Pharmacy Appreciation Month is celebrated each March as a time to highlight the growing role pharmacy professionals play in our healthcare system and thank them for their extraordinary efforts. Pharmacists are the most accessible health professional and serve a vital role as part of the healthcare team. At Charlton Health, we are fortunate to have a team of dedicated, knowledgeable, and caring professionals who have great passion for their profession. It gives us great pleasure to educate patients on their specialty medications and the conditions they treat. Some of our pharmacists are involved in teaching at the University of Toronto, writing journal articles, serving on committees of the Ontario College of Pharmacists, and lecturing to health professionals across Canada.

The Canadian Pharmacists Association has launched a contest called #MyFavePharm. They are asking the public to share with them why they love their pharmacy team. Those who complete and submit nomination forms before 11:59pm ET on March 21 will be entered into a draw for an opportunity to win a tablet for both them and their favourite pharmacy team member! Open to residents of Canada. Enter here: #MyFavePharm contest

Pharmacists work in hospitals, long-term care facilities, community pharmacies, specialty pharmacies, and the pharmaceutical industry providing medical information and conducting research. They are educators in universities and colleges, and often conduct presentations for the public. Pharmacists usually complete an undergraduate degree in science followed by four years at a faculty of pharmacy along with an internship. Graduates obtain a PharmD designation which is a clinical doctorate in pharmacy. At Charlton Health we are proud to support the education of future pharmacists by offering internship placements to students completing their final year of study.

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.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

As we end the month of February, it is a good time to reflect on the importance of the heart. I recently asked a group of women what the word ‘heart’ meant to them. I received many answers, such as being at the core of a thought or issue, being kind to ourselves and others, and heart health. Working with patients with immune-mediated conditions, we think about heart health regularly since increased inflammation in the body can lead to increased inflammation in blood vessels that supply the heart muscle. People with inflammatory arthritis (such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) and those with psoriasis have greater cardiovascular risk when their immune-mediated condition is not well controlled, and inflammation is high. With that in mind, being on treatments that keep your condition in a low disease state is very important. Ensuring blood pressure and cholesterol are well controlled is also important in reducing this risk.  Of course, healthy eating and exercising for a minimum of 150 minutes a week is a guideline for all of us – whether we live with immune-mediated conditions or not. Similarly, lowering stress is a part of reducing risk to the heart. Remember, being kind to yourself and doing what you can to support your well-being should be a priority, as we all need to take time to do the things that provide the greatest fulfillment. 

Be kind to yourself and be kind to your heart!

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.

The National Advisory Committee on Immunization (NACI) provides vaccination recommendations for Canadians. Each province considers these recommendations and its budget to decide which vaccines will be publicly funded. Part of the decision process is considering which population members are at greatest risk of a particular infection. Pneumococcal vaccination has been available through public health for adults of any age who are compromised adults based on condition or treatment along with all adults age 65 and older. Pneumococcal vaccination is also part of the childhood immunization schedule.

In the newest guidelines, the two pneumonia vaccines approved by Health Canada that offer the greatest protection are Prevnar 20 by Pfizer and Capvaxive by Merck. In a previous blog post, we mentioned that Capvaxive offered 8 different strains compared to Prevnar 20 and that these strains were more prevalent in adults hospitalized with pneumonia. Since 2019, there has been a shift in the most prevalent pneumonia strains. This means that the overall protection, although slightly different between vaccines, is just over 70% regardless of which vaccine is used, resulting in an equal recommendation to receive either vaccine. In Ontario, Prevnar 20 is the only one funded for adults through public health and supplied to family doctor’s offices.   

If you had a different pneumonia vaccine in the past, such as Prevnar 13 or Pneumovax, then it is suggested you wait one year since the older vaccine was given to upgrade to Prevnar 20 or Capvaxive. If someone is going on highly compromising therapy and the update is required sooner, Prevnar 20 or Capvaxive should be given a minimum of eight weeks after a previous older vaccine. Should you have received either of the newer vaccines, no booster dose is suggested. Of course, with research and new vaccines always on the horizon, this guidance may continue to change.

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.

During a recent Ontario-wide educational session, leading pain expert Dr. Andrea Furlan provided valuable insights into the benefits of pain reprocessing therapy. Dr. Furlan, a renowned researcher and engaging educator known for her popular online videos for patients, is the author of 8 Steps to Conquer Chronic Pain. She has successfully integrated pain reprocessing therapy into her clinical practice. This approach is based on the understanding that a significant portion of chronic pain and symptoms are neuroplastic, meaning the brain is responsible for triggering and perpetuating them*.

