“I don’t see a problem with it.”  During the cold snap in January, it was difficult to get Eric to put on appropriate outdoor attire.  I’d ask him to walk Sheldon, the dog, and catch Eric at the front door dressed in a hoodie and slides.  Apparently plastic sandals without a heel strap are called “slides”.  No, I didn’t know that either.  I assume they are called slides because you can slide your foot in.  They are also appropriately named for what your feet do when you go outside with them at -30 C in the snow.  As Sheldon was bouncing around on his leash, excited to go outside, I had to tell my 15 year old that -30 C was cold and the should put on a coat, hat, mitts and boots.  However, when it warmed up to -4 C at beginning of February, I asked Eric to walk Sheldon again.  This time he put on a coat, winter boots, mitts and a full balaclava all without me asking.  At -4 C, Eric could easily have gotten around the block with the dog wearing just a hoodie, but he chose to excessively bundle up.  When I asked him why, all he said was, “I don’t see a problem with it.”  

We have been told for quite a while that omega 3 fatty acid supplements reduce the chance of heart problems.  It is now starting to look like they maybe they don’t.  This is despite what looked like good news from a study called REDUCE-IT looking at a prescription omega 3 supplement called Vascepa. 

Let’s back up and talk about cholesterol and the heart.  Cholesterol is a naturally occurring substance in the body that is essential for life.  If you had no cholesterol in you, you would die. Cholesterol helps form bile acids in your digestive system, hormones in your endocrine system and important components of every cell membrane in your body.  Your liver can make all the cholesterol your body needs.  The cholesterol in the food you eat doesn't go directly into your blood stream.  Your liver makes cholesterol for you.  We care about blood cholesterol levels because if they are too high for too long you have higher chance of getting a heart attack or a stroke.  Every 7 minutes in Canada, someone dies of cardiovascular disease.  That is why we care about blood cholesterol levels.  And that is why cholesterol medications are so common.  

Before we get back to omega 3’s, fish oils and heart disease, we must quickly mention statins.  Statins are the most popular cholesterol medications because they have by far the most and best evidence for reducing heart attacks, strokes and death.  Even the REDUCE-IT trial was done with people who were already on a statin.  The omega 3 fatty acid was an add on to the statin.  Now why are we so interested in fish oils and omega 3’s?  In the late 1960’s, some Danish researchers looked at the diets of American, Danish and Inuit peoples in Greenland.  They all eat about the same amount of fat, but the Inuit had way fewer heart attacks.  It was attributed to the Inuit consuming more omega 3 fatty acids.  Those omega 3 fatty acids came from their diet which contained the meat of a lot of cold water marine fish, birds and mammals.  There were further studies that showed adding omega 3 supplements decreased heart attacks and strokes in the participants in recent years.  However, the pendulum might be swinging the other way on omega 3’s.

Back to REDUCE-IT.  Vascepa contains a very specific component of omega 3 fatty acids called EPA or eicosapentaenoic acid.   Half the participants in REDUCE-IT were given the EPA (Vascepa) and half were given mineral oil.  They were all already on a statin.  Even though they were on a statin, one of their blood lipid numbers, their triglycerides, were still high.  After about 5 years, 4.9 % fewer of the people getting the EPA group had a heart event than those on mineral oil.  Heart events were cardiovascular death, nonfatal heart attack, nonfatal stroke, getting a by-pass operation or unstable angina.  That means you’d need to treat about 21 people with EPA for 5 years to prevent one heart event.  That sounded very promising for EPA and omega 3’s in general.

REDUCE-IT wasn’t perfect.  It showed a higher incidence of a less serious heart condition called atrial fibrillation in the EPA group.  There is some possibility that the mineral oil used in the placebo group might have interfered with the absorption of the statin in the placebo arm.  It is possible the people in the placebo arm just got less statin drug.

