In February 2018, we started a series on how specific biologic medications work. Rituxan was the first medication presented. This was prompted by a patient asking me to express in writing what I verbally explain when someone is starting this medication.

Today we are featuring Orencia, also known as abatacept.  This medication is approved for rheumatoid arthritis.  Within our immune system are dendritic cells.  Their job is to survey the body and report any irregular cells or invaders; such as a virus or bacteria. Unfortunately, in rheumatoid arthritis, these cells generate an alert to the immune system that results in excess inflammation being made within joints; when there is no virus or bacteria present.  The goal of Orencia is to block the signalling from the dendritic cells to prevent excess inflammation from being produced.  Unlike other biologic medications, which trap and remove specific inflammatory substances, Orencia works to prevent excess inflammation from being produced in the first place.

As with all biologic medication, Orencia is composed of protein and therefore it cannot be swallowed or it would be digested in the stomach and destroyed. There is an option of receiving a weekly injectable form of this medication or an infusion that is given monthly after the loading dose at week 0, 2, and 4.  The goal of all biologic medication for rheumatoid arthritis is to achieve a level of low disease activity or remission.

All biologics used in autoimmune conditions have a risk of infection, which is a little greater than in the general public, and therefore updating adult vaccines is suggested.  This treatment is not given when a person is experiencing an active infection.  Orencia has been used safely in many patients with pre-existing medical conditions such as kidney and liver disease.

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.

People with psoriatic arthritis now have another effective biologic treatment.  We have identified more than one inflammatory chemical which is  involved in generating excess inflammation in the joints and skin of people with psoriatic arthritis.  One of these chemicals is called IL-17 (interleukin-17).  There are two treatments which remove IL-17 which were both initially approved for psoriasis only.  Of these two treatments removing IL-17, the first one released on the Canadian market called (secukinumab) Cosentyx, has also received approval for  treating psoriatic arthritis and ankylosing spondylitis.  The second IL-17 biologic released in Canada is called (ixekizumab) Taltz.  In the last two months it has received approval for treating for psoriatic arthritis. We are thrilled to add Taltz to our list of effective treatments for this condition.  Both of these treatments are available in easy to use auto-injectors and both have a loading dose, where the medication is given weekly for the first five doses (Cosentyx ) or every other week for the first seven doses (Taltz) before starting the maintenance dose of once per month.  Our pharmacists are happy to share more information on all treatment options for psoriatic arthritis.

The Ontario Nurses’ Association is proud to celebrate and acknowledge Nursing Week 2018. Nursing Week is a time to recognize the year-round dedication and achievements of Registered Nurses (RNs), Registered Practical Nurses (RPNs) and Nurse Practitioners (NPs), and to increase awareness of their contribution.

A BIG THANK YOU to our Charlton Nurses.  As frontline care providers, they work tirelessly to meet the needs of our patients from our infusion and injection clinics, to home infusions and with our Hepatitis clinic; their compassion extends to our patients’ families as well.

This week, take the time to thank our nurses for the effort, compassion, professionalism, and vital care they give. On behalf of all of us here at Charlton, we thank our nurses for their extraordinary care, dedicated service and contributions to quality healthcare.

FibroScan,® also called transient elastography, measures the stiffness of your liver by emitting a small pulse of energy. The more damaged or stiff the liver, the more rapidly the energy waves will pass through it. FibroScan® calculates the speed of this energy and gives your healthcare provider an immediate measure. Not only can exam results be used to monitor and assess liver damage, they can be used to anticipate complications as well.

What is a FibroScan® exam like?

You will lay on your back, with your right arm raised behind your head. Your healthcare provider will apply a water-based gel to your skin and then place the probe on the right side of your ribcage. You may feel a slight vibration on your skin, but it will be momentary and painless.

FibroScan® is ideal for patients who have steatosis and fibrosis in certain liver conditions, including:

Fatty liver/ Nonalcoholic fatty liver disease (NAFLD)

Nonalcoholic steatohepatitis (NASH)

Hepatitis B and C

FibroScan® should not be used if you are pregnant or have an implantable electronic device.

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.

Foods/Beverages to TRY 

• Bananas, apple sauce, canned varieties of fruit 
•  White bread, crackers made with white flour, plain cereals  
• White rice, refined pastas 
• Potatoes without the skin  
• Cheese (if you’re not lactose intolerant) 
• Smooth peanut butter 
• Bland soft foods
• Cooked vegetables  
• Broth
• Broiled or steamed fish (e.g.,herring, salmon, halibut, flounder, swordfish or pollack) 
• Canola and olive oils 
• Low-sugar sports drinks and Crystal Light® diluted with water 

Food/Beverages to AVOID  

• Fresh fruit(unless blended or juiced)  
• Prunes, raisins or dried fruit  
• Uncooked vegetables and raw foods  
• High-fiber foods (such as fiber-rich breads, cereals, nuts and leafy greens)  
• High-sugar foods 
• Skins, seeds, popcorn  
• High-fat foods  
• Spicy foods
• Beans
• Some dairy products 
• Largefood portions  
• Caffeine in coffee, tea and other beverages 
• Ice-cold liquids (even water) 

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.

