Indigestion & reflux or heartburn...a reminder during the silly season

Wow, how did we get to December already? I could hardly believe my eyes when I started seeing Christmas decorations in shops, but I can't hide any longer, Christmas and New Year is almost here.

Regardless of whether or not you celebrate Christmas, December is a month for office parties and catching up with friends and family. It's always such a hectic month where fitting in social engagements is almost a competitive sport. One thing that's difficult to avoid is the celebratory food and drink...excellent for the tastebuds, but sometimes not so much for the stomach!

Many people complain about suffering from indigestion. Indigestion is a general term for discomfort in the upper abdomen (tummy). Symptoms can include pain or discomfort, burping, loss of appetite or bloating. It is often related to eating or drinking, especially spicy or fatty foods or indulging too much.

Heartburn or reflux occurs when stomach contents come back up into the oesophagus. The stomach acid causes a burning sensation which rises up from the stomach into the throat and you may even feel or taste food or acid in your mouth. If you find you are having frequent bouts of reflux, see your doctor as it could mean you have Gastro-Oesophageal Reflux Disease (commonly abbreviated to GORD) which can damage the lining of your oesophagus.

People with reflux may have different symptoms and triggers, but risk factors include being overweight, smoking, eating spicy, rich or fatty foods, pregnancy, caffeine, large meals, stress and anxiety and some medications such as aspirin, anti-inflammatory medications (such as ibuprofen or diclofenac), some antibiotics (such as doxycycline) and some medications for osteoporosis (such as alendronate or risedronate). If you suddenly notice symptoms of reflux or anything else new after starting a new medication, speak to your pharmacist to see if the two could be linked.

Berwick Pharmacy have plenty of potential solutions for you. Antacids such as Mylanta or Gastrogel help neutralise the stomach acid and reduce burning. Some antacids also have an ingredient which sits on top of your stomach contents to help try and keep them inside your stomach, instead of rising into your oesophagus.

We also sell stronger medications which prevent the acid pump in the stomach from releasing so much acid. These medications generally come from one of two groups - the H2 antagonists such as ranitidine (Zantac is one brand) and the proton pump inhibitors such as omeprazole (Losec) or pantoprazole (Somac). Many people take these medications regularly on a prescription from their doctor for long-standing conditions or to protect their stomachs from bleeds (especially if they take medication such as anti-inflammatory medications or blood thinners), but they can also be purchased without a prescription for more minor reflux.

So in addition to medications, there are also some simple changes to your diet and lifestyle that can help:

• Avoid foods which you know trigger the symptoms (e.g. spicy, fatty or rich foods)
• Eat smaller meals
• Try not to eat too close to bedtime
• Avoid wearing clothes which are tight around the waist
• Try to reduce or even avoid caffeine, alcohol and smoking
• Raise the head of your bed to sleep
• If your symptoms are triggered by stress or anxiety, learn some relaxation techniques.

Don't forget that sometimes symptoms that seem to be reflux, may actually be something else. If you also notice chest pain, pain radiating to your arm, neck or jaw or sweatiness, you may be having a heart attack so seek immediate medical attention (possibly even call an ambulance). See you doctor if:

• You notice blood in your stools (stools may appear very dark or black or you may see blood on the toilet paper)
• You vomit and notice blood or your vomit resembles coffee grounds
• You are getting symptoms often (e.g. more than once a week) or they start increasing in frequency or severity
• Your symptoms wake you from your sleep
• You are losing weight for no particular reason.

By all means, enjoy this special time of the year, but don't forget to look after your health too. Come into Berwick Pharmacy and speak to our pharmacists who can help you with advice and treatment. Don't forget to ask for a free Self Care Card on Heartburn and Indigestion.

Oh, and while you're visiting Berwick Pharmacy, why not pick up some Christmas gifts? We have a great selection of goodies to pop a smile on the faces of all your friends and family such as perfumes and fragrances, beauty products from brands such as Chanel, Estee Lauder, Clinique, Napolean Perdis and Jurlique or even a voucher for a pampering treatment to our beauty rooms, Indulge at Berwick.

References and further reading

• Heartburn and Indigestion Self Care Card, Pharmaceutical Society of Australia, published February 2011
• Heartburn is a Form of Indigestion Fact Sheet - Better Health Channel, published November 2011 (accessed 29 November 2011)

Diabetes...not just about jelly beans

Diabetes used to be thought of as a disease that children and young people had. And not many young people, just a few unlucky ones. All most of the general public knew about it was that it involved patients giving themselves needles and ensuring a supply of jelly beans was always available.

Nowadays, the majority of Australians are much more aware of diabetes. We know it can affect people of all ages. Most people realise there are basically two different types of diabetes. And if you asked your friends and family if they or anyone they knew have diabetes, you would probably be surprised at how common it is.

Unfortunately, diabetes is Australia's fastest growing chronic disease, with 275 Australians developing diabetes everyday. Currently, nearly one million Aussies are diagnosed as having diabetes, but it is estimated that there are probably another 700,000 people who have not yet been diagnosed. In addition, is is thought that there are 3.2 million Aussies with diabetes or pre-diabetes. It is currently the sixth leading cause of death in Australia.

So when words such as "health epidemic" and "national crisis" are thrown around by the media reporting about diabetes, they're not just being dramatic. Diabetes has a significant cost to the community, not just health-wise, but financially. But it's not all doom and gloom. Up to 60% of cases of Type 2 diabetes can be prevented and there are plenty of ways that people with diabetes can improve the complications associated with the disease.

Two types of diabetes

In Type 1 diabetes, patients' bodies are unable to produce insulin. The role of insulin is to convert sugar into energy which the body can use. Without insulin, toxic chemicals build up in the bloodstream and this can be fatal if left untreated. People with Type 1 diabetes must therefore inject themselves with insulin everyday (usually multiple times a day) as well as religiously test their blood sugar levels to make sure they are not too high or too low. It usually occurs in people under 30 years of age (and more often in children or teenagers), but can start at any stage of life.

