Falls, bones, and bleeds

Posted on December 11, 2019 by admin

Falls are very serious as we age and our bones aren’t as a strong. A break of an osteoporotic bone has far more consequences than breaking a healthy bone. The body is under extreme stress after such a fracture such that death rates the year following are significant – often due to pneumonia.

The other risk of falls is having a bleed within the brain when hitting your head. The use of blood-thinners to prevent heart attack and stroke can be very effective but must be balanced agains the risk of bleeding. Taking low dose Aspirin is not recommended for everyone! You must have specific risks to merit its use. Prescription blood thinners are appropriately used to prevent strokes in people who have atrial fibrillation, post cardiac surgeries and after surgeries such as hip and knee replacements. The dose and amount of time needed to stay on these treatments varies with the condition. Be sure to check with your health practitioner.

In addition, be aware that several supplements and over the counter products can increase bleeding, including in the gastrointestinal tract. Ensure you check with your pharmacist before purchasing any over the counter product when you are taking a blood thinner. Some prescription medications can also increase fall risk and therefore, their use should be minimized. Be sure you have proper foot wear in the cold days ahead and use an appropriate walker/cane if needed for stability.

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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Atopic Dermatitis

Posted on December 4, 2019 by admin

Atopic Dermatitis is commonly referred to eczema. Of the people with this condition, 85% start in childhood and 25% of those will continue to have flares throughout adulthood. 90 % of cases will be mild to moderate. The areas of skin effected can include the face, scalp and neck, with greater involvement in adulthood in areas of flexion (inside the elbows and behind the knees) as well as hands and ankles. The intense itch that accompanies the the red irritated skin has a large impact on quality of life, causing sleep disturbance, anxiety and depression.

The condition is as a result of genetic factors leading to a defect in the skin barrier allowing allergens, bacteria and viruses to penetrate through the skin. This generates an immune response causing excess inflammation along with histamine release. When not treated well in young children, this sensitization referred to as atopy, can lead to the development of asthma and allergic rhinitis.

Treatment strategies include twice daily application of a perfume-free moisturizer (vaseline works well along with moisturizers certified by the Canadian Dermatology Association). Using warm baths and showers, soapless cleansers, humidifiers and avoiding food triggers can all be helpful. Antihistamines can reduce the itch. Scratching is not helpful as it will trigger further inflammation and promote more itch.

Low dose topical steroid creams/ointments such as hydrocortisone 0.5-1% can be used sparingly on the face and in folds while higher dose prescription steroid products can be used on other areas of the body. Prescription products Elidel and Protopic are calcineurin inhibitors that can be used on the face (including eyelids) and all over the body. They suppress the immune response in the skin. The newest ointment is a prescription product called Eucrisa, which inhibits an enzyme called PDE-4, thereby reducing the production of inflammatory substances. It is not immunosuppressive like the calcineurin inhibitors and does not thin the skin as steroid creams can do over time. It can be used anywhere on the body including eyelids. This is a very exciting addition to our topical treatments. All creams and ointments mentioned are used twice daily and may require several weeks of regular application before the skin is completely clear. Some may cause a burning sensation which commonly goes away after a few days of use.

For severe atopic dermatitis there is a biologic therapy available that is given by injection. It blocks receptors on the outside of the cells that produce inflammatory chemicals. It is called Dupixent.

As cold weather approaches, be sure to moisturize heavily, use your humidifier and avoid extreme temperatures that can increase the risk of a flare.

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Have you received your flu shot yet?

Posted on November 27, 2019 by admin

The flu shot arrived in Ontario pharmacies a little later this year. The choice of which strains of influenza would be picked for each year‘s vaccine is based on the circulating influenza viruses on the other side of the world. Information collected from Australia is very helpful in determining which strains we include in our vaccine each year. There was some uncertainty as to the best selection for our North American strains and this resulted in a delay.

The flu shot available throughout Ontario pharmacies is the standard dose vaccination which includes four influenza virus strains. Ideally, for people age 65 and over, the high-dose vaccination is preferred as it offers better efficacy without increased adverse effects. The high-dose vaccine is only available through family physician offices.

If you are age 65 or older, it is suggested that you contact your family physician to see if they have any high dose vaccine available. There may not be enough high-dose vaccine for all people over 65 years of age. For this reason, family physicians have to prioritize the people at highest risk of infection to receive it. If there is none available, it is still worthwhile having the standard dose flu shot either through your family physician or community pharmacy.

