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.
Terry O'Reilly is an ad producer and also comments on advertising in a radio show called The Age of Persuasion. In one episode he talked about some unwritten rules of advertising such as women in beer ads are impossibly good looking and beer is always to be served in glasses that are dripping with condensation. I’d like to add one of my own. When you see an ad on TV for blood sugar testing machines, you never see anyone poking their finger.
At least a couple of times a month, I get a diabetic in the pharmacy asking for that machine that can check their sugars without a finger poke. I get the pleasure of telling them it doesn’t exist. The customer is never very happy with that answer and I understand why. Poking your finger several times a day to check your blood sugar is annoying and painful. Isn’t there a better way?
Checking you blood sugar without getting your finger poked is possible, but not simple. A decade ago, I was playing pool with another pharmacist and a friend of his. The friend was a graduate student in biochemistry, so I asked what he was working on. He said they had developed a piece of equipment that could test someone’s blood sugar without the diabetic person having to poke their finger! I was immediately interested and asked him more. He said it worked by firing infra-red light through the skin and figuring out the blood sugar from that. I was floored! This was definitely something that every diabetic would want! The researcher said the piece of equipment was about the size of a VCR and wasn’t commercially available. Oh well.
Jumping back to the present, there is one poke free machine available in Canada. It is called the Guardian REAL-Time Continuous Glucose Monitoring System made by Medtronic. Before you get too excited, it is not really the finger poking replacement I was hoping for. On the positive side it has a small wireless transmitter that sends blood sugar readings to a machine without a finger poke. On the negative side, the transmitter itself is has needle that must go under the skin and you have to poke your finger up to three times a day to calibrate the meter. The Guardian wasn’t really designed to replace finger pokes. It was designed to continuously monitor your blood sugar and be used with an insulin pump. One of the problems with leaving a needle in the skin to continuously monitor the blood sugar is it may cause local inflammation which can effect the blood sugar readings. That is why you still need to finger poke to calibrate the machine.
Other interesting technology involves lasers. I just like saying lasers. A hole is still poked in the skin, but it is supposed to be painless, about the width of a human hair and drilled into just the outer layer of the skin with lasers. The fluid that comes out is called interstitial fluid and can be tested for sugar. Again this is really more for continuous sugar monitoring. You need to poke the finger once a day to calibrate the machine and you have to measure the temperature of the skin to keep the readings accurate.
There was a cool sounding product in the US called the Glucowatch G2 Biographer. It generated a small electrical current the sucked sodium ions out of the skin which pulled water and glucose along. The process is called reverse iontophoresis. So the good news is it actually got a blood glucose reading without poking a hole in the skin. The problems were it often required a finger poke to calibrate it, it took 2 hours to warm up before it would work and it was very expensive. It never was marketed in Canada, and to the best of my knowledge they have stopped selling it in the US.
Then there is my favorite, infrared light. The machines to measure blood sugar with infrared light have shrunk down from the size of a VCR. And we can successfully measure other things in the blood with infrared. For a long time now we put little infrared clips on people’s fingers to measure the oxygen saturation of their blood. Unfortunately, it isn’t so easy for glucose. Things like dehydration, body temperature, hemoglobin level and even medications effect how well the infrared light can measure the glucose level. So, again there are many finger pokes to calibrate the machines.
Recently, there was a new device developed by the company GlySens. It is an implantable device that is put under the skin. It has been in pigs for more than a year and seems to be working well. The best news is it doesn’t seem to need calibration with finger pokes. But it has not been tested in people yet.
So maybe art really does imitate life. The women in Dauphin are impossibly good looking. The beer is always so cold it forms condensation on the glass. But as for blood sugar tests without finger pokes? Not just yet.
Link to Juvenile Diabetes Research Foundation – artificial pancreas project: www.artificialpancreasproject.com
Link to Candian Journal of Diabetes article on less invasive home blood sugar monitoring: www.diabetes.ca/files/HomeGlucoseGabbaySept03.pdf
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, August 06, 2010
Friday, July 30, 2010
ARTHRITIS
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
The Public Health Agency of Canada released a tiny little 128 page report on July 19 called “Life with Arthritis in Canada”. While I was manning my post at the Winnipegosis Clinic Pharmacy last week, I had a flip through it, and it contained some surprising things.
Manitoba has an average amount of arthritis according to the report. For people 15 and over, Manitoba had 156,349 people with arthritis in 2007-08. That works out to 15.2 people with arthritis for every 100 people in Manitoba. In 2001 survey of disabilities in Canada, in the top ten causes of disability, arthritis was the most frequently reported cause of disability among women and second most frequently mentioned condition among men. Arthritis costs the Canadian economy $6.4 billion per year in health care expenses and lost work days. Arthritis accounts for 6% of all hospitalizations in Canada.
What is arthritis? Arthritis literally means “inflammation of the joint”. As the Arthritis Society points out arthritis encompasses over 100 conditions ranging from tennis elbow, and gout on the mild end to severe crippling forms of rheumatoid arthritis and arthritis related disease like systemic lupus erythematosus. We are going to talk about the two most common types: osteoarthritis and rheumatoid arthritis. Osteoarthritis (OA) is a complicated disease, but on its simplest level it is when the cartilage in a joint wears out and bone rubs on bone. Rheumatoid arthritis (RA) is an autoimmune disease condition in which the body’s own immune system attacks the lining of the joints.
So if the joint wears out in osteoarthritis, what is a normal joint like? In a normal joint, a tough, smooth, elastic-like material called cartilage lets the two ends of the bones in the joint slide by each other with almost no friction. As cartilage wears down, bits can break off and go into the soft tissue around the joint and cause pain. The new thing I learned as I was researching this article is that cartilage doesn’t have any nerve endings, so it doesn’t feel any pain. The pain from OA is from the cords that connect muscle to bone (tendons), bone to bone (ligaments) and the muscles which are forced to work in ways they weren’t designed to because of the cartilage break down. When the cartilage breaks down so much that bone rubs on bone, the bone can thicken and form spurs.
What symptoms might I have if I had osteoarthritis? Pain, stiffness and swelling around a joint that lasts longer than 2 weeks. Unlike rheumatoid arthritis, morning pain and stiffness usually lasts less than 30 minutes. Although there can be swelling around the joint in OA, it is usually less than that expected in rheumatoid arthritis. The joints usually affected are the hips, knees and spine. Finger and thumbs joints may also be affected.
Rheumatoid arthritis (RA) is an autoimmune disease condition in which the body’s own immune system attacks the lining of the joints. The first symptom a patient might notice is pain in the hand or foot joints but can also affect other joints. Unlike osteoarthritis, in rheumatoid arthritis morning stiffness usually lasts longer than 30 minutes. The pain of RA can be in 3 or more joints at the same time. (Often osteoarthritis effects only one joint like a knee.) The pain from RA can last all night long. The pain from RA can be symmetrical on both sides of the body. That means, for example, both your wrist are sore. Other symptoms a person might experience include fatigue, dry eyes, dry mouth, fever and/or chills. RA can cause the immune system to attack other internal organs like the eyes, lungs and heart.
Treatment for both types of arthritis often starts with non-steroidal anti-inflammatory drugs or NSAIDS like ibuprofen, diclofenac or naproxen. These medications can work well for the pain, and inflammation but have side effects like stomach upset, risk of ulcers, and risk of increasing blood pressure. In osteoarthritis sometimes synovial fluid replacements can be injected directly into the joint and help lubricate it. It can be effective. It is used most often on knees and it is expensive. In rheumatoid arthritis the body’s own immune system is attacking the joints. The most common medication to calm the immune attack in mild RA is hydroxychloroquine and is generally well tolerated. For moderate RA, methotrexate once a week is very common and seems to work very well. Depending on the DMARD, these drugs can take 6 weeks to 6 months to work.
As our population ages, more disability will be caused by arthritis. Hopefully new and better treatments will keep pace.
For more information visit www.arthritis.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
The Public Health Agency of Canada released a tiny little 128 page report on July 19 called “Life with Arthritis in Canada”. While I was manning my post at the Winnipegosis Clinic Pharmacy last week, I had a flip through it, and it contained some surprising things.
Manitoba has an average amount of arthritis according to the report. For people 15 and over, Manitoba had 156,349 people with arthritis in 2007-08. That works out to 15.2 people with arthritis for every 100 people in Manitoba. In 2001 survey of disabilities in Canada, in the top ten causes of disability, arthritis was the most frequently reported cause of disability among women and second most frequently mentioned condition among men. Arthritis costs the Canadian economy $6.4 billion per year in health care expenses and lost work days. Arthritis accounts for 6% of all hospitalizations in Canada.
What is arthritis? Arthritis literally means “inflammation of the joint”. As the Arthritis Society points out arthritis encompasses over 100 conditions ranging from tennis elbow, and gout on the mild end to severe crippling forms of rheumatoid arthritis and arthritis related disease like systemic lupus erythematosus. We are going to talk about the two most common types: osteoarthritis and rheumatoid arthritis. Osteoarthritis (OA) is a complicated disease, but on its simplest level it is when the cartilage in a joint wears out and bone rubs on bone. Rheumatoid arthritis (RA) is an autoimmune disease condition in which the body’s own immune system attacks the lining of the joints.
So if the joint wears out in osteoarthritis, what is a normal joint like? In a normal joint, a tough, smooth, elastic-like material called cartilage lets the two ends of the bones in the joint slide by each other with almost no friction. As cartilage wears down, bits can break off and go into the soft tissue around the joint and cause pain. The new thing I learned as I was researching this article is that cartilage doesn’t have any nerve endings, so it doesn’t feel any pain. The pain from OA is from the cords that connect muscle to bone (tendons), bone to bone (ligaments) and the muscles which are forced to work in ways they weren’t designed to because of the cartilage break down. When the cartilage breaks down so much that bone rubs on bone, the bone can thicken and form spurs.
What symptoms might I have if I had osteoarthritis? Pain, stiffness and swelling around a joint that lasts longer than 2 weeks. Unlike rheumatoid arthritis, morning pain and stiffness usually lasts less than 30 minutes. Although there can be swelling around the joint in OA, it is usually less than that expected in rheumatoid arthritis. The joints usually affected are the hips, knees and spine. Finger and thumbs joints may also be affected.
Rheumatoid arthritis (RA) is an autoimmune disease condition in which the body’s own immune system attacks the lining of the joints. The first symptom a patient might notice is pain in the hand or foot joints but can also affect other joints. Unlike osteoarthritis, in rheumatoid arthritis morning stiffness usually lasts longer than 30 minutes. The pain of RA can be in 3 or more joints at the same time. (Often osteoarthritis effects only one joint like a knee.) The pain from RA can last all night long. The pain from RA can be symmetrical on both sides of the body. That means, for example, both your wrist are sore. Other symptoms a person might experience include fatigue, dry eyes, dry mouth, fever and/or chills. RA can cause the immune system to attack other internal organs like the eyes, lungs and heart.
Treatment for both types of arthritis often starts with non-steroidal anti-inflammatory drugs or NSAIDS like ibuprofen, diclofenac or naproxen. These medications can work well for the pain, and inflammation but have side effects like stomach upset, risk of ulcers, and risk of increasing blood pressure. In osteoarthritis sometimes synovial fluid replacements can be injected directly into the joint and help lubricate it. It can be effective. It is used most often on knees and it is expensive. In rheumatoid arthritis the body’s own immune system is attacking the joints. The most common medication to calm the immune attack in mild RA is hydroxychloroquine and is generally well tolerated. For moderate RA, methotrexate once a week is very common and seems to work very well. Depending on the DMARD, these drugs can take 6 weeks to 6 months to work.
As our population ages, more disability will be caused by arthritis. Hopefully new and better treatments will keep pace.
For more information visit www.arthritis.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, July 23, 2010
Asthma and Other Diseases
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’m the King of the World!” That may be the most famous line yelled from the front of a ship. However the real story about the discovery of the Titanic was fascinating too. Dr. Robert Ballard had a long time interest in the Titanic and had developed some equipment and the underwater robot Argo that could look for it. The US Navy had no interest in the Titanic, but it wanted to find two of its submarines that had sank. So they struck a deal. Ballard would look for the two subs, and could use the money left over to find the Titanic. When Ballard found the subs, he found that each had a long trail of debris that led to the sub. The debris trail was relatively easy to find, and he could follow it to the sub. Ballard used this technique to follow the debris trail and find the Titanic on September 1, 1985. Are diseases like asthma a debris trail to other conditions?
Asthma is usually associated with young, otherwise healthy people. Unlike diabetes which seems to directly or indirectly cause heart disease, kidney disease, blindness, amputation and other conditions, asthma isn’t usually associated with other conditions. During some of my asthma training we were told that there is an asthma, eczema, allergic rhinitis triad. That means people with asthma often also have the skin condition eczema and the runny nose that comes from allergic rhinitis. We aren’t exactly sure why. It may be genetics or environment, but whatever goes wrong with the immune system to cause asthma also seems to be involved with eczema and allergic rhinitis. So I was really interested when I heard there was a study in Ontario that was looking into what other diseases people with asthma get.
The study I read was published by Gershon et al. in the July issue of Thorax. It looked at 4 databases that covered all 12 million people in Ontario in 2005. They found that there were about 1.7 million people in Ontario with asthma or about 13% of the population. Of those people with asthma, they determined about 400,000 had active asthma, and the rest were determined to be less active asthma.
One of the main measures the researchers used to detetmeine how sick the patients were was how often their doctors made a claim to Ontario Health. Over one year for every 100 active asthma patients their doctors made an average of 1616 claims for clinic visits. For non-asthmatics, for every 100 patients their doctors billed Ontario Health an average of 942 times in one year. So the authors estimated that there were an extra 674 claims for the asthmatics.
Another way of looking at is for all the health claims in Ontario 6% of all clinic claims, 8% of all ER visits, and 6% of all hospitalizations were from asthmatics from diseases other than their asthma. That would be like an asthmatic visiting their doctor for depression.
As I said before, these extra co-existing conditions in the asthmatics is interesting because we usually think of asthmatics as being young and otherwise healthy. For example of all the identified active asthmatics in the 2005 Ontario study, the average age of an active asthmatic was 31 years old. However this group had more than twice as many claims for non-asthma respiratory diseases, almost twice as many psychiatric conditions like depression and anxiety and more musculoskeletal claims than the non-asthmatic control group.
Now for the chicken and egg part. Does having asthma make you more likely to get a psychiatric condition like depression? We don’t know. Does treating asthma with inhaled steroids make you more likely to get a musculoskeletal condition like osteoporosis? We don’t know. Do some of these other conditions make it more likely to get asthma? We don’t know. We need more studies.
If you look in the sky, it can be very hard to see a tiny jet plane. But if you follow the contrails or smoke from the plane, you can more easily find it. Dr. Ballard used the debris trail to find the Titanic. Is asthma like a debris trail we can use to find more diseases in a person? We don’t know yet, but it will be interesting to follow the trail.
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’m the King of the World!” That may be the most famous line yelled from the front of a ship. However the real story about the discovery of the Titanic was fascinating too. Dr. Robert Ballard had a long time interest in the Titanic and had developed some equipment and the underwater robot Argo that could look for it. The US Navy had no interest in the Titanic, but it wanted to find two of its submarines that had sank. So they struck a deal. Ballard would look for the two subs, and could use the money left over to find the Titanic. When Ballard found the subs, he found that each had a long trail of debris that led to the sub. The debris trail was relatively easy to find, and he could follow it to the sub. Ballard used this technique to follow the debris trail and find the Titanic on September 1, 1985. Are diseases like asthma a debris trail to other conditions?
Asthma is usually associated with young, otherwise healthy people. Unlike diabetes which seems to directly or indirectly cause heart disease, kidney disease, blindness, amputation and other conditions, asthma isn’t usually associated with other conditions. During some of my asthma training we were told that there is an asthma, eczema, allergic rhinitis triad. That means people with asthma often also have the skin condition eczema and the runny nose that comes from allergic rhinitis. We aren’t exactly sure why. It may be genetics or environment, but whatever goes wrong with the immune system to cause asthma also seems to be involved with eczema and allergic rhinitis. So I was really interested when I heard there was a study in Ontario that was looking into what other diseases people with asthma get.
