Diabetes can affect your feet negatively in two ways:

1)      Persistently high blood sugar can damage the nerves in your feet. This can result in numbness, tingling and loss of feeling. If you lose feeling in your feet, you may not notice if you have a blister or a cut. Also, nerve damage can prevent the muscles in your foot from functioning properly leading to misalignment and pressure ulcers.

2)      High blood sugar can also damage the blood vessels in your feet. Poor blood flow to the skin prevents infections from healing, and increases the risk of ulcers and gangrene (death of tissue due to lack of blood flow).

The combination of nerve and blood vessel damage means that even a small cut or blister that goes unnoticed can result in a serious infection. In fact, diabetes is the most common cause of lower limb amputations. Every hour, 3 people with diabetes must have a foot, ankle or leg amputated. Many, if not most, of these infections and amputations can be prevented with proper food care.

If you are diabetic, you need to take extra care of your feet to prevent injuries and resulting complications. The Center for Disease Control recommends the following foot care guidelines for those with diabetes:

• Have your health care provider check your feet at least 4 times a year. Take your shoes and socks off at the start of each visit and ask your doctor to look at your feet. They should be looking to see if your feet are deformed or mis-shaped.   They should perform a test to check the feeling in your feet and test the strength of your pulse at least once per year.
• Check your feet thoroughly each day for any small cuts, cracks or blisters.  Remember to check between your toes and the bottom of your feet.
• Wash your feet daily.  Dry them well and rub a lotion or cream on the tops and bottoms.  Do not put lotion between your toes as this can lead to infection.
• Trim your toenails carefully OR better yet, have someone do this for you.  Cut them straight across following the natural curve of your toe.  Do not cut into the corners.
• Have corns and calluses treated by a doctor or a foot care specialist.   To learn how to care for these conditions speak with a member of our Home Healthcare team today.
• Wear shoes and socks at all times.  Don’t walk barefoot.   Be sure to wear shoes that fit well and protect your feet.   Don’t wear sandals with thongs between the toes.
• Be physically active to increase the circulation in your feet.

If you are diabetic and develop any swelling, warmth, redness or pain in your feet see you doctor right away. Delaying treatment of any infection can result in serious complications such as amputation.

If you have questions about diabetic foot care, speak with a member of our pharmacy or home healthcare team today!

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Most people are born with healthy feet; however as we age, ~75% of people will develop serious foot problems.   Foot problems are most common in seniors and those with diabetes and arthritis. Keeping your feet healthy is essential to maintaining an independent lifestyle.

Here are some basic foot care tips to help you avoid problems:

• Check your feet everyday – Take a few minutes to look for any damage (cuts, blisters, redness etc.)
• Wash your feet every day – Use warm water and soak them for less than 10 minutes. Dry well.
• Keep your feet soft and smooth – Use an unscented cream all over your feet to prevent drying and cracking of skin.
• Wear comfortable shoes and socks – Poorly fitting, inadequately supportive shoes can cause foot problems.
• Be active every day – Walking is the best way to keep you and your feet healthy!
• Take care of your toenails – Cut or file your nails regularly with proper nail care tools. Trim them straight across and never shorter than the end of your toe.

Foot pain is not normal. If you are experiencing pain or difficulty with your feet, speak with a member of our Home Healthcare team today.   They have specialized knowledge and skills in the area of foot care and can help you maintain happy and healthy feet!

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Medication adherence, or the extent which individuals take their medications, is the key to drug therapy. It has been found that the more complex the medication regimen, the lower the adherence. Studies have shown that up to half of prescription medications are not taken properly (i.e. taken at the wrong time, missed doses etc.).  When medications are missed or taken at the wrong time, the patient may suffer from unwanted side effects or worse the drug may not work at all.