Studies of EPA and DHA (another specific omega 3 with the name docosahexaenoic acid) together show no benefit when it comes to heart problems.  Researchers aren’t sure why.  One possibility is the DHA counteracts the benefits of the EPA.  Another is the mineral oil.  It is possible the mineral oil placebo in the REDUCE-IT trial actually made the placebo group absorb less of their statin and so got less statin benefit.  The mineral oil might also have increased the LDL and the C-reative protein in the placebo group.  And the last reason not to get Vascepa is it is expensive.  It is about $340 per month.

So, do omega 3 supplements help the heart?  Maybe, maybe not. The Canadian Cardiovascular Society does not recommend taking an omega-3 supplement just to protect your heart.  A large study called ASCEND with 15,480 people found no difference in heart problems between people who took an omega-3 supplement versus a placebo over about 8 years.  Another large trial called VITAL with 25,871 people also found no real difference in total heart problems between omega-3 and placebo over about 5 years.  VITAL did seem to indicate that people on omega-3 fatty acid supplements might get fewer heart attacks.

If you want to get the benefits of omega 3’s but now think that supplements might not help, what should you do?  Eat fish.  The American Heart Association still recommends adults eat a 3.5 ounces of cooked or ¾ cup flaked fatty fish like tuna or salmon twice a week.

We ordered a couple pizzas from one of our local shops on Saturday.  I served pizza to Doris and Eric.  Serving Eric is really just opening his bedroom door and putting food next to his Xbox.  Whether doing school work, watching Netflix or gaming, that is where he seems to be all day.  Then I put the remaining pizza back in a box and hid it in the garage.  I left an empty box on the stove.  I knew Eric would come out of his room scavenging for food at 2 am while Doris and I were sleeping.  I hoped he would find the empty pizza box and stop looking.  It worked.  We got to enjoy left over pizza the next day.  Eric was annoyed.  “Hey!  I thought we finished off all the pizza yesterday.  You tricked me!”  My answer was, “I don’t see a problem with it.”  

As always if you have any questions or concerns about these products, ask your pharmacist. 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

NEJM – REDUCE-IT trial - https://www.nejm.org/doi/full/10.1056/NEJMoa1812792

American Heart Association- Omega-3 fatty acids - https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids

Historical overview of n-3 fatty acids and coronary heart disease - https://academic.oup.com/ajcn/article/87/6/1978S/4633486

The scene begins with the skyline of Chicago.  The sky is a cloudless above the Sears Tower which is a little off to the left.  Center foreground is a completely empty highway.  The Star Wars soundtrack is playing.  Suddenly a red Ferrari, a 250 GT California to be precise, flies directly overhead.  Two valets have taken the car for an epic joy ride.  In real life, there is no way the Ferrari would have survived this jump, but this is a John Hughes movie.  The car just speeds off towards the City center.  I kept thinking about this scene from Ferris Buellers’s Day Off as I lined up outside Aspen Insurance last week.  Aspen seemed to have the earliest opening time out of the places I could go in Dauphin to sign Eric up for Driver’s Education.  

Ferris Bueller is a kid for whom everything seems to always go right, no matter what he does.  Parkinson’s Disease is a condition in which your body’s movements don’t seem to go right.  The reason your body is misbehaving in Parkinson’s Disease starts in your head.  Deep in your brain is an area called the substantia nigra.  One of the functions of the substantia nigra is to relay messages from the brain to the body that plan and control movements.  For reasons we don’t completely understand, in Parkinson’s Disease (PD) some cells in the substantia nigra start to die off.  The nerve cells that die off are ones that produce the brain signaling chemical dopamine.  When 80% of the dopamine cells in the substantia nigra die off, PD symptoms like tremor, slowness of movement, stiffness and balance problems occur.

Parkinson’s Disease is one of the most common neurologic disorders and affects about 1% of individuals over 60.   The symptoms of PD vary from person to person.  We also say PD is progressive, which means it gets worse over time.  However, the rate it gets worse will also vary from person to person. Not everyone who has PD will experience all the symptoms.  Some of the more common or "hallmark" symptoms include: tremor at rest, impaired dexterity, expressionless face, rigidity and a sense of imbalance. Patients often compensate by lowering their center of gravity, which results in a stooped posture.  Other symptoms that may or may not occur include: freezing or being stuck in place, shuffling gait or dragging of one foot, sleep problems, apathy, depression, lowered voice volume or tremor when speaking, difficulty swallowing, constipation, and cognitive impairment.