Symptoms of Type 1 diabetes tend to appear very suddenly and include significant weight loss, lack of energy, excessive thirst, increased risk of infections and a frequent need to urinate (including during the night). It is important that if you or anyone you know has these or similar symptoms, that they see their family doctor as soon as possible, as it can quickly develop into a medical emergency.

Type 2 diabetes is much more common and affectes 85-90% of diabetics. It is caused by the body being unable to produce enough insulin or failing to respond properly to insulin. It is brought on by a combination of genetic and environmental and lifestyle factors such as being overweight (especially carrying excess weight around the stomach area), having high blood pressure or heart disease, an unhealthy diet and a lack of exercise. Most people are diagnosed with Type 2 diabetes are over 40 years old, but we are now seeing it in teenagers, and even children.

Unlike with Type 1 diabetes, patients with Type 2 diabetes often do not show any obvious symptoms and are usually diagnosed after a health professional assesses them for the above risk factors and then recommends a blood sugar test. If the blood sugar levels are particularly high, patients may display similar symptoms to those experienced by Type 1 diabetics.

Some people with Type 2 diabetes can manage their disease with lifestyle factors such as diet and exercise. Most will require medication in the form of tablets and some will need to inject insulin. Starting tablets and insulin early leads to less complications and better outcomes for patients, and is just due to the natural progression of the disease.

Complications of diabetes and how Terry White Chemists Berwick can help

Diabetes is a complex disease and since the high levels of sugar in the bloodstream travel to every cell of the body, it can affect a variety of areas. Our team at Terry White Chemists Berwick have a wealth of expertise and would be happy to help.

Firstly, Terry White Chemists Berwick is an agent for the National Diabetes Services Scheme (NDSS). The NDSS is administered by Diabetes Australia and is an initiative of the Australian Government. All Australians with diabetes can register for free and are then eligible for diabetes-related products (especially things like blood glucose test strips and needles) at subsidised prices. The NDSS is also a very useful resource for information and support.

We stock a wide range of blood glucose meters to help you monitor and manage your diabetes. Nowadays, these devices are small, simple to use and have lots of features such a large memory to store your results, allowing yourself or your doctor to easily review them. Speak to our pharmacists to determine which one is right for you. And feel confident that if you purchase your blood glucose meter from us and then have any trouble with it, bring it into the pharmacy and if we can't fix it, we'll contact the manufacturer to try and sort it out for you. Of course, we also stock blood glucose strips to use in the machines.

Many people with Type 2 diabetes also have high blood pressure, (known as hypertension). Come in for a free blood pressure check or speak to us about purchasing your own blood pressure monitor. Click here for more information on both blood glucose meters and blood pressure machines.

Being diagnosed with diabetes is definitely an extra good reason to give up smoking. At Terry White Chemists Berwick, we can help you kick the habit for good with sensible advice and a range of products to make it a little bit easier for you.

People with diabetes are more prone to developing eye problems and should have their eyes checked at least every two years. Speak to your doctor if you notice any changes to vision (such as blurred or distorted vision), problems with balance, reading, watching television and recognising people, difficulty seeing at night or becoming more sensitive to sunlight. If your optometrist diagnoses you with a mild short or long-sightedness, you may find "Readers" glasses a cost-effective solution. Come in and give them a try.

Diabetes can damage the blood and nerve supply to your feet so it is important to take good care of your feet everyday and to have them regularly checked by your doctor or a podiatrist. You should look out for signs of tingling or numbness, changes in colour of your feet (especially a blue tinge) , pain or cramping, cuts or calluses or corns and get them checked out as soon as possible. At Terry White Chemists Berwick, we have a large range of footcare products such as nail clippers and moisturisers. We sell the Circulation Booster which may help relieve aches, pains and swelling. Pop in for a free trial. We are also authorised sellers of of Homy Ped shoes, including their Homy Ped Diabetes range, specially designed to assist blood supply and minimise stress on feet.

People with diabetes may find that wounds, particularly on areas such as the feet, can quickly develop into something more serious or may take a long time to heal. This is due to diabetes affecting the blood supply. We stock a large range of wound care products and can help assess and dress the wound for you.

Taking control of diabetes

Know that if you or someone you know has Type 1 or Type 2 diabetes, you are not alone. There are so many resources available which can help you to take control and manage this condition and prevent it from overtaking your life.

A great place to start is by paying a visit to our pharmacists and staff at Terry White Chemists Berwick. We deal with diabetes every single day and can help with professional advice and resources such as blood glucose meters, medications and additional supplies as mentioned above. We are an accredited NDSS agent. We also have free Self Care Cards on both Type 1 and Type 2 diabetes for you to take home and read. And don't forget, we also make sure we are always in stock of the best jelly beans in the world, Glucojels.

References and further reading

• Diabetes Type 1 Self Care Card, Pharmaceutical Society of Australia, published February 2011
• Diabetes Type 2 Self Care Card, Pharmaceutical Society of Australia, published February 2011
• Diabetes Fact Sheet - Better Health Channel, published October 2011 (accessed 10 November 2011)
• Diabetes Australia website
• The NDSS (National Diabetes Service Scheme) website

Generic medicines - are they really the same?

When you go to your Terry White Chemists Berwick or your local pharmacy to get a prescription dispensed, you may be asked whether you would prefer the generic medicine. You may be someone who says yes. You may be part of the community who prefers to stick to the brand prescribed by your doctor. Or you may be in the group that doesn't really understand what generics are all about so say no, just to be safe.

Hopefully, this post will clear up some of the confusion.

Active ingredients VS brand names

Medicines are marketed under two different names - the brand name and the active ingredient name. The active ingredient name is the chemical compound that actually makes it work. For example, paracetamol is an active ingredient name, but Panadol is a brand name. In Australia (and generally around the world), the active ingredient is always known by the same name. So you could be in a pharmacy in England and ask for paracetamol and still get the same thing (although for some reason, paracetamol is known as acetaminophen in the USA!).

There may be, however, many different brand names for the same active ingredient, just like there are many different brands of milk in the supermarket fridge. Companies use different brands as part of their marketing strategy and to try and make it easier for you to remember their product. Each brand will be produced by a different company, but if you look at the packaging, they will all tell you the active ingredient and the dose or amount inside the medication.

So why are there so many different brands?

Basically, medications are invented and developed by pharmaceutical companies. They spend many years on research and development and invest literally millions of dollars to invent each new medication. Then they have to put the medicine through a stringent clinical trials process, which means giving the medicine to volunteer patients. This is not only to show that their medicine works, but also to make sure it is safe.

Pharmaceutical companies are granted a patent on new medications. This patent means that for a number of years, no other company is allowed to manufacture and sell that medication with that particular active ingredient. During this time, only the one original brand is available and this allows the pharmaceutical company to recoup back some of the money spent inventing, researching and developing the medication. This encourages pharmaceutical companies to continue to try and invent new medications.

Once the patent expires, however, other companies can develop their own version of the medication, called generics. These generic brands will have the same active ingredient as the original brand, but will be marketed under a different brand name with different packaging.

So what's the difference?

You can feel confident that if the pharmacist offers you a generic brand of medication, it will have the exact same active ingredient in the exact same dose as the original brand. So for most people, the only difference will be that you can save a few dollars at the cash register (this differs from medication to medication, but often the original brands will have a slight additional cost to them). Since the active ingredient is the same, it will work the same way in your body as the original.

Is there any reason why I shouldn't use a generic medication?
If you have any allergies or intolerances, it's important to ask your pharmacist about the inactive ingredients inside your medication. These may be things like preservatives or gluten which can differ from brand to brand, despite the active ingredient being the same.

Some people also like to stick to the same brand to avoid confusion. You don't want to accidentally take two different brands of the same medication because you didn't realise they were the same. If you do decide to use generic medications, your pharmacist can help make sure you understand about the active ingredients and also ensure that you stick to the same generic brand to make things easier.

Your doctor may also prefer that you stick to the one brand and you can ask them to discuss this with you.

Finally...
So you should rest assured that when our pharmacists at Terry White Chemists Berwick offer you a generic brand medication, it will have the same ingredient, in the same dose, and will work the same way as your original medication. Get to know your medications and the active ingredients and you may just be able to save a little money on the way. And make sure you ask your pharmacists if you have any questions related to your medicines - it's what we are there for.

References and further reading

• NPS website

Healthy, happy hearts

Thursday, 29th September, 2011 was World Heart Day, a day where global awareness is raised of the fact that heart disease and stroke are the world's leading cause of death. Astoundingly, 17.1 million deaths a year worldwide are due to heart disease and stroke. It is estimated that at least 80% of these premature deaths could be avoided just by addressing some simple risk factors.

Cardiovascular disease is also the leading cause of death in Australia, killing one Australian nearly every 11 minutes. That's quite a scary statistic. That's more than five Aussies who die during every episode of Packed to the Rafters. In 2008, 34% of deaths in Australia (that's 48,500 people) were due to cardiovascular disease.

Cardiovascular disease, or CVD, includes heart, stroke and blood vessel diseases. The heart is basically one giant muscle which is responsible for pumping blood and nutrients all around the body. Both heart and attacks and strokes are basically caused by a blockage in a blood vessel which then prevents the blood from reaching crucial areas. If not treated early enough, these blockages can quickly cause damage and death to cells and can possibly kill you. Blockages can be due to clots or a build-up of fatty deposits, often called plaques.

Despite the scary statistics, it is fortunate that heart disease is largely preventable. Many risk factors for heart disease have been identified. Some, like having a family history of heart disease or increasing age, are non-modifiable (i.e. unable to be changed). The following are the modifiable risk factors that we should all be aware of and work towards changing for a longer and healthier life:

• Smoking
• High blood cholesterol
• High blood pressure
• Diabetes
• Being physically inactive
• Being overweight
• Depression, isolation and a lack of quality support.

So what can you and your family do to reduce your risk of CVD?

• Avoid smoking - both being a cigarette smoker and inhaling second-hand smoke from people around you increase your risk. So if you're a smoker, it's now time to quit. Even if you've tried to quit before, it often takes people multiple attempts so don't be disheartened. Pop into Terry White Chemists Berwick to speak to our pharmacists about ways to help you. If you're not a smoker, try to avoid people smoking around you, and especially your babies and children.
• Have a healthy diet - this means lots of fruit and vegetables, plenty of water rather than sugary soft drinks or alcohol (it's recommended no more than two standard drinks per day for men and women), avoiding fatty foods, choosing foods containing wholegrains or lean cuts of meat and eating oily fish.
• Exercising - try to do at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week. Try and incorporate this into your life so it doesn't feel like such a chore. Try getting off the bus a couple of stops earlier and walk the rest of the way. Perhaps take the stairs instead of the lift. Schedule exercise dates with friends. Even kicking a ball or running around the park with the kids or your dog count.
• Maintain a healthy weight - do this with diet and exercise.
• If you think you may be depressed (signs may include difficulty sleeping, loss of interest in food, sex, exercise or other activities, increased irritability and frustration, or staying home from work or school), speak to your doctor. There are many medical and also non-medical therapies which can help. Check out the Beyond Blue website for more information.

