Archive for the ‘Health Articles’ Category

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Honk, Honk, Honk.  I hate it when I accidentally hit the panic button on my car fob.  I was inside my car but, as the car was in the garage everything was very, very loud.  I hit the panic button again to turn off the honking.  The honking didn’t stop.  I hit the unlock button on the car fob.  The honking didn’t stop.  I got out of the car.  It was even louder outside the car.  The horn was going off, lights were flashing, and I started to panic.  Then I noticed that the lights weren’t just flashing on my car.  They were flashing on my wife’s car as well.  I ran back into the house, got her car fob and hit her panic button.  Finally the noise and lights stopped.  I guess my panic alarm set off the car alarm in my wife’s car.  Stupid panic buttons.  And that Myles, is why I was late getting back from lunch.

On days when nothing seems to be going right, it is nice when someone does some of your work for you.  That’s what happened with this week’s story idea.  We had an email into the store asking if we could do an article on domperidone.  So here it is.

Domperidone is an interesting medication.  It blocks the neurotransmitter dopamine.  Neurotransmitters are chemical messengers in your brain.  But domperidone doesn’t get into your brain.  It can’t cross the blood brain barrier.  It blocks dopamine from getting to another large clump of nerve cells in your body.  This large clump of nerve cells is in your guts.  There are so many nerve cells in your gut, it is sometimes called your gut brain.  Some researchers say you have as many nerve cells in your gut as a cat has in its head.

When domperidone blocks dopamine in your gut it speeds things up.  Food moves faster from your mouth to your stomach.  This makes it useful to treat heart burn from acid reflux.  If you give some one an acid blocker and domperidone that can be an effective way to stop the acid from splashing back up the esophagus. 

I like to tell patients that domperidone helps everything in the gut move in a downward direction.  So if someone has nausea, when we give domperidone before they eat, that can be help their nausea a lot.

In some conditions, the guts don’t move as well as they should.  For example, some people with diabetes get diabetic gastroparesis.  Their diabetes effects those gut brain nerves such that their guts don’t move their food and waste in a downward direction very well.  Giving domperidone can help stimulate those damaged nerves and get the guts moving again.

Domperidone has off label uses too.  One of the more unusual ones has to do with milk.  Domperidone increases the hormone prolactin.  As a useful side effect, this increase in prolactin means that domperidone can help increase the amount of milk a nursing mother produces when breast feeding.

The off-label use of domperidone for enhanced milk production brings up an interesting controversy.  Domperidone is available inCanadabut not in theUS.  That seems backward to many of us in pharmacy because new medications are often available first in theUSand can take years to be available here.  Domperidone is an older medication, but you can’t find it on the shelves of aUSpharmacy.  The Food and Drug Administration or FDA has banned domperidone in theUS.  Among the reasons it has cited is the increased risk of heart problems with domperidone, especially in nursing mothers.

The FDA isn’t wrong about domperidone and heart problems.  Domperidone can cause a specific type of heart problem call QT interval prolongation.  But this side effect is quite rare and usually only happens if the person has a pre-existing heart condition, if they are on other medications that interact with the domperidone or they are on other medications that cause QT prolongation.  In theUSthe closest alternative they have to domperidone is metoclopramide.  Metoclopramide is available inCanadatoo and it can be used to treat nausea, diabetic gastroparesis, and it can be used off label to promote milk production.  It also blocks dopamine receptors in the gut brain nerve cells.  However, metoclopramide crosses the blood brain barrier.  That means unlike domperidone, metoclopramide can cause sedation, dizziness and depression.  Even more scary is that metoclopramide can cause movement disorders that make the person move as if they had Parkinson’s disease. 

It’s not that we don’t use metoclopramide inCanada.  We do and it is a very good drug that is very safe in most people.  But when you look at the possible side effects, domperidone has many fewer side effects because it doesn’t cross the blood brain barrier.  It seems odd that out of the two, the FDA has banned domperidone.  It is kinda like the FDA didn’t know which of the two drugs it hit the panic button on.

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

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

Food Scientist Heribert Watzke talks about “The brain in your gut”- www.ted.com/talks/heribert_watzke_the_brain_in_your_gut.html

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Snow and wind follow Cliff Clavin as he walks into Cheers and orders a cold beer.  Diane asks how Cliff how he could drink cold beer on such a cold day.  Cliff explains it’s all about equilibrium.  “It is a well-known fact that when the British were in India they drank hot tea on hot days to equilibrate their inside and outside temperatures,” Cliff explains.  So Diane asks why Cliff drinks ice cold beer on hot summer days.   Cliff answers, “What else are you going to do with it?”