Many diseases and conditions can affect the gastrointestinal (GI) tract, which is part of the digestive system and includes the esophagus, stomach, small intestine and large intestine. These diseases and conditions include inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).

Inflammatory bowel diseases are a group of inflammatory conditions in which the body’s own immune system attacks parts of the digestive system. The two most common inflammatory bowel diseases are Crohn’s disease (CD) and ulcerative colitis (UC). IBD affects as many as 1.4 million Americans, most of whom are diagnosed before age 35. There is no cure for IBD but there are treatments to reduce and control the symptoms of the disease.

Irritable bowel syndrome is a condition that affects the function and behavior of the intestines. Normally, the muscles lining the intestines intermittently contract and relax to move food along the digestive tract. In IBS, this pattern is disturbed, resulting in uncomfortable symptoms. More than 40 million people are affected by IBS. It is important to remember that patients with IBD can also have IBS.

Many people experience only mild symptoms of IBS, but for some, symptoms can be severe. Symptoms can include cramping, abdominal pain, bloating, gas, mucus in the stool, diarrhea and/or constipation. Similar to IBD, IBS is characterized by times when symptoms are present and times when little or no symptoms are present. Unlike IBD, IBS does not cause inflammation, permanent damage to the GI tract or an increased risk of colorectal cancer.

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.

Tofacitinib (Xeljanz) is a  medication which is approved by Health Canada for the treatment of rheumatoid arthritis.  It is taken as a tablet twice daily and has the same level of effectiveness as biologic therapies.  It works by entering cells that produce excess inflammatory chemicals and prevents signalling within these cells to reduce inflammation.   Tofacitinib has the same infection risk as biologic treatments and therefore updating adult vaccines before starting treatment is suggested.

Current research has shown Tofacitinib to be effective for treating ulcerative colitis.  Health Canada must evaluate this research in order to approve this medication for use in ulcerative colitis.  We are hopeful this  approval will happen by the  end of 2018.  It will wonderful to have another treatment option; stay tuned…

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.

Naloxone can quickly restore normal breathing and save the life of a person who is overdosing on opioids. In 2015, over 33,000 people died from an overdose on opioid drugs, including prescription pain relievers, heroin, and fentanyl.  Naloxone is a safe medication that is widely used by emergency medical personnel and other first responders to prevent opioid overdose deaths.

Naloxone is now available at pharmacies and covered by OHIP for use by patients.  Should you or someone you know be at risk for opiate overdose, please speak to your pharmacist for more information on how you can obtain a kit.  Training will be given and you will learn how to safely and properly administer naloxone in case of emergency.

Source.

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.

This is the second half of the blog we started last week on Fatty Liver Disease. To see Part One, click here.

How is fatty liver treated?

There isn’t a medication or surgery to treat fatty liver. Instead, your doctor will offer recommendations to reduce your risk factors. These recommendations include:

limiting or avoiding alcoholic beverages

managing your cholesterol and reducing your intake of sugar and saturated fatty acids

losing weight

controlling your blood sugar

If you have fatty liver because of obesity or unhealthy eating habits, your doctor may also suggest that you increase physical activity and eliminate certain types of food from your diet. Reducing the number of calories you eat each day can help you lose weight and heal your liver.

You can also reverse fatty liver disease by reducing or eliminating fatty foods and foods high in sugar from your diet. Choose healthier foods such as fresh fruits, vegetables, and whole grains. Replace red meats with lean animal proteins such as chicken and fish.

What is the long-term outlook for fatty liver?

Many cases of fatty liver don’t develop into liver disease. The liver can repair itself, so if you take the necessary steps to treat high cholesterol, diabetes, or obesity, you can reverse your fatty liver. If you’re a heavy drinker, stopping drinking or limiting your alcohol intake to 1-2 beverages a day may heal your liver completely. A liver biopsy can help your doctor identify permanent liver damage, as well as determine the severity of damage and the best way to treat it.

If fatty liver persists and is not reversed, it can progress into liver disease and cirrhosis. The progression to cirrhosis is dependent on the cause. In alcoholic fatty liver, continuing to drink alcohol in excess can lead to rapid development of cirrhosis and subsequent liver failure.

The progression of nonalcoholic fatty liver disease varies, but in most people it does not lead to liver scarring and cirrhosis. However, if you are diagnosed with steatohepatitis, you have a higher chance of developing scarring and liver disease. Twenty-five percent of people with steatohepatitis will develop cirrhosis within a decade.

If a fatty liver has progressed to cirrhosis, the risk of liver failure and death rises significantly.

How do I prevent fatty liver disease?

Protecting your liver is one of the best ways to prevent fatty liver and its complications. This includes drinking alcoholic beverages in moderation. According to the Centers for Disease Control and Prevention (CDC), “moderate alcohol consumption is defined as having up to one drink per day for women and up to two drinks per day for men.”

Follow your doctor’s instructions, and take medications for diabetes or high cholesterol as directed. Additionally, aim for at least 30 minutes of exercise most days of the week to maintain a healthy weight.

Source

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.