Many Australians take medications which also help reduce your risk of CVD. These may include medications to treat high blood pressure (also called hypertension), to lower cholesterol, to slow down your heart rate or control your heart rhythm or to thin the blood and prevent blood clots. Sometimes people stop taking these medications as they may cause side effects or people may not feel they need them anymore. It is very important to talk to your doctor and pharmacist about any concerns you have as these medications need to be taken long-term to be effective. Many side effects only occur at the start of taking a new medication and others can often be managed with simple measures or by changing the dose or to a different medication. Pharmacists are experts on medication so are a valuable source of advice.

Finally, I just wanted to mention that CVDs are medical emergencies and are often treatable as long as you get medical help as soon as possible. If you suspect you or anyone you know is having a heart attack or stroke, call 000 (or your local emergency number) immediately. Don't wait for it to get worse as it may mean the difference between life and death. The phone operators are trained to work out if you need an ambulance. The following are some of the warning signs of heart attacks and strokes:

• Heart attack - pain, pressure, heaviness or discomfort in your chest, shoulder(s), neck, arm(s), jaw or back. You may also feel dizzy, nauseous, short of breath or cold and clammy.
• Stroke - do the FAST test.
• F for Face - Check their face. Has their mouth drooped?
• A for Arms - can they lift both arms?
• S for Speech - has their speech slurred? Can they understand you?
• T for Time - time is critical so if you see any of these signs, call 000 straight away.

The team at Terry White Chemists Berwick are ideally placed to help you and your hearts. Pop in and speak to them about what you can do to reduce your risk. Or if you're worried about some aspect of your medication, speak to our pharmacists. And we have plenty of Self Care Cards which you can take home on topics such as Exercise and the Heart, High Blood Pressure, Diabetes Type 1 and Type 2, Smoking, Nicotine Replacement Therapy, Depression and many more.

References and further reading

• Heart Foundation of Australia website
• World Heart Federation website
• National Stroke Foundation website
• Beyond Blue website

Travel Health

We all love a good holiday and for some, the planning stage is all part of the fun. We check out weather forecasts, accommodation options, tourist must-dos and try and find the best places to eat. But it's also really important to think about our health and take appropriate precautions to make sure we come home as healthy as possible.

Travel insurance is essential for any trip. We are very fortunate that in Australia, we have an excellent public health system so in an emergency, everyone will be treated, but that is not always the case overseas. A few years ago, Darren and I went to Singapore for a wedding. It was only a five day trip, but thought we should get travel insurance just in case, especially since I was pregnant with The Munchkin. It turned out it was very lucky that we did because although I was fine, Darren ended up needing to see a GP then a specialist and have some expensive tests and we got the cost of everything back on our travel insurance. As they say, "If you can't afford travel insurance, you can't afford to travel."

You should definitely see your doctor at least eight weeks before you travel for a basic check-up and to see whether you need any vaccinations. General vaccines such as typhoid and hepatitis A and B are advisable even in Australia. Some countries such as those in parts of Africa and South America, will not allow you to enter unless you have proof of certain vaccines such as yellow fever. The vaccine lasts ten years and needs to be given at least ten days before entry into a high-risk country. You don't want to fly all the way across the world, only to be sent straight back home at the airport!

Speaking of flying, long flights can increase the risk of you getting a DVT (deep vein thrombosis, or a blood clot which starts in the leg but can move to other areas). Pop into Terry White Chemists Berwick to check out our large range of compression stockings and socks and try and stay hydrated during the flight (go easy on caffeine and alcohol!) and make sure you move your legs and feet around periodically and occasionally walk around.

For some countries such as those in Africa and South East Asia, it may be advisable to take malaria medication. There are different regimes depending on where you are travelling to, but they all need to be started before your trip, taken whilst you are away and generally also for a short time once you return. Make sure you read the directions carefully and finish the entire course to ensure you are protected. Some malaria medications can reduce the effectiveness of oral contraceptives so you may need to take extra precautions during this time. You can protect yourself further by using appropriate insect repellents, covering arms and legs with clothing when outdoors (especially at sunset) and using mosquito nets.

Traveller's diarrhoea is also a risk, especially in developing countries. It is usually caused by consuming contaminated food or water which local residents seem to have acquired an immunity to. Symptoms can include nausea, bloating, cramps, loose and frequent bowel motions and a general feeling of being unwell. You can reduce your risk by avoiding ice, drinking bottled or canned water and other drinks, avoiding salads which may have been washed in local water, only eating fruit which you peel, avoiding undercooked or improperly stored foods (especially seafood and meat) and washing and drying hands thoroughly before and after meals and going to the toilet. If you are unlucky enough to come down with traveller's diarrhoea, keep hydrated (buy some oral rehydration solution from Terry White Chemists Berwick before you leave home), rest and stick to bland foods.

If you need to travel with prescription medication, ask your doctor for a letter explaning the details of the medications, what they are for and that they are for personal use. Make sure you have enough medication for the duration of your trip. Ensure you have some medication in your hand luggage in case your suitcase goes missing and make sure that all your medications are in their original packets with the pharmacy labels on them. It's also worth checking that your medications are legal in the countries you are visiting. For example, codeine which is found in many over-the-counter painkillers such as Panadeine, is illegal in Greece and classed in the same category as heroin. Click here for contact details of the foreign embassies in Australia to check on your medications.

Our staff at Terry White Chemists Berwick are a great source of advice before you travel. They can assist you in putting together a basic first aid kit, help with alert bracelets and necklaces, dispense any vaccines and other medications and supply everything to protect and treat sunburn, insect bites, cuts and grazes and other common health conditions. We also have a Travel Health Self Care Card with lots more advice to help you on your way.

So get organised before your trip and happy travelling!

References and further reading

• Travel Health Self Care Card, Pharmaceutical Society of Australia, published February 2011
• Australian Government's Smart Traveller website
• Travel Clinics Australia website
• World Health Organization website
• Travel Health - Yellow Fever Vaccine Fact Sheet - Better Health Channel, published November 2010 (accessed 19 September 2011) 
• Travellers's Diarrhoea Fact Sheet - Better Health Channel, published August 2011 (accessed 22 September 2011)

Springtime & Hay Fever...aa-aa-choo!