Getting a diagnosis of PD is not the end of the world.  Many Parkinson's patients enjoy an active lifestyle and a normal life expectancy. Maintaining a healthy lifestyle by eating a balanced diet and staying physically active contributes to overall health and well-being. Parkinson's disease can be managed with self-care, medication, and surgery.

Exercise is as important as medication in the treatment of PD. It helps maintain flexibility and improves balance and range of motion. Patients may want to join a support group and continue enjoyable activities to improve their quality of life.  Focus on exercise to maintain strength and flexibility. Maintain a healthy diet. Remove throw rugs and low-lying obstacles from pathways inside and outside your home.  Replace clothes that have complicated fasteners with those you can slip on easily, such as sweatpants, sweatshirts, or pants with elastic waistbands.  Exaggerate lifting your feet and swinging your arms. With each step, pretend you are stepping over a log.  Take extra-small bites of food, chew thoroughly, and swallow carefully. Take a breath before you start to speak, and pause between every few words or even between each word. Instead of writing by hand, use a computer.

When we start adding medications to a PD patient’s treatment plan, we usually start with levodopa/carbidopa.  As a pharmacist, I find these treatments fascinating.  In PD, we don’t have enough dopamine in the substantia nigra.  But if we just give a person a dopamine pill, it wouldn’t cross the blood brain barrier.  The blood brain barrier is kinda like a biological force field that keeps most substance out of the brain, especially if they are polar molecules.  Most medications are polar molecules, including dopamine, so it is kept out of the brain.  So, chemists tinkered with dopamine and changed it into levodopa.  Levodopa is non-polar enough to cross the blood brain barrier.  In the brain levodopa is changed by enzymes into dopamine so it can help with PD symptoms!  Perfect, right?  Well, levodopa starts to get converted into dopamine outside the brain too.  And, remember dopamine can’t cross the blood brain barrier.  Plus, dopamine outside the brain can lead to side effects like nausea and vomiting.  That is why we add carbidopa.  Carbidopa prevents enzymes outside the brain from changing levodopa into dopamine, so more levodopa can pass into the brain where it can do some good.  

Even though it has been around for quite a while, levodopa/carbidopa is still the most effective choice for PD symptoms.  However, PD symptoms tend to get worse over time.  As symptoms get worse, the dose of levodopa/carbidopa will get increased.  The doctor may consider adding other medications like pramiprexole.  Pramiprexole mimics the effects of dopamine in the brain so we call it a dopamine agonist.  Adding pramiprexole can also reduce some of the potential side effects of levodopa/carbidopa.  One type of side effect of levodopa is called dyskinesias.  Dyskinesias are an involuntary, erratic writhing movements of the face, arms, legs and trunk caused by muscle spasms.  If dyskinesias occur, the doctor can reduce the levodopa/carbidopa dose and add on a different medication like pramiprexole.  After a time on levodopa/carbidopa, patients may notice that each dose wears off before the next dose can be taken (the wearing-off effect) or erratic fluctuations in dose effect (the on-off effect). We can counter-act wearing-off and on-off by changing when the levodopa/carbidopa is given or by adding a different medication like pramiprexole.

There are fascinating surgical options for PD as well.  The surgery is called Deep Brain Stimulation.  It doesn’t destroy any brain tissues and it is reversible.  It involves putting tiny electrodes deep into the brain.  When these electrodes are turned on they can greatly improve or eliminate the symptoms of PD.  Because this treatment involves, well brain surgery, it is not the simplest treatment option.  It is generally reserved for severe PD for which mediations aren’t working anymore.  

