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.

One definition of adherence is: attachment or commitment to a person, cause, or belief. When talking about medication, adherence refers to how closely a patient follows the treatment plan that was agreed upon between physician and patient. At the pharmacy level, this is often measured by looking at the interval between medication refills, with the pharmacist checking to see that these are reasonable.

There are many barriers to medication adherence, some of which may include complex treatment schedules, cost, social and cultural challenges, as well as the way our healthcare system is set up. For patients on long term therapies, non-adherence may be due to a loss of response to drug over time, a difficult to manage side effect, or frustration with the chronic nature of their disease.

For patients with chronic diseases, the rate of adherence to treatment tends to be anywhere from 50-75%.

When patients are not adherent to taking their medication, the effect is far-reaching. The non-adherent RA patient tends to end up with more prescriptions for prednisone or NSAIDs (like ibuprofen, naproxen, etc). They tend to make more visits to the emergency room, and have a higher hospitalization rate. They require more home care and rehabilitation services. In addition, the non-adherent patient creates more drug waste.

Please let us know if you are having trouble being adherent to your medication schedule. It is very likely that we can help manage a difficult side effect, manage insurance coverage concerns, simplify a challenging treatment schedule, or clarify your understanding of the benefits of treatment. We understand that a chronic condition can be a tremendous burden and want to help you gain success and confidence by improving adherence to treatment.

For most people, regular exercise will improve your overall health. Patients with IBD are no exception and may see additional benefits outside their GI system.

Ankylosing Spondylitis, an inflammatory arthritis, has been associated with IBD and can be improved with exercise. Symptoms typically appear in early adulthood and include reduced flexibility in the spine, which can eventually result in a hunched-forward posture. Pain in the back and joints is also common. Exercise therapy will improve spinal column flexibility and strength, and decrease joint pain.

Patients with Crohn’s Disease and Ulcerative Colitis should enjoy a regular exercise regimen to obtain and maintain bone density. Differences have been found in both the spine and hip on x-ray when patients consistently exercising. Patients should aim to exercise at least three times per week.

Small changes can make a big difference – think about taking regular walks. If you need to be close to a washroom, try heading to the mall and walk. Use small free weights, climb stairs or dance! Do what is most enjoyable to you!

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.

In recent years, there has been an increase in Clostridium Difficile (commonly known as C. Diff) which is a bacteria causing debilitating diarrhea.  C. Diff has various strains  which are often resistant to antibiotics,  which makes the infection difficult to treat. Surprisingly, C. Diff is often caused by over use of antibiotics.  Antibiotics disrupt the normal bacteria flora in the gut referred to as the gut biome. As a result of changing the healthy bacteria, the processing of carbohydrates ( fruits, vegetables, pastas and all grains) also changes which affects the body’s ability to absorb water from the bowel contents.  This causes a person’s stool to be more liquefied.

One potential solution to combatting the increase in C. Diff is the use of probiotics. The claim is they decrease or prevent diarrhea by maintaining the flora in the gut and allow for ongoing carbohydrate fermentation and/or  competitively slowing down the growth of C Diff bacteria. Though animals studies found the use of probiotics for C. Diff inconclusive, probiotics are still marketed to humans to treat C. Diff and autoimmune diseases. With this in mind, it is important to stay tuned to ongoing studies that may give us a clearer picture regarding the effectiveness of probiotics for C. Diff.

Another option for battling C. Diff is fecal transplant, where a healthy patient donates their stool which is then processed into an enema to be administered to the person suffering with C Diff. Fecal transplantation has been around for decades, as it was first performed on humans in 1958.  Patients become candidates for fecal transplant after three reoccurrences of the infection. On average, 91-93% of cases are cured with fecal transplant. After fecal transplants, the antibiotic Vancomycin is again able to keep C. Diff in check without affecting the microflora of the gut. Of course, there are risks associated with fecal transplants, but many health practitioners believe that the benefit of the procedure outweigh the risks.

For more information, speak to your healthcare provider.