On the TV show Cheers, Cliff Clavin has been known to tell stories that bored people to sleep.  In real life, we’ve all had trouble sleeping at one time or another.  Sometimes we were worried about an exam at school.  Sometimes problems from family or work just seem to bounce around in our heads when we try to relax.  So what can we do to improve our sleep?

Let’s start with normal sleep.  Normal sleep involves four to six cycles divided between rapid eye movement (REM) and non-REM sleep.  Non-REM sleep consists of four stages.  Stage 1 is a transition from wakefulness to sleep and lasts 30 seconds to 7 minutes.  Stage 2 is a light sleep and we are in stage 2 about half the time we are sleeping.  Stages 3 and 4 (sometimes called delta sleep) are deep sleep stages and these stages make you feel rested the next morning.  If something disturbs your delta sleep, you will wake up in the morning not feeling rested.  REM sleep is when you eyes move back and forth under your lids very quickly, but the rest of your body remains very still.  REM is when you do your dreaming.

Insomnia can be having trouble falling asleep, getting enough sleep, but not feeling rested, broken up sleep, or waking up too early.  There are some general rules you should follow to help get a good night’s sleep.  Go to sleep and get up at the same time every day.  Use the bedroom only for sleep and sex.  Don’t read, knit, work, or watch TV in the bedroom.  Do not drink coffee, tea or cola 4-6 hours before sleep, and try to drink as little of these caffeinated beverages as possible during the day.  If you cannot sleep after 15 to 20 minutes, get out of bed and go to another room and read in a dimly lit area.  Avoid watching TV as the bright light may wake you up more.  Go back to bed only when feeling sleepy again.  Avoid watching the clock.  Some people even turn the clock face away them.  Finally, avoid daytime naps. 

If you still aren’t sleeping well after adopting good sleep habits, you might need a medication to help you.  If that is the case, talk to your doctor.  First your doctor will check you for any underlying health problems.  For example, insomnia can be a symptom of another condition like painful arthritis.  If we treat the arthritis pain, sometimes the insomnia will go away on its own.

If your doctor decides you need a sleep medication, there are several to choose from.  Many  over the counter sleep medications contain diphenhydramine.  It is safe in many patients, but it doesn’t work as well as the prescription sleep aids.  It starts working in 30-60 minutes, but probably shouldn’t be used more than 3 nights in a row or the patient will become tolerant to the effects.  One of the common prescription medications for sleep problems are the benzodiazepines.  A common benzodiazepine used for sleep is temazepam.  Temazepam takes 1-2 hours to kick in and lasts 6-10 hours.  Benzodiazepines work well for sleeping, but can become habit forming.  Because temazepam can last for 10 hours in some people, morning drowsiness can be a problem.  A different prescription sleep aid is zopiclone.  Zopiclone starts working in 15-30 minutes and lasts 8 hours or longer.  Because it is not a benzodiazepine, it is less likely to be habit forming.  It has the interesting side effect of leaving a bitter, metallic taste in the mouth.  If you drink something acidic like orange juice in the morning, that usually washes it away.  If you drink something plain like water it can make it worse.

There is a new prescription sleep aid on the market called zolpidem.  It is marketed in Canada as Sublinox.  You’ve probably seen the US TV ads for Ambien.  Ambien is the US trade name for zolpidem.  Zolpidem is one of the most popular sleep aids in the world.  It starts working in 15 to 30 minutes and lasts 7-8 hours.  This should mean less chance of morning drowsiness.  It isn’t recommended in patients over 65 years old due to the risk of dizziness, drowsiness and falls.  An interesting thing about zolpidem is it is an oral disintegrating tablet.  That means it dissolves quickly when you put it in your mouth.  The downside is it can’t be split in half.  If you try, the remaining half will just turn to dust.

A general warning with all the sleeping medications, is don’t mix your sleeping medication with alcohol.  Alcohol can prolong the effects of a sleeping medication, effect your breathing , and mixing alcohol and sleeping medications have lead to very dangerous things like driving and having no memory of doing so.

If you have questions about sleep or sleeping medications, come down to the Dauphin Clinic Pharmacy where everybody knows your name.  Everyone one needs someone like our pharmacists in their corner.  Because like Norm would say, “It’s a dog eat dog world out there and I’m wearing milk bone underwear.”

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

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

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Do you have your affairs in order?  Are you ready for the End of Days?  December 21, 2012 is less than a year away.  Some really bright astronomers in ancient Mayans times made some amazingly accurate calendars.  Accurate calendars are no mean feat as they take a large understanding of math and excellent observations of the sun and stars.  The Mayan calendars just happen to end December 21, 2012.  Does this mean the Mayan calendar makers just got tired and stopped carving the calendars into stone December 21, 2012?  Is December 22, 2012 just the start of a new period of time just like Y2K was the beginning of the new Millennium?  We don’t really know, but several dooms-dayers interpret the end of the Mayan calendar as the end of the world.

