Dauphin Clinic Pharmacy Health Articles

BLOOD GLUCOSE METERS-No More Pokes?

2010-08-06T09:00:00.000-05:00

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.

ARTHRITIS

2010-07-30T09:00:00.000-05:00

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.

Asthma and Other Diseases

2010-07-23T09:00:00.000-05:00

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.

BENIGN PROSTATIC HYPERTROPHY

2010-07-09T09:00:00.000-05:00

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.

BuTrans - Audio

2010-07-02T17:45:00.000-05:00

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

2010-07-02T09:00:00.000-05:00

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.

Drug Allergies - Audio

2010-06-18T17:41:00.000-05:00

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

2010-06-18T09:00:00.000-05:00

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.

Custom Compounding - Audio

2010-06-11T17:38:00.001-05:00

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

2010-06-11T16:34:00.000-05:00

SUN SCREENS - Audio

2010-06-04T17:33:00.000-05:00

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

2010-06-04T11:01:00.000-05:00

Plavix Genetics - Audio

2010-05-28T16:42:00.001-05:00

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

2010-05-28T09:48:00.000-05:00

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.

Diabetic Feet - Audio

2010-05-14T16:40:00.000-05:00

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

2010-05-14T09:00:00.000-05:00

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.

Pharmacare 2010 Redux - Audio

2010-05-07T11:06:00.001-05:00

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

2010-05-07T09:00:00.001-05:00

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.

Vitamin C

2010-04-30T14:57:00.000-05:00

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.

Vitamin C - Audio

2010-04-30T11:06:00.001-05:00

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

Oxycontin EDS

2010-04-16T14:53:00.000-05:00

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.

Oxycontin EDS - Audio

2010-04-16T11:05:00.001-05:00

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 - Audio

2010-04-09T16:03:00.001-05:00

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

2010-04-09T09:00:00.000-05:00

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.

Medicine Cabinet Cleanup - Audio

2010-03-26T15:32:00.002-05:00

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

2010-03-26T15:27:00.000-05:00

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.

Colon Cancer - AUDIO

2010-03-12T16:27:00.002-06:00

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

2010-03-12T09:00:00.001-06:00

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.

High Blood Pressure - AUDIO

2010-03-05T15:36:00.002-06:00

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

2010-03-05T09:00:00.000-06:00

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.

DRUG INTERACTION WITH TAMOXIFEN

2010-02-19T09:00:00.000-06:00

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.

Measles, Mumps and Rubella Vaccine

2010-02-12T09:00:00.001-06:00

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.

Antihistamines - AUDIO

2010-02-05T14:08:00.002-06:00

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

Antihistamines

2010-02-05T09:00:00.000-06:00

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.

“Na Na-Na Na Na. Thunder. Na Na-Na Na Na. Thunder.” The opening bars of AC/DC’s Thunder Struck played over the speakers as the Parkland Source for Sports Thunder whizzed around the Ste Rose arena warming up. Okay whizzed around might be a little strong. Rode their sticks like ponies, ambled aimlessly, and made the occasional snow angel on the ice is more accurate, but the Source For Sports Thunder Novice team eventually got started on their warm up drills. The seven and eight year old mostly boys and a couple of girls like my daughter on the Thunder were psyching up to play the mighty McCreary Mustangs. I was lost in thought about how cool it would have been if my seven year old friends and I had a theme song playing over the speakers when we played hockey way back when. Anthony Wiens was remarking how cold it was in the Ste. Rose rink eventhough it was up to -3 C outside. Then he noted that not all music was created equal. He said it was funny how the older rock songs just seemed to suit hockey games better than newer music. And as I listened to the songs during the breaks in play, I began to think he was right. Different pop music has different uses.

If you get an allergic reaction, one of the types of medication we reach for are antihistamines. Not all medications that block histamine are created equal either. Histamine blockers that block the H2 histamine receptor don’t even treat allergies. They have names like ranitidine and actually are used to reduce stomach acid and treat heart burn and ulcers. For our purposes, H2 blockers are like classical music, interesting but irrelevant for a discussion of pop music. For allergies, we want H1 receptor blockers which are usually just called antihistamines.

Allergic reactions start more or less the same way. When your body comes in contact with what you are allergic to (the allergen), certain cells in your immune system release a chemical messenger called histamine. The histamine connects with the H1 histamine receptor and tells your body to start the allergy symptoms, like the runny nose, or the itchy rash. So the easiest and best way to avoid an allergic reaction is to identify and avoid the allergen. If you are allergic to the cat at your mother-in-law’s house, avoid your mother-in-law. If that horrible cologne your wife bought gives you an itchy rash, don’t use it. Simple, right? Well, even if we can identify the allergen, sometimes they are hard to avoid. If you are allergic to pollens that are common in Manitoba, you will probably get a stuffy nose in the fall no matter what you do. So if we can’t identify and avoid the allergen, we may need to block the H1 histamine receptor with a medication.

There are two basic types of antihistamines. The first generation antihistamines are have names like chlortripolon (chlorpheniramine), and benadryl (diphenhydramine). They are inexpensive, work quite well, but they also often cause drowsiness, and some other side effects like urinary retention, and worsening glaucoma. They work fast, which is great if you have an itchy rash, but they don’t last that long and you may have to take several pills a day. So they are cheap and fast, but have no staying power and might bore you to sleep. So, let’s call first generation antihistamines dance music.

Second generation antihistamines cause much less sedation, have far fewer side effects, but they are more expensive. These are agents like reactine (cetirizine), and claritin (loratadine). A nice benefit is one pill often lasts all day. Reactine is good for both runny noses and itchy rashes, but I have seen it make some people sleepy. Claritin only works well on runny noses, but it is much less likely to make someone sleepy. So they are more expensive, but have fewer side effects and more staying power. So, let’s call second generation antihistamines classic rock.

So, different antihistamines have different uses. Classic rock is what should be played during breaks at hockey games. Any beware the Source For Sports Thunder. Or you’ll be Thunder Struck!

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

NETI POTS - AUDIO

2010-01-22T13:50:00.003-06:00

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

NETI POTS

2010-01-22T09:00:00.000-06:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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

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

I have something very important to tell you. Come in really close. Don’t tell ANYONE where you heard this. Oprah might be wrong. The reason I don’t want my name disclosed is I’m pretty sure the Queen of Day Time Talk could make me disappear if she wanted.

Obviously I’m kidding (and a little scared) about Oprah. But neti pots were my first introduction into Ms. Winfrey’s powers. A few years ago, people started coming into the pharmacy demanding neti pots. I had no idea what they were talking about. I few days later I saw a re-run of Oprah on in the evening and low and behold one of her guests, I think it was Dr. Oz, was demonstrating neti pots.

A neti pot looks like a little tea pot. The user fills the pot with a salt water solution. Then they tip their head to the side over a sink. They place the neti pot spout into their top nostril and pour gently. The salt water runs into the top nostril, through the sinuses and out the bottom nostril into the sink. The Oprah guest said the first time you try the neti pot, it will feel like you are drowning. I have tried it, and yes, it does feel like you are drowning.

So after the Oprah Show, everyone wanted a neti pot. The more medical term for what a neti pot does is called nasal irrigation. It isn’t a new practice. Some yoga practitioners have espoused the benefits of nasal irrigation for years. I remember a medical resident talking about nasal irrigation. A specialist that had taught during her training actually liked the idea of nasal irrigation. However when the specialist recommended nasal irrigation to patients, the patients usually refused as it was too weird. The resident thought it was funny now that Oprah recommended nasal irrigation, the masses were running to the pharmacy to pour salt water into their noses.

So what does nasal irrigation with a neti pot do? Well, from personal experience, it definitely washes mucus and all the dust, dirt and other assorted gunk out of your nose and sinuses. The are some more interesting claims I read as well. One is the salt water (saline) reduces swelling in your nasal passages and sinuses because the fluid causing the swelling flows into the saline and is flushed out. Another claim is that the saline rinse flushes histamine and leukotrienes out of the sinuses. These chemical messengers that your body produces can cause inflammation and swelling. A negative claim says that the saline rinse gets rid of good stuff like immune globulins from your nasal passages. Immune globulins can help fight infection.

There are some small studies saying that nasal irrigation may be modestly effective in reducing sino-nasal symptoms. The side effects of nasal irrigation are mild and infrequent. They include nasal irritation, stinging or burning in a small number of patients. Nasal irrigation is relatively inexpensive. So it sounds like Oprah hit it out of the park when she sent everyone to the pharmacy looking for neti pots. Well, there might be a fly in the ointment.

There is a small study showing some possible harm from nasal irrigation. Now usually people would irrigate their sinuses for a few days to a couple of weeks because they were stuffed up. This study followed 68 people. These people got that drowning feeling once a day for a year. Then half the people stopped pouring salt water into their sinuses while the other half kept pouring. The non-irrigating group got fewer sinus infections.

Why did the non-neti potters get fewer infections? Is Oprah leading us down the garden path? We don’t know. It was a small study, so the results could be a fluke. It could be the neti potters didn’t clean their apparatti properly and infected themselves. It could be all that continuous saline washed out important stuff in the nasal passages that should be there to protect us from infections.

So was Oprah wrong? Probably not. If you want to try nasal irrigation, keep you neti pot clean, only use it once or twice a day to prevent dryness and don’t use it for more than a couple weeks in a row. If you are also on a prescription nasal steroid, use the neti pot first then the steroid.

When I tried nasal irrigation, I used a product called HydraSense. It is more expensive than a neti pot, but it is an all in one product. You don’t need to mix the salt water or use the clumsy tea pot up the nose. It comes pre-mixed in a pressurized nose spraying bottle. Yes I got the water to go all the way from one nostril, through my sinuses and out the other nostril. Yes my nose and sinuses felt clean. Yes it felt like I was drowning. No, I don’t think I’ll do it again. And I’m really sorry I suggested Oprah might be wrong.

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

Smoking Cessation - 2010 - AUDIO

2010-01-15T13:34:00.004-06:00

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

Smoking Cessation - 2010

2010-01-15T09:00:00.001-06:00

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.

I heard a lecture from a cancer researcher, and he was asked what the next big break through would be in eliminating cancer. He said we can already significantly reduce the amount of cancer in the population. He said the number 1, 2, 3, and 4 best things for reducing cancer in the population is quitting smoking. So….HAPPY NEW YEAR!!!! Have you quit smoking yet?

There has been a Manitoba wide smoking ban since October 1, 2004. It is hard to believe that is now over 5 years ago. Across the pond in the European Union, Ireland was first to institute smoking ban in March 2004. Bans now exist in Italy, Spain, Belgium and Britain. On January 1, 2008, the smoking ban in France was extended to bars, discotheques, restaurants, hotels and cafes. Those romantic images of people in Paris discussing the issues of the day in a Parisian café over a cigarette and café au lait are a thing of the past. Who says the world doesn’t follow Manitoba’s lead?

Smoking is the number 1 cause of premature death in North America. Name a body part, and we can tell you how smoking is bad for it. Other than the heart and lungs that everyone knows about, let's talk about some less discussed problems. Smoking decreases the blood flow to the skin, and this leads to leathery-looking skin and increased wrinkling. The more you smoke, the more likely you are to get cataracts -an eye problem that can lead to blindness. Smoking is the main reason people get cancer in the mouth. Smoking makes it harder for your saliva to remove germs in your mouth. You'll get stains, bad breath, and a higher chance of gum disease. Smokers are twice as likely as non-smokers to develop psoriasis - a disfiguring red and silver rash that can occur anywhere on your body. Smokers are more prone to stomach ulcers. The ulcers don't heal as fast, and they're more likely to recur. There's also growing evidence that smoking may increase the risk of chronic bowel disease. Finally, guys, smoking causes impotence.

Are you ready to quit this year? It won't be easy. The numbers I could find said that only about 10% of people who try to quit cold turkey will succeed. The numbers double to about 20% if a medication and a detailed smoking cessation plan worked out with a health care professional are added onto just plain will power.

The first thing you may want to do is check with your doctor and pick a medication to help you. Many people have already tried the nicotine patch, the nicotine gum and the prescription pills Zyban or Champix. Maybe its time to try something different. How about a Nicotine Lollipop or a Nix Stix? Nicotine Lollipops and Nix Stixs are prescription items that we can custom make for people under the direction of their doctor.

At the moment we make 2mg and 4mg Nicotine Lollipops in strawberry flavor, but we can customize the flavor or the strength under the direction of your doctor. The idea behind the Nicotine Lollipop is the same as the nicotine gum or nicotine patch. We are putting some of the nicotine back into your system that the cigarette used to provide. This will help reduce (not eliminate) the cravings for cigarettes. The added bonus is psychological. People who have used the Lollipop say they like that they are still putting something in their mouth like they used to do with cigarettes.

How do you use the Nicotine Lollipop and how long does it last? This will vary person to person, but in general one Lollipop will last about 1/2 a pack of cigarettes. During your regular cigarette break you put the Lollipop in your mouth for about 5 minutes or until the craving passes (whichever is less) and then you reseal the Lollipop in our special child proof container and put it away until your next craving. What strength of Lollipop do I need? Your doctor will help you choose when they write the prescription, but usually the 2mg Lollipop is for 1 or less packs a day, and the 4 mg is for people who smoke more than a pack a day.

Let’s say we have a smoker with a craving at a meeting, and sticking something like a lollipop in their mouth is inappropriate. What should they do? Well the nicotine patch is too slow for an immediate craving. What if you had a discreet little applicator which you could rub on your wrist and get nicotine immediately? Well at the Dauphin Clinic Pharmacy, we are compounding such a device for patients at the request of their doctors. We call it a Nic-Stix and with a prescription from your doctor, we can compound a device that looks like a chap stick tube. The Nic-Stix has 30mg of nicotine in it so is will last 1-4 weeks depending on use, but it also must be kept away from children because it would be toxic if ingested. The Nic-Stix will melt easily, so it should be kept in a cool place, but is small enough to be carried almost anywhere.

Smoking kills three times more people than alcohol, AIDS, illicit drugs, car accidents, suicide and murder all combined. Quitting smoking is very difficult, and it takes the average ex-smoker six serious quit attempts before they succeed, but the results are worth it.

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

Cholesterol Guidelines

2009-12-24T09:00:00.000-06:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

Rubber duckies are evil. Erectile dysfunction is bad in more ways than you would think. All this and much more were released in the new 2009 Dyslipidemia guidelines! These are what your doctor reads to see how the experts in the field recommend that he or she treats your high cholesterol. The Guidelines are a big document, so I’m going to focus on two parts. Who should get their cholesterol tested and something called Apo-B.

Who should get their cholesterol levels tested? The first group includes any male over 40 (I’m getting close), and any female over 50 or who is in menopause. It is nice the guideslines were more specific about exactly who should get tested, but these recommendations weren’t surprising. Us guys probably start getting fatty streaks in our arteries in our teens or twenties due to poor diets and lack of exercise. By the time we hit 40, our doctors should start testing our cholesterol because those fatty streaks in our arteries may have started to partially block them. You women have estrogen in you to protect the lining of your blood vessels for a decade longer than us guys.