It's so lovely to see the blue sky and flowers blooming after Winter. Ah, who doesn't love Spring?

Hay fever sufferers, that's who. And when I say sufferers, I really mean sufferers.

For those who don't get hay fever, it's difficult to understand exactly how terrible it can be. I mean, it's just a bit of sneezing, right? Wrong.

Hay fever is also known as allergic rhinitis - rhino- from the Latin word for nose and -itis meaning inflammation. Around 1 in 5 Australians are expected to have an allergic condition at some point in their lives and it can occur anytime of the year, not just in Spring. Symptoms may include sneezing (mild to uncontrollable), a runny or blocked nose, an itchy or tickling sensation in the nose, throat, ears and roof of the mouth, red, puffy and itchy eyes and a loss of smell or taste. These symptoms may affect concentration and even sleep, making severe sufferers tired and irritable. The symptoms are often at their worst in the morning and on windy days when there is more pollen in the air.

Hay fever is caused by an overactive immune system reacting to certain triggers or allergens. Pollen is the most common allergen, but dust mites, mould spores and animal cells or hair (commonly cats or dogs) can also cause problems. Often people with hay fever are also unlucky enough to get eczema, asthma or hives and it generally runs in families. In fact, if either mum or dad has hay fever, the child has about 30% chance of also having it. If both parents have hay fever, it's about 70% likely the child will have it.

There are lots of non-prescription treatments for hayfever available at Terry White Chemists Berwick. Some of these include:

• Antihistamine tablets, capsules or liquids - the most popular ones are non-drowsy and can be taken once a day. For whatever reason, different ones work best for different people so it may be worth trying a few to work out your favourite.
• Antihistamine eyedrops - these help itchy, swollen and runny eyes.
• Decongestant nasal sprays or drops - particularly useful for a runny or blocked nose, but shouldn't be used for more than five days in a row as long-term use can damage nasal tissue.
• Corticosteroid nasal sprays - these help prevent and reduce the inflammation in the nose and help with symptoms of sneezing, runny or blocked nose and puffy or watery eyes. They start to work within a few hours, but will achieve their maximum effect within a few days. They need to be taken continuously during the hay fever season to work best and are safe to use long-term.

Some people may benefit from immunotherapy which aims to build up your body's tolerance to allergens by gradually increasing exposure to them, usually by repeated injections or sometimes drops placed under the tongue. Immunotherapy should only be done under medical supervision as it can be dangerous and even life-threatening. Speak to your doctor for more information or check out this link.

So what else can you do to help manage your hay fever? Some suggestions include:

• Avoiding triggers. For example, keep an eye on the pollen count during weather reports and stay inside on days with high pollen forecasts, windy days or after thunderstorms.
• Keep car and house doors and windows closed during pollen season.
• Shower and wash your hair after being outdoors to remove pollen.
• Splash eyes often with cold water to help flush out any pollen.
• Smear petroleum jelly inside your nose to reduce the amount of pollen that you inhale.
• Avoid cigarette smoke as it can make you more sensitive to other allergens.
• Keep animals outdoors.
• Clean your house regularly to reduce dust and mould.
• Hard surfaces such as floorboards and tiles are likely to be better than carpets and rugs.
• Remove sheepskins and woollen and feather bedding from bedrooms.
• Wash soft toys regularly in hot water (60°C).

Our staff at Terry White Chemists Berwick would love to help you manage your hay fever, regardless of how mild or severe it is. Pop in for a chat and don't forget to ask for your Hay Fever Self Care Card.

To finish, I thought I'd attach this very cute clip. I can't be certain that this bear has hay fever, but I'm sure hay fever sufferers can relate!

References and further reading

• Hay Fever Self Care Card, Pharmaceutical Society of Australia, published February 2011
• Australasian Society of Clinical Immunology and Allergy website
• Hay Fever Fact Sheet, Better Health Channel, published June 2011 (accessed online 8 September 2011)

Safety of Medicines in Pregnancy and Breastfeeding

When I was pregnant with The Munchkin, I was lucky enough to have a pretty uneventful pregnancy. I never got morning sickness, I didn't have too much by way of sleep disturbances, I felt pretty energetic throughout. As I said, very lucky. Pretty much the only weird thing I had was the occasional urge to dry retch when I brushed my teeth. Weird, right?

There were times when I almost forgot I was pregnant, and was only reminded when I looked down at my ever-growing belly. But when you are pregnant, there's suddenly a whole bucketload of new things you need to think about, and not just in relation to decorating the nursery.

It would be lovely to think that pregnant and breastfeeding women never get sick and never need any medications, but unfortunately, this is just not the case. Long-standing conditions such as asthma and epilepsy still require treatment during pregnancy and breastfeeding. Then there's the usual bugs and viruses that we are all still susceptible to. And don't forget that we are not just talking about prescription medications. There's also medications that you buy over-the-counter at your pharmacy and herbal and complementary products. Even medications that are in creams or ointments, in nasal sprays or eyedrops or patches can be passed across to your baby.

Medications taken by pregnant women can pass across to the baby via the placenta, just as the baby receives nutrients. Some medications can actually affect baby's development or cause miscarriage.

In addition, medications taken by breastfeeding women can pass across to the baby via the breastmilk. This may cause baby to have symptoms of drowsiness, difficulty settling, cause vomiting or diarrhoea or may affect baby's suckling reflex, making feeding difficult.

So how do we know what is safe and what isn't? This question is slightly more complicated than you would expect.

As a general rule, pharmaceutical companies don't test their medications in pregnant or breastfeeding women. For that reason, pharmaceutical companies are usually reluctant to emphatically state their medications are safe. Information about the potential safety of medications in pregnancy and breastfeeding is usually extrapolated from studies in animals such as mice. There are, however, groups worldwide which collate information and look for trends and your pharmacist and doctor will be able to access this information for you.

