When you have your “cholesterol levels” measured, typically the doctor or pharmacist is ordering a lipid panel.   The lipid panel consists of 4 main components:

1)    Total cholesterol – the total amount of cholesterol in your blood, including both the good and the bad cholesterol.

2)    Low Density Lipoprotein (LDL) – this cholesterol is the known as the bad cholesterol. When LDL levels in the blood are too high they lead to plaque build up in artery walls.

3)    High Density Lipoprotein (HDL) – this cholesterol is known as the good cholesterol. We want HDL levels to be high as HDL carries the LDL away from the artery walls.

4)    Triglycerides (TG) – are the most common type of fat in your body. When elevated they appear to speed up the process of plaque build up in artery walls.

If you are found to have elevated cholesterol or triglycerides, the doctor/pharmacist will recommend changes to your diet and exercise.  Dietary changes include avoiding saturated fats and refined carbohydrates and increasing consumption of fruits, vegetables, nuts, and seeds.

It is also possible that you may require medication to help lower your cholesterol.   If medication is included, this drug regime would be in addition to your diet and exercise strategy and not instead of these important lifestyle changes.

 If you are concerned about your cholesterol levels, or would like to know what they are, speak with one of our pharmacists today!

Top of Page

Why do I, along with the majority of the pharmacy profession,  beleive inducements should be banned?

There are many reasons, some of which  include the following:

• it calls into question the integrity of the pharmacy profession
• it says that the pharmacist’s clinical decision is secondary after the rules of the points program
• it thereby gives a mechanism for  some pharmacists employers to unduly influence the pharmacist by placing time and resource limitations on that healthcare practitioner
• they contribute to medication waste, and therefore taxpayer dollars
• inducements cost the health care system, and thus taxpayers; they are an opportunity cost that should be reallocated to improve the access to care for everyone
• they have the potential to negatively impact treatment goals and health outcomes
• they disrupt relationships between patients, pharmacists and other health team members
• they erode the professional status of pharmacists
• prevents the pharmacist from being able to make independent decisions that he/she knows is best for the health outcomes of their patients – that’s you!

For more information on the banning of inducements offered by pharmacy visit:

http://www.newswire.ca/en/story/1148627/alberta-college-of-pharmacists-pushes-for-ban-on-rewards-for-prescription-drugs

The practice of offering inducements, is bad medicine and this author feels that banning inducements is a big leap forward for the profession of pharmacy.

Top of Page

The March 7th Alberta Provincial Budget introduced a number of changes that many have described as “austerity” measures.   These represent a long list of spending cuts including healthcare cuts.  As a healthcare professional who is also a small business owner, fiscal responsibility or economic responsibility is a term that all business owners understand.   No different than a business or a family household, you can’t spend more than what you make unless you have some substantial cash reserves and even then, you can only go back to those funds so many times before the cash must be replenished.  Furthermore, we have asked the provincial government to maintain a balanced budget, making certain that spending does not exceed government revenues.  This year’s budget introduced a deficit budget 0f some $4.2 Billion.

As part of this March 7th Budget, the provincial government introduced additional cuts to healthcare that did not receive the media attention it deserves.  These cuts to the healthcare budgets are not the first but instead are one more of many cuts that have taken place over the past 3 years.   Although the Alberta Government has “reinvested” in pharmacy by reimbursing pharmacists for some of the valuable patient services previously provided without any compensation, the economics are still such that those dollars represent only a small portion of that taken from pharmacy and possibly more important is the timeline of these cuts.  Most pharmacists and in particular pharmacist owners will explain that they have been scrambling to accommodate the original funding cuts that took place in what was referred to as, “Phase 1″ of the Province’s Pharmacy Strategy in 2010/2011.

Pharmacists across the province have for the first time in their history raised the alarm, explaining that these cuts are too severe -that they will negatively affect patient care.

To give Albertans the background information necessary to understand what has occurred and to help separate Myth from Fact, we have prepared a series of briefs.   These have been done with the help of the Alberta Pharmacists Association who have been meeting with Alberta Health Representatives in an effort to resolve some of the serious consequences that will impact Alberta citizens in the coming weeks and months.

MYTH

• Alberta is the only province to provide transition funding from Generic Price Reductions

FACT

•   Ontario provided 3 years of transition funding expiring March 31, 2013
• Nova Scotia provided transition funding expiring June 2014
• Newfoundland and Labrador implemented a transition allowance ending on April 1, 2015
• British Columbia, Saskatchewan, Ontario, Nova Scotia, New Brunswick, Newfoundland all increased dispensing fees using savings from generics
• Unlike transition fees these dispensing fee increases do not expire
• Most recently, New Brunswick has announced generic price reduction from 35% to 25% and is expected to reinvest in Community Pharmacy with a $0.10 increase in dispensing fee and an increase in markup on Generic Drugs from 4% to 8% and Brand markup of 8% on Manufacturers Lowest Price
• No dispensing fee increase in Alberta since 2005

MYTH

• The Alberta Government has provided $95M in transition funding to pharmacies

FACT

• $70.2M has been spent by Government to March 31, 2013 at which time transition fees are eliminated
• Estimates from Alberta Health Pharmaceutical Funding and Guidance department for transition fees are:
  •  $34.8M in year 1 of agreement
  • $23.5M in year 2 of agreement
  • $11.9M in year 3 of agreement (ending March 31, 2013)

   

MYTH

• Alberta has offset the generic price reduction with significant reinvestments into pharmacy

FACT

•  Since 2010 government savings have exceeded $300M while reinvestment (Transition funding, Remote Access Grant and Pharmacy Services) is:   $89.2M including the $70.2M in transition fees

MYTH

• Limited financial impact of generic price reduction to pharmacies

FACT

• Since 2010
  • Total Annualized reduction in Pharmacy Revenue (public/private) is $627M
  • Average Revenue reduction per Pharmacy in Alberta = $607K

 MYTH

• Ontario has withstood significant generic price reductions and more pharmacies have opened

FACT

• Ontario has a different billing system that allows separation of private and public billings
  • The average dispensing fee on the private book of business is significantly higher than on the public book of business
  • Changes to Generic Drug Prices have resulted in significantly reduced pharmacy wages and a reduction in pharmacists’ hours, resulting in an abundance of pharmacists looking for work.
  • Generic drug pricing is at 25%, not 18%, and decreased over a longer period of time

MYTH

•  Pharmacists are happy with the Alberta Pharmacy Services Framework as a new reimbursement system that compensates pharmacists for providing professional pharmacy services

FACT

• Pharmacists are generally pleased to receive recognition for performing services within their full scope of practice, but admit that that the Framework is difficult to implement and cannot be a replacement for lost revenue
• The Framework was implemented in July, 2012 with no assistance for change management or IT infrastructure to support the services in the community
• The current Framework is a work-in-progress that requires significant modifications to allow easier implementation and permit a greater number of Albertans to qualify for the services
• Many of the “free” services offered by pharmacists are still not reimbursable through the Alberta Pharmacy Services Framework, for example:
  • Free Prescription Delivery
  • Consulting with other health care professionals on a patient’s care
  • Compliance Packaging
  • OTC Counseling
  • Triaging of patients
  • Answering drug information questions

MYTH

• The Remote Access Grant has $10.6M unallocated

FACT

• The original Rural Access Grant of $5M was allocated in 2010/11
• A Remote Access Grant was re-introduced in July 2012 with $5.3M allocated for each of 3 years.  The unallocated $10.6M is set to be spent in 2013/14 and 2014/15 using defined criteria established by Alberta Health.
• Government of Alberta is now recommending the $10.6M be re-purposed to assist with Stabilization.

Now you know the facts behind this continuing story.  It is far from being over, as government, industry, pharmacists and the pharmacy profession continues to work through what has turned out to be a very poorly planned attempt to save a few dollars at the expense of Alberta’s already struggling healthcare system.

Top of Page

Let’s look at your lifestyle in a new light—as medicine.   Did you know that the first line therapy (the best and first therapy that should be tried to treat a disease) in many cases is lifestyle change?   Have you ever considered that in many instances increasing your activity level and eating healthier can prevent the need for medications?

Lifestyle changes are considered first line therapy for the following medical conditions:

• High blood pressure
• High cholesterol
• Type 2 Diabetes
• Osteoporosis
• Metabolic Syndrome
• Cardiovascular Disease
• Conditions related to aging
• Obesity

In addition to the conditions listed above, lifestyle changes are imperative for the management of:

• Hormone Imbalance
• Fatigue
• Low Sex Drive
• Stress-Related Symptoms
• Poor Memory or Lack of Mental Clarity

If you have chosen to become healthier through lifestyle changes this year, the pharmacists at Stafford Pharmacy can help you make the change.   We are now offering the Metagenics First Line Therapy Program®, a lifestyle program that helps people dealing with the conditions listed above.  This is NOT a diet, because we all know they rarely work!  Our first step includes body composition analysis using a bio-impedance analysis (BIA)  meter.  This analysis provides information about body water distribution, what percentage your body retains within cells (intra-cellular) and that which exists outside of cells (extra-cellular).  This distribution allows us to make some inferences about fat distribution since fat is water hating, while conversely muscle is water loving.    This distribution of water, representing fat and muscle distribution is what the bio-impedance meter measures using a very, very weak electrical current which is passed through the body.   Complex algorithms have been developed and built into such bio-impedance meters to accurately interpret the conductive characteristics of men, women, and even different ethnicity’s  to accurate measure the distribution of fat.

These results from the BIA are valuable in the creation of effective and personalized lifestyle and dietary programs including meal planning, nutritional supplements, and physical activity.  This is the only way any such program can be successful in helping you achieve and most importantly, to maintain optimal health and well being for a lifetime.   The focus is improving lifestyle, improving nutrition, losing fat without the risk of losing muscle mass, improving bio-markers of health and as a result preventing disease as well as improving existing disease status.

This year, choose a lifetime of good health.  For more information on the Metagenics First Line Therapy Program and to find out how you can enroll, speak with one of our pharmacy staff today!

Note:  This topic was included in a recent Newsletter, The Mortar & Pestle. 

Top of Page

Although February was Heart Month and to celebrate, we were checking in on your heart health we think this is important enough to continue this service twelve months of the year.

We offer the Framingham Cardiovascular Risk Assessment.

The Framingham Risk Assessment will tell us whether or not you have a low (<10%), medium (10-20%), or high (>30%) 10 year risk of having a major cardiovascular disease event (I.e. Heart attack). It will also determine if you need to make lifestyle changes or be placed on drug therapy to reduce your risk.

 What information is used to assess your Cardiovascular Risk?

During this assessment, one of our pharmacists will check your blood pressure and assess your cholesterol levels (this may require sending you for a blood test if you have not had one recently). Using this information, along with your age, gender, smoking status and diabetes status, your 10 year cardiovascular risk will be calculated.

What happens if you are found to be at risk?

If you are found to be in the medium to high risk categories or have high blood pressure or elevated cholesterol, your pharmacist will help you to make any necessary lifestyle changes. They will also notify your family physician of the findings and make any necessary drug therapy recommendations.

Who should participate in our Heart Health Clinic?

We recommend participating in our screening clinic if you any ONE of the following:

• You are male and over 40 years of age.
• You are female and over 50 or post-menopausal.
• You have heart disease, diabetes, high blood pressure or had a stroke.
• Your waist measures more than 102 centimeters (40 inches) for men or 88 centimeters (35 inches) for women. For persons of Chinese or South Asian descent, if your waist measures more than 90 centimeters (35 inches) for men or 80 centimeters (32 inches) for women.
• You have a family history of heart disease or stroke.

If you would like to have your cardiovascular risk assessed, stop by the pharmacy on Tuesday’s or Thursdays between 10 AM and 4 PM and ask us to check on the health of your heart.   We don’t want to discourage anyone from pursuing an answer to this question so we will make every effort to work through the assessment but depending on your personal health history the pharmacist may recommend that you set up a designated time with the Pharmacist to make certain adequate time is given to your assessment.   We’re certain you can appreciate how important this assessment can be to your future health strategies.

Don’t wait until you become another statistic!

