Each year an average of 20,000 people are hospitalized, and between 2,000 and 8,000 Canadians can die of influenza and its complications. Those most likely to suffer complications of the flu are the most vulnerable; children under two and adults over 65. The seasonal influenza vaccine is safe and effective and can benefit people of all ages. The flu shot only provides protection up to 12 months; immunization is required each year. This year’s flu shot protects against the H1N1 flu virus as well as two other strains of flu. October to mid-November is the best time for immunization, but the vaccine may still be given in winter months.

Who should get immunized? The following is a list from the recommended guidelines.

People at high risk of influenza-related complications, including:

•  Adults and children with chronic conditions such as:

- Cardiac or lung disorders such as asthma

- Diabetes mellitus and other metabolic diseases

- Cancer, immunodeficiency, immunosuppression

-Renal disease

-Anemia

 
• Children and adolescents with conditions treated for long periods with aspirin
• All residents of nursing homes or other chronic care facilities
• Seniors aged 65 years or older
• Pregnant women
• Children aged 6 months to 23 months of age
• Persons who are morbidly obese
• Aborigional peoples

People capable of transmitting influenza to those at high risk of complications, including:

• Health care and other care providers
• Household contacts of those at high risk and to infants less than six months
• Members of a household expecting a newborn during flu season
• Women at all stages of pregnancy or breastfeeding mothers
• Those providing regular child care to children 0-23 months
• Those who provide services within closed settings to persons at high risk

Others

• People who provide essential community services
• People in direct contact with avian influenza infected poultry
• Healthy people aged 5-64 years should consider getting the vaccine even if they are not in one of the above groups

The list of those who should receive the vaccine is extensive. If you have had an anaphylactic reaction to the vaccine or one of its components you should not get the vaccine. Or, if you have an allergy to eggs you should discuss getting the vaccine with your health care practitioner. However, it has been shown that egg-allergic individuals may be vaccinated using the TIV vaccine.

Children 6 months to less than 9 years who have never received the seasonal flu vaccine require two doses, with a minimum of four weeks between doses.

Please remember that the flu shot cannot cause the flu. If you have become sick after getting the shot in the past it was a coincidental infection of some other kind. The main side effect is pain and redness at the site of injection for a day or two afterward.

The flu shot is effective. Scientific studies show the effectiveness of the flu shot to range from 70% to 90%.

Adults over 65 should also look in to getting the pneumococcal vaccine. Pneumococcal disease, a common complication of influenza, is a bacterial disease that can cause meningitis, bacteremia (a bloodstream infection) and pneumonia. You can get this vaccine at the same time as the flu shot through your doctor.

To date you must get your flu shot through your doctor or the flu shot clinics in the area. At some point in the near future this vaccine may become available to be given by your pharmacist who will be trained to give injections.

If you have any questions about any of the above information please call or visit your local pharmacy.

Management for superficial fungal infections involves some simple non-drug methods, and over-the-counter remedies in the form of sprays lotions and creams.  Affected individuals should try to reduce moisture in the affected area.  Loose-fitted clothing made of cotton or material that absorbs moisture should be worn.  The skin should be dried completely before covering with clothing.  If the infection involves the feet, flip flops should be worn with bare feet to prevent spread to others and reinfection.

There are also many topical antifungal agents available.  Examples include Canesten cream (clotrimazole), Nizoral shampoo (ketoconazole), and Monistat-Derm (miconazole), to name a few. Creams and solutions are useful because they can be rubbed into the area.  Solutions work in hairy areas because they are easier to apply.  Powders can serve as useful additions to creams and solutions.  They are helpful when the infection is wet or oozing, or where a drying agent is needed.  When applying the antifungal product it should be applied to the lesion as well as one to two inches around the lesion.  The antifungal should also be used for one to two weeks after lesions clear to reduce the rate of recurrence.

Patients who have diabetes, or those who are immunosuppressed may need prescription oral therapy.  It is best for your doctor to assess theses fungal infections.  Fungal infections of the nail are also resistant to over-the-counter treatment. 

There are some home remedies for treating nail fungus.  Patients have tried applying Vics VapoRub and tea tree oil.  There is not a lot of evidence to suggest the efficacy of these products for this condition, however some people may wish to try them before resorting to an oral medication.

If you think you may be affected by a fungal infection there are a number of treatment options available.  Most issues can be resolved with some persistence and the proper product.  Please speak to your pharmacist about what option is best for you.

Infection with HPV occurs with skin-to-skin contact.  Warts are caused by viruses and are passed from person to person.  A common way of contracting the virus is by walking barefoot in public pools, showers etc.

