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DR. HISTER ON
STROKE RISKS & SYMPTOMS HOW TO MANAGE
ACID REFLUX LIVING
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People First contents
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What You Need To Know About Strokes Dr. Art Hister looks at stroke risks and how to identify symptoms.
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Vitamins & Supplements Great savings on a wide selection of quality vitamins and supplements.
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Acid Reflux Peoples Pharmacist Ian Lloyd brings up different ways to manage acid reflux.
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Better Than Fish Oil Page 5
Save On Health Great selection of quality health and wellness products from Peoples Pharmacy.
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Pharmacist Recommended Helpful information on vitamins and minerals and how they impact your overall health.
Shown to support cardiovascular health by maintaining healthy cholesterol levels.
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Gluten Free Living Darlene Booth offers advice on a gluten free diet.
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Ratatouille Brand new feature recipe From Company’s Coming Healthy Family Recipes.
Helping People Live Better Lives
STROKES I grew up thinking that a stroke was a general sort of problem, a nuisance more than a real health concern, because every time I did something that my mother told me was “bad” (and as a very active, my teachers would say, hyperactive young boy, I was always doing something bad, often several times a day), she complained that she was about to suffer a stroke, and since I can’t recall ever seeing my mom ailing, as a kid, I figured that a stroke was something pretty mild that in any case you got over very easily, although you were of course under direct threat of getting another stroke only minutes later. How little I knew, about many things, of course, but especially about strokes, which as anyone who has ever suffered one or been involved with someone who has had one can attest, are too often anything but mild problems and which, rather than pass quickly, generally alas lead to an often persistent and disabled condition. So let me say this up front: there are lots of conditions you don’t want to end up with but surely very near the top of anyone’s list of I-don’t-wantthat is a stroke. A stroke is brain damage caused by interruption of blood flow to the whole or to a part of the brain. “Mini-strokes,” which are known to doctors as transient ischemic attacks or TIAs, are due to a temporary interruption in blood flow to or in the brain,
Dr. Art Hister
so that the symptoms of a TIA, which can completely mimic those of a stroke – see below – are, as the name implies, transient, although some of the damage a TIA causes may still be permanent, and since a TIA greatly elevates the risk of suffering a fullblow stroke, especially in the near future after suffering a TIA, it’s best to think of a mini-stroke as a “stroke-in-waiting.” The first key thing to note about strokes is that you can do a lot to lower your risks of suffering one by learning what the “preventable” risk factors are – the most important common ones are the sameold, same-old bad guy gang of seven: high blood pressure, smoking, obesity, diabetes, high cholesterol, poor diet, sedentary lifestyle – and doing your utmost to adjust your life to minimize those risks. Unfortunately, though, some risk factors for strokes are not preventable – increasing age (you really don’t want to do anything to lower that risk factor, trust me), a history of having had a stroke or a TIA, having atrial fibrillation, a bad family history, and several others – so if you have any of those, you really have to do as much as you can on the factors mentioned earlier that you can affect. The second important thing to note about strokes is that they are divided into 2 categories: 1) ischemic strokes, which are caused by blockage in an artery feeding the brain, and 2) hemorrhagic strokes, which are caused by a bleed into the brain, such as when a blood vessel Continued On Page 11
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ACID REFLUX
Ian Lloyd Peoples Pharmacist
Despite its caustic sounding name, acid reflux is not a new style of loud dance music. Acid reflux is sometimes referred to as heartburn; a condition where your stomach contents rises up into your esophagus. Like loud music, heartburn can be painful and irritating. Luckily, for most of us, we simply take an antacid and the pain goes away. For others, the pain can be quite intense and return frequently. This month, we shall learn what acid reflux is and what it isn't. What normally happens when we eat or drink is the food travels down our esophagus and then into our stomach. There is a tight band of muscles at the top of our stomach called the lower esophageal sphincter (LES) which keeps all of your stomach contents where they should be. Sometimes the muscles of the LES can relax, allowing the acidic contents of the stomach to come up into the esophagus. This is referred to as acid reflux. The resulting irritation to the esophagus causes a burning sensation, which is usually felt just behind the breastbone and below the throat. The onset of this pain can be quite intense, but it usually goes away when a person takes antacids. It might be hard to determine the exact cause of a person's heartburn. Many people feel that their acid reflux may be related to their diet; they are partially right. Certain foods can trigger heartburn, such as: coffee, mint teas, spicy or fatty foods. This is not a complete list and many people know their heartburn triggers. Obesity, smoking and pregnancy can also exacerbate heartburn symptoms. There is one thing that acid reflux is not: a medical condition called gastroesophageal reflux disease (GERD). GERD can be thought of as a persistent form of acid reflux. The symptoms of GERD are the same as 6 People First Join us on
