Peoples Health Magazine, Volume 16, No. 5 PDM511 Prices in Effect Until May 31

PEOPLES Health URINARY INCONTINENCE HOW TO MANAGE

Helping People Live Better Lives

ANAPHYLAXIS EMOTIONAL EATING

SEVERE ALLERGIC REACTION

CHASE AND MACKENZIE SPOTLIGHT ON

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Features & Cover Articles 4 8

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URINARY INCONTINENCE

HEALTHY SAVINGS

Pharmacist Ian Lloyd provides helpful tips and exercise on managing urinary incontinence.

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

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INCONTINENCE PRODUCTS Save on a wide selection of incontinence products.

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ANAPHYLAXIS

UNDERSTANDING EMOTIONAL EATING Do you eat to live or live to eat? Find out how food plays such a large role in our emotional being.

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SPOTLIGHT ON OUR COMMUNITIES

MARKET MUSHROOM

A look at Chase and Mackenzie, two B.C. communities that Peoples is proud to be a member of.

Brand new feature recipe From Company’s Coming 400-calorie Mains.

Anaphylaxis or severe allergic reaction can be life threatening. Read helpful advice on how to keep your family safe.

Allergy Season Page 5

PEOPLES DRUG MART • PEOPLES PHARMACY Community owned and operated pharmacies, proudly serving British Columbians since 1976. Peoples Pharmacists are truly committed to helping people live better lives by providing trusted and personal health care.

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URINARY INCONTINENCE

Urinary incontinence is nothing to be laughed at, especially since laughing can cause a loss of bladder control in some people. It is thought that almost 10% of the Canadian population (3.3 million people) will experience some form of urinary incontinence. The problem can range from a little dribble when laughing to full loss during a long car ride. Most people might not understand how embarrassing and disruptive this condition can be.

Fortunately, this does not have to be the case.

Drug therapy and life style changes can help relieve the symptoms. This month I shall try to provide some ways to manage urinary incontinence.

There are two main types of incontinence: stress and urge. Stress incontinence is just like it sounds; the bladder leaks or empties when stress is applied.

This stress is usually pressure on the bladder caused by coughing, sneezing, laughing or lifting something heavy. It is more common in women than men. Urge incontinence is the sudden and intense need to urinate, possibly followed by an involuntary loss of urine. This is the classic four year child line, “Daddy, I need to go now!� In others this loss of control can be caused by a bladder infection, diabetes, Parkinson's disease or neurological disorders. See your Doctor to determine what is causing your incontinence, so you can discuss treatment options.

The most overlooked treatment option is blad4 PEOPLES Health

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Ian Lloyd Pharmacist

der training and strengthening. Yes, it is possible to retrain your bladder, and yourself, to work better.

The first step in bladder training is practising delayed urination. With this exercise the goal is to hold off urinating for an increasing amount of time. Start with something short like 5 to 10 minutes. Gradually increase the length of time until you reach two to four hours. This is not something that will happen overnight, so be patient. Another strengthening exercise is called the Kegel exercise. These exercises are very helpful for women after childbirth. First you must learn to isolate the muscles of the pelvic floor. Learn where these muscles are by stopping urination midstream. Once you have learned where these muscles are you can start exercising. If done properly, no one will know you are exercising your pelvic floor muscles. Hold and squeeze these muscles for three seconds, then relax for three seconds. Repeat this set of exercise ten times and then repeat the entire exercise routine three times a day. If this is too challenging, then start with shorter times and work your way up. Again, this might take a while so be patient. There is a really good description of the Kegel exercises on page 103 of the BC Health Guide (my favourite book).

Now that we are training your bladder, the next step is to start training you. Another technique is call double voiding. With this exercise you void Continued On Page 11

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Helping People Live Better Lives Peoples Pharmacists provide a wide range of health services. Ask about disease state management, on-site vaccinations, and in-depth medication reviews.

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ANAPHYLAXIS

OR SEVERE ALLERGIC REACTION

What Is A Anaphylaxis Anaphylaxis is a medical emergency. Though rare, this serious type of allergic reaction occurs after a person is exposed to an allergen (a substance they are allergic to), such as certain foods, medications, or insect stings.

