We have had several questions from our patients with autoimmune diseases regarding antibody testing.  The first thing to be aware of is that there are two different antibody tests.  The initial testing that labs offered is called the Total Nucleocapsid Qualitative Test.  This testing is to measure the antibody that the body generates when exposed to the actual COVID-19 virus (SARS-CoV-2).  It does not measure antibodies produced from having a vaccine.  The second antibody test is for the Total Spike Quantitative Antibody Test and this measures antibodies made in response to being vaccinated.  Some labs are offering a panel of both antibodies, where others only have the initial antibody test.

It is important to know that it is not known what level of antibody to the spike protein is needed to provide protection from developing symptomatic COVID-19 disease.  This testing is an out-of-pocket expense.  Before considering an antibody test,  speak to your specialist to see if this will provide any valuable information in managing your care.

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.

On August 17th,  Ontario updated its vaccine eligibility criteria.  Anyone turning 12 years old in 2021 can now be vaccinated, rather than having to wait until their 12th birthday.  In addition, those who are living in long-term care settings are eligible for a booster dose of COVID-19 vaccine as long as their last dose was at least 5 months prior. Patients who are receiving immunosuppressive treatments that have been shown to impact vaccine efficacy may also receive a booster if at least 2 months have passed from their second COVID-19 vaccine. This includes transplant patients and those receiving treatments for hematological cancers.  In addition, patients with autoimmune diseases and who receive therapies that lower their B Cell levels are now eligible for a booster dose.

Many patients with autoimmune diseases are on treatments that are considered immunosuppressive, however, those with the greatest risk of not responding to the vaccine are people on medications that suppress their ability to make antibodies when getting the vaccine. Treatments such as rituximab (Rituxan, Ruxience, Riximyo) and ocrelizumab (Ocrevus) are in this category. If you are receiving one of these treatments, any vaccine is best given 5 months or more post the last rituximab/ocrelizumab dose.  Where possible individuals with upcoming appointments should consider getting this third dose, 2-4 weeks before their next rituximab/ocrelizumab infusion.  A note from your specialist confirming you are on one of these therapies will likely be needed when booking this appointment. Other evidence may also be accepted, so check ahead with your public health unit. To date, third doses are only available through public health and not at the pharmacy.  Some public health units began giving third doses to eligible patients last week.  It is suggested that whichever vaccine you had for your second dose, be the same vaccine for the third dose.

Learn more about the updated eligibility 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.

We have all felt a burden of stress during this pandemic.  For many, it has been a time to reflect on what we really value in life and the people and experiences that we have missed.  Reflecting on one’s health and trying to prevent disease has certainly been the focus in getting vaccinated. 

However, the most valuable intervention a person can make to prevent disease and prolong life is to quit smoking.  Those who smoke tend to have worse outcomes if they get COVID-19.  There are many health professionals who can support you on your QUIT journey, such as public health, family physicians, nurses, and pharmacists. Smoker’s Helpline is an excellent free resource https://smokershelpline.ca or call 1-866-366-3667. Reaching out is the first step towards quitting.

Regardless of your age, it is never too late to quit as benefits begin within hours. As an example, within one year of quitting, the risk of a heart attack decreases by half.  At one month post quitting, skin appearance improves with less greyish tone and wrinkles lessening. Within 10 years of quitting the risk of lung cancer decreases by half compared to a smoker. Smoking also increases inflammation in the body and increases the progression of many autoimmune diseases. Our most advanced therapies work better in non-smokers. So take a moment to reflect on life as a non-smoker, and all the ways that would impact your life and those around you.  This may be the time to act!

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.

World Hepatitis Day (WHD) takes place every year on July 28th, bringing the world together under a single theme to raise awareness of the global burden of viral hepatitis and to influence real change. In 2021 the theme is ‘Hepatitis Can’t Wait’.

With a person dying every 30 seconds from a hepatitis-related illness – even in the current COVID-19 crisis – we can’t wait to act on viral hepatitis.

People living with undiagnosed viral hepatitis can’t wait for testing
People living with hepatitis can’t wait for life-saving treatments
Expectant mothers can’t wait for hepatitis screening and treatment
Newborn babies can’t wait for birth dose vaccination
People affected by hepatitis can’t wait to end stigma and discrimination
Community organizations can’t wait for greater investment
Decision-makers can’t wait and must act now to make hepatitis elimination a reality through political will and funding.

Charlton Health, along with our Hepatology Team, continues to work hard to treat and eradicate Hepatitis C in our patient population.  We ask you to consider spreading the word and encourage those around you to be tested for Hepatitis C.  No one should suffer from the complications of this disease any longer!

If you or someone you know is living with Hepatitis C, referrals can be sent to Dr. Puglia here at Charlton Hepatology Program (Fax 905-522-7477.)

