May has just come and gone again.  May is a magical month.  It is the birth month of The Buddah, Bob Dylan and yours truly.  May was the 60^th Anniversary of Sir Edmund Hillary and Tenzing Norgay becoming the first men to reach the 29,028ft (8,848m) summit of Mount Everest.  I remember reading a book about Mount Everest on a plane called “Into Thin Air”.  The pilot came on the intercom and announced our cruising altitude of 30,000 feet.  That meant my plane was flying at the same height as Everest!  It is not possible to climb Everest most of the year.  For most of the year, the jet stream winds pound the mountain with 100 to 200 mile per hour winds.  But, May is special.  Usually in May, the Jet Stream shifts away from the mountain.  So, in May there are between 4 and 15 days that it is possible to climb to the top of Everest.  This is called the Summit Window.  Summiting Everest is not for the faint of heart.  Hundreds of people have died in the attempt.  Often their bodies are left on the mountain and serve as grim reminders of how perilous the journey to the top of the world is.  Despite the difficulty and danger, many people follow the footsteps of Hillary and Norgay and challenge Everest every May.

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

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

Compared with big diseases like heart disease, cancer and diabetes, why should you care about MS?  While it is true that MS isn’t as common or as deadly as heart disease, cancer and diabetes, MS is the most common neurological disease affecting young adults in Canada.  In fact, Canada has one of the highest rates of MS in the world.  Within our country, Manitoba has one of the highest rates of MS in Canada.  Dr. Ruth Ann Marrie, who works at the MS Clinic in Winnipeg, published a paper about MS prevalence in Manitoba in the January 2010 issue of Neurology.  She concluded Manitoba has one of the highest prevalence rates of MS in the world.  So, Multiple Sclerosis does affect a lot of people in our area.  There are even more local connections to MS research.  Dr. Mike Namaka, who grew up in Winnipegosis, is also an MS researcher at the Winnipeg MS Clinic.  It’s nice to see a Parkland prodigy work on a Manitoba problem.

On April 9, 2013 Biogen got approval for a new drug for MS.  It is called Tecfidera and its generic name is dimethyl fumarate.  I was fascinated when I heard it was such a relatively simple molecule.  Most of the new MS drugs are complicated proteins like interferon or modified antibodies.  The researchers don’t know exactly how dimethyl fumarate works in MS.  They think it may help protect cells from oxidative stress.  It has been used in Europe for years to treat psoriasis.  Dimethyl fumarate is the second oral drug for relapsing remitting MS.  It seems to work as well as fingolimod, the other oral drug for MS but with less side effects.  It does have side effects, though.  It can cause stomach problems like nausea and flushing.  If you take dimethyl fumarate with food, that reduces the chances of flushing and the stomach problems.  Some have suggested that if you take a regular, non-coated aspirin 30 minutes before the dimethyl fumarate that can reduce the flushing as well.  The flushing also just seems to get better the longer the patients are on the dimethyl fumarate.  The really big downside to the dimethyl fumarate is its cost.  It costs over $2000 per month and being a new drug, Manitoba Health will not cover it yet.

Summiting Mount Everest is an impressive feat that inspires us.  Ending MS is like summiting Everest.  The journey will be difficult and long but as Sir Edmund Hillary and Tenzing Norgay showed the world 60 years ago, it is possible.  The magical month of May has come and gone.  But maybe with dimethyl fumurate and other treatments we are getting closer to ending MS.  That is a Summit Window we can all hope for.

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

MS Society of Canada www.mssociety.ca

Tecfidera FAQ page: mssociety.ca/en/treatments/treatments_tecfidera_faq.htm

When I got home from work the other day, my daughter Emily ran up to me and said, “Dad, for track and field I signed up for a 60 mile run!”  While I was impressed I might have a fifth grade ultra-marathoner in the house, I thought I’d ask more questions.  It turns out Emily had signed up for a 60 m run, which is a very short sprint.  Emily has no concept of distance, so 60 meters or 60 miles sounded the same to her.  I explained to Emily she had been running for may kilometers for the last few months in running club and that just a week earlier she and the running club had gone to Brandon and run a 5 km Fun Run.  I said, “Emily last week you just ran 5000m.  You have been training for 2 months to run long distances, way longer than 60 m.”  I encouraged Emily to try some longer races at track and field as well as the 60 m.

It’s not Emily’s fault she didn’t know the difference between 60 m and 60 miles.  She just doesn’t much experience dealing with distances.  It’s like if I asked you what the difference is between vaccines and homeopathic vaccines or nosodes.  Would you think they are very similar products?  Let’s have a look.

Vaccines are dead or weaken infectious agents or chunks of infectious agents like bacteria or viruses that are given to a patient, often by injection.  This lets the body’s immune system recognize the infection before it happens.  That way if a patient encounters the infection later their body will be able to fight off the infection before they get sick.  Vaccines are very inexpensive, very safe and have already saved thousands, if not millions of lives. These medications have saved more Canadian lives over the last 50 years than any other health program.  There should be headlines screaming, “Diptheria reduced from 3000 case per year to 1-5 cases per year.”  Or “Measles reduced from outbreaks of 300,000 to 400,000 every 2-3 years to an average of 12 cases per year.”  Vaccines have reduced the death rate from infections in Canada to only 5%.  That is incredible when you consider that in the good old days a 100 years ago, infectious diseases were the leading cause of death in Canada.

I first heard about homeopathy in University.  One of my pharmacy classmates did a homeopathy talk for the class.  One of the principles of homeopathy sounded odd to me.  The Law of Infinitesimals said the more you dilute the homeopathic product the more potent it gets.  When you do the math, some of the homeopathic formulations were diluted so much they may not have any active ingredient in them at all.  That means if the product was being diluted in water, the homeopathic product would just be water.  Let’s look at it another way.  Many homeopathic preparations are labeled as 30C.  At a 30C dilution you have a better chance of winning the lottery several times in a row than having a single molecule of active ingredient in the dilution.  Another way to look at 30C is like putting 1 drop of active ingredient in the entire ocean.  Then stir the ocean well.  Now scoop a random bottle of water out of the ocean.  Do you think you would get any active molecules in your bottle?

Homeopathy came to my attention again recently when I read an article in the British Columbia Medical Journal by Dr. Lloyd Oppel.  Dr. Oppel was sounding the alarm against nosodes or homeopathic vaccines.  What Dr. Oppel was concerned about was that nosodes were being approved for sale by Health Canada.  Apparently Health Canada has already licensed homeopathic nosodes to prevent the flu (influenza), polio, measles and pertussis.  Health Canada says it licenses products that are safe and effective when used according to the labelled instructions.

The problem that Dr. Oppel highlights is that Health Canada is only half right.  The homeopathic nosodes are “safe”.  They don’t have any active ingredient in them to cause any side effects.  However, they can’t be effective for the same reason.  If people take a nosode to protect themselves or their children against a disease, they are being misled.  The nosode offers no protection.  In fact when this nosode controversy came up in Britian, the British Homeopathic Society said, “The Society does not endorse the use of homeopathic medicines as an alternative to vaccination for the prevention of serious infectious diseases and recommends that members of the public seek the advice of their GP, and/or relevant Department of Health guidelines, concerning vaccination and protection against disease.”

I have to admit, I haven’t been too worried about homeopathic medications in the past.  I always considered the herbal products more of a problem.  You see herbals act just like drugs in the body.  So I am always worried about the herbal products causing side effects or drug interactions.  I didn’t worry about homeopathic medicines because they were basically sugar and water.  With no active ingredient, there were no side effects or interactions to worry about.  What I didn’t realize was that parents were deciding to give their children homeopathic treatments instead of vaccines and Health Canada was telling parents that it was okay for them to do so.

Emily wasn’t familiar with distances and relied on an authority in her life, her parents, to tell her 60 m and 60 miles weren’t the same.  Parents aren’t necessarily familiar with the difference between vaccines and nosodes.  They should be able to rely on authorities like Health Canada to tell them that vaccines and nosodes are different.  Health Canada should say a polio vaccine will protect your child from polio and a polio nosode will not.  Health Canada should not give a polio nosode a license saying it is safe and effective.

