for a DEXA scan. Some criteria are being over 65, having been on prednisone for more than 3 months, or having an existing compression fracture in your spine. The reason for the strict conditions is that having thin bones on a DEXA scan doesn’t necessarily mean you are at a high risk for fracture.
I know it is a bit confusing, but having thin bones, or a low Bone Mineral Density (BMD), is just one risk factor for getting fractures. This risk should always be viewed in the context of the person’s age and other risk factors. For example a 25 year old with a low BMD has a very low 10-year risk of fracture that is not much different than a 25 year old with a high BMD. However, a person with a low BMD at age 65 has a much higher 10-year risk of fracture.
So what do you do if you are curious about how thin your bones are but you don’t qualify for a DEXA? Come to the Dauphin Clinic Pharmacy’s Heel Scanning Clinic. We will be using a special ultrasound machine to see how dense the bone in your heel is on October 7 and 8th. Please call us at 638-4602 to book your appointment soon as spots are limited! The test is fast, easy, and painless!
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, September 25, 2009
HOMOCYSTEINE
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
What do Smashing Pumpkins, Mother Theresa, Topher Grace and the Dauphin Clinic Pharmacy have in common? 1979. It was a hit song off of the Smashing Pumpkins album Mellon Collie and the Infinite Sadness. It was the year Mother Theresa won the Nobel Peace Prize. The TV Comedy "That 70's Show" that Topher Grace starred in had its last episode set December 31, 1979. Finally, the Dauphin Clinic Pharmacy was opened in 1979 by Mr. Myles Haverluck.
Think of all the things that have changed since 1979. Just today I wrote this article on a personal computer, looked up some information on Google, phoned home on my cell phone, checked my email, tele-commuted to the store in Winnipegosis and played around with Skype Video-conferencing. None of those everyday things existed or were even dreamed of in 1979. Since so many things in our everyday lives seem to be constantly changing, it shouldn't be a surprise that medical knowledge and information is always changing too. Take homocysteine. Homocysteine is an amino acid with some interesting stories to tell.
It was noticed that children with a genetic metabolic condition that gave them high homocysteine levels also got damaged blood vessels more often than we would normally expect. The scientists thought that high homocysteine levels damaged the lining of the blood vessels call the endothelieum and made blood clot more than normal. We think that many people with athererosclerosis or hardening of the arteries also have high homocysteine. We also know that if we give people B vitamins and folic acid we can reduce their homocysteine levels. The big question is if we give people high doses of B vitamins and folic acid will they have fewer heart attacks and strokes and die less often?
Well, there was a big trial in 2005 with 3749 people in it called NORVIT or the Norwegian Vitamin Trial. They gave people who had had a heart attack in the last 7 days folic acid, folic acid plus vitamin B6 or a placebo. The homocysteine levels in the folic acid groups went down. They found no change in risk of heart disease with or without the folic acid and vitamin B6. The actually found an increase in risk of heart attack in the people on high doses of Vitamin B6 and folic acid.
One reason people like me were so excited about homocysteine was that it was so easy to treat. We have good medications to reduce cholesterol called statins. We believe that if we reduce a person's cholesterol with a statin, we will reduce the chance of heart attack and stroke. Many studies have backed this up. Some of the downsides to statins is they are relatively expensive and they can cause side effects in a small number of people. If reducing someone's homocysteine reduced their chance of heart attack and stroke, that would be great because we can reduce homocysteine with B vitamins and folic acid. They are relatively inexpensive, available without a prescription and relatively free of side effects.
But the homocysteine story is a bust, right? The big NORVIT study found no benefit, right? Well the homocysteine story continues to evolve. While it is unlikely that we will recommend everyone go on folic acid and B Vitamins to reduce their homocysteine, there may be some populations that could benefit from folic acid. In an Israeli study published in the American Journal of Cardiology in September 2009 found people with early onset coronary arteries disease and who had high homocysteine levels did benefit from folic acid and B vitamins. It was a smaller study with only 492 patients in it, but the folic acid/B vitamin group did die less often. Remember, though, this was a very specific group of people with the heart condition early onset CAD and who had high homocysteine levels. So the homocysteine story continues.
So what is the take home message for most of us? Whole grains and dark green leafy vegetables. This is where B Vitamins and folic acid come from in our diet. Eat more of them. They do lots of good things for you including lowering your homocysteine levels. Today we can't say that lowering your homocysteine levels will help your heart, but the story continues to evolve. Just like the original UseNet experiments in 1979 developed into a part of the internet we enjoy today and the Dauphin Clinic Pharmacy grew from a tiny one man operation to arguably one of the best pharmacies in Canada, it will be interesting to see where the homocysteine story goes.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
What do Smashing Pumpkins, Mother Theresa, Topher Grace and the Dauphin Clinic Pharmacy have in common? 1979. It was a hit song off of the Smashing Pumpkins album Mellon Collie and the Infinite Sadness. It was the year Mother Theresa won the Nobel Peace Prize. The TV Comedy "That 70's Show" that Topher Grace starred in had its last episode set December 31, 1979. Finally, the Dauphin Clinic Pharmacy was opened in 1979 by Mr. Myles Haverluck.
Think of all the things that have changed since 1979. Just today I wrote this article on a personal computer, looked up some information on Google, phoned home on my cell phone, checked my email, tele-commuted to the store in Winnipegosis and played around with Skype Video-conferencing. None of those everyday things existed or were even dreamed of in 1979. Since so many things in our everyday lives seem to be constantly changing, it shouldn't be a surprise that medical knowledge and information is always changing too. Take homocysteine. Homocysteine is an amino acid with some interesting stories to tell.
It was noticed that children with a genetic metabolic condition that gave them high homocysteine levels also got damaged blood vessels more often than we would normally expect. The scientists thought that high homocysteine levels damaged the lining of the blood vessels call the endothelieum and made blood clot more than normal. We think that many people with athererosclerosis or hardening of the arteries also have high homocysteine. We also know that if we give people B vitamins and folic acid we can reduce their homocysteine levels. The big question is if we give people high doses of B vitamins and folic acid will they have fewer heart attacks and strokes and die less often?
Well, there was a big trial in 2005 with 3749 people in it called NORVIT or the Norwegian Vitamin Trial. They gave people who had had a heart attack in the last 7 days folic acid, folic acid plus vitamin B6 or a placebo. The homocysteine levels in the folic acid groups went down. They found no change in risk of heart disease with or without the folic acid and vitamin B6. The actually found an increase in risk of heart attack in the people on high doses of Vitamin B6 and folic acid.
One reason people like me were so excited about homocysteine was that it was so easy to treat. We have good medications to reduce cholesterol called statins. We believe that if we reduce a person's cholesterol with a statin, we will reduce the chance of heart attack and stroke. Many studies have backed this up. Some of the downsides to statins is they are relatively expensive and they can cause side effects in a small number of people. If reducing someone's homocysteine reduced their chance of heart attack and stroke, that would be great because we can reduce homocysteine with B vitamins and folic acid. They are relatively inexpensive, available without a prescription and relatively free of side effects.
But the homocysteine story is a bust, right? The big NORVIT study found no benefit, right? Well the homocysteine story continues to evolve. While it is unlikely that we will recommend everyone go on folic acid and B Vitamins to reduce their homocysteine, there may be some populations that could benefit from folic acid. In an Israeli study published in the American Journal of Cardiology in September 2009 found people with early onset coronary arteries disease and who had high homocysteine levels did benefit from folic acid and B vitamins. It was a smaller study with only 492 patients in it, but the folic acid/B vitamin group did die less often. Remember, though, this was a very specific group of people with the heart condition early onset CAD and who had high homocysteine levels. So the homocysteine story continues.
So what is the take home message for most of us? Whole grains and dark green leafy vegetables. This is where B Vitamins and folic acid come from in our diet. Eat more of them. They do lots of good things for you including lowering your homocysteine levels. Today we can't say that lowering your homocysteine levels will help your heart, but the story continues to evolve. Just like the original UseNet experiments in 1979 developed into a part of the internet we enjoy today and the Dauphin Clinic Pharmacy grew from a tiny one man operation to arguably one of the best pharmacies in Canada, it will be interesting to see where the homocysteine story goes.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, September 18, 2009
PROBIOTICS
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 parents spent their 40th wedding anniversay in Wawa, Ontario. Wawa is where my dad grew up and they were there helping my grandmother move from her house into an apartment. My grandmother was ahead of her time when it came to feeding my dad the lastest super healthy foods. She insisted that he take cod liver oil, or as she called it "liquid sunshine". That provided him with both Vitamin D and Omega-3 fatty acids, which are all over the news. My grandmother also tried to get him to eat yogurt. Apparently the yogurt was made fresh at the family farm, but my dad wouldn't go near it. He still won't eat yogurt. Score another one for grandma, though. Yogurt is just one of the new "probiotics" that we are all supposed to be eating.