A more recent really bright math guy was Isaac Newton.  Sir Isaac basically wrote the book on physics for everyday sized objects.  Newton’s formulas explain how hockey pucks fly, cars crash and the moon’s gravity causes tides.  It is even more impressive when you consider that Newton died in 1727 but it wasn’t until the early twentieth century that physics started finding problems with the edges of Newton’s theories.  Newton’s classical mechanics don’t work on really small things like sub-atomic particles and really big things like clusters of galaxies.  Newton was so bright he even invented a branch of math to help him solve his physics problems.  You might have heard of it.  Newton invented calculus.

As bright as Newton was, he had a whacky side too.  He was very religious and wrote quite a bit about the occult.  He wrote extensively about his interpretation of the Book of Revelations.  He liked writing and thinking about the Apocalypse.  I think of him writing the 1700’s  version of the “Left Behind” series.  He had a prediction for the end of the world as well.  Newton said the world won’t end before 2060.  So you 2012’ers are way off.

The Mayan calendar makers were very bright.  Newton is one of my heroes for his theories classical physics and calculus.  But even these brilliant folks were way out to lunch on their predictions of the end of the world.  I think the very bright folks at the American Academy of Pediatrics (AAP) might out to lunch about their plan to do cholesterol screening in children.

There is a childhood obesity problem in North America.  Our kids are fatter, less physically active and arguably less healthy than at any point in the recent past.   Obesity, high blood pressure, diabetes, smoking and abnormal cholesterol values are all risk factors for heart attack and stroke.  With the recent increase in childhood obesity, researchers have noticed an increase in children with abnormal cholesterol levels.  We know that abnormal cholesterol levels like high LDL or bad cholesterol, low HDL or good cholesterol and high triglycerides can be contributing factors to fatty streaks in the blood vessels of teenagers.  These fatty streaks can grow into plaques or partial blockages of blood vessels as the person ages.  If a plaque ruptures in the wrong place, that can be a heart attack or stroke.

Because there are more kids with cholesterol problems the AAP is recommending all children between the ages of 9 and 11 should have a cholesterol test done and it should be repeated between the ages of 17 and 21.  The reasoning behind the two ages of testing goes like this.  Cholesterol levels in young children rise to adult levels by about age 2.  They then go up and down through out childhood until puberty.  Cholesterol level drop during puberty and then slowly rise back to adult levels.  So the two testing times are before and after puberty.  Right now the recommendation is that only children who have a family history of heart disease and other risk factors should have their cholesterol checked.  The American Academy of Pediatrics and other organizations claim that if they don’t screen all children they will miss 30% to 60% of children with cholesterol problems.

This is where I think the plan goes off the rails.  If we universally screen all children for cholesterol problems, what are we going to do with that information?  If your doctor told you your 11 year old girl had high cholesterol and that high cholesterol made it more likely she would have a heart attack or stroke when she was older, what would you do?    I think many parents would demand a cholesterol medication for their the child.  We already know many parents demand an antibiotic for their child with a cough whether or not the doctor thinks the infection is caused by bacteria.  I think many parents would demand a cholesterol medication for their child.  At the moment, the most common cholesterol medications are the statins.

If you are 45 years old, diabetic, a smoker and your doctor says you need a statin because your cholesterol is too high, listen to her.  We have lots of evidence to say the statins will prevent heart attacks and strokes in patients like you.  We have very little if any evidence saying treating children with statins does anything good.  Statins have only been around for about 30 years and have a very good safety record.  If you put an 11 year old on a statin, she might be on it for 50 years or more.  We simply don’t know what happens to a person being on a statin that long.  Statins can cause birth defects.  This isn’t a concern when you put a 50 year old woman on a statin, but it certainly is when you start an 11 year old girl on one.

What should be done with children with cholesterol problems?  Reduce the amount of fat in their diet.  Add one hour of moderately vigorous exercise every day to the child’s activities.  Limit time in front of a screen to less than 2 hours per day.  Eliminate sugary drinks from their diet and limit the amount of sugary food they eat.  Instead of spending money on screening all children for high cholesterol and run the risk of many children being put on medications, we should spend money elsewhere.  How about mandatory daily physical education in school from age 5 to 18?  How about taxes on junk food and soft drinks?  How about programs to make fruits and vegetables cheaper?  It just seems to me that cholesterol screening in children is as wrong headed as saying the world is going to end December 21, 2012.