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for acid reflux, except that people who have GERD may also show symptoms of a dry cough or difficulty swallowing. GERD can also cause asthma-like symptoms. If you are having persistent acid reflux symptoms, more than twice a week, it might be wise to bring these symptoms to the attention of your physician. For many people, non-drug options work very well. The first thing is to avoid any foods or beverages that trigger your acid reflux. This might seem obvious, but many people will still have their daily coffee even though it gives them grief. If you must eat your trigger foods, take an antacid prior to or just after the meal. If you smoke, stop. Try not to lie down for at least three hours after eating a meal. If acid reflux is a problem at night, try raising the head of your bed. You only need to raise it by approximately 6-8 inches, about the thickness of a large phone book. Some people find it helpful to eat smaller meals more frequently, about 5-6 meals throughout day. One health tip that I feel is over looked is to eat slowly. People tend to eat their meals too fast, I feel this causes them to eat too much. This is an old weight loss tip that can be helpful for heartburn sufferers. Consciously eat your meals. As a parent, I am often at fault for this. I fill my plate and stuff my face so fast that I am done before my little one is done. The next time you have a meal; take reasonably sized bites, put your fork/spoon down between bites and chew your mouthful at least 20 times. This delay in eating may seem odd at first, but it can be very helpful. It allows your stomach to fill slowly and gives you the signal that you are full, before you eat too much and feel 'stuffed', which can lead to heartburn. Continued On Page 8
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Ian Lloyd...Continued From Page 6
I haven't seen too many vitamins or supplements that are helpful for heartburn, but I have two suggestions. There is a liquid preparation called Iberogast, that some people have found helpful for all sorts of stomach ailments. It is a mixture of various plant extracts: chamomile, Clown's mustard, Angelica root, caraway, milk thistle, lemon balm, celandine, licorice root and peppermint. All of these herbals have historical use for treating all types of digestion ailments. Beware of herbal teas used to treat stomach problems. They might contain peppermint or other mint plants. Plants in the mint family can relax the stomach muscles and may worsen acid reflux symptoms. The other option is betaine hydrochloride (HCL), which helps to increase the amount of acid in your stomach. I know that it may seem counter productive to add acid to try and help with heartburn, but there is a theory behind this. Some natural healers feel that stomach troubles, whether heartburn, gas or irritable bowels, are due to your body's inability to properly digest food. The added acid found in betaine HCL can increase your stomach acid content, which can help to properly digest the food you eat. Ask your physician if
this option could be helpful for your acid reflux condition. If you do decide to try this product, start with a low dose. Take one tablet, usually a 600mg strength, with your largest meal. If you notice any discomfort or burning, discontinue use of this supplement. You can slowly increase the dosage by one or two tablets, with a large meal, until you reach about 6-7 tablets daily. Reduce your dosage as soon as you notice any warmth or burning sensations. Use this supplement with caution because it can sometimes worsen your acid reflux symptoms. The other way to help treat acid reflux is to reduce stomach acid content. The best treatment for mild and infrequent heartburn is calcium carbonate tablets (Tums, Rolaids, etc). These products neutralize stomach acid and help to reduce that burning feeling caused by the stomach acid. They tend to work quite well and have few side effects. You can also get sodium bicarbonate products that act similarly to calcium carbonate tablets. Usually these products are effervescent (ie. Bromoseltzer). These products contain a lot of sodium and might be contraindicated for people with high blood pressure. Ask your physician or Peoples Continued On Page 10
Don’t Play A Guessing Game With Your Daily Medications Many people today are on more than one medication, and when you combine this with a busy and active life, it can lead to the confusion of properly taking your medications. Medication non-compliance is a major concern and accounts for approximately 25% of all hospital admissions among seniors. Peoples Drug Mart and Peoples Pharmacy offer a medication compliance program called “Med Manager.” The Med Manager is a medication compliance card that conveniently organizes your medications for a full week, and helps you easily identify what medications are to be taken at what time of the day. Talk to your Peoples Pharmacist about the convenient and safe Med Manager program.
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pharmacist recommended
Vitamins and Minerals Health & Wellness Information From Your Peoples Pharmacist
What are vitamins?
Vitamins are natural compounds that our bodies need to maintain normal health and development. Vitamins help the body’s cells function optimally. If you don’t get enough of any one vitamin, over time you may not feel your best or may even become ill. We need 13 basic vitamins that are found in foods: A, C, D, E, K, and 8 other vitamins referred to as the vitamin B complex. The B complex includes thiamine (B1), riboflavin (B2), niacin (B3), biotin, pantothenic acid, pyridoxine (B6), folic acid, and cyanocobalamin (B12).
What are minerals? Minerals are elements that are essential for good nutrition. Each mineral plays an important role in keeping the body’s cells in a natural state of balance. Minerals occur naturally, passing into foods grown in soil and into meat sources when animals eat plants. We need 15 minerals to maintain good health: calcium, chloride, chromium, copper, fluoride, iodine, iron, magnesium, manganese, molybdenum, phosphorus, potassium, selenium, sodium, and zinc.
People with unhealthy diets You may need supplements if you: • Miss meals. • Diet to lose weight . • Do not eat enough foods from the four basic groups (grains, fruits and vegetables, dairy, and meat and alternatives). • Regularly eat foods high in sugar and processed or refined foods (for example, fast foods). People with healthy diets Even if you eat a healthy, balanced diet, you may benefit from supplements. If you are…
Supplements may help you because…
over the age of 65
Your appetite may diminish with age and if you do not eat enough food you may develop micronutrient deficiencies.
a woman of child-bearing age
You may not be getting enough iron, calcium, magnesium, or folic acid. If you are not eating enough fruits, vegetables, beans, or dairy products, consider taking a multivitamin supplement.
living with a digestive disease.
You may not be properly absorbing vitamins and minerals.
unable to consume dairy products
You may not be getting enough calcium and vitamin D.
on a weight-loss diet
You may not be getting all the micronutrients you need if you are getting less than 1200 calories a day.
How can I get vitamins and minerals? The best source for vitamins and minerals is a balanced diet of whole foods (foods that have not been unnecessarily processed or refined). Whole foods, particularly fruits and vegetables, contain hundreds of other healthy, natural substances that you won’t find in vitamin and mineral supplements. However, supplements can help ensure that you are getting enough essential vitamins and minerals.
Who needs vitamins and supplements? You are probably getting enough vitamins and minerals if you are in good health and eat the recommended daily servings from each food group. (For recommended daily servings, see Canada’s Food Guide to Healthy Eating). Unfortunately, many people do not have a diet that provides enough micronutrients. (Micronutrients are nutrients found in foods in very small amounts).
Vitamins are not a substitute for a healthy diet but can be beneficial depending on your lifestyle, diet, and other factors. Talk to a Peoples Pharmacist to see if vitamins and minerals can help support or improve your health and wellness. peoplesdrugmart.com People First 9
Ian Lloyd...Continued From Page 8
Pharmacist if these antacids would be right for you. Another option for acid reflux relief is an alginic acid containing product (Gaviscon, etc). This is a natural product, as it is derived from brown seaweed. The alginic acid forms a layer of foam that floats on top of the stomach contents. This helps to protect the esophagus from the acidic contents of the stomach, and thus stops any burning sensation. If these two options do not help your heartburn, you can try the group of medicines referred to as the H2 blockers. You might know them better as ranitidine (Zantac) or famotidine (Pepcid). These medications work by actually stopping your body from producing stomach acid. They are especially helpful if you know that a certain meal will cause heartburn. They are more effective than the antacids, but should be taken about ½ hour before meals. There are a few side effects with taking medications to help reduce stomach acid. The most common ones are digestive problems; bloating, gas, diarrhea, or constipation. This is because your body needs some stomach acid to completely digest your food. With prolonged use, these medications can