Probiotics are "good" microorganisms for the intestines. Probiotics contain actual tiny living things that go into your intestines, start growing and push out the "bad" microorganisms that might be there. Probiotic microbes have names like Lactobacillus, Bifidobacteria and Saccharomyces. There are more and more products in the pharmacy that are promoted as probiotics. Should we all take them? Let's have a look.
Apparently this probiotic movement is older than I thought. A Russian scientist named Elie Metchnikoff was looking at a particularily long lived group of Bulgarian mountain men. These mountain men drank a fermented milk product that had lots of lactic acid producing bacteria in it. Metchnikoff thought the bacteria in the fermented milk drink helped the immune system in the mountain men's gut. This was all going on in the late 1800's and early 1900's. So was Metchinikoff right? Well the human digestive tract is about 5 meters long from end to end and if stretched out it would cover about 2 tennis courts. And it is full of bacteria and other microbes. Our guts get colonized within hours of birth and by adulthood there are actually 10 times more bacteria cells in our guts than there are human cells in our body. The bacteria in our guts help us break down some foods, release some nutrients we otherwise couldn't get at and helps our immune system.
The immune system part surprised me. Apparently up to 75% of the body's immune system cells are in the gut. Our gut bacteria help stimulate our immune system in the prescence of bad invasive microbes and helps calm the immune system so it doesn't go attacking non-harmful things. In interesting experiments researchers took new born mice and put them into a sterile environment before bacteria got into their guts. These mice developed very badly working immune systems. However the mice were "cured" when they were then allowed to live with normal mice with normal gut microbes for a few weeks. We assume the normal gut microbes moved from the normal mice to the guts of the sterile mice.
So should everyone go to the pharmacy and buy some lactobacillus acidophillus capsules? Well, probably not. It is still a stretch from health Bulgarian mountain men and mice with no gut microbes to buying capsules at the pharmacy. However, there are some products in the pharmacy I have recommended in the past that I will share. A big warning first though. The science saying that if you take these probiotics that your condition will get better is incomplete at best. So why do I still recommend them? I do because the chance of harm from probiotics is very, very low.
I have recommended lactobacillus capsules to women who always get yeast infections after taking antibiotics for years. Apparently, there isn't any science to back up that recommendation at all. There is some evidence to support that women who get yeast infections regularily not from antibiotics who take lactobacillus capsules will get less yeast infections.
Well couldn't you just eat more yogurt. Maybe. I was surprised to learn yogurt isn't necessarily probiotic. To be probiotic the product has to be able to survive through the acid of the stomach, the bile acids of the small intestine and then be able to reproduce in the large intestine. Only yogurt may with certain types of bacteria can do that. For example the brand "Activa" reports to be made with bacteria that can survive the trip through the acid stomach.
I have recommended BioGaia for colic. Colic is when an infant cries and cries for no apparent reason. If you have an infant that may have colic, have the infant checked out by your doctor just to make sure there is nothing else wrong. BioGaia is a probiotic drop which has some evidence that it reduces how often a colicy baby cries. Now as it is hard to tell when an infant will just grow out of colic, there are some people who question if BioGaia works. However, as there is very little chance of harm with BioGaia, I have recommended it. BioGaia requires refridgeration.
TuZen is an lactobacillus capsule that is being promoted as helpful for irritable bowel syndrome (IBS). IBS is when you have diarrhea or constipation and other stomach disorder for no apparent reason. If you think you have IBS, please have your doctor rule out other causes. I have had people take TuZen and had their IBS symptoms get better. Since IBS symptoms tend to come and go in some people, it is a little controversial if TuZen works or not. What I can tell you is that TuZen is made with a special type of lactobacillus that can survive its trip through the stomach and unlike some other products it does not require refridgeration
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 parents spent their 40th wedding anniversay in Wawa, Ontario. Wawa is where my dad grew up and they were there helping my grandmother move from her house into an apartment. My grandmother was ahead of her time when it came to feeding my dad the lastest super healthy foods. She insisted that he take cod liver oil, or as she called it "liquid sunshine". That provided him with both Vitamin D and Omega-3 fatty acids, which are all over the news. My grandmother also tried to get him to eat yogurt. Apparently the yogurt was made fresh at the family farm, but my dad wouldn't go near it. He still won't eat yogurt. Score another one for grandma, though. Yogurt is just one of the new "probiotics" that we are all supposed to be eating.
Probiotics are "good" microorganisms for the intestines. Probiotics contain actual tiny living things that go into your intestines, start growing and push out the "bad" microorganisms that might be there. Probiotic microbes have names like Lactobacillus, Bifidobacteria and Saccharomyces. There are more and more products in the pharmacy that are promoted as probiotics. Should we all take them? Let's have a look.
Apparently this probiotic movement is older than I thought. A Russian scientist named Elie Metchnikoff was looking at a particularily long lived group of Bulgarian mountain men. These mountain men drank a fermented milk product that had lots of lactic acid producing bacteria in it. Metchnikoff thought the bacteria in the fermented milk drink helped the immune system in the mountain men's gut. This was all going on in the late 1800's and early 1900's. So was Metchinikoff right? Well the human digestive tract is about 5 meters long from end to end and if stretched out it would cover about 2 tennis courts. And it is full of bacteria and other microbes. Our guts get colonized within hours of birth and by adulthood there are actually 10 times more bacteria cells in our guts than there are human cells in our body. The bacteria in our guts help us break down some foods, release some nutrients we otherwise couldn't get at and helps our immune system.
The immune system part surprised me. Apparently up to 75% of the body's immune system cells are in the gut. Our gut bacteria help stimulate our immune system in the prescence of bad invasive microbes and helps calm the immune system so it doesn't go attacking non-harmful things. In interesting experiments researchers took new born mice and put them into a sterile environment before bacteria got into their guts. These mice developed very badly working immune systems. However the mice were "cured" when they were then allowed to live with normal mice with normal gut microbes for a few weeks. We assume the normal gut microbes moved from the normal mice to the guts of the sterile mice.
So should everyone go to the pharmacy and buy some lactobacillus acidophillus capsules? Well, probably not. It is still a stretch from health Bulgarian mountain men and mice with no gut microbes to buying capsules at the pharmacy. However, there are some products in the pharmacy I have recommended in the past that I will share. A big warning first though. The science saying that if you take these probiotics that your condition will get better is incomplete at best. So why do I still recommend them? I do because the chance of harm from probiotics is very, very low.
I have recommended lactobacillus capsules to women who always get yeast infections after taking antibiotics for years. Apparently, there isn't any science to back up that recommendation at all. There is some evidence to support that women who get yeast infections regularily not from antibiotics who take lactobacillus capsules will get less yeast infections.
Well couldn't you just eat more yogurt. Maybe. I was surprised to learn yogurt isn't necessarily probiotic. To be probiotic the product has to be able to survive through the acid of the stomach, the bile acids of the small intestine and then be able to reproduce in the large intestine. Only yogurt may with certain types of bacteria can do that. For example the brand "Activa" reports to be made with bacteria that can survive the trip through the acid stomach.
I have recommended BioGaia for colic. Colic is when an infant cries and cries for no apparent reason. If you have an infant that may have colic, have the infant checked out by your doctor just to make sure there is nothing else wrong. BioGaia is a probiotic drop which has some evidence that it reduces how often a colicy baby cries. Now as it is hard to tell when an infant will just grow out of colic, there are some people who question if BioGaia works. However, as there is very little chance of harm with BioGaia, I have recommended it. BioGaia requires refridgeration.
