One of the sessions at the Canadian Rheumatology Association meeting held last month focused on the Association’s recently created Position Statement on the use of Medical Cannabis in Rheumatic Disease. Patients seen by rheumatologists who report using cannabis, indicate pain as being the most common reason for using medical cannabis, however there are no trials and limited information on its’ use  for this patient group. Recognizing that better pain control is needed and the fact that this drug is now legal in Canada, it is necessary to address this issue. It is important to recognize that medical cannabis is not a replacement for disease modifying therapies prescribed by rheumatologists that prevent the progression of conditions such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Many other modalities for treating arthritis such as physiotherapy are part of the foundation for joint health. Cannabis would be seen as an additional therapy to augment evidence based treatments.

With that in mind, the recommendation is that medical cannabis be avoided in patients under 25, as neurological development continues into the early 20s. Use before this age may impact brain maturation, and has an impact on lifetime achievement. The product chosen should have a low THC to high CBD ratio.   It is important that smoking/edibles are avoided as oil is preferred to avoid harm to the lungs and to offer a uniform reliable amount per dose. There is not one ideal ratio as each person’s response can be different, so starting with low doses and gradually increasing the amount is suggested. Most people will use 1-3 grams/day. It important to try both prescription and non prescription methods to relieve pain prior to trying medical cannabis, as the long term effects of medical cannabis for this patient group are unknown. The use of opioid pain killers is not suggested for treating arthritic conditions.

For more information, please see the Canadian Rheumatology Association Position Statement on Medical Cannabis Use in Rheumatic Disease January 2019.

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.

A common misconception is that arthritis only affects adults. Although about 24,000 Canadian children are currently living with some form of arthritis.  Here are some resources for children who are currently living with arthritis.

Brittany Cook is a 4th year pharmacy student completing one of her final rotations at Charlton Health. During her schooling has been extensively involved in arthritis care. She has participated in pharmacy practice research and is the recipient of various awards and scholarships.

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.

Brittany Cook is a 4th year pharmacy student completing one of her final rotations at Charlton Health. During her schooling has been extensively involved in arthritis care. She has participated in pharmacy practice research and is the recipient of various awards and scholarships

The current biopsychosocial model approach to manage pain in rheumatoid arthritis seeks to address the reality that pain has a biological, psychological, and social aspect. In addition to the objective physical pain felt by the patient, there is a subjective component involving the experience of the patient and a social aspect that relates to their experience of pain within society. Looking at pain through the lens of this model makes it far likelier that the chronic pain patient can experience relief. This model looks beyond analgesic (pain killers) use alone to focus on goal setting, challenging negative thoughts, self- management, and non -pharmacological ways to improve pain. It expands the scope of pain management to include acupuncture, massage, hydrotherapy, splints, proper shoes, assistive devices, orthotics, knee sleeves, protection, positioning, motivational interviewing, education, rest, graded activity, and exercise.

It is recommended to exercise 150 minutes per week for all Canadians and the patient with rheumatic disease is no exception; only the type of exercise may need to be modified.  Patients living with arthritis need to learn the difference between hurt and harm. It may be best to start with the least anxiety provoking activity, or to start with exercising a non-affected area of the body. There will often be some hurt before there is benefit.

Utilizing the expertise of a physiotherapist who has experience with RA is an excellent place to start!  The Arthritis Society also has physiotherapy resources available.  Charlton Health has compiled an excellent resource list, which will be featured on a future blog.  Don’t hesitate to ask us for a copy.

Janice Maretzki is a pharmacist at Charlton Health who recently attended the Canadian Rheumatology Association meeting in Montreal.

Our pharmacists Carolyn Whiskin and Janice Maretzki recently attended the Canadian Rheumatology Association meeting in Montreal. Charlton Health was very proud to have been selected to present our practice research project at this meeting. A large poster outlining the project is on display in our Hamilton office.