The next group of people that should be screened might be a little more surprising. This is not the complete list, but cholesterol testing is recommended in any adult who: has diabetes, is a current smoker, has high blood pressure, has obesity, or has erectile dysfunction. All of these conditions, yes even erectile dysfunction, can be signs of damage to the lining of your arteries or to the very small blood vessels in your body. Any of the above conditions increases your risk of a heart attack or stroke. This is why your doctor should keep an eye on your cholesterol.

This year the Guidelines talked a lot about Apo-B. Now I don’t want to confuse you. The Guidelines still says the number one indicator we should follow is LDL. LDL is the famous “bad cholesterol”. HDL is the famous “good cholesterol”. These are still the most important markers. But they are still markers. Remember we don’t really care about your cholesterol. What we want to do is reduce your chance of heart attack and stroke. Cholesterol is just a surrogate marker of your cardiovascular risk.

Another marker you will probably hear more about soon is called Apo-B. Apo-B’s full name is Apolipoprotein B. Remember LDL or bad cholesterol and HDL or good cholesterol? Well LDL’s full name is low density lipoprotein and HDL’s is high density lipoprotein. Although we talk about cholesterol floating around in your blood, that isn’t really how it works. Just like oil doesn’t mix with water, cholesterol alone doesn’t mix with blood. Cholesterol (a lipid) must be attached to a protein to form a lipoprotein for it to stay in your blood. There are a lot of different lipoproteins like chylomicrons, very-low density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), low density lipoprotein (LDL), or high-density lipoprotein (HDL). All lipoproteins except HDL (remember the good cholesterol) have a particle of Apolipoprotein B in them. So counting the number of particles of Apo-B in someone’s blood sample is another way to access cardiovascular risk.

Traditional measurements of LDL actually weighs the amount of LDL cholesterol in a blood sample. This is still the gold standard for assessing risk in someone who isn’t on any cholesterol medications. LDL levels of less than 2.0 mmol/L is still the goal the doctors are trying to reach when they put you on a cholesterol medication. But, the guidelines say doctors could look at your Apo-B levels too when they are trying to figure out if they have you on the right dose of your cholesterol medication. The Apo-B level to shoot for is less than 0.8 g/L.

In some cases, Apo-B may be more useful to see how someone on a cholesterol treatment is doing than LDL. First remember that rubber duckies are evil. So, LDL is measured by weight. Let’s pretend low density lipoproteins are evil rubber duckies filled to bursting with oil. The doctor orders an LDL test and we weigh the evil oil filled rubber duckies and we get a number. Then, the doctor puts you on a cholesterol pill and in 6 months measures your LDL again. The number is lower. That is good, right? Well, since we just weighed the evil rubber duckies, we don’t know if we have less evil rubber duckies, or if each evil rubber ducky just dumped some oil out. To keep track of the evil rubber duckies, it would be better to count them. So in our world, Apo-B is the bill on the rubber ducky. To do an Apo-B test we draw out some blood, put all the evil rubber duckies in a blender and count the number of duck bills that come out. This way we can count how many evil rubber duckies we have.

So count your evil rubber duckies. Remember erectile dysfunction puts you at higher risk for heart attacks and stroke. And have a Merry Christmas.

For more info on Cholesterol Guideline visit:
www.ccs.ca/download/consensus_conference/consensus_conference_archives/2009_Dyslipidemia-Guidelines.pdf

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

Infant Cough and Cold Medications

2009-12-18T09:00:00.000-06:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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

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

I have kids. Emily is seven and Eric is four. I am sure this won’t be the first or last time Eric thinks this, but apparently I favor his sister. If both my kids got a cough at the same time, I can help seven year old Emily, but I have to let four year old Eric suffer. You will now notice most over the counter cough and cold medications say don’t used in children under 6 years old. Why is this?

Back in January 2008 the Food and Drug Administration (FDA) in the US said all cough and cold medications should be avoided in children under the age of two. A little later Health Canada made a similar recommendation. In October 2008 in the US manufacturers warnings said not to give cough and cold products to children under four and to not give any children antihistamines just to make them sleepy. Canadian labeling changes came into effect in the fall of 2009 and now say most cough and cold medications shouldn’t be given to children under 6.

So why all the fuss? Yes, my mom gave me Neo-Citran because it had an antihistamine in it which would make me sleepy. Yes, I gave my own children cough and cold medication before the age of four. The fuss boils down to safety and efficacy. For every medication we should ask: Is it Safe? Is it Effective? And what is the risk versus benefit of using it? For infant cough and cold medications, let’s start with are they safe?

It is safe to give over the counter cough and cold medication to infants and toddlers MOST of the time. The problem is the dose. There have been documented cases of parents giving their children the wrong dose. “No problem,” you say, “I can read. I’ll give my child the right dose!” Well, between 1969 and 2006 in the US there were 69 deaths in children from antihistamines and 54 deaths in children due to decongestants. Now, these are small numbers. Even if we assume the actual number of deaths are much higher than those reported, and we stipulate that the number of injuries is not counted at all, not many children were harmed. When you consider the probable millions of doses of cough and cold medications given to children over the 37 years considered, cough and cold medications didn’t kill many children. But, they did kill and injure some children, so the risk isn’t zero.

So why do well meaning parents give the wrong dose to their kids? There are four main reasons: multiple ingredients, wrong formulations, kitchen spoons and small margin of error. Multiple ingredients means many cough and cold medications have more than one ingredient. For example let’s assume you bought a cough syrup, a anti-sneezing pill and Tylenol cold for your child. There is a decongestant in all three of those products. If you were unaware of this you could give your child 3 times the recommended dose of decongestant. That dose could cause a rapid heart rate or theoretically it could cause death. Wrong formulation means some products come in different strengths. Acetaminophen (or Tylenol) comes in 80 mg/ml and 160mg/5ml liquid. If a parent uses the 80mg/ml liquid when they meant to use the 160mg/5ml and gives their child 1 tsp (5 mL), the child get 400 mg (not 160 mg) of acetaminophen which is 2.5 times too much. Kitchen spoons means don’t use your kitchen spoons to measure your child’s medication. When a pharmacist says 1 teaspoon, we mean 5 mL. A kitchen teaspoon is not calibrated. Kitchen teaspoons vary from 2.5 to 10 mL. So if you use your kitchen teaspoon and I say give the child 1 teaspoon of medication you could be giving them anywhere from ½ the dose to twice the dose you were supposed to. Small margin of error refers to the fact children are small. Since children are small, their medication doses are small. Unfortunately that means even small errors in measuring a child’s medication can be harmful.

So we’ve seen that cough and cold medications have a small but real chance of harming children. So do cough and cold medications actually work? Are they effective? Probably not. What we need is to run some experiments where we give possibly dangerous chemicals to a bunch of babies….Any volunteers? For good ethical reasons, we don’t test cough/cold meds on babies. Even if we did, it is hard to ask them if they are feeling better or not. Cold medications have been tested on teenagers and adults. There is only a little proof that they improve symptoms like reducing the amount of cough and sneezing in teens and adults. If we assume infants and toddlers are just “little adults”, cold meds should help them a little too, right? The problem is infants and toddlers aren’t just little adults. Their lungs and immune systems are different. So we now think cold meds may not be effective in infants and toddlers at all (remember we can’t actually test meds on them). If cough and cold medications probably don’t help my child’s symptoms, and…If I give them the wrong amount I may harm them…Are Cough and Cold Medications in infants and toddlers worth the Risk? Probably not. And that is why Health Canada says I can treat my 7 year old but not my 4 year old.

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

Lower Back Pain

2009-12-11T13:09:00.000-06:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

You are pretty weak. And you’re slow. Your teeth are dull, your claws are non-existent, your hide is very thin and you have no fur to keep you warm. How on Earth have you lived this long? This is how I imagine an average wolf, coyote, cougar, bear or for that matter elk or moose looks at us humans. Even if you look closer on our family tree, picture a human next to a chimpanzee. If you put a human and a chimp in hand to hand combat, the chimp could literally pull the human’s arms off. It is odd when you think that humans with no natural weapons or effective defenses now live in nearly every corner of the planet.

So how have we become so dominant on the planet? Big brains, opposable thumbs, tools and fire undoubtedly all helped. But arguably one of the first things we did right as a species was to start walking on our back legs. Walking up right helped us do simple things like collect stuff in one place and bring it back to another. It helped us do more complicated things like use tools and run while poking things with sharp sticks. As helpful as standing upright has been, it puts a lot of stress on our lower backs.

I’ve read stats that say up to 85% of us will get lower back pain during our lifetime. It is very common. And it can start with what seem to be minor injuries. People have come into the pharmacy saying they hurt themselves tying their shoes or just sleeping funny. So what should you do? Let’s start with non-drug measures.

The physiotherapists and chiropractors will remind you to prevent lower back pain. You should remain active, lift with you legs, work on keeping your stomach muscle strong and avoid twisting and lifting. After your back is already sore, physios and chiros can recommend different exercises, stretches and/or manipulations to help you. As for exercise in general after your back is sore, the 2007 guidelines from the American College of Physicians and the American Pain Society say you should keep moving. In general, bed rest is not recommended for lower back pain.

Another non-drug measure you can use is heat. Whether it is a warming blanket, a gel pack you put in the microwave or a hot water bottle, heat can help lower back pain. An interesting category of products in the pharmacy are the 8 heat hour patches. These have iron in them that slowly oxide or burn for 8 to 12 hours. They can be put over the sore area and worn all day.

Once we more into the medication zone we always recommend acetaminophen first. This is because acetaminophen is generally the safest pain medication. However, acetaminophen only treats pain. It doesn’t reduce inflammation. A lot of the discomfort in lower back pain is due to inflammation in the muscles or possibly even the nerves. So I usually point people towards ibuprofen. It is a good pain killer and antiiflammatory. Naproxen sodium or aleve would work as well.

The problems with over the counter antiinflammatory pain killers like ibuprofen are stomach, blood, and kidneys. Now I don’t want to scare you. Medications like ibuprofen are safe for most people, most of the time. However, if you have problems with ulcers in your stomach, are on blood thinners, or have kidney problems let your pharmacist know before taking them. Between you and your pharmacist you can decide if the ibuprofen like drug will have a benefit that will out weigh the risk in your case.

The other over the counter medication that is often used for back pain is a muscle relaxant. Some common brand names are Robaxacet, Robaxasol, and Robax Platinum. These all have the same muscle relaxant in them, but one has acetaminophen, one has ASA and the last has ibuprofen. The over the counter muscle relaxants can work very well, but they can make you sleepy. I usually suggest that a patient take the first dose at home when they don’t have to do anything that requires a lot of attention. That way they can see how it effects them. And definitely don’t mix muscle relaxants with alcohol.

When should you see the doctor? Well if your lower back pain is very severe, go immediately. In general, though, we expect lower back pain to go away in 4-6 weeks. If yours lasts longer, stop treating it with over the counter medications and it is probably time to see your family doctor.

So as we evolved to stand up right. This has allowed us to hold a beverage and popcorn and still walk to our seats at a Kings game. However our evolutionary advantage can be a pain in the back.

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

MS Surgery

2009-12-04T09:00:00.000-06:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

Now remember I’m not a surgeon, neurologist, or multiple sclerosis specialist of any sort. I’m just a pharmacist who thinks MS and its treatment is interesting. But I have to tell you about a possible MS treatment that has been getting a lot of buzz lately.

For me it started with a documentary on CTV’s W5. They were interviewing an Italian vascular surgeon named Paolo Zamboni. They told a compelling tale. You could see from his hands that Dr. Zamboni could no longer perform operations. He had developed a neurological condition that wouldn’t allow him to hold a scalpel. He continued to work as a doctor and professor and then his wife developed MS. So, Dr. Zamboni started doing lots of reading about Mutiple Sclerosis.

During his research, Dr. Zamboni read about iron deposits in the brains of MS patients. Others had noted them before, but no one had attributed much significance to them. Have you heard the saying, “To a carpenter, the whole world looks like a nail”? Well that’s what I thought of when Dr. Zamboni explained what he thought when he read about these iron deposits. Dr. Zamboni, the former vascular surgeon, thought the iron deposits were due to improper drainage of blood from the brain. So took some ultra sound images of the necks of some MS patients and found many of them had strictures or narrowing of the veins that drain the brain.

Dr. Zamboni’s team then went the next step and used little balloons to open the narrow veins and let the blood drain properly from MS patient’s brains. Low and behold, many had improvement in their MS symptoms! Dr. Zamboni calls the condition of narrow veins draining the brain CCSVI or Chronic Cerebrospinal Venous Insufficiency.

At the moment Dr. Zamboni and colleagues in the US are testing more MS patients to see how many have CCSVI. They will be doing more opening of the veins with balloons to see how many people’s symptoms improve. Even the Canadian Multiple Sclerosis Society is now offering research money to the best candidates to research CCSVI. It is very exciting.

Now I am going to be a wet blanket. The odds are CCSVI and its treatment is not a cure for MS. I’d love to be wrong, but that is not usually how these things turn out. Five years from now, probably the best we can hope for is CCSVI diagnosis and treatment is one more tool in the toolbox for MS treatment. The worst case is that when we look back five years from now we will see that some people were hurt or worse from a surgery that was eventually proven to have more risks than benefits.

Two MS treatments from the past that come to mind are substance P and massive chemotherapy. Several years ago a Canadian researcher was convinced a dysfunction in a brain chemical called substance P was involved in MS. Substance P is usually involved in pain transmission. Since in MS there is a problem with nerve transmission, this theory seemed plausible. However, I haven’t heard any more about substance P and MS in the last few years. I don’t know if it was disproven or just fell out of favor, but substance P is no longer the next big thing in MS treatment. A more troubling treatment involved massive chemotherapy. Despite Dr. Zamboni’s work, the current belief is that in MS the body’s own immune system attacks the myelin sheaths around nerve fibres. This makes nerve transmission not work as well. A fascinating presentation I went to a few years ago talked about a trial in which they destroyed the immune systems of some severely ill MS patients. They used chemotherapy drugs to kill off the bone marrow which produces immune cells that fight disease. Then they regrew “normal” bone marrow in these patients to give them “normal” immune systems. They did have some success. Some of these MS patients no longer had attacks. That is wonderful, but a few of the test subjects died from the massive chemotherapy. In my mind the risk of that treatment surely out weighed the benefit.

So has Dr. Zamboni found a cure for MS? No one really knows. I’ll definitely be watching for his papers to be published as he tests more and more people. It is great that he is bringing a whole new type of thinking to the problem of MS. If I had MS would I run out and get the surgery? Not yet. I would wait and see what happens with the ongoing trials. But if you haven’t seen it yet, go to the W5 website and watch the documentary. I found it fascinating.

http://www.ctv.ca/w5 CTV's W%

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

Vitamin D

2009-11-27T09:00:00.000-06:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

I was at a Multiple Sclerosis Society conference several years ago, when I went to a talk by an epidemiologist. He was showing how the further north you went in the world, the more likely it was that you would get MS. In other words MS is relatively common in places like Manitoba, Canada, but almost unheard of near the equator. I thought that was very interesting because I also have an interest in asthma and asthma has a similar distribution around the world. Asthma is more common the further you get from the equator. Now what else changes the further you get from the equator? The amount of sunshine does. Is that related? Maybe.

