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By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy

As a pharmacist, I get to see a lot of very cute babies and infants. Some of my fiancées best friends have also either recently had babies or are soon to give birth. So far our friends seem to have very “good” babies and even though I am not yet a parent, in my opinion they do not seem to cry all that much. However; this is not always the case, especially when infant colic is present.

Colic is reported to occur in approximately 10-20% of healthy infants. Colic usually follows the “rule of three” which defined as unexplained bouts of crying and fussing lasting more than three hours a day, for more than three hours a week, for greater than three weeks. Colic is often also associated with clenching of the fists, reddening of the face, abdominal bloating and sometimes vomiting. Colic occurs in both breast fed and formula fed babies, most commonly in infants aged 4-6 weeks.

The exact cause of colic is unknown, which can be very frustrating for parents because they may not be able to pinpoint a cause. There are a few proposed categories of causes which include organic, behavioral and psychological. Organic causes include things like carbohydrate intolerance, gas, impaired stomach motility and possible food allergy. Behavioral and psychological include things like improper feeding, exposure to cigarette smoke and difficulties in parent-child interactions. Organic causes are likely the most significant. Gas and digestive intolerances are quite common, even if the infant’s symptoms are not severe enough to classify as colic. Newborn gas is a natural by-product of digesting lactose, proteins and other nutrients from food. Breast milk may also contribute to higher rates of stomach cramping, leading to increased fussiness.

Monitoring a baby showing signs of colic is an extremely important step in symptom improvement. A colic diary documents crying and fussing spells, which can then be used to create some management strategies. Parents can log behaviors and look for patterns, which will enable them to modify things like feeding and sleeping times to try and improve the situation. The diary may also give parents a sense of control and understanding of the situation, which is very important.

Treatment goals include ensuring the child is eating well, not dehydrated, sleeping well and most importantly we try to decrease crying episodes. Because the child cannot communicate properly it is also important to consult a family physician to ensure there are not any underlying causes contributing to the symptoms. While finding the cause of colic can be frustrating, treatment can be even more frustrating. Non-drug measures should always be tried first. Various types of massages can be tried including whole body gentle massages and belly massages, gently performed in a clockwise spiral motion. Sometimes babies who show gastric distress may find some relief in having their legs pushed gently back and forth in a bicycle type motion. Warm water baths may help relief bowel spasms, but parents must be very careful with the temperature of the water used.

If using a medication is deemed necessary, the lowest effective dose should always be used. Medications should only be given to treat symptoms when necessary. Giving sucrose (sugar) dissolved in water is sometimes recommended, but effectiveness is not well studied. Sucrose is believed to have a pain relieving effect, but its duration of action seems short at about 30 minutes. Simethicone (Ovol) works to allow gas bubbles to be more easily released by the baby. The effectiveness of simethicone in colic is often doubted, but it is safe for babies, and can be worth a try for some infants. An over the counter product called “Kolik” combines a probiotic, sodium bicarbonate and oil of fennel, all which may have some benefit.

Probiotics have significantly increased in popularity for treatment of colic. While data is limited, probiotics have shown to provide significant reduction in crying times. Probiotics are also accepted as being very safe for babies and infants. Probiotics have shown to help promote digestive health when health conditions such as infant colic arise. Biogaia is a probiotic which has shown to reduce the average crying time by as much as 56%, although some may question the quality of this data. From my experience with parents in the pharmacy, this medication does have some definite benefit.

Some treatments which may be suggested, but not recommended include: Benydryl, due to sedation, constipation and urinary retention; Sedatives, due to the risk of excessive sedation and limited benefit; and although gripe water is commonly used, it may only increase flatulence.

Small infants are very delicate and we need to be cautious when using medications. If you ever have any medication questions or questions on an illness regarding your infant, your pharmacist can help.

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

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

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

THE DAUPHIN CLINIC PHARMACY HAS MADE A DONATION TOWARDS THE PARKLAND TAPPERS “OLD TYME DANCE FUNDRAISER” TAKING PLACE AT THE WATSON ARTS CENTRE JUNE 7/2013.

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

The camera pans in on darkened hospital room.  A worried looking young doctor puts away his stethoscope.  He stands over a middle aged lady in the hospital bed.  From camera left, a nurse enters the room and asks, “Doctor has Mrs. Smith regained consciousness?”  The doctor turns to the nurse gravely and says, “No, she is touch and go.”  In this tension filled fictions medical drama “touch and go” means we aren’t sure if the patient is going to get better or not.  What I didn’t realize is “touch and go” has a more nautical origin.  In the British Royal Navy, “touch and go” meant a sailing ship just barely ran aground, but then freed herself again.  I’m sure the sailing ship in question was also tension filled as everyone on board wondered if they were going to drown or not.