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

 Deep fried garlic stuffed olives and deep fried sushi both taste way better than you would think.  Deep fried spinach tastes as bad as it sounds.  I was at a clog your arteries party for New Year’s Eve.  The Roncins offered up their house and back yard for us to deep fry everything and anything.  As it happened, there was a Fire Fighter at the party.  We didn’t end up needing his expertise, but I tried hard.   You see I contributed my version of fireworks to the evening by forgetting the burner on under my new deep fry pot.  That started quite a nice grease fire.  We turned off the burner and put the lid on the pot to put out the fire.  Luckily there were no injuries or damage.  Obviously you should double check to make sure your deep fry burner is off before you go in and watch the hockey game.

I know I’m not alone when I say I love deep fried food.  Despite our collective love of grease, as a group it isn’t cholesterol that is killing us the fastest.  Smoking is the number 1 cause of premature death inNorth 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.

On the plus side for public health, over the last few years smoking bans have made it been harder to smoke in public places.  These bans have encouraged many people to quit.  Arguably those smokers who find quitting easy have quit already.  Those who are still smoking may need some help.  Maybe they even need a little incentive to quit.  The Dauphin Clinic Pharmacy is running a quit smoking program with a cash prize of up to $1000.  Would that help you decide to quit?

Here is how the program works.  You come into the pharmacy and say you want to sign up for the quit smoking program.  We will charge you $40 and give you a questionnaire to fill out.  The pharmacy is going to keep $20 to run the quit smoking program and put $20 into a prize pot.  We are going to try to enroll 50 people into our quit smoking program.  If we get 50 people to put down their money, the prize pot will be $1000!  We have already had several people sign up.

What do you have to do to have a chance to win the cash?  After you pay your money you will get several questionnaires and assignments to fill out over several days.  These assignments include having you log every cigarette you smoke and why you smoked it for 24 hours, and completing questionnaires that will help determine how addicted you are to nicotine.  Then you will book an appointment to sit down with one of our pharmacists.  The two of you will review how you smoke and how would be the best way to get you to quit.  You will also have to pick a medication to help you quit smoking.  Yes, you can quit smoking without medication, but we need you to be on one for this program.  I’ll tell you why in a moment.

After you have finished your assignments and met with the pharmacist, the pharmacist will help you make a plan to quit smoking.  If you pick a prescription medication, the pharmacist will contact your doctor to get a prescription for you.  You will then fill your prescription every 2 weeks for at least 8 weeks.  If you do that, you are eligible for the cash prize draw of up to $1000.

Some of you might be saying, “Hey, they aren’t going to check to see if I quit smoking or not!”  You’re right.  There are two reasons for that.  First, I can’t physically follow 50 people 24/7 to see if they are smoking or not.  Second, I don’t want people to feel the need to lie to me.  When people try to quit smoking, many are going to slip up or relapse.  If someone relapses we want them to talk to the pharmacist about their relapse cigarette and make a plan to prevent that from happening next time.  We don’t want them to deny it ever happened in the first place.  To be eligible for the cash prize, you just have to do all the assignments we ask and fill your medication on time every 2 weeks for at least 8 weeks.  At the end of the program we will draw one name from the people who completed all their tasks and draw one cash prize winner.

The Dauphin Clinic Pharmacy quit smoking program will run from November 24, 2011 to April 30, 2012.  If you pay your $40 and do everything we ask, your name stays in the prize draw.  If we get 50 people in the program, the prize pot will grow to $1000.  That should be an extra incentive to quit!  As an added bonus, on November 24, 2011 the quit smoking medication Champix went on the Pharmacare formulary.  That means if you are over your pharmacare deductible, and your doctor writes you a prescription for Champix, you won’t have to pay for it! 

Maybe this is the year you will quit smoking.  Quitting smoking is far and away the best thing you can do for your health.  Think about laying your $40 on the table.  Maybe you’ll even win up to $1000!  And if when you see me this New Year, ask me if my burner is off.

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

Attention Deficit Hyperactivity Disorder affects 5% to 12% of Canadian children, making it the most commonly diagnosed psychiatric disorder in Canadian Children. If you child does not have ADHD, the chances are one or two of their classmates does. Although ADHD is diagnosed in childhood, it is not just a children’s disease. Research shows symptoms persist in adulthood in almost two thirds of those diagnosed in childhood.

ADHD is a brain condition that makes it difficult for children to control behavior. About three times more boys than girls are diagnosed. The three groups of behavior symptoms in ADHD are inattention, hyperactivity, and impulsivity. Inattention describes excessive daydreaming, not listening, distraction from work or play and organization. Hyperactivity is better described by constant motion or it is as if the person is driven by a “constant motor”. Impulsivity symptoms include speaking out of turn, not being able to wait for others and acting without thinking first.

Everyone’s child will have some of these symptoms from time to time. If fact I have these symptoms from time to time! Your child may just be reacting to stress in their life, may be bored or may be going through a difficult stage in life. On the other hand, some parents may not recognize these symptoms and it is the teacher or pediatrician to first bring the matter to light. If your child shows regular symptoms for more than six months, discuss the behaviors with a doctor.

