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Wise Words Wednesday Blog

This series features answers to some of the most frequently asked questions our pharmacists receive, as well as information on all the latest research surrounding biologics and the conditions they treat.

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Influenza Vaccine Distribution

We have received many calls with concern that their community pharmacy has already run out of the influenza vaccine.  I want to reassure you that although  there was a preliminary distribution of influenza vaccine around October 7-9th from public health, the actual launch date of full distribution to pharmacies is not until October 26th.  Pharmacies will be able to order from this date onward through their standard wholesaler under the direction of public health.  Both the standard dose and high dose vaccines will be available.  The high dose has four times the amount of inactivated influenza vaccine and has shown to illicit a greater immune response (more antibodies) against the flu for people who age 65 or older.  This does not mean that the standard dose will not work for a person over 65 but if you can access the high dose and you are age 65, it is suggested .  In provinces other than Ontario, the high dose is only being distributed to long term care homes.  We are fortunate in Ontario to have extra doses that are being distributed to family physicians and pharmacies.  The best protection however is for everyone around you, including yourself, to be vaccinated as this is what reduces spread the most. 

For those who are taking advanced therapies for their autoimmune disease, such as biologic treatments, it is safe to get either influenza vaccine as they are both inactivated.  There is no need to hold or delay a dose of your biologic to receive any non-live vaccine. If there is a perfect time to get your influenza vaccine when the effectiveness could be a littler greater, it would be 2 weeks before your next biologic dose when the level of drug is lowering. The vaccine takes 2 weeks to process. For people doing a weekly or every other week dose, take the vaccine half way between your doses.

The National Advisory Committee on Immunization (NACI) is suggesting when booking an appointment for the influenza vaccine, that you consider what other vaccines you are in need of.  This could include the pneumonia vaccines (Prevnar 13 first followed by Pneumovax 8 weeks later), the shingles vaccine (Shingrix given as 2 doses, 2-6 months apart) and others including the tetanus shot given every 10 years.  Multiple vaccines can be given at the same time.

Important Update to our Blog…

We have very much enjoyed bringing you this weekly blog for the past few years. As of this month, we will be publishing blogs on a bi-weekly basis. However, if there is critical information that needs to be shared, we will post more often. We also bring you content over on our Facebook and Twitter pages, so you can always tune in there if you miss having us in your inbox as frequently!

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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When can a person on rituximab receive the flu shot?

Question:
When can a person on rituximab receive the flu shot?

Answer:
Let me first speak about our biologic treatments for autoimmune conditions in general, where it is fine to get the flu shot as it is not a ‘live’ vaccine and we do not need to interrupt the biologic treatment. If we could pick an ideal time when a person might get a little bit more immune response, it would be 2 weeks before the next biologic dose, as vaccines take 2 weeks to process and this is when the biologic is at its lowest level.

However, people waiting for a ‘perfect’ time often miss the window and never get the vaccine.  So we don’t want to make a person feel a specific time is necessary.

For rituximab, it is a different story.  As B cells are depleted by this treatment, which we need to make antibodies when receiving a vaccine, there will be almost no benefit to getting any vaccine for about 5 – 5 ½ months after a rituximab dose.  It will do a person no harm to receive the vaccine, it just won’t have the benefit. So once the flu shot is available, receiving it  2 weeks prior to the next rituximab dose would be highly suggested.  If you have missed this opportunity, then the best thing a person can do is to ensure all those in close contact with them are vaccinated. We expect the flu vaccine to be available within the first two weeks of October.

Important Update to our Blog…

We have very much enjoyed bringing you this weekly blog for the past few years. As of this month, we will be publishing blogs on a bi-weekly basis. However, if there is critical information that needs to be shared, we will post more often. We also bring you content over on our Facebook and Twitter pages, so you can always tune in there if you miss having us in your inbox as frequently!

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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Importance of Blood Monitoring

We are often asked if it is necessary to have ongoing blood work while on disease modifying treatments for autoimmune conditions. 

