Today is  Bell ‘Let’s Talk’ Day.  You have probably seen this event advertised on social media, radio, and television.  This is a day to open  the dialogue on mental illness.  One of the concerns we address at Charlton Health is the issue of mental health with relation to chronic pain.  When we are in conversation with our patients this issue often arises.  It is a well-known fact that living with chronic pain predisposes a person to depression.  We recognize this and want to open the discussion.

Bell Let’s Talk Day donations are fully funded by Bell directly based on engagement by Canadians in the cause. Bell donates 5 cents to Canadian mental health programs for each of these interactions on Bell Let’s Talk Day at no extra charge to participants:

• Every text message, mobile and long distance call made by Bell Canada and Bell Aliant customers.
• Twitter: Every tweet using #BellLetsTalk and @Healthy_Minds
• Facebook: Every view of the Bell Let’s Talk Day video.
• Instagram: Every post using #BellLetsTalk and tagged @HealthyMindsCanada
• Snapchat: Every use of the Bell Let’s Talk Snapchat geofilter

So please consider getting involved  today – raise awareness and financial support!

Learn more here.

Do you know the risk factors for contracting Hepatitis C?  Hepatitis C is a blood to blood transmitted virus that we can now cure at 95-99%.  If you have any of the following risk factors, please ask your family to test you for Hepatitis C.

1. Were you born between 1945-1975? The Canadian Liver Foundation suggests that anyone born between these years receive a simple Hepatitis C test
2. Have you received a blood transfusion or blood products prior to 1990?  This is a known risk factor for Hepatitis C as they did not know that the virus existed at that time and blood you received may have been tainted
3. Have you ever injected or snorted drugs? Even using drugs once can put you at risk for being infected with Hepatitis C
4. Was your Mother hepatitis C positive? There is a chance you could have been infected through birth.  Although the chance is low (approximately 1%, it is not zero)
5. Do you know if any of your sexual partners were hepatitis C positive?  Have you had multiple sexual partners or high risk sexual behaviors? All of these situations can put you at risk for being infected with Hepatitis C
6. Have you every received a home made tattoo or piercing? Hepatitis C blood can be found in a needle or other instruments used that have not been disinfected properly
7. Have you ever had an accidental needle stick?  If the person who was stuck with needle first is Hepatitis C positive, this could put you at risk for being infected after being stuck with their needle
8. Have you received surgery, blood products, dental work or vaccines in a country with a high prevalence of Hepatitis C? Some countries with lower economic status do have a higher rate of Hepatitis C.  If you think a country that you have received any of the above may be effected by Hepatitis C, please discuss with your Family Physician.

If you have even one of these risks factors or you have unexplained symptoms such as; fatigue, yellowing of your eyes, severe pain in the right side of your abdomen, ask your Family Doctor for a hepatitis C test.  Hepatitis C can lead to cirrhosis of your liver and liver cancer when left untreated.

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.

In our cold winter weather, many people complain of cold hands and feet with reduced circulation to these areas.  Often the skin will be whiter than normal and quickly normalizes once warmed.  Raynaud’s Phenomenon is a level beyond this whereby blood vessels constrict to a greater extent than normal as a result of cold temperatures or stress. There are three phases to the colour change of the skin. Initially, the restricted blood flood causes the skin surface to feel cold and the skin has a white colour, then the skin turns to a purple-blue colour, followed by a pink or red colour as the blood flow eventually returns.

There are prescription medications which can swallowed to promote blood flow that often cause a lowering of blood pressure.  A variety of prescription ingredients can also be prepared in a prescription cream and applied to the affected areas.  Feel free to ask our pharmacists about these options.  Raynaud’s can exist on its own or happen as a result of a pre-existing autoimmune condition.  Be sure to speak to your physician if you are experiencing the symptoms outlined above.  If severe and not treated, lack of blood flow can result and ulceration and the skin and serious consequences.

Our pharmacist Carolyn Whiskin is asked to speak at many professional conferences along with presenting at community forums for the general public. On Monday Jan. 15, Carolyn will be addressing the Men’s Probis Club in Burlington Ontario promoting the aspect of being an advocate for your health. Carolyn believes that having knowledge in how to prevent illness is of vital importance. The goal is not to just live long but to live well!! In December, Carolyn spoke at a senior’s luncheon at a local church.

Shingrix is a shingles vaccine that will offer greater protection against shingles than our current vaccine, Zostavax.  One of its advantages is that it is extremely effective regardless of the age it is administered, offering over 90% protection in those over age 70. Effectiveness of our current vaccine, Zostavax, decreases significantly when given to adults over age 70.

