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Boggios Pharmacy

“Boggios: A healthy choice for your whole life”

April 22, 2011 Menopause

Symptoms of menopause can be very uncomfortable.  The three most common complaints are hot flashes, insomnia, and vaginal dryness.  After the Women’s Health Initiative trial many patients discontinued their hormone therapy due to concerns about cardiovascular problems and breast cancer with Premarin and Premplus.  Unfortunately this left many women struggling with their symptoms.

Mort recent guidelines have emphasized that short-term use of hormone therapy during early menopause may not be that risky.  The risk of heart disease is small if hormones are taken within the first 10 years of menopause.  Also, evidence indicates that the risk of breast cancer probably doesn’t increase when combination hormone therapy is used for only 2 to 3 years.  (Of course you should consult your doctor for their opinion on this information).

There are other options if patients do not want to go the traditional route of hormone replacement.  The best way to deal with symptoms is to treat them individually.

For patients with hot flashes try non drug options first.  Patients should exercise, manage their weight, stop smoking and avoid hot drinks, caffeine and alcohol.  There are some herbal products on the market that can be tried, but in general do not have much evidence for effectiveness.  Black cohosh is being used by many women but it does not seem any better than placebo for hot flashes.  In addition there have been some reports of liver toxicity with its use.  Soy may provide a small benefit.  A common dose is 60 grams /day of soy protein from food, or up to 120 mg/day of soy isoflavones from supplements.  Evening primrose, dong quai, wild yam, and red clover, chasteberry and ginseng have not been shown to work for hot flashes.   There are some prescription drugs that can be tried as well.  These include venlafaxine, gabapentin, and clonidine.  You can ask your doctor if one of these agents are right for you.

Vaginal dryness can be treated by an over the counter product called Replens.  If this proves ineffective a local estrogen therapy such as Vagifem can be tried.

Insomnia can be treated with a low dose non addictive prescription medication such as Zopiclone. An over the counter medication like Gravol or Benadryl can also be used on an occasional basis.

Osteoporosis is a real concern for menopausal women not on hormone therapy.  Women of this age should make sure they are getting 1500 mg of calcium and 1000 IU of vitamin D daily.

Bio-identical Hormone Replacement is another option for symptom treatment.  Hormones used in this treatment are identical to those in the human body.  Bio-identical Hormone therapy is very individualized treatment.  Patients have their hormones analyzed through a saliva test and then their prescriptions are tailor made to meet their needs.  Doses and hormones used are compounded in the pharmacy for each individual depending on their deficiencies and physician’s prescription.  For further information on this type of treatment please visit our website www.boggios.com.

Menopause can be an extremely difficult time for many women.  Luckily there are some good treatment options for the most bothersome symptoms.  The best approach to dealing with them is to consult your doctor and pharmacist about the safest most effective treatment for you.

April 22, 2011 What’s New in Diabetes Care?

Right now one million Canadians have Type 2 diabetes and do not know it.  That statement is from the Canadian Diabetes Association Website (www.diabetes.ca).  Diabetes is a growing epidemic and health concern.  There are new treatments and resources available to help manage diabetes.

Bayer and Roche have new meters recently available.  Bayer has a meter called the Didget.  This meter is aimed at kids and rewards them for good monitoring habits.  It comes with games and connects to the Nintendo DS or Ds Lite System.  Patients can get this through their local diabetes education centre or specialist.  Another new meter is called the A1C Now Selfcheck.  This meter captures the three month average of a patient’s glycosylated hemoglobin.  This is close to lab results that your doctor sees and gives patients a very good idea how well controlled their diabetes is.  This test can now be performed at certain pharmacies that have this meter.

Roche’s new meter is called the Accu-Chek Mobile.  This meter uses strip-free testing.  Instead of inserting individual test strips for each blood test a cartridge is inserted which is good for 50 separate tests.  The benefit of this machine is the elimination of strip handling which can be difficult for people with arthritis, Parkinson’s or other dexterity issues.  This machine is free for Humalog or Novorapid insulin users since they must test their blood sugar more often.