The study I read was published by Gershon et al. in the July issue of Thorax. It looked at 4 databases that covered all 12 million people in Ontario in 2005. They found that there were about 1.7 million people in Ontario with asthma or about 13% of the population. Of those people with asthma, they determined about 400,000 had active asthma, and the rest were determined to be less active asthma.
One of the main measures the researchers used to detetmeine how sick the patients were was how often their doctors made a claim to Ontario Health. Over one year for every 100 active asthma patients their doctors made an average of 1616 claims for clinic visits. For non-asthmatics, for every 100 patients their doctors billed Ontario Health an average of 942 times in one year. So the authors estimated that there were an extra 674 claims for the asthmatics.
Another way of looking at is for all the health claims in Ontario 6% of all clinic claims, 8% of all ER visits, and 6% of all hospitalizations were from asthmatics from diseases other than their asthma. That would be like an asthmatic visiting their doctor for depression.
As I said before, these extra co-existing conditions in the asthmatics is interesting because we usually think of asthmatics as being young and otherwise healthy. For example of all the identified active asthmatics in the 2005 Ontario study, the average age of an active asthmatic was 31 years old. However this group had more than twice as many claims for non-asthma respiratory diseases, almost twice as many psychiatric conditions like depression and anxiety and more musculoskeletal claims than the non-asthmatic control group.
Now for the chicken and egg part. Does having asthma make you more likely to get a psychiatric condition like depression? We don’t know. Does treating asthma with inhaled steroids make you more likely to get a musculoskeletal condition like osteoporosis? We don’t know. Do some of these other conditions make it more likely to get asthma? We don’t know. We need more studies.
If you look in the sky, it can be very hard to see a tiny jet plane. But if you follow the contrails or smoke from the plane, you can more easily find it. Dr. Ballard used the debris trail to find the Titanic. Is asthma like a debris trail we can use to find more diseases in a person? We don’t know yet, but it will be interesting to follow the trail.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, July 09, 2010
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.
“Luke, I am your father! Join me on the Dark Side and together…Wait a minute I have to pee!” Okay, I may have butchered a classical scene from Star Wars Episode V: The Empire Strikes Back, but think about it. Luke Skywalker is in his mid-twenties. Darth Vader would then be right around 50. That is the age many of us men will begin to have problems with benign prostatic hypertrophy, or BPH.
The prostate is a walnut size gland that 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 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.
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 and over 80 percent for men in their 80s have symptoms. Common symptoms of BPH include needing to urinate often, feeling like you really need to go now, straining to start urinating, a stream that starts and stops several times, feeling like you haven’t completely emptied your bladder, and more frequent nighttime urination.
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 your treatment options. What treatment options are available for BPH? Well there is surgery and medication. The gold standard for surgery is called TURP or trans-urethral resection of the prostate. It is usually reserved for more severe cases of BPH. Usually BPH treatment will start with medication.
Now just because you go to the doctor and complain about trouble peeing, don’t be disappointed if they don’t immediately offer you surgery or medication. If your symptoms don’t bother you that much or if your prostate is still considered small, watching and waiting is a very reasonable strategy. Treatment of BPH is only recommended when it poses a health risk for the patient or when it becomes very bothersome.
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 two weeks to a month. As good as alpha blockers are their benefits don’t last a long time. Their effects usually only last 6 months to a year and then symptoms often return. And alpha blockers don’t shrink the prostate. 5-alpha-reductase inhibitors like dutasteride and finasteride stop the conversion of testosterone to dihydrotestosterone (DHT). DHT causes the prostate to grow. 5-alpha-reductase inhibitors help BPH symptoms and also reduce the size of the prostate. Unfortunately these medications work slowly. It takes 6 months to a year for a 5-alpha-reductase inhibitor to help a guy’s symptoms.
One obvious solution to the problem of quick acting but no staying power alpha blockers and slow acting but good in the long haul 5-alpha-reductase inhibitors is to use them together. So, doctors often put guys on both an alpha blocker and a 5-alpha-reductase inhibitor. 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. Recent studies like the Combination of Avodart and Tamsulosin (CombAT) study have showed that the combination of these two types of drugs works well together.
So, yes Luke Skywalker would have won that classic, “My dad can beat up your dad” school yard controversy. But even Darth Vader would have to worry about frequent night time trips to the bathroom. So be kind to your prostate and have that talk with 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.
“Luke, I am your father! Join me on the Dark Side and together…Wait a minute I have to pee!” Okay, I may have butchered a classical scene from Star Wars Episode V: The Empire Strikes Back, but think about it. Luke Skywalker is in his mid-twenties. Darth Vader would then be right around 50. That is the age many of us men will begin to have problems with benign prostatic hypertrophy, or BPH.
The prostate is a walnut size gland that 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 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.
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 and over 80 percent for men in their 80s have symptoms. Common symptoms of BPH include needing to urinate often, feeling like you really need to go now, straining to start urinating, a stream that starts and stops several times, feeling like you haven’t completely emptied your bladder, and more frequent nighttime urination.
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 your treatment options. What treatment options are available for BPH? Well there is surgery and medication. The gold standard for surgery is called TURP or trans-urethral resection of the prostate. It is usually reserved for more severe cases of BPH. Usually BPH treatment will start with medication.
Now just because you go to the doctor and complain about trouble peeing, don’t be disappointed if they don’t immediately offer you surgery or medication. If your symptoms don’t bother you that much or if your prostate is still considered small, watching and waiting is a very reasonable strategy. Treatment of BPH is only recommended when it poses a health risk for the patient or when it becomes very bothersome.
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 two weeks to a month. As good as alpha blockers are their benefits don’t last a long time. Their effects usually only last 6 months to a year and then symptoms often return. And alpha blockers don’t shrink the prostate. 5-alpha-reductase inhibitors like dutasteride and finasteride stop the conversion of testosterone to dihydrotestosterone (DHT). DHT causes the prostate to grow. 5-alpha-reductase inhibitors help BPH symptoms and also reduce the size of the prostate. Unfortunately these medications work slowly. It takes 6 months to a year for a 5-alpha-reductase inhibitor to help a guy’s symptoms.
One obvious solution to the problem of quick acting but no staying power alpha blockers and slow acting but good in the long haul 5-alpha-reductase inhibitors is to use them together. So, doctors often put guys on both an alpha blocker and a 5-alpha-reductase inhibitor. 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. Recent studies like the Combination of Avodart and Tamsulosin (CombAT) study have showed that the combination of these two types of drugs works well together.
So, yes Luke Skywalker would have won that classic, “My dad can beat up your dad” school yard controversy. But even Darth Vader would have to worry about frequent night time trips to the bathroom. So be kind to your prostate and have that talk with your doctor.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, July 02, 2010
BuTrans - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
BuTrans
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.
There is a new pain patch on the market. It is called BuTrans. It contains the narcotic buprenorphine which is new to Canada but has been in other countries like Australia for several years. The medication buprenorphine in the patch is very potent. That means the patch only needs to contain a tiny amount of the buprenorphine to be a good pain killer. The three things that caught my attention, though, were how long the patch lasts, what type of pain it is aimed at, and if it can used early or late in the course of pain treatment.
When I first heard about the BuTrans patch, I assumed it would be very similar to the fentanyl pain patch. In pharmacy world we call that a “me-too” drug. One company develops an innovative product and many other companies market products that are very similar, offer no real advantages and just let the other companies say “me-too”. I could be wrong about BuTrans. It seems not to be a me-too of the fentanyl patch. The first difference is duration. The fentanyl pain patch is designed to release pain medication for 72 hours or 3 days. BuTrans is different. The BuTrans patch is designed to release pain medication at a steady rate for 7 days.
The second big difference between the two is what type of pain they are used for. Fentanyl pain patches are usually reserved for very severe pain. Although I have seen fentanyl patches used in all sorts of severe pain from severe arthritis to severe nerve pain, the most common use I see for fentanyl patches is still cancer pain. Again, BuTrans is different. The official indication says it is aimed at moderate persistent pain that lasts longer than 6 months. Notice it doesn’t say severe pain, and it doesn’t mention cancer pain.
So, what kind of pain is BuTrans for? Two studies I looked at examined BuTrans versus osteoarthritis of the knee and hip and BuTrans versus lower back pain. These two types of pain would usually be considered not severe enough warrant a fentanyl patch. The first study was a small trial with 327 patients in it that took people with osteoarthritis of the knee and/or hip and put everyone on BuTrans. Once they got their pain under control, the patients were randomly split into two groups. Half the people got a BuTrans patch and half got a placebo patch. The amount of time it took for the “first pain episode” in the placebo group was 7 days. The amount of time it took for the “first pain episode” in the BuTrans group was 21 days. So BuTrans did better than placebo.
The second study was more interesting, but smaller. It was more interesting because it compared BuTrans versus an established pain killer. Unfortunately being a smaller study, we are less confident about the results. The study looked at lower back pain. It only had 134 patients in it, but it looked at BuTrans, oxycodone/acetaminophen (Percocet, oxycocet) and placebo. Again BuTrans was better than placebo, but that wasn’t a big surprise. The part I found more interesting was BuTrans seemed to be a similar strength pain killer as taking 2 tablets of oxycodone/acetaminophen four times a day. So if a patient required 2 tablets of oxycodone/acetaminophen four times a day for over six months to treat their lower back pain, their doctor may be able to switch them to one BuTrans patch every week instead.
The third thing that surprised me about the marketing of BuTrans is the company, Purdue, is aiming BuTrans at opioid naïve patients. Opioid naïve patients means they haven’t had any narcotics before. For example 80% of the patients in the lower back pain study mentioned earlier were opioid naïve. In contrast, the fentanyl patch, must only be used in someone who has tried other weaker narcotics before. It usually goes something like this: the patient gets a fast acting narcotic pain killer like morphine which is given 4 to 6 times a day. Once the doctor figures out what dose controls the patient’s pain, they are converted to long acting morphine that can be given twice a day. If the pain control remains stable, the patient is then converted to the fentanyl patch which only needs to be changed every three days.
The side effects of BuTrans are similar to other narcotic pain killers and include nausea, vomiting, dizziness, sleepiness, constipation, itchy skin and dry mouth. Not everyone will get every side effect. Effects like nausea, vomiting and sleepiness are common at the start of taking a narcotic pain killer, but go away as you get used to the medication. Effects like constipation will usually last as long as you are on the medication and should be treated with stool softeners.
Now the bad news. BuTrans is new which means it is not paid for by pharmacare, Indian Affairs, Social Assistance or any insurance company I am aware of. That will probably change over time, but as with most new drugs, there is no coverage yet. And it isn’t cheap. BuTrans can run from $70 to $200 a month depending on the strength you need.
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.
There is a new pain patch on the market. It is called BuTrans. It contains the narcotic buprenorphine which is new to Canada but has been in other countries like Australia for several years. The medication buprenorphine in the patch is very potent. That means the patch only needs to contain a tiny amount of the buprenorphine to be a good pain killer. The three things that caught my attention, though, were how long the patch lasts, what type of pain it is aimed at, and if it can used early or late in the course of pain treatment.
When I first heard about the BuTrans patch, I assumed it would be very similar to the fentanyl pain patch. In pharmacy world we call that a “me-too” drug. One company develops an innovative product and many other companies market products that are very similar, offer no real advantages and just let the other companies say “me-too”. I could be wrong about BuTrans. It seems not to be a me-too of the fentanyl patch. The first difference is duration. The fentanyl pain patch is designed to release pain medication for 72 hours or 3 days. BuTrans is different. The BuTrans patch is designed to release pain medication at a steady rate for 7 days.
The second big difference between the two is what type of pain they are used for. Fentanyl pain patches are usually reserved for very severe pain. Although I have seen fentanyl patches used in all sorts of severe pain from severe arthritis to severe nerve pain, the most common use I see for fentanyl patches is still cancer pain. Again, BuTrans is different. The official indication says it is aimed at moderate persistent pain that lasts longer than 6 months. Notice it doesn’t say severe pain, and it doesn’t mention cancer pain.
So, what kind of pain is BuTrans for? Two studies I looked at examined BuTrans versus osteoarthritis of the knee and hip and BuTrans versus lower back pain. These two types of pain would usually be considered not severe enough warrant a fentanyl patch. The first study was a small trial with 327 patients in it that took people with osteoarthritis of the knee and/or hip and put everyone on BuTrans. Once they got their pain under control, the patients were randomly split into two groups. Half the people got a BuTrans patch and half got a placebo patch. The amount of time it took for the “first pain episode” in the placebo group was 7 days. The amount of time it took for the “first pain episode” in the BuTrans group was 21 days. So BuTrans did better than placebo.
The second study was more interesting, but smaller. It was more interesting because it compared BuTrans versus an established pain killer. Unfortunately being a smaller study, we are less confident about the results. The study looked at lower back pain. It only had 134 patients in it, but it looked at BuTrans, oxycodone/acetaminophen (Percocet, oxycocet) and placebo. Again BuTrans was better than placebo, but that wasn’t a big surprise. The part I found more interesting was BuTrans seemed to be a similar strength pain killer as taking 2 tablets of oxycodone/acetaminophen four times a day. So if a patient required 2 tablets of oxycodone/acetaminophen four times a day for over six months to treat their lower back pain, their doctor may be able to switch them to one BuTrans patch every week instead.
The third thing that surprised me about the marketing of BuTrans is the company, Purdue, is aiming BuTrans at opioid naïve patients. Opioid naïve patients means they haven’t had any narcotics before. For example 80% of the patients in the lower back pain study mentioned earlier were opioid naïve. In contrast, the fentanyl patch, must only be used in someone who has tried other weaker narcotics before. It usually goes something like this: the patient gets a fast acting narcotic pain killer like morphine which is given 4 to 6 times a day. Once the doctor figures out what dose controls the patient’s pain, they are converted to long acting morphine that can be given twice a day. If the pain control remains stable, the patient is then converted to the fentanyl patch which only needs to be changed every three days.
The side effects of BuTrans are similar to other narcotic pain killers and include nausea, vomiting, dizziness, sleepiness, constipation, itchy skin and dry mouth. Not everyone will get every side effect. Effects like nausea, vomiting and sleepiness are common at the start of taking a narcotic pain killer, but go away as you get used to the medication. Effects like constipation will usually last as long as you are on the medication and should be treated with stool softeners.
Now the bad news. BuTrans is new which means it is not paid for by pharmacare, Indian Affairs, Social Assistance or any insurance company I am aware of. That will probably change over time, but as with most new drugs, there is no coverage yet. And it isn’t cheap. BuTrans can run from $70 to $200 a month depending on the strength you need.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, June 18, 2010
Drug Allergies - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
Drug Allergies
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
The black doctor’s phone rings in the dispensary. The doctor on the other end of the line is frustrated. She wants to prescribe an antibiotic to a patient with a sinus infection. When the doctor asked the patient if she had any allergies, the patient said she couldn’t remember which medication she was allergic to. The patient told the doctor to phone the pharmacy to get a list. When I look at the patient’s profile on the pharmacy computer, I see at least 7 different medications the patient claimed to be allergic to. Now the doctor is even more frustrated. The only medication the doctor thought would work for the patient’s sinus infection was on the allergy list. The doctor has no other medications in her arsenal to help the patient.
We really do have people who come into the pharmacy claiming to be allergic to everything. Now, it isn’t that I’m calling them liars. I am sure they have had a bad reaction to the medications they tell me about. However, part of my job is to try to determine which are true allergies, and which are just intolerances.
So what is the difference between a medication allergy and an intolerance and why should you care? An intolerance is a bad reaction like having an upset stomach, vomiting, diarrhea or headache. Not that these aren’t very unpleasant reactions, but they aren’t true allergies. True allergies are reactions such as a measles-like rash or hives. The most serious type of allergic reaction is called anaphylaxis. Symptoms that could be suggestive of anaphylaxis include facial or throat swelling, light headedness from low blood pressure, asthma or wheezing, and shortness of breath.
