My son Eric is a picky eater.  Frankly, he doesn’t want to eat anything that isn’t covered with sugar.  His sister Emily has always eaten well.  In fact by the age of two she had tried and liked several different types of fish, buffalo, elk, and liver.  I hate liver, but my two year old daughter would eat it.  Eric is different.  He is always raiding the pantry for cookies, and treats.  We find sucker sticks and granola bar wrappers all over the house.  However, it is difficult to get him to eat the veggies and meat on his plate.  Once he even licked the icing off of a cinnamon bun and tried to leave the table because he said he was full.  I mean who doesn’t finish eating a cinnamon bun?  So imagine our surprise when Safeway started sampling sushi and Eric liked it.  He now wants to pick up sushi every time that we going grocery shopping.  I assumed Eric would never voluntarily eat any healthy food until sampling at Safeway made him aware of other choices.  Sometimes we aren’t aware of diseases in our community until a spot light is shone on them as well.  That’s why May is 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 an employees with MS unfairly.

In the last couple of years, all the media attention on MS has revolved around CCSVI.  CCSVI stands for chronic cerebro-spinal venous insufficiency.  It was a theory put forward by Italian surgeon Dr. Paolo Zamboni.  CCSVI proponents believe veins in the neck of MS patients narrow.  This causes blood which would normally drain out of the brain to back up and cause inflammation and damage.  So Dr. Zamboni proposed that if you surgically open these neck veins up, the excess blood drain properly and the MS symptoms would go away.  The best that can be said for CCSVI surgery is that the jury is still out.  Some people have had CCSVI surgery and feel very good now.  There have also been some strokes and deaths associated with the surgery.  CCSVI surgery isn’t available in Canada, and many people have flown out of Canada and paid for the surgery out of there own pockets.  Recently, the Food and Drug Administration in the US has come out with a warning on CCSVI surgery.  The warning says in part, “the FDA has learned of death, stroke, detachment and migration of the stents, damage to the treated vein, blood clots, cranial nerve damage and abdominal bleeding associated with the experimental procedure”.  In Canada, Health Canada is still planning a clinical trial of CCSVI treatment.  So although researchers believe we are getting closer to a cure for MS, it is unclear if CCSVI will be that cure.

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.

With Manitoba having one of the highest rates of MS in the World, Multiple Sclerosis is a disease Manitobans should be aware of.  Just like Eric discovering sushi in Safeway and hopefully opening up a world of healthy food choices to him, we hope researchers like Dr. Namaka will discover a cure to end MS.

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.

Have you heard Trevor on the radio?  Listen to 730 CKDM Tuesday Mornings at 8:35 am!  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

FDA CCSVI warning: www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm303538.htm

In April the pharmacy hosted two different sets of pharmacy students.  Pharmacy students are always a lot of fun because they ask interesting questions.  As pharmacists we get to show them how we practice our profession and why we do what we do.  That involves a lot story telling.  A cautionary tale Pat always breaks out is about Trevor and the EpiPen.  Pat explains to the student how Trevor was demoing how to use an EpiPen to a patient with an EpiPen trainer or fake pen.  After Trevor had finished the demonstration, he pulled the trainer away from his leg, and realized it was a real EpiPen and he had stuck a real needle with real epinephrine into his leg.  At this point in the story Pat and the pharmacy student laugh and laugh.  And now that all of you have finished laughing, let’s talk about how to properly use an EpiPen.

EpiPens are autoinjecting syringes designed to deliver epinepherine (adrenaline) for the emergency treatment of allergic reactions.  Accidental injections with EpiPens, like mine, do happen.  If you accidentally inject yourself, get someone to take you to the hospital.  This is especially important if you accidentally inject your finger as the epinephrine can reduce the blood flow to that finger and the finger can be damaged.

How to Use the EpiPen

• To use the EpiPen, hold the pen the middle with it in your fist.  Think “Blue to the sky, orange to the thigh”.  The needle comes out the orange end.  Hold than end against your thigh.  The blue caps should be pointed up if you are sitting.  Remove the blue safety cap with your other hand.  We want you to hold the pen in the middle so you don’t accidentally poke your finger.
• Hold the orange tip near the outer thigh.  Swing and jab firmly into the outer thigh so that the auto-injector is perpendicular (at a 90° angle) to the thigh.  Hold the needle in the thigh and count to 10 seconds slowly.  This is so the whole dose goes into the muscle (Note: most of the liquid epinephrine never leaves the auto injector and it cannot be re-used).  Remove the unit and massage the area for several seconds to promote the epinephrine’s distribution.
• After administering, the needle is automatically covered by the orange tip.  Note the time of injection.  Go immediately to the nearest hospital, or call 911.  Bring the EpiPen with you.
• If in doubt, use the EpiPen.  The cause of the reaction can be investigated later.
• EpiPen can be used through light clothing.  It will not work though a snowsuit, but most pants are okay.
• The effects of the EpiPen may wear off after 10-15 minutes.  If you live a long way from the hospital you need one EpiPen for every 15 minutes you are away from the hospital.
• If you need an EpiPen, strongly consider getting a Medic Alert Bracelet with the type of allergy, and the words “Use EpiPen” on it.

EpiPens come in 2 strengths: the EpiPen, and the EpiPen Jr.  A child moves from the EpiPen Jr. up to the full strength when he/she weighs 15-30 kg (33-66 lbs.).  By school age, most children should have the full strength, not the Jr.  With children it is tempting to keep the EpiPen with a parent or with a teacher.   The problem is that runs the risk of the adult and the child being separated at the time of an allergic reaction.  The EpiPen should be with the child at all times.  Children five years of age and older are capable of carrying their own EpiPen in a fanny pack.  The EpiPen should preferably not be carried in the child’s backpack or in mom’s purse, but on the child.  My seven year old niece Bailey has a peanut allergy.  She has carried her own EpiPen since she was four.

The epinepherine (adrenaline) in the pen is light, heat and cold sensitive.  We don’t want the EpiPen to freeze because the inner working of the pen could crack and then the EpiPen won’t be able to inject when need.  So keep the EpiPen under a jacket in the winter.  The heat of summer will actually degrade the epinephrine.  So never leave your EpiPen in a hot car.  Keep your EpiPen cool in the summer.  The EpiPen has a window in it.  Periodically check to make sure the epinephrine is clear.  If it has anything floating in it or changes color at all, replace the EpiPen.  EpiPens are usually good for about a year.  Have your pharmacist show you the expiry date on the EpiPen, and record the expiry date in a place you will look often so you can see when it needs to be replaced.

.

EpiPens are expensive.  They are over $100 each.  Parents and patients are understandably concerned by the price.  But in my opinion, they are worth the price.  So buy the EpiPen if your doctor says you need one.  Replace the EpiPen every year when they expire.  Although they are expensive, they can save a life.

One of the best parts about being a pharmacist is I learn something new everyday.  I think I learn as much from the pharmacy students that visit as they learn from us.  Learning from experience is a great teacher, but I encourage our students to read and talk to people too.  For example, unlike me, they shouldn’t have to learn from experience that an EpiPen injection really doesn’t hurt.

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

EpiPen site - www.epipen.ca