SUN SCREENS

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Last week my daughter’s school, MacNeill, had a Family BBQ over the lunch hour. It was hot. Emily informed me that she had sunscreen on, and asked me if I did. Of course I forgot. I also wasn’t wearing a hot to protect my head which seems to have less hair on it everyday. So this summer whether you are going to the Fair, Countryfest, Ukrainian Festival and all those other wonderful summer Parkland activities, don’t forget the sunscreen and a hat.

Skin cancer is the most commonly occurring cancer in Canada, and the fastest growing cancer in the world. In 2000 68,000 Canadians were diagnosed with non-melanoma skin cancer, and 3,700 with malignant melanoma, the more aggressive form of the disease. In 2003 the estimates are 75,000 Canadians with non-melanoma skin cancer and 3,900 with malignant melanoma. Since 1988 the death rate from malignant melanoma is up 41% for men and 23% in women. The Canadian Cancer Society says that anyone born today has a one in seven chance of getting skin cancer in their lifetime.

The Canadian Dermatology Association recommends:

• Reduce sun exposure between 11 a.m. and 4 p.m. The sun's rays are at their strongest between these hours. It's easy to remember - during these hours your shadow is shorter than you are. If you can, plan your outdoor activities before 11 a.m. or after 4 p.m.
• GOLFERS: Choose a high SPF product – 30 – 60 – that offers greater protection as you may be out for more than four hours. Use a golf umbrella or golf cart for personal shade. If possible, wait for play in shaded, treed areas.
  
• Cover your arms and legs. Covering your skin will protect it from the sun. Choose clothing that is: loose fitting; tightly woven; and lightweight.
  Wear a wide-brimmed hat (3 inches or 7.5 cm). Most skin cancers occur on the face and neck. This area needs extra protection. Wear a hat with a wide brim that covers your head, face, ears and neck. Hats without a wide brim, like baseball caps, do not give you enough protection.
• Use a sunscreen with SPF (Sun Protection Factor) SPF 30 or higher. Look for "broad spectrum" on the label. This means that the sunscreen offers protection against two types of ultraviolet rays, UVA and UVB. Don’t forget to use SPF 30, broad spectrum lip balm.
  Apply sunscreen generously, 20 minutes before outdoor activities.
• Reapply often - at least every 2 hours (and after swimming or exercise that makes you perspire). No sunscreen can absorb all of the sun's rays.
• Use sunscreen along with shade, clothing and hats - not instead of them. Use sunscreen as a backup in your sun protection plan.
  
• Keep babies under one year out of the direct sun. Babies need extra protection because their skin is very sensitive. Keep your child's stroller, playpen or carriage in the shade.
  
  For More Information visit:
  The Canadian Cancer Society: www.cancer.ca
  The Canadian Dermatology Association www.dermatology.ca
  
  As always if you have any questions or concerns about these or other products, ask your pharmacist.

THE FLU - Audio

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Thanks to all the good people at the Parkland's Best Music 730 CKDM
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THE FLU

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have most of the articles published in the Parkland Shopper on our Website 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.

I watch way too much television. I was watching a bit on the History Channel about Venice, Italy. During the Bubonic Plague outbreak in Europe in the 1600’s, Venice had an effective, if brutal, infection control program. You see as the Plague was killing a quarter of the population of Europe, the people of Venice just shipped their sick to an island. Anyone in Venice who had any plague symptoms was stuck on this one island to die. The infection rate in Venice stayed lower than other parts of Europe.

Despite the high media interest, I don’t think we should ship all Manitoba flu cases to Hecla Island. The media interest sure is intense, though. Last week my mom emailed me because the news said Dauphin had confirmed H1N1 flu cases. Then my sister-in-law called my wife because she thought the news said Dauphin had closed and quarantined its schools. Last week neither of these things were true. The only thing that seems to spread faster than the flu is bad news about the flu.