The body's immune system quickly reacts, causing swelling of the face and throat, difficulty breathing, dangerously low blood pressure, and leaky blood vessels. These effects can lead to shock. If not treated quickly, anaphylaxis can be fatal.

About 1% to 2% of Canadians are at risk of an anaphylactic reaction. Avoiding the allergen and knowing what to do if you are exposed are the keys to managing the problem.

Causes 'ust about any substance can bring on an anaphylactic reaction. But anaphylaxis is most commonly caused by: R allergy shots R blood products R foods such as peanuts, tree nuts, shellfish, eggs, fish, sesame, soy, milk, and wheat R insect bites or stings R latex (a type of natural rubber found in certain medical supplies) R medications such as antibiotics, vaccines, anti-inflammatories and painkillers, and dyes used for CT or MRI scans Sometimes, the cause for the anaphylaxis is never 6 PEOPLES Health Join us on

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found. The medical term for this is idiopathic anaphylaxis.

When a person with an anaphylactic allergy is exposed to an allergen, their immune system goes into overdrive. The substances the body produces (e.g., histamine) are intended to protect the body from a foreign invader, but they overreact, causing the throat to swell up and the blood vessels to leak fluid. This leads to the symptoms of anaphylaxis and can be life-threatening.

People with asthma, seasonal allergies, or eczema are at a higher risk of anaphylaxis. Although anaphylaxis rarely occurs, it can happen at any age.

Race and geographic location do not affect the risk of anaphylaxis.

Symptoms and Complications The most common symptoms of anaphylaxis include: R dangerously low blood pressure, dizziness, sweating, and fainting R hives R nausea, cramping, diarrhea, or vomiting R swelling of the face and throat R wheezing or difficulty breathing Sometimes, anaphylaxis can cause other symptoms as well. These include: R chest pain R flushing R headache R itching Continued On Page 1

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Spotlight

On Our Communities

Chase Chase is located on the shores of Little Shuswap Lake, between Kamloops and Salmon Arm, along the Trans Canada Highway (#1). Chase provides an excellent base to experience the Shuswap region - explore nature's bounty, events and attraction.

Chase has a fabulous climate offering hot dry summers and mild winters. Known for its wildlife, surrounding mountains are scattered with big horn sheep, Osprey, black bears, white tail and mule deer.

During the sockeye salmon spawning cycle in fall, bald eagles and osprey are easily spotted along the shore of the South Thompson River and Shuswap Lakes. Just a short drive from Chase are several Provincial Parks.

Photo courtesy www.Chase Chamber.com

Photo courtesy Province of B.C.

Photo courtesy www.chasechamber.com

Mackenzie Surrounded by mountains, lakes and rivers Mackenzie is a place where connecting to nature is as simple as walking out the door. There is a wide array of adventures for residents and visitors to experience that combine to produce the ultimate four season adventure playground.

From snowmobiling, snowshoeing, downhill and cross country skiing, snowboarding and ice fishing in the winter months to fishing, kayaking, canoeing, swimming, biking, boating, camping, bird watching, hiking, golfing, geocaching, mountain bike riding and excursions into the alpine in the summer.

Whether nature is your playground or your passion or both, Mackenzie’s outdoor excursions have the excitement and serenity to please all tastes.

Photo courtesy Province of B.C.

Photo courtesy RMTA

$1000 was donated to the Mackenzie District Hospital. The hospital is raising funds for a patient transfer disk.

The transfer disk will make it easier and safer to transfer patients from a bed to a chair. Karen L’heureux, Store Manager and Sheri Ukrainetz, Pharmacy Manager presenting cheque to Shelly Barwise, Clinical Practice Leader, Mackenzie District Hospital.

The Peoples Drug Mart Healthy Communities Fund (HCF) is a community support program that provides financial assistance to health related organizations in Peoples Drug Mart communities. The HCF is funded by the owner operators of Peoples Drug Mart and from the proceeds of the Peoples Drug Mart corporate fundraising. peoplesdrugmart.com People First

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Anaphylaxis...Continued From Page 6

• seizures If you experience these symptoms, seek immediate medical attention. Anaphylaxis can be fatal if not treated. The usual causes of death are cardiovascular collapse, which means that the heart cannot supply the body with the oxygen it needs; or laryngeal edema, which means that the throat swells up and prevents the person from breathing in enough oxygen to survive.