It turned out Eric and I were lucky.  From what I’ve heard, many people didn’t get their kid into Driver’s Ed this time around.  I hope another class for driving instruction gets added to satisfy all the pent-up demand.  As for Eric, I’m sure he will be a very safe driver.  I’m sure he will listen well to everything the driving instructor tells him.  I’m sure he won’t be like Cameron in Ferris Bueller’s Day Off.  Cameron discovers he can’t roll back the odometer on his dad’s Ferrari by running it in reverse on a car jack.  In frustration, Cam kicks the front bumper repeatedly.  Unsurprisingly, the Ferrari eventually falls off the jack and speeds backward through the back wall of the garage and over a cliff.  Cam then says how he dad always loved that car more than him and now his dad would have to talk to Cam.  These movie flash backs better not be premonitions.  

As always if you have any questions or concerns about these or other products, ask your pharmacist. 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

Parkinson Canada - https://www.parkinson.ca/
Ferris Bueller’s Day Off Car Jump Scene - https://www.youtube.com/watch?v=_fQDnDKhcaM
Ferris Bueller’s Day Off Car Destruction Scene - https://www.youtube.com/watch?v=FVqqVlW1a34&t=23s

There are several types of medications used to manage Parkinson's. These medications may be used alone or in combination with each other, depending if your symptoms are mild or advanced.
Conserve dopamine in the brain by blocking the breakdown action of MAO-B. These drugs are selegiline (Eldepryl, Zelapar) and rasagiline (Azilect), which are also neuroprotective and can slow disease progression.
Block the action of the neurotransmitter glutamate, which allows for an increase in dopamine release. This drug is amantadine (Symmetrel).
Introduce agents that mimic dopamine and bind to the receptors in the neuron's synapse. These drugs include pramipexole (Mirapex), and ropinirole (Requip), and apomorphine (Apokyn).

Replace missing dopamine in the brain. The drug levodopa helps with movement problems of tremor, stiffness, slowness, and walking. Levodopa is combined with carbidopa (Sinemet) to reduce nausea side effects and to ensure that levodopa is converted to dopamine in the brain and not in the intestine or blood.

Optimize delivery of Levodopa to the brain by blocking COMT, which breaks down dopamine in the digestive system, allowing a steady supply of Levadopa to reach the bloodstream. These drugs include tolcapone (Tasmar) and entacapone (Comtan).

Reduce activity of the neurotransmitter acetylcholine. These drugs reduce tremor and include trihexyphenidyl (Artane) and benztropine (Cogentin).

Body movement is very complicated.  The dopamine in the substantia nigra is only a very small link in the chain.  We think the idea to move starts in the motor cortex, goes through the striatum and the striatum and substantia nigra work together to send signals back and forth from the brain to the spinal cord.  Then the basal ganglia and cerebellum ensure the movement is carried out in a smooth and fluid manner.  When a part of the chain gets damaged, like the substantia nigra other parts of the system try to compensate.  Unfortunately, when other part of the system compensate that can lead to over and under stimulation of other brain parts.  This is why we get both shut down of motion and rigidity in some parts of the body and tremor in others. 

Dylan DeMelo didn’t make it to work Jan 14th.  In case you don’t follow them, DeMelo plays defensive for the Winnipeg Jets.  Jan 14th was the Jets Home Opener.  In fact, DeMelo says he won’t be playing until this Saturday.  The condition stopping DeMelo from playing seems to be more common than ever.  My co-workers at the pharmacy have noticed an increase in the condition in people coming into the store and calling for prescriptions.  One of our pharmacist’s daughter has the condition as well.  And it all seems to be linked to something that was going on last April. 

Another common condition is a sore throat.  The medical term for a sore throat is pharyngitis.  A sore throat is most commonly caused by a virus.  Other causes include bacteria, allergies and exposure to something irritating like second hand smoke.  If you have a sore throat, what should you do?  In normal, non-pandemic times, I would just reassure you that most sore throats get better on their own in about a week.  That is still true during a pandemic, but if you have a fever of 38 C or higher, trouble swallowing or breathing, a rash, or loss of taste or smell in addition to your sore throat, phone your doctor or walk-in clinic.  These could be signs of strept throat or COVID-19 and your doctor might want to examine you further or refer you for COVID testing.

