Project ECHO (Extension for Community Healthcare Outcomes) is a collaborative model of medical education that empowers all types of health care professionals to provide better care to more people in their own communities. Wait times to see specialists can be lengthy and those in remote communities may have challenges being able to travel long distances to these appointments. Project ECHO was first launched in New Mexico for better access to Hepatitis C treatments and recently came to Ontario, focusing on: Hepatitis C, pain, mental health. In January, ProjectECHO added rheumatology as a new speciality focus where family physicians, nurses, pharmacists, physiotherapists, occupational therapists, and chiropractors from over 20 sites across the province access a live video conference for a two-hour weekly session. A team of experts in rheumatology, called “the hub,” share their knowledge through a brief weekly lecture, followed by group discussion and problem solving of cases brought forward by the participating community members. It is a wonderful learning community.

Our pharmacist Carolyn Whiskin is the pharmacist expert on the Rheumatology “hub”. We encourage health professionals from across the province to join this wonderful government sponsored learning opportunity.

Fatigue can be caused by many factors from low levels of iron or vitamin B12 to low thyroid function.  However, feeling fatigued can be a complaint of people suffering with psoriasis and psoriatic arthritis in whom these levels are normal.   We can feel tired anytime our body is undergoing a stressor and chronic inflammation definitely places a burden on the body. At times of stress the adrenal glands produce cortisol.  After prolonged periods of stress, which may include poor sleep, pain, and inflammation, the ability to make cortisol can be reduced to a level below what is needed for healthy daytime function, leading to feelings of exhaustion.

In addition,  as psoriasis is a condition that can be visibly seen, and therefore carries a higher rate of depression than other chronic conditions. Depression also increases symptoms of fatigue. When well treated, all symptoms of psoriasis including possible fatigue are hoped to be improved. It is important to consult with your doctor or pharmacist as some of swallowed medication that is used to treat psoriasis may also be causing fatigue,  such as methotrexate.

There are plenty of ways that you can reduce tiredness. Exercise, a healthy diet,  7-8 hours of sleep and activities which reduce stress such as yoga and meditation, when done regularly, can help reduce fatigue.

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.

Moisturizing the skin is one of the hallmarks of psoriasis treatment. Choose a  moisturizer that is free from perfumes and is endorsed by the Canadian Dermatology Association. Multiple applications may be needed each day especially in cold dry weather.

The ideal time for applying a moisturizer is immediately after a bath or shower when the skin is just lightly patted with a towel but is still moist. This will allow the moisture to be trapped within the skin. It is important to note that although hot showers during the winter are relaxing, they can dry out your skin. When you shower you are not only washing away dirt, but also your bodies natural oils that keep your skin lubricated. Try to keep your showers to a maximum of 10 minutes long using lukewarm water to preserve your skin’s natural oils.

It may also be a good idea to have a humidifier in your house or where you work for when the weather gets cold and dry, especially during the winter months.

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.

Over the last couple of years, Arthritis Consumer Experts have been diligently working on an educational program for people living with rheumatoid arthritis. They have developed an online educational program, JointHealth Education, which helps patients better communicate with their rheumatologist and other healthcare providers, by understanding their diagnosis and the medical terminology often used within an appointment. The group explains, “this new education program is based on the latest research and will help you go from being a ‘student’ of arthritis to full-fledged ‘graduate’, and help you in your role as leader of your health care team.”¹

There are six lessons involved in the program and at the completion of these modules a certificate of graduation is issued.

More information about the program is available in this video that Arthritis Consumer Experts have released:

Click here to register for this program.

Sources:
¹ http://info.jointhealth.org/jhed-landing-page

Hormonal, environmental, genetic, and immunological factors are all important considerations in autoimmune diseases. Approximately 50% of all trigger factors are unknown. “Many retrospective studies found that a high proportion (up to 80%) of patients reported uncommon emotional stress before disease onset.” It is felt that stress triggers neuroendocrine hormones leading to immune deregulation thereby causing an alteration of cytokine production. Cytokines can cause inflammation or reduce inflammation.

Here are some tips on how to minimize the impact that stress has on your life:

1. Try to identify the things in your life that cause you stress. Once you identify and understand how these stressors affect you, you can begin to figure out ways to change your environment and manage them.

2. Take control and solve the problem. For example, try to impose limits on the things that cause you stress and/or learn to say “no.”

3. For stressors that cannot be changed, try joining a support group, or engage in wellness activities such as meditation and gentle exercise. There are online resources for self-study meditation programs. Seek a healthcare professional such as your Family Physician to guide you in the right direction.

Sources:
http://www.sciencedirect.com/science/article/pii/S0016508502007369 https://www.ncbi.nlm.nih.gov/pubmed/18190880
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2785020/

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 December of 2016, pharmacists  in the province of Ontario who have received injection training were given the authority by the Minister of Health to administer additional vaccines. Until this time, pharmacists could only administer the annual flu shot. From 2012, Ontario pharmacists have administered over 1.8 million flu shots and it is the success of this program has led to this expanded scope of practice for pharmacists. Beyond the flu shot which is publically funded, the additional vaccines that pharmacists can administer will be ones that are not funded by the government, meaning there will be a charge for both the vaccine itself and its administration. Some private insurance plans may pay for these vaccines. Physicians will still need to prescribe these vaccines, while pharmacists will be able to fill and administer them. This is extremely helpful for travel vaccines where timely administration is so important.  The Shingles vaccine is an example of one which is publically funded for residents aged 65-70 only.  Therefore if you are in this age bracket, you would receive your vaccine from a publically funded supply in your doctor’s office.  Anyone wishing this vaccine who is outside of this age range would have a prescription written by their physician and then could have it filled and administered by the pharmacist.  