TuZen is an lactobacillus capsule that is being promoted as helpful for irritable bowel syndrome (IBS). IBS is when you have diarrhea or constipation and other stomach disorder for no apparent reason. If you think you have IBS, please have your doctor rule out other causes. I have had people take TuZen and had their IBS symptoms get better. Since IBS symptoms tend to come and go in some people, it is a little controversial if TuZen works or not. What I can tell you is that TuZen is made with a special type of lactobacillus that can survive its trip through the stomach and unlike some other products it does not require refridgeration
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, September 11, 2009
Lyme Disease
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
You know what is cool about a phone call from Hong Kong? It sounds just like a phone call from across the street. In today’s world of fax, email, Facebook, satellite phones, Skype videoconferencing, text messaging and many, many other forms of electronic communications, the overseas phone call is still almost magical to me. About a year ago a friend I grew up with called me from Hong Kong. He asked if I was going to Winnipeg in the following couple of weeks. It turned out I was, so he was asked if I could meet this guy, Allen for dinner. I said sure.
Allen was in Winnipeg because he was driving a bus for a tour company. He was taking people from a downtown hotel to the airport who were on their way to Churchill to see polar bears. Allen was originally from Texas, went to university in the eastern states and has had a variety of fascinating jobs. He had run for Congress, twice, had helped record music for a national book chain. He had played his small part as a member of the massive team that helped get Barack Obama elected president last year. He had many tales to tell. The one that came closest to my line of work involve a lime green van. Allen had driven this lime green van across the US to promote Lyme disease awareness. I have to admit, I really didn’t know much about Lyme disease, and after dinner with Allen, I quickly forgot about the story of the lime green van. However, recently Manitoba Health sent the pharmacy a Deer Tick information package. So thinking about Allen and his green van, I read it. Here is some of what it said.
Deer ticks are cousins to the wood tick that you are probably familiar with. They are smaller than wood ticks and they don’t have any white marks or streaks like wood ticks. They are of interest because deer tick can transmit Lyme disease to people. Deer ticks haven’t been in Manitoba long. Apparently they have only been identified here since 1989. Deer tick are predominantly in the south eastern part of the province and probably only 10% carry Lyme disease. Most Manitobans are unlikely to run into a deer tick. However, unlike wood ticks, deer ticks are more common in the fall. I guess that’s why Manitoba Health sent out the info package in the late summer.
Lyme disease is caused by the bacterium, Borrelia burgdorferi. Bacteria are transferred from the deer tick to the person when the tick bites and feeds on the person. This gives us our first opportunity to prevent Lyme disease. If you remove of attached within 18 to 24 hours you can reduce the risk of infection. Do not forget to check children and pets as well. Carefully remove attached ticks using tweezers. Grasp the tick's head and mouth parts as close to the skin as possible and pull slowly until the tick is removed. Do not twist or rotate the tick and try not to damage the tick (i.e., squash or crush it) during removal.
The symptoms of Lyme disease are often described as having three stages, although not all patients have symptoms of each stage. The first sign of infection is usually a circular rash called that’s been described as a “bull’s eye rash”. This rash occurs in about 70-80% of infected persons and begins at the site of the tick bite after a delay of three days to one month. Patients may also experience symptoms such as: fatigue, chills, fever, headache, muscle and joint pain, and swollen lymph nodes. If the infection goes untreated, the second stage of the disease can last up to several months with possible symptoms including: central and peripheral nervous system disorders, multiple skin rashes, arthritis, heart palpitations, extreme fatigue and general weakness. If the infection continues to go untreated, the third stage of the disease can last months to years with possible symptoms including, chronic arthritis and neurological symptoms.
The good news is since Lyme disease is caused by a bacteria, it can be treated with antibiotics. The earlier in the disease the doctor can start you on the antibiotics the better. Late stage disease may have to be treated with antibiotics for a long period of time.
I don’t want to scare anyone about Lyme disease. It is still something Manitobans are unlikely to catch. But forewarned is for-armed, and if you happen to see a lime green van driving around promoting Lyme disease awareness, talk to the driver. It could be a very interesting conversation. And phone someone you know that lives a long way away. Remember to marvel at how that familiar voice can travel so easily along those little wires.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
You know what is cool about a phone call from Hong Kong? It sounds just like a phone call from across the street. In today’s world of fax, email, Facebook, satellite phones, Skype videoconferencing, text messaging and many, many other forms of electronic communications, the overseas phone call is still almost magical to me. About a year ago a friend I grew up with called me from Hong Kong. He asked if I was going to Winnipeg in the following couple of weeks. It turned out I was, so he was asked if I could meet this guy, Allen for dinner. I said sure.
Allen was in Winnipeg because he was driving a bus for a tour company. He was taking people from a downtown hotel to the airport who were on their way to Churchill to see polar bears. Allen was originally from Texas, went to university in the eastern states and has had a variety of fascinating jobs. He had run for Congress, twice, had helped record music for a national book chain. He had played his small part as a member of the massive team that helped get Barack Obama elected president last year. He had many tales to tell. The one that came closest to my line of work involve a lime green van. Allen had driven this lime green van across the US to promote Lyme disease awareness. I have to admit, I really didn’t know much about Lyme disease, and after dinner with Allen, I quickly forgot about the story of the lime green van. However, recently Manitoba Health sent the pharmacy a Deer Tick information package. So thinking about Allen and his green van, I read it. Here is some of what it said.
Deer ticks are cousins to the wood tick that you are probably familiar with. They are smaller than wood ticks and they don’t have any white marks or streaks like wood ticks. They are of interest because deer tick can transmit Lyme disease to people. Deer ticks haven’t been in Manitoba long. Apparently they have only been identified here since 1989. Deer tick are predominantly in the south eastern part of the province and probably only 10% carry Lyme disease. Most Manitobans are unlikely to run into a deer tick. However, unlike wood ticks, deer ticks are more common in the fall. I guess that’s why Manitoba Health sent out the info package in the late summer.
Lyme disease is caused by the bacterium, Borrelia burgdorferi. Bacteria are transferred from the deer tick to the person when the tick bites and feeds on the person. This gives us our first opportunity to prevent Lyme disease. If you remove of attached within 18 to 24 hours you can reduce the risk of infection. Do not forget to check children and pets as well. Carefully remove attached ticks using tweezers. Grasp the tick's head and mouth parts as close to the skin as possible and pull slowly until the tick is removed. Do not twist or rotate the tick and try not to damage the tick (i.e., squash or crush it) during removal.
The symptoms of Lyme disease are often described as having three stages, although not all patients have symptoms of each stage. The first sign of infection is usually a circular rash called that’s been described as a “bull’s eye rash”. This rash occurs in about 70-80% of infected persons and begins at the site of the tick bite after a delay of three days to one month. Patients may also experience symptoms such as: fatigue, chills, fever, headache, muscle and joint pain, and swollen lymph nodes. If the infection goes untreated, the second stage of the disease can last up to several months with possible symptoms including: central and peripheral nervous system disorders, multiple skin rashes, arthritis, heart palpitations, extreme fatigue and general weakness. If the infection continues to go untreated, the third stage of the disease can last months to years with possible symptoms including, chronic arthritis and neurological symptoms.
The good news is since Lyme disease is caused by a bacteria, it can be treated with antibiotics. The earlier in the disease the doctor can start you on the antibiotics the better. Late stage disease may have to be treated with antibiotics for a long period of time.
I don’t want to scare anyone about Lyme disease. It is still something Manitobans are unlikely to catch. But forewarned is for-armed, and if you happen to see a lime green van driving around promoting Lyme disease awareness, talk to the driver. It could be a very interesting conversation. And phone someone you know that lives a long way away. Remember to marvel at how that familiar voice can travel so easily along those little wires.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, September 04, 2009
Hemoglobin A1C Testing for Diabetes
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 was watching PBS the other day. There was a guy telling an audience he could “cure” diabetes with the right diet. Some of what he said was reasonable. He was recommending lot of fruits and vegetables and less sugar, white bread and potatoes. I think he was exaggerating saying he could “cure” diabetes, though. The part I found really interesting was that he was talking about getting your hemoglobin A1C (HbA1C) checked. The hemoglobin A1C is a three month average of your blood sugars, and it doesn’t get enough attention.
If you are diabetic, you know you have to test your blood sugar. We have lots and lots of evidence from huge studies with funny names like DCCT and UKPDS that the closer a diabetic person keeps their blood sugar to normal values the less chance they have of getting the big four problems of diabetes.