Assuming you have just a sore throat with no fever, breathing problems, or rash, the best thing for you is lots of rest and fluids.  Sucking on ice cubes, sipping on warm broth, sucking on a sugar free candy or gargling with saltwater can all help reduce the discomfort of a sore throat.  Ice cubes, ice chips and popsicles should all be melted in the mouth and just the cold liquid should be swallowed.  Hard candies and non-medicated lozenges work by stimulating saliva flow but should be avoided in kids under 4 as they could be a choking hazard.  Saltwater gargles are usually made with ½ tsp of salt in an 8 oz glass of warm water.   We save saltwater gargles for kids over the age of 6 so that they understand to spit out the water and not swallow it.  Honey can soothe a sore throat.  Try 2 teaspoons at bedtime or as needed.  I like mine in herbal, caffeine free tea. The honey can also help calm a cough.  Honey is not recommended in children under the age of 1 due to the rare risk of botulism.

Over the counter acetaminophen (aka Tylenol) and ibuprofen (aka Advil) are excellent choices to reduce the pain of a sore throat, however they do take 30 minutes or more to kick in.  Usually, we start with low doses in adults like 325 mg of acetaminophen or 200 mg of ibuprofen.  If you want something faster that pain killing pills, we reach for sprays and lozenges.  

Sprays and lozenges work faster than oral analgesics but they don’t last as long.  And there is some evidence that sprays and lozenges don’t work any better than non-drug measures.  Most sprays and lozenges have several ingredients in them.  Feel free to ask your pharmacist to help you pick one out.  Two common ingredients are menthol like in many of the Halls lozenges and benzocaine like in many of the Chloraseptic lozenges.  Menthol is an oldy but goody medication that makes cough drops smell “mediciny”.  Menthol is also considered soothing for a sore throat.  Benzocaine is a local anesthetic.  It will actually numb your throat.  In fact, I warn people not to drink hot beverages right after using a benzocaine lozenge because they might accidentally burn their throat and not realize it.  Benzocaine is to be avoided in kids under 2.  This is due to rare cases of methemoglobinemia which makes your red blood cells less able to carry oxygen throughout your body.  Symptoms include blue skin, confusion and breathing problems.  If someone is experiencing these symptoms, seek medical attention.

Two newer products on the market are Betadine Sore Throat Gargle and Betadine Sore Throat Spray.  They both contain povidone -iodine.  Since iodine is a topical antiseptic, the hope is they will kill bacteria and viruses in your throat.  The down side is since they contain iodine, the iodine might stain clothing, towels, wash cloths, dentures, braces and other dental work.  Also, since they contain iodine, the Betadine’s should be avoided in people with thyroid issues.  Finally, to keep things confused, Betadine makes Cold Defense Nasal Spray.  It does not contain any povidone-iodine at all.  It has iota-carrageenan in it.

Do you remember April 2020?  The NHL and NBA had been cancelled.  Schools were closed.  Movie theaters, bars and restaurants were closed.  Everyone was spending a lot of time at home, because well, there wasn’t much else to do.  And nine months later, there seems to be a lot of babies being born.  It seems like NHL’ers like DeMelo weren’t immune to this condition.  I have no idea if there are any official stats to back me up, but I think we are going through a small COVID baby boom.  And hey, with all the bad COVID news out there, I’ll take any small bit of good news I can find.

As always if you have any questions or concerns about these or other products, ask your pharmacist.  

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

Did you know there was a specific tool to remove the intestines of a turkey in a slaughterhouse?  It probably has an official name, but Doris just called them turkey butt-hole cutters.  It was a cylinder with teeth at one end and the other was hooked to a vacuum system that sucked the innards out of the carcass.  Before moving to Dauphin, Doris sharpened turkey butt-hole cutters, as well as end mills, reamers, carbide tipped saw blades, chain saw blades and high-speed steel saw blades.  Doris always told me the high-speed steel saw blades were not worth the money to straighten and sharpen and when dull, you might as well just buy a new one.   Towards the end of Doris’s sharpening career, she was being trained on CNC machines that could turn a $10 blank of carbon steel into a $150 tool.  Doris’s background in professionally sharpening industrial implements came up a couple months ago while talking to our daughter, Emily.  Emily’s welding course in Saskatoon was going well when it came to the actual welding.  But at this point, her class was sent to a shop to learn about tools.  Emily described turning many former drill bits into smooth cylinders while attempting to sharpen them.  She was very frustrated.