Top of Page

March 2013 is Pharmacist Awareness Month, when pharmacists across the country reach out to make Canadians aware of the many services they offer to improve their patients’ health.

A 2012 survey by Environics Research Group showed that while many Canadians are willing to see pharmacists for expanded services, they simply aren’t aware of the full range of issues they can discuss with their pharmacist. The survey of over 1500 adults showed that Canadians report high levels of interaction and satisfaction with pharmacists’ services, and a full 80% of respondents indicated that they’ve received counselling or advice from a pharmacist. About half of respondents said that they would see a pharmacist for a flu shot or other vaccination, and over 75% said that they would be comfortable going to a pharmacist to order and interpret lab tests.

At Stafford Pharmacy, we celebrate Pharmacist Awareness Month to make sure that our patients know that their pharmacists are there to help, in more ways than they know. There are many health-related issues that pharmacists can work through with patients, without appointments or wait times.

Most Canadians know that pharmacists are the most equipped health care provider to help understand the best use of medications. They can help patients learn how to take medications properly, suggest alternate medications to avoid dangerous interactions and explain potential side effects. For Canadians on multiple medications, most pharmacists can conduct a complete medication review to ensure they’re getting the most from their medications.

But many Canadians don’t know that pharmacists across the country can offer even more than medication expertise and advice. They have the education, knowledge, experience and skills to offer a very wide variety of health care services. In Alberta, pharmacists can prescribe for some situations, including treating minor ailments, adjusting dosages, monitoring and refilling prescriptions. They can also order and interpret lab tests, administer injections and make therapeutic substitutions and help to manage chronic diseases.

Pharmacists are also a more cost-effective solution to Canada’s rising health care expenditures. According to the Canadian Society for Hospital Pharmacists, analyses from a variety of studies have shown that for every $1 spent on a pharmacist’s services, between $6-$25 in hospital costs were saved or avoided.

Pharmacists can help alleviate backups and delays in the health care system. When you walk into a pharmacy,  you don’t require an appointment to talk to a knowledgeable professional about a wide variety of health concerns. Pharmacists are a key member of the health care team and can make a huge difference in the lives of their patients.

During Pharmacist Awareness Month 2013, ask your pharmacist how you can work together to make sure you’re as healthy as can be. Providing more health care than you know: Ask a pharmacist.

Top of Page

On January 24th, Health Canada announced that it was changing the labeling requirements for all statins. Drug labels for six statins (atorvastatin, rosuvastain, simvastatin, lovastatin, pravastatin and fluvastatin) will now include a warning that states these medications may increase the risk of developing diabetes. This information has the many patients on these medications wondering if they should continue to take them.

The new labeling requirements are based on a review of multiple studies which showed that statins may increase the risk of developing diabetes in patients that have other diabetes risk factors. Risk factors for diabetes include: obesity, high triglycerides, high blood sugar and high blood pressure.

It is important to keep in mind that despite these new warnings about statins, in the majority of cases the overall cardiovascular benefits of statins will outweigh the other risks. You should never stop taking your statin drug without first speaking to your healthcare professional.

If are taking a statin and you must remain on statin therapy to protect your heart, it is important to monitor for early warning signs of diabetes. The signs and symptoms of diabetes (increased blood sugar) can be severe frequent urination, thirst or hunger. If you develop these symptoms should contact your healthcare professional. Diabetes may also present without any symptoms. If you are concerned, speak with your healthcare professional about having a blood test to check your blood sugar.

If you are currently taking a statin and have concerns please speak with your pharmacist or physician.

Top of Page

This particular Blog is focused on new developments in the sciences that often lead to many of the innovative products that are composed of those nutrients and plant based medicinals that although are not considered nor classed as Scheduled drugs,  are developed with some therapeutic contributions when used alone or in combination with other regimens.    Many of these products are focused on wellness from a holistic perspective, based on the theory that many diseases are shown to be chronic injury due to toxic and reactive chemicals, and/or may in fact result in sub clinical nutrient deficiencies that produce their own subset of symptoms.

The following information was posted on The Cutting Edge blog, April 2012 and offers some newly discovered technologies that a few manufacturers have incorporated into some new products.  AOR is one of those companies making use of the NOx technology to provide some unique benefits to a small line of their product offering.   The NOx technology discussed in the article utilizes the latest research in maximizing NO levels, rapidly and safely.   This is achieved through use of proprietary technology that prevents any nitrosamine formation and promoting optimal health.

Every now and then there are discoveries that can be called true paradigm shifts in nutrition.  NOx technology is exactly that, a monumental paradigm shift.

Nitric oxide (NO) is a small, very simple molecule made up of just two atoms, nitrogen and oxygen.   After extensive research in 1998, the Nobel Prize in medicine was awarded to three researchers in elucidating the mechanism of action of NO which at the time was called endothelial relaxing factor (EFR) or relaxer of blood vessels.

Since then, the research into the biology of NO has progressed with zealous fervor.   NO has been shown to be an important signaling molecule which is produced in our bodies for specific purposes. NO is involved in essentially all important aspects of our biology including regulation of blood pressure, nerve transmission, brain function, penile erection, immunity, metabolism, gastrointestinal health, kidney function and more. The reason for this is due to the fact that NO itself is a radical and thus is highly prone to reacting with a wide variety of tissues and molecules e.g. enzymes, lipids and proteins. The diversity of these physiological processes, which are precisely controlled, is quite remarkable.

Up till 1994 it was thought that the only way to produce NO was via the amino acid L-Arginine.    L-Arginine could be oxidized via the various enzymes present (called NO synthases) throughout the body.   However, this process was dependent on adequate amount of oxygen, higher pH’s and the activity of these enzymes.    Then in 1994, two independent research teams from Sweden and the UK showed that there was an alternate mechanism of generating NO.   This was a radical finding (no pun intended) and it seemed that this was nature’s way of having a backup system in place during times of emergencies like when there isn’t much oxygen e.g. during strenuous exercise, asthma, heart disease like angina, high altitudes, or infections such as upper respiratory tract infection and so on, and also when the pH of the body becomes acidic which often happens when there is insufficient oxygen. Moreover, the process was opposite to oxidation, it was a process via reduction and occurred much quicker than the long winded conversion from L-Arginine.    Moreover, the amount of the active ingredient required was significantly lower (10 fold at least) than the quantity of L-Arginine required (e.g. several grams versus couple of hundred milligrams).

The active ingredient is the nitrate; over 80% of which comes from our diet, chiefly through the consumption of fruits and vegetables like spinach, celery, broccoli, lettuce and particularly beetroot. These and other leafy green vegetables are loaded with nitrates and the body is able to quickly absorb these and reduce them first in the mouth and then in the stomach into NO. The effect is quite rapid e.g. consumption of half liter of beetroot juice results in a blood pressure reduction as early as 30 minutes. Furthermore, the effects last for well over 24 hours. Again, unlike L-Arginine supplementation the effect is considerably longer lasting.

Nitrate rich formulas have been used by Chinese physicians since the 11^th century and unlike the prescriptive nitrates (glyceryl trinitrate) used for angina, do not develop tolerance and are thus more useful. Interestingly, good health often equated with the consumption of fruits and vegetables may in large part be due to the high nitrate content. Many healthy diets like the Mediterranean diet or DASH (dietary approaches to stop hypertension) and Japanese diets are extremely high in the nitrate content.  Furthermore, as we age the levels of NO in the body decreases and may account for the increased blood pressure, susceptibility to infections, increased disease of the heart, kidneys and the brain as well as poor immune function.

One of the biggest concerns over using nitrates is the negative associations with cancer, especially cancer of the liver and the stomach due to the potential formation of carcinogenic substances called nitrosamines. However, careful review of the literature suggests that within the regulatory (WHO, European Food Safety Authority, Expert Committee on Food Additives etc) guidelines for nitrate dose, there is no relationship between risk of cancer or other adverse health consequences. In fact, these conservative guidelines may in fact be depriving the body of this unique opportunity of synthesizing the NO molecule. There are other anomalies about nitrates being classified as dangerous. First, on a regular basis, the body actually uses nitrates in large quantities to produce nitrites. In fact nitrites act as a reservoir or depot for NO for future requirements by the body. In situations where NO is required, the circulating nitrite is quickly converted into NO and once NO has performed its biological function it is converted back into nitrite for future needs. This way the body can easily modulate its NO requirements. Second, a plate of salad typically contains more nitrate than the maximum daily intake as per regulations. Isn’t consumption of more salads good for us?   Third, human breast milk is loaded with nitrates perhaps in part to offer maximal protection to the newborn. Finally, people living in high altitudes like Tibet have increased nitrate and NO levels.

NO generation from nitrates offers a significant advantage especially during periods of stress, and various physical and environmental insults (e.g. pollution). By maintaining levels of NO, one can achieve significant health benefits as well as optimal exercise performance. Studies show that increased intake of nitrates decreases the time of exhaustion, in other words, it increases endurance and physical performance.

If you would like find out more information about this technology and the important of  Nitric Oxide (NO) in normal physiology as well as disease, here is an additional link to AOR’s articles on Nitric Oxide as well  as some of the NOx technology as it is incorporated into several new products that they have brought to market.   Their publication ADVANCES, discussed the NOx Technology in Volume 3, Issue 10.

Top of Page

#1 – Forbidden Festive Foods

The following is a list of foods that are toxic to household pets:

• Chocolate
• Candy Canes
• Onions
• Raisins and currents
• Poinsettias
• Holly Leaves and Berries
• Mistletoe
• Leftover Bones

Although not a food, the artificial sweetener xylitol  is found in so many products from candy to soft drinks.  Although safe for human consumption as a  sugar substitute or sometimes referred to as a sweet enhancer, it is NOT safe for your companion canine or ferret.    So far, cats have not shown the same response to xylitol consumption.   Human metabolism of this sugar alcohol is quite different than that of your dog or ferret.

The harm done by something as simple as xylitol is a due to the release of insulin from the pancreas leading to a rapid uptake of blood sugar (glucose) into tissues and organs such as the liver, muscle and fat cells.  This sudden uptake of glucose causes a sudden hypoglycemia (low blood sugar)  which compounds the liver toxicity and liver damage.   As little as a xylitol containing cookie or cupcake can be enough to be fatal to an animal.  In fact ingesting as little as 0.5gm of xylitol per kg of body weight increases the risk for liver toxicity.    As little as 0.1gm of xylitol per kg of animal body weight can lead to the rapid hypoglycemia in 30 to 60 minutes.   If you suspect that your dog has consumed xylitol in any form and displays sudden symptoms of lethargy (drowsy, listless, no energy), weakness or trouble walking contact your veterinarian or transport the animal to a local veterinary emergency care center.  It is important that emergency care be provided within 30 min to 45 min of ingestion to prevent organ damage.

#2 – Decoration Dangers

• Ensure your tree is stable and secure so that your pet cannot knock it over while you are away from home
• Glass ornaments can become dangerous to animal paws if they fall off of the tree and shatter. Consider using plastic ornaments if you have pets.
• Ensure that electrical cords (from Christmas lights) are kept out of your pets reach while you are out and about

#3 – Salt

• 5,000,000 tonnes of salt is used each year on roads to keep them free from ice. Be sure to wipe your pets paws off when you come in from outside to avoid salt burns and cuts.

Make this a time for family, friends and of course your furry friends but keep them safe by taking a few sensible precautions.

Each minute in Canada, someone needs blood. In fact, 52% of Canadians state that they or a family member has needed donated blood. Canadian Blood Services needs each of us to donate, and donate often. Here’s why. Each time you donate, you give one unit of blood. However, to save a life it takes more than one unit. In fact, it may take up to 50 units to save the life of someone who has been in a car accident. It takes 5 units of blood to save the life of someone receiving cancer treatment.

In addition to blood, specific blood products are also in demand. Plasma and platelet donors as well as stem cell donors are equally as important as blood donors. Platelets are responsible for helping the blood to clot. Patients with prolonged bleeding caused by certain diseases, including cancer, require platelets as part of their treatment.
This holidays, consider giving the gift of life by donating blood, platelets, plasma or stem cells. For more information and videos of the donation process visit www.blood.ca.

To make an appointment contact 1-800-2-DONATE.

Top of Page