Blood work is one part of understanding how well your condition is being managed, as well as watching for any changes that may be due to your treatment. Blood work alone of course, never tells the full story, as your symptoms along with an examination of your joints in the case of arthritic conditions or a scope in the case of inflammatory bowel diseases is needed to understand the full picture.

The reason why we need the blood work on a regular basis (often every 1-3 months) is that there may be changes in your liver or kidney function, white or red blood cells etc., that you cannot feel and by spotting these changes early in your blood work, changes in your treatment can be made before any damage is caused. 

We also use blood work before starting treatments to see if you have any underlying infections that you were unaware of, such as, hepatitis or HIV.  There is even a blood test (Quantiferon Gold) for detecting tuberculosis.  Disease modifying medications, such as biologics do not cause these infections, but if you already unknowingly were infected, they could make these infections worse.  These blood tests are called screening tests and in some patients they may be repeated on an annual basis.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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ReBlog: Community Based Resources for Adults with Arthritis

In honour of Arthritis Awareness Month, we thought we would share one of our most popular past blogs on arthritis. In April 2019, we brought you this list of helpful resources. If you didn’t see it then, we hope you enjoy it now.

The original post is as follows…

150 minutes per week of exercise is important for all Canadians. Although some individuals with arthritis may find it hard to find modified activities. At Charlton Health we have compiled a list of community resources and on-line programs for individuals with arthritis to help you to achieve 150 minutes of exercise per week.

ResourceWhat it is?LocationContact information / Website
Arthritis Society – Arthritis Rehabilitation and Education programHelps facilitate access to physiotherapists, occupational therapists and social workersVarious – Click here for more information1-800-321-1433 ext. 1301
INMOTIONWeekly education sessions by a physiotherapist for individuals with chronic bone and joint health problems such as osteoporosis and arthritis. This program allows participants to access; GentleFit, hydrotherapy and Walkfit classes along with individualized exercise plansLes Chater Family YMCA (356 Rymal Road East, Hamilton, ON)    Phone: 905-667-1515   https://www.ymcahbb.ca/Programs/LiveWell/InMotion
Your Exercise SolutionProgram by the arthritis foundation that helps individuals find exercises that will work for themOnlinehttps://www.arthritis.org/living-with-arthritis/tools-resources/your-exercise-solution/
From Soup to Tomatoes (exercise program)Online exercise videos that are for individuals with mobility impairment, all exercises are done with the support of a chair.OnlineFrom Soup to Tomatoes YouTube
GLA:D exercise programThis is a standardized education and exercise program, that is twice a week for 6 weeks. 2 sessions are education and the rest of the sessions are exercise with a trainer.   Referrals to this clinic need to be accessed via the Rapid Access Clinic (RAC) ask your physician if you would qualify.Wilson Medical Centre (130 Wilson St lower level Hamilton, ON, L8R 1E2    Phone:  905-526-6250   https://gladcanada.ca/index.php/what-is-glad-canada/

To view the entire post in full, click here.

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When is the flu shot coming?

As we have seen in Australia, there is a definite expectation that Canadians will want to be protected against any vaccine preventable infection possible, including influenza. It is known that getting influenza changes the airway lining, increasing the risk of also getting pneumonia and with Covid-19 numbers rising this adds even greater concern. The National Advisory Committee on Immunization is suggesting that when receiving the flu shot this year, other vaccines should be updated at the same time.  There is a large emphasis on the pneumonia vaccines and shingles vaccines being updated; especially in the most vulnerable populations.

Pharmacists anticipate that they will receive the flu vaccine by mid-October. Now could be a good time to consult with them and your family physician about other vaccines that you may require.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health.  Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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September is Arthritis Awareness Month

Did you know 1 in 5 Canadians live with Arthritis?

Charlton Health would like to recognize September as Arthritis Awareness Month. The Arthritis Society has posted several ways for us to be involved, including information sessions, an online concert, and more. Read more about the ways you can take part in Arthritis Awareness Month here.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health.  Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

 

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Do you continue methotrexate while on biologics?