There is new medication available as well. Victoza is a relatively new product on the market.  This medication is for patients with type 2 diabetes.  This is a non-insulin, once-daily, injectable  medication, that can help improve blood sugar and has been shown to be able to provide the additional benefit of weight loss.  This medication may used alone or with other medications such as Metformin.  Other similar medications to this will be on the market shortly.  You can call your insurance company to see if this medication would be covered for you.

Besides additional products on the market there are also additional services available for diabetics.  Pharmacists can provide a diabetes medication consult, free to the patient, paid for by the Ministry of Health, and an unlimited number of diabetes follow-ups.  These consults can involve the pharmacist explaining medications, insulin use, and glucometers.  The pharmacist can also use the A1CNow meter and check your average three month blood sugar.  Pharmacists can also provide referrals to diabetic community services and web resources that are available to patients.

If you have diabetes, or are concerned that you may be at risk please call the pharmacy and book an appointment today.

April 22, 2011 Head Lice

Head lice is a very common problem that can affect anyone.  Head lice are tiny insects that are the size of a sesame seed.  They live on the scalp of humans where they feed on blood and lay their eggs (nits). Young lice are transparent but as they feed on blood they become reddish brown or black in colour.  Nits are whitish-grey tan, or yellow ovals about the size of a grain of sand.

To check for head lice look at the back of the head at the base of the skull.  Diagnosis of a lice infestation requires detection of a living louse.  The presence of nits alone is a sign of a past infestation and may not indicate an active infestation.    You may not be able to see the actual lice but you can probably spot the nits which will be attached to the shaft of the hair, usually in a tear drop shape.  The farther the nits are away from the scalp indicates the longer the individual has been infected.

Head lice can not fly or jump from one person to another.  They can move quickly and transmission occurs through close contact with an infected individual.  Sharing hats brushes, combs, or pillows, can spread head lice.  Also, when children are playing together and they have close head to head contact they can transmit head lice.  To help avoid them advise your child not to try on dress-up clothes at school, and to tuck their hat and mittens in their coat when they are not wearing them.

There are a couple of treatment options available over the counter in Canada.  These include Nix, Kwellada-P, R&C, and Resultz.  Nix, Kwellada-P, and R&C contain insecticides.  Resultz contains ingredients that are not classified as traditional insecticides that work by dissolving the wax that covers the exoskeleton of head lice causing subsequent dehydration and death.  All of the products are considered safe if they are used as directed.

Do not rinse the products while your child is in the bath to avoid over exposure to the active ingredients. Read the instructions on the packaging carefully. Some products must be applied to dry hair and others to wet hair.  All close contacts to the infected individual should be treated regardless if lice can be detected on them or not.  Also, the  affected individual should be retreated within in 7 to 10 days of the first infestation.  In addition to using an OTC product, manual removal of lice and nits is necessary.  The hair should be inspected in one inch segments. A fine-toothed come can be used to comb out remaining live lice and nits.  This may need to be repeated several times throughout the week.  Not doing proper manual removal can cause failure of treatment.

Wash all bedding, stuffed animals and soft toys in the washer, and dry in a hot dryer.  Vacuum areas that can not be washed.  Do not use mayonnaise, petroleum jelly, olive oil, margarine, or other natural products.  There is little evidence to prove efficacy and/or safety.

If all of the steps are followed and the lice persist, they may be resistant to traditional treatment.  In some cases the individual can be prescribed an antibiotic (trimethoprim/sulfamethoxazole) which will kill the lice when they take blood from the host.  Another option is to try permethrin 5% cream left on the head overnight.  If you run into treatment resistant lice you will need to contact your physician before these methods are attempted.

Although lice can be troublesome and time consuming to treat, most problems can be solved by following the directions of the products and being persistant in making sure the problem is eradicated.

For further information on lice treatment please come and speak to your pharmacist.

April 22, 2011 Antibiotics Use Vs. Misuse

One of the greatest breakthroughs in medicine was the discovery of antibiotics.  Antibiotics have saved more lives than any treatment or other type of medication to date.  When used properly antibiotics can heal individuals, who previous to their discovery, would never have recovered.  However, often antibiotics are used inappropriately and indiscriminately.  This leads to a number of problems.

The first of these is antibiotic resistance.  The bacteria we are trying to eliminate get “smart”. A mutation occurs in the bacteria and they “develop” defenses against the antibiotics.  Picture it like a battle front in your body.  You get infected with a bacteria and then you send an “army” of antibiotics against the bacteria.  If used properly you eliminate all of the bacteria.  However, sometimes not all of the bacteria are eliminated and now that they have been exposed to that type of antibiotic they develop a defense mechanism against it.  This “smart” bacteria can be passed on to another individual or remain in your system.  The bacteria can grow and next time you try to treat the bacteria the antibiotic is no longer effective.   This leaves doctors with fewer antibiotics to treat the same infection.  Eventually “Super Bugs” are created which can’t be treated with the usual antibiotics and the individual can develop an untreatable infection that may be life threatening.

The second problem with overuse of antibiotics are adverse drug reactions.  One in five emergency room visits for adverse drug events are due to antibiotics.  Antibiotics can also cause side effects such as diarrhea and rash.   As well, patients can sometimes develop C. Difficile diarrhea.  This is an extremely perfuse diarrhea which can result in hospitalization.  Some antibiotics can interfere with patient’s medication like warfarin and cause the patient’s INR to fluctuate.  They can affect patient’s blood sugar if they have diabetes, and can cause problems for elderly patients if they aren’t dosed properly for ageing kidneys.

Sometimes it’s difficult to know when an antibiotic should be used, however, statistics show they are not needed for most upper respiratory infections.  The common cold and influenza do not respond to antibiotics.  Less than 10% of acute bronchitis cases are caused by bacteria.  Most middle ear infections also resolve without antibiotics.  Sore throats are usually caused by a virus.  Only 15% to 30% of sore throats in children are cause by bacteria and only 10% of cases are strep throat in adults.  Also, almost all cases of acute bacterial sinusitis resolve without antibiotics.

If your family or emergency physician are reluctant to prescribe an antibiotic it is because they suspect a viral infection that is usually self limiting.  Also it is best not to save antibiotics from dental visits or previous infections.  Firstly, they expire and become less effective over time.  Secondly, what is good for one type of infection is not necessarily what is needed for a different type of infection.  Different bacteria are susceptible to different types of antibiotics.  A chest infection requires a different agent from a urinary tract infection.  If you are using the wrong type of antibiotic you are delaying appropriate treatment and putting yourself at risk for resistance and side effects.  Sometimes it is best for the physician to order blood work or urine cultures to determine the type of antibiotic needed.  This allows them to choose the agent that will best treat your infection.

All this being said there are definite times when antibiotics are needed and patients shouldn’t hesitate to be seen by a physician.  Often we see patients with skin infections caused by bug bites where they have delayed being treated because they didn’t realize they needed an antibiotic.

If you are unsure whether an antibiotic is necessary contact a physician, or your pharmacist.  Follow the directions on your medication and finish all of it as directed.    There is definitely a need for antibiotics but overuse is going to lead to fewer and fewer treatment options.  This will be less of a problem if patients and health care practitioners work together to make good decisions about their medication.

April 22, 2011 The Birth Control Pill

The birth control pill is one of the most commonly used medications.  However, there still remain some misconceptions about the pill.

There are a number of different types of pills.  They all contain the same type of estrogen.  Newer pills have less estrogen than older pills.  Newer pills are effective in preventing pregnancy and they demonstrate reduced symptoms of bloating and breast tenderness.  The lower dose pills may be less effective if one pill is missed.  If an individual goes for longer than seven days in a pill free interval that is when they are at most risk of pregnancy.  This means it is very important to take the last pill and the first pill of a cycle.  There are some recommendations that a pill with a higher dose of estrogen should be used in women weighing over 154 pounds for increased effectiveness.

Pills differ in the type of progesterone they contain.  Some pills are particularly effective for improving acne.  Diane 35 is used to treat moderate to severe acne.  Yaz is used for mild to moderate acne.  There may be a very small increased risk of forming a clot on these pills, and so pills such as Alesse and Marvelon can be tried first.

