Archive for the ‘Health Articles’ Category

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.

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.

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

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.

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

In this world of GPS’s, cell phones, satellite communications and instantaneous internet chat, it is easy to forget there are remote and in hospitable places on our planet.   I was listening to a documentary about an around the world solo sailing race.  The competitors talked about huge waves and storms, the incredible wild life they ran into and Point Nemo.  I had never heard of Point Nemo before.  Point Nemo is the farthest you can get from land anywhere in the ocean.  At Point Nemo in the Southern Pacific Ocean you are over 2000 km from any land and any people. Point Nemo is far away from normal shipping lanes.   In fact, if the International Space Station flies over you at 400 km up, the closest living human to you at Point Nemo is an astronaut in orbit.  So if you get in trouble, help is a long, long way away and you better have a plan on how to look after yourself.  Although not nearly as dramatic, if you are diabetic and you get a stomach flu, you also should have a plan in place to look after yourself.

In the March 2013 Pharmacists Letter I found an excellent article on sick day management in diabetes.  It seems like in the last few weeks everyone I know has had some flu bug or other.  The care homes in Dauphin have had flu-like symptom outbreaks.  Stomach flus have gone through several of the senior’s complexes.  My parents even came back from Texas just in time to be stuck in the house for a few days with flu-like symptoms.  What should people do if they have nausea, vomiting and diarrhea and also have diabetes?

Ideally, before the person gets sick they should have a sick day plan made up.  This can be made up with the patient’s doctor, but often it would be made up with the patient’s diabetic educator which can be a nurse, dietician, pharmacist or other health care professional with extra diabetes training.  The patient and educator will discuss when holding medications is wise, what to eat when you are nauseous and when to get to the hospital.

In general, if a person with diabetes gets sick, it is important to check their blood sugars.  Just the stress of being sick will probably make their blood sugars go up.  To make matters more complicated, if a person with the flu doesn’t feel like eating, their blood sugar may go down.  So especially if a person takes insulin, they should check their sugars every 2 to 4 hours when they are sick.  Even if a diabetic isn’t on insulin, they should still check their sugars 2 to 4 times a day when they are sick.  If a diabetic uses insulin, they may be told to check their ketones every 4-6 hours while they are sick and if their blood sugars go above 14.  If their ketones are high, they should contact their doctor.

Diabetics with the flu should be careful to prevent dehydration.  They should try to consume ½ to 1 cup of water every hour while they are awake.  If they are vomiting a lot, they can try to take small sips every 5 to 15 minutes.  If possible, the diabetic with the flu should try to eat their regular meals and snacks.  If they can’t eat and their blood sugar is 14 or less they can try to eat 15 g of carbs per hour.  That is about ½ cup of juice, ½ cup of regular pop, ½ a cup of Jello, ½ a twin popsicle or about 6 saltine crackers.  If their sugar is higher than 14, the diabetic with the flu should just drink water, broth, sugar free jello, ice chips and sugar free popsicles.

If the diabetic with the flu’s sugar goes below 4 they should drink or eat about 15 g of carbs.   That could be honey, regular pop, fruit juice, life savers or glucose tablets.  Their blood sugar should be checked again in 15 minutes.  If it is still low, eat or drink another 15 g of carbs.  If that doesn’t work or the patient loses consciousness, consider using glucagon if available and seek medical attention immediately.

Usually during a sick day, a diabetic will continue to use their medication and insulin the same way as when they are well.  With their doctor’s advanced permission, a diabetic may be told to hold their metformin when they are sick.  If a patient has nausea, vomiting and diarrhea they have a theoretical risk of getting lactic acidosis if they are on metformin.  If the diabetic with the flu can’t consume enough carbs, the might be instructed to reduce or with hold their fast acting insulin.  They will keep using their long acting insulin, though.  Again, this should be a plan you and your doctor or educator should have discussed before you get sick.

If a person who takes insulin keeps getting sugar levels above 14, their doctor may have them take extra doses of their fast acting insulin.  And again they will probably be told to check their ketones while their sugars are high and to contact their doctor if their ketones are too high.

If you type in the latitude and longitude of Point Nemo into Google Earth or Google Maps you will see a dot in the Ocean and the word “Nemo”.  I can’t imagine how much preparation and planning it must take to be able to sail by yourself in that most remote location.  Preparation and planning for a sick day if you are diabetic is not nearly so onerous.  Before you get sick, talk to your doctor and diabetes educator about what to do if you get sick.  Planning for a diabetic sick day is

much easier before your head is in the toilet.  So plan ahead with your doctor or diabetes educator and may sailing over your Point Nemo be smooth.