This week we’re bringing you the another question submitted by our one of our clients and social media followers! If you have a question you’d like to submit, please email us here.
Question:
I am currently taking methotrexate for my rheumatoid arthritis. My rheumatologist is considering adding an advanced therapy such as a biologic.  Will I stop the methotrexate as soon as I start the biologic treatment?
Answer:
Advanced treatments for rheumatoid arthritis such as our biologic therapies, have all been studied in combination with methotrexate. In many cases the combination tends to work better than taking the advanced therapy without methotrexate. The decision of whether to continue methotrexate or lower its dose is usually made after the biologic therapy has an opportunity to start working. This can be up to three months from the time it is started. Even in a low-dose, methotrexate can reduce the likelihood of a person’s body recognizing the biologic treatment as a foreign protein. This could protect the longevity of the biologic medication. So, if methotrexate is tolerated well, combining it with a biologic therapy is very common to both increase the overall efficacy of the therapy and to protect the longevity of the biologic.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health.  Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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Can I have the Shingrix vaccine while on Prolia?

This week we’re bringing you the another question submitted by our one of our clients and social media followers! If you have a question you’d like to submit, please email us here.

Question:
Can I have the Shingrix vaccine while on Prolia?

Answer:
Prolia is a biologic medication used to treat osteoporosis.  It is not a immunosuppressive treatment and any vaccine (live or non-live) can be given while on Prolia.  Shingrix is a non-live vaccine so not only is it safe to give with Prolia, it can be given while on other types of biologic therapies, such as those used to treat autoimmune diseases.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health.  Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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How do we know when we achieve remission?

This week we’re bringing you the another question submitted by our one of our clients and social media followers! If you have a question you’d like to submit, please email us here.

Question:
How do we know when we achieve pharmaceutical remission? Does remission have any pain?  Fatigue?

Answer:
There are different ways to look at remission. For patients this can mean being pain free, but having no pain does not necessarily mean the disease process is not active.  To truly assess remission, rheumatologists evaluate inflammatory markers in blood work as well as images of the joints such as ultrasound, X-Ray or MRI, in addition to asking questions about your pain, morning stiffness, and ability to function at home, work, and socially. In addition the “hands on” assessment of your joints is also important.  Achieving full remission is easier to achieve when treatments to stop disease progression are started early; ideally within the first year after symptoms are first identified. Remission can also be easier to achieve in non-smokers and those who are not overweight as fat cells produce inflammation themselves.  The goal of treatment ideally is to achieve remission, but as this is not always possible, achieving low disease activity can still make a significant difference in a person’s quality of life and preventing joint damage.

Fatigue can certainly be reduced when disease is under control, however, some people can continue to have fatigue despite their arthritis being well controlled. Pain, inflammation and the stress of illness overtime can place a large burden on the body if a disease has not been well managed. This may lead to adrenal stress, whereby fatigue can remain despite low disease activity. The same can be said for pain. An increased sensitization to pain can occur in people who have experienced untreated pain overtime. If the pain is coming from tissue beyond the joints and it is experienced as a generalized pain sensitivity, then this type of pain may not necessarily resolve even though the inflammatory condition is in good control.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health.  Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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Is it safe to have the Shingles vaccine if you are on Prolia?

This week we’re bringing you the another question submitted by our one of our clients and social media followers! If you have a question you’d like to submit, please email us here.

Question:
Is it safe to have the Shingles vaccine if you are on Prolia?

Answer:
The shingles vaccine used most often is called Shingrix which is a non-live vaccine.  Prolia is a biologic therapy for the treatment of osteoporosis which does not increase infection risk.  It is fine to receive Shingrix while taking Prolia.

Even when taking a biologic therapy for an autoimmune condition which does increase infection risk, there is no problem in receiving any non-live vaccine including Shingrix.


Carolyn Whiskin is the Pharmacy Manager for Charlton Health.  Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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