Some pills are monophasic, meaning they have constant levels of estrogen and progesterone.  Others have changing levels of progesterone.  Both types of pills are effective, the only difficulty with a triphasic pill is that it is not ideal to be taken without a pill free interval.  If an individual wants to take their pills back to back to avoid a period, they may still get a period with the triphasic pill.

Sometimes women develop migraines on the pill because of a drop in estrogen during the week off the pill, or they want to avoid having a period.  In this case it may be worth taking Seasonale.  This is a pill you take for three months in a row without a break.  This is safe to do and may help with the above mentioned issues.

Patients should be aware that some medications can decrease the effectiveness of the pill.  Rifampin, barbiturates, phenytoin and carbamazepine can all decrease effectiveness.  Experts say that antibiotics are unlikely to reduce efficacy of the pill.

The pill is a good tool for treating a myriad of issues.  It can prevent pregnancy, clear acne, regulate and lighten cycles.  There a number of options when it comes to the type of pill you take to address each of these concerns.  Talk to your doctor or pharmacist to determine the right one for you.

April 22, 2011 Pinworms

In the last few months we have seen a number of people for treatment of Pinworms.  This type of infection is fairly common most often found in children five to ten years of age because of poor hand washing and close contact in school.  The treatment is simple but some steps need to be followed to help prevent reinfection and spread of this problem.

The most common symptom of this problem is an itchy rectal area.  This is caused by tiny eggs deposited around the anus by a female worm.  When someone with pinworms scratches their perianal area, eggs may lodge under their fingernails and spread to anything he or she touches.  Infested dust, clothing, bedding, or toys can also spread eggs.  When someone accidentally ingests these eggs they become infected.  Adult females live for approximately three months in a human host.  At night they migrate from the rectum to the anus and deposit their eggs.  In moist, humid conditions eggs can survive for up to two weeks.

Pinworms do not cause abdominal pain, bloody stools, fevers, or poor appetite.  If you have these symptoms you should go to the hospital.

If you suspect your child has pinworms the best way to detect them is the “Scotch tape test”.  This is best done at night after a few hours of sleep.  Wrap a piece of cellophane tape around a tongue depressor sticky side out and press it to the skin around the anus to collect any eggs.  Take the tape to the doctor who can look under a microscope to look for pinworm eggs.  If you can collect several samples of tape, 90% of cases will be detected.

If one person in the household is diagnosed with pinworms all of the members of the family should be treated for the condition.  There are two main types of treatment.   The first is Combantrin (taken as a single dose as a liquid or tablet) which is purchased without a prescription.  It is dosed based on weight and should not be given to pregnant women or children under one year of age.  The second is Vermox.  This is a prescription medication also not recommended for pregnant woman, or children under two years of age.  Both types of treatment may need to be repeated because eggs can survive for a few weeks.

Other steps to take include careful hand washing (including scrubbing under fingernails), especially after using the toilet and before eating.  All bedding, clothing and toys need to washed.   Clean underwear and pajamas need to be worn every night.  Bathrooms should also be cleaned particularly well to remove eggs.

It is common to become reinfected with pinworms several months after treatment.  If this happens the doctor should be contacted and everyone should be retreated.

Pinworms are an annoying, but usually, unserious infection.  With proper treatment and care it can be cured.  Talk to your doctor or pharmacist if you suspect you or a family member is infected.

April 22, 2011 Treatment of “Pink Eye”

Pharmacists get many questions about how to treat “pink eye”, also known as infectious conjunctivitis.  Pink eye can be bacterial or viral.   Bacterial pink eye is common in children as they share toys, towels and come in close contact with each other at school and day care.  In general however, most cases of pink eye are viral.

Depending on the type of pink eye treatment will differ.  Bacterial conjunctivitis can be treated with antibiotic drops.  There is no medicinal treatment for viral conjunctivitis.

In 45% to 73% of children with purulent ‘pink eye” an ear infection is also present.  If the eye has a purulent discharge, swelling and burning, this usually points to a bacterial infection.  A mild watery discharge with itching, associated with a concurrent upper respiratory infection signals viral conjunctivitis.

