Preventative measures 8 - Immunization can help keep you healthy - The Healthy Living Magazine for Costco Members - Costco Pharmacy
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The Healthy Living Magazine for Costco Members
Preventative
measures 8
Immunization can help
keep you healthy
FALL//WINTER 2017
FALL //WINTER 2017
Distribution of this magazine has been funded in part by the following sponsors. This funding is independent
of the care you receive as a patient of Costco Pharmacy.
The Healthy Living Magazine for Costco Members
The Healthy Living Magazine for Costco Members
Preventative
measures 8
Immunization can help
keep you healthy
2 Milk alternatives
Examining the trending alternatives to dairy milk
4 Discover Costco Pharmacy
Quality services you can trust FALL//WINTER 2017
6 Understanding ADHD 150796-17_Wellness-Fall-Winter.indd 1 2017-07-14 1:39 PM
Paying attention to the signs and management of ADHD WELCOME to the Fall/Winter
edition of The Wellness Connection.
8 Adult immunization Healthy eating aids in your
Keeping you healthy overall wellbeing and milk
alternatives are one of the latest
10 Dementia versus aging popular health trends. Check out
What caregivers should know page 2 to learn about the best
milk-alternative products.
12 Treating an uncomfortable condition
Learn more about benign prostatic hyperplasia Staying healthy during the
winter months can be difficult,
14 A new breed of diabetes drugs which is why getting vaccinated
Managing your blood sugars is as important for adults as
it is for children. Our cover
16 Sleep condition: sleep apnea story on page 8 explains how
Familiarize yourself with a condition that affects
immunization can help prevent
MAXIMUM STRENGTH ACID REDUCER a good night’s sleep
disease and illness and which
WITHOUT PRESCRIPTION vaccines you might need, based
on age and medical conditions.
THE WELLNESS CONNECTION We welcome your feedback on this magazine. Send an email
• REDUCES STOMACH ACID Editor and Director of Professional Services,
to magazine@costco.com.
Published semi-annually by Costco Wholesale Canada Ltd.
Caring for a loved one with
FOR UP TO 12 HOURS Costco Pharmacy (“Costco”) Copyright © 2017. dementia? Find out about this
• PREVENTS HEARTBURN Joseph Hanna, B.Sc. Phm., CDE, CGP, RPh. All editorial rights reserved. All articles are medically reviewed and condition and how it differs
approved by McCann Pharmacy Initiative prior to publication.
McCann Pharmacy Initiative from normal aging on page 10.
BEFORE IT STARTS Writer - Vijay Sharma, Hons. B.Sc., B.Sc. Phm., RPh.
McCann Pharmacy Initiative is solely responsible for
the content of all articles and educational material unless
• SMALL, EASY-TO- Reviewer – Sandra Carey, B.Sc. Phm., RPh. otherwise indicated. It’s normal to slow down a little
SWALLOW TABLET
Reviewer and Costco Professional The information in this magazine is intended as an educational
aid only, not as medical advice for individual conditions or
during winter. A good night’s
Services Pharmacist
Nancy Bazzi, Pharm. D., RPh. , CDE
treatment. This information is not a substitute for a medical sleep can reenergize you, but if
exam, nor does it replace the need for services provided by
Copy Editor medical professionals. Talk to your doctor or pharmacist before
you’re feeling unusually tired
Caroline Szpak taking any prescription or over-the-counter drugs (including despite several hours of sleep, you
any herbal medicines or supplements), or following any
RELIEVES AND PREVENTS: Art Direction and Production Design treatment or regimen. Only your doctor or pharmacist can may be suffering from a common
Lee-Ann Hall and Allison Prindiville provide you with advice on what is safe and effective for you. disorder called sleep apnea,
HEARTBURN Publishing Project Manager
You should consult your health care professional if you are
making significant health-related changes. described on page 16.
Julie Kinnear
ACID INDIGESTION Neither Costco nor McCann Pharmacy Initiative is liable for
any claims or actions or damages that the reader may have We strive to provide you and
Publishing Coordinator
through reliance on the magazine’s content respecting the
UPSET STOMACH Heather Downs-MacIntosh reader’s health. your family with useful health
Production Specialist ®*Registered trademark of Price Costco International, Inc. content and hope that this
Élaine Émond used under license.
TM
Kirkland Signature is a trademark owned by Costco
issue helps you achieve your
Pharmacies in Costco’s Quebec locations are independently owned and operated by pharmacists. This ad does not apply to the province of Quebec. Ask your Costco pharmacist about all your pharmacy needs. Product selection may vary by location. Wholesale Corporation and is used under licence in Canada. health goals.
150796-18
Cover/Contents photography: © GagliardiImages
Costco_FallWinter 2017_Acid Reducer_Half Page Ad EN.indd 1 2017-07-19 2:25 PM
www.costcopharmacy.ca 1
Healt h Fad?
Health Fad? However, many flavoured soy
milk options (such as chocolate
Milk alternatives
in your child’s diet
Milk allergy is one of the most
nutrients such as protein,
B vitamins, potassium, and
.
and vanilla) have a very high phosphorus, which occur naturally
sugar content. Also, soy common allergies in children, in cow’s milk. It is important to
contains oligosaccharides—a triggered by casein – a milk check the nutritional label before
type of sugar that some people protein.4 Thus, avoiding dairy and buying a product to see if it has
AAcloser
closerlook
lookatatmilk
milkalternatives
alternatives
may have problems digesting. choosing milk substitutes is a been fortified with calcium and
Soy is also considered to be a other vitamins.1,3 The table below
“phytoestrogen,” which behaves
common practice. However, it is
shows the nutrients typically
like the natural hormone estrogen important to consider that 30% found in cow’s milk and common
in the body. This may be a concern of children with food allergies
WITH HEALTH TRENDS What is a milk alternative? Lactose-free milk
Lactose is a naturally occurring for some women at risk of certain have other allergies, which may
milk alternatives.