Researchers are making more links between Vitamin D and health all the time. Although not a direct cause and effect, some researchers think that the increased sunshine in the lower latitudes may be a reason there is less Multiple Sclerosis and less asthma the further south you live. More sunshine means your body produces more Vitamin D. Vitamin D effects many things in the body. One thing Vitamin D does is to reduce inflammation. Both MS and asthma involve inflammation. So maybe Vitamin D deficiency is involved in asthma and MS.

Another interesting theory that came out was Vitamin D and the flu. If you ignore the current H1N1 scare, influenza is a group of viruses that move around the world. They move between humans, birds and pigs and they mutate a bit every year. The interesting part for our Vitamin D story is when people get sick. Flu season in North America is in the winter months, when sunshine is in short supply. However flu season in Australia is about 6 months before us, in their winter months, when sunshine there is the least abundant. In countries around the equator, when the hours of sunshine are the same all year round, flu season happens in the rainy season when there is less sun. So there is research into whether Vitamin D deficiency makes you less able to fight off the flu.

What is Vitamin D? As usual, there isn’t a simple answer. There are different forms of Vitamin D. The type of Vitamin D your body makes is called Vitamin D3 (or cholecalciferol). The formation is complicated, but it goes like this. A precusor chemcial is converted to Vitamin D3 in the skin with the help of sunlight (UV Radiation). Vitamin D3 is converted in the liver to a second form called calcidiol. The calcidiol is converted to calcitriol by the kidney. Calcitriol is the most active form of Vitamin D. So you can get Vitamin D3 from taking pills, you can go outside and have your skin make it from sunshine or you can eat things like fish. Then you hope your kidneys are healthy enough to convert the Vitamin D3 to calcitriol. There is another form of Vitamin D called Vitamin D2 . It is formed by plants and it can be converted to calcitriol in your body as well. There are those that argue that Vitamin D2 doesn’t form calcitriol as well at Vitamin D3.

Why do we care about Vitamin D? Despite the interesting, but speculative research into other good things Vitamin D does, it is still mostly about the bones. Vitamin D helps your gut absorb calcium. This was originally discovered by people who studied Rickets. Rickets is most common in children and is a characterized by bone deformaties and “soft bones” which don’t have enough calcium. However if we gave these children Vitamin D, we could reverse and prevent rickets. Moving back to the present, current research shows that if adults get between 400-800 IU of Vitamin D per day their bones break less often. Research also shows these adults fall less often if they get enough Vitamin D. Some of the newer research is talking about people taking up to 2000 and more IU per day.

How much Vitamin D do we need? The easy answer is that most of us adults should get 1000 IU of Vitamin D3 per day. The dose is still being debated among groups like the Osteoporosis Society and the Canadian Cancer Society, but 1000 IU seems to be a safe middle road. Although Vitamin D is a fat soluable vitamin and can build up in your tissues, the toxic dose of Vitamin D is probably above 10,000 IU per day.

We live in a Northern Country. Most of us probably get Vitamin D deficient in the winter as the days get shorter and we put on more clothes. A Vitamin D supplement may be an inexpensive health booster most of us should look at.

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

Ear Infections in Children

2009-11-20T09:00:00.000-06:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

Today you are a family doctor. Congratulations on making it through 7 plus years of education and a bunch of on the job experience in about 15 seconds. Your patient is this little kid I know called Eric. He is 4 years old. Eric complains to his mom that his ear hurts. His mom takes him to see you. You examine Eric and determine that he has acute otitis media or a middle ear infection. What should you do? Should Eric get an antibiotic? Recent guidelines from the Canadian Pediatric Society say maybe not.

Acute otitis media or a middle ear infection is very common in children. It is estimated that 75% of children will have an ear infection by the time they are one year old. Why do so many children get ear infections? Well, just being young gives children a shorter and more horizontal eustachian tubes as compared to adults. The eustachian tubes, among other things, helps fluid from behind the ear drum drain out. If these eustachian tubes become blocked or squeezed shut by inflammation, fluid behind the ear drum can become trapped. Allergies and viral infections are also common in young children. These can cause the eustachian tubes to become inflamed and blocked. There is even the suggestion that children who get many ear infections have less of a certain antibody called secretory immunoglobulin A. Since this antibody makes it harder for bacteria to stick in the nose and throat, if children have less of it, they may have more bacteria hanging around ready to cause ear infections.

As you talk to Eric’s mom, you find out he had an upper respiratory tract infection for a few days before his ears started to hurt. You figure that the virus from this infection inflamed his eustachian tubes and caused his adenoids to swell. Eric’s eustachian tubes got blocked eustachian tubes and fluid got trapped behind his ear drum. The blocked tube also created a bit of a vacuum and pulled bacteria from Eric’s nose and throat back into his middle ear space. The bacteria grew in the trapped fluid and voila, Eric got an ear infection!

An interesting thing about middle ear infections is we don’t know exactly what is going on behind the ear drum. The only way to find out what is causing an ear infection is to push a big needle through Eric’s ear drum, draw out some fluid and test it. I don’t think he’d like that much. However some brave, unfortunate children have had their ear drums poked for science, so we know that most ear infections have bacteria in the fluid behind the ear drum. As you are a doctor, you know that antibiotics can kill bacteria. So every ear infection should get an antibiotic, right? That brings us back to the Canadian Pediatric Society.

So what are the experts at the Canadian Pediatric Society recommending you do with Eric? Nothing. If the child is older than 6 months, doesn’t have other under-lying complicating diseases, and doesn’t have a fever over 39 C or severe ear pain, then parents should just watch the child. The reason is that about two thirds of children will have their ear infection symptoms just go away in 48 to 72 hours without antibiotics. If the child doesn’t get better in 48 to 72 hours, then the parents should take them back to the doctor to get an antibiotic.

So you are a good family doctor and follow the guidelines. You tell Eric’s mom that although she has taken time off work, and she has a cranky four year old with a sore ear that she should just go home with no antibiotic prescription. Do you think she will be very happy? Probably not. So you make a deal with her. First you explain to her that only about 1 in 15 kids with ear infections get better faster on antibiotics than without. Then you tell Eric’s mom that antibiotics aren’t without risk. About 20% of kids on antibiotics get diarrhea. A smaller number of children on antibiotics can get things like rashes, trouble breathing or antibiotic resistance. Eric’s mom calms down. Eric has gotten a rash before on a certain antibiotic, so his mom starts to see the risk.

You tell Eric’s mom to go to the pharmacy and ask the pharmacist for the appropriate doses of acetaminophen and ibuprofen for Eric based on his weight. This should make Eric’s ear feel better for the next 48 to 72 hours. You also give Eric’s mom a prescription for an antibiotic, but you tell her not to fill it. She will leave the prescription at the pharmacy. That way if he doesn’t get better in 48 to 72 hours, Eric’s mom can get him a prescription without having to get back into see you. Good job, doc!

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

Angina Meds

2009-11-13T16:00:00.000-06:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

One good idea can go a long way. Did you know that an ingredient in TNT or dynamite can helped chest pain?

A long time ago, I thought I was going to be a physicist. That turned out not to be the case, but I did get to go to one physics conference. I forget most of what I learned at that conference. However I remember I saw two Nobel Prize winners. The Nobel Prize is an international award administered by the Nobel Foundation in Stockholm, Sweden. It was started by Alfred Nobel. Alfred Nobel was a great scientist and inventor in 1800’s. One of his greatest inventions was dynamite. His inventions made him very wealthy, but at some point he grew very concerned about all the war around him in the 1800’s and how his inventions were being used to kill people. So in his will he left money to be given out the person who accomplished "the most or the best work for fraternity among nations, for the abolition or reduction of standing armies and for the promotion of peace congresses." This turned in to the Nobel Peace Prize. Every year since 1901 the Nobel Prize has been awarded for achievements in physics, chemistry, physiology or medicine, literature and for peace.

In places like Alfred Nobel’s dynamite factories, people worked with nitroglycerin. The workers noticed they got awful headaches every Monday morning after being away from the factory for a few days. These headaches went away in a few hours. It was eventually determined that the headaches were caused by the nitroglycerin opening blood vessels in the brains of the workers. Opening up blood vessels in the brain can hurt, but if we open up blood vessels in the heart, we can actually make pain go away. This type of pain is called angina.

You may hear your doctor call chest pain angina pectoris, but many people simple call it angina. If suddenly start experiencing chest pain, get to your doctor or the hospital as soon as possible. For those people that the doctor has diagnosed as having angina, he/she may have given them a nitro-spray, or a nitro-patch. Both of these medications contain nitroglycerin, which helps open the blood vessels to the heart. Opening up blood vessels to the heart gets more blood and oxygen to the heart muscle and helps the pain go away. Even though both nitro-spray, and the nitro-patch contain nitroglycerin, they are used in different ways, and are used under different circumstances.

The nitro-spray is used at the first sign of angina, and should help the chest pain immediately. At the first sign of chest pain, sit down or recline, because the nitro-spray will probably make you dizzy. Don’t shake the canister. Hold it in an upright position, and remove the plastic cover. Open your mouth, bring the canister as close as possible, and spray the nitro under or onto your tongue. Don’t inhale the spray. If the pain persists, you can spray again in 5 minutes. If you need more than 3 doses in 15 minutes, seek medical attention immediately. Finally, if your doctor has prescribed nitro-spray for you, you should always carry it with you.

The nitro-patch works differently than the spray. With the nitro-patch, the nitroglycerin is absorbed slowly through the skin instead of through the mouth. It is designed to be used every day to prevent angina, where the spray is used to treat angina that is occurring now. To apply the patch, first wash your hands, then tear open the package. Hold the patch so that both brown lines are vertical and facing you. Bend the patch forward and back until you hear a light “SNAP”. Twist the patch to peel off its plastic backing, and avoid touching the backing. Apply the patch to a hairless area, such as the shoulders, back or hip. Unless your doctor tells you differently, you should only have the patch on for 12 hours, then it should be off for 12 hours. You should also rotate the various places you put the patch each day, to avoid irritating the skin.

So Alfred Nobel’s prizes still motivate and reward those who push forward the boundaries of science and medicine. Alfred Nobel’s own great invention, dynamite is still in use today. And nitroglycerin, one of the main ingredients in dynamite is still helping people’s hearts. One good idea can go a long way.

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

Tamiflu Liquid

2009-11-06T09:00:00.000-06:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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

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

Sometimes I get asked if I like being a pharmacist. I do. Very much. I have to keep learning new things all the time. Every day on the job is different, and I never know what to expect when I show up to work. Let me walk you through a couple exciting days last week.

A few weeks before our story begins, a father had taken his children to the Children’s Hospital in Winnipeg with flu like symptoms. Fearing they might have H1N1, the doctor gave the children a prescription for tamiflu liquid. The father had to go to three different Winnipeg pharmacies before he could get the tamiflu filled. The first two pharmacies didn’t have the liquid. It is not really the pharmacies’ fault as there is a shortage of liquid tamiflu. The third pharmacy mixed the adult dose of tamiflu in some syrup for the children. The father was understandably upset and called CBC.

What is tamiflu, and why is liquid tamiflu in short supply? Tamiflu (or oseltamivir) and Relenza (or zanamivir) are called neuramidnase inhibitors. They can stop or slow viruses from reproducing. If tamiflu is given within the first 48 hours of the onset of symptoms, it can decrease the amount and severity of flu symptoms. Even during this current flu scare, most people will not get flu symptoms. Those that do get symptoms, most will get very mild symptoms. Only a small number of people will get very sick and need to be hospitalized. Tamiflu can reduce the chance the patient will end up in the hospital or die from influenza. The adult capsule of Tamiflu is 75 mg. That is too strong for little children. The company, Roche, makes a liquid form for kids, but it is not always available. Roche says it takes 20 times as long to make the liquid form as the capsule form. So, especially during a flu scare, liquid Tamiflu is hard to come by.

So now the first two pharmacies were being blamed for delaying treatment of the children. The Federal Minister of Health was on CBC saying pharmacies should just compound the liquid tamiflu when required. Our regulator in Manitoba, the Manitoba Pharmaceutical Association or MPhA, sent all Manitoba pharmacies a fax with instructions how to compound liquid tamiflu for children.

The story gets better. The specific liquid we are supposed to use to compound the liquid tamiflu with is now in short supply. I guess that’s what happens when MPhA tells every pharmacy in the province to order the same thing. In fact, the company that makes tamiflu recommended pharmacies compound liquid tamiflu with that specific liquid also. So pharmacies all over North America are trying to order that specific liquid.

So what is a pharmacist to do when handed a prescription for liquid tamiflu? Do a little homework. We went to a very good talk by Dr. Blair Seifert. He is a pharmacist who specializes in pediatrics at Children’s Hospital in Winnipeg. He had a few good ideas about how to make the liquid tamiflu. We also used our contacts at PCCA Canada and did some research in the International Journal of Pharmaceutical Compounding. We made a liquid tamiflu a formula. We have flavored it so it is not so bitter. We are ready to fill a liquid tamiflu prescription.

So on top of the usual crisises of computers not working, student doctor questions, reports due for nursing homes and of course my main job of checking prescriptions and talking to patients, the challenge of that day was liquid tamiflu. We got that one figured out and are ready for the next challenge. And I still really like being a pharmacist.

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

HEARTBURN

2009-10-30T09:00:00.000-05:00

Antibiotic Resistance

2009-10-20T12:52:00.000-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

I like Pink Floyd. Yes that psychedelic British rock band from the 1960’s. Although I don’t think I’ve played their album “The Wall” from end to end in a decade, I used to listen to it a lot in University. One of the many themes on The Wall is the difficulty of losing a father in World War 2 and how hard it was to grow up in post war Britain. And in a couple of places they mentioned Vera Lynn.

I honestly had no idea who Vera Lynn was when I heard her name in the Pink Floyd songs. However, on September 13, 2009, Dame Vera Lynn had a Number 1 record in Britain at the very young age of 92. After that I heard an interview with her. She described her career entertaining the troops with hits like “We’ll Meet Again” and “There’ll Be Blue Birds Over the White Cliffs of Dover”. For us on this side of the Atlantic, picture her as a British Bob Hope. She described visiting field hospitals in Burma to see wounded soldiers. She actually saw a new drug being used. She saw penicillin powder poured onto open wounds to help them heal. For the record, she said it was a yellow powder.

Sir Alexander Fleming discovered penicillin in 1928. He was doing research on bacteria and was already known as a good researcher, but a messy lab technician. Coming back to his lab after a few days off, he found some cultures of his bacteria that he’d forgotten had been spoiled by mold. Instead of just throwing out all the culture plates, he noticed a zone around some of the mold was completely free of bacteria. The mold (later named Penicillium notatum) produced a substance (now called penicillin) that killed the bacteria. Penicillin was eventually isolated and made in large quantities. When it was given to people, certain infections were cured!