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.

If you have any topics you want us to write about, email us at dcp@mymts.net or call 638-4602.

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

Point Nemo – type  48°52.6′S 123°23.6′W / 48.8767°S 123.3933°W / -48.8767; -123.3933 (Oceanic Pole of Inaccessibility) into Google Maps or Google Earth

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

My son Eric came to me at breakfast and said, “Dad, here’s something.  For your article you should write about why our dog Sheldon barks at our neighbor’s garbage bags.”  I was going to tell Eric that Sheldon barked because they are black and must look like a big dog to him.  But everyone’s garbage bags and bins are black.  Sheldon only barks at this one neighbor’s bin and bags.  Then I was going to say it was because the bin and bags are close to our house, so Sheldon is just protecting his territory.  But that doesn’t make sense, because this neighbor isn’t our immediate next door neighbor.  They are a few houses down.  Sheldon passes a few garbage bins before barking at this one.  Finally I have to admit Eric has a good question that I have no answer for him.  It is like the question, “Are my calcium supplements going to kill me?”

This question seems to have been popping in and out of the news over the last couple of years.

So what do we know?  One study by Bolland et al in the British Medical Journal in 2008 looked at a large group of women with an average age of 74 and their calcium intake.  The problem is this study wasn’t designed to look for heart problems.  Bolland’s group looked at the results after the fact to draw some conclusions.  Bolland found an increase in heart attacks.  This should be scary, right?  Well the problem is the results weren’t statistically significant.  That means we don’t know if the calcium group really had more heart attacks than the control group or if it was just a random fluke.

A large German study published by Li et al in Heart in 2012 followed over 25,000 people with an average age of 50 for about 11 years.  It found people who used calcium supplements were almost twice as likely as those who didn’t to have a heart attack.  The good things about this study were that it was designed to look for heart attacks, it wasn’t just looking back on someone else’s data and it was very large.  The bad things were it really only asked people about their food and calcium intake once at the beginning of the study.  They don’t really know what food or calcium the patients consumed during the 11 years.

United States Preventative Services Task Force (USPSTF) now says that taking 400 IU of vitamin D per day and up to 1000 mg of calcium per day may not prevent broken bones in postmenopausal women.  So, should we abandon calcium supplements altogether?  In my opinion, no.  Let’s look at the reasons.

First, when it comes to stopping people from breaking bones, you have to look more carefully at the USPSTF recommendations.  Most guidelines suggest higher calcium and vitamin D intakes than those the USPSTF said were ineffective for preventing fractures in postmenopausal women. The Institute of Medicine and Health Canada both recommend 1000 mg of calcium per day for women up to age 50, and 1200 mg per day for women over 50.  Canadian osteoporosis guidelines recommend 1200 mg per day for people over 50 years of age.  The USPSTF recommendations do not apply to people with established osteoporosis, vitamin D deficiency, or people in nursing homes.  So the USPSTF recommendations may only mean that less than 1000 mg of calcium per day might not be enough calcium to stop broken bones.

The story gets a little murkier with calcium and heart attacks.  If we believe a meta-analysis by Bolland et al in a 2010 British Medical Journal article then for every 1000 older adults who take calcium as a supplement for five years, there will be 26 fewer fractures at the expense of 13 more deaths, 10 more strokes, and 14 more heart attacks.  That sounds like a lot of risk for the relatively small benefit.  But the science still seems to be evolving and the evidence that calcium supplements cause heart attacks is still controversial.  It is definitely not is the same realm as things like smoking and obesity and inactivity causing heart attacks.  I would first worry about quitting smoking, getting 5 serving of vegetables into my diet per day and walking 30 minutes a day before I would stop my calcium supplements.

On the one hand the question of, “Will my calcium supplements kill me?” is similar to “Why does Sheldon bark at one specific neighbor’s garbage bags and bin?”  The answer to both is I don’t know.  However when it comes to preventing heart attacks, I would suggest letting the researchers determine if the calcium effect is real or not and not worry about it too much.  In the meantime focus on 0 cigarettes, 5 vegetables per day and 30 minutes of exercise per day to prevent heart attacks.

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.