Cow’s milk is a great source Whatever your reason may be for
CONSTANTLY CHANGING of the important nutrients sugar in milk that causes medical conditions, so it’s best to
first consult your doctor if you
also include allergies to soy and
choosing milk alternatives, stay
that we require on a daily uncomfortable digestive symptoms nuts.4 Since many milk alternatives
and new products basis, such as protein, calcium, in people with lactose-intolerance have any health issues.1
are made from these common
informed and know what to expect
from the beverage you consume.
or lactose-sensitivity. Lactose-free
appearing in stores, and other vitamins and minerals.1
However, some people prefer to milk is regular cow’s milk that has Nut milk
allergens, it’s recommended to seek As you can see, there are a variety
an enzyme called lactase added advice from a pediatrician before of milk alternatives available with
you may have noticed avoid cow’s milk altogether due
to lifestyle, taste, or allergies. to it to make the lactose easier to
Nut milk is made from a mixture
of water and ground nuts (e.g. selecting a milk alternative different nutritional values. Hence,
it is advised to read nutrition labels
a variety of milk These people may opt for dairy- digest. However, if you have an
allergy to cow’s milk, or are trying
almonds, walnuts). It is free from for your child.
and to consider consulting with a
free alternatives, which are lactose, soy and gluten, and is
alternatives that have usually made from nuts, grains or to avoid dairy entirely, there are
other options.1
low in calories and fat, but also
dietitian before “moo-ving” to a
milk alternative.
legumes.1 While there are plenty lacking important nutrients such as
quickly become new of milk alternatives, not all are calcium and protein.1 In the case References
© Africa Studio
created equal. Soy milk
“health foods.” This Soy milk is made from ground
of coconut milk, the fat content is
much higher than that of low-fat
look for fortified versions. Grain 1. Harvard Health Publication. In search of a milk
alternative. Available from: www.health.harvard.
and seed milks are also about
short guide will help
edu/staying-healthy/in-search-of-a-milk-
soybeans and water. It is similar to milk, and protein is close to zero.2 alternative. Accessed April 3, 2017.
1% milk, with its low fat and high twice as high in carbohydrates and
Therefore, if you want to try this sugar than other milk alternatives.1
you stay informed and protein content. milk alternative, make sure to If you have a medical condition
2. Consumer Reports. Choosing the right milk for
you. Available from: www.consumerreports.org/
cro/2014/08/milk-substitutes-should-you-sip-or-
select a fortified version to get the
select the best milk nutrients you may need.
such as diabetes or heart disease, skip/index.htm. Accessed March 31, 2017.
or are overweight, speak to your 3. National Dairy Council. What’s in your glass?
alternative for you dietitian before switching to grain Available from: www.nationaldairycouncil.org/
content/2015/whats-in-your-glass-infographic.
Grain and seed milk and seed milk alternatives.
and your family.
Accessed March 31, 2017.
Grain and seed milk is made
from water and ground rice, oats, So what’s in your glass? 4. Nelson JK for Mayo Clinic. What you need to know
about milk substitutes. Available from: www.
mayoclinic.org/healthy-lifestyle/nutrition-and-
quinoa or hemp. Like nut milk, it Milk alternatives may not have healthy-eating/expert-blog/milk-substitutes/bgp-
is low in protein and calcium, so adequate amounts of essential 20147532. Accessed April 3, 2017.
Milk type
Nutrient per 250 mL (1 cup)3 Low-fat cow’s milk Plain soy milk Almond milk Coconut milk Rice milk
Calories 110 110 60 80 120
Protein 8g 8g 1g
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HEALTH AND WELLNESS CLINICS
We offer pharmacist-led clinics on a variety of topics that may interest you, such as diabetes, heart health, osteoporosis and more.
MEDICATION MEDICATION MEDICATION
We use the latest devices to get real-time information about your health and how well your medicines are working for you. For REVIEWS MANAGEMENT ORGANIZER
example, with our diabetes clinic, we can determine within a few minutes how well your diabetes is managed by using a device As the medication experts, pharmacists Our pharmacists can authorize prescription Our pharmacies also offer blister
that measures your A1C. This is a percentage that tells us how well controlled your blood sugars were in the past three months. can help you get the most out of refills for your chronic use medications so packaging, which organizes all of
The pharmacist’s knowledge and expertise can help you make sense of the test results and develop well-tailored action plans your medicines. Our friendly and that you don’t miss a single dose. They can your medications for you. To get your
to become healthier. knowledgeable dedicated pharmacists even adapt your doctor’s prescription so supplements and vitamins in the blister
offer comprehensive medication reviews that it better suits your needs. This could packs, you need to have them on a
IMMUNIZATION SERVICES to help you better understand your mean changing the dosage form from, prescription. All of your prescriptions can
Costco pharmacy makes fighting the flu easier than ever. Every fall, we host several flu shot clinics in each of our locations to medicines, so that you can get the best for example, a tablet to a liquid, so that be inserted into easy-to-use packages
fit your busy schedule, and if you don’t have time to make an appointment, just come in. Our pharmacists can also conveniently results with the least side effects. By it’s easier for you to take your medicine. that clearly show when each dose needs
administer other vaccines, such as the shingles vaccine or vaccines needed for travel. Come in today and ask about how our looking through all of your prescription In some provinces, we can also substitute to be taken, whether it’s in the morning,
pharmacists can help keep you and your family up to date on immunization. medicines, as well as over-the-counter your prescription for another drug within at noon, in the evening or at bedtime.
supplements you are taking, they can the same class to help make it more This helps give you the peace of mind
PRESCRIPTIONS BY MAIL identify drug-related concerns and work affordable. The pharmacist will then notify and confidence that your medications
with you and your doctor to offer solutions. your doctor about the change. are being taken as intended.