Over the years, I’ve been frustrated by warts.  I’ve had warts on my hands and feet come and go.  Fortunately, at the moment I’m wart free.  But I’ve tried many, many different wart potions in my time.  Compound W, home freezing products, and the stomach medication cimetidine.  Remedies I’ve heard of but never tried include: covering the wart with duct tape for a day and removing the duct tape, and rubbing a penny on the wart and burying the penny in the garden.  What are warts and why are they so hard to get rid of?

Warts are caused by a viral infection in the top layer of the skin.  The virus is called the human papillomavirus (HPV) and there are more than 100 different types of human papillomavirus (HPV).  Children and young adults are the most commonly affected age group.  Handlers of meat, poultry and fish also have a high incidence of warts.  It has been estimated that up to 25% of the population will have a wart at some time.  Warts are usually spread from direct skin-to-skin contact with an infected person.  It can also be spread by contact with surfaces like communal showers and swimming pool decks.  It can take 2 to 6 months from the time of infection until the wart appears.  Although there is limited proof, some experts think it could take up to 3 years between exposure and wart development.  

Warts are hard to get rid of because the human papillomavirus is really, really good at hiding from your immune system.  HPV  convinces the security guards of your immune system that it is really okay for them to be there and to not sound the alarm.

When should you see a doctor and when can you try to treat a wart yourself?  If you have warts on your face or genitals, or if you have flat warts you should get them checked out by your family doctor.  People with diabetes or circulatory problems also should not self treat because these people are more likely to have problems with healing wounds in the skin.

Many non-prescription wart products contain salicylic acid.  They can harm the skin around the wart if not used as instructed.  To use the salicylic acid products first gently remove the top layer of skin from the wart with an emery board, pumice stone or rough wash cloth.  If you make the wart bleed, you rubbed too hard, and may actually cause the wart to spread.  Then soak the wart in warm water for 2-5 minutes.  Dry off the wart and the area around it.  Then apply the salicylic acid product only to the wart and not to the healthy skin around it.  You can protect the healthy skin around the wart with some Vaseline if you wish.  You will have to repeat this wart removal process everyday, so most people choose to rub, soak, and apply at bedtime.  The wart will turn white and soft over time and you will rub off more and more of it until it goes away. Also, don’t share your wart emery board or pumice stone with others.

Freezing products are now available over the counter.  Common trade names include Compound W Freeze Off.  It is not liquid nitrogen like your doctor uses, but accomplishes the same thing.  Think way back to high school chemistry.  When a gas expands, it cools.  When a gas expands rapidly, it cools rapidly.  These over-the-counter products allow liquids similar to lighter fluid expand into a gas within an applicator.  So, my first warning is that these products are flammable.  My second warning is the applicator gets cold.  It can get below -55 C.  Follow the instructions in the package carefully.  Most importantly, don’t freeze the skin around the wart.  It will damage your skin.

It was fun to see Doris’s eye light up as I handed her the phone.  Of course, she was happy to talk to her daughter, but she seemed extra excited to talk about drill bit sharpening.  Doris described the angles Emily should be aiming for.  Emily told Doris that she was told never to sharpen a drill bit with a rat tail file as the taper on the file would screw up the drill bit.  Doris told Emily that a drill bit should always be sharpened in a specific jig because it was impossible to get the cutting surface right by hand.  While we were walking the dog after talking to Emily, Doris was still excitedly describing different drill bit sharpening techniques to me.  I told her, I thought she should teach Emily’s class at SaskPolytech.  I think Doris would do very well as a guest lecturer.  And I get a giggle imagining Emily introducing Doris to her class.  “Hi, this is my Mom.  She drove up from Dauphin to make sure I was eating okay, doing my laundry properly, getting some exercise and because she thinks our industrial implements sharpening instructor doesn’t have a clue what he is talking about.”

As always if you have any questions or concerns about these or other products, ask your pharmacist. 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca