People First Magazine Volume 13, Number 3 Until March 31 PDM306

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DR. HISTER ON

OSTEOARTHRITIS CLEANUP & SAFETY FOR

MEDICINE CABINETS UNDERSTANDING

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People First contents

4

Osteoarthritis Dr. Hister on the most common arthritic condition and provides helpful tips on treatment.

5

Trusted Pain Relief Selection of products that can help you manage muscle and joint pain.

6

Medicine Cabinet Clean Up and Safety Make your home safer by cleaning out your unused and expired medications.

7

Great selection of quality health and wellness products from Peoples Pharmacy.

Topical Pain Relief Page 5

Save On Health Products

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There are different options available to help you manage muscle, joint and back pain.

Pharmacist Recommended Information on lutein and how it helps prevent age-related macular degeneration.

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Understanding Anger Helpful tips on being proactive and managing your daily stress and anger.

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Soft Sweetie Pork Stew Brand new feature recipe From Company’s Coming Healthy Family Recipes.

Helping People Live Better Lives

OSTEOARTHRITIS

Dr. Art Hister

When it comes to discussing “arthritis,” the topic I was handed for this month, it’s vital to start, I think, with the observation that unlike Madonna or Adele or Coke, arthritis is not a one-name-only single entity.

Rather, there are several forms of arthritis, and each one demands its own unique approach in terms of diagnosis and especially treatment, which means that if I were to discuss the various forms of arthritis in this column, I really couldn’t do much more than list them and offer you perhaps 2 facts about each.

So what I’ve chosen to do instead is limit my discussion to only the most common form of arthritis, namely osteoarthritis or OA, an entity that used to be called wear-and-tear arthritis because OA occurs much more commonly in joints such as the knee and the hip that absorb more, well, wear and tear, which means, of course, that some degree of OA is inevitable as we age (but then isn’t everything? Yes, it is, as I can surely testify), and most of us will have at least some mild OA symptoms (see below) in one (often more) joint, by the time we reach age 70.

The interesting thing, however, is that as so many baby boomers have already found out, OA certainly doesn’t wait for the last decades of life to set in before appearing as an unwelcome intruder on well-being.

In fact, because so many of us baby boomers misused and abused our bodies when we were

younger (see risk factors below), we are currently witnessing a huge rise in advanced OA in people in their 50s and 6os, so that nearly everyone reading this will likely know at least one baby boomer who has already had severe enough OA to require knee or hip replacement surgery.

So what happens in OA that can result in such dramatic joint deterioration? Well, in a joint that’s working as it should, cartilage tissue acts as a shock absorber to prevent the bones that meet in that joint from rubbing on each other (ouch ) In OA, though, the cartilage gradually wears away, and when there is enough cartilage wearand-tear, the bones in that joint end up rubbing each other every time the joint is used, leading to inflammation, pain and swelling.

It doesn’t take an advanced degree, then, to figure out that the more “pressure” on a joint, the greater the risk of OA, so it also follows that for joints that bear weight (the knee, hip, feet), the two greatest risk factors for OA are excess weight and previous injury (anyone who follows sports in young athletes will know that knee ligament tears have become incredibly prevalent even among kids - especially in girls and young women, who seem to suffer 3-5 times more knee ligament tears than do boys and young men - and the bad news is that even with the best repairs to those knees, a lot of those athletes will eventually end up with significant OA in those joints).

OA also happens in joints that are subject to freContinued On Page 11

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MEDICINE CABINET CLEAN UP AND SAFETY Spring time is upon us. It is time for waking up the garden, filing taxes and spring cleaning. I'm a pharmacist so my focus is on the medicine cabinet.

While it is a good idea to vacuum under the bookcases, it is also important to take a little time to clean out your medicine cabinet. This cleanse will remove unused, expired medications and replace them with items you might actually use. Let's open this door together, shall we?

The first thing that should NOT be in your medicine cabinet is any medicine that is out of date.

While it is true that medications are thought to be fine past their listed expiry date, I feel that anything which is six months to a year past its expiry date should be brought to your Peoples Pharmacist for proper disposal. All medicines that are kept in their original containers will have an expiry date listed somewhere. I also recommend that you buy the smallest possible container of a medication, unless it is something that you use regularly. While it may not be the best value, it will be of no value once its expiry date has passed. Many times I have disposed of medicine bottles where only two tablets have been used.

