Archive for the ‘Health Articles’ Category

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

“Men stumble over the truth from time to time, but most pick themselves up and hurry off as if nothing happened.”  Good quote from Winston Churchill, but not the one I was thinking of.  “I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character.”  Great quote by Dr. Martin Luther King Jr., but that is still not it.  It’s more like “Oh, the searing kiss of hot lead.  How I’ve missed you!”  You know Apu Nahasapeemapetilon from the Simpsons.  The Simpsons had their 500^th episode in February 2012.  Quite an accomplishment!  Over their 22 years the Simpson’s have influenced a generation of animated comedy and made the whole field smarter, edgier and more topical.  I’d like to think the profession of pharmacy has had the same positive impact on the health of Manitobans.

Health Minister Theresa Oswald has proclaimed March 4th-10th, 2012 as “Pharmacist Awareness Week”.  The theme this year is “Talk to Your Pharmacist.  A Healthy Choice”.  There are currently 1327 practicing pharmacists in Manitoba.  Pharmacists are the most accessible health care professional.  You can just walk into or phone any pharmacy and ask to speak to a pharmacist without an appointment.  Here are some other ways pharmacists can help you:

1)       You can trust us

A recent poll from Ipsos Reid, showed that 78 per cent of poll respondents said they trust pharmacists the most, followed by doctors (75 per cent), Canadian soldiers (74 per cent), airline pilots (73 per cent) and teachers (65 per cent.) Meanwhile, CEOs, municipal politicians, union leaders, national politicians and car salespeople were ranked in the bottom five out of 26 professions.

2)       Pharmacists are everywhere!

If you are in the hospital, there is a pharmacist looking after your medications.  Hospital pharmacists are often in the basement, and you might never see them, but they are looking after you.  For example if you are on a complicated series of cancer injections, a pharmacist did the calculations and mixed those up for you.  If you are in the military, there is a pharmacist looking after you.  In the military, pharmacists order and look after the shipping of everything from aspirins to X-ray machines.  There are community pharmacies in most towns, but even if you town doesn’t have one, we can always be reached by phone and get your medications shipped to you.

3)       We detect and solve problems with your medication.

Before filling any new prescription, we check your records to make sure you are not allergic to the medication, the dose is correct for you, and to spot possible interactions with other drugs you may be taking.  If you experience difficulties after you start taking your medication, such as unpleasant side effects, we can help by suggesting ways to overcome the problem.

4)       We answer your questions with expert information.

We have spent more years learning about medications than any other health care professional.  Even after we leave school, it is part of our job to stay up to date on new drugs and treatments.  Please feel free to ask us anything you would like to know about your medicine or other health-related concerns.

5)       We teach you how to use your medicine effectively.

Even the best medicine will not help if it is not taken properly.  Sometimes small things – like what time of day you take your medication or what you take with it can make a big difference in the effectiveness.  We advise you on how and when to take your medication to make certain you get the greatest benefit from it.

6)       We consult your doctor concerning your care.

As partners in your health care, we communicate with your doctor whenever necessary to ensure your drug therapy is going according to plan.  We are always available to discuss your medications with your doctor.

7)       We give you advice on staying healthy.

We give personalized counselling on topics such as vitamins and nutritional supplements, and how to use products designed to help you stop smoking.  We also offer a wide range of educational materials to teach you good health habits.

8)       We guide you in managing your illness.

Are you living with a chronic illness such as diabetes, asthma or heart disease?  We are here to help you monitor your condition, provide advice about the safe use of non-prescription drugs and answer any questions about your medications or your illness.  We work with you to keep you on track and feeling the best you can be.

That’s probably enough from me saying how good I think pharmacists are.  The most important member of the health care team is you!  To find out the opinions of the most important people in the health care system, we are running a contest.  We want you to tell us how a Dauphin Clinic Pharmacist has made your life better.  You could win a 32” flat screen TV!  Here is how you enter: go to the pharmacy and fill out a testimonial form saying how a Dauphin Clinic Pharmacist has made your life better.  Can’t get to the store?  Our Delivery people have the forms with them, or you can email your testimonial to us at dcp@mymts.net with “TV Contest” in the subject line.  March 12 we will be drawing the winning entry live on 730 CKDM.  With one pharmacist story, that TV could be yours!

“Thank you.  Come Again!”