We are also committed to providing the most convenient and cost-effective ways for you to receive your prescription medications.
This is why we have implemented our prescription home delivery by mail service. You can now order your prescriptions online and
have them delivered straight to your doorstep in just three to five business days. This service is accessible 24 hours a day, from the At Costco Pharmacy, we put patient care at the forefront When you choose Costco Pharmacy, you are choosing more
comfort of your home or even through your mobile device. With free expedited shipping, this cost-effective program even provides a of our values, which means we are committed to ensuring than just quality products and low prices—we provide value
tracking number so you can follow your prescription from the pharmacy straight to your home. that our pharmacists are supported with the most up-to- through good service and convenience. Take charge of your
date knowledge and tools to provide you with the care you health and come see for yourself what we have to offer. You
INTERACTIVE VOICE RESPONSE SYSTEM (IVR) deserve. Our pharmacists and their teams provide motivated, can depend on our pharmacy teams to support your best,
With our interactive voice response system (IVR), you can also order your prescriptions over the phone for pick-up at the pharmacy passionate care, and are there for you when you need them, healthy self!
at the time that is most convenient for you. with no appointment needed.
4 The Wellness Connection Fall // Winter 2017 www.costcopharmacy.ca 5
© Suzanne Tucker
Unde
Since there is no single test to • Manage distractions. Turn When chosen with your child’s
diagnose ADHD, the doctor may off devices and the television individual needs in mind, ADHD
need to perform a complete health when a child is focusing on a medication can become a real key
rstan evaluation, and interview you and task. Reduce screen time. The component in the success of your
ADHD
even school staff to learn more about Canadian Paediatric Society child’s therapy. Some noticeable
ding your child’s health and behaviour.1,2
Behavioural and
lifestyle changes
recommends no television
watching time to children under
the age of 2 and suggests that
children 2 years of age and older
changes after a period of taking
appropriate ADHD drugs are
improvements in the child’s ability
to focus and reduced behavioural
Raising children with ADHD can be limited to less than one to issues.4
be challenging, but it is important two hours per day.5
to remember that day-to-day life • Simplify. Break down
can be just as hard for them as they complicated tasks into smaller, As with any drug, there are
struggle with their own behaviour. simpler steps. benefits as well as serious risks
On a positive note, effective • Healthy lifestyle. A balanced that need to be discussed with
techniques exist that can help you diet and spending more time your child’s doctor or pharmacist.
Paying attention to the signs and management of ADHD and your child learn how to better
manage this condition, such as
outside exercising can help If your child is currently taking
your child manage his or her any ADHD medication or has been
embracing certain lifestyle changes symptoms by burning off prescribed one, speak to your Costco
and learning new coping skills.4 excess energy. pharmacist today to learn more
One effective treatment is Drug treatment about the medication, its effects,
FOR CHILDREN WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD), behavioural therapy. It is risks, and any
While behavioural therapy can
it may feel like their brains are on fast-forward, and that they are unable to facilitated by a licensed therapist
be very helpful, sometimes it’s other special
who aims to provide a child with instructions you
remember where the remote is to press “pause.” This behavioural disorder affects practical skills to help with tasks not enough, and your child may
need some extra help to cope. should know.2
that he or she may struggle with,
children’s day-to-day functioning and development. Worldwide, 5% to 12% such as being more organized and Your child’s doctor may prescribe
completing detailed work. The ADHD medication, which
of school-age children have ADHD, and boys are about three times more likely therapist also educates parents and generally comes in two types:
© jiris
stimulants and non-stimulants.
to be affected than girls.1 caregivers about the condition
and helps them learn ways to Stimulants are the most commonly
assist their child and manage the Dealing with ADHD behaviour
Children with ADHD may appear overly excited, Symptoms and diagnosis used medications. They get to work
can be challenging for both
impulsive, unfocused and disorganized. While it is behaviour effectively.4 fast and help your child by balancing
ADHD can be broken down into three subtypes children and caregivers. Although
normal for a child to be restless sometimes, when based on a distinct pattern of behaviours.1,2 Here are some lifestyle changes out dopamine and norepinephrine
ADHD can’t be cured, it can be
such behaviour becomes an ongoing pattern that can that may be suggested during (chemicals in the brain responsible
successfully managed through
have ill effects on a child’s life, it should be assessed for thinking and attention).
by a medical professional.2 What’s more, 60% of Inattention • Difficulty paying attention to details
behavioural therapy sessions: lifestyle strategies, behavioural
Non-stimulants take a bit longer therapy, and/or medication,
diagnosed children are still affected by symptoms in • Making careless mistakes • Create a routine. Together
to start working, but may help so that your child can lead a
adulthood.3 However, when recognized and treated • Trouble staying focused and organized with your child, create a daily
to manage ADHD symptoms by productive, happy and successful
effectively in childhood, it can be more successfully schedule that includes time for
• Forgetting and losing things improving focus, attention, and life as an adult.
managed in adulthood. Here is a short summary on play, homework and chores, and
understanding the disorder and helping your child • Getting easily distracted try to follow it every day. This decreasing impulsive behaviour.4
cope with his or her ADHD symptoms. can help add some structure to
Hyperactivity- • Fidgeting and extreme restlessness your child’s day. References
Causes impulsivity (i.e., seeming to be always on the go) • Be more organized. Put
1. Centre for ADHD Awareness Canada. What is Attention Deficit Hyperactivity Disorder? Available from:
www.caddac.ca/cms/page.php?67. Accessed March 3, 2017.