Both types of infections are generally self-limiting, (they will resolve on their own with out medication).  Most types of bacterial conjunctivitis will resolve within eight days.  These infections can be treated to speed up recovery and prevent the spread of the infection.  Cold and warm compresses can be used as well as a variety of topical antimicrobial agents.  Polysporin drops are available over-the-counter and will cover most pathogens causing bacterial conjunctivitis.  Other prescription eye drops are also available.

Bacterial conjunctivitis is contagious as soon as symptoms are present and for as long as there is discharge from the eye, and continue for one to two days after starting the antibiotic.

With viral conjunctivitis compresses are about the only treatment available.  If one eye is involved the other eye will become infected within days in about half the cases.  Symptoms may worsen for a few days slowly improving over one to two weeks.  This condition is contagious before the appearance of symptoms and as long as symptoms last.

If you wear non-disposable contact lenses clean them thoroughly and buy a new storage case.  Disposable lenses should be thrown away.  Glasses should be worn for the duration of the infection.  If you use other drops for treating conditions like glaucoma you should replace these to avoid inadvertent contamination.

To prevent the spread of infection practice good hygiene, washing hands and towels of the infected person.

If you are having trouble with your child’s school you can ask the pharmacy for an explanatory note.  This helps clear up any misconceptions they may have regarding the treatment that is necessary, and steps that need to be taken to prevent the spread of the condition.

Please contact your pharmacy or doctor if you have any further questions regarding this condition.

April 22, 2011 Otitis Media (Ear Infections)

About 75% of children will suffer from an ear infection before they reach one year of age.  It is a common childhood ailment that is often treated inappropriately.

Many ear infections are caused by viruses and resolve on their own without antibiotic treatment.  For every 15 children treated with antibiotics only one will have resolution within 48 hours.  Also antibiotics can cause some adverse effects such as diarrhea, skin rashes, allergic responses, and an increase in antibiotic resistance.  Most children who have ear infections can be treated with “watchful waiting”.

In general healthy children six months and older can be treated with “watchful waiting”.  Children younger than this and those with other ailments should be treated with an antibiotic.  If the oral temperature exceeds 39˚C, there is severe ear pain, or your child is extremely ill, an antibiotic should also be considered.  You can also ask your doctor for an antibiotic prescription to be used if your child is not improving on their own within 48 to 72 hours.  (This way you don’t have to make a repeat trip to the doctor).

If your child requires an antibiotic take careful note of the kind of medication and the dose being given.  The drug of choice is Amoxicillin given at a high dose (80mg/kg/day) divided twice a day for five days.  (If your child is less than two, or has had frequent infections, a ten day course should be given).  For children with a penicillin allergy, clarithromycin (Biaxin) can also be given.  There are other choices as well but the above are the most common starting place.  If there is no improvement after two days of antibiotics the medication should be changed.  If you are seeing a different physician make sure you inform them what type of antibiotic your child has had, and what dose they were on.

All children complaining of ear pain can be treated with ibuprofen (Advil), and/or acetaminophen (Tylenol).  This will help to lessen any fever and reduce the pain being caused by the infection.

To help reduce the risk of ear infections it is important to use frequent hand washing, and washing of toys, and linins on a regular basis.  Breastfeeding until three months of age can also reduce the risk of infection in a child’s first year.  Limiting pacifier use and exposure to tobacco smoke can help, as well as limiting daycare in children less than one year of age. It is also important to have your child vaccinated for influenza and pneumococcal infections.

Luckily most kid’s ear infections will improve on their own in seven to ten days.  Symptomatic treatment of pain and fever is all that is really needed.  However, if you feel your child is very ill, make sure you see a doctor and use the antibiotic prescribed appropriately.

April 22, 2011 Colon Cleansing and other Detox Methods

People often come to the store looking for products that will cleanse their colon, or detoxify their system.  They have heard that regular colon or liver cleansing and other methods of detoxification can rid the body of pollutants, aid in weight loss, and prevent cancer.

The theory that over time the body can accumulate harmful toxins such as metals and pesticides is often perpetuated by the media and other advertisers.  Proponents believe special treatments including herbals or supplements given orally, or as enemas, or special diets, can remove these toxins from the body.