Penicillin was a miraculous discovery. Bacterial infections can kill people. Before antibiotics, strept throat, sexually transmitted diseases and child birth often killed people. In fact, bacterial infections remain still one of the only maladies that drugs can “cure”. Yes insulin treats diabetes, celebrex treats arthritis and Viagra treats erectile dysfunction, but the malady doesn’t go away. If you take away the insulin, the celebrex or the Viagra the diabetes, arthritis and erectile dysfunction come back. However, if I have strept throat and the doctor gives me a 10 day course of penicillin, I am cured. The bacteria are dead and that infection is over.

As miraculous as antibiotics are, they aren’t perfect. Several decades after penicillin was discovered, people started talking about antibiotic resistance. Antibiotic resistance is when bacteria aren’t killed by a certain antibiotic anymore.

How do bacteria become resistant to an antibiotic? There are a few ways including complicated things like sharing plasmids, but often it is when the bacteria are exposed to a small dose of the antibiotic. This dose is either too small to kill them or given for too short a time to kill them. For example, let’s say you go to the doctor and insist that she give you an antibiotic for your “cough”. Then, you only take 2 or 3 days worth of the antibiotics and “save the rest for next time”. This will kill off the most of the bacteria, but it will leave some alive. The ones that are left will have a natural immunity to the antibiotic. Those bacteria will reproduce and all their offspring will have a resistance to that antibiotic. Now that original antibiotic won’t work anymore. You now have an antibiotic resistant infection!

So finish your antibiotics! I want you to be like my new Pink Floyd inspired hero Vera Lynn. Be working and productive for seven decades. Get that number 1 album on the British charts when you are 92. Do not stop taking an antibiotic part way through the course of treatment without first discussing it with your doctor. Even if you feel better, use the entire prescription as directed to make sure that all of the bacteria are destroyed. Dead bacteria don’t cause resistance.

And like Vera Lynn says, “We’ll meet again….Some sunny day”.

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

OSTEOPOROSIS

2009-10-02T09:00:00.000-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

In Pharmacy world, we have a problem. We call it look alike, sound alike drugs. For example losec looks like lasix when a doctor writes it on a prescription pad and they sound similar when a doctor phones it into the pharmacy. Losec or omeprazole reduces stomach acid and is often used to treat stomach ulcers. Lasix or furosemide causes the body to pass out extra fluid and is used to treat swelling and heart failure. As a pharmacist if I get confused by a doctor’s order and give someone the wrong medication, bad things can happen. So we are very careful to catch the differences between look alike sound alike drugs when the doctor orders them. So I understand when people get confused between look alike sound alike conditions such as osteoporosis and osteoarthritis.

Osteoarthritis is when the joints between the bones wear out. Moving those joints hurt. Osteoporosis may not hurt at all. It is when the bones themselves lose calcium and become less dense and more brittle. Do you want to learn more about these two conditions? Call Linda Watt at the Arthritis Society 638-8107. She is putting on a talk Oct 7, 7-9 pm at the Senior’s Center where Bonnie Hopps will discuss the differences between the two conditions and even lead you through some helpful exercises.

Osteoporosis is a disease of the skeleton that can have many contributing factors. It’s most important characteristic is the loss of bone strength. If you look at a bone under a microscope, bones look like a honey comb. It isn’t solid. When a person has osteoporosis, the microscopic structure changes, and the holes in the honey comb get bigger. The bone also gets weaker. Osteoporosis is called a silent disease. Sometimes the first sign of the disease is when a person breaks a bone unexpectedly. For example, someone with osteoporosis can break ribs by coughing. Other bones that can break in osteoporosis are the vertebrae in the spine (they usually compress and the person gets shorter), the upper thigh bone, the wrist, and the hip.

What factors put someone at risk of osteoporosis? Being female, being Caucasian or Asian, being over 65, having a small frame, having relatives with osteoporosis, being inactive, low calcium intake, smoking and high caffeine intake.

What can you do to help reduce the risk of osteoporosis? Depending on your age, you should be getting 1000 to 1500 mg of calcium per day either from your diet or supplements and you should be getting 800-1000 IU of Vitamin D per day. Calcium helps build bone and maintain it, and Vitamin D helps your body absorb calcium from the gut. Regular weight-bearing exercise will also help building bone. So regular walks with the dog 4-5 times a week for about 20 minutes each will help strengthen your bones. Also, quit smoking and reduce your caffeine intake.

How can you tell if your bones are thinning before you break one? The gold standard is special X-ray called a DEXA. The problem is the DEXA machine is in Winnipeg and it can take a while to get in and get your bones tested. In fact, you have to meet some pretty specific criteria to qualify for a DEXA scan. Some criteria are being over 65, having been on prednisone for more than 3 months, or having an existing compression fracture in your spine. The reason for the strict conditions is that having thin bones on a DEXA scan doesn’t necessarily mean you are at a high risk for fracture.

I know it is a bit confusing, but having thin bones, or a low Bone Mineral Density (BMD), is just one risk factor for getting fractures. This risk should always be viewed in the context of the person’s age and other risk factors. For example a 25 year old with a low BMD has a very low 10-year risk of fracture that is not much different than a 25 year old with a high BMD. However, a person with a low BMD at age 65 has a much higher 10-year risk of fracture.

So what do you do if you are curious about how thin your bones are but you don’t qualify for a DEXA? Come to the Dauphin Clinic Pharmacy’s Heel Scanning Clinic. We will be using a special ultrasound machine to see how dense the bone in your heel is on October 7 and 8th. Please call us at 638-4602 to book your appointment soon as spots are limited! The test is fast, easy, and painless!

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

HOMOCYSTEINE

2009-09-25T09:57:00.000-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

What do Smashing Pumpkins, Mother Theresa, Topher Grace and the Dauphin Clinic Pharmacy have in common? 1979. It was a hit song off of the Smashing Pumpkins album Mellon Collie and the Infinite Sadness. It was the year Mother Theresa won the Nobel Peace Prize. The TV Comedy "That 70's Show" that Topher Grace starred in had its last episode set December 31, 1979. Finally, the Dauphin Clinic Pharmacy was opened in 1979 by Mr. Myles Haverluck.
Think of all the things that have changed since 1979. Just today I wrote this article on a personal computer, looked up some information on Google, phoned home on my cell phone, checked my email, tele-commuted to the store in Winnipegosis and played around with Skype Video-conferencing. None of those everyday things existed or were even dreamed of in 1979. Since so many things in our everyday lives seem to be constantly changing, it shouldn't be a surprise that medical knowledge and information is always changing too. Take homocysteine. Homocysteine is an amino acid with some interesting stories to tell.
It was noticed that children with a genetic metabolic condition that gave them high homocysteine levels also got damaged blood vessels more often than we would normally expect. The scientists thought that high homocysteine levels damaged the lining of the blood vessels call the endothelieum and made blood clot more than normal. We think that many people with athererosclerosis or hardening of the arteries also have high homocysteine. We also know that if we give people B vitamins and folic acid we can reduce their homocysteine levels. The big question is if we give people high doses of B vitamins and folic acid will they have fewer heart attacks and strokes and die less often?
Well, there was a big trial in 2005 with 3749 people in it called NORVIT or the Norwegian Vitamin Trial. They gave people who had had a heart attack in the last 7 days folic acid, folic acid plus vitamin B6 or a placebo. The homocysteine levels in the folic acid groups went down. They found no change in risk of heart disease with or without the folic acid and vitamin B6. The actually found an increase in risk of heart attack in the people on high doses of Vitamin B6 and folic acid.
One reason people like me were so excited about homocysteine was that it was so easy to treat. We have good medications to reduce cholesterol called statins. We believe that if we reduce a person's cholesterol with a statin, we will reduce the chance of heart attack and stroke. Many studies have backed this up. Some of the downsides to statins is they are relatively expensive and they can cause side effects in a small number of people. If reducing someone's homocysteine reduced their chance of heart attack and stroke, that would be great because we can reduce homocysteine with B vitamins and folic acid. They are relatively inexpensive, available without a prescription and relatively free of side effects.
But the homocysteine story is a bust, right? The big NORVIT study found no benefit, right? Well the homocysteine story continues to evolve. While it is unlikely that we will recommend everyone go on folic acid and B Vitamins to reduce their homocysteine, there may be some populations that could benefit from folic acid. In an Israeli study published in the American Journal of Cardiology in September 2009 found people with early onset coronary arteries disease and who had high homocysteine levels did benefit from folic acid and B vitamins. It was a smaller study with only 492 patients in it, but the folic acid/B vitamin group did die less often. Remember, though, this was a very specific group of people with the heart condition early onset CAD and who had high homocysteine levels. So the homocysteine story continues.
So what is the take home message for most of us? Whole grains and dark green leafy vegetables. This is where B Vitamins and folic acid come from in our diet. Eat more of them. They do lots of good things for you including lowering your homocysteine levels. Today we can't say that lowering your homocysteine levels will help your heart, but the story continues to evolve. Just like the original UseNet experiments in 1979 developed into a part of the internet we enjoy today and the Dauphin Clinic Pharmacy grew from a tiny one man operation to arguably one of the best pharmacies in Canada, it will be interesting to see where the homocysteine story goes.

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

PROBIOTICS

2009-09-18T09:52:00.000-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

My parents spent their 40th wedding anniversay in Wawa, Ontario. Wawa is where my dad grew up and they were there helping my grandmother move from her house into an apartment. My grandmother was ahead of her time when it came to feeding my dad the lastest super healthy foods. She insisted that he take cod liver oil, or as she called it "liquid sunshine". That provided him with both Vitamin D and Omega-3 fatty acids, which are all over the news. My grandmother also tried to get him to eat yogurt. Apparently the yogurt was made fresh at the family farm, but my dad wouldn't go near it. He still won't eat yogurt. Score another one for grandma, though. Yogurt is just one of the new "probiotics" that we are all supposed to be eating.
Probiotics are "good" microorganisms for the intestines. Probiotics contain actual tiny living things that go into your intestines, start growing and push out the "bad" microorganisms that might be there. Probiotic microbes have names like Lactobacillus, Bifidobacteria and Saccharomyces. There are more and more products in the pharmacy that are promoted as probiotics. Should we all take them? Let's have a look.
Apparently this probiotic movement is older than I thought. A Russian scientist named Elie Metchnikoff was looking at a particularily long lived group of Bulgarian mountain men. These mountain men drank a fermented milk product that had lots of lactic acid producing bacteria in it. Metchnikoff thought the bacteria in the fermented milk drink helped the immune system in the mountain men's gut. This was all going on in the late 1800's and early 1900's. So was Metchinikoff right? Well the human digestive tract is about 5 meters long from end to end and if stretched out it would cover about 2 tennis courts. And it is full of bacteria and other microbes. Our guts get colonized within hours of birth and by adulthood there are actually 10 times more bacteria cells in our guts than there are human cells in our body. The bacteria in our guts help us break down some foods, release some nutrients we otherwise couldn't get at and helps our immune system.
The immune system part surprised me. Apparently up to 75% of the body's immune system cells are in the gut. Our gut bacteria help stimulate our immune system in the prescence of bad invasive microbes and helps calm the immune system so it doesn't go attacking non-harmful things. In interesting experiments researchers took new born mice and put them into a sterile environment before bacteria got into their guts. These mice developed very badly working immune systems. However the mice were "cured" when they were then allowed to live with normal mice with normal gut microbes for a few weeks. We assume the normal gut microbes moved from the normal mice to the guts of the sterile mice.
So should everyone go to the pharmacy and buy some lactobacillus acidophillus capsules? Well, probably not. It is still a stretch from health Bulgarian mountain men and mice with no gut microbes to buying capsules at the pharmacy. However, there are some products in the pharmacy I have recommended in the past that I will share. A big warning first though. The science saying that if you take these probiotics that your condition will get better is incomplete at best. So why do I still recommend them? I do because the chance of harm from probiotics is very, very low.
I have recommended lactobacillus capsules to women who always get yeast infections after taking antibiotics for years. Apparently, there isn't any science to back up that recommendation at all. There is some evidence to support that women who get yeast infections regularily not from antibiotics who take lactobacillus capsules will get less yeast infections.
Well couldn't you just eat more yogurt. Maybe. I was surprised to learn yogurt isn't necessarily probiotic. To be probiotic the product has to be able to survive through the acid of the stomach, the bile acids of the small intestine and then be able to reproduce in the large intestine. Only yogurt may with certain types of bacteria can do that. For example the brand "Activa" reports to be made with bacteria that can survive the trip through the acid stomach.
I have recommended BioGaia for colic. Colic is when an infant cries and cries for no apparent reason. If you have an infant that may have colic, have the infant checked out by your doctor just to make sure there is nothing else wrong. BioGaia is a probiotic drop which has some evidence that it reduces how often a colicy baby cries. Now as it is hard to tell when an infant will just grow out of colic, there are some people who question if BioGaia works. However, as there is very little chance of harm with BioGaia, I have recommended it. BioGaia requires refridgeration.
TuZen is an lactobacillus capsule that is being promoted as helpful for irritable bowel syndrome (IBS). IBS is when you have diarrhea or constipation and other stomach disorder for no apparent reason. If you think you have IBS, please have your doctor rule out other causes. I have had people take TuZen and had their IBS symptoms get better. Since IBS symptoms tend to come and go in some people, it is a little controversial if TuZen works or not. What I can tell you is that TuZen is made with a special type of lactobacillus that can survive its trip through the stomach and unlike some other products it does not require refridgeration

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

Lyme Disease

2009-09-11T09:43:00.000-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

You know what is cool about a phone call from Hong Kong? It sounds just like a phone call from across the street. In today’s world of fax, email, Facebook, satellite phones, Skype videoconferencing, text messaging and many, many other forms of electronic communications, the overseas phone call is still almost magical to me. About a year ago a friend I grew up with called me from Hong Kong. He asked if I was going to Winnipeg in the following couple of weeks. It turned out I was, so he was asked if I could meet this guy, Allen for dinner. I said sure.

Allen was in Winnipeg because he was driving a bus for a tour company. He was taking people from a downtown hotel to the airport who were on their way to Churchill to see polar bears. Allen was originally from Texas, went to university in the eastern states and has had a variety of fascinating jobs. He had run for Congress, twice, had helped record music for a national book chain. He had played his small part as a member of the massive team that helped get Barack Obama elected president last year. He had many tales to tell. The one that came closest to my line of work involve a lime green van. Allen had driven this lime green van across the US to promote Lyme disease awareness. I have to admit, I really didn’t know much about Lyme disease, and after dinner with Allen, I quickly forgot about the story of the lime green van. However, recently Manitoba Health sent the pharmacy a Deer Tick information package. So thinking about Allen and his green van, I read it. Here is some of what it said.

