In the area of treating autoimmune conditions where inflammation is high, biologic treatments have been revolutionary in offering patients the potential to achieve a very low level of disease activity, if not full remission.  These biologics are targeted at removing or decreasing the production of specific inflammatory substances.

Currently we have five biologic medications that decrease the inflammatory substance TNF, two that reduce interleuken-6 (IL-6), and one that reduces interleuken 12 &23.  The newest additions in treatment reduce IL-17.  Newer treatments that can work as well as biologic therapies are not made of protein, as our biologic medications are. These are “small molecule” medications that can be swallowed and are able to enter the cells that make inflammatory substances to reduce their production. Currently there is only one medication on the market in this category called, Tofacitinib.  This type of treatment is only approved for Rheumatoid Arthritis, however many other conditions are being studied and more of these swallowed options are on the horizon.

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.

At a recent conference of the American College of Rheumatology, research was presented regarding the incidence of sleep apnea in people with rheumatoid arthritis.  Many people complain of poor sleep who  have arthritic pain.  Joint problems and finding a comfortable position during sleep are often the cause.  However, it has been found that cartilage changes can contribute to the airflow in the nasal passages which can result in sleep apnea and therefore people with rheumatoid arthritis experience sleep apnea at a greater rate than the general public.  As a result of having sleep apnea,  a person can waken feeling less rested and not be aware of the reduced oxygen they are receiving while they are sleep.

If you are having difficulty sleeping and feel unrested when you waken, ask your doctor about referring you for a sleep apnea assessment.

As health care professionals, we are always so quick to point out the DON’Ts in approaching life with illness.  Here is Gunnar Esiason’s “common sense approaches to living life with a chronic illness that everyone can find useful.

1. Follow Direction

Be consistent with your care and your therapies.  Never skip on yourself.

2. Designate a First Responder

Designate family members or member or friend who you can rely on to know what to do if you have a medical emergency and can respond to any exacerbations you may have.

3. Be Organized

Keep the list of medications and paperwork that has to do with your health in good order.  It could be a file that your responders can use in case of emergency.   Please clean equipment in your care after each use (i.e. thermometers).

4. Use Trusted Sources of Information

Dr. Google, well-meaning friends, and strangers are notoriously wrong.  Please write down questions or concerns to review with your healthcare team.

5. Get the Most Out of Your Appointments

Make notes and lists of questions when you meet with your healthcare team.  Bring a friend or family member for support; they often think of things you may miss or forget in the moment.

6. Have Faith in Yourself

In the beginning of managing chronic illness, there may be many changes to your life. However, soon you will begin to settle into a new normal and you will be surprised at how well you are handling things.

7. Ask for Help

Focus on your health and staying well and allow others to do things for you. Local volunteer groups can offer care giving help as well as help around the house and garden.

8. Don’t Let Negative Feelings Get You Down

You will need to push aside anger, frustration and sadness.  Focus on getting well. Try to be positive about your treatment plan.

9. Be Adaptable

Depending on how severe your illness is, you may find that you simply cannot do as much as you used to or live your life exactly as you did before.  Try to embrace a new healthy lifestyle.  Be selective with your calendar.  Your health comes first so be selective.

10. Laugh

Laughter will not cure your chronic illness but it will make life with it more fun.  Spend time with people who make you happy and take joy wherever you can find it.

Evelyn Gilkinson is the Nurse Lead for Charlton Health Inc. Before devoting herself solely to Infusing Biologics, Gilkinson worked at Toronto General Hospital, Flinders Medical Centre (Adelaide, Australia), and the London Health Science Centre in Thoracic Step Down, neonate, pediatric and adult Intensive Care, Recovery Room, and Emergency Medicine. Evelyn has done research for The Canadian Cervical Spine Study and with the AIM Health Group. She established the first out-of Hospital Infusion Centres in London and Waterloo. For the last twelve years, Evelyn was the Nurse Supervisor for South Western Ontario for many infusion sites until joining the Charlton team in the summer of 2016.

Cinnamon has many health benefits including antioxidants, polyphenols and unique chemicals that can help regulate blood sugar in those with type 2 Diabetes by increasing uptake of glucose, improving the sensitivity of insulin in fat and muscle tissue and slowing the rate of gastric emptying thanks to cinnamaldehyde, a compound of cinnamon. There is research that indicates it might help prevent Alzheimer’s disease, decrease inflammation in arthritis and limit the hardening of arteries.

It is important to know that there are different kinds of cinnamon, which come from the bark of several species of evergreen trees of the Cinnamomum genus.  It is important to only purchase Ceylon cinnamon because of a chemical called coumarin.  Coumarin can cause liver damage in large doses.  With Cassia varieties of cinnamon, a teaspoon per day could put an average sized adult at risk pf liver damage.  Caution should be used with types of cinnamon such as Cassis cinnamon as well.

Evelyn Gilkinson is the Nurse Lead for Charlton Health Inc. Before devoting herself solely to Infusing Biologics, Gilkinson worked at Toronto General Hospital, Flinders Medical Centre (Adelaide, Australia), and the London Health Science Centre in Thoracic Step Down, neonate, pediatric and adult Intensive Care, Recovery Room, and Emergency Medicine. Evelyn has done research for The Canadian Cervical Spine Study and with the AIM Health Group. She established the first out-of Hospital Infusion Centres in London and Waterloo. For the last twelve years, Evelyn was the Nurse Supervisor for South Western Ontario for many infusion sites until joining the Charlton team in the summer of 2016.