Sometimes, the symptoms of an anaphylactic reaction can return anywhere from 1 to 72 hours after the first attack. This is called biphasic anaphylaxis and happens in about 20% of cases. The cause of biphasic anaphylaxis remains unknown, as does a method of predicting the return of symptoms.

Your doctor may wish to keep you for a period of observation after your first attack has been treated.

If your anaphylaxis symptoms come back, seek immediate medical attention.

Making the Diagnosis The diagnosis of anaphylaxis is based on symptoms. The doctor will evaluate your symptoms to rule out other conditions. In general, anaphylactic

reactions are easier to recognize while they are happening and more difficult to diagnose after the attack. If anaphylaxis was not diagnosed during the attack, it can also be diagnosed after the fact using lab tests and a description of your symptoms.

The cause of an anaphylactic reaction is often clear - you may experience a reaction shortly after being stung by an insect, eating a certain food, or taking a certain medication. If the cause is not clear, additional tests may be done to determine the cause.

These include keeping a diary, skin testing, and blood tests. Because anaphylaxis is a medical emergency, tests to find out the cause of the reaction will be delayed until after the reaction is treated.

Treatment and Prevention Anaphylaxis requires immediate medical attention. If you are having a reaction, use your epinephrine* kit (e.g., Allerject, EpiPen®) as instructed by your doctor and call 9-1-1. Lie down with your legs elevated to combat the effects of low blood pressure that can occur with the reaction.

Once medical help arrives, health professionals will check your vital signs (pulse, breathing rate, temperContinued On Page 12

If you’ve had chickenpox... you are at risk of shingles The shingles vaccine is the best way to protect you from getting shingles. The vaccine has been shown to reduce the risk of getting shingles by 50%. For those who still get shingles after being immunized, the vaccine can reduce pain, including the type of pain that lingers after shingles.

Talk to your Peoples Pharmacist today to find out how to help protect yourself against shingles and if the shingles vaccination is right for you.

Peoples Locations That Administer The Shingles Vaccination ASHCROFT

KITIMAT

NELSON

SALMO

403 Railway Ave.

327 City Center

405 Hendryx St.

#107- 4th St.

1101 Dewdney Ave.

CHETWYND

LYTTON

PENTICTON

SOOKE

UCLUELET

4733 - 51 Street

531 Main Street

166-1848 Main St.

8-6716 Sooke Rd.

1892 Peninsula Rd.

MACKENZIE

PORT MCNEIL

SPARWOOD

VANCOUVER

700 MacKenzie Blvd.

1584 Broughton Blvd.

107 Centennial Square

NAKUSP

REVELSTOKE

SURREY

CRANBROOK

East Kootenay Hospital

KELOWNA 200-3591 Elliott Rd.

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555 Victoria Rd.

107-15551 Fraser Hwy

TRAIL

7160 Kerr St. 571 West 57th Avenue

VICTORIA 1600 Feltham Rd.

PEOPLES PHARMACISTS

Ian Lloyd...Continued From Page 4

once, then wait a few minutes and try again. This helps to completely empty and bladder and can be helpful with urge incontinence. Scheduled toilet trips can also be useful for urge incontinence.

Stay ahead of the issue instead of rushing to solve it. Set the timer on your smart phone to remind you to go every two to four hours. If waking up in the middle of the night is an issue, then prepare your room before bed. I always make sure that the path between my bed and the bathroom is clear: no mats, no clothes and no furniture is in the way.

If your bathroom is quite a distance away and you have trouble making it in time, consider purchasing a bedside commode. While this may seem like a nuisance at first, it is a better solution cleaning up accidents or hurting yourself while rushing to the bathroom during the night.

Diet is often overlooked as a cause of incontinence. If you do suffer from urinary incontinence then there are certain foods you should avoid or minimize. The classic three foods to avoid are caffeine, alcohol and acidic foods. Now that I think of it, if you have any health concerns, you might want to consider avoiding these three food types anyway. Constipation is also a possible cause of incontinence. It makes sense that if the abdominal cavity is full, something has to empty.