It is estimated  that allowing pharmacists to administer these vaccines would result in an additional 4.3 million vaccines administered for pneumococcal diseases, approximately 7.6 million additional vaccinations for shingles, and 275,000 additional HPV vaccines by 2045. This represents a reduction in the number of cases of pneumococcal diseases and shingles by 17 per cent and eight per cent respectively. Increasing the immunization rates for HPV could prevent 37 per cent of the cases of genital warts, 50 per cent of the cases of cervical cancer, and 14 per cent of the cases of anal cancer in Ontario.

Before receiving any vaccines our pharmacy team is happy to guide you on which ones can be administered while receiving immunosuppressant therapy.  We have established a protocol for patients on which vaccines are highly recommended before treatment initiation and can share this with you.

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.

Some medications can affect the way our nutrients are absorbed from the stomach.  One class of medications known to have this effect are called proton pump inhibitors (PPIs).  These medications lower stomach acid production and are commonly taken with anti-inflammatory medications to reduce stomach irritation.  Many people use these medications to reduce reflux of acid which causes heartburn.

Medical photograph designed by Shayne_ch13 – Freepik.com

The issue with lowering stomach acid is that some nutrients require acid for absorption.  In the presence of low acid, magnesium, vitamin B12, and iron are all poorly absorbed.  This can have many effects such as low energy, restless legs, and leg cramps.  Our pharmacists can help suggest the best types of supplements to restore these levels.  Whenever possible, supplements that can be dissolved on or under the tongue are preferred over those that must be swallowed, as it allows for direct absorption into the blood stream instead of requiring absorption through the stomach.

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 cold dry weather can certainly have its impact on everyone’s skin. Those who have psoriasis need to be vigilant about moisturizing their skin on a regular basis.

Here are some helpful tips:

1. Use tepid rather than hot water when showering or bathing.
2. When finished bathing, gently pat the skin dry leaving some residual moisture. Apply your moisturizer to the slightly dampened skin as this will enhance its benefit.
3. When participating in vigorous activity that may cause sweating, whether in a gym or outside,  be sure to wear breathable clothing to avoid skin irritation.
4. Shaving the skin with a multi-blade razor or using products which cause hair removal can both lead to irritation of sensitive skin. An electric razor may offer the gentlest approach.
5. When heading to the south for a winter holiday, remember that although the sun can provide benefit to the skin, a burn can cause a flare of psoriasis, so sun protection is a must. Moisturize your lips and skin and don’t forget to protect your eyes with sunglasses.

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.

Carolyn, along with other health professionals, is a contributor to Psoriasis Busters, which has features lots of great tips for dealing with psoriasis. 

We know winter can be tough on a lot of people. Here are some tips on beating the winter blues courtesy of our Nurse Lead, Evelyn Gilkinson.

Keep active

Research has shown that a daily one-hour walk in the middle of the day could be as helpful as light treatment for coping with the winter blues.

Get outside

Go outdoors in natural daylight as much as possible, especially at midday and on brighter days. Inside your home, choose pale colours that reflect light from outside, and sit near windows whenever you can

Keep warm

If your symptoms are so bad that you can’t live a normal life, see your family doctor for medical help. Being cold makes you more depressed. It’s also been shown that staying warm can reduce the winter blues by half.

Keep warm with hot drinks and hot food. Wear warm clothes and shoes, and aim to keep your home between 18C and 21C (or 64F and 70F degrees).

Eat a healthy diet

A healthy diet will boost your mood, give you more energy and stop you putting on weight over winter. Balance your craving for carbohydrates, such as pasta and potatoes, with plenty of fresh fruit and vegetables.

Designed by Freepik

See the light

Some people find light therapy effective for seasonal depression. One way to get light therapy at home in winter is to sit in front of a light box for up to two hours a day.

Light boxes give out very bright light at least 10 times stronger than ordinary home and office lighting. Some people find that using a dawn simulator [a bedside light, connected to an alarm clock, that mimics a sunrise and wakes you up gradually] as well as a light box can enhance the beneficial effect.

Take up a new hobby

Keeping your mind active with a new interest seems to ward off symptoms of SAD. It could be anything, such as playing bridge, singing, knitting, joining a gym, keeping a journal, or writing a blog. The important thing is that you have something to look forward to and concentrate on.

See your friends and family

It’s been shown that socializing is good for your mental health and helps ward off the winter blues. Make an effort to keep in touch with people you care about and accept any invitations you get to social events, even if you only go for a little while.

Talk it through

Talking treatments such as counselling, psychotherapy or cognitive behavioural therapy (CBT) can help you cope with symptoms.

Join a support group

Sharing your experience with others who know what it’s like to have SAD is very therapeutic and can make your symptoms more bearable.

Seek help

If your symptoms are so bad that you can’t live a normal life, see your family doctor for medical help.

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.