Lloyd Oppel in BC Medical Journal www.bcmj.org/council-health-promotion/health-canada-licenses-homeopathic-vaccines

Stopnosodes campaign www.stopnosodes.org/

Immunize Canada – www.immunize.ca

The 10:23 Campaign: www.1023.org.uk/

British Homeopathic Society says to use vaccines www.guardian.co.uk/society/2013/apr/15/homeopathy-measles-mp

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

When I first came to Dauphin, several people told me they knew my father.  I was surprised to hear this because my Dad, Bob Shewfelt, lives in Pinawa, MB and grew up in Wawa, ON.  It turns out people thought I was the son of Ben Shewfelt.  I’m sure Ben Shewfelt was a wonderful barber and a nice man, but I’m not related to him.  Apparently Ben’s wife was a teacher in the Eclipse, but again no relation to me as far as I know.  As I said, my Dad grew up in Wawa, ON.  Our family made many trips to Wawa during the summer when I was growing up.  Sometimes we continued down the road to Bruce Mines to visit my grandmother’s family.  My grandmother’s family is Finnish.  I have fond memories of hanging out at my great Aunt and Uncle’s cottage on Georgian Bay.  Sunshine, saunas, swimming and a lot of people speaking a language I couldn’t understand.

The summer weather needed to start hanging out at the cottage here in the Parkland is getting closer.  Remember when you’re outside to use sunscreen.  Too much sun can damage your skin.   And that damage can add up.  Sun exposure can lead to serious problems like skin cancer.

The sun emits radiation across the entire electromagnetic spectrum, from radio waves to X-rays.  The part of the spectrum we are interested in for skin damage are the Ultra-violet wavelengths.  There are 2 types of UV radiation we talk about with skin damage, UVA and UVB.  Sun burn is most often caused by UVB.  UVA & UVB can both cause premature skin aging, and skin cancer.

Sun exposure is a factor in the development of three types of skin cancer.  Basal cell carcinoma is caused by the exposure to UV radiation and is the most common type of skin cancer.  Basal cell carcinoma often affects fair-skinned people with blond or red hair who sun burn easily.  Basal cell carcinoma is usually very easy to treat.  Squamous cell carcinoma, the second most common form of skin cancer, is caused by repeated exposure to the sun over a long period of time.  It can be very successfully treated if it is identified early.  Malignant melanoma is a less common skin cancer.  We believe sun exposure is one of its causes.  If malignant melanoma is found early, it has a high cure rate.  However, if it is not caught early, it can spread to the blood stream and in the worst cases, it can cause death.  If sunscreen is used properly, it has been shown to reduce the number of cases of squamous cell carcinoma, and it may help reduce the risk of malignant melanoma.  There is debate about how well sun screens protect against basal cell carcinoma.

The Food and Drug Administration in the US started to require changes in the labeling of sunscreens in 2012.  It is believed Health Canada will follow suit in the near future.  In the US sunscreens can no longer be labeled “Sunblock”, and they can’t claim immediate protection upon application.  The FDA thinks “sunblock” implies too much protection.  If the sunscreen protects against both UVA and UVB and has an SPF of 15 or greater, it can be labelled as “Broad Spectrum”.  The FDA also won’t allow a sunscreen to claim an SPF of greater than 50 as they feel there is no evidence that numbers above 50 have any real meaning.  Sunscreens won’t be able to say they are “water proof” or “sweat proof”.  The will only be able to say they are water resistant.  The label must state how long they are water resistant for.  The two labeling options will be water resistant for 40 minutes or water resistant for 80 minutes.

Sunscreen shouldn’t be the only defense used to prevent skin cancer.  Here are some practical suggestions.

• Avoid the sun when it is most intense.  These are between the hours of 10 am and 4 pm.
• Seek the shade when you are outside for a long period of time
• Wear a hat with a wide brim and long-sleeved shirt.

I have lots of fond memories of time at the lake.  Yes, sunshine, a cottage, a lake and bunch of people speaking a language I can’t understand.  This time, though, I’m not a little kid.  This time I’m in my late twenties.  I’m on Windigo Lake near Lac du Bonnet, MB.  I’m with my new wife, Doris, my new parents-in-law and several of their family friends.  This time everyone around me is speaking German not Finnish.  The whole scene feels familiar and just right, though.  In my mind the fact that déjà vu isn’t an English phrase seems perfectly appropriate.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Psoriasis Info  www.livingwellwithpsoriasis.com

Psoriasis Treatment Guidelines – Canadian Dermatology Association

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

US National Psoriasis Foundation www.psoriasis.org

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

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

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