Unfortunately, the precise causes have not been • Difficulty waiting or being patient everyday items in the same place 2. National Institute of Mental Health. Attention Deficit Hyperactivity Disorder. Available from: www.nimh.nih.gov/
found yet, but the following factors may be linked so that it’s easy for your child health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml. Accessed February 23, 2017.
to the development of ADHD:2 • Excessive talking, interrupting,
blurting out answers to find them and to prevent 3. Centre for ADHD awareness, Canada. ADHD Facts—Dispelling the Myths. Available from: www.caddac.ca/cms/
• Genetics misplacing or losing them. page.php?138. Accessed March 3, 2017.
• Making rash decisions without considering
4. Centers for Disease Control and Prevention. Attention-Deficit / Hyperactivity Disorder (ADHD). Available from:
• Cigarette smoking, alcohol or drug use the consequences www.cdc.gov/ncbddd/adhd/treatment.html. Accessed February 24, 2017.
during pregnancy 5. Canadian Paediatric Society: Caring for Kids. Tips for limiting screen time at home. Available from:
• Low birth weight Combined • The most commonly diagnosed type of ADHD www.caringforkids.cps.ca/handouts/limiting_screen_time_at_home. Accessed March 3, 2017.
• Brain injuries is a combination of the two subtypes
6 The Wellness Connection Fall // Winter 2017 www.costcopharmacy.ca 7
COVER STORY
Available vaccines Diseases common in other parts of public health unit to acquire
the world that may be prevented a summary of your current
Different vaccines are recommended
by vaccination are: vaccination status.
for different ages and medical
conditions, and children and adults • Cholera Your pharmacist’s role
ARM YOURSELF
should get vaccinated for common • Hepatitis A and B in immunization
diseases at certain stages of their • Encephalitis Pharmacists are accessible health
life. For more information on your
• Meningitis care professionals who can provide
immunization schedule, contact
• Rabies you with valuable information on
your doctor or local pharmacist.
getting vaccinated. Your Costco
Vaccines can help shield you Vaccine-preventable diseases for
which an adult (18+ years) may
•
•
Typhoid fever
Yellow fever
pharmacist can provide education,
counselling, monitoring and
from disease and illness need a vaccine include:5
• Diphtheria and tetanus
Getting vaccinated is easy
Getting vaccinated is an easy and
administration of certain vaccines
such as flu or travel vaccines.
simple process. To get started:4 Immunization is one of the best
© Horoscope (booster every 10 years)
• Hepatitis A and B 1. Talk to your doctor, pharmacist or ways to prevent serious illness
How the immune of memory T-lymphocytes, this
local public health unit about the and death. Speak to your local
process can be reduced to a matter • Herpes zoster (shingles)
system works
© DRogatnev
especially for adults ≥ 50 vaccines you need. To determine pharmacist or doctor today to
of hours or days—so fast that if a vaccine is needed, a health
The immune system is the body’s make sure you are up to date
illness doesn’t even occur.2 • Human papillomavirus (HPV) care provider may ask you:
natural defense against illness on your vaccines.
IMMUNIZATION is from bacteria and viruses (germs).2 Vaccines are made from the same • Measles, mumps and rubella • what vaccines and diseases
When germs invade, they cause (German measles) References
recognized as one of the germs that cause the disease. you had as a child or adult
1. Immunize Canada – Immunization Success.
an infection. The immune However, they are either killed or • Meningitis • your current age and if Retrieved March 13, 2017, from www.immunize.ca.
world’s most successful system, which is designed to fight weakened so that they won’t cause • Pertussis (whooping cough) you have certain medical 2. CDC. (2013, February). Understanding How Vaccines
infection, is made up of many any illness.3 The vaccine can come conditions
and cost-effective health types of white blood cells. They in different forms: it can contain
• Pneumonia Work. Retrieved March 1, 2017, from https://www.
cdc.gov/vaccines/hcp/conversations/downloads/
are primarily composed of the especially for adults ≥ 65 • if you are pregnant, planning vacsafe-understand-color-office.pdf.
discoveries. In fact, vaccines following: 2
a dead germ, a piece of the germ,
• Poliomyelitis (polio) to become pregnant or
an inactivated toxin made by the breastfeeding
3. Healthy Children. (2015, November 21). How
have saved more lives in • T-lymphocytes attack cells in the germ, or a live, weakened form of • Varicella (chickenpox)
• if you have certain risks
do Vaccines Work? Retrieved March 1, 2017,
from https://www.healthychildren.org/English/
body that have been infected the germ.3 safety-prevention/immunizations/Pages/How-do-
Canada in the past 50 years Unlike those listed above, an resulting from your lifestyle, Vaccines-Work.aspx.
by a germ.3 Sometimes it’s enough to get one type of work or if you are
important vaccine recommended 4. Government of Ontario (2015, August 18). Vaccines
than any other medical • B-lymphocytes produce dose of a vaccine to protect a once a year seasonally for anyone travelling and Immunization. Retrieved March 1, 2017, from
https://www.ontario.ca/page/vaccines.