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lead to vitamin and mineral deficiencies. The most common deficiencies include: vitamin B12, calcium, magnesium and other minerals. If you are taking acid suppressing medications. you might want to consider taking a multivitamin. Make certain any mineral supplements you are taking are in the citrate form (ie. calcium citrate). The citrate form of minerals are not as dependent on stomach acid for adequate absorption. I hope this article has answered all of your burning questions about acid reflux. If you do suffer from acid reflux, first try the non-drug ideas I mentioned above. These options will usually help to relieve your symptoms. Another worrisome issue is that the pain from a heart attack is similar to that caused by acid reflux. If chest pain appears suddenly, does not occur after eating, or happens after physical exertion, you should seek medical attention quickly. Eat well and eat slowly; you should only have to experience your meal once. Written By Ian Lloyd, Pharmacist & Chartered Herbalist, Peoples Pharmacy
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Dr. Hister...Continued From Page 4
bursts. The reason that two-type of stroke breakdown matters so much is that the treatment of each kind is radically different, so while ischemic strokes are treated with a clot buster (to try to open up the blocked artery), if you treat a hemorrhagic stroke with anti-bleeding drugs, you will make that person much, much worse (they’ll continue to bleed and not clot). The 3rd key thing to note about strokes is that unlike just a few years ago, these days, if doctors can get clot-busting medication into the artery being blocked in an ischemic stroke, that person’s prognosis is much better than it used to be when we just waited for a stroke to settle down to see what damage that person was left with. In fact, in some stroke units, it’s claimed that a significant number of people who get there quickly enough after recognizing they are suffering a stroke can leave the unit with no discernible symptoms (although alas, they may still have some permanent subtle damage). So that brings up the next very important point to know about strokes: you have to get to a hospital as quickly after the onset of the stroke symptoms as you can, and certainly in less than 6 hours, preferably in less than 3. So here’s part one of your homework: to memorize what the stroke specialists keep insisting, namely, that time is brain, meaning that the sooner you treat the symptoms of a stroke, the more brain function you save and the better your chance of recovery. Which naturally brings up the last key point about strokes and the second (and more difficult) part of your homework, namely to memorize the symptoms of a stroke so that you can recognize them instantly, something that‘s particularly important for anyone at high risk. So you better pay attention to this, all you aging baby boomers who are overweight, sedentary, etc, because survey after survey reveals that most people don’t recognize the symptoms of a
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Dr. Hister...Continued on Page 13
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Dr. Hister...Continued From Page 11
stroke, and even if they do, they put off doing anything about it figuring that the symptoms will disappear magically if they wait long enough. They won’t, and even if they do (as in a TIA), you should still be evaluated ASAP. So here is that list (and if you can’t memorize it, then at least pin a copy to your fridge, or write it down where you’ll see it often to jog your imperfect memory). • Sudden numbness or weakness of the leg or arm on one side of the body or the face. • Sudden confusion or trouble understanding speech or difficulty with speech. • Sudden trouble seeing in one or both eyes • Sudden trouble walking, dizziness, loss of balance or coordination. • Sudden severe headache – often described as “the worst headache I ever had”- with no known cause. If you ever get one of those symptoms, or as happens often, someone around you seems to be suffering one, you don’t call your spouse to ask what to do, you don’t say, “let’s take a walk to see if the symptoms ease” but you dial 9-1-1 right away, and get them (or you) to a hospital ASAP. Happily, some of the time, those symptoms won’t mean anything and you’ll have wasted a few hours (or in the case of an ER I once went to with a friend for a problem she was having, a day or more; I’ve written books in less time than it took to get that particular problem sorted out), but if it is a stroke, and you get the right treatment, you may leave hospital as well as you were just before you started suffering those symptoms. Of course, if you weren’t well before you got those symptoms, I’m really sorry, but there’s nothing I can do to help you with that. Dr. Art Hister can be heard on CKNW and other Corus Radio Network stations on House Calls on Saturdays at 10 AM, as well as seen on Global TV news on Saturday mornings at 9:20.