Osteoporosis is a gradual weakening of bone that can lead to a fracture (break) of bone with very little stress to the area.  For example,  if a person falls off a chair or falls to the ground from a standing position, there should not be enough force for a bone to break.  However, if a bone is fragile it is much more likely to break in these situations. The danger from breaking a weakened bone is that it is very difficult to heal compared to a healthy bone and this puts a significant stress on the body.

After a bone with osteoporosis breaks, people are often hospitalized and become very vulnerable to infection and other complications.  This can result in the person not being able to return to their past activities of daily living and in fact the rate of fatality within the year  after a fracture is quite high.   For this reason, it is very important to prevent fracture.

Excellent preventative treatments exist and should be discussed with your health care provider.  People with inflammatory arthritis or inflammatory bowel diseases have an increased risk of osteoporosis and should have their bones assessed.  Prednisone use can also greatly increase the risk of osteoporosis.  For more information, please speak to your healthcare provider.

As health professionals, we are often asked about the role inflammatory foods play in reducing inflammation throughout the body.  The natural body fluids in a healthy person are alkaline (high pH) and are found to be more acidic in those who are ill (low pH).   The pH scale is from 1 to 14, with 7 being considered neutral.  Numbers above 7 are considered acidic and numbers below 7 are referred to as alkaline.

Some people who have chosen foods in their diet which are not acidic have noticed a difference in their pain, while others have not found a difference.

Foods that have the greatest acidity include: soybean, hazelnuts, walnuts, brazel nuts, barley, beef, lobster, processed cheese, ice cream, beer, sugar, cocoa and white vinegar.  Foods that are the least acidic (alkaline) include lime, nectarines, raspberries, watermelon, lentils, yams, onion and pumpkin seeds.  For those interested in seeing a chart of these foods, Charlton Health is happy provide one to you.

Keep in mind this does not replace researched treatments and may not be effective for everyone.  Reducing sugar intake and eating a well balanced diet with omega-3 fish oil and limited processed foods is always suggested.

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 July 28th is World Hepatitis Day.  The World Health Organization’s Global Strategy on viral hepatitis is to eliminate hepatitis B and C by 2030.  Governments from 194 countries, adopted this goal at the 69th World Health Assembly meeting in Geneva, Switzerland.

There are several ways we can all work towards achieving this goal:

• receive a Hepatitis A and B vaccine
• ask for a Hepatitis B and C blood screening blood test to see if you unknowingly are carrying and potentially spreading this virus
• never share needles with another person and  seek out treatment if you have Hepatitis.

Viral hepatitis causes inflammation of the liver which can lead to liver failure and an increased risk of liver cancer.  Approximately 250,000 Canadians are living with Hepatitis C and many are unaware that they have it as symptoms can be silent for many years.

Charlton Health is proud to provide specialized treatments for patients living with Hepatitis C.  These treatments offer a cure for most patients.  We are happy to answer questions about these treatments  and to advise on available vaccines.  For more information on World Hepatitis Day, visit their website.

This Monday July 24th is International Self-Care Day.  This annual day was established in 2011 by the International Self-Care Foundation to encourage people to be aware of the daily choices they make in promoting a healthy lifestyle.  When you choose to wear a bike helmet, go for a walk instead of sitting on the couch, apply sunscreen before going outside or to take your medication as recommended, these are all actions that exhibit self-care.

The seven pillars of self-care are:

• heath literacy
• self-awareness
• physical activity
• healthy eating
• risk avoidance
• good hygiene
• optimal use of products and services

At Charlton Health we strongly promote self-care and encourage you to ask questions about your medical condition and treatment.  We are happy to offer strategies to assist you in reaching your own health goals.  For more information on the International Self-Care Day, visit their website here.

As a pharmacist specializing in both arthritis and menopause, I am often asked about changes in libido with aging and if arthritis can affect this.  There is a natural lowering of libido with age as blood flow to the genital area decreases and hormone levels decline. This is true for both men and women.  As estrogen levels fall after menopause, there can be significant dryness and decreased blood flow which can affect drive and comfort associated with intimacy.  To make this worse, people with arthritis who may have pain and stiffness can have difficulty finding a comfortable position.

The Arthritis Society has published a series of booklets on lifestyle and one is entitled, “Intimacy and Arthritis”.  This can also be found on their website: www.arthritis.ca. Don’t hesitate to discuss options, including hormone therapy with your health care provider as there are many helpful strategies.

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 is a list of DON’TS….. key questions developed by Dr Geoffrey Nguyen, a Gastroenteritis at Mount Sinai in Toronto and Choosing Wisely Canada, a national healthcare campaign. A specialized group of physicians and patients worked on these questions.

1. Don’t use steroids such as prednisone (whose brand names include Deltasone and other labels) for maintenance therapy in IBD.
2. Don’t use opioid-based therapies for long term management of IBD abdominal pain.
3. Don’t continue giving intravenous corticosteroids to patients with severe ulcerative colitis who fail to respond to the treatment.
4. Don’t start or ramp up longterm medical therapies for IBD on the basis of symptoms only.
5. Don’t use abdominal computed tomography (CT) scans to evaluate acute IBD unless there is a suspected complication, such as a bowel obstruction, perforation, or abscess.