When you tell me that you had a bad reaction to a medication, I am listening for words like “my throat closed”, “I had trouble breathing”, or “my face puffed up”. These can mean that you had an anaphylactic reaction, and another dose of that medication could kill you. So I will put a big warning on my computer not to give you that drug or similar drugs in the future. I will caution you to get a Medic Alert bracelet to warn doctors and EMS personnel that you have a life-threatening drug allergy. We may even talk about whether you should get a referral from your family doctor to an allergy specialist. If, instead, you tell me that you had the worst stomach cramps of your life, as unpleasant as they were, stomach cramps are not life threatening. I will put a note on your file and we will tell doctors not to give you that particular medication again, but you didn’t have a drug allergy.
As a patient, you might feel equally bad whether your reaction to a medication was horrible stomach cramps or puffy face and trouble breathing, but to me the difference is very important. If you had stomach cramps on the antibiotic amoxicillin, we will try to not give you amoxicillin again. But, if the doctor determines amoxicillin is the best medication for you, we can still give it to you. We can tell the doctor to give you a lower dose for a longer time, or we can tell you to take it with food or maybe even recommend a stomach medication to take with the antibiotic to make it less likely to bother you. If you tell me that your face got puffy and you had trouble breathing on amoxicillin, things will be different.
We will suspect you had an anaphylactic allergic reaction to amoxicillin. Anaphylactic allergic reactions can be life threatening. If you get amoxicillin again, the second reaction may be worse than the original reaction. So if a doctor prescribes amoxicillin again, I will tell the doctor there is no way you should get the amoxicillin. In fact, I will tell the doctor not to give you penicillin, cloxacillin, ampicillin, or clavulin because they are all very close chemical cousins to amoxicillin and may also cause a life threatening reaction.
If the doctor says, “Okay, what about cephalexin?” things get a little more complicated. Cephalexin is a more distant chemical cousin to amoxicillin. In pharmacy school, I was taught the chance of cross-reactivity between amoxicillin and cephalexin was about 10%. Apparently, now experts are saying it is really more like 1%. So there is very little chance that someone with an amoxicillin allergy will also be allergic to cephalexin. However, if you tell me that your throat closed on amoxicillin, the doctor and I would still be very nervous about giving you cephalexin and would probably avoid it. If you said you had a rash on amoxicillin, and the doctor wanted to give you cephalexin, I would probably say to go ahead. Eventhough a rash is usually a sign of a true allergy, the chance of cross reactivity between amoxicillin and cephalexin is very low and a rash is not life threatening.
So talk to your doctor and pharmacist about your bad reactions to medications. Tell them exactly what kind a reaction you had, how long after the starting the medication it happened and how long ago it happened. If you tell your doctor you are allergic to four or five medications that really just gave you stomach cramps, that may make it very difficult for your doctor to give you medications that might really help you. On the other hand, if you forget to tell your pharmacist that a certain medication made your throat close, we can’t stop you from getting a medication that could threaten your life.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
The black doctor’s phone rings in the dispensary. The doctor on the other end of the line is frustrated. She wants to prescribe an antibiotic to a patient with a sinus infection. When the doctor asked the patient if she had any allergies, the patient said she couldn’t remember which medication she was allergic to. The patient told the doctor to phone the pharmacy to get a list. When I look at the patient’s profile on the pharmacy computer, I see at least 7 different medications the patient claimed to be allergic to. Now the doctor is even more frustrated. The only medication the doctor thought would work for the patient’s sinus infection was on the allergy list. The doctor has no other medications in her arsenal to help the patient.
We really do have people who come into the pharmacy claiming to be allergic to everything. Now, it isn’t that I’m calling them liars. I am sure they have had a bad reaction to the medications they tell me about. However, part of my job is to try to determine which are true allergies, and which are just intolerances.
So what is the difference between a medication allergy and an intolerance and why should you care? An intolerance is a bad reaction like having an upset stomach, vomiting, diarrhea or headache. Not that these aren’t very unpleasant reactions, but they aren’t true allergies. True allergies are reactions such as a measles-like rash or hives. The most serious type of allergic reaction is called anaphylaxis. Symptoms that could be suggestive of anaphylaxis include facial or throat swelling, light headedness from low blood pressure, asthma or wheezing, and shortness of breath.
When you tell me that you had a bad reaction to a medication, I am listening for words like “my throat closed”, “I had trouble breathing”, or “my face puffed up”. These can mean that you had an anaphylactic reaction, and another dose of that medication could kill you. So I will put a big warning on my computer not to give you that drug or similar drugs in the future. I will caution you to get a Medic Alert bracelet to warn doctors and EMS personnel that you have a life-threatening drug allergy. We may even talk about whether you should get a referral from your family doctor to an allergy specialist. If, instead, you tell me that you had the worst stomach cramps of your life, as unpleasant as they were, stomach cramps are not life threatening. I will put a note on your file and we will tell doctors not to give you that particular medication again, but you didn’t have a drug allergy.
As a patient, you might feel equally bad whether your reaction to a medication was horrible stomach cramps or puffy face and trouble breathing, but to me the difference is very important. If you had stomach cramps on the antibiotic amoxicillin, we will try to not give you amoxicillin again. But, if the doctor determines amoxicillin is the best medication for you, we can still give it to you. We can tell the doctor to give you a lower dose for a longer time, or we can tell you to take it with food or maybe even recommend a stomach medication to take with the antibiotic to make it less likely to bother you. If you tell me that your face got puffy and you had trouble breathing on amoxicillin, things will be different.
We will suspect you had an anaphylactic allergic reaction to amoxicillin. Anaphylactic allergic reactions can be life threatening. If you get amoxicillin again, the second reaction may be worse than the original reaction. So if a doctor prescribes amoxicillin again, I will tell the doctor there is no way you should get the amoxicillin. In fact, I will tell the doctor not to give you penicillin, cloxacillin, ampicillin, or clavulin because they are all very close chemical cousins to amoxicillin and may also cause a life threatening reaction.
If the doctor says, “Okay, what about cephalexin?” things get a little more complicated. Cephalexin is a more distant chemical cousin to amoxicillin. In pharmacy school, I was taught the chance of cross-reactivity between amoxicillin and cephalexin was about 10%. Apparently, now experts are saying it is really more like 1%. So there is very little chance that someone with an amoxicillin allergy will also be allergic to cephalexin. However, if you tell me that your throat closed on amoxicillin, the doctor and I would still be very nervous about giving you cephalexin and would probably avoid it. If you said you had a rash on amoxicillin, and the doctor wanted to give you cephalexin, I would probably say to go ahead. Eventhough a rash is usually a sign of a true allergy, the chance of cross reactivity between amoxicillin and cephalexin is very low and a rash is not life threatening.
So talk to your doctor and pharmacist about your bad reactions to medications. Tell them exactly what kind a reaction you had, how long after the starting the medication it happened and how long ago it happened. If you tell your doctor you are allergic to four or five medications that really just gave you stomach cramps, that may make it very difficult for your doctor to give you medications that might really help you. On the other hand, if you forget to tell your pharmacist that a certain medication made your throat close, we can’t stop you from getting a medication that could threaten your life.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, June 11, 2010
Custom Compounding - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
Custom Compounding
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
My mom has a picture of me with my dad, Bob, my grandfather, Stan and my great-grandfather Tom. I was very young in the picture and I don’t remember meeting Tom. But at least I was alive at the same time as him. I don’t know anything about Tom’s dad, my great-great grandfather. Now imagine if my great-great grandfather without writing it down, could somehow give me the knowledge of how to get to a secret cabin in the woods. Remember, were never alive at the same time. Sounds a little like science fiction, doesn’t it? Well that’s exactly what Monarch butterflies do!
Monarch butterfly generation one is born in Mexico flies north to the southern US, mates and dies. Generation two flies from the southern US to the northern US, mates and dies. Generation three flies from the northern US to Canada, mates and dies. Each of these three generations lives only about a month. Now generation four is special. Obviously this is because it is Canadian. Generation four lives for about 9 months. Nine times longer than each of the previous generations. But the really incredible thing is generation four flies all the way back to Mexico. It flies over 3200 km. It seems to know where to go even though it never flew it before. In fact no butterfly has flown the trip in four generations. Just like if my great-great grandfather passed the knowledge of the location of the secret cabin in the woods to me.
Other useful knowledge from the past is custom compounding. Custom compounding is when a pharmacist mixes together a preparation that isn’t commercially available for a patient at the direction of a physician, vet or dentist. In the past, a lot of what pharmacists did was compounding because there weren’t that many commercially available medications around. Now most pharmacies dispense pre-fab pills. However, there are some pharmacies that have retained the knowledge from the past of how to customize a medication for a particular patient.
At the Dauphin Clinic Pharmacy, we have taken the arcane knowledge of compounding and given it a modern twist so we can tailor medications to an individual patient’s needs. For example, we made a topical version of lorazepam for a nursing home patient. Lorazepam can be used to calm someone who is very agitated. But, as you can imagine, trying to give a pill to someone who is very agitated and has dementia can be difficult. Sometimes the nurse even gets bitten. There is an injectable version of lorazepam, but again it is difficult for the nurse and distressing for the patient. But, holding an agitated patient’s hand and rubbing a medication on their wrist is a very natural and calming thing for a nurse to do. So, we made a topical version of lorazepam so the nurse could rub into onto the wrist. It worked well for both nurse and patient.
For animals, under a vet’s direction, we have made a variety of products. We have made everything from injections for cattle to liquid antidotes for dogs who ate rat poison. One interesting thing we compounded was an antibiotic for a cat. We started with a human medication, ground it up an put it into a special fish paste that the cats love. However, we found one cat didn’t like fish, so that cat gets its medication in a chicken paste. When the patient is a cat, it is still important to listen to the patient’s needs.
Any one who has had hemorrhoids will tell you how annoying, painful and itchy they can be. The problem is most suppositories slide right by the hemorrhoid and so they don’t release much of their medication onto the hemorrhoid. At the Dauphin Clinic Pharmacy we have a suppository mold called a Rectal Rocket. It flares at both ends so the suppository stays where it can do the most good. And, of course we can customize which medications we put in the suppository.
So just like the Monarch Butterflies, we have received our compounding knowledge from our pharmacy fore-fathers. Then we put a modern twist on the knowledge of compounding and with it we can help our patients by customizing their medications to their specific needs.
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.
My mom has a picture of me with my dad, Bob, my grandfather, Stan and my great-grandfather Tom. I was very young in the picture and I don’t remember meeting Tom. But at least I was alive at the same time as him. I don’t know anything about Tom’s dad, my great-great grandfather. Now imagine if my great-great grandfather without writing it down, could somehow give me the knowledge of how to get to a secret cabin in the woods. Remember, were never alive at the same time. Sounds a little like science fiction, doesn’t it? Well that’s exactly what Monarch butterflies do!
Monarch butterfly generation one is born in Mexico flies north to the southern US, mates and dies. Generation two flies from the southern US to the northern US, mates and dies. Generation three flies from the northern US to Canada, mates and dies. Each of these three generations lives only about a month. Now generation four is special. Obviously this is because it is Canadian. Generation four lives for about 9 months. Nine times longer than each of the previous generations. But the really incredible thing is generation four flies all the way back to Mexico. It flies over 3200 km. It seems to know where to go even though it never flew it before. In fact no butterfly has flown the trip in four generations. Just like if my great-great grandfather passed the knowledge of the location of the secret cabin in the woods to me.
Other useful knowledge from the past is custom compounding. Custom compounding is when a pharmacist mixes together a preparation that isn’t commercially available for a patient at the direction of a physician, vet or dentist. In the past, a lot of what pharmacists did was compounding because there weren’t that many commercially available medications around. Now most pharmacies dispense pre-fab pills. However, there are some pharmacies that have retained the knowledge from the past of how to customize a medication for a particular patient.
At the Dauphin Clinic Pharmacy, we have taken the arcane knowledge of compounding and given it a modern twist so we can tailor medications to an individual patient’s needs. For example, we made a topical version of lorazepam for a nursing home patient. Lorazepam can be used to calm someone who is very agitated. But, as you can imagine, trying to give a pill to someone who is very agitated and has dementia can be difficult. Sometimes the nurse even gets bitten. There is an injectable version of lorazepam, but again it is difficult for the nurse and distressing for the patient. But, holding an agitated patient’s hand and rubbing a medication on their wrist is a very natural and calming thing for a nurse to do. So, we made a topical version of lorazepam so the nurse could rub into onto the wrist. It worked well for both nurse and patient.
For animals, under a vet’s direction, we have made a variety of products. We have made everything from injections for cattle to liquid antidotes for dogs who ate rat poison. One interesting thing we compounded was an antibiotic for a cat. We started with a human medication, ground it up an put it into a special fish paste that the cats love. However, we found one cat didn’t like fish, so that cat gets its medication in a chicken paste. When the patient is a cat, it is still important to listen to the patient’s needs.
Any one who has had hemorrhoids will tell you how annoying, painful and itchy they can be. The problem is most suppositories slide right by the hemorrhoid and so they don’t release much of their medication onto the hemorrhoid. At the Dauphin Clinic Pharmacy we have a suppository mold called a Rectal Rocket. It flares at both ends so the suppository stays where it can do the most good. And, of course we can customize which medications we put in the suppository.
So just like the Monarch Butterflies, we have received our compounding knowledge from our pharmacy fore-fathers. Then we put a modern twist on the knowledge of compounding and with it we can help our patients by customizing their medications to their specific needs.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, June 04, 2010
SUN SCREENS - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
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.
There has been some good news lately about skin cancer. Dr. Gordon Jung and colleagues at the University of Alberta published a study in the April issue of the British Journal of Dermalology. They looked at Nonmelanoma Skin Cancers in Alberta from 1988 through 2007. In women they found these skin cancers increased until 2000 and then the rates leveled off. They found in men the cancer rates leveled off in 2001 and then actually went down. The researchers are hoping that the decrease is due to people listening to all the public health messages about reducing sun exposure.
Skin cancer is the most commonly occurring cancer in Canada, and the fastest growing cancer in the world. The Canadian Cancer Society estimates that 75,500 people will be diagnosed with non-melanoma skin cancer in 2010. Risk factors for developing non-melanoma skin cancer include: exposure to the sun,
light-coloured skin, eyes and hair, and a previous history of skin cancer.
The Canadian Dermatology Association recommends:
Plan outdoor activities before 11 a.m. and after 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.
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. So a hat with a wide brim that covers your head, face, ears and neck is needed. 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 as well.
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.
We have been hearing these sun protection warnings for years. The good news is that if the Alberta study is right, we are starting to listen. Keep up the good work.
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.
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.
There has been some good news lately about skin cancer. Dr. Gordon Jung and colleagues at the University of Alberta published a study in the April issue of the British Journal of Dermalology. They looked at Nonmelanoma Skin Cancers in Alberta from 1988 through 2007. In women they found these skin cancers increased until 2000 and then the rates leveled off. They found in men the cancer rates leveled off in 2001 and then actually went down. The researchers are hoping that the decrease is due to people listening to all the public health messages about reducing sun exposure.
Skin cancer is the most commonly occurring cancer in Canada, and the fastest growing cancer in the world. The Canadian Cancer Society estimates that 75,500 people will be diagnosed with non-melanoma skin cancer in 2010. Risk factors for developing non-melanoma skin cancer include: exposure to the sun,
light-coloured skin, eyes and hair, and a previous history of skin cancer.
The Canadian Dermatology Association recommends:
Plan outdoor activities before 11 a.m. and after 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.
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. So a hat with a wide brim that covers your head, face, ears and neck is needed. 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 as well.
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.
We have been hearing these sun protection warnings for years. The good news is that if the Alberta study is right, we are starting to listen. Keep up the good work.
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.
Friday, May 28, 2010
Plavix Genetics - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
PLAVIX GENETICS
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.
On the Origin of Species was published over 150 years ago by Charles Darwin. It laid out his theory of evolution.