The big four problems associated with diabetes are heart disease, kidney disease, amputation, and blindness. So, if you are diabetic you should follow your diet and exercise plan, use your medications appropriately, and test your blood sugar at home. Home blood sugar testing is one of the best ways for you to see if your diabetic plan that you developed with your health care professional is keeping your blood sugar within normal limits. And if you keep your blood sugar within normal limits, you are more likely to avoid the diabetes big four.
There is another test for blood sugar that fewer diabetics know about. It is called a hemoglobin A1C or glycosylated hemoglobin test. It sort of gives an average of how your blood sugar has been doing over the last 3 months, and should be done at least once a year. Let’s talk about how it works a little more.
Red blood cells carry oxygen in your blood. Red blood cells look like doughnuts with the hole in the middle not quite all the way through. Or another way to picture them is they look like a ball that has been pinched together in the middle. What red blood cells look like is important, because of what they do. A red blood cell picks up its load of oxygen in the lungs, goes through the heart, and drops off its oxygen at a tissue. To get to its tissue, the red blood cell must bend and squeeze to get through very narrow tubes called capillaries.
Now let’s add diabetes to the mix. If you have diabetes, you have too much sugar in your blood.
The hemoglobin A1C test checks to see how many of your red blood cells are coated with sugar. If your blood sugar control over the past 3 months has been good, your hemoglobin A1C will be good. Why does the hemoglobin A1C test 3 months worth of blood sugar control? Because red blood cells live about 3 months.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 was watching PBS the other day. There was a guy telling an audience he could “cure” diabetes with the right diet. Some of what he said was reasonable. He was recommending lot of fruits and vegetables and less sugar, white bread and potatoes. I think he was exaggerating saying he could “cure” diabetes, though. The part I found really interesting was that he was talking about getting your hemoglobin A1C (HbA1C) checked. The hemoglobin A1C is a three month average of your blood sugars, and it doesn’t get enough attention.
If you are diabetic, you know you have to test your blood sugar. We have lots and lots of evidence from huge studies with funny names like DCCT and UKPDS that the closer a diabetic person keeps their blood sugar to normal values the less chance they have of getting the big four problems of diabetes.
The big four problems associated with diabetes are heart disease, kidney disease, amputation, and blindness. So, if you are diabetic you should follow your diet and exercise plan, use your medications appropriately, and test your blood sugar at home. Home blood sugar testing is one of the best ways for you to see if your diabetic plan that you developed with your health care professional is keeping your blood sugar within normal limits. And if you keep your blood sugar within normal limits, you are more likely to avoid the diabetes big four.
There is another test for blood sugar that fewer diabetics know about. It is called a hemoglobin A1C or glycosylated hemoglobin test. It sort of gives an average of how your blood sugar has been doing over the last 3 months, and should be done at least once a year. Let’s talk about how it works a little more.
Red blood cells carry oxygen in your blood. Red blood cells look like doughnuts with the hole in the middle not quite all the way through. Or another way to picture them is they look like a ball that has been pinched together in the middle. What red blood cells look like is important, because of what they do. A red blood cell picks up its load of oxygen in the lungs, goes through the heart, and drops off its oxygen at a tissue. To get to its tissue, the red blood cell must bend and squeeze to get through very narrow tubes called capillaries.
Now let’s add diabetes to the mix. If you have diabetes, you have too much sugar in your blood.
The hemoglobin A1C test checks to see how many of your red blood cells are coated with sugar. If your blood sugar control over the past 3 months has been good, your hemoglobin A1C will be good. Why does the hemoglobin A1C test 3 months worth of blood sugar control? Because red blood cells live about 3 months.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, August 28, 2009
BENIGN PROSTATIC HYPERTROPHY
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
There are many joys of getting older. Hopefully the mortgage gets paid off, the kids leave home, I get to spoil grandchildren, I have trouble peeing, you know the good stuff. Apparently many of us guys have something in common. By the time we turn 80 years old, most of us will have benign prostatic hypertrophy.
The prostate is walnut size gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. The prostate surrounds the urethra, the canal through which urine passes out of the body. Benign prostatic hypertrophy (BPH) is a condition where a male's prostate becomes enlarged to the point that it causes discomfort. Common symptoms of BPH include needing to urinate often, feeling like you really need to go now, weak urine stream, feeling like you haven’t completely emptied your bladder, and more frequent nighttime urination. The prostate goes through two main periods of growth during a male's life. The first is puberty, where the prostate doubles in size. The gland begins to grow again at age 25. This second stage of growth is what may cause BPH much later life.
Symptoms of BPH rarely show up before age 40. However as men age, the chance of BPH symptoms go up. About 50 percent of men in their 60s have BPH symptoms and over 80 percent for men in their 80s have symptoms. Symptoms happen when swelling of the prostate starts to push against the urethra, much like clamping a garden hose. This causes the bladder wall to thicken and become irritable. The bladder starts to contract even when it contains only a small amount of urine. Eventually the bladder weakens and becomes incapable of empty itself completely, leaving behind urine. Although BPH and prostate cancer share similar symptoms, having BPH does not increase your chances of developing prostate cancer.
So what should you do if you have trouble urinating? Visit the doctor. They can determine if your symptoms are related to BPH and discuss treatment options.
Treatment of BPH is only recommended when it poses a health risk for the patient or when it becomes very bothersome. Mild BPH may not require treatment and it is very reasonable for the doctor to watch and wait to see if the symptoms get better or worse.
There are two main types of medications used to treat BPH. They are alpha blockers and 5-alpha-reductase inhibitors. Alpha blockers include alfuzosin, doxazosin and tamsulosin. Alpha blockers relax the smooth muscle in the prostate and the bladder neck. They work quite quickly, and gentlemen say they can pee more easily in about two weeks. 5-alpha-reductase inhibitors like dutasteride and finasteride stop the conversion of testosterone to dihydrotestosterone (DHT). DHT causes the prostate to grow. So 5-alpha-reductase inhibitors reduce the size of the prostate, which is good. Unfortunately these medications work slowly. It takes 6 months to a year on a 5-alpha-reductase inhibitor before a guy’s symptoms will improve.
Doctors often put guys on both an alpha blocker and a 5-alpha-reductase inhibitor together. That way the alpha blocker can get the guy to urinate more easily within two weeks while the 5-alpha-reductase inhibitor is slowly starting to shrink the gland. Also recent studies like the Combination of Avodart and Tamsulosin (CombAT) study have showed that the combination of these two types of drugs works better than either drug separately.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
There are many joys of getting older. Hopefully the mortgage gets paid off, the kids leave home, I get to spoil grandchildren, I have trouble peeing, you know the good stuff. Apparently many of us guys have something in common. By the time we turn 80 years old, most of us will have benign prostatic hypertrophy.
The prostate is walnut size gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. The prostate surrounds the urethra, the canal through which urine passes out of the body. Benign prostatic hypertrophy (BPH) is a condition where a male's prostate becomes enlarged to the point that it causes discomfort. Common symptoms of BPH include needing to urinate often, feeling like you really need to go now, weak urine stream, feeling like you haven’t completely emptied your bladder, and more frequent nighttime urination. The prostate goes through two main periods of growth during a male's life. The first is puberty, where the prostate doubles in size. The gland begins to grow again at age 25. This second stage of growth is what may cause BPH much later life.
Symptoms of BPH rarely show up before age 40. However as men age, the chance of BPH symptoms go up. About 50 percent of men in their 60s have BPH symptoms and over 80 percent for men in their 80s have symptoms. Symptoms happen when swelling of the prostate starts to push against the urethra, much like clamping a garden hose. This causes the bladder wall to thicken and become irritable. The bladder starts to contract even when it contains only a small amount of urine. Eventually the bladder weakens and becomes incapable of empty itself completely, leaving behind urine. Although BPH and prostate cancer share similar symptoms, having BPH does not increase your chances of developing prostate cancer.
So what should you do if you have trouble urinating? Visit the doctor. They can determine if your symptoms are related to BPH and discuss treatment options.
Treatment of BPH is only recommended when it poses a health risk for the patient or when it becomes very bothersome. Mild BPH may not require treatment and it is very reasonable for the doctor to watch and wait to see if the symptoms get better or worse.