I don’t want to minimize the seriousness of H1N1. At the time of writing we had nearly 300 confirmed cases and we have had our first two deaths. However, the experts are still talking about only 1 in 1000 people who get H1N1 will get serious symptoms. Let’s look at the H1N1 timeline. The H1N1 virus seems to have sprouted up in Mexico in April 2009. Then it spread to the US and Canada. And shortly thereafter through the miracle of airplane travel it went around the world. The World Health Organization has a really interesting website that you can follow the world wide spread day by day. http://www.who.int/csr/disease/swineflu/en/

On June 6, 2009 the WHO decided H1N1 had reached a Pandemic level six. That is the WHO’s highest pandemic level. The declaration marks the first pandemic call since 1968, when the Hong Kong flu killed about one million people. Although Pandemic sounds dramatic, it means the virus spreads easily between people in two or more areas of the world. It really doesn’t say anything about how severe the illness is once someone contracts it. Although the over 28,000 cases of swine flu worldwide and the about 150 deaths sounds scary and any illness or death of someone close to you is traumatic, it is important to keep the numbers in perspective. Regular seasonal flu kills 250,000 to 500,000 people worldwide per year.

So what can you do to protect yourself and your family?
-Keep your immune system healthy. Eat health foods, get regular, moderate exercise and get enough sleep. If you let yourself get run down, you are more likely to get the flu.
-Cough or sneeze into your elbow or a tissue. If you cough on your hand, and then touch someone, you can pass on the virus.
-Wash you hands often, especially after you cough or sneeze. You still have to use soap and water if you can see dirt on your hands. The alcohol-based hand cleaners are fine in between soap hand washings to kill germs, but they don’t remove dirt.

What do should you do if you get the flu?
-Stay home from work or school. Try to limit the number of people you come in contact with.
-Wash your hands often.
-Remember you may be contagious for up to a week.
-If you are having trouble breathing, go to the hospital.

On the good news side last week the pharmaceutical company Novartis announced they had an H1N1 vaccine ready for human testing. They plan to have it ready for use in the fall.

For more information:
Manitoba Health
http://www.gov.mb.ca/flu/index.html
World Health Organization (WHO)
http://www.who.int/csr/disease/swineflu/en/

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

COLD SORES - Audio

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Thanks to all the good people at the Parkland's Best Music 730 CKDM
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COLD SORES

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 associate cold sores with small blisters on the outside of the lip. Apparently they can occur anywhere on the body, but most often appear on gums, lips, inside of the cheek, nose and fingers. Cold sores are caused by the Herpes Simplex Virus (HSV). There are different types of Herpes Simplex Virus but the type that most often causes cold sores is called Herpes Simplex Type 1 (HSV-1). Most of us will get at least one cold sore in our lifetime. A HSV-1 infection happens when the virus gets on the skin or muscous membrane. It eventually makes its way into some nerve cells and stays there for life. So, the percentage of us that have HSV-1 in us goes up as we age. So in young adults 20% to 40% are infected. Each year beyond age 29, another 1.5% of patients reportedly contract the infection, up to age 50. By age 70, 90% of us will be infected.

About half the people who get cold sores know when one is coming. They will describe a tingling, burning or stinging sensation in the area where the cold sore is going to erupt. We call this feeling prodromal symptoms. The first visual sign is usually fluid filled blisters. Next the blisters break and ooze liquid that is just teaming with millions of viruses. Finally, the broken blisters scab over and start to heal. The entire batch of cold sore symptoms usually lasts 7 to 10 days. After the symptoms have resolved, the virus goes back into the nerve cells and hides until the next outbreak.

Outbreaks can be triggered by trauma to the skin, menstruation, sun exposure, stress, illness, fever and anything else that reduces the body's immune system. Most people only have two occurrences per year, but 5-10% of patients can have more than 6 episodes per year.

We can't cure cold sore infections. There are a few prescription and over the counter medications that can help reduce the number of days an outbreak lasts.

Valacyclovir 2000 mg twice a day for 1 day can be very effective if it is started within 6 hours of the beginning of symptoms. As valacyclovir an anti-viral medication we believe it suppresses how fast the virus can replicate. The study I read found the valacycolvir group's cold sores healed 1 day or 24 hours faster than the placebo group. The downside is valacycolvir is a prescription product and expensive. You would almost need your doctor to prescribe it to you ahead of time so you would have it when you feel the first symptoms of your next outbreak.