Deer ticks are cousins to the wood tick that you are probably familiar with. They are smaller than wood ticks and they don’t have any white marks or streaks like wood ticks. They are of interest because deer tick can transmit Lyme disease to people. Deer ticks haven’t been in Manitoba long. Apparently they have only been identified here since 1989. Deer tick are predominantly in the south eastern part of the province and probably only 10% carry Lyme disease. Most Manitobans are unlikely to run into a deer tick. However, unlike wood ticks, deer ticks are more common in the fall. I guess that’s why Manitoba Health sent out the info package in the late summer.

Lyme disease is caused by the bacterium, Borrelia burgdorferi. Bacteria are transferred from the deer tick to the person when the tick bites and feeds on the person. This gives us our first opportunity to prevent Lyme disease. If you remove of attached within 18 to 24 hours you can reduce the risk of infection. Do not forget to check children and pets as well. Carefully remove attached ticks using tweezers. Grasp the tick's head and mouth parts as close to the skin as possible and pull slowly until the tick is removed. Do not twist or rotate the tick and try not to damage the tick (i.e., squash or crush it) during removal.

The symptoms of Lyme disease are often described as having three stages, although not all patients have symptoms of each stage. The first sign of infection is usually a circular rash called that’s been described as a “bull’s eye rash”. This rash occurs in about 70-80% of infected persons and begins at the site of the tick bite after a delay of three days to one month. Patients may also experience symptoms such as: fatigue, chills, fever, headache, muscle and joint pain, and swollen lymph nodes. If the infection goes untreated, the second stage of the disease can last up to several months with possible symptoms including: central and peripheral nervous system disorders, multiple skin rashes, arthritis, heart palpitations, extreme fatigue and general weakness. If the infection continues to go untreated, the third stage of the disease can last months to years with possible symptoms including, chronic arthritis and neurological symptoms.

The good news is since Lyme disease is caused by a bacteria, it can be treated with antibiotics. The earlier in the disease the doctor can start you on the antibiotics the better. Late stage disease may have to be treated with antibiotics for a long period of time.

I don’t want to scare anyone about Lyme disease. It is still something Manitobans are unlikely to catch. But forewarned is for-armed, and if you happen to see a lime green van driving around promoting Lyme disease awareness, talk to the driver. It could be a very interesting conversation. And phone someone you know that lives a long way away. Remember to marvel at how that familiar voice can travel so easily along those little wires.

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

Hemoglobin A1C Testing for Diabetes

2009-09-04T09:32:00.000-05:00

BENIGN PROSTATIC HYPERTROPHY

2009-08-28T09:24:00.000-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

There are many joys of getting older. Hopefully the mortgage gets paid off, the kids leave home, I get to spoil grandchildren, I have trouble peeing, you know the good stuff. Apparently many of us guys have something in common. By the time we turn 80 years old, most of us will have benign prostatic hypertrophy.

The prostate is walnut size gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. The prostate surrounds the urethra, the canal through which urine passes out of the body. Benign prostatic hypertrophy (BPH) is a condition where a male's prostate becomes enlarged to the point that it causes discomfort. Common symptoms of BPH include needing to urinate often, feeling like you really need to go now, weak urine stream, feeling like you haven’t completely emptied your bladder, and more frequent nighttime urination. The prostate goes through two main periods of growth during a male's life. The first is puberty, where the prostate doubles in size. The gland begins to grow again at age 25. This second stage of growth is what may cause BPH much later life.

Symptoms of BPH rarely show up before age 40. However as men age, the chance of BPH symptoms go up. About 50 percent of men in their 60s have BPH symptoms and over 80 percent for men in their 80s have symptoms. Symptoms happen when swelling of the prostate starts to push against the urethra, much like clamping a garden hose. This causes the bladder wall to thicken and become irritable. The bladder starts to contract even when it contains only a small amount of urine. Eventually the bladder weakens and becomes incapable of empty itself completely, leaving behind urine. Although BPH and prostate cancer share similar symptoms, having BPH does not increase your chances of developing prostate cancer.

So what should you do if you have trouble urinating? Visit the doctor. They can determine if your symptoms are related to BPH and discuss treatment options.

Treatment of BPH is only recommended when it poses a health risk for the patient or when it becomes very bothersome. Mild BPH may not require treatment and it is very reasonable for the doctor to watch and wait to see if the symptoms get better or worse.

There are two main types of medications used to treat BPH. They are alpha blockers and 5-alpha-reductase inhibitors. Alpha blockers include alfuzosin, doxazosin and tamsulosin. Alpha blockers relax the smooth muscle in the prostate and the bladder neck. They work quite quickly, and gentlemen say they can pee more easily in about two weeks. 5-alpha-reductase inhibitors like dutasteride and finasteride stop the conversion of testosterone to dihydrotestosterone (DHT). DHT causes the prostate to grow. So 5-alpha-reductase inhibitors reduce the size of the prostate, which is good. Unfortunately these medications work slowly. It takes 6 months to a year on a 5-alpha-reductase inhibitor before a guy’s symptoms will improve.

Doctors often put guys on both an alpha blocker and a 5-alpha-reductase inhibitor together. That way the alpha blocker can get the guy to urinate more easily within two weeks while the 5-alpha-reductase inhibitor is slowly starting to shrink the gland. Also recent studies like the Combination of Avodart and Tamsulosin (CombAT) study have showed that the combination of these two types of drugs works better than either drug separately.

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

Hemorrhoids

2009-08-21T09:00:00.000-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

Today we are going to talk about the part of your body you sit on. There used to be a Preparation H commercial that showed a hard wooden stool and said, “Does this scare you?” I thought this was a great way to use humor to start the conversation about an embarrassing topic. Discomfort around the anorectal area cause problems for about half the population at some point in their life. Unfortunately, as this is an embarrassing topic, many people simply suffer in silence. Others will use over the counter products instead of seeing their doctor. Since hemorrhoids are so common, let’s try to get more comfortable with them so the wooden stool won’t scare you.

What are hemorrhoids? They are swollen, twisted veins in the walls of the rectum or anus. If they are outside the anus they are called external hemorrhoids. If they are inside the anus, they are called internal hemorrhoids. External hemorrhoids may cause a lump. If a blood clot forms in the swollen, twisted vein, the lump may become more swollen and painful. Internal hemorrhoids may not form a lump or become painful, but they often bleed during bowel movements. Signs included blood streaked stool or toilet paper.

What causes hemorrhoids? Hemorrhoids happen when there is an increase in pressure in the veins of the anorectal area. The increase in pressure can be from pregnancy, heavy lifting, or straining when you go to the bathroom. Straining is often caused by constipation, so we want to keep stools soft. This leads us to believe that high fibre diet may help prevent hemorrhoids, while a low fibre diet (which leads to small hard stools) may help cause hemorrhoids. Hemorrhoids don’t seem to be passed on genetically. There seems to be no discrimination between men and women. (However, pregnancy makes hemorrhoids more likely.) You are more likely to get hemorrhoids the older you get. We used to say that straining to pass stool caused hemorrhoids, but more recent research suggests that sitting on the toilet for a long time may be a more likely culprit.

How can you treat hemorrhoids? If they aren’t causing you any discomfort, they don’t need to be treated. If you wish to prevent or treat hemorrhoids yourself, first consider fluids and fibre Eight glasses of water per day is recommended to establish good bowel habits. Water helps expand the fibre in the stool to make it bigger and softer. So, the next thing to do is increase the amount of fibre one eats. Unprocessed wheat bran is an excellent choice. Vegetables and fruit vary in their ability to absorb moisture. Carrots have the greatest absorption capacity of the vegetables, about half that of bran. Other high absorption vegetables are brussel sprouts, eggplant, spring cabbage and corn. High-absorption fruit include apples, pears, and oranges. Adding 20 to 30 g of fibre to your diet will help with symptoms of mild hemorrhoids. If you can’t seem to eat enough bran and veggies, consider a fibre supplement like Metamucil with psyllium in it. The final non-drug measure to relieve hemorrhoids is a sitz bath. A sitz bath is a tub of warm water (46oC) in which the person sits for 15 minutes at a time. Plastic sitz baths may be fitted over the toilet seat rim for greater convenience.

Without a prescription one can get a variety of hemorrhoid products. They have various ingredients in them like protectants and local anesthetics. There are a dozen or more different products, so instead of list them all, I'll just say ask your pharmacist. The key is though, don't self treat for more that 7-10 days. If the symptoms haven't cleared in 7-10 days, see your doctor.

What are some of the other red flags? If you experience any rectal bleeding, any rectal tissues protruding from the anal opening after a bowel movement, or if the patient is under 12 years old, see your doctor.

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

Stye's

2009-08-14T09:00:00.001-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

“I’ve got a stye. My wife is says it’s ugly. My co-workers don’t like looking at it. What should I do?”

Unfortunately, this is not the beginning of a conversation with a patient at the pharmacy. I have had a few stye’s in the past and I assume I’ll get them in the future. What do I do when I get a stye? First, I ignore my wife and her complaints about how ugly my eye looks until her complaining gets sufficiently loud. Then we put a hot wash cloth on it for a few nights, and sometimes a cold tea bag. If that doesn’t work, I see my doctor.

A stye, or hordeolum, is an infection of the eyelid glands. Stye’s are a very common eyelid infection. When people have stye’s, they usually only have swelling on one eyelid. The swelling will usually be sore and red (the more swollen, the more painful). The eye may water, become sensitive to bright light and feel like something is in it. Usually, only a small area of the eyelid is swollen, but sometimes the entire eyelid swells. Often a tiny, yellowish spot develops at the center of the swollen area, usually at the edge of the eyelid. The stye tends to pop after 2 to 4 days, releasing a small amount of pus and going away on its own.

The bacteria that most often causes the problems with stye’s is Staphylococcus aureus. There is a slight increase in number of stye cases when the patient is between 30 and 50 (I am in the zone!). People with diabetes, chronic eyelid infections, seborrhea, and people with high cholesterol are all more likely to get stye’s. I found the cholesterol one the most interesting. I don’t have high cholesterol, but if you do that increases how often the eyelid glands are blocked. Unfortunately, lowering the blood cholesterol doesn’t decrease the rate of stye formation.

What should you do if you get my favorite eye bump? Well, if you have any problems with your eyes that involve severe pain, being very sensitivity to all light, any vision disturbance, blunt trauma, chemical exposure, imbedded foreign body, heat exposure (e.g. welder’s arc), or eye protrusion please see a doctor immediately. If the problem is just with your eyelid, and your eyelid is swollen with a lump, it is probably a stye. You can treat it at home for 48 hours. If it doesn’t go away, you should see a doctor.

What can you do at home before you see the doctor? You can apply a hot wash cloth to your eye for 15 minutes four times a day. This will encourage blood flow to the area and hopefully it will spontaneously drain on its own. In between the hot wash cloth, you can try a cold (still wet) tea bag for 5 to 10 minutes. Some people believe that the tannic acid in the tea bag will help the stye dry up faster.

For my last stye, I had to see one of the family doctors at the walk-in clinic. The doctor recommended continuing with the hot compresses, and recommended cleaning my eyelashes with baby shampoo either with a eyelash brush (my make-up kit is surprisingly non-existent) or a cotton swab. Then I was given a prescription for an oral antibiotic, and an antibiotic eye ointment.

The eye ointment was interesting. I’ve told people for years how to use eye ointments, but I’ve never used one myself. What I had always told patients was that an eye ointment was much thicker than a drop. You pull down the bottom lid until it forms a pocket. Then you squeeze out a little ribbon of ointment (about ¼” to ½”) into the eyelid pocket. The problem is when you do that, the ribbon of ointment remains hanging off the end of the applicator and doesn’t break. You are supposed to twist your wrist to break the ribbon of ointment. That was still too hard for me. So I put the eye ointment on a cotton swab and used that.

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

Tanning Beds

2009-08-07T09:00:00.002-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

A few years ago, I was volunteering with Kinsmen to work at Safe Grad. We were working at the bar. I remember some of the female Grads coming up to the bar who were very tanned. Now remember high school graduation is in June, so there isn't a lot of time to tan outside before the event. I remember one young lady in particular had very dark, dry and wrinkly looking skin. I commented to one of the other volunteers that at 18 she already had the skin of a 40 year old. We assumed she had over done it on a tanning bed. It seems the World Health Organization says that use of tanning beds by young people does worse things than cause wrinkles. It can lead to skin cancer.

The WHO has a group called the International Agency for Research on Cancer or IARC. At the end of July the IARC moved UV tanning beds to its highest risk category –Group 1- “carcinogenic to humans.” Other Group 1 compounds include: arsenic, asbestos, and mustard gas. The IARC reported the re-classification in the Lancet Oncology journal. The argument used to be that the UVA light in tanning beds was safer than the UVA, and UVB light in sunshine. The IARC now calls UVA a Group 1 carcinogen and says that it should be avoided.

The IARC also says a specific group of people in particular should avoid tanning beds. It says if you first use a tanning bed before the age of 30, there is an associated 75% increase in melanoma risk. Melanoma is a type of skin cancer. So it is recommended that young people avoid UV tanning beds.

I found this report about tanning beds especially interesting. You see earlier this year, the Canadian Dermatology Association said Canadians born in the 1990’s are two to three time more likely to get skin cancer in their lifetimes compared to those born in the 1960’s. This report didn’t make any sense to me. It’s not that I didn’t believe it, the Canadian Dermatology Association are the Canadian skin experts, but it didn’t make sense. If I think about my childhood, we rarely wore sunscreen, never wore hats, got sun burnt at the beginning of every summer and spent lots of time outside. If I look at my children, they always have sunscreen and hats on, and if I do everything I am supposed to as a parent, they may never get a sun burn. Since there are more computers, video screens and since unlike my parents I am too scared to just send my kids out on their bikes unsupervised, they don’t spend as much time outside as I did. Why would my children (if the trend holds) be more likely to get skin cancer than me? You would think they should be more protected.

Well, there are probably lots of reasons the rate of skin cancer is increasing. The ozone may be thinner, doctors may be better now at diagnosing skin cancer or there may be other confounding factors that haven’t been thought of yet. I wonder if a big reason for the increase in skin cancer in those born in the 1990’s are tanning beds. I don’t remember anyone going to a tanning bed before my high school graduation. Now it seems to be almost a requirement. In addition to the IARC saying early exposure to a tanning bed increases your melanoma risk, the national institutes of health in the US published a study last year. The NIH found that the melanoma rates among young women in the United States tripled between 1973 and 2004. We don’t know for certain this is due to tanning beds, but there are suspicions.

So, before the users and owners of tanning beds shoot the messenger, are there any upsides to them? Well, arguably getting UV radiation exposure helps your skin produce Vitamin D. We need Vitamin D and Canadians are often Vitamin D deficient. I guess the problem is if you get that Vitamin D through the use of a tanning bed at 17, will you be rewarded with skin cancer at 47? Would it be safer to get Vitamin D by eating more oily fish or taking a Vitamin D pill? You will have to make that call. Just remember the next time you see someone who seems to have over done it at the tanning salon, they may be getting more than wrinkles.