Mental health professionals will all agree it is important to catch ADHD early and treat diagnosed individuals promptly. Treatment may, but does not always involve medication. ADHD patients must be given tools to help them cope with ADHD and medication is just one of those tools.

Stimulant medications are proven to be a safe and effective treatment option. Thus in combination with behavior therapy, they are a first line treatment recommendation for most children. A Stimulant works by altering chemicals in the brain to induce temporary improvements in either mental or physical function. An example would be enhanced alertness.  Stimulants help put things into focus for someone with ADHD, but that is it. Contrary to popular belief they do not make a child perform better. These medications do not get an assignment finished in class or homework done in the evenings. That work must still be done by the child with a support system from the parents and teacher. The same is for teens and adults; stimulants are only a tool to enable better performance, they do not do it for you.

The stimulant class contains commonly known drugs like Ritalin, Adderall, Concerta and Biphentin. My advice to parents is to make sure they have an accurate diagnosis before considering medication use. It is important to select a medication which is effective beyond the end of the school day. Optimal treatment will allow the patient to engage in appropriate behavior and interact with others throughout the full day. It used to be common to stop medications during weekends, holidays or the summer months. This is no longer recommended as ADHD is a “lifelong condition”.

Ultimately, parents must weigh the pros and cons of including medication in the treatment plan for ADHD. The more educated you are about the medication process, the better prepared you will be to make this decision. Also, parents must remember this is not their medication, there child will be taking it. So consider if it is the right thing for your child, not for you.

I have heard the comment teachers promote ADHD medication because they just do not want to deal with a difficult child. This is completely unfair to the teacher, as they are with your children during times where they must apply as much attention and focus as possible. If your child’s teacher notices an ongoing problem, you should consult a doctor for further examination. The key with ADHD is to recognize the problem first and then work toward a solution.

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

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

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Some parenting moments are special.  Like when your six year old son cuddles up next you on the couch, puts his arms around you and says, “Dad, you have a big belly.  You should lose some weight.”  Or when you are at the Dauphin Clinic Pharmacy Cashspiel and your nine year old daughter announces to strangers, “My mom made my dad lose that ugly moustache.  Next she is going to make him lose some weight.  He’s really too fat.”  I love those kids of mine.  I can’t wait for the time when they come home from school with head lice and I get to say, “Eww.  You have bugs in your hair!”

Of course if or when my children get head lice, I will be the adult and not make fun of them.  Head lice are actually quite common.  Having head lice doesn’t mean someone has dirty hair.  Lice actually seem to prefer clean hair.  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 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 in two main ways.  Lice can be transmitted directly by close contact from one infested scalp to another (e.g. touching heads together).  They can also be transmitted indirectly by sharing personal articles that come in contact with the head (e.g. brushes, hats, etc). 

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 stays in the hair 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 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.  Permethrin 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.

There has been talk over the last few years about resistance to treatments like permethrin.  Although resistance has been found in the US and the UK, the Canadian Pediatric Society says none has been proven in Canada.  Because of the resistance fears, there have been new products developed that don’t work like permethrin.  One of these is called Resultz.  It contains isopropyl myristate.  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.  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 Resultz is definitely better than permetherin yet, but it is nice to have another tool in the tool box.

I’m obviously biased, but my favorite alternative to permethrin is called Nice ‘N Natural lice treatment.  We compound Nice ‘N Nature lice treatment at the Dauphin Clinic Pharmacy with a variety of natural oils.  It coats the hair and suffocates the lice.  It smells really nice and customers tell us it works really well.

There are some non-medication measures that 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 65^oC 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.

If you or your children get head lice, it is nothing to be ashamed of.  It is a bit tedious to treat with all the nit picking that is required, but treatment with a medicated shampoo, nit picking and cleaning are usually very successful.  And I guess I shouldn’t wish lice upon my children.  Revenge is a dish best served cold.  I think I’ll just wait until my kids start dating and tell their future boyfriends and girlfriends embarrassing stories.  That’ll work.

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

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

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

The moustache is gone.  It went from barely noticeable to itchy over the first two weeks.  Over the next two weeks it started catching food and now it is gone.  My upper lip does feel a little cold and naked, but I wasn’t really happy with how grey my whiskers were coming in anyway.  I was feeling kinda old.  In case you missed Barret’s talk last week and all the hairy lips around town the last month, Movember has just come to an end.  Now we are onto the season of Santa, kid’s Christmas concerts, and eating and drinking too much.   I have to remember to be nice to my wife and be helpful with the kids so the holiday season doesn’t make Doris’s blood pressure go up too much.