Shingrix will require two injections given 2 months apart.  Unlike the live vaccine, Zostavax, Shingrix isn’t a live vaccine and therefore can be given to patients who are taking immunosuppressant treatment. However, recipients may experience more redness and and skin irritation from Shingrix as it is a very immunogenic vaccine.  Therefore we are uncertain if could cause a flare in people with an auto-immune disease.

We will keep you informed of all information once this vaccine is released.  We are not yet sure of how the provincial government will respond in offering coverage of this vaccine. Currently Zostavax is provided through public health to those between 65-70 years of age.

For more information on this vaccine or any other medications, please speak to your healthcare provider.

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 lining of the nose needs  to be kept moist to prevent “cracking” of the lining of the nasal passages which can lead to discomfort and bleeding. This problem is more prevalent in our dry winter months.  Some patients who autoimmune conditions can be prone to both dry eyes and dry nose, however either can occur in many people.  Having a humidifier especially in the winter months can be helpful.  Over the counter prescription nasal gels can help and newer nasal sprays containing sesame oil can offer great long lasting protection which may be less irritating.  Some patients have found applying coconut oil to be the most effective while others prefer squeezing the contents of a vitamin E oil capsule and applying this to the lining of the nose.  Once to twice daily application is suggested to prevent nasal irritation.

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.

Dry eyes can be caused by many things: from too much “screen time” being on your computer or tablet, to auto-immune conditions. There is a 30% incidence in dry eye in people over age 50. There are three layers to the eye tears that protect our eyes; water, oil and mucous. In conditions where tears evaporate too quickly, this is often due to a lack of the oil layer. The water layer being deficient occurs in about 80% of people with dry eyes. There are now artificial tears which include an oil layer. Prescription eye drops can also offer great benefit especially when there is an autoimmune cause for the dry eye. The eye drop chosen depends on the reason for the dry eye and this can be properly assessed by an optometrist or ophthalmologist.

A helpful website to assess your dry eye is: www.dryeyedisease.ca. The Canadian Dry Eye Assessment Tool is included on this site.

Stay tuned for our next blog where we will discuss patients who suffer from dry nose and treatment options.

It is well known that even 1/2 a grapefruit or one glass of juice can reduce an enzyme called cytochrome P450 (CYP 450) by 50% for up to 24 hours.  This is important because some medications such as atorvastatin, amlodipine, carbamazepine and one of our newest medications for rheumatoid arthritis, tofacitinib (Xeljanz) need this enzyme to be eliminated from the body.  If grapefruit juice is combined with these medications, they could accumulate in the body increasing the potential for adverse effects. Therefore, it is recommended that grapefruit not be ingested with medications requiring this enzyme for processing.

Not all fruits contain furanocoumarin derivatives which seem to the culprit in affecting this enzyme. However, lab studies indicate that pomegranate, pomelo, black mulberry juice, wild grape juice, and black raspberry juice also interfere with CYP3A4. Pomegranate is now known to have as significant an impact as grapefruit.

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.

Last Thursday, the first dose in Canada of a new biologic treatment for psoriasis was injected at Charlton Health.  Guselkumab is marketed under the name of Tremfya and is approved by Health Canada for moderate to severe plaque  psoriasis.  It is given by injection using a pre-filled syringe on day 1 of treatment, followed by an injection on day 28 and a maintenance of every 8 weeks.  Guselkumab works by removing an inflammatory cytokine called interleukin 23, which is produced in excess in the skin cells of patients with psoriasis.  We are very excited to be offering this new and effective treatment at Charlton Health.

In April of 2017 a new form of hormone therapy was approved by Health Canada for women with an intact uterus.  It has already been in the United States for over a year. When giving systemic doses of estrogen for the treatment of hot flashes and other symptoms of menopause, progesterone is commonly given to block estrogen stimulating the lining of the uterus.  As some women cannot tolerate progesterone, this new product offers the benefits of estrogen with a different agent to block stiumulation to the uterus.  The additional benefit is that it also blocks estrogen stimulus to the breast.  This product is referred to as a tissue selective estrogen complex (TSEC).  It is a combination of oral conjugated estrogen and a selective estrogen receptor modulator called Bazedoxifene.  It is sold under the name of Duavive.  This offers women who are appropriate candidates for hormone therapy another option.

Our pharmacist Carolyn Whiskin is not only a specialist in the field of biologic medication but is also a certified menopause practitioner with the North American Menopause Society (NAMS).  She recently returned from the annual NAMS meeting in Philadelphia. Over the next several weeks we will be sharing some of the key learnings from this meeting. Be sure to follow our weekly blog and Facebook page for this information.