In the world of immune-mediation conditions, we do find that some patients may continue to have pain even when advanced treatments are managing their inflammation. Treating an immune-mediated condition to prevent irreversible damage to tissue from excess inflammation is the foundation of treatment.  When there is pain beyond that, addressing how the brain processes pain can provide additional benefits for overall well-being. 

One of the leaders in this field of PRT is Dr. Alan Gordon, who authored, The Way Out. Nicole Sachs is also a great resource who hosts regular podcasts on the subject, as well as chronic anxiety. You can learn more about her work here and look out for her new book, Mind Your Body.   “Curable” is another podcast that many people have found valuable. 

* What is Pain Reprocessing Therapy? — Pain Psychotherapy Canada Inc.

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.

Charlton Health specializes in supporting the management of many autoimmune and immune-mediated conditions. Recently, a treatment has become available for vitiligo, an autoimmune condition with a great unmet need.

Vitiligo is an autoimmune condition in which the immune system targets and destroys the skin cells that make pigment (colour). As a result, individuals with vitiligo may develop white patches of skin that can appear anywhere on the body (e.g. face, hands, feet). The hair may also turn white in the affected areas. This condition can greatly impact an individual’s confidence and mental health due to this change in appearance.

Recently, a new topical treatment, Opzelura (ruxolitinib), has been made available to manage a specific type of vitiligo. Opzelura is part of a class of medications that are referred to as JAK inhibitors. JAK inhibitors are treatments that disrupt the signaling for excessive inflammation and help control autoimmune and immune-mediated conditions. Opzelura is a cream-based treatment designed to be applied to the affected areas. This is different from the other JAK inhibitors which are only available in tablet form to be swallowed. Opzelura is meant to be applied as a thin layer twice daily to the affected areas and patients may see the benefit within 24 weeks.

Interestingly, Opzelura may also be used for an immune-mediated condition, known as Atopic Dermatitis (eczema), adding to the growing list of advanced therapies for this condition. For atopic dermatitis, patients are likely to see benefits within 8 weeks.

Charlton Health is excited to be offering this new treatment to eligible patients. Please speak with your specialist to check if this treatment is appropriate for you.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

As we wrap up 2024, we want to wish everyone joy this holiday season, no matter which tradition(s) you celebrate. Spending time with family and friends is the greatest gift for our health and well-being—one that no medication can replace!

All the best from the Charlton Health Team for health and happiness in the coming year.

For those that visit our primary Hamilton location, our holiday hours are listed below. Anyone outside of this area should please get in touch with your location directly to confirm holiday hours.

December 24 – Open until 12PM (noon)
December 25 – CLOSED
December 26 – CLOSED
December 27/30 – Regular Hours
December 31 – Open until 12PM (noon)
January 1 – CLOSED
January 2 onwards – Regular Hours

We often hear patients ask how they got an immune-mediated condition.  Autoimmune diseases occur when the immune system mistakenly attacks the body’s own cells, leading to long-term inflammation and damage. While genetics play a role in the development of these conditions, environmental factors can also contribute to them.

Trichloroethene (found in paint removers and adhesives), silica (used as a food additive), mercury (found in thermometers and fish), pristane (a lubricant), pesticides, and smoking, have been linked to a higher risk of autoimmune diseases. These substances can cause oxidative stress and disrupt the normal functioning of the immune system.

For instance, exposure to mercury (from a broken fever thermometer) can lead to inflammation and the production of autoantibodies, a reaction similar to what occurs in lupus. Pesticides and chemicals like trichloroethene can interfere with immune function, making autoimmune reactions more likely by altering how immune cells operate and communicate.

The gut microbiome also plays a crucial role in autoimmune diseases. This complex mix of microorganisms in our intestines helps regulate immune responses and maintain a healthy gut barrier. Environmental chemicals can disrupt this balance, leading to inflammation and increasing the risk of autoimmune diseases.

Although understanding and managing these environmental factors is important, it’s important to recognize that controlling them does not guarantee prevention of autoimmune conditions. The development of these diseases is more complex, with stress and genetics also playing a crucial role.

Joyce Ayad is a 4th-year pharmacy student from the University of Waterloo who completed one of her rotations at Charlton Health. She believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. Joyce is eager to become a licensed pharmacist this year. 