About 30% of warts clear spontaneously in six months and 65% to 78% clear in two years without any treatment.  However, most people would like to resolve warts more quickly than this.  Salicylic acid is a first line OTC option.  This medicine slowly destroys virus-infected skin and may stimulate the immune response of the person infected through mild irritation, which in turn helps clear the infection.  There are a number of salicylic products available.  They range in concentration from 17% to 40%.  A 40% product should be used for plantar warts.  The use of salicylic acid on facial warts is not recommended because of a potential risk of hypo- and hyperpigmentation (skin discolouration).

There is a bit of a regimen to follow with salicylic acid products.  Before treatment the warts should be soaked in warm water for five minutes.  Then, an emery board or pumice stone should be used to remove dead tissue.  The salicylic acid treatment should then be applied.  Treatment may need to be continued for up to 12 weeks. If the wart causes pain, patients can take acetaminophen or ibuprofen for the discomfort. Examples of OTC salicylic acid wart removal products include Compound W, Dr. Scholl’s Clear away Plantar, and Duofilm Wart Remover.

Cryotherapy (freezing) is another common wart removal treatment. This causes irritation and tissue destruction so that the individual mounts an immune response against the virus.  Doctors typically use liquid nitrogen which freezes tissues to -196ºC.  There are also home cryotherapy systems available.  These contain dimethyl ether and propane (DMEP).  Examples include Dr. Scholl’s Freeze away wart Remover, Or, Compound W Freeze off.  Evidence shows DMEP and liquid nitrogen are fairly similar in efficacy.  After application of cryotherapy a blister is formed under the wart.  The frozen skin and wart falls off after about ten days and reveals newly formed skin underneath.   It is recommended that OTC cryotherapy only be repeated three times usually in ten day intervals.

The use of duct tape as a wart treatment has gained popularity.  By putting duct tape over the wart they think the virus is deprived of oxygen which causes irritation and stimulates the immune response to the virus.  Typical administration involves applying silver duct tape over the wart and removing a week later.  Scrubbing the area with an emery board and leaving it open over night.  Then reapplying duct tape.  Silver duct tape has been shown to be more effective than clear duct tape, possibly because of the adhesive.

There are also a number of prescription products that can be used for warts if OTC treatments are ineffective.  Patients with diabetes should consult their physicians before beginning treatment for their warts.  Also, genital warts must be treated by physicians and are not suitable for treatment with OTC methods.

In general OTC wart treatments are effective, however, it may take several weeks for the wart to be removed.  For proper selection of a treatment method come in and speak to your pharmacist.

Constipation is a symptom that occurs when waste moves too slowly through the body, resulting in stool that is dry and hard. This often makes it difficult and painful to pass.

Some medications such as antidepressants, water pills, and certain pain killers (such as Oxycontin and Codeine) may cause constipation.

The frequency of bowel movements varies from person to person, from as little as twice a week to a couple of times a day, and is affected by diet, medications, and exercise.

If you are having trouble going to the washroom, the first thing a pharmacist will usually recommend is increasing the amount of fibre in the diet by eating whole grains, fruits and vegetables. In addition, drinking at least 8 glasses of water will minimize constipation.

If these suggestions do not work, there are several options available to you.

For  short-term treatment of constipation, ( if you haven’t been to the washroom in several days), a saline laxative such as Milk of Magnesia can be tried.  Alternatively glycerin suppositories work quite well.  If symptoms still do not resolve you could consider an enema with the advice of your physician.

Stimulant laxatives such as Dulcolax and Senokot can also be used to maintain regularity.  If you are on long term narcotic therapy you may need to take these types of medications as long as you are taking the narcotics.

For long-term treatment of constipation, bulk-forming agents such as Metamucil or Prodiem Plain can be used. These bulk-forming agents increase the stool weight, allowing the stool to pass through the body faster and cause more frequent bowel movements. These agents typically take about 12-72 hours to take effect and are usually safe to use for long periods of time. When taking bulk-forming agents, it is recommended to drink lots of fluid.

For young children there are a few options.  For immediate relief a pediatric glycerin suppository can be tried.  For chronic long term management PEG 3350 is often prescribed, or is available over-the-counter as LAX-A-Day.  You should consult your family doctor however if you want to try an oral medication for a child suffering from chronic constipation.

If you are not having trouble going to the washroom, but you find the stool to be too hard and painful to pass, the pharmacist may recommend a stool softener such as Colace (docusate sodium) that will soften the stool for increased comfort.