Darwin actually published many papers, and books over his career. He was a barnacle expert and spent a lot of time breeding plants. In his green house he determined that you got better, stronger plants if you cross-fertilized them than if you self-fertilized them. Remember, Darwin had no idea what DNA or genes were or that you could pass your genes on to your off-spring. But when he saw that during breeding it is better to cross breed than to put close relatives together, this made him worried about his own children. You see, Darwin married his first cousin, Emma Wedgwood. A recent study of Darwin’s family tree showed a higher than expected inbreeding coefficient. That means his offspring were more likely than average to have two identical copies of a gene. All genes come in pairs. Most “bad” genes are what we call recessive. That means if you have one copy of the bad gene and one good gene, the good gene will win out and you will not develop the bad trait. However, if you have two identical genes, and they are both for a bad trait, you will get that bad trait. If you marry your first cousin, your children are more likely to have two identical bad genes than the general population. So your children are more likely than average to have genetic diseases.
Speaking of genetics, they are becoming more and more important in the pharmacy. We have always known that not all people react the same way to a medication. Certain medications work well for some people and not for others. Now we think some of this difference could be from genetics. Let’s look at two blood thinners, warfarin and clopidogrel.
Warfarin is a very common blood thinner. It thins the blood by effecting how Vitamin K is used in the body. Vitamin K is involved in the clotting cascade which is a complex series of chemical steps that lead to blood clots. Two enzymes that effect how warfarin works are the one that breaks down warfarin in the liver and other that helps the body form Vitamin K. There are different genetic variations of these enzymes in different people. So, one 5 mg tablet of warfarin may thin the blood a lot in one person and not very much in another depending on the genetic variations of these enzymes.
There was a study was to see if genetic testing could help doctors to better choose doses of warfarin for their patients. They did genetic testing of 868 patients on warfarin and compared them to 2688 controls on warfarin without genetic testing. The result was that the people with the genetic testing had less side effects than the non tested patients. So we should do the warfarin genetic tests on everyone, right? Well, not yet. The problem is that the genetic testing is very expensive. And, there are those that argue that the people in the genetic testing arm of the study were just followed more closely than the control group and that is why they did better. So at the moment doing the standard INR test is still the most cost effective way to adjust someone’s warfarin dose. Down the road, will we be doing genetic tests? Maybe.
Clopidogrel or plavix is a different blood thinner. Clopidogrel is a pro-drug. It must be broken down by an enzyme to be activated. Last November clopidogrel was in the news because the FDA in the US said the stomach medication omeprazole slowed down this activating enzyme and that might make clopidogrel a less effective blood thinner. Now, the FDA is requiring a warning on clopidogrel about the different genetic variations of the activating enzyme. About 3% of us are poor clopidogrel metabolizers, which means that if you give us clopidogrel our genetic variation of the enzyme won’t activate it very well and our blood won’t be thinned as much. There is a genetic test to see if you are a poor metabolizer of clopidogrel, but again it is expensive and not very common in Canada. And the studies haven’t been done to see if the results of the genetic tests would help patients or not. So this is another example of a genetic test that might be helpful down the road , but not today.
So whether you are the great great great grandchild of the father of evolutionary biology or you are on a blood thinner, genetics may play a pivotal role in your health
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.
On the Origin of Species was published over 150 years ago by Charles Darwin. It laid out his theory of evolution.
Darwin actually published many papers, and books over his career. He was a barnacle expert and spent a lot of time breeding plants. In his green house he determined that you got better, stronger plants if you cross-fertilized them than if you self-fertilized them. Remember, Darwin had no idea what DNA or genes were or that you could pass your genes on to your off-spring. But when he saw that during breeding it is better to cross breed than to put close relatives together, this made him worried about his own children. You see, Darwin married his first cousin, Emma Wedgwood. A recent study of Darwin’s family tree showed a higher than expected inbreeding coefficient. That means his offspring were more likely than average to have two identical copies of a gene. All genes come in pairs. Most “bad” genes are what we call recessive. That means if you have one copy of the bad gene and one good gene, the good gene will win out and you will not develop the bad trait. However, if you have two identical genes, and they are both for a bad trait, you will get that bad trait. If you marry your first cousin, your children are more likely to have two identical bad genes than the general population. So your children are more likely than average to have genetic diseases.
Speaking of genetics, they are becoming more and more important in the pharmacy. We have always known that not all people react the same way to a medication. Certain medications work well for some people and not for others. Now we think some of this difference could be from genetics. Let’s look at two blood thinners, warfarin and clopidogrel.
Warfarin is a very common blood thinner. It thins the blood by effecting how Vitamin K is used in the body. Vitamin K is involved in the clotting cascade which is a complex series of chemical steps that lead to blood clots. Two enzymes that effect how warfarin works are the one that breaks down warfarin in the liver and other that helps the body form Vitamin K. There are different genetic variations of these enzymes in different people. So, one 5 mg tablet of warfarin may thin the blood a lot in one person and not very much in another depending on the genetic variations of these enzymes.
There was a study was to see if genetic testing could help doctors to better choose doses of warfarin for their patients. They did genetic testing of 868 patients on warfarin and compared them to 2688 controls on warfarin without genetic testing. The result was that the people with the genetic testing had less side effects than the non tested patients. So we should do the warfarin genetic tests on everyone, right? Well, not yet. The problem is that the genetic testing is very expensive. And, there are those that argue that the people in the genetic testing arm of the study were just followed more closely than the control group and that is why they did better. So at the moment doing the standard INR test is still the most cost effective way to adjust someone’s warfarin dose. Down the road, will we be doing genetic tests? Maybe.
Clopidogrel or plavix is a different blood thinner. Clopidogrel is a pro-drug. It must be broken down by an enzyme to be activated. Last November clopidogrel was in the news because the FDA in the US said the stomach medication omeprazole slowed down this activating enzyme and that might make clopidogrel a less effective blood thinner. Now, the FDA is requiring a warning on clopidogrel about the different genetic variations of the activating enzyme. About 3% of us are poor clopidogrel metabolizers, which means that if you give us clopidogrel our genetic variation of the enzyme won’t activate it very well and our blood won’t be thinned as much. There is a genetic test to see if you are a poor metabolizer of clopidogrel, but again it is expensive and not very common in Canada. And the studies haven’t been done to see if the results of the genetic tests would help patients or not. So this is another example of a genetic test that might be helpful down the road , but not today.
So whether you are the great great great grandchild of the father of evolutionary biology or you are on a blood thinner, genetics may play a pivotal role in your health
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, May 14, 2010
Diabetic Feet - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
DIABETIC FEET
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.
“So is there any such thing as a diabetic shoe?” My parents are snowbirds. Every winter they go down to Texas. They got back recently, and we were catching up on the phone. While down south my dad was out walking, and saw an ad for diabetic shoes in a pharmacy window. It sounded like a scam to him, but I told him foot care was actually very important for diabetics.
I often talk about the big 4 problems in diabetes. The big 4 are: heart attack and stroke, blindness, kidney disease and amputation. I call these the big 4 because diabetics sometimes ask, “Why do I have to test my blood sugar, take my medications, watch my diet and exercise. I feel fine.” The answer is although a diabetic may feel okay, if they keep their blood sugar down and look after themselves, hopefully they can avoid these big 4 problems.
Diabetes is considered the leading, non-traumatic cause of amputation. The part of the body most likely to be amputated in diabetics are the feet. Unfortunately, over the years in the pharmacy I have seen many diabetics that I've known get their feet amputated. Some people with an extra dose of misfortune had more and more of their foot and leg amputated in several consectutive operations. So, not to scare you, but foot care in diabetics is deadly serious.
Why are diabetics so prone to foot problems? Well diabetes works against the feet in a couple of ways. Over time diabetes can damage nerves. If those are sensory nerves from the feet, a diabetic can't feel things that poke, scrape, or pinch their feet. We call that diabetic neuropathy. This lack of feeling in the feet makes it more likely that a diabetic won’t feel small injuries like blisters or scrapes. So these small injuries can go unnoticed and thus untreated. Which brings us to the second problem working against the diabetic foot. Many diabetics have poor circulation due to the damage diabetes has done to their blood vessels. Less blood to the foot makes it less able to heal after an injury and less able to fight off an infection if one occurs. So diabetics are less likely to notice an injury to their feet and so they are more likely to leave it untreated. That untreated injury is less likely to heal than in a non-diabetic foot and is more likely to get infected. So diabetics are more prone to foot problems.
What can diabetics do to help protect their feet? Start by looking at you feet everyday. Get into the routine of inspecting your feet everyday to make sure there are no cuts, cracks, ingrown toenails or other problems. Get a small mirror to look at the bottom of your feet. When possible, wear white socks. Any blood or other drainage from sores you may not have noticed will show up well on a white sock. Cut your toenails straight across, not too short and file the sharp corners. Do not do home surgery on corns, calluses, slivers or warts. Talk to your doctor about anything you want cut off your foot. The doctor may do it themselves or refer you to a diabetic foot care nurse. And speaking of your doctor, may sure they look at your feet at least once a year. I have even heard it suggested that you take off your shoes and socks on every visit to your doctor to encourage them to look at your diabetic feet as routinely as they would check your blood pressure and sugar.
So what about that diabetic shoe my dad saw advertised in Texas? Do they exist? Rather than just one diabetic shoe, it is more that there are certain characteristics that diabetics should look for in a pair of shoes. Shoes for diabetics should be supportive, and have low heels. Diabetics should not wear pointed toe shoes or shoes like sandals with open toes or heels. Diabetics should never go barefoot. It is recommended they have a pair of shoes to change into for walking around the house. And diabetics should make sure their shoes are fitted properly in a store where the staff are trained to professionally fit their feet.
Canadian Diabetes Association www.diabetes.ca
Canadian Footwear www.canadianfootwear.com
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.
“So is there any such thing as a diabetic shoe?” My parents are snowbirds. Every winter they go down to Texas. They got back recently, and we were catching up on the phone. While down south my dad was out walking, and saw an ad for diabetic shoes in a pharmacy window. It sounded like a scam to him, but I told him foot care was actually very important for diabetics.
I often talk about the big 4 problems in diabetes. The big 4 are: heart attack and stroke, blindness, kidney disease and amputation. I call these the big 4 because diabetics sometimes ask, “Why do I have to test my blood sugar, take my medications, watch my diet and exercise. I feel fine.” The answer is although a diabetic may feel okay, if they keep their blood sugar down and look after themselves, hopefully they can avoid these big 4 problems.
Diabetes is considered the leading, non-traumatic cause of amputation. The part of the body most likely to be amputated in diabetics are the feet. Unfortunately, over the years in the pharmacy I have seen many diabetics that I've known get their feet amputated. Some people with an extra dose of misfortune had more and more of their foot and leg amputated in several consectutive operations. So, not to scare you, but foot care in diabetics is deadly serious.
Why are diabetics so prone to foot problems? Well diabetes works against the feet in a couple of ways. Over time diabetes can damage nerves. If those are sensory nerves from the feet, a diabetic can't feel things that poke, scrape, or pinch their feet. We call that diabetic neuropathy. This lack of feeling in the feet makes it more likely that a diabetic won’t feel small injuries like blisters or scrapes. So these small injuries can go unnoticed and thus untreated. Which brings us to the second problem working against the diabetic foot. Many diabetics have poor circulation due to the damage diabetes has done to their blood vessels. Less blood to the foot makes it less able to heal after an injury and less able to fight off an infection if one occurs. So diabetics are less likely to notice an injury to their feet and so they are more likely to leave it untreated. That untreated injury is less likely to heal than in a non-diabetic foot and is more likely to get infected. So diabetics are more prone to foot problems.
What can diabetics do to help protect their feet? Start by looking at you feet everyday. Get into the routine of inspecting your feet everyday to make sure there are no cuts, cracks, ingrown toenails or other problems. Get a small mirror to look at the bottom of your feet. When possible, wear white socks. Any blood or other drainage from sores you may not have noticed will show up well on a white sock. Cut your toenails straight across, not too short and file the sharp corners. Do not do home surgery on corns, calluses, slivers or warts. Talk to your doctor about anything you want cut off your foot. The doctor may do it themselves or refer you to a diabetic foot care nurse. And speaking of your doctor, may sure they look at your feet at least once a year. I have even heard it suggested that you take off your shoes and socks on every visit to your doctor to encourage them to look at your diabetic feet as routinely as they would check your blood pressure and sugar.
So what about that diabetic shoe my dad saw advertised in Texas? Do they exist? Rather than just one diabetic shoe, it is more that there are certain characteristics that diabetics should look for in a pair of shoes. Shoes for diabetics should be supportive, and have low heels. Diabetics should not wear pointed toe shoes or shoes like sandals with open toes or heels. Diabetics should never go barefoot. It is recommended they have a pair of shoes to change into for walking around the house. And diabetics should make sure their shoes are fitted properly in a store where the staff are trained to professionally fit their feet.
Canadian Diabetes Association www.diabetes.ca
Canadian Footwear www.canadianfootwear.com
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, May 07, 2010
Pharmacare 2010 Redux - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
PHARMACARE 2010 Redux
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 been getting a lot of questions about Pharmacare lately. People seem to be surprised that they need to pay for their medications in April, they don’t understand how Pharmacare works, they don’t know you can get Pharmacare benefits if you are under the age of 65 and some people don’t even seem to know they are entitled to Pharmacare benefits at all.
Manitoba Health defines Pharmacare as “…a drug benefit program for any Manitoban, regardless of age, whose income is seriously affected by high prescription drug costs” So some of the tax money we pay the Manitoba Government goes into a big pool and then if we need a prescription medication and meet certain conditions, Pharmacare will pay for our medications.
So what are those conditions? First, you have to apply for the Pharmacare program. If you don’t apply, no matter what your income is or how expensive your medications are, Pharmacare won’t pay for anything. The good news is the application form is only one page long and you can pick one up at any pharmacy or at the Manitoba Health website. Your pharmacist can help you fill it out.
Once you have applied for Pharmacare benefits, in 4 to 6 weeks, Pharmacare will send you a letter stating your Pharmacare Deductible. Your Deductible is the amount of money you have to spend on eligible prescription medications before Pharmacare starts paying. Your Deductible is based on your income. The higher your income, the more medication you will have to buy for before Pharmacare starts to pay.
The Pharmacare year runs from April 1 to March 31. So every year, everyone has to start paying for their medications again once April fool’s day passes. Then as you pay for your eligible prescriptions, you may eventually spend more than your Deductible. Once you spend more than your Deductible, Pharmacare will start paying for your eligible prescription medications until the next March 31.
What is an eligible prescription medication? Pharmacare has a formulary. A formulary is a list of all the medications that Pharmacare will pay for. Not every medication a doctor can prescribe is on the formulary. Two common questions I get asked are: “My doctor prescribed it. I need it. That means the government pays for it, right?”, and “This new medication is now approved for sale in Canada. If my doctor prescribes it, it will be covered, right?” Unfortunately, the answers to both those questions can be, “No.” Health Canada approves medications for sale, if they determine the medication is safe and effective. Manitoba Health determines which medications it wants to pay for. It puts those medications on the Pharmacare formulary. New medications are usually not covered for a few years after they are released. Manitoba Health only has a limited amount of money with which to pay for prescription medications. So it must make a list of medications it feels it can afford to pay for. Unfortunately, if the medication you need isn’t on the formulary, Pharmacare won’t pay for it.
Actually, the government doesn’t make the formulary as simple as a medication is covered or not. There are actually three different parts of the formulary. Part 1of the formulary are medications that any doctor can prescribe for any condition and Manitoba Health will pay for them. Part 2 (EDS Part 2) are medications that Manitoba Health will not pay for unless the drug is used for a specified condition for a specified time. The doctor is supposed to indicate that the medication meets these criteria by writing “Meets EDS” on the prescription. Part 3 (EDS Part 3) or Exceptional Drug Status is really all other medications that Manitoba Health doesn’t normally pay for. Your doctor can contact Manitoba Health and ask for an exception in your case (exceptional drug status) and hope that Manitoba Health will pay in your exceptional case.
The last question I am often asked is about Pharmacare Pre-Pays. A Pre-Pay is if you want to pay off your whole Deductible at once. Pre-Pays are a Dauphin Clinic Pharmacy program and don’t involve Manitoba Health. Manitoba Health doesn’t want all your Deductible money up front. But, if you go to the Dauphin Clinic Pharmacy, you can pay off your whole Deductible at once. We put your money as a credit on your account. When you fill prescriptions, we charge them against that credit. When the credit runs out, you will be over your Deductible and Pharmacare will start to pay. And the best part about paying your deductible up front is the Dauphin Clinic Pharmacy will give you 10 percent of your deductible back.