antibodies that protect you from person for life, but many vaccines
intervention.1 Even though getting the disease a second time. require a booster shot. For
6 months and older is the influenza 2. Obtain and safely store your
5. Government of Canada. (2015, October 15).
vaccine (flu shot). personal immunization record Vaccination for adults. Retrieved March 1, 2017, from
vaccines have nearly • Macrophages eat and digest instance, the antibodies produced used to keep track of all the https://www.canada.ca/en/public-health/services/
germs, then leave parts of the by the measles vaccine can last a Your risk of disease can increase immunizations you have received. vaccination-adults.html.
eliminated diseases that germ on its surface. This allows lifetime; however, antibodies for when you travel to another This can either be your yellow
the immune system to recognize tetanus can fall below protective country. To prevent infections, immunization card or an app
were once common, there it as a germ and create antibodies levels and require another injection discuss your travel plans with your called CANImmunize, which
are still instances of vaccine- against it. to remind your body to keep itself pharmacist or health care provider can be downloaded to your smart
protected.3 Some viruses, like at least four weeks prior to your phone or other mobile device.
preventable conditions Vaccines explained the flu virus, change enough that departure. You can also visit your local
? Did you know
Vaccines take advantage of the the existing antibodies will not
occurring. Getting vaccinated body’s ability to produce memory recognize the virus and respond,
T-lymphocytes, and help the body which is why a new flu vaccine is
and keeping up to date on develop immunity by imitating a needed every year.3
your vaccinations is the best specific infection without causing
an illness. This way, the body can Vaccines are generally safe and
way to prevent diseases that remember how to fight the disease effective, and provide protection As the body builds immunity, it’s possible to experience
again. Normally, the process for everyone. Side effects from some minor symptoms of illness. These minor symptoms
could be life-threatening. of producing a targeted attack vaccines are rare, and may include are normal after taking a vaccine, and often resolve within
can take several days or weeks pain, redness, swelling at the 24 hours of getting the shot. © Horoscope
to happen.2 With the presence injection site and rash.4
8 The Wellness Connection Fall // Winter 2017 www.costcopharmacy.ca 9
Coping with Dementia
What tools can be used by Your pharmacy may be able to
people with dementia to help by preparing blister packs.
help them remember to These packages organize each
dose of medication by time of day
take their medication? and day of the week. Speak with
People with dementia may need
© Syda Productions
A simple guide for caregivers to take a number of medications
your Costco pharmacist to learn
more about this packaging system
and families for various medical conditions.
Dementia can make it difficult
that can help patients take their
medication regularly and
IT IS ESTIMATED that up to half a million for them to remember to take as prescribed.
Canadians are currently living with dementia.1 their medications every day. References
Certain habits may help a person Dementia is a progressive 1. Alzheimer Society of Canada. Dementia numbers in
Even though dementia mostly affects older cope with memory problems so condition that gets worse with Canada. 2017 January 18, 2017 [cited 2017 March 22].
people, it is not a normal part of healthy that they remember to take their time. While it may progress faster 2. Suzy L. Wong, Heather Gilmour, and P.L.
RamageMorin. Alzheimer’s disease and other
aging.2 Here is a quick guide to understanding medication regularly:3 for some people, it usually takes dementias in Canada. 2016 [cited 2017 March 22].
years to reach the advanced stages.
this condition and to providing caregivers with • Keeping a routine (taking the If you or someone you love has
3. Alzheimer Society of Canada. Normal aging vs
dementia. 2017; Available from: www.alzheimer.ca/
tips that may help them cope when caring for medication at the same time symptoms that cause you concern, en/Aboutdementia/Whatisdementia/
Normalagingvsdementia.
each day) discuss them with your doctor or
a loved one with dementia. 4. Alzheimer Society of Canada. Early stage.
• Setting an alarm as a reminder pharmacist. For more information 2017; Available from: www.alzheimer.ca/en/
to take the medication and advice on how to recognize Livingwithdementia/Caringforsomeone/Earlystage.
• Organizing the medication and manage dementia, visit the 5. Alzheimer Society of Canada. Understanding
Alzheimer Society of Canada at behaviour. 2017 [cited 2017 March 22]; Available
© Photographee.eu
(e.g., with a dosette or from: www.alzheimer.ca/en/Livingwithdementia/
blister pack) www.alzheimer.ca. Understandingbehaviour.