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GLUTEN FREE LIVING Gluten is a protein found in barley, rye, triticale and all wheat and wheat related grains including spelt and kamut. It provides structure to baked goods and is the “glue� that holds things together. Gluten can be difficult to avoid; it is extremely prevalent in much of our standard dietary food chain. Aside from the obvious wheat based pastas and baked goods, gluten hides in soups, sauces, snack foods, spices, condiments, processed meats and even candy. Gluten free living has traditionally been a challenge for shoppers but you only have to look around the grocery store to see that this is changing. Gluten free is a fast growing dietary trend and manufacturers are rising to meet the demands of the gluten savvy shopper. Over the past couple decades, many people have begun to recognize that gluten may be undermining their health; as a result there is a growing demand for gluten free products which has created a new niche for the food manufacturing industry. Certainly, a wider range of gluten free products to choose from is good news for many people whose gluten intolerance used to mean a denial of many of life’s simple edible pleasures. It has also opened up a new lifestyle option for those who find that they just feel better with less gluten in their life. For some, gluten free living may be a choice but for others it is a necessity. Celiac disease is a condition where gluten causes inflammation and damage to the lining of the small intestine; this creates a problem with the assimilation of nutrients needed for optimal health. Even a tiny amount of gluten is enough to create an inflammatory reaction in people with celiac disease so they have to be extremely vigilant about what and where they eat. Cross contamination can be a danger if food is prepared in a kitchen or facility that also handles glutinous grains. A gluten intolerance or sensitivity is not quite as serious as celiac disease; it may create digestive problems but will not damage the intestinal lining. People with a sensitivity or intolerance can sometimes eat gluten occasionally without too much problem. Some people find that they just feel better when they eat less gluten; this choice to be gluten free is usually in tandem with a desire to eat a healthier diet.
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Darlene Booth R.H.N
If you read labels looking for gluten you will not always be met with the obvious. Any product derived from wheat will be suspect, as will barley, malt, beer and soy sauce. The list of food ingredients that contain gluten is quite prolific and often surprising. If you are new to the gluten free lifestyle, it is well worth investing in a gluten free book or doing an Internet search to educate yourself. Many whole foods such as fruits, vegetables, meat, poultry, fish, nuts, seeds and dairy are naturally gluten free; take care to note that binders derived from gluten will sometimes be added to dairy products and processed meats so be sure to read all labels carefully. Gluten free whole grain options are varied and include rice, quinoa, amaranth, corn, sorghum, buckwheat, and teff. Oats are a controversial topic in the gluten free world. There is often confusion around oats and whether they belong in the glutinous group, but the main problem with oats is that they are often processed in a facility that processes other grains. Manufacturers are now producing non-contaminated oats, which are a safer bet for those with celiac disease. Up until recent times, wheat has pretty much ruled the snack food and bakery aisles. Thankfully, this has begun to shift, as there are a wide variety of flours available that will work for the gluten free connoisseur. Almond, amaranth, bean flours, corn, millet, potato starch, quinoa, rice, sorghum, tapioca and teff are often used in different combinations to create sweet and savoury goodies. Baking success comes by adding a binder or stabilizer to the products to help with texture and in the rising process; guar gum and xanthan gum are two of the most common in use. Without them, baked goods can be heavy and dense. Some people think that by shifting to a gluten free diet they will lose weight. This may be true if you cut out all processed foods and grains but seeing a gluten free label does not equate to a free ride. Gluten free products can be just as chock full of empty calories as their gluten loaded counterparts. Balance is always the key; keep the goodies to an occasional treat. Good Health to You