If you are on high blood pressure pills and the holidays or the holiday parties give you a headache, what medication should you reach for?  Without a prescription, the most common choices in the pharmacy are ibuprofen, naproxen sodium, ASA and acetaminophen.  Let’s look at how they affect blood pressure and blood pressure pills.

The safest choice is acetaminophen.  The brand name for acetaminophen is Tylenol.  Acetaminophen won’t make your blood pressure go up.  Acetaminophen is very unlikely to interact with your blood pressure medications.  The only time we really worry about acetaminophen is if a person has liver problems.  Acetaminophen is broken down by the liver so if a person has liver problems it might need to be avoided.

If acetaminophen is so safe, why would someone with high blood pressure take anything else?  Acetaminophen treats pain, but doesn’t treat inflammation.  Some headaches have an inflammatory component.  So some people find acetaminophen doesn’t work that well for their headaches.  What about ASA?

ASA or aspirin or acetylsalicylic acid treats both pain and inflammation.  Some people find ASA works very well one their headaches.  The downside to ASA is the blood thinning.  Many people on high blood pressure medications are also on blood thinners.  So if they take ASA with their blood thinners, their blood make get too thin and cause bleeding problems.  What else could someone use?

Ibuprofen which goes by the brand name Advil or Motrin, and naproxen sodium which goes by the brand name Aleve are called NSAIDs.  NSAIDs or non-steroidal anti-inflammatories are very good at treating pain and inflammation.  They can be very effective for treating headaches.  The problem with NSAIDs is that they can increase your blood pressure.  NSAIDs are more likely to increase your blood pressure if you are older, male, overweight, have diabetes or certain heart, liver or kidney conditions.

Now stop panicking.  I know some of you are on blood pressure pills and have taken an NSAID once in a while for a headache already.  That’s okay.  If you take an NSAID for 2-3 days for a headache, a sore tooth or a sore knee, that won’t be a problem.  But if you have to start using an NSAID everyday for a week or more, let your pharmacist or doctor know.  They may want you to monitor your blood pressure to see what is going on.  How much NSAIDs will affect your blood pressure can depend on which blood pressure pill you are on too.  Calcium channel blockers like nifedipine and amlodipine should be the least affected by NSAIDs.  However, if you are on an ACE inhibitor like ramipril or an ARB like telmisartan plus a diuretic like hydrochlorothiazide, you should probably avoid NSAIDs without checking with your doctor first.

Just like itchy lips in Movember, headaches during the holiday season are common.  If you have high blood pressure, acetaminophen is the safest way to treat a headache just like shaving December 1^st is the best cure for an itchy mustached lip.  During a board meeting of the MS Society we were discussing, with a little envy, how Movember is close to the perfect fund raiser.  Other than a website, there is no overheard like making meals or supplying safety vehicles like we need to do for the MS Bike Tour.  You don’t have to gather all the participants in one place.  For Movember the participants are all over the world.  And all the monetary pledges are done online.  You don’t have to mail out pledge forms, or collect and count money.  The whole Movember idea is just fabulous from a fund-raising point of view.  And it is fun to look like a 70’s adult film star for a month knowing your wife can’t complain.

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

November is really a time for men! It is a month of deer hunting, curling and hockey. The snowmobiles are getting their tune ups and the Grey cup is on. It is also Movember, so no matter what our girlfriends and wives think we can grow a moustache. Since November seems to be somewhat of a man’s month it might be a good time to close out the month with some information on prostate health.

This discussion involves lower urinary tract symptoms and a big long word called benign prostatic hyperplasia (BPH). Simply BPH means the prostate enlarges or gets bigger. The male prostate is a reproductive organ found below the bladder. The problem with it enlarging is the urethra runs from the bladder right through the middle of the prostate. When it enlarges it closes in on the urethra, blocking the flow of urine and causing urinary problems. Prostate growth begins at around age 30 and 50% of men have evidence of enlarged prostate by the time they are fifty. Seventy five percent of men have enlarged prostates by the time they are 80. Almost 50% of those with an enlarged prostate will show symptoms of BPH.

The signs are symptoms of BPH are classified as storage or voiding issues. Storage symptoms include urinary frequency, urgency to void, urgency incontinence and voiding at night. This may mean waking up multiple times during the night to use the washroom. Some men may think they have a sleeping problem, when really it is BPH causing them to wake up because of the urge to use the washroom. Voiding symptoms include small urinary stream, a need to wait for the stream to begin, a stream which stops and starts intermittently and straining to void.

If symptoms are minimal or sporadic further monitoring and assessment is performed. Caffeinated beverages and alcohol should be avoided in the evening. Some medications such as decongestants can also be avoided to improve symptoms. If the symptoms progress and become bothersome your doctor may start a medication. The good news on BPH is it is very treatable with medications we have available.