Before deciding on a therapy, talk to a pharmacist and they can help you decide on a treatment that is right for you.

However, there are compounds in grapefruit called furanocoumarins that can interfere with the way your body metabolizes certain medications. This can lead to dangerously high levels of medication in the body and may increase the risk of rare but serious or life-threatening side effects such as slowed heart rate and muscle deterioration. For a few medications, it can lead to decreased effectiveness because these medications need to be metabolized in order to become active. Don’t take these interactions lightly, as some can cause potentially dangerous health problems.

Both grapefruit juice (either fresh or frozen) and the fruit itself can affect certain medications and the effects have been seen with as little as one 8-ounce (250 mL) glass of grapefruit juice. The effects of grapefruit juice on medications can last up to 3 days, so taking them at different times of day will not help. Naturally sweet orange juice has not been shown to affect medications the way grapefruit juice does, but tangelos (which are related to grapefruit), lime juice, andSeville(sour) oranges may affect medications.

Many medications may be affected by grapefruit juice, including medications for:

This is not a complete list; grapefruit juice may affect medications for conditions other than those listed here. Also, if you are taking any natural health products, check the labels to see if they contain grapefruit, tangelo, Seville orange, or lime juice. Avoid these fruits and juices until your doctor or pharmacist has told you it’s safe to have them.

However, it doesn’t take long before we quickly remember that along with the summer heat comes the return of mosquitoes, spiders, and ticks. In Ontario, most residents are well informed about the illnesses mosquitoes can spread and ways of protecting yourself. But how informed are we about ticks?

There are many different species of ticks; however, the one that is of concern is the blacklegged tick, also known as the deer tick. This sesame seed sized tick can be the host to the bacteria that can cause Lyme disease, which, if untreated, can result in arthritis, heart problems, and various nervous system problems. The American brown dog tick is approximately half a centimeter and has not been shown to carry Lyme disease.

The Niagara region has a high concentration of ticks, especially in the areas surrounding Lake Erie. The Niagara Health Department recommends wearing pants and long sleeved shirts when walking in wooded areas to minimize the chances of a tick bite.

If you notice a tick has attached to your skin, it should be removed immediately by grabbing the head with a pair of tweezers and pulling straight up. Do not try to burn the tick off of the skin using a match or lighter. The area should be then be washed with soap and water. If you are unable to remove the entire tick, you should give your doctor a call and they can remove it for you.  The tick can be brought to the health department for analysis to see if it was infected with the bacteria that causes Lyme disease.

Ticks often pick up the bacteria that cause Lyme disease while feeding on infected rodents. However, it should be noted that most ticks are not carriers.

The majority of people who are bitten by ticks do not develop Lyme disease, however if you notice a red bullseye rash on the skin, develop a fever, headache or muscle and joint pains, you should seek medical attention. The symptoms typically develop within 1 to 2 weeks of a bite. Lyme disease can often be cured with antibiotics if treatment is started early.

For more information about Lyme disease or information about ticks and where to drop them off, you can call 1-888-505-6074.

There are 2 primary options to smoking cessation; Cold Turkey or Medication. There have been many success stories of patients able to quit cold turkey, however it is much more difficult and shown to have an increased rate of relapse. It may be the most cost effective option, but these people suffer greatly from nicotine withdrawal symptoms, which include irritability, anger, restlessness, impatience, difficulty concentrating, depression and anxiety. These symptoms often start just a few hours after the last cigarette and are known to persist for weeks and months. Medications are available to help decrease these withdrawal symptoms, reduce the urge to smoke and help ease the patient to a continued smoke-free life.

Nicotine Replacement Therapy (NRT) is available over-the-counter in 4 forms; gum, patch, inhaler, and lozenge. There are different dosages available which is dependent on the amount of cigarettes the individual smokes. If you have questions regarding which dose you should start on and the proper technique to use the NRT, please speak to your pharmacist for assistance.

NRT provides nicotine in a safe form so the body does not have to endure nicotine withdrawal while a person adapts to not smoking. As opposed to cigarettes, NRT are medications that contain only nicotine and not the other harmful chemicals that are present in cigarettes. NRT is considered a ‘step down’ approach where the patient is exposed to a gradual decrease in the amount of nicotine in the blood. This enables the body to adjust to the changes in a slow and steady manner and experience less side effects.

The general length of therapy is 12 weeks, however this is NOT set in stone. It is also common practice to combine different forms of NRT such as using the patch and chewing gum. Some common side effects of the NRT include nausea, insomnia and local irritation if using the patch or inhaler.