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

Some people may become a little uneasy, embarrassed or nervous when the word colon cancer comes up for discussion. Thanks to some very good programs endorsed by Cancer Care Manitoba, public awareness of colon cancer has dramatically improved. However, it is not something we can eliminate. We just need to continue to improve our awareness of the cancer and catch it early in screening programs.

The colon is approximately 6 feet long and transfers waste material from the small intestine to the rectum. Its main function is to absorb excess water from the stool. The greatest risk for colon cancer is age, as over 90% of cases occur in people 50 years of age or older. Some other risk factors for colon cancer are smoking, strong family history and especially a personal history of polyps or inflammatory bowel disease. Contrary to popular belief hemorrhoids do not cause colon cancer. Polyps are growths which can develop in the colon and rectum. These growths, shaped like a mushroom, are commonly small like the size of a pea, although they can get as large as a plum! If untreated polyps can bleed and eventually turn cancerous.

In Manitoba there will be over 800 new colorectal cancer cases this year and an estimated 320 colorectal cancer deaths. However; statistics show deaths caused from colon cancer are dropping. This is because of improved home screening programs and polyps are being discovered earlier and are being treated, before they develop into cancer. Colon cancer is not going away; we are just doing a little better job of finding it earlier in its progression.

The message here is very simple, just get screened. If you are between the ages of 50 and 74 a home screening test is recommended every two years. The home screening test or Fecal Occult Blood test involves sending in a sample of your stool to be tested in a lab. Data shows the home screening test reduces colon cancer death by up to 25%. If you have never been sent a home screening test and would like one, contact the Manitoba ColonCheck program at 1-866-744-8961. I know sending a stool sample away is not very exciting; however, when colon cancer is detected in the earliest stage, there is over a 90% chance of survival.

If irregularities in a home screening test are found or a person is at high risk of colon cancer a colonoscopy may be necessary. A colonoscopy allows for the visual examination inside your colon and rectum with small video camera. Sometimes a small tissue sample will also be taken. This is called a biopsy. A colonoscopy is done under sedation and pain is usually not present, although you may feel some discomfort. The procedure can be completed in as little as 20 minutes! Studies recently have assured us colonoscopies were very effective in finding colon cancer or polyps likely to develop into cancer. This saves lives. The procedure is safe and very quick, however many people dread the preparation for a colonoscopy.

The day prior to the procedure your colon must be emptied so the doctor can see the lining clearly. You will be given a very strong oral laxative, correctly called an oral purgative to completely clean out the colon. Sometimes an enema will also be used for certain situations although it seems to be less commonly used. These products can be purchased at the pharmacy and your pharmacist can explain how to use them correctly. As you can imagine, have probably heard or maybe have experienced; the oral purgative is not the most pleasant to use. You will have to be nearby a washroom at all times. Food and certain beverages must also be avoided to keep the colon clean. If you do not follow your pre-operative instructions closely your procedure will be cancelled. You can always ask your pharmacist questions if any arise. Much like the home screening test colonoscopy preparation is not the more pleasant thing to do; however, when you consider the alternative perhaps it is not all that bad.

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 most of the articles published in the Parkland Shopper on our Website www.dcp.ca

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I’m lying on a cold gurney. There is a green sheet draped over my head. There is one hole in the sheet over my left eye. Dr. Willemse comes at my eye with a large needle. Thankfully he avoids my eyeball and gives me a few injections around the eye. Each injection pinches and I wince, but soon my eye goes numb. Then Willemse flips my eyelid inside out and clamps it. He comes at my eye with a small curved blade. The blade does something to my eyelid, but I can’t feel anything. Willemse brings another instrument towards my eye. I can’t see what he is doing with it, but suddenly I see smoke rising up from my eyelid. Eventhough there was no pain, watching smoke come from your own eyelid is very disconcerting.

The thing on my eye lid was a stye. Dr. Willemse was very nicely lancing it on the inside of the lid so there would be no visible scaring. I have had a few stye’s in the past and I assume I’ll get them in the future. What do I do when I get a stye? First, I ignore it. Then I ignore my wife and her complaints about how ugly my eye looks until her complaining gets sufficiently loud. You should be smarter than me. If you look after a stye early, you can avoid having a doctor make your eyelid smoke.