A class of drugs which includes tamsulosin (Flomax), doxazosin, alfluzosin and terazosin all work by changing the muscle tone in the bladder neck and prostate. This helps increase the flow of urine from the bladder. Side effects from these medications include dizziness, weakness in muscle strength, headaches and nasal congestion. These medications may also potentiate the effect of blood pressure medications. Tamsulosin is extremely popular because it is a controlled release medication and is very selective to the prostate, therefore decreasing the risk of bothersome side effects.

Finasteride is in a class of medications which works by altering a man’s testosterone. By doing this it creates a reduction in prostatic volume. When the volume of the prostate is reduced there is less bladder obstruction. This medication works best in males with a large prostate.  There was concern Finasteride increased the risk of prostate cancer, however; new studies show the drug may even decrease the risk of it. It shrinks the prostate making cancer cells easier to detect but does not cause cancerous cells. A newer medication in this class called dutasteride (Avodart) is another good treatment option.

There are also products available in pharmacies, health food stores and on the internet which boast to cure urinary issues naturally. A lot of these products contain the plant extracts Saw Palmetto and African Plum Tree. They may have some positive effect, we just do not know how they work, how well they work or if they are safe long term. If you are looking at trying one of these products consult your pharmacist first.

Unfortunately BPH treatment is indefinite because symptoms will reoccur if the medication is stopped. Medications can be switched and doses can be altered to lessen side effects and create better urine flow. If you have questions about your medications, make sure to 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

A few summers ago we were camping with friends and in the evening I was smoking a cigar.  I really like cigars.  The next day someone mentioned the cigar to my daughter, Emily.  She told them that her dad would never smoke, because smoking is very bad for your health.  She said her dad was only using the cigar smoke to keep the mosquitoes away.  Despite my daughter’s good intentions, I have smoked cigars and inhaled on many fishing trips.  I wouldn’t consider myself a regular smoker, but after a few beers I have enjoyed a cigarette or two.  Yes, this is an occasional habit that isn’t doing me any good.  Emily wouldn’t be impressed.

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.

Maybe I need a little more incentive to quit.  What about you?  What if the Dauphin Clinic Pharmacy ran a quit smoking program with a cash prize of up to $1000?  Would that help you decide to quit?

Here is how the program will work.  You will come into the pharmacy and say you want to sign up for the quit smoking program.  We will charge you $40 and give you a questionnaire to fill out.  The pharmacy is going to keep $20 to run the quit smoking program and put $20 into a prize pot.  We are going to try to enroll 50 people into our quit smoking program.  If we get 50 people to put down their money, the prize pot will be $1000!

What do you have to do to have a chance to win the cash?  After you pay your money you will get several questionnaires and assignments to fill out over several days.  These assignments include having you log every cigarette you smoke and why you smoked it for 24 hours, and completing questionnaires that will help determine how addicted you are to nicotine.  Then you will book an appointment to sit down with one of our pharmacists.  The two of you will review how you smoke and how would be the best way to get you to quit.  You will also have to pick a medication to help you quit smoking.  Yes, you can quit smoking without medication, but we need you to be on one for this program.  I’ll tell you why in a moment.

After you have finished your assignments and met with the pharmacist, the pharmacist will help you make a plan to quit smoking.  If you pick a prescription medication, the pharmacist will contact your doctor to get a prescription for you.  You will then fill your prescription every 2 weeks for at least 8 weeks.  If you do that, you are eligible for the cash prize draw of up to $1000.

Some of you might be saying, “Hey, they aren’t going to check to see if I quit smoking or not!”  You’re right.  There are two reasons for that.  First, I can’t physically follow 50 people 24/7 to see if they are smoking or not.  Second, I don’t want people to feel the need to lie to me.  When people try to quit smoking, many are going to slip up or relapse.  If someone relapses we want them to talk to the pharmacist about their relapse cigarette and make a plan to prevent that from happening next time.  We don’t want them to deny it ever happened in the first place.  To be eligible for the cash prize, you just have to do all the assignments we ask and fill your medication on time every 2 weeks for at least 8 weeks.  At the end of the program we will draw one name from the people who completed all their tasks and draw one cash prize winner.

The Dauphin Clinic Pharmacy quit smoking program will run from November 24, 2011 to April 30, 2012.  If you pay your $40 and do everything we ask, your name stays in the prize draw.  If we get 50 people in the program, the prize pot will grow to $1000.  That should be an extra incentive to quit!  As an added bonus, on November 24 the quit smoking medication Champix goes on the Pharmacare formulary.  That means if you are over your pharmacare deductible, and your doctor writes you a prescription for Champix, you won’t have to pay for it!  So some lucky people will only have to lay down $40, do some assignments and then pick up their Champix for free every two weeks for 8 weeks to be eligible for the prize draw of up to $1000.