Another reason to remove outdated or unused medications is for safety. The numbers don't lie; 95% of accidental medication overdoses happened when a caregiver wasn't paying attention. 31% of fatal poisonings, in children aged 5 and under, were due to prescription and over the counter pain medications. Another awkward fact is that teenagers can abuse prescription medications. According to a US health department survey, in 2005, 6 People First Join us on

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Ian Lloyd Peoples Pharmacist

one in five teens misused prescription drugs. Also, one in three teens reported knowing another youth who misused prescription drugs.

Here are a few tips to safely store medication away from little ones: Q Always store medications securely and out of sight, even if the next dose is to be given in the near future. In other words, out of reach and in child proof containers.

Q Never refer to medicine as candy or a treat Q Ask house guests to store handbags, which may contain medications, in a safe location Q Don't take your own medication in front of children, as we all know, they like to imitate grown ups.

Now we come to the issue of storage. Most medications like to be kept at room temperature, out of direct light and with little exposure to moisture.

This is why, in some cases, the bathroom medicine cabinet is the worst place to store medications.

Many bathrooms can be warm and steamy. If this is the case in your home, you might want to think about storing your medications elsewhere. Just make sure that wherever you store your medications, they are out of the reach of children and pets.

Ask your Peoples Pharmacist if your medications have any special storage requirements.

This brings up another point; always keep medicines in their original containers. I recommend this for two reasons. The first is that many people forget what a specific medication is for when it is not in its original container. I have been asked to identify a non-distinct, round, white tablet more times than I care to mention. Without the original package, Continued On Page

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Ian Lloyd...Continued From Page 6

you will not know the expiry date, dosages or warnings. Another reason is that many of us travel with our medications. Would you like to explain to a Customs Officer why you have unmarked white tablets in an unlabeled bottle? Probably not.

So what do you do with any unused or expired medications? You can return expired medications, vitamins and over the counter medication to any pharmacy. Every pharmacy in BC has the means to dispose of these items properly. If you would like to be helpful and make it easy on the pharmacy staff, there are a few things you can do. Return all liquid products in their original containers. If any items are narcotics, please return them in their original container with a note of how many tablets are in the bottle. All other tablets and capsules can be emptied into a single container. A large bottle or Ziploc bag works great. There are some exceptions. If you have any questions, call your local pharmacy about returning medications. Basically, if you bought it at a pharmacy, it can come back to a pharmacy.

There is much talk this year about emergency pre-

paredness. Your medicine cabinet is not the best place to store supplies for power outages, wildfires or tsunamis. But, it is the best place to be prepared for all, reasonable, household emergencies. Being prepared means making sure you have what you need at all times. Please, please, please don't wait until you take the last tablet of your regular heart medication before calling your Peoples Pharmacist for a refill. It is recommended that you have at least two weeks of your usual medications on hand at any given time. So visit your Pharmacist before your medication bottle is empty.

The first things that should be in any medicine cabinet are first aid supplies. It does not have to be a Work Safe BC level three emergency first aid kit.

Most people need a box of various sized bandaids, some sterile gauze pads, antibiotic ointment and a tensor bandage. That is all. Anything else you might need, can be found around the house. Things such as adhesive tape, scissors, tweezers or large bandages (small towels) are usual household items. Just keep an eye on the bandages, that box tends to Continued On Page 10

Providing more health care than you know: Ask a pharmacist.

March Is Pharmacist Awareness Month Pharmacists are medication experts, and so much more. Pharmacist awareness month is about raising public awareness on the increasing role pharmacists play in the provision of health care services and the tangible benefits they bring as health care providers. Throughout March, Pharmacist Awareness month’s goal is to inform Canadians about all the different services pharmacists are qualified to provide, beyond dispensing, and encourage patients to use these valuable services that can improve their health.

Travel & Flu Vaccinations Disease State Managment Prescription Adaptation Smoking Cessation Nutrient Deficiency Advice Peoples Pharmacists help people live better lives.

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pharmacist recommended Health & Wellness Information From Your Peoples Pharmacist

Age-related Macular Degeneration The leading cause of blindness in adults over 40 is the degeneration of the macula of the eyes, called age-related macular degeneration or AMD. Those at the greatest risk of experiencing macular degeneration are smokers, Baby Boomers, women, and those with light-coloured irises (blue). The macula form the central area of the retina, the better known part of the eyes that receive focused images of light for pick-up and transmission to the brain by the optic nerve. Macular degeneration disables this retinal function, leaving only a margin of peripheral vision. Such blindness for all practical purposes ushers in a loss of independence, an end to normal or robust sighted living, and effectively prevents enjoyable reading or fine finger work.

A lifetime of exposure to solar light causes critical degeneration of the macula tissue, unless they are regularly supplied with the dietary pigment, lutein. The macula have been shown to concentrate dietary lutein, and convert some of it into zeaxanthin as another related protective pigment. They belong to the carotinoids, the pigment class to which well known beta-carotene belongs.

These pigments are able to absorb harmful blue light, modulating the exposure to solar damage. The evidence is clear that people who regularly consume green leafy vegeta-

bles as an important part of their weekly diet are at a significantly reduced risk for blindness due to the deterioration of the macula region of the retina.

Another debilitating eye problem is the formation of cataracts, caused by solar damage to the lens proteins. The lens is also able to accumulate lutein to prevent cataracts and it has been found that when there is a high level of lutein in the macula, there is also a reduced incidence of cataracts. A Harvard University study examined the prevalence of cataracts in 50,000 nurses who responded to a dietary inquiry. It found that women who consumed five servings per week of spinach had significantly lower risk for cataracts than women who consumed five servings per week of carrots, sweet potatoes, or winter squash. This study bears out the understanding that the green leafy vegetables are the best sources of lutein.

Lutein is an an excellent choice for those people who do not consistently consume green leafy vegetables and who may be at risk of macula or lens solar damage.

Talk to a Peoples Pharmacist about supplements for eye health and if they will be a benefit to your long term vision.

peoplesdrugmart.com People First 9

Ian Lloyd...Continued From Page 8

empty quickly.

What else should be in your medicine cabinet?

The most common reason for a visit to the medicine cabinet is to treat pain; usually a headache. My personal choice for this is acetaminophen or ibuprofen.

However, acetaminophen has no anti-inflammatory action because it only works on the central nervous system and not in the rest of the body. This means that acetaminophen is generally safer and has fewer side effects. It is the best choice for treating pain or fever in children. People with liver disease or those w h o a r e t a k i n g m e d i c a t i o n s t h a t c a n d am a g e t h e liver should talk to their Doctor or Peoples Pharmacist before taking acetaminophen.

Ibuprofen is an anti-inflammatory that is slightly less irritating to the stomach, but people with ulcers s h oul d s t i l l a v oi d us i n g t h i s p r od uc t . Ib up r of e n i s safe for children to use, just ask your Peoples Pharmacist which type is best to use. People with high blood pressure or stomach issues should use ibuprofen cautiously.

The next reason to visit the medicine cabinet is to soothe an upset stomach. For this I recommend

Tums and Imodium. If you are prone to heartburn, Gaviscon may be a better choice. Tums, or other antacid tablets like Maalox, contain calcium carbonate, which neutralizes stomach acid. This usually relieves most cases of stomach upset. Imodium is the b e s t c h o i c e f or d i a r r h e a . I f y o u h a v e to t a k e m o r e than eight tablets a day, of any stomach remedy, you should probably contact a Doctor.

T h e o t h e r i t e m s t o b e i n y o u r m e d ic i n e c a b i n e t are up to you. What do you need to help maintain your health? Do you have allergies, trouble sleeping, prone to chapped lips or dental troubles? These ideas should help get you started; from here you can make your own list. Think back over the past year; what medicine did you wish you had on hand at one time or another. Perhaps it was something for nausea, or maybe it was gas. Ask your Peoples Pharmacist if they have any suggestions.

Always be prepared, the boy scouts had it right.

Written By Ian Lloyd, Pharmacist & Chartered Herbalist, Peoples Pharmacy

Travel Vaccinations At Peoples Pharmacy M Most ost P Peoples eoples P Pharmacists harmacists can can n now ow aadminister dminister ttravel ravel vvaccinations accinations o on-site n-site

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PEOPLES PHARMACISTS

Dr. Hister...Continued From Page 4

quent unusual use, as for example, in the back to people whose jobs require bending over frequently, or in the knees in workers who have to squat constantly.

