Recently I have had people come into the clinic who started on a new medication months prior and persevered with very difficult adverse effects of nausea, fatigue, and headache that were affecting their quality of life. Although most of our medications have a very low incidence of these adverse effects, when you do find that a medication doesn’t agree with you, it is essential that you consult your healthcare professional about ways to manage the adverse effects and to verify if what you’re experiencing is likely due to the medication. In many cases, disease modifying treatments for autoimmune inflammatory conditions are prescribed and then assessed for their full effectiveness three months later. It is important to not suffer for three months if you are experiencing unpleasant side effects but rather call for guidance as a new medication could be ordered to replace the one you are taking or dosage adjustments made.

• Eat fresh non-processed foods with low sugar content
• Drink plenty of water daily (often start with full 8 oz glasses right after you get up to start your day and continue to carry a water bottle with you, drinking often)
• Keep moving; regardless of limited mobility (we’re happy to help with ideas), 150 minutes/week of exercise is so important for overall well being (hot pools, mall walking in the cold weather, chair fitness are all options)
• Spend time with people that make you feel good; human contact and socialization are vital
• Get plenty of rest; 7-8 hours of sleep is important in reducing body stress, repairing tissue, decreasing pain, improving mood, and energy to name a few

We wish you all the best in the new decade!

It is not a surprise that special occasions create both good and bad stress. For some these are happy times spent with friends and family, and for others it can be a very difficult time of year. Regardless of this, managing stress is important. Our body produces cortisol in response to stressors and excess cortisol production translates into increased inflammation in the body. For many conditions where high inflammation causes flares, this can very difficult as not only is the person stressed, but they are also flaring.

So, as we enter into this holiday season filled with busy schedules and many expectations, remember to look after yourself, take some deep breaths and try to enjoy the moments rather than getting overwhelmed.

We wish everyone all the best for the season however you choose to celebrate.

Today we continue our “Looking Back” series with one of our most popular blogs, “Beating the Winter Blues.” It seems pretty appropriately timed, too!

Here is the original post…

We know winter can be tough on a lot of people. Here are some tips on beating the winter blues…

Keep active

Research has shown that a daily one-hour walk in the middle of the day could be as helpful as light treatment for coping with the winter blues.

Get outside

Go outdoors in natural daylight as much as possible, especially at midday and on brighter days. Inside your home, choose pale colours that reflect light from outside, and sit near windows whenever you can

Keep warm

If your symptoms are so bad that you can’t live a normal life, see your family doctor for medical help. Being cold makes you more depressed. It’s also been shown that staying warm can reduce the winter blues by half.

Keep warm with hot drinks and hot food. Wear warm clothes and shoes, and aim to keep your home between 18C and 21C (or 64F and 70F degrees).

Eat a healthy diet

A healthy diet will boost your mood, give you more energy and stop you putting on weight over winter. Balance your craving for carbohydrates, such as pasta and potatoes, with plenty of fresh fruit and vegetables.

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See the light

Some people find light therapy effective for seasonal depression. One way to get light therapy at home in winter is to sit in front of a light box for up to two hours a day.

Light boxes give out very bright light at least 10 times stronger than ordinary home and office lighting. Some people find that using a dawn simulator [a bedside light, connected to an alarm clock, that mimics a sunrise and wakes you up gradually] as well as a light box can enhance the beneficial effect.

Take up a new hobby

Keeping your mind active with a new interest seems to ward off symptoms of SAD. It could be anything, such as playing bridge, singing, knitting, joining a gym, keeping a journal, or writing a blog. The important thing is that you have something to look forward to and concentrate on.

See your friends and family

It’s been shown that socializing is good for your mental health and helps ward off the winter blues. Make an effort to keep in touch with people you care about and accept any invitations you get to social events, even if you only go for a little while.

Talk it through

Talking treatments such as counselling, psychotherapy or cognitive behavioural therapy (CBT) can help you cope with symptoms.

Join a support group

Sharing your experience with others who know what it’s like to have SAD is very therapeutic and can make your symptoms more bearable.