I hope that explains some of the common questions about Pharmacare.
Pharmacare application form: www.gov.mb.ca/health/pharmacare/docs/pharmform.pdf
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’ve been getting a lot of questions about Pharmacare lately. People seem to be surprised that they need to pay for their medications in April, they don’t understand how Pharmacare works, they don’t know you can get Pharmacare benefits if you are under the age of 65 and some people don’t even seem to know they are entitled to Pharmacare benefits at all.
Manitoba Health defines Pharmacare as “…a drug benefit program for any Manitoban, regardless of age, whose income is seriously affected by high prescription drug costs” So some of the tax money we pay the Manitoba Government goes into a big pool and then if we need a prescription medication and meet certain conditions, Pharmacare will pay for our medications.
So what are those conditions? First, you have to apply for the Pharmacare program. If you don’t apply, no matter what your income is or how expensive your medications are, Pharmacare won’t pay for anything. The good news is the application form is only one page long and you can pick one up at any pharmacy or at the Manitoba Health website. Your pharmacist can help you fill it out.
Once you have applied for Pharmacare benefits, in 4 to 6 weeks, Pharmacare will send you a letter stating your Pharmacare Deductible. Your Deductible is the amount of money you have to spend on eligible prescription medications before Pharmacare starts paying. Your Deductible is based on your income. The higher your income, the more medication you will have to buy for before Pharmacare starts to pay.
The Pharmacare year runs from April 1 to March 31. So every year, everyone has to start paying for their medications again once April fool’s day passes. Then as you pay for your eligible prescriptions, you may eventually spend more than your Deductible. Once you spend more than your Deductible, Pharmacare will start paying for your eligible prescription medications until the next March 31.
What is an eligible prescription medication? Pharmacare has a formulary. A formulary is a list of all the medications that Pharmacare will pay for. Not every medication a doctor can prescribe is on the formulary. Two common questions I get asked are: “My doctor prescribed it. I need it. That means the government pays for it, right?”, and “This new medication is now approved for sale in Canada. If my doctor prescribes it, it will be covered, right?” Unfortunately, the answers to both those questions can be, “No.” Health Canada approves medications for sale, if they determine the medication is safe and effective. Manitoba Health determines which medications it wants to pay for. It puts those medications on the Pharmacare formulary. New medications are usually not covered for a few years after they are released. Manitoba Health only has a limited amount of money with which to pay for prescription medications. So it must make a list of medications it feels it can afford to pay for. Unfortunately, if the medication you need isn’t on the formulary, Pharmacare won’t pay for it.
Actually, the government doesn’t make the formulary as simple as a medication is covered or not. There are actually three different parts of the formulary. Part 1of the formulary are medications that any doctor can prescribe for any condition and Manitoba Health will pay for them. Part 2 (EDS Part 2) are medications that Manitoba Health will not pay for unless the drug is used for a specified condition for a specified time. The doctor is supposed to indicate that the medication meets these criteria by writing “Meets EDS” on the prescription. Part 3 (EDS Part 3) or Exceptional Drug Status is really all other medications that Manitoba Health doesn’t normally pay for. Your doctor can contact Manitoba Health and ask for an exception in your case (exceptional drug status) and hope that Manitoba Health will pay in your exceptional case.
The last question I am often asked is about Pharmacare Pre-Pays. A Pre-Pay is if you want to pay off your whole Deductible at once. Pre-Pays are a Dauphin Clinic Pharmacy program and don’t involve Manitoba Health. Manitoba Health doesn’t want all your Deductible money up front. But, if you go to the Dauphin Clinic Pharmacy, you can pay off your whole Deductible at once. We put your money as a credit on your account. When you fill prescriptions, we charge them against that credit. When the credit runs out, you will be over your Deductible and Pharmacare will start to pay. And the best part about paying your deductible up front is the Dauphin Clinic Pharmacy will give you 10 percent of your deductible back.
I hope that explains some of the common questions about Pharmacare.
Pharmacare application form: www.gov.mb.ca/health/pharmacare/docs/pharmform.pdf
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, April 30, 2010
Vitamin C
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 1492 Columbus sailed the ocean blue”. When Christopher Columbus and his colleagues were sailing around the world, their teeth were falling out. You see they had figured out that on long sea voyages, fresh water could easily go swampy in barrels. So they brought beer instead. It lasted longer. But they hadn’t figured out that only eating salted meat and dried grains for months at a time wasn’t exactly a balanced diet. They were missing fruits and vegetables. This deficiency in their diet had given many of the sailors in the Age of Discovery scurvy. Symptoms of scurvy include: swollen and bleeding gums, loosening of teeth, and bleeding into the muscles and joints. Many people died of scurvy during those early long distance sea voyages.
It was later discovered that citrus fruits like limes could be carried on long distance ships voyages and that something in them prevented scurvy. In fact the British sailors were so renowned for carrying the limes on their boats that they were called Limey’s. Of course, we know now that the citrus fruit have high amounts of Vitamin C in them. We know that a deficiency of Vitamin C causes scurvy, and so getting adequate Vitamin C prevents scurvy.
The amount of scurvy you will see in the streets of Dauphin these days is, well, non-existent. Vitamin C is still an important vitamin. What does Vitamin C do? Vitamin C is used to make collagen. Collagen is an elastic-like goo that is needed to hold together blood vessels, tendons, muscles and bones. So the bleeding and tooth loss of scurvy are due to lack of collagen formation. Vitamin C is involved in making the neurotransmitter, norepinepherine. Neurotransmitters are chemical messengers in the brain, so indirectly Vitamin C can effect mood. Vitamin C is involved in making carnitine, which in turn helps get fat to the powerhouses of the cell called mitochondria. So Vitamin C is involved in burning fat to get energy. Vitamin C may be involved with getting cholesterol out of your blood and into your gut as bile acids. This may effect your cholesterol levels or your chance of getting gall stones.
Lately, Vitamin C is probably most often talked about as an antioxidant. Being an antioxidant means Vitamin C mops up free radicals. Free radicals are special oxygen atoms just itching to have a chemical reaction with anything around them. If that something is the DNA in our cells, that could kill the cell. Or, if the cell isn’t killed, oxygen damaged DNA could even lead to cancer. So it is best if we have antioxidants like Vitamin C to mop up these free radical oxygen atoms before they cause damage.
Why do people take Vitamin C pills? Well, Vitamin C has been used for many things like heart disease, eye disease, cancer, iron absorption, high blood pressure and to prevent sun burn. These all have varying amounts of proof behind them. There is good evidence to support Vitamin C helping the body absorb iron better. The evidence for using oral or injectable Vitamin C in cancer treatment is controversial at best.
One of the most popular uses is to prevent the common cold. This idea was made popular by the brilliant chemist Linus Pauling from the United States. Pauling was the first person to win two unshared Nobel prizes in two different fields. He won a Nobel prize in Chemistry and a Nobel Peace prize. He was a very bright guy. So when he wrote a book called “Vitamin C and the Common Cold” in 1970, people noticed. Despite his brilliance, Vitamin C is questionable against the common cold. Some studies have found big doses of Vitamin C (like 3 g per day) may reduce the duration of the cold about a day. Other studies have found no difference versus placebo. High doses of Vitamin C also increase the risk of upset stomach and diarrhea.
There are many different forms of Vitamin C you can buy. The chemical name for Vitamin C is ascorbic acid. Ascorbic acid dissolves in water. From the reading I’ve done, it doesn’t seem to matter if you dissolved some ascorbic acid in water and drank it, bought an inexpensive pill of Vitamin C at the pharmacy and swallow it, or buy an expensive form of Vitamin C in a specialty store and take it. All forms of Vitamin C seem to be equally bioavailable. That means no matter which form of Vitamin C you use, the same amount gets into you blood stream or into your cells.
So how much Vitamin C do we need? Well you only need about 10 mg of Vitamin C per day to prevent scurvy. Most adults though need around 100 mg of Vitamin C per day. The Health Canada Recommended Daily intake is actually 90 mg in adults males and 75 mg in Adult females, but 100 mg is a nice round number. The upper limit of what Health Canada says we should take is 2000 mg of Vitamin C per day. And you can easily get Vitamin C from your food. A glass of orange juice or ½ a cup of chopped, raw sweet red pepper both have about 100 mg of Vitamin C. Notice I said raw red pepper, though. Vitamin C is very heat labile. That means cooking destroys the Vitamin C.
So you scurvy dogs should remember to eat your fruits and vegetables. Vitamin C will help you keep healthy.
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.
“In 1492 Columbus sailed the ocean blue”. When Christopher Columbus and his colleagues were sailing around the world, their teeth were falling out. You see they had figured out that on long sea voyages, fresh water could easily go swampy in barrels. So they brought beer instead. It lasted longer. But they hadn’t figured out that only eating salted meat and dried grains for months at a time wasn’t exactly a balanced diet. They were missing fruits and vegetables. This deficiency in their diet had given many of the sailors in the Age of Discovery scurvy. Symptoms of scurvy include: swollen and bleeding gums, loosening of teeth, and bleeding into the muscles and joints. Many people died of scurvy during those early long distance sea voyages.
It was later discovered that citrus fruits like limes could be carried on long distance ships voyages and that something in them prevented scurvy. In fact the British sailors were so renowned for carrying the limes on their boats that they were called Limey’s. Of course, we know now that the citrus fruit have high amounts of Vitamin C in them. We know that a deficiency of Vitamin C causes scurvy, and so getting adequate Vitamin C prevents scurvy.
The amount of scurvy you will see in the streets of Dauphin these days is, well, non-existent. Vitamin C is still an important vitamin. What does Vitamin C do? Vitamin C is used to make collagen. Collagen is an elastic-like goo that is needed to hold together blood vessels, tendons, muscles and bones. So the bleeding and tooth loss of scurvy are due to lack of collagen formation. Vitamin C is involved in making the neurotransmitter, norepinepherine. Neurotransmitters are chemical messengers in the brain, so indirectly Vitamin C can effect mood. Vitamin C is involved in making carnitine, which in turn helps get fat to the powerhouses of the cell called mitochondria. So Vitamin C is involved in burning fat to get energy. Vitamin C may be involved with getting cholesterol out of your blood and into your gut as bile acids. This may effect your cholesterol levels or your chance of getting gall stones.
Lately, Vitamin C is probably most often talked about as an antioxidant. Being an antioxidant means Vitamin C mops up free radicals. Free radicals are special oxygen atoms just itching to have a chemical reaction with anything around them. If that something is the DNA in our cells, that could kill the cell. Or, if the cell isn’t killed, oxygen damaged DNA could even lead to cancer. So it is best if we have antioxidants like Vitamin C to mop up these free radical oxygen atoms before they cause damage.
Why do people take Vitamin C pills? Well, Vitamin C has been used for many things like heart disease, eye disease, cancer, iron absorption, high blood pressure and to prevent sun burn. These all have varying amounts of proof behind them. There is good evidence to support Vitamin C helping the body absorb iron better. The evidence for using oral or injectable Vitamin C in cancer treatment is controversial at best.
One of the most popular uses is to prevent the common cold. This idea was made popular by the brilliant chemist Linus Pauling from the United States. Pauling was the first person to win two unshared Nobel prizes in two different fields. He won a Nobel prize in Chemistry and a Nobel Peace prize. He was a very bright guy. So when he wrote a book called “Vitamin C and the Common Cold” in 1970, people noticed. Despite his brilliance, Vitamin C is questionable against the common cold. Some studies have found big doses of Vitamin C (like 3 g per day) may reduce the duration of the cold about a day. Other studies have found no difference versus placebo. High doses of Vitamin C also increase the risk of upset stomach and diarrhea.
There are many different forms of Vitamin C you can buy. The chemical name for Vitamin C is ascorbic acid. Ascorbic acid dissolves in water. From the reading I’ve done, it doesn’t seem to matter if you dissolved some ascorbic acid in water and drank it, bought an inexpensive pill of Vitamin C at the pharmacy and swallow it, or buy an expensive form of Vitamin C in a specialty store and take it. All forms of Vitamin C seem to be equally bioavailable. That means no matter which form of Vitamin C you use, the same amount gets into you blood stream or into your cells.
So how much Vitamin C do we need? Well you only need about 10 mg of Vitamin C per day to prevent scurvy. Most adults though need around 100 mg of Vitamin C per day. The Health Canada Recommended Daily intake is actually 90 mg in adults males and 75 mg in Adult females, but 100 mg is a nice round number. The upper limit of what Health Canada says we should take is 2000 mg of Vitamin C per day. And you can easily get Vitamin C from your food. A glass of orange juice or ½ a cup of chopped, raw sweet red pepper both have about 100 mg of Vitamin C. Notice I said raw red pepper, though. Vitamin C is very heat labile. That means cooking destroys the Vitamin C.
So you scurvy dogs should remember to eat your fruits and vegetables. Vitamin C will help you keep healthy.
As always if you have any questions or concerns about these products, ask your pharmacist.
Vitamin C - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
Friday, April 16, 2010
Oxycontin EDS
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.
Oxycontin is a long acting, powerful narcotic pain killer. It is often used to treat severe pain like that experienced by cancer patients or severe arthritis where other pain medications won’t work. Unfortunately, oxycontin has a bad reputation. It has been called “Hillbilly Heroin” as it has become a popular drug of abuse. Because it has been abused, the Manitoba government is in the process of making it more difficult for patients to get oxycontin paid for by the Pharmacare program.
Why does oxycontin work so well as a pain killer and why has it become popular for abuse? Well it starts with opium and the opium poppy. There is evidence that people were growing opium poppies in Mesopotamis at least 5000 years ago. Opium poppies were traded into Egypt, Greece and Europe. Hippocrates, the father of medicine, would have been aware of opium in ancient Greece. Alexander the Great is credited with bringing opium to the far east. From the 1600’s on opium became the main commodity the British traded with China. They even fight a few wars over it. In the early 1800’s, Friedrich Serturner in Germany discovered how to extract morphine from opium.
Opium seems to have always had its problems with addiction. The extraction of morphine was thought to be a great break-thru as it made the opium like pain killing effects more reliable, longer lasting and safer. Morphine was even called “God’s own medicine”. Morphine is usually referred to as the original narcotic. All the modern narcotic pain killers, including the oxycodone in oxycontin, are derived from morphine. As good as morphine was and a safe as it was compared to opium, problems with addiction seem to have started early as well. Morphine was used during the American Civil War. In that war, there were reports of hundreds of thousands of cases of “soldier’s disease”. Soldier’s disease of the American Civil War is now interpreted as symptoms of morphine addiction.
All the modern derivative of morphine tried to create a safer, more effective pain killer. One of the most unfortunate examples was heroin. It was developed in the late 1800’s and early 1900’s by Heinrich Dreser in Germany for the Bayer company. Apparently heroin was originally marketed as a safe pain killer for children. Then it was marketed as a way to step down off of morphine in adult patients. Unfortunately, although heroin is a stronger pain killer than morphine, it is also much more addictive.
Oxycodone, the active ingredient in oxycontin, was also developed in Germany in the early 1900’s. It is a stronger pain killer than morphine and has the potential to cause slightly fewer side effects. It has been in different pain killers over the years, including in Percocet. Oxycontin was marketed by Purdue in the 1990’s. Its advantage is that is it very long acting. Most people can use just 2 pills a day 12 hours apart. Unfortunately, like other narcotics going back to opium, there have also been problems with addiction and abuse. Rightly or wrongly, oxycontin abuse seems to have received a large amount of media attention in the last few years. So the Manitoba government has decided to act. Although I understand the government’s desire to reduce prescription medication abuse, I worry about patients who need the pain relief. Some of them may get caught in the new paperwork and not be able to afford their medication.
The new rules work through the Part 3 EDS system. EDS stands for Exceptional Drug Status and is an appeal process your doctor can do on your behalf. If you have never been on oxycontin before, and your doctor decides you need it, he or she can fill out forms to say why your pain is very severe, and why other drugs won’t work for you. If Manitoba Health doesn’t like the paperwork, they won’t pay for it, even if you go over your pharmacare deductible.