Some general rules which can help if you do need to take medications whilst pregnant or breastfeeding are:

• Always remind your doctor and pharmacist you are pregnant or breastfeeding so they can check the safety of any medications. Don't forget to mention over-the-counter and herbal products.
• Consult your doctor or pharmacist before suddenly stopping any medications.
• If you are on long-term medication and planning to start a family, discuss this with your doctor and pharmacist before getting pregnant. It may be wise to switch to another medication which is safer in pregnancy.
• If you do need to take a medication whilst breastfeeding, chat to your pharmacist about the best time of day to take it and keep a close eye on baby for any adverse effects (e.g. drowsiness, irritability, change in bowels).
• Limit or avoid alcohol if pregnant or breastfeeding. Click here for a leaftlet produced by the Australian Breastfeeding Assocation titled "Alcohol and Breastfeeding: a guide for mothers".
• Limit or avoid caffeine (coffee, tea, cola, energy drinks).
• Avoid recreational drugs.
• If you are a smoker, there's never been a better time to quit! For more advice on quitting, pop into Terry White Chemists Berwick for a chat with our pharmacists and ask for our Self Care card on Smoking. Quit Victoria also has a great website with heaps of information and advice.

The best advice to always discuss any concerns about your medications with your doctor (and obstetrician if you have one) and pharmacist. Our pharmacists at Terry White Chemists Berwick would be pleased to have a chat about any health-related issues, including those related to pregnancy and breastfeeding. They will be able to look at the appropriate references and help guide you towards what is safest for you and your baby.


References and further reading

• Medicines and Breastfeeding Self Care Card, Pharmaceutical Society of Australia, published July 2008
• Smoking Self Care Card, Pharmaceutical Society of Australia, published February 2010
• The Royal Women's Hospital Victoria website
• Quit Victoria website
• Australian Breastfeeding Assocation website
• Pregnancy and Drugs Fact Sheet - Better Health Channel, published October 2009 (accessed online 3 September 2011)
• Pregnancy and Smoking Fact Sheet - Better Health Channel, published February 2010 (accessed online 3 September 2011)

Cancer and Daffodil Day

This Friday, 26^th August is Daffodil Day in Australia. Daffodil Day is the largest fundraising event of its kind in the Southern Hemisphere and aims to raise much-needed funds for cancer research, prevention and support services. It is run by the Cancer Council of Australia and this year they are celebrating 25 years of Daffodil Days. That’s a lot of daffodils!

The bright, sunny, yellow daffodil is the international symbol of hope for all those touched by cancer, and at this time of the year, daffodils are such a welcome sight after the cold, drab, grey months of Winter.

Cancer is a word which strikes absolute fear into the hearts of pretty much everyone. I don’t think there would be an Australian who hasn’t been affected by cancer in some way, whether it’s through personal experience or that of a family member, friend or colleague.

What are the facts? Well, last year in Australia alone, it is estimated that there were 114,000 new cases of cancer diagnosed. 1 in 2 Australians will be diagnosed with cancer by the age of 85. Cancer is a leading cause of death in Australia, with over 43,000 people dying from cancer in 2010. The most common cancers in Australia (excluding non-melanoma skin cancer) are prostate, colorectal (bowel), breast, melanoma and lung cancer.

Cancer does seem to be on the rise when you compare current figures with those from years ago, but this is largely due to population growth, ageing and improvements in screening and diagnosis. Despite the increase in the number of cancer deaths, the actual proportion of patients who die from cancer has fallen by 16% in the past 30 years.

The other good news is that the survival rate for many common cancers has increased by 30% in the past twenty years. More than 60% of cancer patients will survive more than five years after diagnosis.

Having worked as a pharmacist in a Chemotherapy Day Unit (a ward where patients are admitted for the day just to receive their chemotherapy), it is a fascinating, complex and incredibly busy area of the hospital. It would be impossible for me to cover everything about cancer in the one blog post, but I thought I'd give a brief summary on screening and treatments.

Cancer Screening

Clearly, it is much easier to treat a cancer if it is diagnosed in the early stages of disease. This is where the importance of screening lies. There are currently three national population-based cancer screening programs operating. These are:

• BreastScreen Australia Program - an x-ray of the breast (called a mammogram) is performed every two years to screen for early signs of breast cancer in women aged 50-69 years. Women should also check their own breasts for any changes each month.

• National Cervival Screening Program – a doctor takes a Pap Smear which is used to take a tiny sample of cervical cells to detect changes in the cervix which may lead to cervical cancer in women. Pap Smears should be done every two years either from the age of 18 years old or one or two years after sexual activity starts, whichever is later.

• National Bowel Screening Program – this involves placing a small sample of your stool on a special card in the privacy of your own home and sending the card to a laboratory for analysis. The test looks for the presence of blood in your stool which can be an early warning sign of bowel cancer. If you are turning 50, 55 or 65 between January 2011 and December 2014, the government will automatically arrange for a free test to be posted to you around your birthday. If not, BowelScreenAustralia™ test kits are available for purchase at Terry White Chemists Berwick and Terry White Chemists Eden Rise as well as many other pharmacies. Click here to find a pharmacy that sells the test kits near you.

Cancer Treatments

There are three main treatments for cancer and these can be used either on their own or in combination.

The first is surgery where the tumour itself and surrounding tissue is removed. This is used when the tumour is small and contained to one area.

The second option is radiotherapy which is where precisely targeted x-rays are used to destroy cancer cells. The length of treatment depends on the type, size and location of the tumour(s), but most patients have five treatments a week for a few minutes each time, for one to seven weeks.

The third option, and probably the one that most comes to mind when people hear think about treating cancer, is chemotherapy. Chemotherapy is the use of cancer-killing medicines which can be given in tablet or capsule form or, more commonly, straight into the bloodstream by an infusion (i.e. a drip). There are many different chemotherapy medicines and different doses and combinations are given depending on factors such as the type of cancer involved.

Chemotherapy is incredibly good at destroying cancer cells, but unfortunately, it can also harm healthy cells too which can lead to side effects such as fatigue, nausea, vomiting, mouth ulcers and loss of appetite. We often hear patients voice concerns about hair loss with chemotherapy, but this is dependent on the particular chemotherapy medications that they receive. Your doctors and pharmacists will try to work together to minimise these side effects, perhaps by giving you other medications. Patients should speak to their oncologist, family doctor and pharmacist about any worries they have regarding chemotherapy and any side effects.

We often have queries from patients regarding the safety and efficacy of complementary and alternative cancer treatments. Some treatments are perfectly safe to use and can help you to feel better, but others may interfere with your cancer treatment and should not be used. Always check with your pharmacist or doctor before taking non-prescribed medications, even if they are “natural”. The Cancer Council Victoria has a free book called Complementary and alternative cancer therapies which can be downloaded here.

How Can You Help?

Cancer really is a huge subject and one that needs awareness and public support. So this Friday, do your part and pop into Terry White Chemist Berwick or Terry White Chemist Eden Rise, Coles supermarket or another authorised seller and pick up a badge, teddy bear, pen or bunch of daffodils and feel good that you’re helping researchers find a cure for cancer.

References and further reading

• Cancer Council Australia website
• Cancer Council Victoria website
• Bowel Cancer Australia website 
• Peter MacCallum Cancer Centre website
• The Royal Children's Hospital Melbourne website

• Cancer Fact Sheet, Better Health Channel, published November 2010 (accessed online 23 August 2011)

• Cancer Screening Fact Sheet, Better Health Channel, published December 2010 (accessed online 22 August 2011)
• Cancer Treatments - Chemotherapy Fact Sheet, Better Health Channel, published November 2009 (accessed online 22 August 2011) 
• Cancer Treatments - Radiotherapy Fact Sheet, Better Health Channel, published August 2009 (accessed online 22 August 2011)

Sleep...and a lack of it!

Ask the question, “Who could do with some more sleep?” and just about everybody would put their hand up. But there is a big difference between having a few late nights and chronic sleep issues.

Both Darren and I are slightly obsessed with sleep at the moment, mainly because The Munchkin is going through “a phase”. She’s gone from being a wonderful sleeper, to one who wakes up six times a night and wants you to sit it her room until she falls asleep. Needless to say, we are really hoping this phase ends soon!

Sleep is essential for us to feel physically and emotionally well. People need varying amounts of sleep depending on their age, diet, lifestyle, personality and circumstances. According to his wife, Kevin Rudd, our ex-PM was getting by on only three hours of sleep per night! On average, however, adults need 7-9 hours sleep per night, teenagers need 9.5 hours per night and newborns up to 18 hours per day.

In addition to the tiredness and frustration felt, poor sleep can make us irritable, anxious or depressed and can make it difficult to concentrate and remember things.

There may be medical reasons for sleep problems. Conditions such as pain, restless leg syndrome, worry, pregnancy, anxiety, depression, drug or alcohol use, sleep apnoea (where the walls of the throat collapse during sleep, blocking airways and disturbing sleep) and even snoring can disturb sleep. Some medications such as prednisolone (commonly used for breathing difficulties or rheumatoid conditions) or pseudoephedrine (used as a nasal decongestant and found in flu tablets) can make you more alert, interfering with sleep.

Sleeping tablets can be useful short-term, but many of them have the side effects of both tolerance and dependence. Tolerance is when you need a higher dose to get the same effect and dependence is when your body starts to rely on them and can lead to withdrawal symptoms once they are stopped. If you do need to use sleeping tablets, take the smallest dose you can, for the shortest period of time and only use them when you really need to. Don’t forget that sleeping tablets can also make you feel drowsy, confused or unsteady the next day (like a hangover effect) so do not drive if you are affected and be careful as you may be more prone to falls.

Here are some important tips to help ensure a good night’s sleep

• Is your bedroom conducive to sleep? It should be dark (have a bedside lamp), warm (not too hot or cold), comfortable (perhaps spoil yourself and invest in a good bed, pillow and sheets) and quiet.

• If you have a television in your bedroom, get rid of it! The same goes for using laptops or ipads in bed. Removing these distractions will help your brain to realise that bed is for sleeping, relaxing and sex.

• Avoid napping during the day, but especially after about 3pm.

• If you’re a smoker, quit. The nicotine in the cigarettes acts as a stimulant to your body. There are lots of new products available in pharmacies to help you quit. Have a chat with your pharmacist.

• Try and do some exercise during the day, even if it’s just going for a brisk walk. Avoid doing strenuous exercise close to bedtime though.

• Avoid going to sleep with a full tummy. Try and have dinner at least a few hours before bed, but if not, have a smaller meal to allow some time for it to digest before sleep.

• Avoid caffeine close to bedtime (or cut it out altogether if you’re having real problems). Try a non-caffeinated drink like warm milk or green tea instead.

• Develop a bedtime routine and stick with it. Meditating or having a bath may be helpful. Try and have a reasonably consistent bedtime.

• If you can’t sleep, get up and go to another room and do something else. Wait until you feel sleepy again then return to bed.

• Although we all love a sleep-in, it’s better if you wake up at the same time every day.

You should see a doctor or pharmacist if:

• Your sleep problems are caused by illness, pain or discomfort

• You wake up coughing, wheezing or unable to breathe

• You snore, especially if you wake yourself or others

• You have been taking sleeping tablets regularly for more than four weeks

• You continue to be tired during the day.