Once non-drug treatments have been tried, then you should consider seeing your doctor to consider medications to help with incontinence.

There are quite a few medications that can help.

They fall into a few broad categories. One group is called the anticholinergics and they can help to calm the nerve signals that cause your bladder to want to empty. There are quite a few drugs in this class and they all work a bit differently. Side effects are similar for all of them: dry mouth, mild constipation, dry eyes, confusion and headaches.

Another class of medications specifically designed for men are the alpha blockers. These medications help to relax the muscles around the prostate, which can help the bladder to empty completely.

Helping People Live Better Lives

We Can Help With Medication Blister Packaging.

The blister pack program takes the guesswork out of your daily medications. This convenient and easy to use blister card is ideal if you are on multiple medications.

NEW PHARMACY

1660 FELTHAM RD. , VICTORIA

Vladi Stevenovic

Pharmacist & Owner, Victoria

We Can Help With Medication Reviews.

Medication reviews are in-depth consultations that improve health outcomes by helping resolve any issues that may have arisen due to your medication. Ask about the medication review service.

Sheri Ukrainetz

Pharmacy Manager, Mackenzie

We Can Help With Menopausal Hormone Therapy.

Select Peoples locations provide menopausal hormone therapy to help people transition through menopause more comfortably.

Talk to a Peoples Pharmacist about this health service.

Tamer Mahmoud

Pharmacy Manager, Chetwynd

Ian Lloyd...Continued on Page 13

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Focus On Vitamin B12 Helps Keep Nerve & Blood Cells Healthy In addition to producing red blood cells and keeping nerves healthy, B12 helps make DNA, the genetic material in all cells. B12 also helps the body metabolize fats, proteins, and carbohydrates. In some people, especially those over age 50, the body does not produce sufficient “intrinsic factor,” a component of stomach acid required for absorbing vitamin B12.

Likewise, vitamin B12 is poorly absorbed by people who suffer digestive disorders, such as Crohn’s or celiac disease. Certain acid reducing medications can interfere with the body's absorption or use of vitamin B12 and a supplement should be considered to maintain health and wellness.

Talk to a Peoples Pharmacist about the health benefits of vitamin B12.

Anaphylaxis...Continued From Page 10

ature, and blood pressure) and see whether you need oxygen or more epinephrine. Epinephrine is given to counteract the effects of your body's reaction to the allergen. Oxygen is given (using a tube or mask) when you are having trouble getting enough oxygen through breathing.

More than one dose of epinephrine may be needed to deal with the reaction. You may also receive an inhaled medication such as salbutamol to open the airways, antihistamines or steroids to "tone down" your body's reaction to the allergen, and medications to increase your blood pressure to safe levels (anaphylaxis can cause dangerously low blood pressure).

After your reaction is treated, your doctor will ask you to remain at the hospital for a period of time.

This is important, as the reaction may come back within 1 to 72 hours (biphasic anaphylaxis).

Anaphylaxis can be treated. But the best way of dealing with anaphylaxis is to prevent an anaphylactic reaction from happening in the first place. Here are a few things you can do to protect yourself: • Know your allergies. Talk to your doctor about things that may give you a reaction, how to recog12 PEOPLES Health Join us on

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nize the symptoms of an anaphylactic reaction, and what to do if they occur.

• Have desensitization therapy (allergy shots) if you have an insect venom allergy.

• Follow all treatment for asthma carefully to reduce your risk of a life-threatening anaphylactic reaction.

• Be sure that all health professionals involved in your care are aware of your allergies and ensure that this information is kept on your file.

• Wear a MedicAlert® bracelet (or similar identification) identifying your allergies.

• Always have an epinephrine kit with you. Ideally, have 2 doses of epinephrine available. Be sure you know how to use your epinephrine injection and check regularly to make sure it is not expired.