If you have any topics you want us to write about, email us at dcp@mymts.net or call 638-4602.

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

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Martini.  Shaken, not stirred.  I dreamt of being James Bond when I was younger.  I wanted the fantastic adventures, the cool gadgets, and to save the world.  Of course having a Bond Girl like Halle Berry on my arm wasn’t a terrible idea either.  I’m sure being a real spy isn’t nearly as glamorous or exciting as it looks in the movies.  Recently the Aussie’s really brought my spy fantasy back to reality.  The Australian government is considering making their spies wear bright neon yellow safety vests on the job.  Do you think Kim Jong-Un will have any trouble finding the Aussie mole in his protection detail when his uniform practically glows?  Reality sucks.

For many people, April 1 is back to reality.  For people who go over their Pharmacare Deductible, in March Pharmacare pays for their medication.  Now that it is April, they have to pay again.  Welcome to the new Pharmacare year!  If you don’t know what Pharmacare is, you are not alone.  Also, people are starting to ask how the Dauphin Clinic Pharmacy pre-pay program can help save them money.

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.”  Some of the tax money we pay the Manitoba Government goes into a big pool.  If we need a prescription medication and meet certain conditions, Manitoba Health will pay for our medications out of that big pool.  This pool of money to pay for medications is called Pharmacare.

Under what conditions will Pharmacare pay for my medications?  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.  A Pharmacare form has two options on it.  I recommend most people select Option A.  This means you will only have to apply for Pharmacare once.  Manitoba Health will keep your information on file for future years.  Option B means you will have to apply for Pharmacare every year.

Once you have applied for Pharmacare benefits, in 4 to 6 weeks, Manitoba Health 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 after 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.  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 Pharmacare will pay for them.  Part 2 (EDS Part 2) are medications that Pharmacare 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 and get 10% back for doing so.  Pre-Pays are a Dauphin Clinic Pharmacy program and don’t involve Pharmacare or Manitoba Health.  Pharmacare 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 for your medications.  And the best part about paying your deductible up front is the Dauphin Clinic Pharmacy will give you 10 percent of your deductible back.  So if you take advantage of the Dauphin Clinic Pharmacy pre-pay program, your medications will be cheaper than if you get them anywhere else.

The name is Bond.  James Bond.  But when you picture me behind my keyboard typing out this article, just picture me in a perfectly pressed tuxedo, not a day glow yellow vest.

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

Pharmacare application form: www.gov.mb.ca/health/pharmacare/docs/pharmform.pdf

Aussie spy vests: http://www.dailymail.co.uk/news/article-2296481/The-undercover-spies-Australian-spooks-ordered-wear-high-visibility-vests-work-countrys-strict-health-safety-laws.html

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.

By Nathan Friesen, Pharmacy Student at the Dauphin Clinic Pharmacy

Hi, my name is Nathan Friesen, I am a 4^th year pharmacy student currently working at Dauphin Clinic Pharmacy. The pharmacy program at the University of Manitoba is quite intensive and successful completion of the program involves a large investment of time on the student’s behalf in terms of attending class, studying, and doing homework. The pharmacy program provides us as students, not only with extensive information on the medications that we will see in our future careers as pharmacists but also on a wide variety of other subjects. Attending lectures and reading books however, is only part of how we learn the profession of pharmacy as students. In each year of the pharmacy program, we get let loose on the world for a number of weeks to put our knowledge and skills to practice in pharmacies across Manitoba. Throughout my years in school I have had the opportunity to work in a number of communities across Manitoba for short periods of time, one of these being Dauphin. Through these work experiences I have learned a lot about the practice of pharmacy, the medications that we dispense regularly, and the various medical conditions that present during my time working.  At each of the pharmacies I have been able to work in, there have been a number of common topics/questions/concerns routinely brought up by patients. One such topic is the discussion of pinworms.

What are Pinworms?

Pinworms or otherwise called Enterobius Vermicularis, are small parasites that live in the digestive system of humans. Pinworms are small, white, thin, roundworms that are primarily found in the rectum or colon.

Who Gets Pinworms?

Pinworms are a very common problem and are the most common type of intestinal worm infection in the United States.  Pinworm infections are most common in younger children ages 5-14 years old but can occur in the young and old alike. Pinworm infections can happen to anyone and are not related to being unclean.Poor personal hygiene and unsanitary living conditions however, can contribute to the spread of Pinworm infection.