At Stafford Pharmacy we offer blister packaging services for our clients. Medications are packaged into easy to use weekly cards. These cards organize the medications to ensure that the correct medication is taken at the correct time each day. For each day of the week, the medications are packaged into four convenient time slots: morning, noon, evening and bedtime. When a patient chooses to have their medications blister packaged, the pharmacist reviews the medications to ensure that they are packaged in the appropriate time slots and that there are no drug interactions. This review occurs each time medications are packaged and when new medications are added to the regimen.

Patients can choose to either pick up their blister packs, or have them delivered on a weekly, biweekly, or on a monthly basis. These deliveries and pick-ups are automatically scheduled, so that your medications are ready for you the day before your blister package is scheduled to start!

The benefits of blister packages for the patient and/or caregiver are many and include:

• SAFETY:  The patient gets the correct medication at the proper times. No double dosing or missed doses. Blister packaging saves lives.
• ADHERENCE:  It is easy to see if the medications were taken, and if there were any missed doses.
• PROFESSIONAL MONITORING:  The pharmacy staff will fill your prescriptions for you and call you if you forget to pick up your medication, or deliver for you on your scheduled days.
• CONVENIENCE:  No more fussing or organizing your medications on your own. No more guessing when to take your medications.

Our blister packaging service is for anyone who wants to ensure that they are getting the most from their medications. We recommend blister packaging for anyone who wants to ensure they are taking their medications correctly, including:

• Patients taking 3+ medications multiple times per day
• Seniors on chronic medications
• Patients unable to administer medications to themselves and are being cared for by a family member or caregiver
• Patients with memory impairment

Blister packages save lives by ensuring medication adherence. If you would like to start using blister packs, speak with a member of our pharmacy team today today!

Drugs don’t work in patients who don’t take them. – C. Everett Koop, M.D

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Glutathione is the most abundant anti-oxidant found within the human body. It is a tripeptide composed of three amino acids.

What does glutathione do?

Glutathione has many important roles within our bodies. Some of which include DNA and protein synthesis, gene expression, immune response, and cell death. Deficiency of glutathione contributes to aging as well as many diseases such as Alzheimer’s, Parkinson’s, cardiovascular disease, AIDS, cancer, liver disease and epilepsy.

How do we get glutathione?

Glutathione is synthesized within the body from amino acids when they are consumed in the form of protein in the diet. Consuming protein is essential for the formation of glutathione.

Can glutathione be used as an ORAL supplement in patients to prevent or treat diseases associated with deficiency?

The use of glutathione in the form of a pill is widely debated. Many health food stores and websites claim that their oral supplements prevent aging and much more. These claims are not based on any scientific evidence, and use of these supplements should be cautioned. They are not going to cause you any harm, but they aren’t going to increase your glutathione levels either.

The reality is that glutathione is not absorbed very well when taken in the oral form. It is largely broken down by enzymes within the intestine. Studies have found that it is not possible to increase the amount of glutathione in your blood by taking it orally. Instead, glutathione must be administered intravenously.

With that being said, it is has been shown that consuming the precursors (amino acids) of glutathione orally will cause the body to increase its production of glutathione. That is, consuming whey protein is one way to increase the amount of glutathione within your body. More studies are needed to determine if consuming a whey protein will affect the course of diseases known to be associated with glutathione deficiency. In the meantime, if you want to increase your glutathione levels, drinking whey protein shakes at the recommended amounts is the best way to do so.

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Each episode presents information from how to lose weight to how to prevent the aging process. Sure Dr. Oz presents excellent information on general health, but with a new show every day the volume of information is likely overwhelming for most. Additionally, it seems to me that each day he is recommending a new supplement or three. Take this to prevent diabetes and that to lower cholesterol. Take this for fighting against aging and that to keep your skin looking great. With one show each week day, by the end of the week Dr. Oz has recommended his viewers be on 5+ supplements.