• Take all reasonable steps to avoid the things you are allergic to. *All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist. All material © 1996-2014 MediResource Inc. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Ian Lloyd...Continued From Page 11

Side effects include lightheadedness, stuffy nose, fatigue and dizziness. For women, topical estrogen can be helpful for incontinence. This is a very short description of the medications used to treat incontinence. If you have any questions, ask your Peoples Pharmacist or doctor.

I'm certainly not the only one who has seen the television ads for incontinence pads. Most people dismiss them as a treatment option because they imagine an adult wearing a big bulky diaper.

Diapers only look bulky on infants because you must pack a large amount of absorbent material into a very small area. Daytime incontinence products for adults are very discrete and no one will know you are wearing them. There are also products designed specifically for men. Ask your Peoples Pharmacist about incontinence undergarments if you have any questions. You can also visit depends.com or tena.ca and request a free sample to try. If your incontinence gets more severe, your doctor might suggest self catheterization. This involves inserting a narrow tube into your urethra a few times a day to help your bladder empty. While this may sound dreadful, it isn't. It is only challenging for the first few times. I'm certain someone you know uses a catheter regularly and no one is aware of it. These catheter supplies can be obtained from your local Peoples Pharmacist.

Urinary incontinence does not have to disrupt your daily activities. With a little planning, you can work around this condition. Ask your community Peoples Pharmacist about any questions regarding your health care. Keeping a journal of your symptoms for this, or any, condition is a smart plan. It can help to determine if there is a pattern for your symptoms, which can be very useful for your doctor's diagnosis. The more you know about your health, the healthier you can be.

PEOPLES PHARMACISTS Helping People Live Better Lives

We Can Help With Shingles Vaccinations.

About 1 in 3 people will get shingles in their lifetime.

Select Peoples locations offer convenient on-site shingles vaccinations that can prevent or reduce the severity of shingles.

Anna Thorrougood

Pharmacist & Owner, Richmond

We Can Help With Medication Reviews.

Medication reviews are in-depth consultations that improve health outcomes by helping resolve any issues that may have arisen due to your medication. Ask about the medication review service.

David Lafreniere

Pharmacy Manager, Revelstoke

We Are Community Owned & Operated.

Being locally owned and operated, the owner operators of Peoples Drug Mart and Peoples Pharmacy take great pride in living in and helping contribute to a healthy community.

Written By Ian Lloyd, Pharmacist & Chartered Herbalist

Troy Clark

Pharmacist & Owner, Nakusp

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UNDERSTANDING EMOTIONAL EATING

There are two kinds of people in the world; those who eat to live and those who live to eat. For the better part of 40 years, the latter category was my life narrative. Early life experiences taught me that eating could be indulged when alone or in a social setting and it could be used as a reward or punishment. Eating could soothe and entertain; nothing assuaged boredom or sadness better than a trip to the kitchen and of course appetite was arbitrary. Emotion would trump hunger every time. Food was pretty much the center of the universe and until I expanded my universe it would always be so. I still love food and I still love to eat. What has changed over the decades is my willingness to accept and embrace my emotions rather than trying stuff them away with bag of chips or slice of pizza. Breaking the pattern of emotional eating is less about getting rid of the emotions and more about learning how to nourish ourselves in new ways.

Essentially, emotional eating is not a personal issue. In our society there is an overarching tendency to individualize problems; we judge and we label. A person who is struggling with a perceived issue may be seen as defective, lazy, unmotivated or just “unfortunate�. We often fail to look past the individual presentation to understand the influences that may have lead them to that exact moment in time. Comfort eating is a collective conditioning that has been passed down through generations of well-meaning grandmothers, mothers and marketing experts. Emotional eating can also be cultivated in times of extreme stress, abandonment and neglect. Perhaps the only constant in your early childhood came in the form of food. You would soon learn to associate eating with love, safety and comfort. These programs run rampant in our society and we often internalize them without ever questioning their source.