Pinworm Infection

Pinworms are spread from human to human by a variety of ways. Pinworm infection generally starts with eggs being introduced to the body via the mouth. This can occur when someone with pinworms scratches around their bum, gets eggs on their fingers, and touches you or a surface that you touch later. The eggs can transfer onto your hands, then onto your food, and finally make their way into your mouth through your digestive tract to your rectal area. Pinworm infection can also occur when:

• An uninfected person puts their hand in their mouth after being touched by an infected person or an object carrying pinworm eggs.
• An uninfected person places an object carrying pinworm eggs in their mouth(ie food that has been handled by an infected person).
• Or when, Pinworm eggs are swallowed from the air after the bedding or clothes of an infected person are fanned in the air, however, this is rare.

The life cycle of the pinworm from egg to mature worm takes about 3-6 weeks to complete and occurs inside the human body. Pinworms live inside the large intestine and feed on nutrients in the digested food. At night, female pinworms crawl out of the body and lay eggs on the skin around the anus. This process can cause itching and subsequently scratching resulting in the eggs being transferred onto the person’s fingers and onto other objects/people.

Pinworm eggs can survive indoors for about 2-3 weeks and can be present on a variety of surfaces such as; clothing, bedding, furniture, food, faucets, hands, and the fur of pets. It is important to note that pinworms can only infect humans and do not infect household pets such as dogs and cats. However, pets can carry pinworm eggs in their fur and thus contribute to the spread of infection. Due to the many ways pinworms can be spread and the fact that the eggs can survive on surfaces for a number of weeks, pinworms are spread easily in families, schools, day care centers, and other institutions where groups of people live in close contact with each other.

What are the Symptoms?

Pinworm infection is not usually associated with serious complications and many infected people may not actually experience any symptoms. The most common symptom is itching around the anus. Some people may experience difficulty sleeping and loss of appetite due to the severity of the itching.

Treatment of Pinworm Infection

Pinworm infections can be treated with a number of different anti-worm medications. One commonly used medication that is available from your pharmacy over the counter is Pyrantel Pamoate or Combantrin. This medication comes only in tablet form but can be chewed or crushed and sprinkled onto food. When used to treat pinworm infections, Combantrin is generally given in 2 single dose treatments 2 weeks apart as the medication works to kill live adult pinworms but does not kill the eggs. Dosing of Combantrin is based upon the person’s weight thus consulting your pharmacist for proper instruction on its use is important. Alternative options available with a prescription from a doctor include albendazole and mebendazole or Vermox. Since pinworms are highly contagious, some doctors suggest that all close contacts of an infected person be treated at the same time to minimize the risk of re-infection. Although the use of these medications is crucial in the elimination of the infection, non-drug measures are very important as well to prevent re-infection as the medication will not cure the infection if the eggs are not controlled and removed from the household. Steps to prevent re-infection include the following:

• Wash hands often
• Machine wash clothes bedding, towels, and
  order cialis

  dishes at the hottest setting

• Wash underwear, pyjamas, and bedding in hot water and dry in a heated dryer daily for 2 weeks
• Practice good personal hygiene
• Bathe and change underwear daily- make sure skin around anus is cleaned. Showers may work better than baths.
• Avoid scratching around your anus- wear gloves at night
• Scrub washable toys
• Change sheets and towels frequently(every 3-7 days for 2-3 weeks)
• Keep fingernails short
• Tell children to keep hands away from their mouth

How Can I Prevent Pinworm Infection?

Proper, frequent, hand washing is the best way to prevent infection with Pinworms. Here are some tips to reduce your risk of infection with Pinworms:

• Wash hands thoroughly and often
• Keep fingernails short
• Avoid sharing a bathtub, face cloths, or reusing face cloths
• Do not fan the bedding of an infected person
• Keep hands out of mouth
• Wash your hands after using the bathroom
• Wash hands before meals

If you suspect you have a Pinworm infection be sure to consult your physician prior to starting any medication therapy as well as discuss any questions or concerns you may have with your Dauphin Clinic 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.