The objective of the project was to improve patient confidence and understanding of their disease and treatment through a pharmacist led consultation prior to initiation and choice of treatment of an advanced therapy such as a biologic. Patients were toured through our infusion clinic, shown all the self injection devices and were educated on the newest oral therapies. In addition, vaccines were updated, insurance status evaluated and smoking cessation counselling offered. The patients were then asked which treatments they would feel most comfortable taking. A report was then sent to their referring physician.

The results of this project were that patients understanding of their disease increased by 33% and understanding of their treatment increased by 187%. On a scale of 1-4, confidence and understanding of their treatment increased from an average score of 1.66 to 3.88 after the visit with the pharmacist.

A second phase of this project is now underway.

Highlights of this conference will shared in future blogs… stay tuned for more!

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 year the Canadian Pharmacists Association is focusing on the public taking a ‘rethink’ of the role of the pharmacist and the impact they have on health care.  There are over 41,000 pharmacists in Canada. They are the most accessible health professional available to you.  From counselling on medication interactions to ensuring the correct dosage of a medication is being used and taken in the correct way– pharmacists manage all your medication needs.  In many cases, pharmacists suggest the discontinuation of a medication that is not providing benefit just as they suggest medications to help treat a problem that is not being managed.  The integration of natural products with prescription medications is often challenging and pharmacists can advise on these combinations; always considering the benefits of therapy compared to the risk.

Helping patients quit smoking is one of the most rewarding services a pharmacist can provide as it is the best thing a person can do for their own health. Pharmacists can prescribe medications for smoking cessation and offer strategies to promote successful quitting.

Vaccination consultations and administering vaccines is another vital role that pharmacists play in preventing disease.

Our Charlton Health pharmacists are well versed in a  multitude of areas including:

• medication management and compliance
• smoking cessation
• vaccination
• treatments for autoimmune and rare diseases
• specialty medications for liver disease

Our pharmacists travel to conferences throughout the world to enhance our education and also engage in research to promote better patient care.

Learn more about the pharmacist’s role in healthcare here.

#rethinkpharmacists

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 Friday, March 8th is International Women’s day upon us. Around the city there are a number of events being planned to celebrate women. One such event taking place at McMaster University is the conference entitled “Women & Their Microbes”. An international conference looking at the microbiome or community of micro-organisms living in our body. Medical Clinicians will be sharing and learning how to help pregnant women manage these micro-organisms which can have an impact on the health of mom and baby.

The two-day conference wraps up with a FREE event for the Public.

“Love your Bugs! The female microbiome and prevention of disease”

When: March 7^th 2019 7pm-9pm (doors open at 6:30pm)
Where: David Braley Health Sciences Centre Auditorium
McMaster University, 100 Main St W Hamilton

Celebrate the women around you this week. Think of those who may benefit to learn about the female microbiome and pass on the details of this free event.

Kerry Roberts has practiced pharmacy in the Halton and Hamilton Regions for 14 years, and recently joined the Charlton Health Pharmacist Team. Kerry specializes in various areas of pharmacy, such as diabetes, medication scheduling and education, compounding, and smoking cessation. She is a Certified Menopause Practitioner with the North American Menopause Society. 

As Valentines Day was celebrated last week, we thought it would be good to take time to  reflect on the importance of loving your own heart. Many chronic diseases can increase the risk of heart attacks, including: diabetes, high blood pressure and many types of inflammatory conditions such as rheumatoid arthritis, psoriasis, psoriatic arthritis, and ankylosing spondylitis.  Women are at increased risk of heart disease after menopause as estrogen plays a heart protective role.  The most valuable thing anyone can do to reduce heart disease is quit smoking.

No medication can replace the value of eating well and regular exercise (at least 150 minutes/week).  Knowing the signs of a heart attack (chest pain/pressure, sweating, nausea, upper body pain (jaw, arm, back), light headedness and shortness of breath) is very important as treatment is the most effective when acting quickly.  Remember that women don’t always experience chest pressure with a heart attack.  The first step is to call 911, stop all activity and sit or lie down, use nitroglycerin if available to you, chew two 81mg ASA (Aspirin), rest, and wait for help to arrive and keep a list of your current medications available for emergency responders.

Click here for more information on heart and stroke prevention.

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.

• light in weight
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