RSV is a seasonal virus that can cause serious lung infections, especially in young children under 2 years old and adults over 60. 

Recently, Health Canada expanded the use of the Arexvy vaccine to include adults aged 50–59 who have certain chronic health conditions that put them at higher risk for severe RSV. These conditions include stable chronic lung diseases like COPD and asthma, heart problems such as heart failure or coronary artery disease, diabetes (both type 1 and type 2), and chronic kidney or liver disease. This update makes the vaccine more widely available to people needing extra protection. We are also aware that people with immune-mediated conditions or those on medications that are considered immunosuppressive are at increased risk of RSV and specialists may also consider them for vaccination before age 60. 

There have also been updates about combining Arexvy with other vaccines. It can now be given at the same time as a flu shot, whether it’s a standard dose or a high-dose option. Studies are ongoing to see if it can be safely given alongside other vaccines, like the pneumococcal vaccine (PCV20) and mRNA COVID-19 boosters. Although Arexvy has been studied with the shingles vaccine (Shingrix), this specific combination isn’t officially approved yet. 

Remember, it is not necessary to hold or delay most biologic/advanced treatments while receiving non-live vaccines such as Arexvy. We would suggest not administering a new vaccine within a few days of a biologic injection or infusion, so if you feel unwell you can determine which was causing your symptoms.

Joyce Ayad is a pharmacy intern working at Charlton Health. She believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. Joyce is eager to become a licensed pharmacist this year.

In the summer, we wrote about the newest pneumococcal vaccine approved in the United States.  It is now available in Canada and is called Capvaxive and is manufactured by Merck.

There are about 100 types of pneumococcal bacteria.  Capvaxive protects against 21 of those types.  The great news is that the 21 strains chosen for the vaccine protect against 80% of the worst pneumonia strains which can cause disease throughout the body and lead to hospitalization.  This is the greatest level of protection available in a pneumococcal vaccine to date.  It is a single dose that is expected to provide long-term protection.  So far, this vaccine is not available through free public health programs but is available through prescription at community pharmacies. With that said, public health does provide the pneumonia vaccine known as Prevnar 20 for people at increased risk of pneumonia.  It protects against a different mix of 20 strains of bacterial pneumonia and still offers good protection for people who do not have a private plan or cannot pay out of pocket for the newer vaccine.

Most people are aware that pneumonia is an infection of the lungs that can cause cough, thick, discoloured mucus, shortness of breath, and fever.  It can be caused by a bacteria, virus or fungi.  What is not commonly known is that bacterial pneumonia (called streptococcus pneumonia,) can go beyond the lungs. This is called invasive pneumococcal disease.  When the infection enters the bloodstream, it is known as bacteremia.  When the infection reaches the tissue covering the brain and spinal cord, it is called pneumococcal meningitis. These are very serious infections requiring hospitalization.   Even pneumococcal pneumonia, affecting just the lungs, causes 150,000 hospitalizations in the United States each year.  Inflammation generated by pneumonia can also increase the risk of heart attack and stroke.   Vaccination is our best way to protect against bacterial pneumonia.

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.

As newer biologic medicines can be incredibly useful in managing many conditions (e.g. immune-mediated, bone disorders, diabetes), their use can be limited by cost. 

The introduction of biosimilars, however, has offered biologic medicines that are just as safe and effective as the originator, at a fraction of the cost. This results in significant cost savings for the healthcare system, insurance companies, and patients. This was the key driving factor for the non-medical biosimilar switch in Ontario, which we blogged about on February 17, 2023. At the time, some of the existing treatments that had biosimilar options included: infliximab (Remicade©), rituximab (Rituxan©), adalimumab (Humira©), and etanercept (Enbrel©). Since then, however, biosimilars have been introduced for other treatments such as ustekinumab (Stelara©), and more recently denosumab (Prolia©). 

The biosimilar for denosumab,  Jubbonti© is also injected subcutaneously every 6 months to manage osteoporosis just as Prolia©. For cash-paying patients, the cost savings through using this biosimilar can be significant, especially over the years. 

At Charlton Health, we actively educate our patients on the use of biologic medicines and their biosimilars in managing immune-mediated and bone-related disorders like osteoporosis. Therefore, we are excited to offer this biosimilar to our patients which can improve access through cost reduction. 

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics.