We are pleased to share the upcoming opening of the Charlton Digestive Disease Centre at 25 Charlton Ave. East in Hamilton. This will be an outpatient Gastroenterology clinic with a primary focus on exemplary patient experience. We have had the pleasure of working with the gastroenterologists that will be servicing the clinic. They are offering a comprehensive service of endoscopy and colonoscopy procedures, as well consultation and follow-up.

The clinic is committed to lowering the wait times that patients are experiencing with digestive health issues. If you are in need of such services, our referral form can be used by your family physician.

Any questions about the Centre and its services can be directed to Jennifer Heipel at 905-526-7002 ext 1104 or visit our website.

Jennifer Heipel has approximately 15 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.

August is Psoriasis Action Month and at Charlton, we are happy to provide advanced therapies to many people living with psoriasis and to acknowledge Psoriasis Action Month. It is important that people without psoriasis are educated to reduce misconceptions they may have about the condition.  

Psoriasis is an autoimmune disease that showcases its symptoms on the skin and nails. There are different types of psoriasis that are diagnosed based on the type of rash and areas the rash presents.  

Below are common misconceptions about psoriasis, clarified. 

For more information about lifestyle and healthy skincare with psoriasis, please see our previous blog “Management of Psoriasis” posted on February 24, 2022. At the end of that blog are great links to resources to further educate yourself about psoriasis.  

World Hepatitis Day is July 28 and we want to help raise awareness for these diseases. They are a group of infectious diseases that affect the liver, known as hepatitis A, B, C, D and E.  

At Charlton Health we have a great team that specializes in hepatology and offer fibroscans for their patients. Fibroscan machines are special ultrasound machines that are used to scan your liver. The machine is looking for liver scarring or otherwise known as fibrosis. This information, along with blood tests, will give the doctor more information about a person’s liver disease.  

The different types of hepatitis have different ways of transmission. They also vary as some are short-term infections while others are long-term infections. The best way to protect your health is to prevent infection, the best ways to prevent the different hepatitis infections are listed in the table below. 

For further information about the details of hepatitis and prevention, visit the Center of Disease Control and Prevention (CDC) Website.

Marija Ilic is a Pharmacy Student from the University of Waterloo currently doing a rotation at Charlton Health as part of her final year of studies. Through Marija’s education, she has gained experience in both hospital and community pharmacy settings and hopes to find a specialized pharmacy role when she graduates. 

Jennifer Heipel has approximately 15 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.

Vaccination to prevent bacterial pneumonia is suggested for all patients with either a medical condition or immunosuppressive treatment that increases their infection risk. Before starting on advanced therapies such as biologics, we suggest adults update their vaccines, which includes pneumonia protection. Prevnar 13 is a vaccine protecting against the main 13 types of bacterial pneumonia and one dose lasts for a person’s whole life.

Health Canada has just approved Prevnar 20, which is already available in the United States. This will provide lifelong protection against an additional 7 types of pneumonia and will likely replace Prevnar 13. It should be available for purchase by the end of July. It is our hope that it will be publicly funded for compromised adults over 50 as Prevnar 13 is currently.

If you have received Prevnar 13 in the past, you may consider upgrading to this enhanced protection when it is made available to you as long as it has been at least 6 months from the previous Prevnar 13 dose.

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.

Many health professionals will be selecting a week in May to promote the prevention of shingles through a Shingrix Awareness Week. Shingrix is a vaccine for the prevention of shingles (Herpes Zoster). It is given as a series of 2 doses, 2-6 months apart. The vaccine is now available without prescription and can be administered by your community pharmacist. It is available at no charge through Public Health supply to family physicians for adults aged 65-70, with a catch up this year to age 72, until December 2022. Many people beyond this age range will benefit from Shingrix and will choose to pay for the vaccine out-of-pocket or may have private insurance to cover the cost.

Shingles (Herpes Zoster) is a serious disease that commonly results in a very painful, blistering rash that occurs in one part of the body and can last for weeks. The pain can be severe, disabling, and interfere with your day-to-day activities. 9 in 10 Canadian adults carry the virus that causes shingles. Shingles that affect the eye (Herpes Zoster Ophthalmicus) can lead to blindness and must be treated immediately. The risk of shingles increases with age and is also increased in people with autoimmune conditions. Vaccination is our best protection, as anti-viral treatments can still leave people with symptoms, including postherpetic neuralgia (nerve pain) lasting weeks-months.

Although the recommendation for vaccination against shingles generally begins at age 50, it is now approved by Health Canada for adults 18 years old and older that have a deficient or suppressed immune system caused by known disease or therapy. As Shingrix is a non-live vaccine, it can be administered to people on advanced therapies for autoimmune conditions. The prior vaccine, Zostavax, is no longer available and its effectiveness is greatly diminished by 5 years. As a result, many adults have upgraded their protection with Shingrix. It is common for people to experience pain at the site of injection along with fatigue, aches, pains, and/or a low-grade fever for a day or two after the injection. Consult with your health care provider about vaccination against shingles.

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.

Recently we have been receiving several questions from our patients about the new COVID medication Paxlovid©. Given that we are currently in the 6^th COVID-19 wave, we thought it was important to clarify who qualifies and how to access Paxlovid© if it is needed. 

Paxlovid© consists of two medications, nirmatrelvir and ritonavir. The nirmatrelvir stops the virus from multiplying, while the ritonavir helps keep the levels of nirmatrelvir high so it can continue to work in the body for a longer time than without the ritonavir. 

Paxlovid© has been shown to reduce the risk of hospitalization for adult patients in the community with a positive COVID-19 test when taken within 5 days of symptom onset. In addition, it is prescribed for specific patients who would have a more difficult time fighting the virus. This would include those:

• who are immunocompromised
• with less than 3 COVID vaccines
• who are pregnant
• with other health risks 

Factors like the ones above in addition to your age will lead your doctor to decide whether Paxlovid© is right for you. 

Your doctor may consider other treatments for those patients who are not in the hospital and may not be ideal candidates for Paxlovid©. This may include patients with impaired kidney function; depending on the degree of impairment, a dose reduction in the Paxlovid© may be needed.

Given that the medication needs to be started within 5-days of symptom onset, it is important that your pharmacy is able to dispense the medication in a timely manner. Apart from the prescription and being within the 5-day window, you must also have a positive COVID test. The best way to make sure you get Paxlovid© promptly is to get a prescription and put it on HOLD at your local pharmacy. This way, if you get a positive COVID test, you can show the proof of the test to the pharmacy and get the Paxlovid© quickly.  Keep in mind, that physicians and pharmacies are overwhelmed with calls regarding Paxlovid© at this time. Please be patient as they are trying their best to prioritize their patients at the greatest risk. 

Paxlovid© has many drug interactions, so it is very important you disclose all medications you are taking to your pharmacy. This includes prescription medications, over-the-counter medications, and natural health products. Please also inform your pharmacist if you have impaired kidney function. Your pharmacist will help your doctor make a plan regarding any interacting drugs to ensure the Paxlovid© works as effectively and safely as possible. 

Marija Ilic is a Pharmacy Student from the University of Waterloo currently doing a rotation at Charlton Health as part of her final year of studies. Through Marija’s education, she has gained experience in both hospital and community pharmacy settings and hopes to find a specialized pharmacy role when she graduates.

International Pompe Day is April 15. We would like to celebrate this day by raising more awareness for those who are living with Pompe Disease and help others understand the challenges they face.  It is also a very exciting time as the newest treatment, avalglucosidase alfa (NEXVIAZYME™) has recently been approved by Health Canada. 

Pompe is a genetic disease. People who have Pompe Disease have insufficient functioning of an enzyme called acid alfa glucosidase (GAA) which breaks down glycogen, in the body. Glycogen is how our body stores glucose, a type of sugar that our body uses for energy. Without this enzyme, there is a build-up of glycogen in lysosomes which are in many human cells. Lysosomes function to help rid cells of unwanted cellular debris and waste. The build-up of glycogen in lysosomes can cause symptoms such as muscle weakness, trouble breathing, enlarged heart, and more. 

Pompe Disease is broken down into two forms, infantile and late-onset. The Infantile-form presents in the first few months of life and usually involves an enlarged heart whereas late-onset Pompe can present at any time in life and does not involve the heart. 

For many years, alglucosidase alfa (MYOZYME™) has been the only drug used in Pompe Disease. Myozyme is an enzyme replacement therapy of the GAA enzyme that is deficient in patients with Pompe Disease. It can be used in both infantile Pompe Disease as well as late-onset Pompe.  Patients receive an infusion of this enzyme every 2 weeks lifelong.  However, as of late 2021, Health Canada has approved the use of a new enzyme replacement therapy for late-onset Pompe Disease. 

As Charlton Health was the first centre to offer home infusions of Myozyme in Canada, our nursing team and pharmacists are very excited to be able to offer Nexviazyme as patients become eligible to receive this therapy. 

Nexviazyme has been designed to be absorbed more efficiently into the muscle cells than Myozyme. The studies look very promising for this medication and have even shown to work as well as Myozyme for most assessments, but actually showed it was better than Myozyme when looking at the 6-minute walk test (6MWT). The 6-minute walk test evaluates how much distance a person can walk in 6-minutes and is used to assess their endurance and exercise tolerance. We look forward to helping patients that will be starting this new therapy.  

If you want more information on Pompe Disease, refer to the Canadian Association of Pompe.

Marija Ilic is a Pharmacy Student from the University of Waterloo currently doing a rotation at Charlton Health as part of her final year of studies. Through Marija’s education, she has gained experience in both hospital and community pharmacy settings and hopes to find a specialized pharmacy role when she graduates.

References:

• Diaz-Manera J, Kishnani PS, Kushlaf H, et al. Safety and efficacy of avalglucosidase alfa versus alglucosidase alfa in patients with late-onset Pompe disease (COMET): a phase 3, randomised, multicentre trial [published correction appears in Lancet Neurol. 2022 Apr;21(4):e4]. Lancet Neurol. 2021;20(12):1012-1026. doi:10.1016/S1474-4422(21)00241-6
• Hahn, S. Lysosomal acid alpha-glucosidase deficiency (Pompe disease, glycogen storage disease II, acid maltase deficiency). In: Post T, ed. UpToDate. UpToDate; 2021. Accessed April 4, 2022. www.uptodate.com 
• Six minute walk test (6MWT). American College of Rheumatology. Updated 2015. Accessed April 4, 2022. https://www.rheumatology.org/I-Am-A/Rheumatologist/Research/Clinician-Researchers/Six-Minute-Walk-Test-SMWT