My point is, while Dr. Oz has good advice, no one should be following all of it, especially if you are taking prescription medications. If you think one of his recommendations may be beneficial to you, you should ask your pharmacist or health care provider before starting a new supplement. Many supplements can interact with medications and cause harm. Natural does not a mean safe or free from side effects. Whether you are currently taking prescription medications or not, starting a supplement should be discussed with a health care professional. Supplements are not without side effects, and it is important to know if the benefit of the formulation outweighs the risks for you individually. Pick and choose what advice you follow from television shows like Dr. Oz’s carefully and always speak with your pharmacist or another health care professional before beginning to take these Dr. Oz recommended supplements.

After all, if Simon jumped off a cliff, would you?

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Let’s take look at the common cold. Colds make us feel terrible, causing sore throat, sneezing, stuffy/runny nose and cough. Even worse, they can last for up to 2 weeks with a dry cough possibly lasting longer.   Adults get an average of 3 colds per year, while children have an average of 7.   No one likes to be sick or have a sick child and many people head to the doctor’s office looking to be cured with a prescription for an antibiotic. The problem is, antibiotics kill bacteria and the common cold is caused by viruses. Therefore, antibiotics will not cure the common cold. In fact, instead of making you feel better they can cause side effects like stomach upset and diarrhea and can make you feel worse.  Antibiotics can also cause serious side effects such as tendon rupture in extremely rare cases.   If you are thinking to yourself, that can’t be true because the last time I got a cold I took antibiotics and they made me feel better.   The truth is the antibiotics didn’t make you feel better, you would have felt better without them. By the time you went to the doctor, you had probably already had the cold for 3 days, and your pharmacist told you that the antibiotics wouldn’t start helping for 2-3 days.   That means, on day 6 you started to feel better while taking antibiotics. But, the common cold lasts an average of 7-10 days so you would have started to feel better even without the antibiotics.

You may be wondering why the doctor gave you a prescription for antibiotics if it wasn’t going to help you, and could in fact harm you. Studies have found the following explanations for why you may receive a prescription for an antibiotic, even if you don’t need one:

• The doctor believes the patient is expecting a prescription and they don’t want to jeopardize their relationships with the patient, therefore they write a prescription to make the patient happy
• They feel if they don’t write a prescription, you will see another doctor who will
• They are rushed and don’t have time to explain why an antibiotic won’t help

As a patient, when we go to see the doctor it is important not to have any expectation of receiving a prescription. When the doctor asks you what you are in for try to phrase your complaint so that the doctor isn’t lead to believe you are expecting a prescription. Here are some examples:

• “I am not feeling well and wanted to make sure these symptoms aren’t something serious”
• “I am hoping I just have a cold, but came to see you just to be on the safe side”
• “I don’t think I need a prescription, but I just wanted to make sure I don’t have a serious infection”

Antibiotics are over prescribed leading to unwanted side effects and resistance problems.  When you visit your physician if you don’t expect a prescription for an antibiotic, you are less likely to get one that you may not need.  Similarly the best way to avoid an unnecessary side-effect is to avoid an unnecessary medication.   These are relatively simple rules.

Hopefully you appreciate how important it is that every patient has some understanding of viral and bacterial infections as well as the valuable role that anti-infectives of any kind play in fighting disease and illness.  How you and your physician make that decision to use an antibiotic can have a huge role in the continued effectiveness of antibiotics within our community – local, regional, national and global.

Equally important are our expectations, our demands, when bringing a health complaint to a physician.   Lower your personal expectations but be informed about your health; put some trust in the skill and knowledge of the physician that tends to your complaint; be prepared to work with the health professionals who are working to improve your health.   Start being more effective simply by making extra effort in carefully describing those symptoms that brought you to the physician’s office, even if it means writing them down and taking those notes with you.   Inevitably this will improve the results you gain from your physician visit, will improve your physician’s effectiveness and will likely improve the results that your neighbour gains as well.  Why?  Because we don’t leave in isolation.  We live in a social community where we interact with the people of the community at various levels and therefore have an influence on that community just as it has an influence on us.   And who knows, maybe your expectations will rub off on someone too!

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Critics of these beverages aren’t so much concerned about occasional users of these drinks, however when used in the following manner these seemingly harmless beverages may cause significant harm.

The change in regulations also meant that following warning labels are now required on energy drinks:

• Not recommended for children and teens
  • Why not? The amount of caffeine in these drinks is much higher than the recommended maximum daily intake in children under the age of 12. For teens, no more than 2.5 mg/kg body weight should be consumed therefore the amount in these drinks may be too high for small teenagers as well. Excess caffeine has been shown to cause behavioural effects, irregular heartbeat and nervousness.
• Do not use with alcohol
  • Why not? Alcohol and energy drinks both cause dehydration. When energy drinks are combined with alcohol, the person drinking may not realize that they are becoming dehydrated. Additionally, it may prevent an individual from realizing how intoxicated they actually are.
• Contains high levels of caffeine
• Should not be used by pregnant women
  • Pregnant women should not consume more than 200 mg a day. Consuming more than this increases the risk of miscarriage or a low birth weight baby.

It has been suggested that these drinks be sold only in pharmacies due to their potential health effects. That may be taking things one step too far; after all we don’t have to go to a pharmacy to purchase coffee. While they can cause problems for certain individuals, we believe that consumers need to take responsibility and learn about what they are consuming. It is extremely important to know what you are putting in your body, especially if you have a medical condition.

With that being said, there are a few other warning labels that should be on energy drinks to warn potential consumers of these important hazards:

• Not to be used as a sports drink
  • Why not? These drinks cause dehydration.
• Contains herbal ingredients which may interact with certain medications such as warfarin. Ask your doctor or pharmacist if this is safe to use before consuming.
  • Some energy drinks contain ginseng or gingko
• If you have high blood pressure, a heart condition, or are diabetic consult with your doctor or pharmacist before consuming.

If you are concerned about the health effects of energy drinks and if they are safe for you or a family member ask your pharmacist!

For more information on energy drinks visit: http://www.hc-sc.gc.ca/index-eng.php

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The discovery of these early medicines and the rapid growth of the pharmaceutical industry in those early days is really very amazing, looking back at that time.  In very short order, the practise of homeopathy by physicians of that day quickly saw them adopt those early drugs such as the early antibiotics and drugs such as chlorpromazine which revolutionized the treatment of many seriously ill psychiatric patients.    The dramatic results of these early agents, no doubt took practitioner’s attentions away from those homeopathic remedies which brought their results over a period of time.   Even more time was necessary for the assessment of the patient and the selection of the most appropriate homeopathic remedy.   Sometimes, this was a somewhat lengthy process involving long patient interviews, and a certain amount of “trial and error” application of the homeopathic remedies.    If nothing else, the “new age of medicines” brought about a more rapid process of patient assessment, diagnosis, medicine selection (in this case, drug selection), treatment and follow up. 

Why today is there such a coordinated effort to discredit homeopathy as a treatment option?   A question that continues to puzzle me.   Is it because the idea that a treatment modality other than the traditional milligram or gram quantities of a synthesized molecule, that has NO side effects, NO drug interactions, NO contraindications; that has proven effectiveness in animals as well as humans – is just not acceptable within our current constructs of medical care?    I for one, was certain that we would have outgrown the narrow minded thinking that plagued early medical practitioners.    You know the thinking that said it was impossible that a disease and infections were caused by living organisms too small to be seen by the unaided human eye.    Or the acceptance of the medical practice of “blood letting” to treat everything from gout to schizophrenia.   I mean really!   Reputable medical practitioners actually did this and called it main stream medicine?

There is no doubt that we have yet to develop a complete understanding of the mechanism of action although we do know that traditional “drug-receptor” models that we use to understand drug action, just does not fit here.   In fact, the focus is not on the ingredient – the active principal – but instead on the solution system.    The liquid in which the supposed active principal is dissolved.   Usually a mixture of pure ethanol and a purified water solution to which the active principal transfers it’s energy – it’s essence – to this solution system.   Remember it is not the dilutions that are the real focus, but the many series of “succusions” which simply described is the vigorous, agitation of the active principle in the solvent system.   Each time the active is diluted, it is again succused.   This can occur five, ten, twenty, one-hundred times or more! 

What makes this step even more interesting and yes puzzling, is that if such a solvent system is examined using Nuclear Magnetic Resonance Spectroscopy (NMR), a unique (one of a kind) magnetic imprint is measured.   NMR is one of the tried and readily used analytic technologies that are commonly used by chemists to characterize or verify the identity of a molecule in a chemical sample as part of a quality control procedure to say, confirm the content of a sample or the purity of the chemical sample based on a variety of spectroscopic procedures which may include not only NMR but Infrared Spectroscopy(IR), Ultraviolet Light (UV) Spectroscopy, and High Pressure Liquid Chromatography(HPLC).   To avoid some complex physics and chemistry theory, it should be adequate to state that this procedure is relied on by chemists around the globe and effectively characterizes molecules in a very, very tiny sample representing only a few molecules.   You can see why a result with such a sophisticated analytical technology might be considered to be a significant confirmation that something measurable has been captured in this simple solvent system of ethanol, water and that something that is being measured.   This is science – giving a description that is very difficult to explain away. 

How is this done, this energy transfer?  Well, that’s where science seems to fail us with an adequate explanation, a theory, even a hypothesis.    Of course to start suggesting that there is a transfer of energy from the substance dissolved within this water/alcohol solution is like discussing something paranormal or even a concept akin to quantum physics.    That’s right, E=mc2!   Who knew that Einstein’s theories might best explain how a 200 year old remedy might produce a change in the fundamental energetics of human physiology?   That’s where we might be going with this once science catches up to “homeopathy”.   

In the meantime – it works!  It is safe! And it might just carry us through the 21st Century, even if we have to accept that it is a remedy system that continues to be mis-understood.

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What is insomnia?

Insomnia is defined as difficulty falling asleep, difficulty staying asleep or non-refreshing sleep in a person who has the opportunity to acquire a normal night’s sleep of 7-8 hours. However, the insomnia only requires therapy if it is in combination with daytime dysfunction or distress such as fatigue, poor concentration and irritability.

Insomnia is quickly becoming an epidemic across North America, and it is not being properly managed. Insomnia should be treated by changing behaviours and sleep patterns through non-drug measures. However, in most cases, sleeping pills are prescribed before non-drug measures are tried and this may be costing many their lives.

Do sleeping pills increase your risk of dying?

A study published in British Medical Journal on March 12, 2012 found that taking sleeping pills can increase your risk of death.    In fact, they found that taking 17 pills or less per year had a 3.5 times greater risk of death on a 2.5 year period compared to those who took none. Those who took 18-132 pills per year were 4 times more likely to die in a 2.5 year period, and those who took over 132 doses or more were more than 5 times more likely to die.   In addition to increasing the risk of death, those who took the most pills also had a significant increase in the incidence of cancer.  The study did not determine if this increased risk of death and cancer disappears after a certain period of time.   More studies on the negative effects of sleeping pills need to be completed for us to better understand the long term implications of using these medications.

What does this study tell doctors and pharmacists?

This study is telling us that currently, sleeping pills are being over prescribed and this is causing patients harm, in fact it may be killing them. Doctors need to look at their prescribing habits when it comes to these medications and think twice before they write prescriptions for them. Pharmacists need to be vigilant in educating patients about the risks associated with these medications and recommend smaller doses for shorter durations. Both doctors and pharmacists alike should be educating all patients on non-drug methods that can be used to improve sleep.

What does this study mean for those suffering from insomnia?

This study is telling us, that insomnia needs to be managed with non-drug measures, and that sleeping pills should only be used in some cases. It is also telling us that if someone requires a sleeping pill, they should only receive 7-14 tablets to be used on a short term basis until sleep can be restored using behavioral techniques.

How is insomnia managed without sleeping pills?

In most cases of insomnia, sleeping pills should not be necessary.   Sleeping pills are a band aid solution to an underlying problem.   It is important to try and find a cause for the insomnia.   Insomnia can be caused by depression, anxiety, hormone imbalances, restless leg syndrome, chronic pain, acid reflux, breathing disorders and medications.   In these cases insomnia can be resolved by treating the underlying condition.   When there is no known cause of the insomnia, there are many non-drug measures which should be tried before sleeping pills are prescribed or in combination with sleeping pills.

Non-drug measures include:

• Ensuring good sleep hygiene
• Sleep consolidation techniques
• Stimulus Control
• Relaxation Techniques

The goal with each of the above behavioural techniques is to work towards getting 8 hours of sleep each night.   Speak with your pharmacist to learn how to use each of these techniques to improve your sleep today.

What you should do if you have been taking sleeping pills for a long time?

If you have been taking sleeping pills for a long period of time you will need to slowly decrease the dose until you are no longer using the medication. Additionally, you will need to learn techniques that will help you sleep properly once the sleeping pill is discontinued.   Stopping “cold turkey” will result in withdrawal and rebound insomnia.   If you have been taking sleeping pills and would like to stop, speak to your doctor or pharmacist today.

What should you do if you think you are suffering from insomnia?

If you think suffering from insomnia, you should speak with your pharmacist or physician to be assessed.   Insomnia is a medical disorder that requires therapy. Underlying causes of insomnia need to be considered and ruled out before therapy begins.   Most importantly, treatment of insomnia should always begin with behavioural modifications and non-drug strategies to improve sleep.   If drug therapy is required, it should be prescribed at the lowest effective dose for the shortest duration possible.   Sleeping pills should never be used without education on proper sleep hygiene.

Speak with your pharmacist today to learn more.

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(To view a copy of one of these letters visit:  http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm281843.htm ).

 The plant was responsible for producing 90% of Canada’s injectable drugs.  Without the production from this plant, other companies are trying to increase their production to ward of supply issues.   However, they are fighting from behind as no one expected this major injectables producer to shut down.   This brings about the question, if there was any threat that this plant may be shut down why were other companies that could solve distribution shortages not notified before it was too late?   The government is taking heat over this issue and is trying to find a solution to prevent this problem in the future, for now it is too late.

The Sandoz plant is stated to be up and running in the near future, what this means no one knows, but in the meantime obtaining required injectable medications maybe difficult if not impossible.   These medications are a necessity for treating serious infections, pain, cancer treatment and drugs used during surgeries or as post-surgical care.  In an effort to conserve these medications, some hospitals are choosing to postpone elective surgeries, saving these drugs for emergencies and serious cases.    Until now the shortage has been every dosage form except those drugs intended for intravenous use.   That has meant everything from antibiotics, pain medications, drugs for diabetes,  for the control of high blood pressure, asthma, hypothyroidism and more.   It doesn’t seem to have any rhyme or reason as it includes all dosage forms including tablets, capsules, liquids, suppositories, topical creams and ointments – the list is long an varied. 

At Stafford Pharmacy, we have managed to stay just slightly ahead of these growing shortages as we source the necessary antibiotic medications required for our patients, in particular those on home parenteral therapy.   The Sandoz plant shutdown has added some additional challenges, necessitating that our technicians spend a growing amount  every day securing adequate quantities of antibiotics for intravenous use.  We currently focus on the needs of one patient at a time as each day becomes a new adventure in drug procurement.    Although we are staying just ahead of the demand this may very well change if these shortages continue to grow.   For now all we can do is hope that the situation does not get any worse and that companies like Sandoz correct whatever problems they have been experiencing at that manufacturing level. 

We’ll keep you posted in the coming weeks and months of any developments or changes.   Better or worse, we will be certain to share with you the industry updates as all of us here agree that a permanent solution to the industry troubles will be found, but it appears that it may yet get worse before it gets better.

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