There are two main types of medications used to treat BPH. They are alpha blockers and 5-alpha-reductase inhibitors. Alpha blockers include alfuzosin, doxazosin and tamsulosin. Alpha blockers relax the smooth muscle in the prostate and the bladder neck. They work quite quickly, and gentlemen say they can pee more easily in about two weeks. 5-alpha-reductase inhibitors like dutasteride and finasteride stop the conversion of testosterone to dihydrotestosterone (DHT). DHT causes the prostate to grow. So 5-alpha-reductase inhibitors reduce the size of the prostate, which is good. Unfortunately these medications work slowly. It takes 6 months to a year on a 5-alpha-reductase inhibitor before a guy’s symptoms will improve.
Doctors often put guys on both an alpha blocker and a 5-alpha-reductase inhibitor together. That way the alpha blocker can get the guy to urinate more easily within two weeks while the 5-alpha-reductase inhibitor is slowly starting to shrink the gland. Also recent studies like the Combination of Avodart and Tamsulosin (CombAT) study have showed that the combination of these two types of drugs works better than either drug separately.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, August 21, 2009
Hemorrhoids
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
Today we are going to talk about the part of your body you sit on. There used to be a Preparation H commercial that showed a hard wooden stool and said, “Does this scare you?” I thought this was a great way to use humor to start the conversation about an embarrassing topic. Discomfort around the anorectal area cause problems for about half the population at some point in their life. Unfortunately, as this is an embarrassing topic, many people simply suffer in silence. Others will use over the counter products instead of seeing their doctor. Since hemorrhoids are so common, let’s try to get more comfortable with them so the wooden stool won’t scare you.
What are hemorrhoids? They are swollen, twisted veins in the walls of the rectum or anus. If they are outside the anus they are called external hemorrhoids. If they are inside the anus, they are called internal hemorrhoids. External hemorrhoids may cause a lump. If a blood clot forms in the swollen, twisted vein, the lump may become more swollen and painful. Internal hemorrhoids may not form a lump or become painful, but they often bleed during bowel movements. Signs included blood streaked stool or toilet paper.
What causes hemorrhoids? Hemorrhoids happen when there is an increase in pressure in the veins of the anorectal area. The increase in pressure can be from pregnancy, heavy lifting, or straining when you go to the bathroom. Straining is often caused by constipation, so we want to keep stools soft. This leads us to believe that high fibre diet may help prevent hemorrhoids, while a low fibre diet (which leads to small hard stools) may help cause hemorrhoids. Hemorrhoids don’t seem to be passed on genetically. There seems to be no discrimination between men and women. (However, pregnancy makes hemorrhoids more likely.) You are more likely to get hemorrhoids the older you get. We used to say that straining to pass stool caused hemorrhoids, but more recent research suggests that sitting on the toilet for a long time may be a more likely culprit.
How can you treat hemorrhoids? If they aren’t causing you any discomfort, they don’t need to be treated. If you wish to prevent or treat hemorrhoids yourself, first consider fluids and fibre Eight glasses of water per day is recommended to establish good bowel habits. Water helps expand the fibre in the stool to make it bigger and softer. So, the next thing to do is increase the amount of fibre one eats. Unprocessed wheat bran is an excellent choice. Vegetables and fruit vary in their ability to absorb moisture. Carrots have the greatest absorption capacity of the vegetables, about half that of bran. Other high absorption vegetables are brussel sprouts, eggplant, spring cabbage and corn. High-absorption fruit include apples, pears, and oranges. Adding 20 to 30 g of fibre to your diet will help with symptoms of mild hemorrhoids. If you can’t seem to eat enough bran and veggies, consider a fibre supplement like Metamucil with psyllium in it. The final non-drug measure to relieve hemorrhoids is a sitz bath. A sitz bath is a tub of warm water (46oC) in which the person sits for 15 minutes at a time. Plastic sitz baths may be fitted over the toilet seat rim for greater convenience.
Without a prescription one can get a variety of hemorrhoid products. They have various ingredients in them like protectants and local anesthetics. There are a dozen or more different products, so instead of list them all, I'll just say ask your pharmacist. The key is though, don't self treat for more that 7-10 days. If the symptoms haven't cleared in 7-10 days, see your doctor.
What are some of the other red flags? If you experience any rectal bleeding, any rectal tissues protruding from the anal opening after a bowel movement, or if the patient is under 12 years old, see your doctor.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
Today we are going to talk about the part of your body you sit on. There used to be a Preparation H commercial that showed a hard wooden stool and said, “Does this scare you?” I thought this was a great way to use humor to start the conversation about an embarrassing topic. Discomfort around the anorectal area cause problems for about half the population at some point in their life. Unfortunately, as this is an embarrassing topic, many people simply suffer in silence. Others will use over the counter products instead of seeing their doctor. Since hemorrhoids are so common, let’s try to get more comfortable with them so the wooden stool won’t scare you.
What are hemorrhoids? They are swollen, twisted veins in the walls of the rectum or anus. If they are outside the anus they are called external hemorrhoids. If they are inside the anus, they are called internal hemorrhoids. External hemorrhoids may cause a lump. If a blood clot forms in the swollen, twisted vein, the lump may become more swollen and painful. Internal hemorrhoids may not form a lump or become painful, but they often bleed during bowel movements. Signs included blood streaked stool or toilet paper.
What causes hemorrhoids? Hemorrhoids happen when there is an increase in pressure in the veins of the anorectal area. The increase in pressure can be from pregnancy, heavy lifting, or straining when you go to the bathroom. Straining is often caused by constipation, so we want to keep stools soft. This leads us to believe that high fibre diet may help prevent hemorrhoids, while a low fibre diet (which leads to small hard stools) may help cause hemorrhoids. Hemorrhoids don’t seem to be passed on genetically. There seems to be no discrimination between men and women. (However, pregnancy makes hemorrhoids more likely.) You are more likely to get hemorrhoids the older you get. We used to say that straining to pass stool caused hemorrhoids, but more recent research suggests that sitting on the toilet for a long time may be a more likely culprit.
How can you treat hemorrhoids? If they aren’t causing you any discomfort, they don’t need to be treated. If you wish to prevent or treat hemorrhoids yourself, first consider fluids and fibre Eight glasses of water per day is recommended to establish good bowel habits. Water helps expand the fibre in the stool to make it bigger and softer. So, the next thing to do is increase the amount of fibre one eats. Unprocessed wheat bran is an excellent choice. Vegetables and fruit vary in their ability to absorb moisture. Carrots have the greatest absorption capacity of the vegetables, about half that of bran. Other high absorption vegetables are brussel sprouts, eggplant, spring cabbage and corn. High-absorption fruit include apples, pears, and oranges. Adding 20 to 30 g of fibre to your diet will help with symptoms of mild hemorrhoids. If you can’t seem to eat enough bran and veggies, consider a fibre supplement like Metamucil with psyllium in it. The final non-drug measure to relieve hemorrhoids is a sitz bath. A sitz bath is a tub of warm water (46oC) in which the person sits for 15 minutes at a time. Plastic sitz baths may be fitted over the toilet seat rim for greater convenience.
Without a prescription one can get a variety of hemorrhoid products. They have various ingredients in them like protectants and local anesthetics. There are a dozen or more different products, so instead of list them all, I'll just say ask your pharmacist. The key is though, don't self treat for more that 7-10 days. If the symptoms haven't cleared in 7-10 days, see your doctor.
What are some of the other red flags? If you experience any rectal bleeding, any rectal tissues protruding from the anal opening after a bowel movement, or if the patient is under 12 years old, see your doctor.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, August 14, 2009
Stye's
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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’ve got a stye. My wife is says it’s ugly. My co-workers don’t like looking at it. What should I do?”
Unfortunately, this is not the beginning of a conversation with a patient at the pharmacy. I have had a few stye’s in the past and I assume I’ll get them in the future. What do I do when I get a stye? First, I ignore my wife and her complaints about how ugly my eye looks until her complaining gets sufficiently loud. Then we put a hot wash cloth on it for a few nights, and sometimes a cold tea bag. If that doesn’t work, I see my doctor.
A stye, or hordeolum, is an infection of the eyelid glands. Stye’s are a very common eyelid infection. When people have stye’s, they usually only have swelling on one eyelid. The swelling will usually be sore and red (the more swollen, the more painful). The eye may water, become sensitive to bright light and feel like something is in it. Usually, only a small area of the eyelid is swollen, but sometimes the entire eyelid swells. Often a tiny, yellowish spot develops at the center of the swollen area, usually at the edge of the eyelid. The stye tends to pop after 2 to 4 days, releasing a small amount of pus and going away on its own.