Source – https://www.worldhepatitisday.org/

Jennifer Heipel has approximately 14 years of experience working as a hepatology nurse/clinical research coordinator for several gastroenterologists, hepatologists, infectious diseases and addiction specialists. She is trained in the treatment of Hepatitis B and C therapies as well as general hepatology and pre/post liver transplant follow up. Jennifer serves as Charlton Health’s full-time Hepatology Nurse and manages the Hepatology Program. She has worked and continues to work with Dr. Puglia at McMaster University and other area Gastroenterologists to develop a comprehensive, in-house Hepatology program and Hepatitis C program here at Charlton Health.

Infliximab was launched by Janssen over 20 years ago under the name Remicade.  It continues to be a biologic therapy given by infusion (IV) for many autoimmune conditions including rheumatoid arthritis, ankylosing spondylitis, psoriasis, Crohn’s, and ulcerative colitis.  In the last couple of years, a few biosimilars of infliximab have been approved by Health Canada (Inflectra, Renflexis, and Avsola).  Remsima is a biosimilar of infliximab that was launched in the United States and Europe a few years ago, and is produced by Celltrion. 

In May of this year, Celltrion launched Remsima in Canada with a newly approved dosing regimen for rheumatoid arthritis. The first 2 doses are given by infusion at week 0 and week 2, followed by self-administered injections using an auto-injector pen or syringe,  that begin at week 6 and continue every 2 weeks. This is an exciting option for rheumatoid arthritis patients.  Remsima is now listed on many private insurance plans but still is not listed as a benefit under government-based plans.

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.

We are all aware of the importance of completing both doses of Covid-19 vaccines to get the best protection.  In light of new variants, the push is on to get second doses as soon as possible. 

A recent independent study of mRNA vaccine response in patients with rheumatoid arthritis (RA) was just published on June 8, 2021, in Lancet Rheumatology.  This is a highly regarded and peer-reviewed journal.  The study included 53 patients with RA (9 received the Moderna vaccine and 44 received the Pfizer vaccine.) The study showed that compared to a control group without RA, the response after one vaccine was significantly less and a second dose was needed to offer strong levels of protection.

This is further proof that you should try to arrange for an earlier second vaccine as soon as you are able to, instead of leaving it to the larger interval that the Ontario government initially laid out. People with autoimmune conditions need to be vigilant in getting their appointments as soon as possible.  mRNA vaccines are arriving weekly at many community pharmacies.  You do not have to go to the same location for a second dose if an appointment elsewhere can be arranged sooner. If you are unsure of when you will become eligible for an accelerated second dose, have a look at our last blog!

It is very exciting to share the news that many of you with high-risk health conditions, will be eligible to receive your second dose at an earlier time. Check with your local health department about the opportunity to have your second dose sooner than you may have already been scheduled. Keep in mind, that any other vaccines that you wish to update cannot be given within two weeks before a Covid shot or one month after.

Let’s all work together to ensure that not only ourselves but also those with who we are in close contact are vaccinated. Together we can have a huge impact on reducing the burden of this virus.

Here is the current plan (click on the image to enlarge):

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 is always on the lookout for great educational resources to share with our patients. We love sharing the work that the Arthritis Society does as their programming is abundant and readily accessible. Tonight the Arthritis Society is hosting a seminar focussing on nutrition for patients living with arthritis as part of their Arthritis Talks series.

From their website…

“Featuring registered dietitian Lalitha Taylor, this Arthritis Talks will cover common questions about nutrition:

• Why is having a balanced diet so important for people living with arthritis?
• Should people living with arthritis go gluten-free or avoid nightshade vegetables?
• What small changes can people make that will make a big difference in their overall health and arthritis management?”

Register 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.

This week we are happy to share a great learning opportunity. COVID Discussions is a weekly meeting where a group of Canadian health professionals with expertise in vaccination offer weekly information sessions to answer questions from both the public and health professionals on COVID vaccination.  These health professionals volunteer their time for this excellent public service opportunity. The aim is to “provide a safe space for everyone to bring their questions about the science and social aspects of the COVID-19 pandemic.”¹ The group meets from 8-10 EST on Mondays, Thursdays, and Saturdays.

Learn more and join the discussions 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.

¹ Fong, Bensun. “COVID Discussions”. COVID-19 Resources Canada, 2021, https://covid19resources.ca/public/discussions/.

Recently I was asked if a person’s TNF level could be measured to know if a biologic that lowers TNF is a good treatment for them. I wish it was that easy! Although we can do blood tests for markers of inflammation, such as CRP (C-Reactive Protein) or ESR (Erythrocyte Sedimentation Rate), these tests do not tell which specific inflammatory substance is elevated.
We are very hopeful that pharmacogenetic testing will determine which type of advanced therapies are best suited to an individual in the future.  Currently,  it is often trial and error to find which type of therapy will offer the best result.  It is not unusual for a treatment that has been successful in a close family member to also be successful in their relative with the same autoimmune condition.

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.