BEHAVIOUR STRATEGIES FOR THE CAREGIVER
What is dementia? Age-associated memory loss and dementia can be told apart Wandering: walks away from • Keep a diary of when and where the person wanders to identify
Dementia is a term used to in a number of ways:3 home unattended with the a pattern and possible triggers
describe a set of symptoms
related to brain function such Normal aging Dementia risk of becoming lost (even • Consider camouflaging doors with posters or wallpaper
as a decrease in memory or a in familiar places) • Consider purchasing an alarm that alerts you when the person
Not being able to remember details of a Not being able to recall details of recent events
decline in thinking skills.2 These conversation or event that took place a year ago or conversations has opened a door or window
symptoms lower a person’s ability • Notify neighbours about the situation
to perform everyday tasks.2 One Not being able to remember the name of Not recognizing or knowing the names of
an acquaintance family members • Have your loved one wear an ID bracelet (e.g., MedicAlert)
of the most common examples is
Alzheimer’s disease, although less Forgetting things and events occasionally Forgetting things or events more frequently • Ensure regular walks and exercise
common types of dementia are
Person may be worried about their memory Relatives are worried about the person’s memory, Restlessness: paces nervously, • Distract the person with a meaningful activity
vascular dementia and dementia
with Lewy bodies.2 Many diseases but relatives are not but the person is not aware of any problems drums fingers, etc., for long • Provide a healthy balanced diet with limited intake of caffeine
and injuries that affect the brain periods of time and sugar
can also lead to dementia.2
• Calm the person with music or touch
What is the difference Sometimes, people in the early How can caregivers manage
stage may not need much help,⁴ the behaviour changes that
between dementia and and they may understand how Repeated actions: repeats • If the behaviour does not bother you, do nothing
normal aging? happen in a person with words and actions over and over
they are changing and wish • Change the subject and stay calm
Almost 40% of people over the to help plan and direct their
dementia? again (e.g., repeating questions)
age of 65 experience some form of future care.⁴ As the disease gets Behaviour and personality changes
memory loss.3 When this memory worse, the person may have less from dementia are a major source
loss is not caused by a medical control over their emotions and of distress to people with the
Suspicion: thinks others are • Provide comfort
condition, it is known as “age- behaviour.⁴ Their behaviour and disease and their caregivers.
The chart (opposite page) shows trying to hurt him/her, accuses • Don’t argue or try to reason with him/her
associated memory impairment,” personality may change, and they
strategies to help caregivers manage others of stealing possessions • Don’t take accusations personally
which is considered a part of may need more help taking care
normal aging.3 of themselves. these common behaviours.⁵
10 The Wellness Connection Fall // Winter 2017 www.costcopharmacy.ca 11
Management Solutions
important to note that PSA tests aren’t foolproof, and it’s possible to have
a high PSA level when cancer isn’t present. Talk to your doctor about
Having blood in your urine whether a PSA test is right for you.⁴
may be a red flag for a
What options do I have to treat BPH?
for an Uncomfortable Problem more serious condition.
You should see your
doctor immediately in
You don’t have to suffer through unpleasant and uncomfortable BPH
symptoms. Fortunately, there are several options available to you. Your
doctor will suggest the best treatment for you based on the size of the
this situation.3 prostate, age, overall health, and the level of discomfort caused by your
Understanding benign prostatic hyperplasia symptoms.⁵
IT IS NORMAL to notice some health changes as and the bladder, resulting in some uncomfortable There are two general approaches to BPH management:1,3
we get older. One such age-related health concern, urinary symptoms. Approximately 50% of men with Are herbal
common among men, is called benign prostatic
hyperplasia (BPH), also known as an enlarged
BPH experience some or all of these unpleasant
symptoms:2,3
remedies a 1 Watchful waiting and lifestyle adjustments. See your doctor for regular
follow-ups and update him or her about your symptoms. Although
BPH may get worse with time, many men will never require treatment
prostate. In fact, it is so common that approximately
• Difficulty passing urine/trouble starting to urinate
40% of men in their 50s will have it.1 Here is more
information on how to recognize BPH and help treat • Frequent and/or uncontrollable need to urinate good option? and can manage mild symptoms through lifestyle adjustments such as:
• Restricting fluid intake several hours before going to bed
its uncomfortable symptoms. (especially at night)
• Weak, slow or interrupted urinary stream or One herbal option often marketed • Avoiding caffeinated drinks, smoking and spicy foods
Understanding the prostate gland and BPH straining to urinate
The prostate gland is a part of the male reproductive
to manage BPH is a supplement • Urinating on a schedule, even without the urge
• Inability to empty bladder completely
system. This walnut-sized organ sits around the called saw palmetto. Saw
2
urethra, the tube that carries urine and semen • Dribbling of urine In addition to lifestyle adjustments, medication options are available
through the penis.1 The main function of the prostate
palmetto is made from the and can be very effective in managing symptoms. The two most
is to add nutrients and fluid to sperm to create semen ripe berries of a native plant in common classes of drugs used to treat BPH are:1
as it flows through the tube. America. However, most studies • 5-alpha-reductase inhibitors: Work by shrinking the prostate. They
are most effective in men with large prostates.
It is common for the prostate to grow as men age, have shown that taking saw
particularly for men over the age of 40.1,2,3 • Alpha-adrenergic blockers: Work by relaxing the muscle fibres in
palmetto doesn’t help with BPH the prostate so that urine can flow more smoothly. The effectiveness
In some instances, this growth may not lead to
any symptoms. However, in some men, this may
symptoms.5 Stay safe and talk of this class is not influenced by the size of the prostate. The most
common side effect may include lightheadedness and dizziness.
cause the prostate to press on the urinary tract with your doctor or pharmacist
before starting any herbal therapy,
In some cases, your doctor may recommend a combination of these
as some of your current medical medication classes to better manage your symptoms.