The bacteria that most often causes the problems with stye’s is Staphylococcus aureus. There is a slight increase in number of stye cases when the patient is between 30 and 50 (I am in the zone!). People with diabetes, chronic eyelid infections, seborrhea, and people with high cholesterol are all more likely to get stye’s. I found the cholesterol one the most interesting. I don’t have high cholesterol, but if you do that increases how often the eyelid glands are blocked. Unfortunately, lowering the blood cholesterol doesn’t decrease the rate of stye formation.
What should you do if you get my favorite eye bump? Well, if you have any problems with your eyes that involve severe pain, being very sensitivity to all light, any vision disturbance, blunt trauma, chemical exposure, imbedded foreign body, heat exposure (e.g. welder’s arc), or eye protrusion please see a doctor immediately. If the problem is just with your eyelid, and your eyelid is swollen with a lump, it is probably a stye. You can treat it at home for 48 hours. If it doesn’t go away, you should see a doctor.
What can you do at home before you see the doctor? You can apply a hot wash cloth to your eye for 15 minutes four times a day. This will encourage blood flow to the area and hopefully it will spontaneously drain on its own. In between the hot wash cloth, you can try a cold (still wet) tea bag for 5 to 10 minutes. Some people believe that the tannic acid in the tea bag will help the stye dry up faster.
For my last stye, I had to see one of the family doctors at the walk-in clinic. The doctor recommended continuing with the hot compresses, and recommended cleaning my eyelashes with baby shampoo either with a eyelash brush (my make-up kit is surprisingly non-existent) or a cotton swab. Then I was given a prescription for an oral antibiotic, and an antibiotic eye ointment.
The eye ointment was interesting. I’ve told people for years how to use eye ointments, but I’ve never used one myself. What I had always told patients was that an eye ointment was much thicker than a drop. You pull down the bottom lid until it forms a pocket. Then you squeeze out a little ribbon of ointment (about ¼” to ½”) into the eyelid pocket. The problem is when you do that, the ribbon of ointment remains hanging off the end of the applicator and doesn’t break. You are supposed to twist your wrist to break the ribbon of ointment. That was still too hard for me. So I put the eye ointment on a cotton swab and used that.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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’ve got a stye. My wife is says it’s ugly. My co-workers don’t like looking at it. What should I do?”
Unfortunately, this is not the beginning of a conversation with a patient at the pharmacy. I have had a few stye’s in the past and I assume I’ll get them in the future. What do I do when I get a stye? First, I ignore my wife and her complaints about how ugly my eye looks until her complaining gets sufficiently loud. Then we put a hot wash cloth on it for a few nights, and sometimes a cold tea bag. If that doesn’t work, I see my doctor.
A stye, or hordeolum, is an infection of the eyelid glands. Stye’s are a very common eyelid infection. When people have stye’s, they usually only have swelling on one eyelid. The swelling will usually be sore and red (the more swollen, the more painful). The eye may water, become sensitive to bright light and feel like something is in it. Usually, only a small area of the eyelid is swollen, but sometimes the entire eyelid swells. Often a tiny, yellowish spot develops at the center of the swollen area, usually at the edge of the eyelid. The stye tends to pop after 2 to 4 days, releasing a small amount of pus and going away on its own.
The bacteria that most often causes the problems with stye’s is Staphylococcus aureus. There is a slight increase in number of stye cases when the patient is between 30 and 50 (I am in the zone!). People with diabetes, chronic eyelid infections, seborrhea, and people with high cholesterol are all more likely to get stye’s. I found the cholesterol one the most interesting. I don’t have high cholesterol, but if you do that increases how often the eyelid glands are blocked. Unfortunately, lowering the blood cholesterol doesn’t decrease the rate of stye formation.
What should you do if you get my favorite eye bump? Well, if you have any problems with your eyes that involve severe pain, being very sensitivity to all light, any vision disturbance, blunt trauma, chemical exposure, imbedded foreign body, heat exposure (e.g. welder’s arc), or eye protrusion please see a doctor immediately. If the problem is just with your eyelid, and your eyelid is swollen with a lump, it is probably a stye. You can treat it at home for 48 hours. If it doesn’t go away, you should see a doctor.
What can you do at home before you see the doctor? You can apply a hot wash cloth to your eye for 15 minutes four times a day. This will encourage blood flow to the area and hopefully it will spontaneously drain on its own. In between the hot wash cloth, you can try a cold (still wet) tea bag for 5 to 10 minutes. Some people believe that the tannic acid in the tea bag will help the stye dry up faster.
For my last stye, I had to see one of the family doctors at the walk-in clinic. The doctor recommended continuing with the hot compresses, and recommended cleaning my eyelashes with baby shampoo either with a eyelash brush (my make-up kit is surprisingly non-existent) or a cotton swab. Then I was given a prescription for an oral antibiotic, and an antibiotic eye ointment.
The eye ointment was interesting. I’ve told people for years how to use eye ointments, but I’ve never used one myself. What I had always told patients was that an eye ointment was much thicker than a drop. You pull down the bottom lid until it forms a pocket. Then you squeeze out a little ribbon of ointment (about ¼” to ½”) into the eyelid pocket. The problem is when you do that, the ribbon of ointment remains hanging off the end of the applicator and doesn’t break. You are supposed to twist your wrist to break the ribbon of ointment. That was still too hard for me. So I put the eye ointment on a cotton swab and used that.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, August 07, 2009
Tanning Beds
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 years ago, I was volunteering with Kinsmen to work at Safe Grad. We were working at the bar. I remember some of the female Grads coming up to the bar who were very tanned. Now remember high school graduation is in June, so there isn't a lot of time to tan outside before the event. I remember one young lady in particular had very dark, dry and wrinkly looking skin. I commented to one of the other volunteers that at 18 she already had the skin of a 40 year old. We assumed she had over done it on a tanning bed. It seems the World Health Organization says that use of tanning beds by young people does worse things than cause wrinkles. It can lead to skin cancer.
The WHO has a group called the International Agency for Research on Cancer or IARC. At the end of July the IARC moved UV tanning beds to its highest risk category –Group 1- “carcinogenic to humans.” Other Group 1 compounds include: arsenic, asbestos, and mustard gas. The IARC reported the re-classification in the Lancet Oncology journal. The argument used to be that the UVA light in tanning beds was safer than the UVA, and UVB light in sunshine. The IARC now calls UVA a Group 1 carcinogen and says that it should be avoided.
The IARC also says a specific group of people in particular should avoid tanning beds. It says if you first use a tanning bed before the age of 30, there is an associated 75% increase in melanoma risk. Melanoma is a type of skin cancer. So it is recommended that young people avoid UV tanning beds.
I found this report about tanning beds especially interesting. You see earlier this year, the Canadian Dermatology Association said Canadians born in the 1990’s are two to three time more likely to get skin cancer in their lifetimes compared to those born in the 1960’s. This report didn’t make any sense to me. It’s not that I didn’t believe it, the Canadian Dermatology Association are the Canadian skin experts, but it didn’t make sense. If I think about my childhood, we rarely wore sunscreen, never wore hats, got sun burnt at the beginning of every summer and spent lots of time outside. If I look at my children, they always have sunscreen and hats on, and if I do everything I am supposed to as a parent, they may never get a sun burn. Since there are more computers, video screens and since unlike my parents I am too scared to just send my kids out on their bikes unsupervised, they don’t spend as much time outside as I did. Why would my children (if the trend holds) be more likely to get skin cancer than me? You would think they should be more protected.
Well, there are probably lots of reasons the rate of skin cancer is increasing. The ozone may be thinner, doctors may be better now at diagnosing skin cancer or there may be other confounding factors that haven’t been thought of yet. I wonder if a big reason for the increase in skin cancer in those born in the 1990’s are tanning beds. I don’t remember anyone going to a tanning bed before my high school graduation. Now it seems to be almost a requirement. In addition to the IARC saying early exposure to a tanning bed increases your melanoma risk, the national institutes of health in the US published a study last year. The NIH found that the melanoma rates among young women in the United States tripled between 1973 and 2004. We don’t know for certain this is due to tanning beds, but there are suspicions.
So, before the users and owners of tanning beds shoot the messenger, are there any upsides to them? Well, arguably getting UV radiation exposure helps your skin produce Vitamin D. We need Vitamin D and Canadians are often Vitamin D deficient. I guess the problem is if you get that Vitamin D through the use of a tanning bed at 17, will you be rewarded with skin cancer at 47? Would it be safer to get Vitamin D by eating more oily fish or taking a Vitamin D pill? You will have to make that call. Just remember the next time you see someone who seems to have over done it at the tanning salon, they may be getting more than wrinkles.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 years ago, I was volunteering with Kinsmen to work at Safe Grad. We were working at the bar. I remember some of the female Grads coming up to the bar who were very tanned. Now remember high school graduation is in June, so there isn't a lot of time to tan outside before the event. I remember one young lady in particular had very dark, dry and wrinkly looking skin. I commented to one of the other volunteers that at 18 she already had the skin of a 40 year old. We assumed she had over done it on a tanning bed. It seems the World Health Organization says that use of tanning beds by young people does worse things than cause wrinkles. It can lead to skin cancer.
The WHO has a group called the International Agency for Research on Cancer or IARC. At the end of July the IARC moved UV tanning beds to its highest risk category –Group 1- “carcinogenic to humans.” Other Group 1 compounds include: arsenic, asbestos, and mustard gas. The IARC reported the re-classification in the Lancet Oncology journal. The argument used to be that the UVA light in tanning beds was safer than the UVA, and UVB light in sunshine. The IARC now calls UVA a Group 1 carcinogen and says that it should be avoided.
The IARC also says a specific group of people in particular should avoid tanning beds. It says if you first use a tanning bed before the age of 30, there is an associated 75% increase in melanoma risk. Melanoma is a type of skin cancer. So it is recommended that young people avoid UV tanning beds.
I found this report about tanning beds especially interesting. You see earlier this year, the Canadian Dermatology Association said Canadians born in the 1990’s are two to three time more likely to get skin cancer in their lifetimes compared to those born in the 1960’s. This report didn’t make any sense to me. It’s not that I didn’t believe it, the Canadian Dermatology Association are the Canadian skin experts, but it didn’t make sense. If I think about my childhood, we rarely wore sunscreen, never wore hats, got sun burnt at the beginning of every summer and spent lots of time outside. If I look at my children, they always have sunscreen and hats on, and if I do everything I am supposed to as a parent, they may never get a sun burn. Since there are more computers, video screens and since unlike my parents I am too scared to just send my kids out on their bikes unsupervised, they don’t spend as much time outside as I did. Why would my children (if the trend holds) be more likely to get skin cancer than me? You would think they should be more protected.
Well, there are probably lots of reasons the rate of skin cancer is increasing. The ozone may be thinner, doctors may be better now at diagnosing skin cancer or there may be other confounding factors that haven’t been thought of yet. I wonder if a big reason for the increase in skin cancer in those born in the 1990’s are tanning beds. I don’t remember anyone going to a tanning bed before my high school graduation. Now it seems to be almost a requirement. In addition to the IARC saying early exposure to a tanning bed increases your melanoma risk, the national institutes of health in the US published a study last year. The NIH found that the melanoma rates among young women in the United States tripled between 1973 and 2004. We don’t know for certain this is due to tanning beds, but there are suspicions.
So, before the users and owners of tanning beds shoot the messenger, are there any upsides to them? Well, arguably getting UV radiation exposure helps your skin produce Vitamin D. We need Vitamin D and Canadians are often Vitamin D deficient. I guess the problem is if you get that Vitamin D through the use of a tanning bed at 17, will you be rewarded with skin cancer at 47? Would it be safer to get Vitamin D by eating more oily fish or taking a Vitamin D pill? You will have to make that call. Just remember the next time you see someone who seems to have over done it at the tanning salon, they may be getting more than wrinkles.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, July 31, 2009
TOO MUCH ACETAMINOPHEN?
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 my line of work, dose is very important. Warfarin can stop a blood clot from giving you a stroke. This is good. Too much warfarin can make your brain bleed and cause a stroke. This is bad. “A little of this is good, more must be better,” definitely doesn’t apply to medications. If you take enough of anything it can be bad for you. Did you know you can drink enough water to cause swelling of the brain? The same goes for acetaminophen or Tylenol. We consider acetaminophen a very safe medication. However, too much acetaminophen can be harmful. In fact the FDA in the US is considering new regulations to limit the doses of acetaminophen.
Acetaminophen is used for pain and fever, but it does not reduce inflammation. Acetaminophen is less irritating to the stomach than some other over the counter products like ibuprofen, naproxen sodium or asa. Acetaminophen is found in many, many products. It can be a single ingredient like in Tylenol or in combination with other medications. Combination products include many cough and cold products, sinsus products, and pain medications like robaxacet. Also many prescription products like Tylenol #3 and Percocet have acetaminophen in them too. So you can see how it would not be difficult to accidentally take two or more products all with acetaminophen in them and so get too much.
If you take too much acetaminophen it can damage the liver and kidneys. Acetaminophen is usually metabolized by the liver. Your liver breaks it down into non-harmful chemicals and excretes it. If you take too much acetaminophen the usual metabolic pathway gets overwhelmed and the acetaminophen is broken down by another pathway which leads to a poisonous product. Some of the symptoms of acetaminophen poisoning are loss of appetite, nausea, vomiting, stomach pain, confusion, yellowing of the skin and eyes, coma and even possibly death.
At the end June 2009 a sub-committee at the Food and Drug Administration (FDA) in the US made some recommendations to the FDA about acetaminophen. They recommended prescription products with acetaminophen and other painkillers should be pulled off the market. The panel recommended that the daily maximum of acetaminophen should be lower than its current 4 grams (although they didn’t say what it should be). The panel would like the single dose maximum of acetaminophen to be reduced from 1000 mg to 650 mg. The panel would like 1000 mg of acetaminophen to only be available by prescription. However the panel rejected the idea of pulling cough and cold products that contain acetaminophen.
Now the FDA doesn’t have to follow the panel’s recommendations. But especially with the acetaminophen and strong painkiller combination prescription drugs, the panel cites that 60% of acetaminophen deaths are due to prescription products. Acetaminophen remains the leading cause of liver failure in the US despite years of warnings. And the panel says acetaminophen sends 56,000 people to the emergency room in the US every year.
Canada obviously doesn’t have to follow the decisions made by another country. But it will be interesting to see what Health Canada has to stay after studying the FDA decision. Will 1000 mg of acetaminophen become a prescription product? That could make for a whole lot of people needing to see their doctor in an already over-taxed health care system. Will medications like Percocet be pulled off the market? If yes, what will replace them? Oxycontin? It is effective, but has some issues with some people abusing or selling it. NSAID’s? They are effective, but will we now get more ulcers and kidney disease?
I think the answer should be for people to read their bottles of medication more carefully and ask their pharmacist before they take medications together. The FDA would argue we have been telling people that for years and it hasn’t helped. But does it make sense to take away useful drugs instead of coming up with better educational campaigns?
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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 my line of work, dose is very important. Warfarin can stop a blood clot from giving you a stroke. This is good. Too much warfarin can make your brain bleed and cause a stroke. This is bad. “A little of this is good, more must be better,” definitely doesn’t apply to medications. If you take enough of anything it can be bad for you. Did you know you can drink enough water to cause swelling of the brain? The same goes for acetaminophen or Tylenol. We consider acetaminophen a very safe medication. However, too much acetaminophen can be harmful. In fact the FDA in the US is considering new regulations to limit the doses of acetaminophen.
Acetaminophen is used for pain and fever, but it does not reduce inflammation. Acetaminophen is less irritating to the stomach than some other over the counter products like ibuprofen, naproxen sodium or asa. Acetaminophen is found in many, many products. It can be a single ingredient like in Tylenol or in combination with other medications. Combination products include many cough and cold products, sinsus products, and pain medications like robaxacet. Also many prescription products like Tylenol #3 and Percocet have acetaminophen in them too. So you can see how it would not be difficult to accidentally take two or more products all with acetaminophen in them and so get too much.
If you take too much acetaminophen it can damage the liver and kidneys. Acetaminophen is usually metabolized by the liver. Your liver breaks it down into non-harmful chemicals and excretes it. If you take too much acetaminophen the usual metabolic pathway gets overwhelmed and the acetaminophen is broken down by another pathway which leads to a poisonous product. Some of the symptoms of acetaminophen poisoning are loss of appetite, nausea, vomiting, stomach pain, confusion, yellowing of the skin and eyes, coma and even possibly death.
At the end June 2009 a sub-committee at the Food and Drug Administration (FDA) in the US made some recommendations to the FDA about acetaminophen. They recommended prescription products with acetaminophen and other painkillers should be pulled off the market. The panel recommended that the daily maximum of acetaminophen should be lower than its current 4 grams (although they didn’t say what it should be). The panel would like the single dose maximum of acetaminophen to be reduced from 1000 mg to 650 mg. The panel would like 1000 mg of acetaminophen to only be available by prescription. However the panel rejected the idea of pulling cough and cold products that contain acetaminophen.
Now the FDA doesn’t have to follow the panel’s recommendations. But especially with the acetaminophen and strong painkiller combination prescription drugs, the panel cites that 60% of acetaminophen deaths are due to prescription products. Acetaminophen remains the leading cause of liver failure in the US despite years of warnings. And the panel says acetaminophen sends 56,000 people to the emergency room in the US every year.
Canada obviously doesn’t have to follow the decisions made by another country. But it will be interesting to see what Health Canada has to stay after studying the FDA decision. Will 1000 mg of acetaminophen become a prescription product? That could make for a whole lot of people needing to see their doctor in an already over-taxed health care system. Will medications like Percocet be pulled off the market? If yes, what will replace them? Oxycontin? It is effective, but has some issues with some people abusing or selling it. NSAID’s? They are effective, but will we now get more ulcers and kidney disease?
I think the answer should be for people to read their bottles of medication more carefully and ask their pharmacist before they take medications together. The FDA would argue we have been telling people that for years and it hasn’t helped. But does it make sense to take away useful drugs instead of coming up with better educational campaigns?
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, July 24, 2009
ALEVE
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
Aleve is here. This is a pain killer that is heavily advertised on US television stations. It has always been available in Canada, but until very recently, only by prescription. Aleve is now available without a prescription in Canada.
Aleve has been available in the US without a prescription since 1994. It was quite a marketing feat when they launched it. Within one week of its launch, supermarket scanner data showed it was available in more than 90% of monitored stores. In two months it had over 6% of the market share. After 4 months it was tied for third place in its category. The makers of aleve spent over $100 million dollars in marketing during its first year. In fact they felt they had to pull the television ads for the last 3 months of 1994 for fear that the stores would run out of stock. Now that is a well marketed, well funded drug launch.
Is aleve better than other pain killers like ibuprofen (Advil), acetaminophen (Tylenol) or asa (aspirin)? Well it is different than acetaminophen (Tylenol), may be a little safer than asa and is practically the same as ibuprofen. Acetaminophen (Tylenol) is a good painkiller and good at relieving fever, but it doesn’t reduce inflammation. So, if you sprained your ankle, it would hurt and get swollen. Acetaminophen (Tylenol) would reduce the pain but not the swelling. Aleve would reduce both the pain and swelling so would probably work better. However, acetaminophen (Tylenol) is safer because it doesn’t cause ulcers, bleeding problems or affect the kidneys. When you compare aleve and asa, they both reduce pain and inflammation, but aleve is probably a little safer. ASA is more likely to cause bleeding problems (bleeding problems are possible with aleve but less likely) and asa is more likely to cause ulcers. Ibuprofen (advil) and aleve are very similar. They are both NSAIDs (non-steriodal anti-inflammatory drugs). In fact you can sub-divide NSAIDs into different sub-types, and even still ibuprofen (advil) and aleve are still both in the same sub-type called arylpropionic acids. So what does that mean? Well even though milligram for milligram aleve is stronger than ibuprofen, if you take an equivalent dose of each drug, they should work the same.
So what is in aleve? Aleve contains 220 mg of naproxen sodium. The claim is that it can relieve pain for up to 12 hours. Its prescription name used to be anaprox. For those of you who have a prescription of naproxen at home and wonder if it is the same thing, it is probably a little different. If you doctor wrote a prescription for naproxen , the pharmacist would have filled it with just plain naproxen, not naproxen sodium. When naproxen sodium was originally marketed as anaprox, the manufacturers claimed naproxen sodium worked a little faster than naproxen. On an interesting side note, naproxen sodium was never paid for by Manitoba’s pharmacare program even when it was prescription only, whereas plain naproxen is covered.
So who will aleve be good for? Younger patients with no pre-existing health conditions. If a person is between 20 and 50, has no history of ulcers, kidney problems or heart problems and sprains their ankle, aleve may be a good choice. The aleve should only be used for a relatively short time, like a couple of weeks, and if the pain lasts longer than a couple of weeks the person should see their doctor.
Who do I have concerns about? The elderly with arthritis. Compared to younger patients, people over 60 are about 4 times more likely to get bleeding in their stomachs from taking NSAIDs. People over 65 are more likely than younger patients to develop kidney problems while on NSAIDs. If you have arthritis, the pain you have is probably not only short term pain. I worry about people over 65 with arthritis treating their pain for months or years with aleve and not mentioning that to their doctors. Their doctors won’t know to monitor these people for kidney or stomach problems.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website 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.
Aleve is here. This is a pain killer that is heavily advertised on US television stations. It has always been available in Canada, but until very recently, only by prescription. Aleve is now available without a prescription in Canada.
Aleve has been available in the US without a prescription since 1994. It was quite a marketing feat when they launched it. Within one week of its launch, supermarket scanner data showed it was available in more than 90% of monitored stores. In two months it had over 6% of the market share. After 4 months it was tied for third place in its category. The makers of aleve spent over $100 million dollars in marketing during its first year. In fact they felt they had to pull the television ads for the last 3 months of 1994 for fear that the stores would run out of stock. Now that is a well marketed, well funded drug launch.
Is aleve better than other pain killers like ibuprofen (Advil), acetaminophen (Tylenol) or asa (aspirin)? Well it is different than acetaminophen (Tylenol), may be a little safer than asa and is practically the same as ibuprofen. Acetaminophen (Tylenol) is a good painkiller and good at relieving fever, but it doesn’t reduce inflammation. So, if you sprained your ankle, it would hurt and get swollen. Acetaminophen (Tylenol) would reduce the pain but not the swelling. Aleve would reduce both the pain and swelling so would probably work better. However, acetaminophen (Tylenol) is safer because it doesn’t cause ulcers, bleeding problems or affect the kidneys. When you compare aleve and asa, they both reduce pain and inflammation, but aleve is probably a little safer. ASA is more likely to cause bleeding problems (bleeding problems are possible with aleve but less likely) and asa is more likely to cause ulcers. Ibuprofen (advil) and aleve are very similar. They are both NSAIDs (non-steriodal anti-inflammatory drugs). In fact you can sub-divide NSAIDs into different sub-types, and even still ibuprofen (advil) and aleve are still both in the same sub-type called arylpropionic acids. So what does that mean? Well even though milligram for milligram aleve is stronger than ibuprofen, if you take an equivalent dose of each drug, they should work the same.
So what is in aleve? Aleve contains 220 mg of naproxen sodium. The claim is that it can relieve pain for up to 12 hours. Its prescription name used to be anaprox. For those of you who have a prescription of naproxen at home and wonder if it is the same thing, it is probably a little different. If you doctor wrote a prescription for naproxen , the pharmacist would have filled it with just plain naproxen, not naproxen sodium. When naproxen sodium was originally marketed as anaprox, the manufacturers claimed naproxen sodium worked a little faster than naproxen. On an interesting side note, naproxen sodium was never paid for by Manitoba’s pharmacare program even when it was prescription only, whereas plain naproxen is covered.
So who will aleve be good for? Younger patients with no pre-existing health conditions. If a person is between 20 and 50, has no history of ulcers, kidney problems or heart problems and sprains their ankle, aleve may be a good choice. The aleve should only be used for a relatively short time, like a couple of weeks, and if the pain lasts longer than a couple of weeks the person should see their doctor.
Who do I have concerns about? The elderly with arthritis. Compared to younger patients, people over 60 are about 4 times more likely to get bleeding in their stomachs from taking NSAIDs. People over 65 are more likely than younger patients to develop kidney problems while on NSAIDs. If you have arthritis, the pain you have is probably not only short term pain. I worry about people over 65 with arthritis treating their pain for months or years with aleve and not mentioning that to their doctors. Their doctors won’t know to monitor these people for kidney or stomach problems.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
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