Ratatouille
Ratatouille
A new take on a beloved classic, this dish abounds with lycopene, vitamin C and antioxidants. It pairs well with anything and reheats very well for leftovers. 1 Tbsp (15 mL) extra virgin olive oil 1 red onion, diced 2 red peppers, diced 2 zucchini, diced 2 large eggplant, diced 2 cloves garlic, finely chopped 1 ⁄4 cup (60 mL) red wine 1 ⁄2 cup (125 mL) tomato paste 1 tsp (5 mL) chopped fresh thyme 2 bay leaves 1 Roma tomato, diced 1 ⁄2 tsp (2 mL) salt 1 ⁄4 tsp (1 mL) pepper 1 Tbsp (15 mL) lemon juice 1 tsp (5 mL) agave syrup Heat oil in a heavy bottomed pot over medium-high. Add onion and red pepper, and cook for 1 minute. Add zucchini, eggplant and garlic, and cook until vegetables begin to sweat. Pour in wine and tomato paste and mix well. Fold in remaining ingredients and lower heat. Cover, allowing to braise for 10 minutes, stirring occasionally. Remove bay leaves. Remove from heat and allow to rest for 4 minutes, then serve. 1 serving: 130 Calories; 3 g Total Fat (1.5 g Mono, 0.5 g Poly, 0 g Sat); 0 mg Cholesterol; 24 g Carbohydrate; 10 g Fibre; 4 g Protein; 270 mg Sodium
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Healthy Family Recipes Cookbooks are available at participating
PEOPLES DRUG MART & PEOPLES PHARMACY Reprinted from Healthy Family Recipes © Company's Coming Publishing Limited
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PEOPLES DRUG MART & PEOPLES PHARMACY LOCATIONS LOWER MAINLAND
VANCOUVER • 7160 Kerr St. 434-2656 • 571 West 57th Ave. 324-2258 • 683 Denman Street 683-6933 BURNABY • 4218 Dawson St. 299-6677 NEW WESTMINSTER • 825 McBride Ave. 525-2474 PORT COQUITLAM • 2529 Shaughnessy 941-2413 COQUITLAM • 137-3030 Lincoln Ave. 464-1033 • 1001 Austin Ave. 936-0024 ABBOTSFORD • 1945 McCallum Rd. 859-2351
Recipes For Good Health
LOWER MAINLAND
VANCOUVER ISLAND CENTRAL NORTH
GOLD RIVER • 375 Nimpkish Drive 283-9042 UCLUELET • 1892 Peninsula Rd. 726-2733 COURTENAY VICTORIA • 3825 Cadboro Bay Rd. • 102-1350 England 334-9311 477-2131 CAMPBELL RIVER • 15-1594 Fairfield • #101-2276 S.IslandHwy. 598-9232 923-7311 • 1282 Fairfield Rd. • #984 Shoppers Row 595-5997 287-8311 • 2642 Quadra St. QUADRA ISLAND 383-1188 • 3643 Shelbourne St. • 5-654 Harper Road 477-1881 285-2275 • #102-2020 RichmondRd. PORT McNEILL 370-1166 • 1584 Broughton St. 956-3126 VANCOUVER ISLAND PORT HARDY • SOOKE • 100-8950 Granville St. 8-6716 Sooke Rd. 949-9522 642-2226 SURREY • 10212 - 152nd St. 580-7457 WHITE ROCK • 1463 Johnston Rd 531-4636
MACKENZIE • 700 Mackenzie 997-5460
THOMPSON OKANAGAN KELOWNA • 1715 Ellis St. 712-2484 • #104 – 330 Hwy. 33 491-1999 • 200-3591 Elliot Rd. 768-7645 • 101-5315 Main St. 764-4222 PENTICTON • 166-1848 Main St. 493-7200 LYTTON • 531 Main Street 455-6685 ASHCROFT • 403 Railway Ave. E. 453-2553
THOMPSON OKANAGAN KOOTENAYS CHASE • 825 Shuswap Ave. 679-3553 SCOTCH CREEK • 3874 Squilax-Anglemont 955-0601
KOOTENAYS REVELSTOKE • 555 Victoria Rd 837-5191 GOLDEN • 1104 -10th Ave S. 344-6821 TRAIL • 1101 Dewdney Ave. 364-1993 SALMO • 107 - 4th St. 357-9444 NELSON • 405 Hendryx St. 352-3121
SPARWOOD • 107 Centennial Sq. 425-2015 NAKUSP • 88 Broadway St. 265-2228 CRANBROOK • East Kootenay Hospital 13 -24th Ave. North 420-4133
PEACE RIVER CHETWYND • 4733 - 51 Street 788-3393 st
www.facebook.com/peoplesdrugmart *Points awarded on net pre-tax purchases. Certain restrictions apply (check with your local Peoples Drug Mart or Peoples Pharmacy for a complete list of non-eligible medications, services & products). Some stores may use a manual system with a different reward level.
The articles published in People First are for the general information of the reader. While effort is made to reflect accepted medical practice and knowledge, articles should not be relied upon for the treatment or management of any specific medical concern or problem and People First accepts no liability for reliance on the articles. For proper diagnosis and medical care, you should always consult your family physician promptly. Opinions expressed in sponsored articles by, Dr. Art Hister, Ian Lloyd, and Darlene Booth are paid editorials and are not necessarily shared by Peoples Drug Mart stores or Peoples Drug Mart (B.C.) Ltd. Some advertised products are not available in all stores. We reserve the right to substitute products or limit quantities. Prices effective while quantities last. Sale in retail quantities only.
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