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The most effective way of protecting yourself from the flu is by getting the flu shot each year. A new vaccine is developed annually based on the three strains of influenza which are predicted to be the most prevalent that year. The vaccine works by introducing a small amount of inactivated influenza virus into our body allowing our immune system to build an army of antibodies to the virus. If we are then exposed to the live virus, our immune system sends the antibodies to “attack” the foreign invader, preventing an infection from developing.
Unfortunately, sometimes the unexpected happens, as was the case this flu season. The influenza strain that ended up being the most widespread this year was not one of the three strains contained in the vaccine, so there were many cases of people getting sick – even those who did get vaccinated. Naturally, people are concerned about the effectiveness of the flu shot and have doubts about whether they should get the vaccine again.

Here are some points to consider when making your decision to get immunized next flu season:

1. Extensive research is done each year to make the decision about which three strains will be included in the vaccine. Generally, the predictions are very accurate and the vaccine prevents many thousands of people from becoming ill each year. However, we need to remember that the annual flu vaccine does not protect against all strains of the influenza virus, so there is a chance that someone could become infected with another strain.

2. We need to understand that what happened this year was unusual. This season, the virus essentially ‘outsmarted’ us. It was determined that the main viral strain mutated, leaving the vaccine less effective than expected. This mutation meant that the virus changed in such a way that the antibodies our immune system had developed after receiving the vaccine, were not able to mount a very effective response to infection by the live virus.

3. The flu vaccine CANNOT give you the flu. The components of the vaccine are inactivated influenza viral particles – meaning only pieces of the killed virus are present and are not able to cause infection.

4. Immunity from the flu shot is not immediate. It takes about 14 days for our immune system to develop antibodies to the strains contained in the vaccine. During this lag period, it is possible to develop an infection if contact with the virus occurs during the first two weeks after vaccination.

5. It is recommended that everyone over the age of 6 months be immunized each year. Not only can it protect you from becoming very sick, but it can help to protect those around you, by reducing the spread of the virus. Furthermore, if you do come down with the flu after receiving the vaccination, the infection will likely be less severe and may not last as long.

6. Vaccines – including the flu vaccine – do NOT cause developmental disorders like autism. People have become very concerned with the idea that thimerosal (a preservative used in some vaccines) is linked to the development of autism in children, but there is no evidence of this being true. However, there are flu vaccines available that do not contain thimerosal if you still have concerns.

6. It is beneficial to get the flu shot at any point during flu season; not only at the beginning. Also, it is a good idea to get vaccinated even if you have already had the flu that season as the infection may have been caused by a different strain.

Although the flu vaccine is the most important form of protection from the flu virus, people must remember that hand hygiene is also a key component to preventing the spread of infection. Washing hands thoroughly and often, using hand sanitizer when washing is not possible, and staying home if you have flu-like symptoms to avoid spreading the virus to others.
Influenza can be a serious illness for many people, especially children, the elderly and those who are immunocompromised, but the flu vaccine is important for everyone. It helps to protect yourself and those around you from potentially becoming very ill. If you have more questions about the flu vaccine, please talk to your pharmacist.

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What are the measles?

According to the World Health Organization, measles is a highly contagious, serious disease caused by a virus. It is characterized by a red blotchy rash, commonly causes diarrhea and pneumonia and in more severe cases can even cause brain swelling or death. Measles is an airborne disease that spreads easily through the coughs or sneezes of an infected person. It may also be spread through contact with saliva or nasal secretions of an infected individual. People can be contagious for as many as 4 days before the rash and for up to 4 days after the start of the rash.

Why has there been so much talk about measles lately?

In the past several years there have been multiple measles outbreaks. Currently we are dealing with a number of cases throughout the Niagara Region. Over the last year you may have also heard about the much larger multi-state outbreak that has occurred in the United States. This larger outbreak has been linked to some of the cases in Canada while other cases have been linked to travel to countries where measles is endemic.

What are the symptoms?
• Fever
• Runny nose
• Drowsiness
• Irritability
• Red eyes or sensitivity to sunlight
• Small white spots on the inside of the mouth and throat
• Red blotchy rash that starts on the face and spreads to the rest of the body within 3 to 7 days after the start of symptoms

How can I prevent myself or my family from contracting measles?

The most important measure you can take to prevent the measles is to get vaccination with two doses of a measles-containing vaccine. The first dose of measles vaccine is typically administered at 12 months of age with a second dose administered prior to a child’s fifth birthday. All adults and children are advised to ensure that their vaccinations are up to date. For more information on whether your vaccinations are up to date, contact your health care provider or the Niagara Region public health department.

What to do if you suspect you have the measles:

• Before visiting your health care provider, be sure to contact them first and describe your symptoms over the phone so that they can take appropriate precautions before assisting you, or direct you to the most appropriate health provider.
• Contact your health care provider or Niagara Region public health at 905-688-8248, ext. 7330.