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

TOO MUCH ACETAMINOPHEN?

2009-07-31T09:00:00.000-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

In my line of work, dose is very important. Warfarin can stop a blood clot from giving you a stroke. This is good. Too much warfarin can make your brain bleed and cause a stroke. This is bad. “A little of this is good, more must be better,” definitely doesn’t apply to medications. If you take enough of anything it can be bad for you. Did you know you can drink enough water to cause swelling of the brain? The same goes for acetaminophen or Tylenol. We consider acetaminophen a very safe medication. However, too much acetaminophen can be harmful. In fact the FDA in the US is considering new regulations to limit the doses of acetaminophen.

Acetaminophen is used for pain and fever, but it does not reduce inflammation. Acetaminophen is less irritating to the stomach than some other over the counter products like ibuprofen, naproxen sodium or asa. Acetaminophen is found in many, many products. It can be a single ingredient like in Tylenol or in combination with other medications. Combination products include many cough and cold products, sinsus products, and pain medications like robaxacet. Also many prescription products like Tylenol #3 and Percocet have acetaminophen in them too. So you can see how it would not be difficult to accidentally take two or more products all with acetaminophen in them and so get too much.

If you take too much acetaminophen it can damage the liver and kidneys. Acetaminophen is usually metabolized by the liver. Your liver breaks it down into non-harmful chemicals and excretes it. If you take too much acetaminophen the usual metabolic pathway gets overwhelmed and the acetaminophen is broken down by another pathway which leads to a poisonous product. Some of the symptoms of acetaminophen poisoning are loss of appetite, nausea, vomiting, stomach pain, confusion, yellowing of the skin and eyes, coma and even possibly death.

At the end June 2009 a sub-committee at the Food and Drug Administration (FDA) in the US made some recommendations to the FDA about acetaminophen. They recommended prescription products with acetaminophen and other painkillers should be pulled off the market. The panel recommended that the daily maximum of acetaminophen should be lower than its current 4 grams (although they didn’t say what it should be). The panel would like the single dose maximum of acetaminophen to be reduced from 1000 mg to 650 mg. The panel would like 1000 mg of acetaminophen to only be available by prescription. However the panel rejected the idea of pulling cough and cold products that contain acetaminophen.

Now the FDA doesn’t have to follow the panel’s recommendations. But especially with the acetaminophen and strong painkiller combination prescription drugs, the panel cites that 60% of acetaminophen deaths are due to prescription products. Acetaminophen remains the leading cause of liver failure in the US despite years of warnings. And the panel says acetaminophen sends 56,000 people to the emergency room in the US every year.

Canada obviously doesn’t have to follow the decisions made by another country. But it will be interesting to see what Health Canada has to stay after studying the FDA decision. Will 1000 mg of acetaminophen become a prescription product? That could make for a whole lot of people needing to see their doctor in an already over-taxed health care system. Will medications like Percocet be pulled off the market? If yes, what will replace them? Oxycontin? It is effective, but has some issues with some people abusing or selling it. NSAID’s? They are effective, but will we now get more ulcers and kidney disease?

I think the answer should be for people to read their bottles of medication more carefully and ask their pharmacist before they take medications together. The FDA would argue we have been telling people that for years and it hasn’t helped. But does it make sense to take away useful drugs instead of coming up with better educational campaigns?

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

ALEVE

2009-07-24T09:00:00.000-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

Aleve is here. This is a pain killer that is heavily advertised on US television stations. It has always been available in Canada, but until very recently, only by prescription. Aleve is now available without a prescription in Canada.

Aleve has been available in the US without a prescription since 1994. It was quite a marketing feat when they launched it. Within one week of its launch, supermarket scanner data showed it was available in more than 90% of monitored stores. In two months it had over 6% of the market share. After 4 months it was tied for third place in its category. The makers of aleve spent over $100 million dollars in marketing during its first year. In fact they felt they had to pull the television ads for the last 3 months of 1994 for fear that the stores would run out of stock. Now that is a well marketed, well funded drug launch.

Is aleve better than other pain killers like ibuprofen (Advil), acetaminophen (Tylenol) or asa (aspirin)? Well it is different than acetaminophen (Tylenol), may be a little safer than asa and is practically the same as ibuprofen. Acetaminophen (Tylenol) is a good painkiller and good at relieving fever, but it doesn’t reduce inflammation. So, if you sprained your ankle, it would hurt and get swollen. Acetaminophen (Tylenol) would reduce the pain but not the swelling. Aleve would reduce both the pain and swelling so would probably work better. However, acetaminophen (Tylenol) is safer because it doesn’t cause ulcers, bleeding problems or affect the kidneys. When you compare aleve and asa, they both reduce pain and inflammation, but aleve is probably a little safer. ASA is more likely to cause bleeding problems (bleeding problems are possible with aleve but less likely) and asa is more likely to cause ulcers. Ibuprofen (advil) and aleve are very similar. They are both NSAIDs (non-steriodal anti-inflammatory drugs). In fact you can sub-divide NSAIDs into different sub-types, and even still ibuprofen (advil) and aleve are still both in the same sub-type called arylpropionic acids. So what does that mean? Well even though milligram for milligram aleve is stronger than ibuprofen, if you take an equivalent dose of each drug, they should work the same.

So what is in aleve? Aleve contains 220 mg of naproxen sodium. The claim is that it can relieve pain for up to 12 hours. Its prescription name used to be anaprox. For those of you who have a prescription of naproxen at home and wonder if it is the same thing, it is probably a little different. If you doctor wrote a prescription for naproxen , the pharmacist would have filled it with just plain naproxen, not naproxen sodium. When naproxen sodium was originally marketed as anaprox, the manufacturers claimed naproxen sodium worked a little faster than naproxen. On an interesting side note, naproxen sodium was never paid for by Manitoba’s pharmacare program even when it was prescription only, whereas plain naproxen is covered.

So who will aleve be good for? Younger patients with no pre-existing health conditions. If a person is between 20 and 50, has no history of ulcers, kidney problems or heart problems and sprains their ankle, aleve may be a good choice. The aleve should only be used for a relatively short time, like a couple of weeks, and if the pain lasts longer than a couple of weeks the person should see their doctor.

Who do I have concerns about? The elderly with arthritis. Compared to younger patients, people over 60 are about 4 times more likely to get bleeding in their stomachs from taking NSAIDs. People over 65 are more likely than younger patients to develop kidney problems while on NSAIDs. If you have arthritis, the pain you have is probably not only short term pain. I worry about people over 65 with arthritis treating their pain for months or years with aleve and not mentioning that to their doctors. Their doctors won’t know to monitor these people for kidney or stomach problems.

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

COENZYME Q10

2009-07-17T09:00:00.001-05:00

HEAT DISORDERS

2009-07-10T09:02:00.002-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

A few years ago, I was volunteering at Country Fest and working at the Kinsmen Bar. It wasn’t that hot out, maybe 25 C. The work area was shaded and I was allowed to take breaks. Apparently, I didn’t take enough of them, and didn’t consume enough fluids. At the end of my shift I was dizzy, and nauseous. What was wrong with me? What did I do? First, let’s talk about different heat disorders. Having your body get too hot is dangerous. To see how heat leaves the body, let’s go back to high school physics.

It takes energy for water to go from a liquid state to a vapour. When the thin film of perspiration on your skin changes into water vapour, it takes heat energy away from your body and you cool down. Heat loss through perspiration accounts for about 30% of the body’s heat loss. This is why you feel much cooler if it is 25oC and 0% humidity than if it is 25oC and 100% humidity. At 0% humidity you can think of the air as empty of water vapour, so the perspiration on your skin can easily change to vapour, and take heat away from you. At 100% humidity, the air is full of water vapour so the perspiration on your skin stays as liquid water and doesn’t cool you down. So if you exercise when it is warm and humid, your body will produce extra heat, but your perspiration won’t be able to remove it and you can dangerously over heat.

What are some of the heat disorders? Heat edema is quite mild and is when the hands or feet swell. Heat cramps are caused by sore muscles especially in the arms, legs, and stomach. Heat cramps can be the first sign of heat exhaustion which is more serious. Heat syncope is dizziness or fainting from the heat and is more serious. Heat exhaustion has symptoms like weakness, dizziness, nauseau, vomiting, and headache. It is when the core body temperature rises above 38 C but less than 40.5C. Heat stroke is a medical emergency. People die from heat stroke. It is when the core temperature goes above 40.5 C. Get heat stroke patients to an emergency room.

So what actions should be taken for which symptoms? If the person losses consciousness, is confused or hallucinating, has convulsions, has trouble breathing, is vomiting a lot, or has hot dry skin with no sweat, it could be heat stroke so get the person to an emergency room or call an ambulance. If the person is nauseated and vomits a little, has headaches, cramps, dizziness or tiredness this may be heat exhaustion. Take off excessive clothing and get the person somewhere cool. Have them drink fluids. Wet the skin with cool or lukewarm water. Elevate the feet or hands if they are swollen. If the person doesn’t recover in 2-3 hours get them to an emergency room. Again, if in doubt about how serious the heat disorder is, assume heat stroke and get them to an emergency room.

Some medication can make it more likely to have heat related problems. Certain antipsychotics and antidepressants, diuretics and beta-blockers can inhibit sweat production. Cocaine constricts the blood vessels to the skin which can lead to over-heating. Amphetamines (including Ecstasy) can disrupt the hypothalamus which is the part of the brain that effects heat regulation.

To prevent heat disorders:
• drink plenty of cold water on hot summer days, especially before and during heavy physical exercise
• avoid heavy outdoor activity from 10 am to 3 pm
• stay out of the sun if possible and take lots of rest breaks (drink fluids during these breaks)
• get used to hot weather slowly over several days by gradually increasing you activity out in the hot weather

So what did I do when I got heat exhaustion? I had a cool shower, stayed where it was air conditioned and drank Gator Aid. I should have been smarter and drank more fluids before and during my activities.

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

SUN SCREENS

2009-06-26T09:00:00.000-05:00

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

For More Information visit:
The Canadian Cancer Society: www.cancer.ca
The Canadian Dermatology Association www.dermatology.ca

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

THE FLU - Audio

2009-06-19T10:00:00.003-05:00

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

THE FLU

2009-06-19T09:00:00.001-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have most of the articles published in the Parkland Shopper on our Website http://www.dcp.ca/

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

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

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

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

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

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

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

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

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

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

COLD SORES - Audio

2009-06-12T10:00:00.001-05:00

Click to hear Trevor's Pharmacy Feature-Audio Segment
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COLD SORES

2009-06-12T09:00:00.000-05:00

TOPICAL ARTHRITIS MEDICATIONS- Audio

2009-06-05T11:11:00.002-05:00

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TOPICAL ARTHRITIS MEDICATIONS

2009-06-05T10:36:00.000-05:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

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

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

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

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

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

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

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

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

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

WORLD MS DAY - Audio

2009-05-29T11:09:00.003-05:00

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

WORLD MS DAY

2009-05-29T10:27:00.000-05:00

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.

Wednesday, May 27, 2009 was the first World MS Day! The plan is every year to mark World MS Day on the last Wednesday in May. World MS Day is being established by the Multiple Sclerosis International Federation to raise awareness of MS, national MS Societies (like the MS Society of Canada) and the global MS movement.

What is MS or multiple sclerosis? It is an unpredictable and often debilitating disease of the brain and spinal cord. Some of the long nerves in the brain and spinal cord have a covering called myelin. Myelin works a little like the plastic covering around a telephone cord. Without the insulating plastic cover, some of the signal that goes down the telephone wire would leak out. The voice on the phone would sound delayed, weakened, garbled or possibly not there at all. In MS, the body mistakenly attacks the insulating myelin sheath around some of the nerve fibers. So the signals from the brain to the body or body back to the brain get weaker, delayed, garbled or go missing altogether.

The fact that MS affects some myelin covers, some of the time leads to one of the most fascinating and frustrating facets of the disease. The symptoms of MS change and are unpredictable. The most common form of MS, relapsing and remitting MS, has well defined attacks followed by complete or partial recovery. It can go away and come back. And it can affect vision, hearing, memory, balance and mobility. And this is not just that the disease affects different people in different ways! The same person can have different symptoms each attack. You can imagine how frustrating it would be to both worker and employer if a worker came to work one week in a wheel chair and then the next week could walk. Then six months later she can still walk, but says she can’t read her computer screen without magnification. And then she is fine. And then six months later she calls in sick for 3 weeks because she is too fatigued to leave the house. Unfortunately, changing symptoms that come and go and not being able to look at someone a see obvious signs that they are sick can confuse some employers and lead them to treat an employee with MS unfairly.

Compared with big diseases like heart disease, cancer and diabetes, why should you care about MS? While it is true that MS isn’t as common or deadly heart disease, cancer and diabetes, MS is the most common neurological disease affecting young adults in Canada. In fact, Canada has one of the highest rates of MS in the world. Within our country, Manitoba has one of the highest rates of MS in Canada. So Multiple Sclerosis does have a lot of relevance in our area.

What can you do to help end MS? How about tell you kid to study hard and maybe they will be the next Mike Namaka. Dr. Mike Namaka originally trained as a pharmacist and then did a lot more schooling and got a Ph.D. in neuroscience. His is now an Assistant Professor at the Faculty of Pharmacy and does research about the causes, treatments and possible cures for MS. He treats people with MS at the MS Clinic in Winnipeg along with an extensive healthcare team. Did I mention Dr. Mike Namaka grew up in Winnipegosis? If your child studies hard, maybe she will discover the cure and finally end MS.

After you remind your child to do their homework, why not visit the MS Society? The MS Society is your best place to go with general MS questions. They also run several fund raisers during the year like the Manitoba Lotteries MS Walk, MS Read-A-Thon and my favorite the RONA MS Bike Tour. They money raised goes to both world class research and innovative services to help people with MS across Canada. The MS Society has an excellent website at mssociety.ca, but if you are in the Dauphin area, why not go visit Robin Searle? Robin manages the Parkland Chapter of the MS Society which is located in the beautifully restored train station in Dauphin on 1st Ave NW. Robin is an excellent resource for information about MS, for services provided to people in the Parkland with MS and for information about local fund raising for MS.