Neither flu shot is live and therefore it is safe to receive the vaccine while on biologic therapy.

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Looking Back: Beating the Winter Blues

Posted on November 20, 2019 by admin

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.

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Looking Back: Managing Methotrexate Adverse Effects (Part 3)

Posted on November 13, 2019 by admin

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.

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Looking Back: Managing the Adverse Effects of Methotrexate

Posted on November 6, 2019 by admin

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…

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Public Pain Forum this Sunday

Posted on October 30, 2019 by admin

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

Public Forum - Poster 2019-Poster

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Looking back: Is Folic Acid Needed With Methotrexate?

Posted on October 23, 2019 by admin

This week on our #WiseWordsWednesday blog we’re continuing to look back at some of our most popular blogs. Today, we’re focusing on our blog about taking folic acid alongside methotrexate. This continues to be a question we get all the time, so we thought we would share it with you today!

Here is the original post…

Is Folic Acid Needed With Methotrexate?

Methotrexate is a medication used in low weekly doses in the treatment of many autoimmune conditions, from rheumatoid arthritis to psoriasis to inflammatory bowel disease. One way methotrexate works is by decreasing the production of folate. For this reason, folic acid supplementation is used to offset possible adverse effects. If too much folic acid is taken, it could decrease the effectiveness of methotrexate and if not enough is taken, there is a greater chance of nausea, mouth ulcers and changes in liver function tests. The amount suggested ranges from 5 mg a week up to 5mg everyday except the day methotrexate is taken.

If you are experiencing adverse effects from methotrexate and are taking a low dose, you may wish to speak to your specialist about the way you take folic acid. Another option is to use the prescription medication folinic acid instead of folic acid. It is the “activated” form of folic acid and is more costly. As up to 20% of patients cannot process folic acid into the active form, folinic acid can be a good alternative. In people who make this conversion, folinic acid doesn’t offer better protection against adverse effects but in others it could make a difference. It is generally taken as 5mg once weekly.

Stay tuned for next week’s blog when more strategies for reducing potential fatigue from methotrexate will be discussed…

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Looking Back: Which foods are inflammatory?

Posted on October 16, 2019 by admin

As we’ve been doing over the past few weeks, today for our #WiseWordsWednesday blog, we’re looking back at some of our more popular blogs from over the years. As the seasons change and we start to eat higher amounts of comfort foods, we thought it would be a great time to look back at which foods are found to be inflammatory. Inflammatory foods can sometimes impact those that live with inflammation-based illnesses, such as arthritis.

Here is the text of the original article:

As health professionals, we are often asked about the role inflammatory foods play in reducing inflammation throughout the body. The natural body fluids in a healthy person are alkaline (high pH) and are found to be more acidic in those who are ill (low pH). The pH scale is from 1 to 14, with 7 being considered neutral. Numbers above 7 are considered acidic and numbers below 7 are referred to as alkaline.

Some people who have chosen foods in their diet which are not acidic have noticed a difference in their pain, while others have not found a difference.

Foods that have the greatest acidity include: soybean, hazelnuts, walnuts, brazil nuts, barley, beef, lobster, processed cheese, ice cream, beer, sugar, cocoa and white vinegar. Foods that are the least acidic (alkaline) include lime, nectarines, raspberries, watermelon, lentils, yams, onion and pumpkin seeds. For those interested in seeing a chart of these foods, Charlton Health is happy provide one to you.

Keep in mind this does not replace researched treatments and may not be effective for everyone. Reducing sugar intake and eating a well balanced diet with omega-3 fish oil and limited processed foods is always suggested.

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Osteoporosis Specific Exercise Program

Posted on October 9, 2019 by admin

Bonefit is a program that was designed by health professionals in cooperation with the Osteoporosis Society to “reduce fractures, morbidity, mortality and costs from osteoporosis through an integrated and comprehensive approach aimed at health promotion and disease management.”¹The program has three self directed modules and a workshop component. Specialists in rehabilitation medicine must complete a certification course to be instructors. The Bonefit website lists where instructors can be found anywhere in Canada. There are several in southern Ontario in a range of settings, from private clinics to the YMCA.

Learn more about this program by contacting:
Phone: 416-696-2663 ext. 2290
Email: bonefit@osteoporosis.ca

Maintaining the goal of 150 minutes of exercise per week is important for all Canadians. However, doing it in a way that is safe and offers your the most benefit is important. Using this resource can help you make sure any exercise you’re doing is done safely.

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