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

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

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

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

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

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

The legendary band Deep Purple visited Winnipeg recently. The lyrics from one of their most famous songs is “Smoke on the water, a fire in the sky”. If you want to avoid smoke coming from your eye, treat your stye’s early, and don’t ignore your wife.

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 most of the articles published in the Parkland Shopper on our Website www.dcp.ca

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Stephen Harper lost my children.  That’s my story and I’m sticking to it.  In our house February is the beginning of Tax Season.  Doris goes back to work at Meyer’s Norris and Penny as a tax preparer.  She likes the job, but if Stephen Harper was a good Conservative, he would eliminate all income tax and make Doris’s job redundant.  But instead Harper greedily keeps taxing us which causes mass confusion as Doris, myself and the two kids all try to get out the door to work and school at the same time.  Last Monday, in all this Harper taxation confusion, Eric went missing.  Emily had last seen him wearing his snow stuff, so we assumed he left for school.  But at 6 years old, he is supposed to walk to school with his older sister.  Now thanks to Harper taxation madness, no one knew where he was.  Doris eventually found him on the play ground at school on her way to MNP.  However, that wasn’t the end of Stephen Harper’s child disappearance shenanigans.  After school, Doris was still preparing taxes for Mr. Harper.  That meant that instead of the kids walking home after school, they were scooped up by Florence at School Aged Daycare.  Mr. Harper’s change in the after school routine caused Doris to forget to call Judith the tutor.  Emily usually sees Judith on Monday afternoons.  Harper’s taxation-greed caused Judith to worry that Emily had gone missing.  Harper’s taxation-gate has played havoc with my family’s routine and caused my kids to go missing.  Harper’s taxation-gate is a royal pain in the…knee.

Osteoarthritis can also be a pain in the knee.  Osteoarthritis is the most common type of arthritis.  In fact, by age 75 nearly every one will have at least one joint that under X-Ray will have changes consistent with osteoarthritis.

Arthritis means “inflammation of the joint”.   As the Arthritis Society points out, arthritis encompasses over 100 conditions ranging from tennis elbow, and gout on the mild end to severe crippling forms of rheumatoid arthritis and arthritis related disease like systemic lupus erythematosus.  In the pharmacy, people seem to get the terms osteoarthritis and osteoporosis confused.  Osteoporosis is NOT a form of arthritis.  Osteoporosis can be debilitating and painful, but it does not directly affect the joints.  Osteoporosis is when the bones get weak and break easily.  We will leave osteoporosis for another article.  Osteoarthritis (OA) is a complicated disease, but on its simplest level it is when the cartilage in a joint wears out and bone rubs on bone.

In a normal joint, a tough, smooth, elastic-like material called cartilage lets the two ends of the bones in the joint slide by each other with almost no friction.  When we age, the cartilage can break down.  As cartilage breaks down, bits can break off and go into the soft tissue around the joint and cause pain.  I was surprised to learn that cartilage doesn’t have any nerve endings in it.  So cartilage doesn’t feel any pain.  The pain from OA is from the cords that connect muscle to bone (tendons), bone to bone (ligaments) and the muscles which are forced to work in ways they weren’t designed to because of the cartilage break down.  When the cartilage breaks down so much that bone rubs on bone, the bone can thicken and form spurs. 

What symptoms might I have with osteoarthritis?  The hallmarks are pain, stiffness and swelling around a joint that lasts longer than 2 weeks.  Unlike rheumatoid arthritis, morning pain and stiffness usually lasts less than 30 minutes.  Although there can be swelling around the joint in OA, it is usually less than would be expected in rheumatoid arthritis.  The joints usually affected are the hips, knees and spine.  Finger and thumbs joints may also be affected.

How is OA treated?  Osteoarthritis treatment is usually a combination of non-drug and drug treatments.  Non-drug treatments can include physical therapy to strengthen the muscles around a joint, canes to remove stress from a joint or orthotics to correct problems like one leg being slightly longer that the other.  OA can also be treated by surgical replacement of the joint.  Drug treatments can be divided into pain killers, steroid injections, and synovial fluid replacements.