If you are on oxycontin right now, you have a little time. The government has put in a grandfather clause until May 26, 2010. That means you have between now and May 26 to contact your doctor and ask them to fill in the Part 3 EDS paperwork. After May 26, all patients on oxycontin, new and existing, will require a Part 3 EDS to get coverage from Manitoba Health. If you get the letter from Manitoba Health saying you have a Part 3 EDS, remember your medication is still not necessarily free. You still have to spend your pharmacare deductible before Manitoba Health will pay.
Do I think these new oxycontin rules will fix the problems with abuse and addiction? Not to be a pessimist, but probably not. There are other medications to abuse if you have an addiction. And although Manitoba Health is well intentioned, we have been dancing with the fantastic benefits and dangerous pitfalls of the opium like drugs for over 5000 years and I don’t think this will be the last song.
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.
Oxycontin is a long acting, powerful narcotic pain killer. It is often used to treat severe pain like that experienced by cancer patients or severe arthritis where other pain medications won’t work. Unfortunately, oxycontin has a bad reputation. It has been called “Hillbilly Heroin” as it has become a popular drug of abuse. Because it has been abused, the Manitoba government is in the process of making it more difficult for patients to get oxycontin paid for by the Pharmacare program.
Why does oxycontin work so well as a pain killer and why has it become popular for abuse? Well it starts with opium and the opium poppy. There is evidence that people were growing opium poppies in Mesopotamis at least 5000 years ago. Opium poppies were traded into Egypt, Greece and Europe. Hippocrates, the father of medicine, would have been aware of opium in ancient Greece. Alexander the Great is credited with bringing opium to the far east. From the 1600’s on opium became the main commodity the British traded with China. They even fight a few wars over it. In the early 1800’s, Friedrich Serturner in Germany discovered how to extract morphine from opium.
Opium seems to have always had its problems with addiction. The extraction of morphine was thought to be a great break-thru as it made the opium like pain killing effects more reliable, longer lasting and safer. Morphine was even called “God’s own medicine”. Morphine is usually referred to as the original narcotic. All the modern narcotic pain killers, including the oxycodone in oxycontin, are derived from morphine. As good as morphine was and a safe as it was compared to opium, problems with addiction seem to have started early as well. Morphine was used during the American Civil War. In that war, there were reports of hundreds of thousands of cases of “soldier’s disease”. Soldier’s disease of the American Civil War is now interpreted as symptoms of morphine addiction.
All the modern derivative of morphine tried to create a safer, more effective pain killer. One of the most unfortunate examples was heroin. It was developed in the late 1800’s and early 1900’s by Heinrich Dreser in Germany for the Bayer company. Apparently heroin was originally marketed as a safe pain killer for children. Then it was marketed as a way to step down off of morphine in adult patients. Unfortunately, although heroin is a stronger pain killer than morphine, it is also much more addictive.
Oxycodone, the active ingredient in oxycontin, was also developed in Germany in the early 1900’s. It is a stronger pain killer than morphine and has the potential to cause slightly fewer side effects. It has been in different pain killers over the years, including in Percocet. Oxycontin was marketed by Purdue in the 1990’s. Its advantage is that is it very long acting. Most people can use just 2 pills a day 12 hours apart. Unfortunately, like other narcotics going back to opium, there have also been problems with addiction and abuse. Rightly or wrongly, oxycontin abuse seems to have received a large amount of media attention in the last few years. So the Manitoba government has decided to act. Although I understand the government’s desire to reduce prescription medication abuse, I worry about patients who need the pain relief. Some of them may get caught in the new paperwork and not be able to afford their medication.
The new rules work through the Part 3 EDS system. EDS stands for Exceptional Drug Status and is an appeal process your doctor can do on your behalf. If you have never been on oxycontin before, and your doctor decides you need it, he or she can fill out forms to say why your pain is very severe, and why other drugs won’t work for you. If Manitoba Health doesn’t like the paperwork, they won’t pay for it, even if you go over your pharmacare deductible.
If you are on oxycontin right now, you have a little time. The government has put in a grandfather clause until May 26, 2010. That means you have between now and May 26 to contact your doctor and ask them to fill in the Part 3 EDS paperwork. After May 26, all patients on oxycontin, new and existing, will require a Part 3 EDS to get coverage from Manitoba Health. If you get the letter from Manitoba Health saying you have a Part 3 EDS, remember your medication is still not necessarily free. You still have to spend your pharmacare deductible before Manitoba Health will pay.
Do I think these new oxycontin rules will fix the problems with abuse and addiction? Not to be a pessimist, but probably not. There are other medications to abuse if you have an addiction. And although Manitoba Health is well intentioned, we have been dancing with the fantastic benefits and dangerous pitfalls of the opium like drugs for over 5000 years and I don’t think this will be the last song.
As always if you have any questions or concerns about these products, ask your pharmacist.
Oxycontin EDS - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
Friday, April 09, 2010
Yeast Infections - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
Yeast Infections
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 share a birthday with some important people, including: Queen Victoria, The Buddha, and Bob Dylan. So while I was listening to the Parkland’s Best Music, 730 CKDM in the Winnipegosis Clinic Pharmacy, I was happy to hear a song by one of my birthday mates. It was “Signs”. You known, “And the sign said long haired freaky people need not apply…” And then the announcer rocked my world. That wasn’t a Dylan song. It was by the Five Man Electrical Band! And to top it all off, they are a Canadian band. The other game-changer I learned about in Winnipegosis that day was how over the counter yeast infection treatments had changed.
The new over-the-counter treatment for vaginal yeast infections is called CanesOral. It is a one time only oral capsule. It contains 150 mg of fluconazole. That medication used to only be available by prescription. Fluconazole is general considered a safe medication. After swallowing one pill of fluconazole150 mg, the patient should start feeling relief in a few days. Side effects are usually mild but could include: nausea, indigestion, diarrhea, headache or rash.
What is a vaginal yeast infection? A vaginal yeast infection is caused by a fungus called Candida albicans. Yeast are tiny organisms that live in small numbers on the skin and inside the vagina. The inside of the vagina is usually too acidic for a lot of yeast cells to grow. But if the conditions change, yeast cells may begin to multiply. Things such as the menstrual period, pregnancy, diabetes, antibiotics and birth control pills can change the inside of the vagina so that yeast cells can grow more easily. Moisture and irritation of the vagina may also make it easy for yeast to grow.
What are the signs of a yeast infection? You may have: itching and burning, a white discharge that looks like cottage cheese or pain during sex. Vaginal yeast infections are very common. However, the symptoms are similar to other more serious conditions (e.g., some sexually transmitted diseases – STDs), and some less serious conditions like bacterial infections. Your doctor can tell you if you have a yeast infection or not. Unfortunately, women have not been shown to be very good at self diagnosing vaginal yeast infections. A 2002 study of 95 women by Ferris showed only about 1/3 of the women correctly self diagnosed their vaginal yeast infections. Treating yourself for a yeast infection when you have another kind of infection won’t help and can make the problem worse. So when should you see your doctor? If you still have symptoms seven days after the treatment or, if the symptoms get worse during treatment.
There are also a group of people who should always see their doctor before trying an over the counter treatment. See your doctor if: you are under 18 years old, you have never had a yeast infection before, you have diabetes, you are pregnant or if the symptoms seem different than your last yeast infection.
What is the treatment for a yeast infection? Well, over the counter we used to just have creams and tablets that were inserted inside the vagina. Now we also have the option of this one time only oral capsule you swallow. There is also the CanesOral combi-pak that has the oral pill, plus a cream for external itching.Is it okay to have sex while using the treatment? No, sex is not recommended. Your partner could become infected. Also the yeast infection medication that is inserted into the vagina can decrease the effectiveness of spermicides, condoms, diaphragms and cervical caps. These birth control methods will not work as well during a treatment and for up to three days after.
I think it is great women have another convenient option for treating themselves for a yeast infection. However, remember that although the symptoms might feel the same, women can be wrong up to 2/3 of the time when self diagnosing a yeast infection. So if you have doubts, or if any yeast infection treatment doesn’t clear the symptoms in seven days, see your doctor.
For your next yeast infection, try CanesOral. If you want to meet Bob Dylan, and the Five Man Electrical Band, I can’t help you. However, if you want your blood sugar checked and learn more about Diabetes, come down to the Dauphin Clinic Pharmacy Thursday, April 8th from 10 am to 2 pm. We will have a nurse and our capable staff there for an informative Diabetes Clinic.
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 share a birthday with some important people, including: Queen Victoria, The Buddha, and Bob Dylan. So while I was listening to the Parkland’s Best Music, 730 CKDM in the Winnipegosis Clinic Pharmacy, I was happy to hear a song by one of my birthday mates. It was “Signs”. You known, “And the sign said long haired freaky people need not apply…” And then the announcer rocked my world. That wasn’t a Dylan song. It was by the Five Man Electrical Band! And to top it all off, they are a Canadian band. The other game-changer I learned about in Winnipegosis that day was how over the counter yeast infection treatments had changed.
The new over-the-counter treatment for vaginal yeast infections is called CanesOral. It is a one time only oral capsule. It contains 150 mg of fluconazole. That medication used to only be available by prescription. Fluconazole is general considered a safe medication. After swallowing one pill of fluconazole150 mg, the patient should start feeling relief in a few days. Side effects are usually mild but could include: nausea, indigestion, diarrhea, headache or rash.
What is a vaginal yeast infection? A vaginal yeast infection is caused by a fungus called Candida albicans. Yeast are tiny organisms that live in small numbers on the skin and inside the vagina. The inside of the vagina is usually too acidic for a lot of yeast cells to grow. But if the conditions change, yeast cells may begin to multiply. Things such as the menstrual period, pregnancy, diabetes, antibiotics and birth control pills can change the inside of the vagina so that yeast cells can grow more easily. Moisture and irritation of the vagina may also make it easy for yeast to grow.
What are the signs of a yeast infection? You may have: itching and burning, a white discharge that looks like cottage cheese or pain during sex. Vaginal yeast infections are very common. However, the symptoms are similar to other more serious conditions (e.g., some sexually transmitted diseases – STDs), and some less serious conditions like bacterial infections. Your doctor can tell you if you have a yeast infection or not. Unfortunately, women have not been shown to be very good at self diagnosing vaginal yeast infections. A 2002 study of 95 women by Ferris showed only about 1/3 of the women correctly self diagnosed their vaginal yeast infections. Treating yourself for a yeast infection when you have another kind of infection won’t help and can make the problem worse. So when should you see your doctor? If you still have symptoms seven days after the treatment or, if the symptoms get worse during treatment.
There are also a group of people who should always see their doctor before trying an over the counter treatment. See your doctor if: you are under 18 years old, you have never had a yeast infection before, you have diabetes, you are pregnant or if the symptoms seem different than your last yeast infection.
What is the treatment for a yeast infection? Well, over the counter we used to just have creams and tablets that were inserted inside the vagina. Now we also have the option of this one time only oral capsule you swallow. There is also the CanesOral combi-pak that has the oral pill, plus a cream for external itching.Is it okay to have sex while using the treatment? No, sex is not recommended. Your partner could become infected. Also the yeast infection medication that is inserted into the vagina can decrease the effectiveness of spermicides, condoms, diaphragms and cervical caps. These birth control methods will not work as well during a treatment and for up to three days after.
I think it is great women have another convenient option for treating themselves for a yeast infection. However, remember that although the symptoms might feel the same, women can be wrong up to 2/3 of the time when self diagnosing a yeast infection. So if you have doubts, or if any yeast infection treatment doesn’t clear the symptoms in seven days, see your doctor.
For your next yeast infection, try CanesOral. If you want to meet Bob Dylan, and the Five Man Electrical Band, I can’t help you. However, if you want your blood sugar checked and learn more about Diabetes, come down to the Dauphin Clinic Pharmacy Thursday, April 8th from 10 am to 2 pm. We will have a nurse and our capable staff there for an informative Diabetes Clinic.
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, March 26, 2010
Medicine Cabinet Cleanup - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
MEDICINE CABINET CLEAN-UP
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at http://www.dcp.ca/
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
My parents were both born and raised in Canada but they got married in Cambridge, England. I always enjoyed their tales about life in England and their trips to places like France and Portugal. One of my favorite characters from their stories was their friend Shugoon. Shugoon was a Nigerian guy my mom described as 5 feet tall, black as the ace of spades with an infectious laugh. On one trip they all stayed in a hotel. Just as my parents were settling in for the night, Shugoon burst into their room. There was an animal in his bed! My parents went back with him to investigate, and found a hot water bottle under his covers. You see in England, central heating was not common and a hot water bottle was a way to warm up a bed before getting in.
The Shugoon story reminds me I going on a sabbatical. I’m going to be a submarine captain for a week. Will you fill in at the pharmacy for me? Thanks. I’m excited about my submarine trip, but hot racking creeps me out a bit. You see on a sub when you are done your shift, you get to sleep in a bunk that someone from the previous shift just got out of. It is still warm, thus “hot racking”. I’ll let you know how it goes.
You arrive at the pharmacy and put on your white coat. You find a counter to stand behind. You manage to look wise, concerned and not too goofy all at the same time. Then the phone rings. The customer on the line says, “I feel like I have a cold coming on. I’ve got these pills in the bathroom. They are spelled T-E-T-R-A-C-Y-C-L-I-N-E. They were prescribed to my daughter 2 years ago. Will they help me?” Questions like this one are quite common in our pharmacy. Here are your choices:
a) Tell him to go ahead and take them. What’s the worst that can happen?
b) Tell him that it is completely reasonable for a patient to self diagnosis his illness and select a drug that is probably expired, will probably harm him, and wasn’t even prescribed for him in the first place.
c) Tell the patient that if he has already touched the bottle the toxin inside has already leached through his skin and is right now eating at his brain.
d) Tell the patient to collect all the expired medications in his house, plus all the prescription drugs that haven’t been used in 6 months and bring them into the pharmacy. The pharmacist can help him decide which to discard. The pharmacy will also make sure the discarded meds are disposed of properly. Finally, if he is feeling ill perhaps he should see his family doctor to have his condition properly diagnosed.
I know that as my relief pharmacist want to keep this guy as a repeat, breathing customer, so you choose (D). Let’s review why all you smart folks choose (D):
Medications expire. Most of the time, they just become less potent so they won’t work as well. But, there are drugs like tetracycline that actually change into toxic substances when they expire.
When medications need to be destroyed they should be brought back to the pharmacy. It is no longer considered safe to flush them down the toilet. Also, if you throw them in the garbage, medications like iron pills are still potent enough to harm children and pets. Pharmacies will make sure they are safely disposed of, often by incineration. It is a good habit to check for unused medications in your house once a year.
The “medicine cabinet” in the bathroom is actually the worse place in the house to store medications. Medications degrade fastest in warm, moist environments. Medications should be stored in a dark, cool, dry, lockable cupboard. Also, don’t put meds in the fridge unless the pharmacist specifically tells you to put them there.
A person should never, ever take prescriptions that weren’t prescribed to them. Medications that are helpful for one person could be poisonous to another. Also, there shouldn’t really be “left-over” medication in the house. Antibiotics should be completely finished when prescribed unless there are side effects and the doctor tells you to stop. And in that case you should drop off the unused medications at the pharmacy for disposal. Keeping them around “just in case” is a recipe for a poisoning in your house.
I’m back from my submarine trip. Thanks for filling in for me at the pharmacy. The hot racking wasn’t too bad. You know what, though? I had a lay-over in London on my way back. It seems three Holiday Inns in the UK now have a bed warming service. And this isn’t the hot water bottle thing of 40 years ago. You can call the hotel and tell them what time you will arrive and request a bed warmer. Before your get there, a hotel staffer gets into full body fleecy footy jammies and gets into your bed. They stay there until your bed is up to 20 C and they get out before your arrive. If that hotel staffer accidentally fell asleep, do you think Shugoon would be more upset by an animal or a person in his bed?
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.