The most commonly prescribed medication available for smoking cessation is Champix (Varenicline). Champix has recently been shown to have great success for smoking cessation. It works by binding to the same receptors as nicotine, which results in decreased cravings and withdrawal symptoms. Additionally, it decreases the pleasure that people get from smoking making the quitting process that much more effective.

The starting dose is 0.5mg once daily for the first 3 days, then 0.5 mg twice daily for the next 4 days, then 1mg twice daily thereafter. People are on Champix for 12 weeks, however many continue treatment for an additional 12 weeks to prevent smoking relapse. It should be taken with a glass of water with or without food. Common side effects include nausea, trouble sleeping and headache.

Caution: A patient may notice changes in their behavior, feeling depressed, agitated or not themselves. If this does occur, it is important to contact the physician.

Although there are medications and therapeutic options available, the single most important smoking cessation aid is a patients’ will and determination to quit. Having confidence and a support system are important for a smoker to kick the habit. Some other options for smoking cessation include hypnosis, counselling (individual and/or group), acupuncture, keeping busy, exercise (joining the gym or a class), or starting a new hobby. Studies have demonstrated that combining medication with advice or behavioural therapy increases the quit rates of up to 6 times. There are many support systems out there and available to help through the difficult time and it is important to know there is a light at the end of the tunnel.

“ The achievement of your goal is assured the moment you commit yourself to it” Mack R. Douglas.

Pharmacists are a great resource for information and support on your journey to quit smoking. Please come in and talk to us if you have any questions about smoking cessation.

Chronic alcohol use increases acetaminophen (Tylenol) metabolism increasing its conversion to metabolites toxic to the liver.  It is always best not to exceed four grams of acetaminophen a day, especially if you are a heavy or binge drinker because of the damage it can due to your liver.

Chronic alcohol use along with NSAIDS (Ibuprofen) or aspirin can increase the risk of GI bleeds.  However, an occasional drink with NSAID use is not likely an issue.

If you are a patient on warfarin alcohol can inhibit warfarin metabolism and increase your INR.  If you change your usual alcohol intake you should have your INR checked.

Certain antibiotics, and in particular metronidazole, has the potential when mixed with alcohol to make people quite ill.  When taken to together a patient may experience low blood pressure, shortness of breath, facial flushing, and nausea.

Diabetic patients taking hypoglycemics such as Glyburide or insulin are at risk of severe hypoglycemia (low blood sugar) when they drink alcohol.  These patients should limit alcohol to an occasional single drink.

Any patient on medication for sleeping should be careful of alcohol consumption because of the additive affects of drowsiness and respiratory depression.    Patients have been known to aspirate their own vomit and die from intoxication.  This could be more likely to happen if a person mixes alcohol with their sleep medication.

This same problem could exist when patients mix alcohol and opiates.

It is always wise to consult your pharmacist or physician if you receive a new prescription and intend to have a few alcoholic beverages.  Also please notify your physician or pharmacist if you are a chronic drinker.  Even if you are not planning to drink while taking your prescription previous liver damage could affect how well you metabolize your medication.  This could result in too high, or too low a dose for you.

There are some distinct benefits of Pradax over warfarin and it may be worthwhile to discuss these with your physician.

Warfarin requires frequent monitoring in the form of a blood test called INR testing.  This is not needed with Pradax.  This makes Pradax a great deal more convenient for patients who have difficulty getting to the lab, and for those patients whose INR is hard to control.  This also cuts down on the frequent change of dosing some patients experience with warfarin.

Pradax may also be better at preventing strokes than warfarin.  It is less likely than warfarin to cause bleeding in the brain, (a rare but serious downside of anticoagulants), and it is less likely to interact with medicines and food.

There are however some drawbacks to consider.  Pradax is more expensive than warfarin.  It costs about $120.00 a month.  Warfarin is much less and is covered by the senior’s drug plan.  As of yet Pradax is not covered by the Ontario Drug Benefit Program, but it may be covered by some private insurers.  It may be worth a call to your insurance company to see if it is covered under your plan.

Pradax is taken twice daily as opposed to once daily for warfarin.  It is more important to not miss a dose as this can increase your risk for stroke.

Pradax is also more likely than warfarin to cause heartburn or a stomachache.  Pradax may also cause bleeding in the stomach more often than warfarin.

Pradax capsules need to be kept in their moisture resistant packaging.  Once they are open the tablets are only good for 30 days.  There are no such storage requirements for warfarin.

Pradax may be a good drug for some people.  If you are having trouble keeping your INR at the right therapeutic range and you need frequent dose changes of your medication, you should talk to your doctor or pharmacist about this medication.