The emotional eater likely becomes enmeshed in a spiral of shame, self-judgment and hopelessness as eating is only a temporary fix for a deeper issue. Emotions become the enemy and every attempt to gain mastery of the emotions creates more stress, which leads to more discomfort, which leads to more eating and more self condemnation. One has

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Darlene Booth R.H.N., B.S.W.

to stop here and question why are we so afraid to sit in our emotions and let them be Why are we so quick to want to band-aid anger, sadness and frustration with food What lies beneath the surface of the emotion itself The first step to healing always begins with awareness and acceptance. Accept that emotions happen and begin to explore the triggers and circumstances that lead you toward unwanted behaviours. You may choose to keep a journal of when, where and how your emotional eating manifests. You might want to work with a counselor and explore deeper work around understanding your personal stressors and survival strategies. The key word here is acceptance - that which we resist will persist.

The next step is a form of harm reduction. Become fully present with the urge to eat and check in to see what is going on mentally and physically in your body. Are you really hungry What are you really feeling Make a list of things you can do instead of using food to quell your discomfort. Deep breathing, a quick walk, a bath, shower or a warm cup of tea might be all you need to interrupt the need to eat. Perhaps boredom in life can be a call to take up a new hobby or activity Try meditation, walking, playing a musical instrument or joining a social activity group. Avoid known stressors if and when you can; sometimes this means distancing ourselves from situations and relationships that drain or trigger us. Be aware that using drugs and alcohol to manage stress is also a temporary fix that will often result in recreational or emotional eating as well.

Emotions are not inherently bad; we are emotional beings and we also need to eat. Emotional eating is natural and culturally endorsed and only a problem if it is causing you physical or emotional distress. Be kind to yourself and find non-caloric ways to nourish and replenish your spirit. For some people this may take the form of a spiritual practice, others may fill up by dancing or taking a walk in nature.

Above all, remember that change happens through patient and persistent practice. Give yourself permission to not be perfect and to love yourself unconditionally.

Good Health to You!

Market Mushroom Reminiscent of a classic French stew, this dish also provides you with a generous diversity of vitamins and minerals.

Market Mushroom

4 large portobello mushrooms, stems and gills removed 1 tsp (5 mL) extra-virgin olive oil 1 tsp (5 mL) lemon juice 1 ⁄4 tsp (1 mL) chopped fresh thyme 1 ⁄8 tsp (0.5 mL) salt 1 ⁄4 tsp (1 mL) pepper 1 Tbsp (15 mL) extra-virgin olive oil 1 ⁄2 cup (125 mL) diced red onion 3 ⁄4 cup (175 mL) diced red pepper 3 ⁄4 cup (175 mL) diced zucchini 3 ⁄4 cup (175 mL) diced eggplant 1 clove garlic, minced 1 ⁄4 cup (60 mL) fine dry bread crumbS 3 Tbsp (45 mL) tomato paste 2 Tbsp (30 mL) dry white wine 1 Tbsp (15 mL) red wine vinegar 1 sprig fresh thyme, chopped 2 tsp (10 mL) brown sugar 1 ⁄8 tsp (0.5 mL) salt

1 ⁄4 cup (60 mL) chopped fresh basil |3 oz (85 g) goat cheese

Cut 2 mushrooms into a small dice. Transfer to a small bowl and set aside. Place 2 remaining mushrooms on baking sheet. Combine next 5 ingredients and drizzle over mushrooms. Bake in 400°F (200°C) oven for 12 to 14 minutes, until mushrooms begin to soften. Remove from oven. Tent with foil. Set aside.

Heat a large heavy-bottomed pan over high. Add second amount of olive oil. Add diced mushroom to pan and cook for 2 to 3 minutes or until mushroom begins to brown. Add onion and red pepper to pan and continue to cook for 2 minutes. Then add zucchini, eggplant and garlic; cook for another 2 to 3 minutes, until all vegetables have begun to sweat.

Stir in next 7 ingredients. Reduce heat. Cover and simmer for 5 minutes.

Scoop mixture generously into par-baked mushroom caps and return to 400°F (200°C) oven for 5 minutes.

Scoop any leftover filling onto plates. Top with baked mushrooms. Garnish with basil and goat cheese.

1 serving: 370 Calories; 17 g Total Fat (9 g Mono, 1 g Poly, 4 g Sat); trace Cholesterol; 43 g Carbohydrate (8 g Fibre, 20 g Sugar); 15 g Protein; 700 mg Sodium

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