Seek help

If your symptoms are so bad that you can’t live a normal life, see your family doctor for medical help.

Evelyn Gilkinson is the Nurse Lead for Charlton Health Inc. Before devoting herself solely to Infusing Biologics, Gilkinson worked at Toronto General Hospital, Flinders Medical Centre (Adelaide, Australia), and the London Health Science Centre in Thoracic Step Down, neonate, pediatric and adult Intensive Care, Recovery Room, and Emergency Medicine. Evelyn has done research for The Canadian Cervical Spine Study and with the AIM Health Group. She established the first out-of Hospital Infusion Centres in London and Waterloo. For the last twelve years, Evelyn was the Nurse Supervisor for South Western Ontario for many infusion sites until joining the Charlton team in the summer of 2016.

This week we bring you the last in our “Looking Back” series on methotrexate. We continue to look at managing methotrexate adverse effects.

Here is the original post from 2017…

In our last two blogs we discussed the importance of folic acid supplementation while on methotrexate,  and the use of dextromethorphan (DM) to reduce the potential “sick day” phenomenon which some people experience the day after taking methotrexate.  In this blog,  I am addressing strategies to avoid nausea that is associated with methotrexate use in some patients.  Of great importance is the use of folic acid as was mentioned earlier.

In addition, methotrexate can be given as a weekly injectable dose instead of swallowed tablets.  This avoids contact with the stomach and reduces nausea.  The injectable is available in three ways.  1. A vial where patients draw up their dose in a syringe,  2. a pre-filled syringe,  3. an auto-injector device (newly available in Canada).  Currently only the first option is a benefit under government based insurance where the other options may be a benefit under private insurance.  The injectable also provides excellent absorption and may be a more effective treatment than the tablets which aren’t as efficiently absorbed.

For patients using tablets, splitting the dose over the day the methotrexate is taken will reduce stomach upset and allow for better absorption.  The maximum number of tablets that can be absorbed at any time is 6.  Doses higher than this need to be split over the day, even if there is no nausea (ie. if you take 8 tablets weekly; swallow 4 after breakfast and 4 tablets after your evening meal on the same day).

It is important to note that many patients using methotrexate experience no adverse effects.

A couple of weeks ago, we looked back on folic acid and methotrexate. At the end of that blog, we referenced today’s “Looking Back” blog, “Managing the Adverse Effects of Methotrexate.” In keeping with our series on some of our most popular blogs and those that we receive questions about regularly, we’re looking back on this one today!

Here is the original post…

Managing the Adverse Effects of Methotrexate

In our last blog, we looked at the role of folic acid and its importance when taking methotrexate. Even though folic acid reduces the adverse effects of methotrexate and is needed, it may fall short in managing the fatigue (or what some call their ‘sick day’) the day following their dose. Methotrexate is known to inadvertently stimulate a part of the brain referred to as the NMDA receptor. Dextromethorphan blocks this receptor and therefore can reduce the tiredness and foggy thinking that some people complain of after taking methotrexate.

An easy way to get the benefits of dextromethorphan, and combat this foggy thinking and fatigue is through taking DM Cough Syrup, which is readily available and can be purchased over the counter at any pharmacy. The suggested dose is two teaspoons twice daily the day before, day of, and day after taking methotrexate. While this tip is not commonly known, it was shared at past Ontario Rheumatology Association Conference by Dr. Jack Cush, a well respected American rheumatologist who uses this approach regularly.

Stay tuned to next week’s blog on options for methotrexate dosing…

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.

Many people in Canada live with chronic pain every day. National Pain Awareness Week is being acknowledged next week and we are involved with a public education forum on Sunday afternoon in Burlington, Ontario. There will also be an educational day on Wednesday, November 6 for health professionals to attend. Our pharmacist, Carolyn Whiskin, has been a speaker at many public pain forum events in the past. She will again be sharing her expertise this Sunday alongside many other knowledgeable health professionals. We encourage anyone living with chronic pain to attend this complementary educational afternoon.

Chronic Pain Public Forum
Sunday November 3, 2019
2-6PM
Burlington Seniors Centre, 2285 New Street, Burlington
FREE