Psoriasis almost never puts the patient in danger for their life.  However, that doesn’t means the life of someone with psoriasis is not tension filled.  One study of 1300 people with moderate to severe psoriasis found 26% of them reported that in the last month someone made a conscious effort not to touch them and 19% of them had been asked to leave a social situation like a gym or swimming pool.

Psoriasis is a skin disease, but it can effect more than the skin.  The most common form of psoriasis is called plaque psoriasis.  Areas of the skin develop red patches.  The red patches often have dry silvery scales on them.  Psoriasis is a chronic disease like diabetes, or high blood pressure.  That means we can’t cure psoriasis, but we can treat the symptoms.

Psoriasis is not contagious.  It is not causes by a bacteria or virus.  You can’t pass psoriasis onto another person by touching them.  Psoriasis is an autoimmune disease.  That means the body’s own immune system attacks itself.  This autoimmune attack causes inflammation.  Healthy inflammation happens when the skin is cut or torn.  The skin gets red and hot and swollen with blood.  Part of the inflammatory cycle is for skin cells to reproduce rapidly.  These rapidly reproducing cells help heal up and repair the wound.  In psoriasis undamaged skin gets inflamed and the skin cells go into wound repair mode.  The cells reproduce rapidly, but there is no wound to repair.  So the extra cells are pushed to the surface.  This causes a raised area.  The cells at the top of this raised area don’t get any blood supply.  These cells die off which forms that silver-white scaly crust that we get with psoriasis.

What causes psoriasis?  We don’t know.  It probably has a genetic component because it does run in families.  Psoriasis usually starts in a person’s twenties or thirties.  It can also start in a person’s 50’s or 60’s but that is less common.  Psoriasis isn’t just a disease of the skin.  Many diseases like arthritis happen more often in people with psoriasis.  Other comorbid conditions include diabetes, high blood pressure, heart disease, obesity, inflammatory bowel disease, liver disease, and stomach ulcers.  Many psoriasis patients also experience low self-esteem, depression, stress, anxiety and feelings of helplessness.

How is psoriasis treated?  It depends on the severity of the disease.  About 80% of people with psoriasis have a mild condition.  By that we mean less than 10% of their body is covered with lesions.  For them usually a topical ointment or cream that you can rub directly onto the lesion can work well.  Some common ingredients in topical psoriasis treatments include steroids, coal tar, Vitamin D analogues and Vitamin A products.

Steroids reduce inflammation.  They are available from quite weak ones that can be bought without a prescription all the way to ones that are so strong that they could burn your face if used there.  Coal tar can help slow the rapid growth of skin cells and restore the skin’s appearance. In addition, coal tar can help reduce the inflammation, itching and scaling of psoriasis.  Calcipotriol is a form of synthetic Vitamin D3 that can slow skin cell growth, flatten lesions and remove scale.  The most common side effect of calcipotriol is skin irritation, stinging and burning.   A form of Vitamin A called a retinoid can be applied to a psoriasis lesion to slow skin cell growth. It is normal for psoriasis plaques to become very red before clearing when using a retinoid. The redness is often intense in color, but it is generally not painful.   The most common side effects from the Vitamin A products are skin irritation, dry skin and increased susceptibility to sunburn.

For more severe psoriasis, there are stronger therapies than topical creams. Phototherapy is when the skin is exposed to ultraviolet light under medical supervision.  Not being a drug, it is outside my expertise, but I read that it can be done in a clinic or at home.  There are oral pills which are similar to those used in rheumatoid arthritis.  They have names like cyclosporin, methotrexate and acitretin.  They are designed to suppress the immune system and so reduce flare ups.  The newest treatments for psoriasis are the injectable biologics.  They are very potent but very specific immune suppressors.  They are designed to only suppress the parts of the immune system that causes the flare ups and so should work better with fewer side effects.  But the biologics are very expensive.  They have names like remicade, humira, enbrel and stelara.  They can cost thousands of dollars a month.  Before someone starts phototherapy, oral immune suppressors or injectable biologics, they should see a dermatologist.

“Touch and go” implies a life or death struggle or tension.  Not all tension from medical conditions is life or death, though.  A hair stylist with psoriasis on her hands may wonder if her clients will come back.  A life guard with psoriasis on his elbow may wonder if anyone will take swimming lessons from him.  Quality of life should be a top concern as the medical professions try to remember psoriasis is more than just a rash.

Psoriasis Info  www.livingwellwithpsoriasis.com

Psoriasis Treatment Guidelines – Canadian Dermatology Association

www.dermatology.ca/wp-content/uploads/2012/01/cdnpsoriasisguidelines.pdf

US National Psoriasis Foundation www.psoriasis.org

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

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

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

THE DAUPHIN CLINIC PHARMACY HAS MADE A DONATION TOWARDS THE TIM HORTON’S CAMP DAY TAKING PLACE ON JUNE 5TH/2013.

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

A couple of weekends ago, I got to hang out at the Max Bell Center at the University of Manitoba.  My daughter Emily, Jessica Miner, Mallory Mathison-Eddie, Brie Toews, and Olive Jonasson from Ecole MacNeill all went to the Provincial Science Fair, the Manitoba School Science Symposium.  The girls got to meet kids from all over province.  They did some neat science activities like designing and flying paper rockets and making catapults out of mouse traps.  I hope their experience got them excited by science.

One of my favorite stories of a real life science fair project involved Dr. Barry Marshall.  Now don’t try this at home, but he drank a beaker full of bacteria to prove a point.  Before the early 1980’s everyone assumed that no bacteria could live in the very acid human stomach.  And it was assumed that stomach ulcers were caused by spicy foods and stress.  As early as the late 1800’s some bacteria were found in the stomach but they were assumed to be contamination, dead or due to a pre-existing hole in the stomach like an ulcer.  In the late 70’s and early 80’s an Australian pathologist named Robin Warren became convinced that a special bacteria called Helicobacter pylori (H. pylori) did live in many people’s stomachs.  When Dr. Warren eventually teamed up with the gastroenterologist Dr. Barry Warren in 1981, the two of them found lots of H. pylori in people’s stomachs during biopsies.  Furthermore the H. pylori seemed to cause stomach ulcers.  The scientific community was unimpressed.  Dr. Marshall and Dr. Warren did a lot of work to convince the scientific community that H. pylori was a cause of stomach ulcers.  However the one experiment that stands out for me is that Dr. Barry Marshall drank a beaker of H. pylori and gave himself an ulcer.  Then he took a cocktail of antibiotics and cured his ulcer.  Because of all the work Dr. Marshall and Dr. Warren did they got the Nobel Prize in Medicine in 2005.  Their work re-wrote the medical texts on ulcers.

If you have consistent stomach problems like heart burn, hunger like pain that is relieved by food or antacids, you may have a stomach ulcer.  Other symptoms can be discomfort after you eat, nausea and occasional vomiting.  Not all stomach problems are ulcers, but if symptoms like these go on for more than a week or two, it is probably time to talk to your doctor to see what is going on with you.

If your doctor thinks that your stomach complaints might be an ulcer, they may test to see if you have H. pylori in your stomach.  The test for H. pylori can be a breath test, a blood test, a stool test, or they may test your stomach lining directly with an endoscope.  If you have H. pylori in your stomach, you will probably be given something called triple therapy.

Triple therapy is a cocktail of medication designed to kill off  H. pylori in the stomach.  It usually includes a PPI, amoxicillin and clarithromycin.  A PPI is a proton pump inhibitor and reduces the amount of acid your stomach produces.  PPI’s have names like omeprazole, esomeprazole and pantoprazole.  Amoxicillin and clarithromycin are antibiotics.  You will probably have to take 1 pill of the PPI, 2 pills of amoxicillin and 1 pill of clarithromycin twice a day for 1 to 2 weeks.  I know that is a lot of pills, but if you take all of them, there is a good chance we can kill off  the H. pylori.  As Dr. Marsh showed about 30 years ago, if we kill off H. pylori, we may permanently get rid of your stomach problems.

Triple therapy seems to kill off  H. pylori about 80% of the time.  If it fails, the doctor may consider something called quadruple therapy.  The drugs change a little.  They include a PPI, bismuth subsalicylate, tetracycline and metronizadole.  Although quadruple therapy is very effective it is usually saved for second line because many people just don’t want to take that many pills.  Finally, quitting smoking is important.  Smoking can stop or slow ulcers from healing, and can cause the sphincter at the top of the stomach to loosen.  The sphincter is a muscular valve that lets food into the stomach.  When smoking causes this sphincter to loosen, it can lead to heartburn.

Not all stomach problems are ulcers.  Not all ulcers are caused by H. pylori.  However, thanks in part to the Science Fair like stunt of Dr. Barry Marshall infecting himself with H. pylori, getting an ulcer and then curing the ulcer with antibiotics we now have an effective treatment for H. pylori caused stomach ulcers.  So encourage your kids to enter Science Fairs.  Let them discover something they didn’t know before.  Maybe their discovery will be something no one knew before.  Your kids are where our next Nobel Prize winning breakthroughs will come from.