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

LICORICE - Audio

2009-05-22T11:05:00.002-05:00

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

LICORICE

2009-05-22T10:16:00.000-05:00

Occupational Asthma

2009-05-15T10:02:00.000-05:00

PHARMACARE 2009

2009-05-08T09:00:00.000-05:00

Custom Compounding - AUDIO

2009-05-01T10:00:00.001-05:00

Click to hear Trevor's Pharmacy Feature-Audio Segment
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Custom Compounding

2009-05-01T09:00:00.000-05:00

Pinkeye - AUDIO

2009-04-25T17:32:00.001-05:00

Click to hear Trevor's Pharmacy Feature-Audio Segment
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Pinkeye

2009-04-24T09:00:00.000-05:00

Prediabetes

2009-04-17T09:00:00.000-05:00

Gout - AUDIO

2009-04-13T10:31:00.003-05:00

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

GOUT

2009-04-10T09:00:00.000-05:00

Omega-3 AUDIO

2009-04-06T00:42:00.004-05:00

Click to hear Trevor's Pharmacy Feature-Audio Segment
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Omega-3 Fatty Acids

2009-04-03T09:00:00.000-05:00

GETTING IN & OUT OF THE PHARMACY FASTER

2009-03-27T09:00:00.000-05:00

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 am a lazy parent. I have been known to complain about helping my daughter with homework assignments. I go to work all day, then to meetings, then I try to scoff down some supper and then the teacher wants me to read with my kid before bedtime. A few times a year the teacher wants me to rearrange my schedule to come meet with them and talk about my kid. Why can't they just do this teaching stuff without me? Why do I have to go to parent teacher interviews? Why do I have to be involved in my child's education at all? I don’t really want to put in the effort. As I said, I am lazy.

The answer is that the more effort I put in, the more my child will learn. So if I get my butt off the couch, it will take less time and aggravation to stuff knowledge into my kid's head. How does this apply to my life in the pharmacy? I am going to give you three tips that will take a little effort on your part, but will save you time and aggravation in the pharmacy. Give the pharmacist your name. Know the names and prescription numbers of your medications. Call your medications in ahead of time.

Everyday in the pharmacy, someone walks up to me and says, "Fill my medicines. Its in the computer” even before they say hello. Even if you have been coming to the pharmacy for years, please start by giving me your name. I know the pharmacists and staff are familiar to you, but we see hundreds of faces in the store everyday. Do you ever get that feeling that you know someone’s face, but can’t place their name? That is an everyday occurrence at the pharmacy for me. It really will speed up your service if you start by telling me your name.

It is also very helpful if you give me a list of your medications, instead of saying, “It’s in the computer.” It will help you to know the names of your medications, so you will be better able to talk to your doctor. It will help me because although your file is “In the computer” I don’t always know what medications you are actually taking. Are you still taking that pain pill the doctor gave you 3 months ago? What about that inhaler you got last summer? Are you still taking it or not? I don’t really know unless you tell me. I know prescription medication names can be long and complicated. However, please feel free to ask us at the pharmacy to write you out a card with all the names on it. While I am writing out the card, you can tell me if you are still taking those medications. That way we both will have a better idea what you are taking.

All pharmacies will print a prescription number on your medications. It is the number with the largest print on the top of the label. This number is very helpful to you and me. If you phone in the prescription number, I can find out who you are and which medication you want. There are a couple of common misconceptions with prescription numbers, though. If you give me just a prescription number from a pharmacy in Winnipeg, it doesn’t help me at all. Prescription numbers are store specific. Prescription numbers also don’t help doctors. If you tell your doctor the prescription number on your bottle, you will get a blank stare. Doctor’s can’t look up your pharmacy files from their office. So knowing the prescription numbers and the names of your medications is very important.

Doctors and pharmacists don’t like the guess “my small yellow pill” game. The doctors will know what a few prescription medications look like, but not all of them. I know what more of the pills look like because I look at pills all day long. However, you will stump me every time with the guess “my round white pill” game. Do you know how many round white pills there are out there? So bring you doctor or pharmacist a written list of you medications or the original pill bottles.

Call a list of your medications into the pharmacy before you come down. Of course we can and do fill prescriptions when you are waiting in the store. But instead of waiting for me to figure out who you are, which medications you want and then filling them, wouldn’t it be nice if you could just walk into the store, pick up your already filled prescriptions and leave? I’ll do you one better. If you call in your list of medications, I can deliver them to you in Dauphin. If you live on our rural courier route, I can get them to your town. You don’t have to come to the store at all if you don’t want.

I know I am asking for some effort on your part. And if you don’t want to learn the names of your drugs, or what a prescription number is, that is okay too. I am getting pretty good at “Fill my prescriptions. They’re in the computer” and at figuring out which one is that “Round white pill.” Just like the teachers will still teach my kid even if I never lift my butt cheeks off the couch to help her. However, if I put in some effort and help my child with her homework and assignments, she will get knowledge stuffed in her head with less time and aggravation. If you get a pharmacist to make a list of your medication names, know your prescriptions by name and number, and call your order in ahead of time we can help you get in and out of the pharmacy with less time and aggravation.

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

CAFFEINE

2009-03-20T09:00:00.000-05:00

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.

Way back in pharmacy school, I went home to Pinawa, Manitoba for the weekend. By Saturday night I had a horrible headache. I was really worried because I don’t normally get headaches. Did I have a tumor? What was wrong with me? My mother asked when I last had a cup of coffee. Turns out I hadn’t had one in about 24 hours. I was in caffeine withdrawal. My mom gave me a cup of coffee and I was fine. So much for me being a future finder of drug related problems.

I told this story once and got another pharmacist-coffee story. This pharmacist started developing a tremor. Their hands were shaking at work. They got very concerned and went to the doctor. The doctor was about to prescribe a medication for tremor, when the doctor asked, “How much coffee do you drink?” The answer was about 12-13 cups a day. The doctor put down their prescription pad and recommended cutting back on the coffee. The tremor went away.

So, even pharmacists often forget that caffeine is the most popular drug in the western world. It has been estimated that 80% of us consume caffeine. As a pharmacist, I find caffeine interesting. To begin with caffeine has a half life of six hours. We say it takes about 5 half lives for a drug to leave the body. That means it takes 30 hours (almost 2 days) for that cup of coffee to leave my body completely. Since I never take a two day break from coffee, that means I always have caffeine in my system. So, for example, caffeine is always making my blood pressure a little higher than normal.
Health Canada says :
· The general population of healthy adults is not at risk for potential adverse effects from caffeine if they limit their caffeine intake to 400mg per day(that is 3-4 cups of coffee per day);
· People who get an adequate daily amount of calcium have greater protection against the possible adverse effects of caffeine on bone health.
· Compared to the general adult population, children are at increased risk for possible behavioural effects from caffeine; and
· Women of childbearing age are at increased risk of possible reproductive effects if they consume caffeine.
Yes, I drink more coffee than Health Canada recommends. I probably go over my daily limit before I get to work in the morning. So what does that put me at risk of? Things like muscle tremors, nausea, irritability, high blood pressure, racing heart, thin bones and anxiety.
Caffeine was in the news again lately because of so-called energy drinks. These have names like “Red Bull”, “Monster”, “Rock Star” and many, many others. Health Canada specifically mentions not to drink more than 500 ml or 2 cans of Red Bull per day. In early March 2009 the Medical Society of PEI, told its legislature that these energy drinks should be banned from sale to minors. The argument is the PEI doctors are seeing racing hearts, anxiety, high blood pressure and sleeping problems in young people that they blame on the caffeine in these energy drinks. These energy drinks may have up to 300 mg of caffeine (2-3 cups of coffee) per can. Since Health Canada says adults should have less than 400 mg of caffeine (3-4 cups of coffee) per day and children 10-12 years old should have less than 85 mg of caffeine per day, you can see why a drink that has 300 mg of caffeine in one can could be a problem.

Dehydration is another problem with these energy drinks. Caffeine is a diuretic so it makes you lose water. That is one of the reasons why all the warnings not to mix energy drinks like Red Bull with alcohol. Alcohol is also a diuretic. So, if you mix caffeine with alcohol and then throw in exercise like dancing, all three cause you to lose water. If you lose too much water, it can damage your kidneys and if you get very dehydrated your blood gets too thick to pump. That can be fatal.

Caffeine is not all bad. There are studies saying caffeine does good things. There are studies saying caffeine protects you from getting colon cancer. There are studies saying that caffeine can prevent diabetes. Just to keep things confused though, another study says if you have diabetes already, consuming caffeine can make it harder to control your blood sugar. The take home message is probably one of moderation. Adults should stay under 4 cups of coffee per day. Children should consume one or less cans of caffeinated pop per day. I should try to get closer to Health Canada’s recommendation. Maybe. I’ll let you know how that goes.

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

ALZHEIMER'S DISEASE

2009-03-13T09:00:00.000-05:00

SINUSITIS

2009-03-06T09:00:00.000-06:00

MEDICINE AT SCHOOL

2009-02-27T09:00:00.000-06:00

HEAD LICE

2009-02-20T09:00:00.000-06:00

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.

Within the last couple of weeks my daughter scored her first goal in hockey. She was very excited. Then she had school cancelled for the first time due to bad weather. She was very upset. Even school children have ups and downs in their lives. One of the downs that hits the lives of many school children is head lice. We usually start getting lice questions at the pharmacy in September and October. Head lice doesn’t just happen at the beginning of the school year, though. It can happen at any time.

What are lice? Head lice are parasites that live in humans’ hair. The scientific name for them is Pediculus Humanus capitis, and they are wingless insects with six legs and range in color from white to brown to dark grey. They don’t fly and they don’t jump. A young louse matures in 10-12 days and the adult is 2-4mm long. They multiply very quickly. Females lay 7 to 10 oval and whitish eggs called nits every day. Seven to ten days later, the nits hatch and are called nymphs. So the whole life-cycle is about 20-30 days. Adults can only survive 1-2 days without a blood meal. Lice are transmitted two main ways. Lice can be transmitted directly by close contact from one infested scalp to another (i.e. touching heads together). They can also be transmitted indirectly by sharing personal articles that come in contact with the head (ie. brushes, hats, etc). Children from 3 to 10 years old are the most affected age group. However, anyone can get lice, regardless of sex, race, age, hair length or socio-economic status.

What are the symptoms of having lice? The most common symptom is itching, especially around the ears and back of the scalp. There can be small sores, or small scabs on the person’s scalp or neck. If these sores get infected, there can be pus. How do you recognize head lice? First you should see nits (the eggs) attached to the base of the hair shafts on the warmer parts of the scalp (the back and sides). The egg or nit is oval and glued to the hair. Nits are laid close to the scalp for warmth, usually around the ears and the nape of the neck. Live nits are brownish in color, and dead ones are whitish. Nits found more than 1.0 cm from the scalp have grown out with the hair and have either hatched or are dead.

The main product used to treat head lice is permethrin (one of the brand names is Nix). It sticks around for up to ten days after use to kill any more lice that hatch. It is generally the product of first choice because is very good at killing the lice, it has low toxicity and it sticks around for about 10 days. Although it is not absolutely necessary to do a repeat application, it is often recommended that one uses the permethrin again in 7 to 10 days. There is a similar product to permethrin on the market and it contains natural pyrethrins (one of the brand names is R&C Shampoo). It is not as good as permethrin at killing the lice. It doesn’t hang around after application. It must be reapplied in 7 to 10 days for it to be effective. Both permethrin and pyrthrins can cause allergic reactions in ragweed or chrysanthemum sensitive individuals. There are older products on the market that contain lindane. Lindane is not as good as permethrin at killing lice. It doesn’t stick around so you must do a second application in 7-10 days for it to be effective. About 10% of the lindane actually goes into the rest of your body and it can accumulate with repeated exposure. It can cause seizures and other neurologic disorders so lindane is not my favorite product.

The newest product on the market for lice is called Resultz. It contains isopropyl myristate. This is different that the Nix like products. The permethrin in Nix attacks the nervous system of the louse. Isopropyl myristate is more like a soap. It dissolves the waxy outer coating on the louse and the louse dehydrates. The claim is that Resultz kills the louse within ten minutes. The down side to Resultz is it does not kill the nits or eggs in the hair. So you absolutely need to do the second treatment in one week. On the positive side, there is no documented resistance to Resultz. Back in the 1980’s permethrin like products killed 100% of lice. I have seen estimates now that in some places in the world it now only kills 28% of the lice. It can be hard to tell if these treatment failures are due to poor application technique, but resistance to permetherin is probably real. There were small studies where Resultz killed more lice than permetherin. One of these small trials was even done in Winnipeg, MB! I don’t know if I am ready to say it is definitely better than permetherin yet, but it is nice to have another tool against lice.

The Dauphin Clinic Pharmacy has developed an all natural oil lice treatment. It coats the hair and suffocates the lice. We call it Nice ‘N Natural lice treatment. It can be used as an alternative to the commercially available products.

Some non-medication measures should be taken when a family member gets lice. Combs and brushes should be soaked in alcohol or Lysol for one hour; or they can be soaked in water 65oC or hotter for 10 minutes. Bedding, towels, and clothing should be washed in hot water and dried in a dryer for 20 minutes to an hour. It is actually the heat from the dryer that kills the lice. Items that can’t be put in the dryer may be dry-cleaned or stored in a sealed plastic bag for 2 weeks. Lice can’t live away from human contact for very long, so the two weeks allows the eggs to hatch and the new lice to die. Some people have even stored these plastic bags full of teddy-bears etc. in the freezer. Vacuuming of carpets and furniture is also a good idea.

Finally, nit picking (actually combing the live and dead nits out of the hair) is very tedious, but very important.

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

Plavix and PPI’s

2009-02-13T09:00:00.001-06:00

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.

People in the Parkland are very well informed. Within hours of a news report that the blood thinner Plavix or clopidogrel interacted with medications for stomach acid called proton pump inhibitors or PPI's, people were coming to the pharmacy and wanting to turn in their blood thinners and stomach medications. I can sympathize with these people being scared by the news reports, but please, please don't stop taking your medications. I am always afraid when these news reports come out that for every one person who comes to the pharmacy to talk to me, there are 10 who just stop taking their medications without telling anyone. Again, please, please don't stop your medications on your own. Let's talk about the good things these medications are doing for you.

Plavix is a blood thinner. It is used for a variety of conditions, but most often to prevent blood clots that might lead to heart attacks and strokes. It can be added to ASA in some patients who are at extra risk of heart attack and stroke to get extra blood thinning. So, if you stop taking your plavix, you increase your chance of having a heart attack or stroke.

Proton pump inhibitors or PPI's reduce the amount of acid the stomach produces. They can be used to treat everything from heart burn to hiatus hernia to ulcers. They are especially good at preventing ulcers caused by ASA or NSAIDs. This is important because let's say we put a patient on ASA to thin their blood and prevent heart attacks or stroke, we don't want to now cause stomach ulcers and bleeding in the stomach. Also, may people with heart conditions that need blood thinners also have arthritis and other painful conditions that need to be treated with NSAID drugs. Again PPI's are a good choice to prevent bleeding stomach ulcers. So, if you stop taking your PPI’s you may increase your chance of bleeding stomach ulcers.

Hopefully I've convinced you not to stop taking your pills. Now let's talk about the study that made it into the news. First we'll talk about the theory behind the trial. Plavix is called a pro-drug. This means that it is not active when it goes into the body. It must be converted by the liver into its active form. Some PPI's like omeprazole, esomeprazole, lansoprazole and rabeprazole inhibit the enzyme CYP 2C19 which converts plavix to its active form. The PPI pantoprazole does not inhibit this enzyme. So one of the things this trial was looking at was if pantoprazole is safer when mixed with plavix than the other PPI's.