My parents were both born and raised in Canada but they got married in Cambridge, England. I always enjoyed their tales about life in England and their trips to places like France and Portugal. One of my favorite characters from their stories was their friend Shugoon. Shugoon was a Nigerian guy my mom described as 5 feet tall, black as the ace of spades with an infectious laugh. On one trip they all stayed in a hotel. Just as my parents were settling in for the night, Shugoon burst into their room. There was an animal in his bed! My parents went back with him to investigate, and found a hot water bottle under his covers. You see in England, central heating was not common and a hot water bottle was a way to warm up a bed before getting in.
The Shugoon story reminds me I going on a sabbatical. I’m going to be a submarine captain for a week. Will you fill in at the pharmacy for me? Thanks. I’m excited about my submarine trip, but hot racking creeps me out a bit. You see on a sub when you are done your shift, you get to sleep in a bunk that someone from the previous shift just got out of. It is still warm, thus “hot racking”. I’ll let you know how it goes.
You arrive at the pharmacy and put on your white coat. You find a counter to stand behind. You manage to look wise, concerned and not too goofy all at the same time. Then the phone rings. The customer on the line says, “I feel like I have a cold coming on. I’ve got these pills in the bathroom. They are spelled T-E-T-R-A-C-Y-C-L-I-N-E. They were prescribed to my daughter 2 years ago. Will they help me?” Questions like this one are quite common in our pharmacy. Here are your choices:
a) Tell him to go ahead and take them. What’s the worst that can happen?
b) Tell him that it is completely reasonable for a patient to self diagnosis his illness and select a drug that is probably expired, will probably harm him, and wasn’t even prescribed for him in the first place.
c) Tell the patient that if he has already touched the bottle the toxin inside has already leached through his skin and is right now eating at his brain.
d) Tell the patient to collect all the expired medications in his house, plus all the prescription drugs that haven’t been used in 6 months and bring them into the pharmacy. The pharmacist can help him decide which to discard. The pharmacy will also make sure the discarded meds are disposed of properly. Finally, if he is feeling ill perhaps he should see his family doctor to have his condition properly diagnosed.
I know that as my relief pharmacist want to keep this guy as a repeat, breathing customer, so you choose (D). Let’s review why all you smart folks choose (D):
Medications expire. Most of the time, they just become less potent so they won’t work as well. But, there are drugs like tetracycline that actually change into toxic substances when they expire.
When medications need to be destroyed they should be brought back to the pharmacy. It is no longer considered safe to flush them down the toilet. Also, if you throw them in the garbage, medications like iron pills are still potent enough to harm children and pets. Pharmacies will make sure they are safely disposed of, often by incineration. It is a good habit to check for unused medications in your house once a year.
The “medicine cabinet” in the bathroom is actually the worse place in the house to store medications. Medications degrade fastest in warm, moist environments. Medications should be stored in a dark, cool, dry, lockable cupboard. Also, don’t put meds in the fridge unless the pharmacist specifically tells you to put them there.
A person should never, ever take prescriptions that weren’t prescribed to them. Medications that are helpful for one person could be poisonous to another. Also, there shouldn’t really be “left-over” medication in the house. Antibiotics should be completely finished when prescribed unless there are side effects and the doctor tells you to stop. And in that case you should drop off the unused medications at the pharmacy for disposal. Keeping them around “just in case” is a recipe for a poisoning in your house.
I’m back from my submarine trip. Thanks for filling in for me at the pharmacy. The hot racking wasn’t too bad. You know what, though? I had a lay-over in London on my way back. It seems three Holiday Inns in the UK now have a bed warming service. And this isn’t the hot water bottle thing of 40 years ago. You can call the hotel and tell them what time you will arrive and request a bed warmer. Before your get there, a hotel staffer gets into full body fleecy footy jammies and gets into your bed. They stay there until your bed is up to 20 C and they get out before your arrive. If that hotel staffer accidentally fell asleep, do you think Shugoon would be more upset by an animal or a person in his bed?
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, March 12, 2010
Colon Cancer - AUDIO
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
Colon Cancer
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
The camera pans in on a frazzled looking middle aged guy buried in paper on his desk. The name plate on the desk identifies him as the “Senior Accounts Manager”. The door to his office opens. In walks an older gentleman and a young dynamic fellow. The older gentleman is heard saying, “…and this what the offices look like. Of course the décor can be changed to your liking…” and the older man wanders out of the office. The young man smiles, introduces himself and shakes the hand of the man behind the desk. The man behind the desk says, “Welcome to the company. What position did you get anyway?”. The young man answers, “Senior Accounts Manager” and leaves the room. Across the bottom of the screen scrolls, “After 50, watch your behind!” I love that commercial. And apparently March is National Colorectal Cancer Awareness Month.
Colorectal cancer (CRC) is the second most common form of cancer in Manitoba. We had 800 new cases of CRC and 360 deaths from CRC in the province in 2009. Men have a 1 in 14 lifetime chance of getting CRC and women have a 1 in 15 chance. The reason for the “After 50, watch your behind” slogan is because 93% of cases of CRC happen after the age of 50. Like many cancers, the earlier it is caught, the easier it is to treat.
So why don’t we talk about CRC if it is so common? Frankly, it has to do with the butt and that embarrasses us. And, for myself at least, the test that is talked about for CRC doesn’t sound pleasant. The most common test is still the colonoscopy during which a camera goes where the sun doesn’t shine. The colonoscopy isn’t just a theoretical bad thing for me either. I’ve got some colon cancer and colon polyps in my family tree. After I turn fifty, I fear someone will be watching my behind from a whole new angle.
Although it may not eliminate my future need for a colonoscopy, I was happy to hear about the ColonCheck Manitoba program. If you are between 50 and 74 you can call 1-866-744-8961 and ColonCheck Manitoba will ask you a few questions. They will ask things like if you age, if your have a colonscopy in the last 5 years and if you currently have colorectal cancer. If you qualify, ColonCheck Manitoba will send you a Fecal Occult Blood Test (FOBT) in the mail that you can do at home. I think that is great. It means squimish people like me can still watch their behind while getting colonoscopies less often.
What is a Fecal Occult Blood Test (FOBT)? A FOBT is basically a stick that lets you sample a little bit of your poop, seal it up and send it to the lab. The ColonCheck Manitoba people will contact you directly and will send the results to your family doctor if you have one. The test is looking to see if there is any hidden blood in your poop. Blood in your poop can be a warning sign of polyps in your colon or colorectal cancer. So if the FOBT comes back positive, you will be asked to get a colonoscopy to see what is going on. If the FOBT comes back negative, you should be able to skip the colonoscopy for at least 2 years.
What can you do to prevent CRC? Besides getting screened to catch the cancer early you can exercise and eat well. Amazing how those two things keep popping up. You should aim to exercise at least 30 minutes per day, at least 5 days a week. You should limit your intake of red meat and processed meats. You should get your 7-10 serving of fruits and vegetables per day. You should drink lots of water. You should have not more than 2 alcoholic drinks per day if you are a man and not more than 1 per day if you are a woman.
So after 50, watch your behind. And to steal another slogan from the commercials, you should care about CRC because you don’t want to die of embarrassment.
Contact ColonCheck Manitoba at www.coloncheckmb.ca or 1-866-744-8961
As always if you have any questions or concerns about these or other products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
The camera pans in on a frazzled looking middle aged guy buried in paper on his desk. The name plate on the desk identifies him as the “Senior Accounts Manager”. The door to his office opens. In walks an older gentleman and a young dynamic fellow. The older gentleman is heard saying, “…and this what the offices look like. Of course the décor can be changed to your liking…” and the older man wanders out of the office. The young man smiles, introduces himself and shakes the hand of the man behind the desk. The man behind the desk says, “Welcome to the company. What position did you get anyway?”. The young man answers, “Senior Accounts Manager” and leaves the room. Across the bottom of the screen scrolls, “After 50, watch your behind!” I love that commercial. And apparently March is National Colorectal Cancer Awareness Month.
Colorectal cancer (CRC) is the second most common form of cancer in Manitoba. We had 800 new cases of CRC and 360 deaths from CRC in the province in 2009. Men have a 1 in 14 lifetime chance of getting CRC and women have a 1 in 15 chance. The reason for the “After 50, watch your behind” slogan is because 93% of cases of CRC happen after the age of 50. Like many cancers, the earlier it is caught, the easier it is to treat.
So why don’t we talk about CRC if it is so common? Frankly, it has to do with the butt and that embarrasses us. And, for myself at least, the test that is talked about for CRC doesn’t sound pleasant. The most common test is still the colonoscopy during which a camera goes where the sun doesn’t shine. The colonoscopy isn’t just a theoretical bad thing for me either. I’ve got some colon cancer and colon polyps in my family tree. After I turn fifty, I fear someone will be watching my behind from a whole new angle.
Although it may not eliminate my future need for a colonoscopy, I was happy to hear about the ColonCheck Manitoba program. If you are between 50 and 74 you can call 1-866-744-8961 and ColonCheck Manitoba will ask you a few questions. They will ask things like if you age, if your have a colonscopy in the last 5 years and if you currently have colorectal cancer. If you qualify, ColonCheck Manitoba will send you a Fecal Occult Blood Test (FOBT) in the mail that you can do at home. I think that is great. It means squimish people like me can still watch their behind while getting colonoscopies less often.
What is a Fecal Occult Blood Test (FOBT)? A FOBT is basically a stick that lets you sample a little bit of your poop, seal it up and send it to the lab. The ColonCheck Manitoba people will contact you directly and will send the results to your family doctor if you have one. The test is looking to see if there is any hidden blood in your poop. Blood in your poop can be a warning sign of polyps in your colon or colorectal cancer. So if the FOBT comes back positive, you will be asked to get a colonoscopy to see what is going on. If the FOBT comes back negative, you should be able to skip the colonoscopy for at least 2 years.
What can you do to prevent CRC? Besides getting screened to catch the cancer early you can exercise and eat well. Amazing how those two things keep popping up. You should aim to exercise at least 30 minutes per day, at least 5 days a week. You should limit your intake of red meat and processed meats. You should get your 7-10 serving of fruits and vegetables per day. You should drink lots of water. You should have not more than 2 alcoholic drinks per day if you are a man and not more than 1 per day if you are a woman.
So after 50, watch your behind. And to steal another slogan from the commercials, you should care about CRC because you don’t want to die of embarrassment.
Contact ColonCheck Manitoba at www.coloncheckmb.ca or 1-866-744-8961
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, March 05, 2010
High Blood Pressure - AUDIO
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
High Blood Pressure
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 walked up to the house. I rang the door bell. I was there to pick up a girl for our second date. A woman whom I had never seen before opened the door, and slapped me across the face. I was shocked and didn’t know what to do. To this day, my sister-in-law swears there was a mosquito on my face. Perspective. It is amazing how a point of view can change how we look at something.
My sister-in-law and I also have different perspectives on our professions. My sister-in-law is an early childhood educator. She likes to brag that during early childhood educator awareness week the board of her daycare in Winnipeg buys the workers gifts and spa packages to show the workers their appreciation for all their hard work. Don’t get me wrong, I think looking after pre-school children would be very hard, and I don’t think I could do it. But, I think if I told my customers they should start bringing me gifts for Pharmacy Awareness Week (PAW), I think they would go to another pharmacy. So for Pharmacy Awareness Week, let me give you a gift. Let’s get some new perspective on high blood pressure.
We all know that having high blood pressure is bad. It increases your chance of having heart attacks, strokes, kidney disease and a variety of other conditions. The World Health Organization estimates that 7.1 million deaths a year can be attributed to high blood pressure. The WHO also says two thirds of strokes and half the cases of ischemic heart disease are caused by poorly controlled high blood pressure.
The new perspective on high blood pressure lately was in a report released by Stats Canada. In February 2010 they released a very ambitious survey. They actually went out and measured the blood pressure of 5600 Canadians between the ages of 6 and 79 years old between March 2007 and February 2009. This is impressive because most surveys of blood pressure just ask people if they have high blood pressure. We call that kind of survey self reporting. Self reporting surveys often underestimate high blood pressure rates.
So what did the Stats Can survey find? About 1 in 5 of Canadians between 20 and 79 have high blood pressure. That means their systolic blood pressure was above 140, their diastolic was above 90 or they reported to have used a blood pressure medication in the last month. Of the people with high blood pressure, one third had blood pressure that wasn’t well controlled. That means 6.6% of the adult population in Canada or about 1.6 million of us have poorly controlled high blood pressure. Mothers Against Drinking and Driving ( MADD) Canada estimates that 1600 of us die and 400,000 of us are injured every year from drinking and driving. That means 4 times as many Canadians are at risk of death and injury from poorly controlled blood pressure than from drinking and driving. This is where your local pharmacist can help.
If you are over 40 and don’t know what your blood pressure is, run don’t walk to your local pharmacy and have it checked. If you kinda stopped taking that blood pressure pill a couple of months ago, call your pharmacist. Maybe we can help figure out a blood pressure pill that will agree with you better and send a recommendation to your doctor. If you don’t think you need that blood pressure pill, come talk to me. I can tell you how much fun you can have with half your body paralyzed due to a stroke.
For Pharmacy Awareness Week, come talk to me about your blood pressure. Let me give you the gift of health information and show you how a new perspective on high blood pressure is better than a slap in the face.
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 walked up to the house. I rang the door bell. I was there to pick up a girl for our second date. A woman whom I had never seen before opened the door, and slapped me across the face. I was shocked and didn’t know what to do. To this day, my sister-in-law swears there was a mosquito on my face. Perspective. It is amazing how a point of view can change how we look at something.
My sister-in-law and I also have different perspectives on our professions. My sister-in-law is an early childhood educator. She likes to brag that during early childhood educator awareness week the board of her daycare in Winnipeg buys the workers gifts and spa packages to show the workers their appreciation for all their hard work. Don’t get me wrong, I think looking after pre-school children would be very hard, and I don’t think I could do it. But, I think if I told my customers they should start bringing me gifts for Pharmacy Awareness Week (PAW), I think they would go to another pharmacy. So for Pharmacy Awareness Week, let me give you a gift. Let’s get some new perspective on high blood pressure.
We all know that having high blood pressure is bad. It increases your chance of having heart attacks, strokes, kidney disease and a variety of other conditions. The World Health Organization estimates that 7.1 million deaths a year can be attributed to high blood pressure. The WHO also says two thirds of strokes and half the cases of ischemic heart disease are caused by poorly controlled high blood pressure.
The new perspective on high blood pressure lately was in a report released by Stats Canada. In February 2010 they released a very ambitious survey. They actually went out and measured the blood pressure of 5600 Canadians between the ages of 6 and 79 years old between March 2007 and February 2009. This is impressive because most surveys of blood pressure just ask people if they have high blood pressure. We call that kind of survey self reporting. Self reporting surveys often underestimate high blood pressure rates.
So what did the Stats Can survey find? About 1 in 5 of Canadians between 20 and 79 have high blood pressure. That means their systolic blood pressure was above 140, their diastolic was above 90 or they reported to have used a blood pressure medication in the last month. Of the people with high blood pressure, one third had blood pressure that wasn’t well controlled. That means 6.6% of the adult population in Canada or about 1.6 million of us have poorly controlled high blood pressure. Mothers Against Drinking and Driving ( MADD) Canada estimates that 1600 of us die and 400,000 of us are injured every year from drinking and driving. That means 4 times as many Canadians are at risk of death and injury from poorly controlled blood pressure than from drinking and driving. This is where your local pharmacist can help.
If you are over 40 and don’t know what your blood pressure is, run don’t walk to your local pharmacy and have it checked. If you kinda stopped taking that blood pressure pill a couple of months ago, call your pharmacist. Maybe we can help figure out a blood pressure pill that will agree with you better and send a recommendation to your doctor. If you don’t think you need that blood pressure pill, come talk to me. I can tell you how much fun you can have with half your body paralyzed due to a stroke.