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

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.

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

THE DAUPHIN CLINIC PHARMACY HAS DONATED A PRIZE FOR THE PINE RIVER LIONS CLUB ANNUAL MOTHER’S DAY PANCAKE BREAKFAST.

THE DAUPHIN CLINIC PHARMACY IS A GOLD LEVEL SPONSOR AT THE PROGRESSIVE AGRICULTURE SAFETY DAY. THE ONE DAY EVENT TEACHES CHILDREN SAFETY LESSONS THAT CAN KEEP THEM AND THOSE AROUND THEM SAFE AT HOME, OR ON THE FARM.

Dear Doctors,

At the Dauphin Clinic Pharmacy, we want to help you help your patients. One way we can help you is through compounding. Compounding is when a pharmacist modifies or mixes a medication for a specific patient with a prescription from that patient’s prescriber. Common reasons to compound a medication are to get a non-commercially available dose, to get a medication into a patient by a different route or to re-create a medication that is temporarily or permanently off the market. Here is our suggestion this month:

We hope that gives you some ideas about how we can help you help your patients! Any questions? Call us at 638-4602.

Thanks,
The Pharmacists of the Dauphin Clinic Pharmacy

THE DAUPHIN CLINIC PHARMACY IS THE CHAMPIONSHIP FLIGHT SPONSOR FOR THE GARY BRANDON MEMORIAL GOLF TOURNAMENT TAKING PLACE AT THE DAUPHIN LAKE GOLF CLUB.

By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy

Spring is right around the corner. We just have to get through this last snow storm. This is very exciting news for most of us, as we cannot wait for warmer weather. However; for asthmatics the thought of the snow melting and pollen season beginning can be worrisome. There is a strong link between seasonal allergies and asthma outbreaks. If you have asthma and are finding yourself using your inhaler more often, you are not alone. Most often, we think of inhalers as the best method to help asthmatics breathe. However; there are pills available which can be very effective in reducing the asthma symptoms.

Over 300 hundred million people in the world suffer from asthma and it is one of the most common chronic diseases in children. Since the 1980’s and 1990’s the prevalence of asthma has almost doubled. This may be due to increasing exposure to allergens and air pollutants. Although asthma is often diagnosed, it is often not properly treated. It a major cause of hospitalization in children and over 300 deaths every year in Canada.

Inhalers are a very effective tool in preventing asthma symptoms and treating asthma attacks. They are very safe and have minimal side effects, even in children. For these reasons inhalers are considered a first line treatment. An issue with inhalers is they are not very convenient. Inhalers are fairly large and can be a nuisance to take to school or to work. They are not always the easiest to use, especially in young children or in the elderly. Most inhaler users do not use proper technique. Even if the inhaler is being used properly, they do not always prevent 100% of asthmatic symptoms.

Therefore, we should consider oral medications in the tablet form more often. The pills we use for asthma are leukotriene receptor antagonists or LTRA tablets. Leuktorienes, very simply, are involved in asthmatic and allergic reactions to sustain inflammation. Inflammation and mucus production in asthma is exactly what we do not want because it makes it harder to breathe. The LTRA pills work to prevent the inflammation, which is what is causing the shortness of breath.

Examining scientific studies concludes the pills are not better than inhalers. However, there seems to be more and more evidence emerging they may be just as good of a treatment option when measuring quality of life. Canadian asthma guidelines recommend the use of LTRAs when asthma is not controlled adequately by low doses of inhaled steroids. They are also recommended as an alternative in patients who cannot or will not use inhalers. In the United States LTRAs are recommended in first line use.

Two examples of LTRA pills available are montelukast and zafirlukast. Zafirlukast is taken twice daily and is recommended for use in adults and children over the age of 12. Montelukast is a once daily pill which is available for children and adults. These medications have shown to be quite safe with few side effects. Montelukast is much more popular due to convenient once a day dosing and it has recently gone generic, making it much more affordable. LTRA pills may be most effective for those who suffer from allergies and asthma. Almost 75% of asthmatic children also have documented allergies.

If you have asthma and your inhalers are not working it may be worth giving them a try. From my experience, they seem to work well in Asthmatics who have a hard time controlling their breathing in the spring and fall seasons. It is also a good treatment option if the dose of steroids being inhaled per day is too high. Within a month of two of trying the medication the asthmatic should know whether it is effective or not.

If you are waking up at night from shortness of breath, have frequent coughing episodes or are unable to exercise because of you cannot breath, your asthma is not controlled. Trevor Shewfelt and I are certified respiratory educators and we may be able to help eliminate your symptoms. Please feel free to ask for help.

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

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

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