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%
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