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

THE DAUPHIN CLINIC PHARMACY RECENTLY MADE A DONATION TO THE GILBERT PLAINS COMMUNITY FUND TO HELP RAISE FUNDS TO FINANCE COMMUNITY PROJECTS.  THE COMMITTEE WILL BE HOSTING A DINNER AND AUCTION AT THE GILBERT PLAINS COMMUNITY HALL FEBRUARY 17, 2012.

THE DAUPHIN CLINIC PHARMACY RECENTLY MADE A DONATION OF ITEMS TO THE GILBERT PLAINS CURLING CLUB. THESE ITEMS WILL BE USED FOR THE UPCOMING 2012 CURLING BONSPIELS.

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

THE DRCSS RECENTLY HELD A SCHOOL CURLING BONSPIEL WITH SEVERAL TEAMS PARTICIPATING. THE DAUPHIN CLINIC PHARMACY DONATED ITEMS FOR PRIZES TO THIS EVENT.

THE DAUPHIN CLINIC PHARMACY IS  A SPONSOR OF THE PARKLAND PANTHERS FEMALE MIDGET AAA HOCKEY TEAM.  THIS IS A NEWLY FORMED TEAM AS OF SEPT. 2011 CONSISTING OF PLAYERS WHO RESIDE IN SWAN RIVER, MINITONAS, BENITO, DAUPHIN, RUSSELL, ROBLIN, MCCREARY, LAURIER, KINISOTA, AND GILBERT PLAINS.

THE DAUPHIN CLINIC PHARMACY ONCE AGAIN MADE A DONATION TO THE DAUPHIN R.I.D.E PROGRAM.  THIS PROGRAM RUNS FROM DEC 2 – DEC 31, 2011.

THE DAUPHIN CLINIC PHARMACY RECENTLY MADE A DONATION TO THE LION’S JOURNEY FOR SIGHT.  THIS RIDE WILL TAKE PLACE FROM JANUARY 16 – 21 2012 WITH ALL FUNDS RAISED GOING TO THE LION’S EYE BANK.