For Pharmacy Awareness Week, come talk to me about your blood pressure. Let me give you the gift of health information and show you how a new perspective on high blood pressure is better than a slap in the face.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, February 19, 2010
DRUG INTERACTION WITH TAMOXIFEN
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
“The TV said my antidepressant is going to give me cancer. Is that true?” The best questions in the pharmacy always come from you, the public. After I got a little bit of background information like who the person was, what antidepressant they were on and what they saw on TV, I was able to reassure the person they were going to be okay. But I thought some of the research I had to read to answer the question was interesting.
The excitement all started with a paper published in the Feb 2010 edition of the British Medical Journal. Catherine M Kelly et al. looked at women 66 years old and over treated with tamoxifen for breast cancer at the same time they were taking one SSRI between 1993 and 2005. An SSRI or selective serotonin reuptake inhibitor is a type of antidepressant. The study included 2430 women. What the researchers were looking for was how many women died after their treatment with tamoxifen was over. Then they looked to see if the number of women who died increased if the time the women were on both tamoxifen and an SSRI increased. The answer is yes if a women is on tamoxifen and one type of SSRI called paroxetine or Paxil at the same time during breast cancer treatment, the women is more likely to die after the treatment. And yes, the longer the woman was on both paroxetine and tamoxifen during the cancer treatment, the more likely she is to die after the treatment was over. But, before everyone panics, let’s do some pharmacology.
Tamoxifen was originally developed from the bark of the Pacific Yew tree. (See I’m not against all natural products). It can be used for different things but most often it is used to prevent or treat breast cancer. Tamoxifen is called a Selective Estrogen Receptor Modulator or SERM. It binds to estrogen receptors in the body and prevents estrogens from having its regular effects. On the negative side, that means it causes hot flashes in women that are very similar to those experienced during menopause. On the positive sign if the women has a tumor in her breast that grows when it is given estrogen, the tamoxifen prevent estrogen from making the tumor grow.
Tamoxifen is also a pro-drug. That means the molecule tamoxifen doesn’t actually do anything in the body. It has to be converted to the metabolite endoxifen by an enzyme in the body called cytochrome P450 2D6 (CYP2D6). It is the endoxifen that fights cancer. So if someone didn’t have functioning CYP2D6 then tamoxifen wouldn’t work for them. Apparently about 7% of us don’t have functional CYP2D6 enzymes. So if you give a women without functional CYP2D6 enzymes to treat her breast cancer, it won’t help her.
In the BMJ study they looked at SSRI’s like paroxetine, because paroxetine stops CYP2D6 from working. Based on the results, the study’s authors estimate that if 20 women took paroxetine at the same time as their tamoxifen 41% of the time during breast cancer treatment that one woman more than expected would die from breast cancer at 5 years after treatment. This is an important finding, but remember the study wasn’t perfect. It only looked at women over 66 years old. The authors didn’t do genetic testing, so they don’t know how many patients naturally had CYP2D6 enzymes that didn’t work. Were women with more severe breast cancer more depressed, so they got paroxetine more often?
If you are on paroxetine and tamoxifen right now, don’t panic. Don’t stop taking either drug. At your next appointment, talk to your doctor about options. We can switch the antidepressant to another one that doesn’t block CYP2D6. Two options are citalopram and venlafaxine. We can switch your tamoxifen to estrogen blockers that aren’t prodrugs. The have names like arimidex. These aromatase inhibitors are more potent and expensive than tamoxifen and they aren’t appropriate for younger women.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
“The TV said my antidepressant is going to give me cancer. Is that true?” The best questions in the pharmacy always come from you, the public. After I got a little bit of background information like who the person was, what antidepressant they were on and what they saw on TV, I was able to reassure the person they were going to be okay. But I thought some of the research I had to read to answer the question was interesting.
The excitement all started with a paper published in the Feb 2010 edition of the British Medical Journal. Catherine M Kelly et al. looked at women 66 years old and over treated with tamoxifen for breast cancer at the same time they were taking one SSRI between 1993 and 2005. An SSRI or selective serotonin reuptake inhibitor is a type of antidepressant. The study included 2430 women. What the researchers were looking for was how many women died after their treatment with tamoxifen was over. Then they looked to see if the number of women who died increased if the time the women were on both tamoxifen and an SSRI increased. The answer is yes if a women is on tamoxifen and one type of SSRI called paroxetine or Paxil at the same time during breast cancer treatment, the women is more likely to die after the treatment. And yes, the longer the woman was on both paroxetine and tamoxifen during the cancer treatment, the more likely she is to die after the treatment was over. But, before everyone panics, let’s do some pharmacology.
Tamoxifen was originally developed from the bark of the Pacific Yew tree. (See I’m not against all natural products). It can be used for different things but most often it is used to prevent or treat breast cancer. Tamoxifen is called a Selective Estrogen Receptor Modulator or SERM. It binds to estrogen receptors in the body and prevents estrogens from having its regular effects. On the negative side, that means it causes hot flashes in women that are very similar to those experienced during menopause. On the positive sign if the women has a tumor in her breast that grows when it is given estrogen, the tamoxifen prevent estrogen from making the tumor grow.
Tamoxifen is also a pro-drug. That means the molecule tamoxifen doesn’t actually do anything in the body. It has to be converted to the metabolite endoxifen by an enzyme in the body called cytochrome P450 2D6 (CYP2D6). It is the endoxifen that fights cancer. So if someone didn’t have functioning CYP2D6 then tamoxifen wouldn’t work for them. Apparently about 7% of us don’t have functional CYP2D6 enzymes. So if you give a women without functional CYP2D6 enzymes to treat her breast cancer, it won’t help her.
In the BMJ study they looked at SSRI’s like paroxetine, because paroxetine stops CYP2D6 from working. Based on the results, the study’s authors estimate that if 20 women took paroxetine at the same time as their tamoxifen 41% of the time during breast cancer treatment that one woman more than expected would die from breast cancer at 5 years after treatment. This is an important finding, but remember the study wasn’t perfect. It only looked at women over 66 years old. The authors didn’t do genetic testing, so they don’t know how many patients naturally had CYP2D6 enzymes that didn’t work. Were women with more severe breast cancer more depressed, so they got paroxetine more often?
If you are on paroxetine and tamoxifen right now, don’t panic. Don’t stop taking either drug. At your next appointment, talk to your doctor about options. We can switch the antidepressant to another one that doesn’t block CYP2D6. Two options are citalopram and venlafaxine. We can switch your tamoxifen to estrogen blockers that aren’t prodrugs. The have names like arimidex. These aromatase inhibitors are more potent and expensive than tamoxifen and they aren’t appropriate for younger women.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, February 12, 2010
Measles, Mumps and Rubella Vaccine
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
One of my favourite TV shows was the X-files. It wasn’t just because it came on Sunday nights when I was supposed to be studying. I loved watching FBI Agents Mulder and Scully tracking down UFO’s, government conspiracies, ghosts and aliens. There was the “Cigarette Smoking Man” whose name we never learned but who periodically gave our daring duo tips about the UFO related Black Ops the government was up to. The tag line for the show was “The Truth is Out There”.
I couldn’t help but think that the truth might be out there in Newfoundland recently. Residents of Harbour Mille, Newfoundland reported seeing a UFO flying over their community Monday, January 25, 2010. The UFO pictures I saw were taken by Harbour Mille resident Darlene Stewart. The UFO looked missile-like to me. However the Prime Minister’s Office and Department of National Defence denied that any missile was fired. I thought the story felt very X-Files-ish. The problem is that if you are always chasing UFO’s and government conspiracies, sometimes you miss the truth that is out there right in front of your nose. One recent conspiracy theory said that the Measles, Mumps, and Rubella or MMR vaccine caused autism. The truth on that conspiracy became even more clear recently and not everyone will be happy.
The MMR vaccine prevents three different viral diseases. Measles, mumps and rubella have no effective treatments once a patient is infected. However, they can be prevented by getting the vaccine before exposure to the virus.
Measles is not a deadly disease in most people. It causes a rash, fever, runny nose and cough that lasts one to two weeks. Why vaccinate against it then? Because large outbreaks of the disease usually happen in children. A small percentage of these children develop meningitis, an inflammation of the brain and spinal cord that can cause headaches, seizures, coma and/or long term brain damage. In rare cases it can even cause death.
Mumps is an uncomfortable condition. It can cause painful, swollen saliva glands (usually in the cheeks) and fever. Painful inflammation of the testicles can occur in 1 out of 4 boys beyond puberty and painful inflammation of the ovaries in about 5% of girls beyond puberty. Again brain lining inflammation (or meningitis) is a rare but serious possibility.
Rubella is an important disease to avoid during pregnancy, as it can damage the unborn baby. Rubella can cause brain damage, an unusually small head, deafness, heart defects, blindness, small eyes, diabetes or death in the unborn child. About 90% of women infected with rubella during the first trimester of pregnancy will give birth to babies with problems. So it is important to try to protect all children at a young age from rubella so they don’t contract the disease when they get pregnant later in life or give the disease to a pregnant woman.
The MMR vaccine is very effective. It protects 94% of those immunized verses rubella, 81% verses mumps and 88% verses measles. Measles protection goes up to 99% after two vaccinations. Protection is believed to be lifelong in most people for all three diseases. So where does the MMR vaccine-autism link come from?
Back in 1998 there was a study published in the Lancet by Dr. AJ Wakefield and colleagues. They looked at 12 children that had lost acquired skills like language. These children ranged in age from 3 to 10 years and 11of the 12 were boys. These children could have had Autism Spectrum Disorder, depending on how that condition is defined. Of these 12 children, eight of them had developed autism like symptoms after the MMR vaccine as determined by the parents. So the controversy began.
What was wrong with people questioning MMR vaccine after those reports? Nothing. But the popular media seemed to ignore that the study was only a study of 12 children, not the 1000’s of people that we usually like to see in a study. The celebrities who announced MMR causes autism seemed to ignore that since 1998 at least a dozen studies looked for a connection between MMR and autism and found none. Now the original publisher, the Lancet, has actually retracted the original study. On February 2, 2010 the Lancet published a short retraction that said in part “Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect…Therefore we fully retract this paper from the published record.”
So the system worked, right? The flawed paper was eventually pulled and now everyone knows the MMR vaccine doesn’t cause autism. Well, unfortunately due to some celebrity endorsements, I think some people will always believe MMR is a conspiracy to cause autism. The original author, Dr. Wakefield and has said the Panel’s findings were “unjust and and unfounded”. But more importantly because fewer parents gave their children the MMR vaccine in the last 12 years, there will be more outbreaks of measles, mumps and rubella.
You don’t believe me? Well in 2004-2005 there was a mumps epidemic in the United Kingdom. The highest rate of infection was among those born during 1983-1986. People in England and Wales born before 1987 were generally not eligible for a mumps vaccine. Only 2.4% of confirmed cases of mumps during the 2004-2005 outbreak would have been eligible for the routine 2 doses of MMR vaccine. There were probably other factors involved, but this seems a clear case of people who didn’t get a mumps vaccine getting sick more often than would be expected.
So the truth is still out there. However in ten to twenty years the conspiracy might be the autism-MMR scare of the late 1990’s, and early 2000’s lead to a lot of pain, suffering and possible death due to measles, mumps and rubella.
UFO in Newfoundland link : http://www.cbc.ca/canada/newfoundland-labrador/story/2010/01/28/ufo-newfoundland-pmo.html
Lancet retraction link: http://download.thelancet.com/flatcontentassets/pdfs/S0140673610601754.pdf
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.
One of my favourite TV shows was the X-files. It wasn’t just because it came on Sunday nights when I was supposed to be studying. I loved watching FBI Agents Mulder and Scully tracking down UFO’s, government conspiracies, ghosts and aliens. There was the “Cigarette Smoking Man” whose name we never learned but who periodically gave our daring duo tips about the UFO related Black Ops the government was up to. The tag line for the show was “The Truth is Out There”.
I couldn’t help but think that the truth might be out there in Newfoundland recently. Residents of Harbour Mille, Newfoundland reported seeing a UFO flying over their community Monday, January 25, 2010. The UFO pictures I saw were taken by Harbour Mille resident Darlene Stewart. The UFO looked missile-like to me. However the Prime Minister’s Office and Department of National Defence denied that any missile was fired. I thought the story felt very X-Files-ish. The problem is that if you are always chasing UFO’s and government conspiracies, sometimes you miss the truth that is out there right in front of your nose. One recent conspiracy theory said that the Measles, Mumps, and Rubella or MMR vaccine caused autism. The truth on that conspiracy became even more clear recently and not everyone will be happy.
The MMR vaccine prevents three different viral diseases. Measles, mumps and rubella have no effective treatments once a patient is infected. However, they can be prevented by getting the vaccine before exposure to the virus.
Measles is not a deadly disease in most people. It causes a rash, fever, runny nose and cough that lasts one to two weeks. Why vaccinate against it then? Because large outbreaks of the disease usually happen in children. A small percentage of these children develop meningitis, an inflammation of the brain and spinal cord that can cause headaches, seizures, coma and/or long term brain damage. In rare cases it can even cause death.
Mumps is an uncomfortable condition. It can cause painful, swollen saliva glands (usually in the cheeks) and fever. Painful inflammation of the testicles can occur in 1 out of 4 boys beyond puberty and painful inflammation of the ovaries in about 5% of girls beyond puberty. Again brain lining inflammation (or meningitis) is a rare but serious possibility.
Rubella is an important disease to avoid during pregnancy, as it can damage the unborn baby. Rubella can cause brain damage, an unusually small head, deafness, heart defects, blindness, small eyes, diabetes or death in the unborn child. About 90% of women infected with rubella during the first trimester of pregnancy will give birth to babies with problems. So it is important to try to protect all children at a young age from rubella so they don’t contract the disease when they get pregnant later in life or give the disease to a pregnant woman.
The MMR vaccine is very effective. It protects 94% of those immunized verses rubella, 81% verses mumps and 88% verses measles. Measles protection goes up to 99% after two vaccinations. Protection is believed to be lifelong in most people for all three diseases. So where does the MMR vaccine-autism link come from?
Back in 1998 there was a study published in the Lancet by Dr. AJ Wakefield and colleagues. They looked at 12 children that had lost acquired skills like language. These children ranged in age from 3 to 10 years and 11of the 12 were boys. These children could have had Autism Spectrum Disorder, depending on how that condition is defined. Of these 12 children, eight of them had developed autism like symptoms after the MMR vaccine as determined by the parents. So the controversy began.
What was wrong with people questioning MMR vaccine after those reports? Nothing. But the popular media seemed to ignore that the study was only a study of 12 children, not the 1000’s of people that we usually like to see in a study. The celebrities who announced MMR causes autism seemed to ignore that since 1998 at least a dozen studies looked for a connection between MMR and autism and found none. Now the original publisher, the Lancet, has actually retracted the original study. On February 2, 2010 the Lancet published a short retraction that said in part “Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect…Therefore we fully retract this paper from the published record.”
So the system worked, right? The flawed paper was eventually pulled and now everyone knows the MMR vaccine doesn’t cause autism. Well, unfortunately due to some celebrity endorsements, I think some people will always believe MMR is a conspiracy to cause autism. The original author, Dr. Wakefield and has said the Panel’s findings were “unjust and and unfounded”. But more importantly because fewer parents gave their children the MMR vaccine in the last 12 years, there will be more outbreaks of measles, mumps and rubella.
You don’t believe me? Well in 2004-2005 there was a mumps epidemic in the United Kingdom. The highest rate of infection was among those born during 1983-1986. People in England and Wales born before 1987 were generally not eligible for a mumps vaccine. Only 2.4% of confirmed cases of mumps during the 2004-2005 outbreak would have been eligible for the routine 2 doses of MMR vaccine. There were probably other factors involved, but this seems a clear case of people who didn’t get a mumps vaccine getting sick more often than would be expected.
So the truth is still out there. However in ten to twenty years the conspiracy might be the autism-MMR scare of the late 1990’s, and early 2000’s lead to a lot of pain, suffering and possible death due to measles, mumps and rubella.
UFO in Newfoundland link : http://www.cbc.ca/canada/newfoundland-labrador/story/2010/01/28/ufo-newfoundland-pmo.html
Lancet retraction link: http://download.thelancet.com/flatcontentassets/pdfs/S0140673610601754.pdf
As always if you have any questions or concerns about these or other products, ask your pharmacist.
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