The trial had its problems, though. The first problem is it was not a randomized double blind placebo controlled trial. It was an observational study, which is a weaker kind of study. The reseachers looked back through some computerized hospital and pharmacy records to find people who were 66 years old or older and got a prescription for plavix when they left the hospital after a heart attack. They then looked at people who died or were re-admitted to the hospital with a heart attack within 90 days of the first heart attack. These were the cases. The researchers then used some statistical procedures to try to find other people who were like the first group. These were the controls. The first thing I noticed when I looked at the two groups is that the case group were sicker than the controls. The cases had more kidney disease, heart failure, and diabetes than the controls. All of these conditions make the cases more likely to have heart attacks. The cases were also on more medications. The cases were on more ACE inhibitors, calcium channel blockers, statins and diuretics than the controls. To me this says the doctors of the case patients thought these people were more likely to have bad things like heart attacks happen to them, so these patients were put on more medications. Again the cases were sicker people.

Here is the part that made the news. If a case patient was on a PPI and plavix at the same time 90 days after his/her first heart attack, he/she was more likely to have a second heart attack. A case patient was also more likely to have a heart attack after 1 year. So that's when people started coming into our pharmacy and handing in their medications. But, remember the case patients were sicker than the control patients. They were more likely to have heart attacks anyway. The part that didn't make the news is that the case patients didn't die any more often than the control patients. So being on a PPI and plavix did not increase the chance of death. Why is that important? Well first if I had to pick between having a heart attack and dying, I'd pick having a heart attack. More importantly, the case patients were sicker than the control patients. They should have died more often. They didn't. Does this mean the PPI-plavix interaction isn't real? I don't know.

I am not saying this isn't a good and interesting study. It just shouldn't have been front page news scaring people away from their medications. The researchers who ran it are very smart people who know lots more than me. In fact I have found other studies that suggest the some PPI's interact with plavix. But none of them are conclusive. There was a really good trial underway called the COGENT 1 trial. It was looking at 4000 patients on a combination pill of plavix and omeprazole, but the trial got cancelled. The company running the trial says it ran out of money and is now filing for bankruptcy.

So what is the take home message at the end of all this confusion? Don't stop taking your plavix or your PPI. The evidence isn't strong enough. The next time you see your doctor, you could ask if you really need to be on that PPI. If you don't, maybe your doctor could switch you to a cheaper, less strong stomach medication like ranitidine for your heart burn. Ranitidine is not suspected of interacting with plavix. If you do need a PPI, pantoprazole is the one PPI that doesn't seem to interact with plavix. There is a problem with pantoprazole, though. In Manitoba, it is much harder to get Pharmacare coverage for pantoprazole than for the other PPI's. That means you might have to pay for pantoprazole but not the other PPI's. So, given that you might have to pay for pantoprazole, and the evidence that pantoprazole is a safer PPI is weak, you and your doctor could reasonably say, "Let's not change your medications at all."

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

Inositol

2009-02-06T09:00:00.000-06:00

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 sister is a physiotherapist in Langley, BC. Physiotherapists give great advice that weak willed people like me have trouble following. You have tennis elbow? Do these exercises and it will go away and the muscles will get strong enough that it won’t come back. Sore back? Work on building up your core abdominal muscles and improve your posture. The problem is that I am lazy. I’d rather not do the exercises. I’d rather take a pill, kill the pain and go play Rec Hockey. The next day I wonder why my elbow and back are sore again. Maybe I should have done the exercises.

As much as I am obviously for “taking a pill” to solve medical problems, I was wondering about my sister the physiotherapist and taking the easy way out when talking about inositol. Inositol in a B vitamin. We can get it by eating whole grains and nuts. We have been told for years that we should eat more whole foods and less highly processed stuff. That means eating things like pumpernickel bread instead of white bread or freshly caught fish instead of fish sticks. One of the reasons to eat whole foods is that you get more vitamins like inositol that way. Lately, thought, we starting getting a run on inositol capsules in the pharmacy.

The reason inositol has been so popular is that there have been news reports that it might treat cancer. Inositol might treat anxiety, depression and “calm the thoughts”. Inositol might also treat diabetes and protect the skin from UVB radiation. Remember I said, “Might”. Although inositol is showing promise, it is probably too early to start recommending it to treat things. There have been many promising treatments in the past that didn’t turn out to work. Let’s start by discussing the cancer trial.

Dr. Stephen Lam of the B.C. Cancer Agency gave smokers with at least one bronchial dysplagia in their lungs a bunch of inositol. Adysplagia is a pre-cancerous area. He gave them up to 30 g of inositol a day but found most of them only tolerated 18 g per day. So they gave a new bunch of smokers with pre-cancerous lesions 18 g per day of inositol (the maximum tolerated dose) for 3 months. The smokers who got the 18 g of inositol had more of their pre-cancerous lesions go back to non-cancerous areas than the placebo group. The inositol group also had their blood pressure drop compared to the placebo group.

This is very interesting research. Does a B vitamin treat cancer? Does a B vitamin treat blood pressure? These are good questions for further research. Unfortunately, they are not good reasons to run to the pharmacy and self treat your lung cancer. Does inositol make actual lung cancer tumors grow faster or slower? We don’t know. Does inositol cause pre-lung cancer cells to go back to normal but cause liver pre-cancer cell to grow? We don’t know. And so on. The other problem is this was a preliminary trial. There were not enough subjects enrolled in the trial for us to be confident about the results. The more subjects in a trial, the stronger the results.

The same goes for inositol treating diabetes. Inositol seems to help diabetic rats. Very interesting but rats aren’t people. Inositol when mixed with another antioxidant called IP6 and put on the skin of mice seems to protect the mice from UBV radiation. Again interesting, but mice aren’t people. What about inositol and depression? Well I found a Cochrane Review of 4 trials of inositol and depression which covered 141 patients. The results were inconclusive, and again 141 is not enough subjects.

But inositol is only a vitamin. It won’t hurt me, and there is a chance it will help. Why not take it? I do have a hard time arguing with that. As far as we know inositol is safe in most people, most of the time. We don’t know if it will help cancer, blood pressure, anxiety, diabetes, etc. If you want to spend you money on inositol supplements, that is your choice. However, you may also want to wait until the scientists figure out if inositol really does help cancer, blood pressure, anxiety, diabetes, etc, because there have been many false hopes in the past.

Which brings me back to the easy way out. Maybe most of us shouldn’t be looking for that one magic supplement distilled from food. Maybe we should just eat whole, healthly foods like grains, nuts, mushrooms, veggies and fish. If they contain one magic ingredient like inositol, I wonder how many more they contain that we haven’t discovered yet? And maybe I should do my exercises.

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

Bio-identical Hormone Replacement Therapy

2009-01-30T09:00:00.000-06:00

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.

If Oprah Winfrey says it, then it must be true. The most powerful woman in America sure can generate interest in something. You see I seem to be fielding a lot of questions lately about “Natural Hormones”, or “Bio-Identical Hormones”. I was wondering why until one of our pharmacy staff, Patti McDill, told me these menopause treatments were featured on Oprah’s talk show. So what is Oprah talking about? Follow me back about seven years.

Let’s go back to July 2002. The Women’s Health Initiative Study, or WHI was being released. A bunch of scientists went on TV, newspapers, radio etc and announced that there was a 26% increased risk in breast cancer and a 29% increased risk in heart attack for women on premarin and provera and their study was stopped because of such a terrible result. Women were scared. The media jumped all over this story. Many women threw their hormone replacement therapy (HRT) in the garbage. Now, almost 7 years later, women are having hot flashes, night sweats, and not sleeping, but are too scared and confused to get treated. What can be done?

First, let’s talk about the original study. The study was very well done and designed. However, it only looked at women on premarin and provera. So these results do not necessarily apply to other types of HRT. Also, the risk in the media was blown way out of proportion. For example only 8 more women than normal out of 10,000 on HRT will develop breast cancer. That isn’t much when you consider that consuming 2 or more alcoholic drinks a day or exercising less than 4 hours per week have each been reported to increase the risk of breast cancer to ~35 out of 10,000 women.

What I’m trying to say is that premarin and provera aren’t necessarily evil. I think women were scared unnecessarily away from a treatment that helped many women. After you and your doctor have a discussion, the two of you may quite logically conclude that an 8 in 10,000 risk of breast cancer is acceptable weighed against the benefit of being able to sleep at night. Your doctor will probably also recommend that you stay on the premarin and provera for 5 years or less. This is because the harm risks increase after 5 years. However, some women may decide to stay on premarin and provera longer. The risk of breast cancer only goes up to ~25 out of 10,000 women after 15 years on premarin and provera. That is still lower than the risk from drinking and not exercising.

What are alternatives to premarin and provera? One popular, non-hormone, alternative is anti-depressants. No, I’m not saying all menopausal women are depressed. I’m saying that anti-depressants like effexor do a nice job of controlling hot flashes and night sweats in some women.

Oprah wasn’t talking about premarin, provera, or antidepressants, though. She was talking about Natural or Bio-Identical Hormones compounded at a specialty pharmacy like the Dauphin Clinic Pharmacy. The ultimate goal of Bio-identical hormone replacement is to imitate, as closely as possible, the hormones that are naturally produced by the human body. Bio-identical hormone replacement therapy has also been referred to as natural hormone replacement therapy. The word “Natural” causes some confusion, so I try to avoid it. Bio-identical hormone replacement therapy does not refer to grinding up leaves and plants to make products. It does not refer to using herbal/natural products such as soy supplements, black cohosh, or yam isoflavones. Bio-identical hormone replacement uses molecules which are taken from yam or soy plants and are then modified so that their structure matches the hormone(s) which are produced by the human body. There are three major classes of hormones which are used in bio-identical hormone replacement therapy; estrogens, progesterone, and testosterone.

How Do I Get Started Using Bio-identical Hormone Replacement Therapy?
Bio-identical hormone replacement therapy products require a prescription from your family doctor. If you and your physician wish, a pharmacist at the Dauphin Clinic Pharmacy can book an appointment with you to discuss bio-identical hormone replacement therapy and make treatment recommendations. Your Dauphin Clinic Pharmacy pharmacist can also discuss Saliva Hormone Testing, which is a whole topic unto itself.

One of the nice things about having your hormone therapy compounded is that it will be customized for you. Maybe you prefer a cream to a pill. Maybe you need an “in-between” dose that isn’t commercially available. Those are all things that can be compounded.

The last thing I want to discuss is the safety of compounded hormone treatments. Despite what Oprah, Suzanne Sommers and other celebrities claim, no hormone treatments are 100% safe. We do have some theoretical reasons to think the compounded hormones are safer than premarin and provera, but the studies haven’t been done to prove that. We have to assume all hormone treatments have the same 8 out of 10,000 risk of breast cancer. We have to assume all hormone treatment should be used for 5 years or less because the Women’s Health Initiative study is still the biggest, best study done on the subject. The only reason to choose compounded hormones over commercially available ones is your find them more convenient (e.g. cream over capsules) or the compounded hormones treat your symptoms better. We have no evidence that compounded hormones are safer than commercial ones.

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

QUITTING SMOKING –Part 2

2009-01-23T09:00:00.001-06:00

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Last time we talked about the nicotine lolly pop to stop smoking. This time we are going to focus on the prescription pill Zyban, the newest stop smoking prescription medication call Champix and a product the Dauphin Clinic Pharmacy can compound for you called a Nix Stix.

Before we get to the new products, though, let’s talk a little bit about nicotine replacement. This includes lollipops, gum, patches and the Nix Stix. People often ask if the various nicotine replacements are safe. This is understandable as nicotine is a dangerous toxin. It raises blood pressure, increases heart rate and other nasty things. My standard answer is if you aren’t sure if it is safe for you, ask your doctor. Assuming that your doctor says nicotine replacement is safe for you, I feel comfortable saying nicotine replacement is safer that smoking. If the various nicotine replacements are used properly, they give you less nicotine than cigarettes and they don’t give you the tar, cyanide, arsenic, carbon monoxide and 5000 plus other dangerous chemicals and mutagens in cigarette smoke.

There is a pill to stop smoking called Zyban or the generic name is bupropion. It is available by prescription only. What should you know about it? First it is a pill, not a patch or a gum. It works on a part of your brain and reduces your craving for smoking. It does not have any nicotine in it. In fact, under the supervision of your doctor, you can be on Zyban and a nicotine gum or patch at the same time. With your doctor's supervision, you would start taking Zyban about a week before you quit smoking. This is to build up enough of the drug in your system, that by quit day you should have less cravings to smoke. The mostly commonly reported side effects with Zyban are dry mouth and insomnia

The newest product on the market is called varenicline or Champix. Champix is available by prescription only. Like Zyban, Champix should be started one to two weeks before quitting smoking. As a pharmacist, I find Champix very interesting because it is a partial nicotine agonist. This means it attaches to nicotine receptors in the brain and stimulates them a little, but not as much as nicotine. So this should take the edge off of nicotine withdrawal. Champix also partially blocks the nicotine receptors, so patients get fewer pleasurable effects from smoking. It is not a good idea to use champix with nicotine replacement. There is no evidence it works any better and increases the chance of nausea. Speaking of nausea, up to 30% of patients may experience mild to moderate nausea.

So what is the best product? Whichever one reduces your triggers and cravings, and gets you to quit. Nicotine replacement has been around the longest, and definitely can help you quit. Zyban may delay ( but not eliminate) the weight gain associated with quitting smoking as compared to nicotine replacement. Champix and Zyban were actually compared head to head, and they did both increase a person’s likelihood of quitting compared to placebo. Champix was more effective than Zyban at helping people quit after 12 weeks. However, by one year Champix and Zyban seemed to have about the same number of people still off of cigarettes. They all can work. Let you doctor or pharmacist help you decide which is going to help you the best with your triggers and cravings.

Speaking of triggers and cravings, sometimes smokers have a craving and sticking something like a lollipop or gum in their mouth is inappropriate. What should they do? Well the nicotine patch is too slow for an immediate craving. What if you had a discreet little applicator which you could rub on your wrist and get nicotine immediately? Well at the Dauphin Clinic Pharmacy, we are compounding such a device for patients at the request of their doctors. We call it a Nic-Stix and with a prescription from a patient's doctor, we compound a device that looks like a chap stick tube. The Nic-Stix has 30mg of nicotine in it so is will last 1-4 weeks depending on use, but it also must be kept away from children because it would be toxic if ingested. The Nic-Stix will melt easily, so it should be kept in a cool place, but is small enough to be carried almost anywhere.

Smoking kills three times more people than alcohol, AIDS, illicit drugs, car accidents, suicide and murder all combined. Quitting smoking is very difficult, and it takes the average ex-smoker six serious quit attempts before they succeed, but the results are worth it.

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

QUITTING SMOKING –Part 1-AUDIO

2009-01-16T23:05:00.006-06:00

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

QUITTING SMOKING –Part 1

2009-01-16T09:00:00.000-06:00

WINTER SKIN AND LIP CARE

2009-01-09T09:00:00.000-06:00