Unfortunately there is no proof to support any of these claims.  There is no special product or method that can rid the body of toxins.

The body is an amazing machine equipped with liver and kidneys that are responsible for filtering and eliminating toxins from the body.

Detoxification programs can actually be dangerous.  They often include laxatives that can cause significant diarrhea resulting in fluid loss, and electrolyte imbalances.  Some laxatives can worsen heart failure or cause kidney failure in people who have kidney disease.

Enemas and colonics can also lead to electrolyte imbalances and can even cause a perforated rectum.  Some deaths have actually been reported with the use of coffee enemas.

For patients who want to optimize their health there are some simple much safer steps that can be taken.  The first step for overweight patients is to lose weight by eating more fruits and vegetables and less refined sugar.  Secondly, drinking a few glasses of water can help with weight loss and general health.  However, it is not necessary to over do water intake either.  The body closely regulates the amount of water in your system through homeostasis and your kidneys.  Drinking too much can force you to the bathroom with increased frequency and not provide you with any other additional “health” benefit.  Simple exercise like walking and some daily fresh air can improve mood and aid in weight loss as well.

For patients who want to take a supplement, there are some that can improve your health.  Vitamin D, and Omega 3’s have shown significant health benefits.  Adults should take at least 1000 IU of vitamin D a day for bone health and cancer prevention.  Omega 3’s (EPA and DHA) have shown benefits for heart and brain health.  An aspirin a day is also promoted for heart and stroke protection.  Finally naturally occurring antioxidants that come in berries, green tea, and other naturally occurring sources can help with general overall health.

If you want to improve your health, it is best to avoid colon and liver cleanses and stick to the above mentioned strategies.  Speak to your family physician or pharmacist if you would like to add in a supplement, and for advice on the best way for you to “get healthy”.

April 22, 2011 Vitamins Supplements and Herbals

Contrary to popular belief there really is no magic pill.  Many people come in search of the right vitamin, or supplement, hoping it will help them sleep better, feel better, or perform better.  Unfortunately there really aren’t any magic supplements that can cure all that ails you.  Even prescription medications are limited.  They can lower your blood pressure or your cholesterol but no pill is going to fix everything.

People want to take herbals because they feel a natural product is “safer” for them.  This is not necessarily true.  Whether you are taking a prescription medication or a natural product you are putting a chemical in your body which can alter your body’s chemistry.  As such you are subject to the effects of the medication either good or bad.

Pharmacists are not against herbal products.  Many of them have evidence to show they can provide some benefit.  However, not all herbals and natural products have undergone standardized testing to ensure that they only contain what’s on the label.   It has even been shown that some products contain very little of the ingredient they are being sold for.  As a consumer it is important you educate yourself regarding which manufacturers have their products tested, and which companies conduct clinical trials to ensure their products are safe and effective.  Some companies now have an NPN number on their products.  This number serves as notice that their products have been tested and contain what is claimed on the label.

As far as supplements are concerned the best thing to do is follow the Canada Food Guide.  A well balanced diet can provide you with all of the vitamins and nutrition you require.  The few supplements that may be worthwhile to purchase are Calcium and Vitamin D.  Even with a well balanced diet most people do not get enough of these.  Recent studies show that almost everyone has a vitamin D deficiency.  New evidence shows that vitamin D is important for bone health as well as preventing some cancers.  It is also important to make sure you are getting enough Omega 3’s (DHA and EPA).  These supplements are linked to both heart and brain health.  Again, they are deficient in most people’s diets.

If you are interested in taking a supplement or vitamin consult your doctor or pharmacist.  Many times you don’t need to spend the extra money.  If you would like to take an herbal product do as much research on the company as possible.  Ask your pharmacist about safety and reliability.  Herbals can interact with your prescription medications and cause liver and kidney toxicity.  For exampleSt. John’sWart can affect the birth control pill, and melatonin can increase blood pressure.  Many herbals can also interact with warfarin, and could be dangerous for some people to take.

It can be confusing with media and advertising if you should be taking a supplement or herbal product, please come and talk to a pharmacist if you have questions about these types of products.

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