September is Arthritis Awareness Month, a month to draw awareness to the millions that are affected by this disease. This inflammatory condition can cause longterm damage to the joints in the body and ongoing pain, swelling, and stiffness. As such a common ailment, most people know someone with Arthritis and can see the toll it can take on a person.

According to the Arthritis Society, by 2035, nearly 40% more people will have arthritis than today – that’s 8.5 million Canadians. The good news is that there are so many support groups, resources, and meetings that you can call on for help. At Charlton, we specialize in treatment for Arthritis and are happy to discuss your options at any time.

Learn more about Arthritis Awareness Month here. 

As school starts back up again and the summer holidays come to an end, I would like to talk about the idea of going on a drug holiday.  This could be interpreted in a variety of different ways but what I am talking about is taking a break from our medications.  This term was made popular with some of the medications for osteoporosis.

When someone has been diagnosed with osteoporosis and starts to take a medication to stop the deterioration of the bone the big questions is: “For how long will I need to take it?” Well it will take at least a year to see some improvement in bone density and maybe even longer.  We are often pleased when we stop seeing loss of bone in a year’s time.  Every day our bones break down and rebuild to become stronger.  As we get older the breaking down process is happening faster than the rebuilding. The medications work by telling the bone to stop breaking down.   We then need to help our bones rebuild by supplying them with the right building materials such as calcium and vitamin D.  Exercise and muscular activity are like the foremen instructing the bones to grow.

There is a theory that if we tell the bones to stop breaking down for too long we may be building new bone on old weak bone which does not provide a good foundation.   This may happen if we continue to take a medication for too long. And thus, the idea of a Drug holiday is born.

A drug holiday only benefits certain people and certain medications.  The bisphosphonates are a class of oral medications often taken once weekly or one a month. Examples are Alendronate, Risedronate.   These drugs stay in our bones for a very long time.  If someone has been on one of these bisphosphates for 5 years, has seen improvement and now has a low risk of fracture, they may qualify for a “drug holiday” and may temporarily stop their medication.  While on “holiday” the drug will still remain in the bone protecting it for some time. This decision to go on holiday would need to be assessed by their doctor and reassessed annually to determine if and when they need to restart.  We don’t usually get to go on vacation forever do we?

What is very important to note is that there is another very common injectable drug for osteoporosis. It is called denosumab and it is given every 6 months at the doctor’s office.  Although the injection is given every 6 months, the medication does not stay in the bone much longer than this.  When a patient misses their injection, we start to see deterioration quite quickly.  This medication would not qualify for a drug holiday.

Whether you get to go on a drug holiday or not, let’s get out there and enjoy these last few days of the summer season.  We are bound to absorb a little more vitamin D and those muscles will tell our bones to start growing.

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. 

Jennifer Heipel would like to introduce Shelter Health Network to the Charlton Health family.  The recent collaboration that was made will allow services such as: Outreach workers, Case workers, Community HCV Nurse and a Hepatitis C Peer Group for all hepatitis C patients.  We look forward to working with them and offering both existing as well as new patients these amazing services that can be offered!  A peer group for Hepatitis patients will allow people to both understand and discuss the treatments that will be offered with those who have actually undergone therapy for Hepatitis C.

For more information, please view the attached flyer: Hep C Peer Support Group

Jennifer Heipel has approximately 12 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.

Experts in women’s health now refer to a “window of opportunity” in regards to when to start menopausal hormone therapy (MHT). The consensus is that hormones are best started around the time of entering menopause. For some women this may mean they are in the late stages of perimenopause when cycles become more infrequent. Estrogen has a protective effect on blood vessels and the heart and when estrogen falls after menopause, this protection declines. Restoring estrogen needs to happen before changes to the blood vessels occur. Once ten years has passed since the last menstrual period, it is not recommended to initiate hormone therapy. If estrogen is added to blood vessels that have signs of damage, it can produce more harm than benefit and increase the risk of heart attacks or stroke.

Once hormone therapy is started, there is some evidence to suggest that stopping it prematurely before the age of 60 can increase heart disease risk, reiterating that there is no need to stop MHT after five years of therapy as was thought in the early 2000’s.

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.

In our last blog, we mentioned the many benefits of estrogen. This week we will address one of the main concerns women have when considering menopausal hormone therapy (MHT): breast cancer. Dr Robert Reid (Queen’s University in Kingston) spoke at the International Menopause Society Meeting in Vancouver in June. He helped put the risk of breast cancer into perspective.

This risk is thought to be insignificant in the first 5 years of hormone use. When compared to other lifestyle risks such as: being overweight, stress, smoking, alcohol use, late menopause, not having children, and not breast feeding, MHT has the lowest risk. If the use of MHT provides benefits such as reducing hot flashes or improving sleep and mood, then stress will be greatly reduced which can reduce the risk for breast cancer. The most significant risk a woman has once reaching menopause is heart disease. More women die of heart disease than all types of cancer combined; when started within the first 10 years of menopause, hormone therapy has a heart protective effect.

Each woman needs to be assessed for individual risks when deciding if MHT is appropriate. A 10-year Danish registry of patients showed that women using hormone therapy had fewer causes of death than those who did not use MHT. Something to seriously consider…

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 impact of estrogen levels falling as women enter the menopausal transition is well known. At the International Menopause Society Meeting, the full extent of the impact on the body was discussed. Here are some of the changes that occur throughout the body when estrogen falls:

• Memory: a decrease in neuronal protection (nerves die off faster in the brain without estrogen) leading to a decrease in cognitive speed and verbal memory of 4.9% over the first 10 years from menopause
• Mood: increase in depressive symptoms especially in the 2 years before the last period and 2 years after
• Sleep: Decreased sleep quality (not only due to night sweats) is seen in 80% of women
• Body Temperature: temperature dysregulation resulting in hot flashes and night sweats along with greater cold intolerance
• Bone Quality: decreased bone density beginning with the vertebrae in early menopause with greater loss in cortical bone (hip) later in menopause
• Pain: joint inflammation is increased leading to greater osteoarthritis and reduced subchondral bone repair.
• Vaginal Dryness: the vaginal lining atrophy leading to dryness in 43% of women by age 61 and 32% of women abstaining from intercourse
• Bladder Control: 67% of women having a change in bladder routine and 47% having stress incontinence (laughing or coughing and leaking). ¾ of women have some degree of urinary incontinence.
• Cardiovascular Disease: blood vessels become less reactive and and dilate less. In addition, LDL (bad cholesterol) begins to increase in perimenopause and HDL (good cholesterol) begins to decline. In fact the lower the estrogen level and the higher the FSH, the greater the risk for atherosclerosis (cardiovascular disease).

It is because of these health risks that estrogen supplementation is recommended for many women. Of particular interest is our many patients who suffer from autoimmune diseases where their inflammation is already high, leading to greater cardiovascular risk. Transitioning into menopause can be very difficult as inflammation can be further increased, leading to greater pain and stiffness. The concern many women have is regarding estrogen stimulating breast tissue and when the appropriate time is to start treatment. Our next blog will look at estrogen’s impact on the breast.

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.

After attending the International Menopause Society Meeting in Vancouver, our pharmacists Kerry and Carolyn were very pleased to see that an app has been developed for patients to have a better understanding about what they can expect during the menopause transition and the treatments available. This app is called ‘Menopause Health Tracker.” The International Menopause Society uses the highest level of evidence in providing quality information for the public and health professionals. It is an excellent resource.

Women are often hesitant to discuss menopausal symptoms with their health care provider, especially regarding intimacy. Many women feel their changes are part of aging and there is no help for them. It is our hope that this app encourages women to seek help as quality of life is vital.

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.

Carolyn Whiskin and Kerry Roberts, two of our pharmacists at Charlton, have just returned from the International Menopause Society Meeting in Vancouver. They are both Certified Menopause Practitioners and were very proud to be attending, as this is the first time this meeting has been hosted in Canada. Presenters from around the world shared their research and many new treatments not yet available in Canada were discussed.

One of the first areas discussed was the amount of menopausal hormone replacement prescribed to patients. Although up to 46% of women go to their health professional with menopausal complaints, only 10% or women receive hormone replacement therapy. This is in part due to the lack of awareness surrounding the most recent evidence: that the benefits of hormone replacement outweigh the low level of risk. IMPART is an online series of educational modules for health professionals designed as a refresher course in the treatment of peri-menopausal and menopausal women. It was launched at the conference and is available through the International Menopause Society’s website at no charge. Experts from around the world wrote the content which will updated on a regular basis. We invite you to share this information with your healthcare practitioners.

We will be sharing some of the information learned at this meeting over the next few weeks.

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.

Saturday July 28th is World Hepatitis Day. The main goal of World Hepatitis Day is to help gain awareness around diagnosing the nearly 300 million people living with viral hepatitis that aren’t aware.

Mark Your Calendars: On Friday July 27th, the Charlton Health Hepatitis C Team will be at Gore Park alongside colleagues and other healthcare providers to provide information, testing, and enjoy some entertainment.  We will be there from 11am to 2:30pm – this is a date you won’t want to miss!

July 23rd is World Sjögren’s Day, a day meant to put a face on the millions of people who live with this disease or suffer from symptoms and have yet to be diagnosed. What is Sjögren’s syndrome? It is an autoimmune condition where glands in the mouth and eyes have a decreased production of tears and saliva which can cause significant distress. Learn more in our past blog.

For our many patients suffering with Sjögren’s we acknowledge this special day to draw awareness to this condition.  As research continues to evolve in this area we are happy that there is a new prescription eye drop for dry eyes that was recently released.  It is called Xiidra (lifitegrast) and it is used twice daily.  If you suffer with dry eyes and are not being managed well with your current eye drop, speak to your ophthalmologist about this new medication.

If you wish to donate to research surrounding Sjögren’s syndrome, please visit this donation page.