Maybe this time you will quit smoking.  Think about laying your $40 on the table.  Maybe you’ll even win up to $1000!  And if you see me with a cigarette in Dauphin, feel free to tell me my daughter wouldn’t be proud of me.

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 Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

If your pants are on fire, that is really more painful in Britain than it is in Canada.  In Dauphin I work with a couple of Lori’s.  In Manchester I might work under a lorry or even in one.  I love how different people say English words and how the words we use change depending on what part of the world we are in.  In England when they say pants, they are talking about underwear.  When they say lorry, they are talking about a truck.  My favorite group of English speakers are Doris’s relatives.  Both of my wife’s parents are from Germany.  When Emily was small we went to Hamburg to visit Doris’s mom’s side of the family.  They were lovely people and they all spoke excellent English except one uncle.  They all sounded the same to me when they spoke German as my German is non-existent.  However, they all spoke English differently.  One of Doris’s aunts went to University in Arizona.  So to my ear she sounded “normal”.  Another of the aunts and Doris’s grandmother had spent time in England, so they sounded very British.  One of the cousins had spent time in Australia, so she sounded very Aussie.  There were two other young cousins who hadn’t been abroad yet, so I really wanted one to go to Boston and another to go to South Africa so the Baumgarteners could have a full compliment of English accents.

How you say a word can change how others look at the word.  If you are diabetic, how you test your blood sugar can change how you look at your disease.  For example, if you are diabetic, you know you have to test your blood sugar at home.  But, there is another blood sugar test out there that looks at your diabetes differently.  We have lots and lots of evidence from huge studies that show blood sugar testing at home and with this other test will help diabetics.  These big studies have funny names like DCCT and UKPDS and they say that the closer a diabetic person keeps their blood sugar to normal values the less chance they have of getting the big four problems of diabetes.

The big four problems associated with diabetes are heart disease, kidney disease, amputation, and blindness.  So, if you are diabetic you should follow your diet and exercise plan, use your medications appropriately, and test your blood sugar at home.  Home blood sugar testing is one of the best ways for you to see if your diabetic plan that you developed with your health care professional is keeping your blood sugar within normal limits.  And if you keep your blood sugar within normal limits, you are more likely to avoid the diabetes big four.

So what is this other blood sugar test?  It is called a hemoglobin A1C or glycosylated hemoglobin test.  It gives an average of how your blood sugar has been doing over the last 3 months.  Most diabetes guidelines say it should be done at least once a year.  Let’s talk about how a hemoglobin A1C test works.

Red blood cells carry oxygen in your blood.  Red blood cells look like doughnuts with the hole in the middle not quite all the way through.  Or another way to picture them is they look like a ball that has been pinched together in the middle.  What red blood cells look like is important, because of what they do.  A red blood cell picks up its load of oxygen in the lungs, goes through the heart, and drops off its oxygen at a tissue.  To get to its tissue, the red blood cell must bend and squeeze to get through very narrow tubes called capillaries.

Now let’s add diabetes to the mix.  If you have diabetes, you have too much sugar in your blood.  The hemoglobin A1C test checks to see how many of your red blood cells are coated with sugar.  If your blood sugar control over the past 3 months has been good, your hemoglobin A1C will be good.  Why does the hemoglobin A1C test 3 months worth of blood sugar control?  Because red blood cells live about 3 months.

What number does your doctor want to see on your hemoglobin A1C test?  The latest guidelines say most Type 1 and Type 2 diabetics should aim to get their hemoglobin A1C to 7% or less.  What if your hemoglobin A1C is higher than 7%?  That just gives you room to improve your diabetes control.  Studies show that for every 1% you can lower you hemoglobin A1C, you reduce your chances of eye, kidney and nerve diseases by 40%.  If you can get your hemoglobin A1C from 10% to 9% even though you aren’t at ideal range yet your eyes, kidneys and nerves will thank you.

To get a hemoglobin A1c test your usually have to go see your doctor.  They then have to send your blood to a lab to get your hemoglobin A1C tested.  Not so on Wednesday, November 23!  On Wednesday, November 23 the Dauphin Clinic Pharmacy has a portable hemoglobin A1C tester available from 9 am to 3 pm.  The whole test takes less than 15 minutes.  There are only a limited number of tests available.  Call the pharmacy at 638-4602 to book your appointment today.  Come have a different look at your blood sugar.

People in different parts of the world look at English words differently, so they say them differently.  Being biased, I think more people should say words like we do in Dauphin.  I just so happens that we have a German student working at the Dauphin Clinic Pharmacy to improve her English.  Her name is Anna, and although her English is very good already, I think she needs more Dauphinisms in her vocabulary.  Come down to the store to say hi to Anna and maybe some of our expressions can go back across the pond with her.

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