© joshya
conditions or the medications
Watching your health more closely as you get older is an important
you take can be affected by habit. Although you may find it awkward to speak about this topic,
While the exact cause of BPH is not completely herbal remedies. paying attention to any new symptoms and speaking about them with
understood, it appears to be related to changes your doctor or pharmacist can help you lead a happy and healthy life.
in testosterone hormone production that come
with aging.3
References
What to expect at a doctor’s appointment 1. Canadian Urological Association. Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms
(LUTS) in Men. Available from: www.cua.org/themes/web/assets/files/pdf/consumers_handbook/21-benign_
To check if you have BPH, your doctor will likely prostatic_hyperplasia_bph_and_lower_urinary_tract_symptoms_luts_in_men.pdf. Accessed March 21, 2017.
start by asking detailed questions about your 2. Canadian Urological Association. Benign prostatic hyperplasia. Available from: www.cua.org/themes/web/
symptoms and request some tests and physical exams, assets/files/patient_info/secured/en/54e-bph_s.pdf. Accessed March 22, 2017.
which can include a digital rectal exam, urine and 3. Canadian Cancer Society. Benign prostatic hyperplasia. Available from: www.cancer.ca/en/cancer-information/
cancer-type/prostate/prostate-cancer/benign-prostatic-hyperplasia/?region=on. Accessed March 22, 2017.
blood tests, and a 24-hour urine voiding diary. If you
have a higher risk for prostate cancer, your doctor 4. Mayo Clinic. Benign prostatic hyperplasia (BPH). Available from: www.mayoclinic.org/diseases-conditions/
benign-prostatic-hyperplasia/basics/tests-diagnosis/con-20030812. Accessed March 22, 2017.
may order an additional test called a prostate-specific
antigen (PSA) blood test. PSA is a substance produced 5. Health Link BC. Saw Palmetto. Available from: www.healthlinkbc.ca/health-topics/hw134773spec#tp21169.
Accessed March 22, 2017.
in your prostate which increases when you have an
enlarged prostate or when cancer is present. It is
© Monkey Business Images © Foxyliam
12 The Wellness Connection Fall // Winter 2017 www.costcopharmacy.ca 13
A New Breed of Diabetes Drugs HOW SGLT2 INHIBITORS WORK:
o s e
Gluc orbed i
ally
norm to body
n
SGLT2 inhibitors: Are they right for you? reab
s
DIABETES IS A COMMON HEALTH CONDITION that affects about 3.5 million Canadians, with the cost to the health care system D by
CKE r
BLO inhibito
estimated at $3.4 billion. It’s a condition in which the body does not manage blood glucose (sugar) properly because it cannot KIDNEY KIDNEY S G LT
effectively produce or respond to insulin. Insulin is an important hormone produced in the pancreas that helps to move sugar
Glucose flows to kidneys
out of the bloodstream and into the cells that need it.1 Extra
gluc
ose n
ow p
a ssed
in ur
ine
When diabetes is not properly managed, the extra Are they right for you?
sugar in the blood can eventually cause health The SGLT2 inhibitors in Canada are known as
problems to the eyes, kidneys, heart and nerves. In Invokana® (canagliflozin), Forxiga® (dapagliflozin),
addition to exercising regularly, eating healthy and and Jardiance™ (empagliflozin).⁵ They are only more commonly affecting women, are yeast References
shedding some pounds, diabetes medications are approved for use in people with type 2 diabetes. infections.3 An easy way to lower your risk of these 1. Canadian Diabetes Association. The Prevalence and Costs of Diabetes. Available
from: www.diabetes.ca/about-diabetes/what/prevalence/. Retrieved April 12, 2017.
often required to help keep blood sugars in check.2 They can be used on their own, along with diet and side effects is to drink plenty of fluids and practice
While a number of different types of diabetes exercise, or with other medications to decrease good bathroom hygiene. People taking SGLT2 2. Canadian Diabetes Association. Types of Diabetes. Available from: www.diabetes.ca/
about-diabetes/types-of-diabetes. Retrieved April 12, 2017.
medications have been available for some time now, blood sugar levels.⁵ inhibitors may also have a need to urinate more
a completely new class of agents is now available frequently and may experience increased potassium 3. Amy Campbell, MS, RD, LDN, CDE. (n.d.). Diabetes Medicine: SGLT2 Inhibitors.
Retrieved April 11, 2017, from www.diabetesselfmanagement.com/blog/
in Canada, called sodium-glucose co-transporter 2 Besides being effective in helping to reduce blood and cholesterol levels.3 diabetes-medicine-sglt2-inhibitors.
inhibitors (SGLT2 inhibitors). This article sheds some sugar levels, these drugs have added benefits. Taken
only once a day, these medications may also help If any unusual or serious symptoms occur that include 4. Cefalu, W. T., & Riddle, M. C. (2015, March 01). SGLT2 Inhibitors: The Latest.
Retrieved April 11, 2017, from care.diabetesjournals.org/content/38/3/352.
light on this newer medication class which may have difficulty breathing, nausea, vomiting, abdominal
lower blood pressure and contribute to weight loss.⁴ 5. Government of Canada, Health Canada, Health Products and Food Branch,
other benefits besides just reducing your blood sugar. pain, confusion or tiredness, seek a doctor’s advice.⁵
Jardiance™ (empagliflozin) is the only diabetes drug Health Products and Food Branch Marketed Health Products Directorate. (2016,
These symptoms are signs of diabetic ketoacidosis May 16). Summary Safety Review - SGLT2 Inhibitors (canagliflozin, dapagliflozin,
What are SGLT2 inhibitors? on the market that has also been proven to protect
(DKA), a more serious, but rare, side effect of
empagliflozin) - Assessing the Risk of the Body Producing High Levels of Acids in
the Blood (diabetic ketoacidosis). Retrieved April 11, 2017, from www.hc-sc.gc.ca/
SGLT2 inhibitors work differently than other diabetic the heart in people with type 2 diabetes and heart SGLT2 inhibitors.⁵ dhp-mps/medeff/reviews-examens/sglt2-2-eng.php.
medications. SGLT2 is a protein in the kidney that disease.⁶ 6. Pharmacologic Management of Type 2 Diabetes: 2016 Interim Update. (n.d.).
