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.

The liver is the second largest organ in the body. Its function is to process everything we eat or drink and filter any harmful substances from the blood. This process is interrupted if too much fat is in the liver. Fatty liver is when fat accounts for more than 5 to 10 percent of your liver’s weight.

What are the causes of fatty liver?

The most common cause of fatty liver is alcoholism and heavy drinking. In many cases, doctors don’t know what causes fatty liver in people who don’t drink much alcohol.

Fatty liver develops when the body creates too much fat or cannot metabolize fat fast enough. The excess fat is stored in liver cells where it accumulates to form fatty liver disease. Eating a high-fat, high-sugar diet may not directly result in fatty liver, but it can contribute to it.

Besides alcoholism, other common causes of fatty liver include:

• obesity
• hyperlipidemia, or high levels of fats in the blood
• diabetes
• genetic inheritance
• rapid weight loss
• side effect of certain medications, including aspirin, steroids, tamoxifen (Nolvadex), and tetracycline (Panmycin)
• high Blood pressure

What are the types of fatty liver?

There are two basic types of fatty liver: nonalcoholic and alcoholic.

Your doctor may use an ultrasound to detect fat in your liver. The fat will show up as a white area on the ultrasound image. Other imaging studies may also be done, such as CT or MRI.

Pharmacy Awareness Month is the perfect time to celebrate pharmacists’ expertise and the important role they play in delivering quality care to patients! Many people are unaware of the many places where pharmacists make a difference in the health care of Canadians.   Pharmacists are the most accessible health professionals and are  counted on for advice on their prescription, non-prescription and herbal treatments. Understanding how medications work, adverse effects to watch for, and interactions between medications are some of the areas where pharmacists educate patients.  In addition, pharmacists advise on vaccinations as well administering them and provide consultation services in helping people quit smoking.

What many people don’t know is the areas of specialization that some pharmacists have developed, such as diabetes education, women’s health, geriatric specialization, oncology, auto-immune diseases, and more.  Pharmacists work in hospitals, family health teams, the pharmaceutical industry and in academia doing research and educating students.  As health professionals, pharmacists are dedicated to being life long learners.  As part of their licence to practice pharmacy, each pharmacist must maintain a learning portfolio of all their educational activities and establish annual learning goals. Most pharmacists graduating today, have had 7-8 years of university education along with a year of internship prior to writing their licensing exams.

This week on our #WiseWordsWednesday blog, we’re excited to bring you some information on some upcoming patient seminars that we think will be useful to you.

Inflammatory Arthritis Info Sessions are held regularly by Registered Allied Health Care Professionals with Rheumatology experience. These FREE sessions are right for you if you suffer from Rheumatoid Arthritis, Psoriatic Arthritis, or Ankylosing Spondylitis. The next sessions are:

Part 1: March 22nd, 3-5PM
Part 2: March 27th, 3-5PM

Ankylosing Spondylitis
May 22nd, 6:30-8:30PM

For more information and to reserve your FREE spot, contact Dianne Freeman at dianne.o.t@gmail.com or 416-523-2995.

As a pharmacist working in the field of biologics, patients often comment on how they appreciate  the way I describe how each medication works in the body.  Recently,  I was asked to put in writing what I had verbally explained about the medication rituximab (Rituxan).

I am sharing that with you in the blog today and will continue to write a series on different medications used in auto-immune diseases.  Feel free to put in requests for medication you would like explained as I have done below.  Stay tuned…