There are two over the counter products I recommend for cold sores. They are Abreva and Lipactin. Abreva is the newer product but also the more expensive one. Abreva contains docosanol 10% and is supposed to prevent viruses from entering the cells and thus reduce their ability to reproduce. Abreva should be started as soon as someone has symptoms and should be used five times a day. If the cold sore doesn't go away in 10 days, the person should see a doctor. There was a fairly large, double blind placebo controlled trial with Abreva. In the study 370 Abreva treated patients had their cold sores heal 18 hours faster than the 367 placebo patients.

Lipactin contains 17.8 units of heparin and 0.56 mg of zinc sulfate per gram. As with Abreva it should be used as soon as the person notices symptoms and again it should be used about 5 times per day. Apparently there are studies backing up lipactin’s use as well, but I couldn’t find them. What I do know is it is cheaper than Abreva and anecdotally many people have used it and been happy with the results.

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

TOPICAL ARTHRITIS MEDICATIONS- Audio

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TOPICAL ARTHRITIS MEDICATIONS

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.

The other day Linda Watt invited me to talk to Dauphin’s Arthritis Support Group. I’ve talked to them before and they are always a fun and interesting bunch. They usually have lots of feedback and strong opinions, and this time was no exception. They asked me to talk about topical medications for arthritis. Here is some of what we talked about.

Topical medications simply means medications you rub on your skin. To keep them straight in my head, I put them into four groups. I called them Smelly, Skin Deep, Joint Deep and Whole Body.

The smelly topicals smell "mediciny". They usually have menthol, camphor and/or phenol in them. They may heat or cool the skin (e.g. Deep Cold and BenGay). Although some people really like them, they don't have any proven efficacy. The act of rubbing alone might be what makes the joint feel better.

Skin Deep topicals just effect the top layer of the skin. There are over-the-counter (OTC) skin deep topicals that have studies to prove their efficacy. The OTC topical medications that work the best have capsaicin in them. Capsaicin is made from hot chili peppers. Capsaicin does work, but it has its limitations. Capsaicin works on a chemical messenger called Substance P. When Substance P is released from a pain receptor in the skin, a pain signal is started and eventually reaches the brain. When the pain signal reaches the brain, you feel a burning sensation. The interesting thing is there is only so much Substance P, so if you rub capsaicin cream on the area 3-5 times a day, that area runs out of Substance P. With no Substance P, the pain signal can't be started, so no pain! Capsaicin cream has considerable downsides, though. It will make the area hurt MORE the first few applications. If you don't use it regularly 3-5 times per day, the pain will come back. It is made of hot chili peppers, so if you accidentally rub it into your eyes, it will hurt (a lot). Use gloves when applying, or wash your hands really well.

The next group I call Joint Deep. It is actually quite difficult to get a medication through the skin and into the joint. The skin is a very effective barrier to the outside world and one of its jobs is to keep stuff out. One of the first methods I know of that successfully got the arthritis medications called NSAID's through the skin is called Pluronic Lecithin Organogel or PLO. These PLO gels were developed by compounding pharmacists. When you make these PLO gels, the NSAID particles are hidden inside little balls called micelles. If the micelles are made small enough, the micelles can sneak NSAIDs through the skin. It does take some skill and knowledge from the pharmacist to make the PLO gel properly, and all compounded products require a prescription.

So why does it matter if you can get NSAID’s through the skin? Well NSAID's when swallowed in pill form can cause ulcers in the stomach, make a patient bleed more easily and effect their kidney function. So theoretically if we can get NSAID’s directly into the joint we can have all the good effects of reducing pain and inflammation and none of the bad effects. Unfortunately, a small amount of the topical NSAID’s can get passed through the joint to the rest of the body. So even topical NSAIDs have a small risk of causing bleeding problems, ulcers and kidney problems.

The last group of topical medications I talked about, I called whole body topical medications. These include medications like the Fentanyl Patch. This is a powerful narcotic pain killer that can be applied to the skin, but is designed to send medication to the whole body. Some of the advantages of this type of medication is that it is long lasting (one fentanyl patch lasts 3 days) and that it avoids the mouth and stomach. Avoiding the mouth and stomach can be important for example if someone was very nauseous. Although the fentanyl patch can be appropriate for some arthritis patients, its use is reserved for those with the most severe pain.

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