Living with diabetes does not have to be overwhelming. Retrieved April 11, 2017, from guidelines.diabetes.ca/browse/chapter13_nov-2016.
helps move sugar back into your blood.3 SGLT2 Because SGLT2 inhibitors increase the amount of If you or a loved one has type 2 diabetes, speak to your
inhibitor drugs stop the protein from doing this, sugar in the urine, one of the most common side Costco pharmacist or doctor about your options. There
allowing the kidneys to remove extra sugar through effects includes bladder infections in both men and are many lifestyle tips and medication options that can
the urine, resulting in lower blood sugars.3,4 women.3 Another concern with this medication, help you have the quality of life you deserve.
If you’re experiencing weight gain with your current diabetes medications and/or are having
problems controlling your blood sugars, make sure to speak with your Costco pharmacist about
conducting a diabetes medication review. This one-on-one consultation allows the pharmacist
to assess all your current medications, including your diabetes medicine, to determine the right
treatment plan for you in conjunction with your doctor. This way, your doctor can also assess
whether SGLT2 inhibitors would be an appropriate option within your diabetes treatment plan.
© rassco
14 The Wellness Connection Fall // Winter 2017 www.costcopharmacy.ca 15
Overcoming References
You can also help to manage sleep apnea by making
changes to your lifestyle and how you sleep. This 1. Public Health Agency of Canada. What is the Impact of Sleep Apnea on Canadians?
developing OSA include obesity, large tonsils and/ includes:2 Fast Facts from the 2009 Canadian Community Health Survey—Sleep Apnea
or adenoids (glands), male gender, and being over Rapid Response. Available from: www.phac-aspc.gc.ca/cd-mc/sleepapnea-
• Maintaining a healthy weight apneesommeil/pdf/sleep-apnea.pdf. Accessed March 10, 2017.
SLEEP APNEA
the age of 40, among others.2,4
• Exercising regularly 2. Breathe: the Lung Association. Sleep Apnea. Available from: www.lung.ca/
How does your doctor confirm if you have sleep apnea lung-health/lung-disease/sleep-apnea. Accessed March 10, 2017.
and what can be done? • Quitting smoking 3. Canadian Respiratory Guidelines. Recommendations for the diagnosis and treatment
Sleep better, feel sharper
© Ilyafs
You may have sleep apnea without even knowing • Limiting alcohol of sleep apnea. 2011 update. Available from: www.respiratoryguidelines.ca/sites/all/
files/cts_sleep_slim_jim_2011_final.pdf. Accessed March 10, 2017.
it. Therefore, it is important to recognize the • Following a regular sleep schedule
4. Public Health Agency of Canada. Sleep Apnea. Available from: www.phac-aspc.gc.ca/
IT IS WELL KNOWN that a good night’s sleep symptoms and promptly seek professional medical • Sleeping on your side and not on your back cd-mc/sleepapnea-apneesommeil/index-eng.php. Accessed March 10, 2017.
plays an important role in health and wellbeing. attention. Your doctor may refer you to a sleep clinic
If you think you might have sleep apnea, make an
However, despite getting enough sleep at night, a for an overnight sleep test to find out how often you
appointment with your doctor. Effective options and
person may still feel tired and sleepy the following stop breathing during sleep and to measure several
lifestyle tips are available to help you get the restful
day. While there could be many possible causes other body functions such as brain activity, oxygen
sleep you need!
for this, one issue worth looking into is a common levels, heart rate and breathing rate.3
type of sleep disorder called sleep apnea. It’s Treatment depends on the severity of the condition.
estimated that about 850,000 Canadian adults Although there are no medications that treat sleep
have this condition.1 apnea, a Continuous Positive Airway Pressure Some medications can interfere with sleep and
(CPAP) machine is one of the most common and make sleep apnea symptoms worse. To learn
What is sleep apnea? effective treatments for moderate to severe OSA.
The word “apnea” means “no breathing,” Through a mask, the machine supplies a consistent
how the medicines and supplements you are
so as the name suggests, sleep apnea is when flow of air into your nose and down to the airways taking may affect your sleep, talk to your
breathing pauses during sleep.1 to hold them open while you sleep. Costco pharmacist today.
A person may temporarily stop
breathing from between just a few times
to up to hundreds of times each night, Sleep apnea should not be ignored! If left untreated,
© sbw18
with each apnea episode usually lasting it can, over time, lead to serious illnesses such as high blood
from 10 to 30 seconds.2 Every time an pressure, diabetes, stroke, heart attack and depression.
apnea episode occurs, your brain detects One could even risk falling asleep while driving,
lowered oxygen levels and makes you causing a motor vehicle collision.4
wake up for a brief moment to resume
breathing. Usually, you will not even ®
realize that you are waking up many times at night.
Loud snoring followed by silent pauses is common
in people with this sleep disorder; simple snoring
may not mean that you have sleep apnea.1 ®
Some common signs and symptoms of
sleep apnea include:2,4
• Fatigue, daytime sleepiness
• Irritability/mood changes
• Gasping/choking during sleep
• Difficulty concentrating/memory problems
• Morning headache
What causes sleep apnea and who’s at risk?
The most common type of sleep apnea is
obstructive sleep apnea (OSA). This happens when
a muscle in the throat, or even the tongue, relaxes
during sleep and leads to a blockage in the airways.
Common causes that may put a person at risk for
16 The Wellness Connection Fall // Winter 2017 © eggeegg www.costcopharmacy.ca 17SAVING DOESN’T HAVE
TO MEAN COMPROMISING
At APOTEX, we don’t just look out for the DID YOU KNOW?
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