I also want to make note of one special avoidable risk for OA that is still, unfortunately, very common, namely the OA that occurs in so many runners (no self-respecting runner allows anyone to call him a jogger any more), especially in all those middle-aged dudes who should have known better but who for many years now have continued to run (and work out desperately hard) despite the recurring pain in their knees or hips or other joints because well, “working through pain must be good for you, right?

After all, no pain, no gain, eh? And besides, it keeps me looking so young”), and the way so many of these runners manage their pain is by masking it via the use of anti-inflammatory drugs (ibuprofen, naproxen, etc) which they take either before running or after their run is over.

But unfortunately, as most of those people have likely learned by now (and if not yet, then surely soon), pain is an important symptom – an objective sign - that should never be ignored and seldom masked because it’s nature’s way of telling you to stop what you’re doing and figure out why you’re getting the pain, and if you simply continue to ignore an exercise-associated pain and continue to do that same exercise just because you can stand the discomfort, you are inevitably eventually going to need the intercession of a good orthopedic surgeon.

As for treatment of OA, it should all start, of course, with lifestyle adjustment, especially weight loss, if it’s a joint affected by excess weight.

And although this sounds counter-intuitive, anyone with OA should also try to do some exercise that they can comfortably tolerate, not because it slows the OA – it won’t – but because the more fit a person is, the better their overall health, not to mention, the better their chances with surgery.

Also for those who think diet and vitamins can help anything, alas, we have no proof that any dietary manipulations help, and a recent study published in the Journal of the American Medical Association concluded that vitamin D supplementa-

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Dr. Hister...Continued on Page 13

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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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Dr. Hister...Continued From Page 11

tion, the current darling of the anti-oxidant world, does not slow OA or reduce the pain.

Nearly everyone with OA turns to medication as the first line of therapy, and to that end, some medications can help reduce the pain, analgesics like acetaminophen, but also non-steroidal anti-inflammatories (NSAIDs) like naproxen and ibuprofen.

But remember, anything that you take regularly, even seemingly-innocuous over-the –counter products, can lead to potential problems, some of them very serious ones (gastric bleeding from the use of NSAIDS, for example), and we’re constantly discovering new negative reactions all the time, so if you are going to treat your pain with any medication, be sure to speak to your pharmacist about the potential pitfalls.

Along with medication, most people with OA also avail themselves of some sort of physical therapy and any of these that help ease the pain are worth trying, but the sad fact is that for many people with OA, and certainly for the vast majority of younger patients (read: under the age of 90), the road to surgery is relentless, so if that’s the route you’re on, it’s important to remember that although joint replacement has become pretty routine stuff and most surgeons are now experts at it – how do you get to Carnegie Hall? Practice, practice, practice – surgery always carries some risks, so it should be a last-choice option, not a first one.

For example, a recent study found that people undergoing major joint replacement are at significantly higher risk of suffering a serious and potentially life-threatening complication of a blood clot in a deep vein in the leg (what’s known as a deep vein thrombosis or DVT), a serious risk that apparently stays raised for months after the surgery, perhaps even up to a year.

For my customary bottom line, I think I’ll aim one last missive at the “No pain, no gain” crowd by retelling an old medical joke that still carries lots of truth.

Patient: It hurts when I do this, doc.

Doctor: Then stop doing that. Next.

Doh! 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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UNDERSTANDING ANGER

Darlene Booth

I grew up in a boisterous household where unchecked anger often set the tone for the day. Anger was the fuel for most familial conversations; both of my parents had a thirst for a good argument and thus my brother and I also learned how to communicate in the same language. We seldom spoke to each other without yelling. It was harsh and unpleasant and often sent me seeking the quiet sanctuary of my bedroom where I would decompress through tears or tantrum.

What I took away from my childhood was a belief that if I shied away from conflict, I had control over anger. I viewed anger as a wholly negative emotion and to be avoided at all costs. It took me many years to begin to understand that anger is a natural emotion and a by-product of living a full life.

Anger can’t always be avoided and it does not have to be a destructive force if recognized and managed well.

Anger has a connection to our survival instincts and can help protect us from a real or perceived threat. It can range along a continuum from mild irritation to full-blown rage and is more than just raw emotion. Our inner equilibrium is affected as the heart races and stress hormones are released into the bloodstream.

A periodic stress response is okay and can be healthy as long as the body returns to normal afterward but when the stress response remains elevated over long periods of time, it can begin to erode our physical and mental well being.