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Although we are in the midst of another flu season here in Canada, it has been the Ebola virus recently dominating headlines and causing fears around the globe. The World Health Organization (WHO) reports more than 14,400 confirmed or suspected Ebola cases as of Nov. 11, 2014, mainly in the African countries of Guinea, Liberia, and Sierra Leone, thus making it the largest Ebola outbreak ever recorded. The current epidemic has led to over 5,100 deaths and the lack of any vaccine continues to cause fears of a global spread of Ebola. However, a closer look at the details regarding these events should ease nerves and help shift focus back to the greater threat of year’s influenza strain.

In the early stages of infection, it is difficult to differentiate Ebola from the flu as both cause non-specific symptoms such as sudden onset of fever, fatigue, headaches and a sore throat. However, Ebola patients will begin to develop vomiting and diarrhea after 3-6 days and approximately half will also experience hemorrhagic events such as nosebleeds, bloody diarrhea, and bruising typically occurring between 2 to 21 days after initial symptoms appearIt is also important to note that unlike the flu, Ebola is not an airborne virus. Furthermore, Ebola can only be transmitted once symptoms appear while flu patients can spread the virus before and during their illness.

Scientists believe that the first Ebola patient contracted the virus after handling an infected animal, possibly a fruit bat or monkey. Unlike humans, these animals are able to ‘host’ the virus without becoming severely ill. Once a human becomes infected, transmission to other people may occur only through direct contact with blood, secretions or other bodily fluids from an Ebola-infected person. In West Africa, this direct contact occurs during traditional West African funerals that involve washing and touching the deceased as part of the mourning process. This practice is not commonly followed in Canada and would limit the rate of transmission if the virus somehow found its way to North America.

You may have heard speculation that mortality rates for the current Ebola outbreak are as high as 90 percent. Keep in mind that these inflated rates are based on patient care settings that are not as sophisticated as the resources available in Canadian facilities. Insufficient medical care, shortage of supplies and a lack of funding are undoubtedly contributing to the epidemic. Although there is no specific treatment or vaccine currently available for Ebola, our hospitals are able to provide high-quality supportive care which can help boost the patient’s own immune system enough to overcome the virus on its’ own.

Therefore, at least within Canada, there is no reason to fear those with a fever or upset stomach. However, reasonable precautions should be followed if we encounter people with Ebola-like symptoms who have also travelled to West Africa within the past 3 weeks. These patients should seek immediate treatment to ensure they receive the best available treatment as quickly as possible. And, of course, getting a flu shot is an easy, effective way to prevent ‘the other virus’ from spoiling your Holiday season!

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Warts are a common viral skin infection caused by human papilloma viruses.  In general warts on the hands and feet are harmless and most resolve on their own.  However, they can cause embarrassment and some discomfort.  There are a couple of over-the-counter (OTC) remedies that work well to treat these kinds of warts.

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.

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Very rarely does a day go by where there isn’t a question about constipation from a patient stopping by the pharmacy. Most patients want to know what they should take that is available without a prescription.

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.

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Grapefruit and grapefruit juice are an excellent source of many nutrients that contribute to a healthy diet. Grapefruit is a good source of vitamin C, fiber, and the pink and red hues contain the beneficial antioxidant lycopene, thought to have a role in preventing various diseases such as cancer and heart disease. Studies have shown that grapefruit helps lower cholesterol, and there is evidence that the seeds have antioxidant properties.

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:

Allergies Fexofenadine (Allegra)
Anticoagulation Dabigatran (Pradax)
Anxiety/Sleep Buspirone (BuSpar), Diazepam (Valium), Triazolam (Halcion), Alprazolam (Xanax), Clonazepam (Rivotril)
Arrhythmia Amiodarone (Cordarone)
Blood Pressure Amlodipine (Norvasc), Felodipine (Renedil, Plendil), Nifedipine (Adalat)
Cholesterol Simvastatin (Zocor), lovastatin (Mevacor), atorvastatin (Lipitor)
Depression Sertraline (Zoloft)
HIV Saquinavir (Invirase, Fortovase), indinavir (Crixivan)
Seizures/Epilepsy Carbamazepine (Tegretol, Mazepine), Clonazepam (Rivotril)
Sexual Dysfunction Sildenafil (Viagra), Taldafil (Cialis)
Transplants/Autoimmune Diseases Cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf, Advagraf), sirolimus (Rapamune)

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.

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Smoking is the most preventable cause of disease and death. In Canada, 45, 000 people die annually, and as many as half of all smokers will die due to tobacco use. Smoking is known to cause various types of cancer, COPD, heart disease, stroke and many other conditions such as influenza, peptic ulcers, osteoporosis, thyroid disease and cataracts. Despite the known risks, there are approximately 5 million Canadian smokers. Nicotine is the addictive chemical component in tobacco. It binds to the ‘reward’ receptors in the brain, which help people relax, improve mood and suppress appetite. Due to the continued stimulation of the reward pathway, people continue to smoke.

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.

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