References

1. http://www.healthlinkbc.ca/kb/content/major/hw50481.html#hw50481-Bib

2. http://www.mayoclinic.com/print/pinworm/DS00687/DSECTION=all&METHOD=print

3. http://www.niaid.nih.gov/topics/pinworm/Pages/cause.aspx

4. http://www.cdc.gov/parasites/pinworm/prevent.html

By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy

This winter just does not want to end, and neither does our cold and flu season. No parent wants to see their baby or child sick, so when they see a high temperature on their thermometer, panic usually sets in. They rush to medicine cabinet, looking from something to bring that “high number” down, and if they don’t have anything, it’s off to the pharmacy. A fever is the body’s response, in which it attempts to find a new body temperature, called a set point temperature. Normally the body’s temperature is around 38°C. Any temperature consistently higher than 38°C is a fever.

Fever itself is not usually harmful and it may actually help activate the body’s immune system to fight the disease. When treating fever we aim to provide patient comfort and avoid further effects from the fever. It is important to remember fever is a symptom of a disease, not an actual diagnosis. Most commonly fever develops in response to an infection. High fevers with temperatures over 41.1°C may indicate a more serious infection and medication attention is advised.

Touching your child’s forehead is not the proper way to determine if they have a fever. Temperature measurements can be taken using a variety of thermometers, which are available at the pharmacy. Measurements can be taken in the rectum, mouth or ear as long as you are using the proper type of thermometer. Axillary temperature or measurements taken from the arm-pit region are not recommended as they are often difficult to measure and are inaccurate.

Acetaminophen and ibuprofen are the fever treatments of choice. Acetaminophen is marketed as Tylenol and Tempra and ibuprofen is sold as Advil or Motrin. Both are available without a prescription.  They have been well studied and are considered safe if given at the proper dose.

Acetaminophen is recommended as first line therapy because of its long term use in paediatrics and its very good safety profile. Acetaminophen should be given in doses of 10-15 mg/kg every four to six hours. Side effects are extremely uncommon if given at the proper dose. It is the only medication recommended for a baby under 6 months old.

Ibuprofen is considered 2^nd line therapy and can be given at doses of 5-10 mg/kg every 6-8 hours. Side effects are also uncommon if given at the proper dose; however, some GI or stomach upset can occur. Acetylsalicylic acid or Aspirin is not recommended in children under 15 years of age.

One of the biggest questions I get asked in the pharmacy is whether Acetaminophen and Ibuprofen can be given together or alternated. The answer I provide is yes, in certain situations when absolutely necessary. However, parents must follow label instructions closely and be sure to monitor their children for any possible side effects. Also if one medication seems to lower the fever effectively, only use one!

Other methods have limited value but they can be tried to lower core body temperature. Sponging with cool water can dissipate body heat. Alcohol is never recommended is it can be absorbed through the skin or ingested by the child. When sponging, always remember colder water is more uncomfortable to the child. Ice Pack or cooling blankets can lower the body temperature by a process called conduction. However it can lead to rebound hyperthermia and you must be very cautious not to freeze sensitive skin. Circulating fans directed over ice may transfer heat away from the child’s skin surface.

Another common question how long parents should wait until taking their feverish child in to see a physician. The answer depends on the age of the child. If the

child is under three months old, consult a doctor immediately. If the child is between three months and two years old consult a physician if the fever lasts more than three days or if it their temperature is 40 degrees Celsius or higher. Children who are greater than two years old and are feverish more than three days, should see a physician.

My advice today is when your child develops a fever, always question why the fever is happening. Sometimes we try to focus on eliminating the fever and forget to investigate the reason behind it. There may be an underlying illness. There is a saying “Don’t treat the thermometer, treat the child.”

As always if you have any questions or concerns about these 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

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I can’t draw.  No really, producing stick figures are a challenge for me.  My mom is artistic.  Her brother is artistic.  My sister and I are not.  My daughter Emily can draw.  In fact in Emily’s grade 5 report card her teacher suggested she try shading to add some depth to her artwork.  Emily is told to add some shading and I can’t draw a discernible happy face.  It is fascinating when your kids get abilities you never, ever had.

Hippocrates must look at his metaphorical children in the same way.  Hippocrates, the Greek healer who is known as the father of western medicine, wrote about powdered willow bark over 2500 years ago.  White willow bark was used to treat pain and fever.  The active ingredient in white willow bark is thought to be salicin.  Salicin is eventually changed in our bodies to salicylic acid and that is the same substance ASA is changed into.  ASA is now used to treat things Hippocrates would have never dreamed of.