Chronic long term stress or anger can contribute to a wide range of health issues including heart disease, sleep disorders, digestive complaints, mood disorders, a lowered immune response, skin problems and more.

Anger management is about becoming more aware of our relationship with anger and taking proactive steps to control things that trigger strong emotions. For chronic anger issues it can be helpful to take an anger management class or attend a group facilitated by a trained anger management counsellor. You might find the following tips and techniques helpful to assuage or prevent a bad case of irritability: 1. Eat a healthy balanced diet – cut out the junk food and keep the blood sugar balanced by eating at least 3 square

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R.H.N

meals a day. Do not skip breakfast. Avoid too much caffeine, sugar and alcohol as they can have a negative effect on your nervous system. In times of greater stress it may be helpful to take a B-complex vitamin and extra vitamin C. 2. Breathe deeply and relax – relaxation can take on many forms for different people. Go for a walk, try meditation, yoga, or a guided visualization exercise.

3. Stay calm and get some perspective on the situation - often we are reacting to what we “think” is happening rather than what is really going on. You may have to walk away to gather your thoughts before proceeding with a courageous conversation. Explore the other person’s perspective and communicate your needs clearly without criticism or accusation.

4. Laugh – sometimes appropriate humour can help diffuse an otherwise tense situation. Don’t use sarcasm as it will likely elevate the event but if you can laugh at yourself you will be ahead of the game. Sometimes the laughter comes later when you reflect on the scenario and see it from another angle. A humourous disposition can also keep the triggers to a minimum.

5. Have realistic expectations – life is not always easy or predictable. Often we meet problems with an all or nothing expectation. Some problems do not have easy solutions, but facing them knowing you are doing your best can help keep the frustration levels down.

Even when well equipped with communication skills, relaxation techniques and the best of intentions, we can still run into people or situations that we cannot navigate easily.

One of my favourite quotes is: “You can't control the outer circumstances of your life but you can control how you react to them.” If rush hour traffic drives you to your limits perhaps it might help to reframe your expectations of speed and flood the car with relaxing music or a motivational CD. Relax into it instead of struggling against it. If you know that Aunt Shirley is confrontational before her morning coffee, then don’t visit her until after lunch. Anger is going to happen, we can’t eliminate it, but we can learn to control it so it no longer controls our life. Good Health to You!

Soft Sweetie Pork Stew

Soft Sweetie Pork Stew

No time to cook? No problem. Just toss all the ingredients for this dish in a crock pot, let it take care of itself, and come home to a delicious, satisfying meal.

1 Tbsp (15 mL) butter 2 lbs (900 g) boneless pork shoulder, cut into 1 inch (2.5 cm) cubes 1 cup (250 mL) pineapple juice 1 ⁄2 cup (125 mL) barbecue sauce 4 cups (1 L) pork stock 1 ⁄8 cup (30 mL) low-sodium soy sauce 2 Tbsp (30 mL) balsamic vinegar 1 ⁄4 cup (60 mL) tomato paste 1 ⁄4 tsp (1 mL) salt 1 ⁄4 tsp (1 mL) pepper 2 Tbsp (30 mL) agave syrup 1 ⁄8 tsp (0.5 mL) ground cloves 1 ⁄8 tsp (0.5 mL) ground cinnamon 1 cup (250 mL) diced carrots 2 cups (500 mL) white mushrooms, quartered 1 cup (250 mL) thinly sliced leek (white part only) 1 ⁄2 cup (125 mL) fresh kernel corn 2 Tbsp (30 mL) chopped fresh sage Melt butter in a heavy bottomed pot over medium-high heat. Add pork and brown each side generously. Add pineapple juice and reduce by three-quarters.

Combine barbecue sauce, pork stock, soy sauce, vinegar, tomato paste, salt, pepper, agave, cloves and cinnamon in a crock pot. Add pork. Liquid should just cover pork— add more water if necessary. Cook until pork is tender and can be easily torn with a fork, about 21⁄2 hours. Once pork is tender, add carrots, mushrooms and leeks. Stir well and cook for an additional 45 minutes.

Remove from heat and add corn and sage. Allow to rest for 10 minutes before serving.

Serves 6 1 serving: 490 Calories; 30 g Total Fat (13 g Mono, 3 g Poly, 11 g Sat); 95 mg Cholesterol; 27 g Carbohydrate; 2 g Fibre; 30 g Protein; 740 mg Sodium

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