One of the least expensive, most safe medications for pain is acetaminophen (common brand name Tylenol).  If that is not fully effective, the doctor may add an NSAID (non-steroidal antiinflammatory drug) like ibuprofen, diclofenac or naproxen.  These medications can work better for the pain, but are more expensive than acetaminophen and have more side effects, like stomach upset, risk of ulcers, and risk of increasing blood pressure.  There are also topical or rub on forms of NSAIDS which get NSAID to the joint and avoid the stomach.  Steroid injections directly into arthritic joints can be an option your doctor may consider if other treatments aren’t working.  They are mostly done on knees, and should be limited to 3 injections per year.  Synovial fluid replacements can also be injected directly into the joint and help lubricate it.  They are used most often on knees and are expensive.

Maybe it really was poor planning and poor parenting that caused of my kids to go missing when Doris went back to work.  Maybe Stephen Harper isn’t to blame.  But I still think paying taxes is a pain in the knee.  If you think the pain in your knee might be osteoarthritis, talk to your pharmacist.  Maybe we can help that knee pain better than Harper can cut taxes.

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

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

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

Arthritis Society’s website : www.arthritis.ca

Osteoarthritis-Mayo Clinic: www.mayoclinic.com/health/osteoarthritis/DS00019

Canadian Arthritis Patient Alliance: www.arthritispatient.ca

By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy

Anti-depressants are a very common class of medications seen in the pharmacy. People of all ages can be diagnosed with depression and everyone from young teenagers to the elderly are prescribed antidepressants. Depression has been an illness treated for many years. However; we now better diagnose the disease in more recent times. While there is not much evidence newer anti-depressants are more effective than the “old ones”, new medications do have less side effects and are much better tolerated.

Antidepressants are good medications and they do work well for most people; helping them feel like their “old self” again. However; it is very important to be realistic about the medication’s effectiveness and about how you are likely to feel during the first few weeks of using the medication. If you can better understand both the positive and negative effects of the medication, you will be more likely to have success with the treatment. While on an antidepressant, take note of any side effects and whether or not they improve. It is a good idea to keep some type of journal for your health care providers.

As mentioned, newer antidepressants now have fewer side effects than older generation treatment options. However, side effects can and still do occur. The good news is side effects usually arise around the start of treatment and diminish in a few days or weeks. Although the side effects may be bothersome most are not dangerous. The most common side effects are nausea, vomiting, diarrhea, trouble sleeping, headaches or jittery feelings.

To reduce side effects, antidepressants are often started at low doses and are slowly increased over time. Your pharmacist can also recommend other strategies to reduce side effects. For example you may want to take smaller, but more frequent doses to reduce nausea or vomiting. If you are finding the antidepressant is making it hard to fall asleep, taking it in the morning may be an effective solution.

Occasionally long term effects from antidepressants do occur. Certain antidepressants may cause these long term effects, while others do not, so do not be surprised if your doctor tries switching to a different antidepressant at some point. Weight gain sometimes does occur when antidepressants are used. This may be due to increased appetite or regaining weight lost due to the depression. Exercise and a well-balanced diet are very effective. Exercise may also help with the treatment of depression so it is something to strongly consider.

As mentioned, insomnia is usually a short term problem but it can be prolonged. Consistent sleeping times, eliminating caffeine consumption later in the day and avoiding alcohol are all good sleep practices. Short term sleep aid medication can be used as a last resort.

A more serious long term effect of antidepressants can be emotional numbness. This is when you feel emotionally detached from events and people you would normally care about. This lack of feeling may result in switching to a slightly different antidepressant or lowering the current dose. No matter the circumstance never stop an anti-depressant without consulting a health professional first. These medications need to be stopped slowly with a decreasing dose.

While antidepressants are effective, they are a very slow acting medication. While Tylenol may help a headache in a matter of minutes or an antibiotic clears an infection in a few days antidepressants can take weeks to start working. Some patients may think their new medication is not working, however; it just has not been given enough time. This misunderstanding can sometimes cause treatment failure. While some patients may feel the benefits in the first week, most benefits begin to appear in two to four weeks. Usually your doctor will make adjustments to doses within four weeks if no response is seen. If a dose increase or multiple increases are not effective, the medication can be switched or another medication is sometimes added. Patience is the key to success. It can take up to eight weeks for some patients to feel the full benefit.

Treating depression successfully will result in improved energy, better sleep and hopefully better overall functioning. You will hopefully see improvements in your social life and in work performance. Life can start looking up again and you will start enjoying things you might have lost interest in.

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

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.