A couple thousand years after Hippocrates, chemists identified the active ingredient in white willow bark as salicin.  In the late 1800’s chemists at the Germany company Bayer made a synthetic version of salicin.  This eventually became ASA or acetylsalicylic acid.  Bayer gave ASA the trade name Aspirin.

ASA does interesting things in the body.  It affects the enzyme cyclooxygenase and this decreases the pro-inflammatory chemicals the prostaglandins.  We think that decreasing these prostaglandins is what causes ASA to be able to decrease pain and inflammation.  We think that the decrease of the prostaglandin E1 in the brain is what causes ASA to be able to decrease fever.  ASA also affects platelets.  Platelets help your blood to clot.  ASA stops the cyclooxygenase enzyme in the platelet from forming thromboxane.  This permanently disables the platelet from being able to clot for the life of the platelet which is 7 to 10 days.

Because of this increase in bleeding risk, ASA has fallen out of favor as a pain and fever fighter and taken on a new role.  Low dose ASA is now used routinely to prevent heart attacks and strokes in certain patients.  Researchers have found that when we give ASA at low doses, it doesn’t bother the stomach as much, but still completely knocks out enough platelets to stop blood clots forming in dangerous places.  If a blood clot forms in the brain, a part of the brain dies and that is a stroke.  If a blood clot forms in a vessel feeding the heart muscle, a piece of the heart muscle dies and that is a heart attack.

The Heart and Stroke foundation of Canada says every 7 minutes someone in Canada dies of heart disease or stroke.  If ASA prevents heart attacks and strokes and it is very inexpensive, why shouldn’t we put all adults on it?  Well it is a risk benefit thing.  If someone is at a low risk for a heart attack or stroke, ASA only prevents a cardiovascular event once out of every 1000 people on ASA.  The problem is the ASA will cause about the same number of serious bleeds in the stomach or the brain.  The risk benefit calculation doesn’t even change if the patient has just diabetes.  Having just diabetes increases your risk of heart attack and stroke, but giving ASA to someone with just diabetes doesn’t prevent enough cardiovascular events to outweigh the bleeding risk.

ASA really starts benefitting people when they have multiple risk factors for heart attack and stroke.  Let’s say the person was over 40, had diabetes, smoked, had high blood pressure, high cholesterol, and a family history of heart disease.  This person is at a significantly higher risk of heart attack and stroke.  Now ASA will prevent enough cardiovascular events to justify the bleeding risk.  Where ASA really comes into its own is secondary prevention.  That means someone has already had a cardiovascular event.  People who have already had a heart attack, mini-stroke, by-pass, stent, a blood expanding a narrowed artery or stroke all are at much higher risk of having another clot causing damage.  These people need to be on a blood thinner and ASA may be the one their doctor chooses.

Does daily, long term low dose ASA do other good things?  Maybe.  Researchers now think ASA may also help fight cancer.  In the March 11, 2013 online version of Cancer, Tang et. al looked at the Women’s Health Initiative study and showed women taking ASA had less chance of getting a skin cancer called melanoma.  That’s good, but a previous study looked at the same Women’s Health Initiative study and found ASA did not prevent colorectal cancer.  In March 2012 issues of the Lancet and Lancet Oncology researchers led by Peter Rothwell and John Radcliffe looked at a bunch of ASA trials.  In one meta-analysis they looked at 51 studies in which some people were put on ASA to prevent heart attacks and strokes and some weren’t.  The ones who weren’t put on ASA got cancer more often.  In another paper they looked at 5 big ASA trials to prevent heart attack and stroke.  They were looking to see how cancer spread or metastasized.  Again the people on the ASA had less cancer spread than those not on ASA.  Although these papers are very interesting, they aren’t randomized, double blind placebo controlled trials.  The patients they were looking at were actually heart patients, some of which happened to have cancer.  Ideally we would like to see a large group of people without cancer half be given a sugar pill and half be give low dose ASA.  Then after a number of years the researchers would check to see which group got cancer more often.  Then we would like to see a trial in which a large number of people with cancer are half given a sugar pill and half given ASA and see in which group the cancer spreads the fastest.  That way we would have a better idea if this ASA effect on cancer is real or not.

Hippocrates wouldn’t recognize a medical world full of micro-surgeries, MRI machines and gene therapy.  He would recognize ASA if you told him it came from white willow bark.  But like a proud father, I think he would be amazed by the properties it now has and the new amazing properties it might be proven to have just over the horizon.

As always if you have any questions or concerns about these 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