Sleep is such a large part of our lives and essential to good health and wellbeing. If you’re having sleep problems, pop into Terry White Chemists Berwick and have a chat to our pharmacists. Make sure you pick up a free Self Care Card on Sleeping Problems and we also have one on Relaxation Techniques. We stock herbal and complementary medicines which can help to aid sleep.

In conjunction with Sleep Services Australia, Terry White Chemists Berwick also offer ‘at home’ sleep apnoea diagnosis and testing. We hire out Continuous Positive Airway Pressure (CPAP) machines to allow patients to try different masks and machines which you can then purchase. We stock the Fisher & Paykel range of Icon CPAP machines as well as a full range of replacement parts and fittings.

Here’s a clip that brought a smile to my face and made me wish everyone (especially The Munchkin) slept this well! Sweet dreams.

References and further reading

• Relaxation Techniques Self Care Card, Pharmaceutical Society of Australia, published August 2009
• Sleeping Problems Self Care Card, Pharmaceutical Society of Australia, published February 2011

• SleepHealth Foundation website

• SleepServices Australia website

• Sleep Apnoea Fact Sheet, Better Health Channel, published May 2011 (accessed online 3 August 2011)

• SleepHygiene Fact Sheet, Better Health Channel, published September 2009 (accessed online 3 August 2011)

Nappy Rash

Babies. Such a little word. Such little beings.

Someone wise once said to me that when you have children, you’ll never know a life without worry ever again, not even when they’re all grown up with children of their own. And now I know that’s true. There’s always something – they’re teething, they’re not eating, they never stop eating, they’re not sleeping, they’re sleeping too much, they’re unwell. And that’s before they hit puberty and bring a whole new barrel of issues with them!

I thought I’d start with a post on a condition that is really common in babies – nappy rash. This is one of those issues that suddenly becomes very important when you have a baby or you’re caring for one who is affected by it. Luckily, it’s relatively easy to treat.

On a side note, this is as good a time as any to send out a massive thank you to everyone who helps care for and raise children, especially grandparents. I know we would be in serious trouble without The Munchkin’s four wonderful and doting grandparents! Not just for their help looking after The Munchkin (allowing us to work and even the occasional date night out), but also for all their advice and support since she was born.

Back to nappy rash. Nappy rash is caused by irritation to the skin, usually as a result of contact with baby’s urine and faeces, and especially when it’s prolonger contact. Chemicals such as soaps, detergents and nappy creams can also lead to or exacerbate the rash. If your baby has sensitive skin or a skin condition such as eczema or psoriasis, they are more likely to get nappy rash. Some babies are prone to nappy rash when teething or unwell.

Basic nappy rash shows up as red, swollen and sore-looking skin in the nappy area. Usually the folds of the skin (and who doesn’t love a baby with rolls on their legs?) remain unaffected as the moisture doesn’t get in. It can be painful for baby and they may be very unsettled as a result, especially in the bath or overnight (as if there wasn’t already enough things to blame for sleep problems!).

If the rash is shiny with a sharply defined edge and little white spots surrounding it, it is likely it is infected with a fungus called candida (thrush). This may also spread to the creases, bottom, thighs and tummy and may be accompanied by a thrush in the mouth (oral thrush). In this case, speak to your pharmacist about an appropriate antifungal treatment for any affected areas, both in the nappy area and in the mouth.

If the rash is weeping or has yellow crusts and is accompanied by a fever, it’s probably infected with bacteria and you’ll need to consult your doctor for antibiotics.

Some babies get nappy rash no matter how well they are cared for, and some babies never seem to be affected by it. If your baby does get nappy rash, it is a relatively simple condition to treat and will generally clear up within 2-3 days of treatment. It makes sense that since moisture causes nappy rash, we need to keep the area as clean and dry as possible in order to treat and avoid it.

Important points to remember:

• Check baby’s nappy often and change it immediately if baby has done a wee or poo
• Gently clean the area with water or a specialised mild baby cleanser (chat to your pharmacist). I keep a spray bottle (the types hairdressers use which can be bought for about $1) filled with water on the change table. We also found using cooled chamomile tea was really soothing and gentle when The Munchkin was younger and had a bad flare-up.
• Pat skin dry, rather than rubbing it which can further irritate the skin. Try and avoid disposable wipes at these times as they can irritate the area further.
• You can use a baby powder (ones specifically for the nappy area, not talcum powder) to help keep the area dry.
• Apply a barrier cream all over the area, concentrating on the red spots. Your pharmacist can help you choose an appropriate one.
• Try and give baby some nappy-free time during the day. I used to pop The Munchkin on a towel on her change mat on the floor. Expect the occasional wee or poo accident. This got more challenging when she started rolling and then crawling, but her skin cleared up by then so didn’t need as much nappy-free time.
• Use non-soap bath lotions and oils in the bath to help soothe baby’s skin. Your pharmacist can help with selection. This is also important for babies with eczema or psoriasis. 

What about cloth nappies? Well, I’m proud to say that we’ve used cloth nappies on The Munchkin since birth (although she now has eco-disposables at night) and the evidence says that due to the very clever materials which absorb moisture whilst still allowing the skin to breathe, they have a lower incidence of nappy rash than disposables. Some babies are actually sensitive to the chemicals in disposables. If your baby does get nappy rash with cloth nappies:

• Wash at least every two days.
• Make sure they are thoroughly rinsed and dry before using.
• Allow them to dry in fresh air and sunlight as often as possible. The UV in the sunlight helps kill any bacteria.
• Avoid waterproof covers as these can make the area hot and sweaty.
• If using barrier creams with cloth nappies, use a liner (washable or flushable) as the creams can accumulate in the nappy and reduce the absorbency.

   

Consult your doctor if:

• The rash spreads outside the nappy area.
• The rash has not improved after five days of treatment.
• The skin is broken and the rash is severe.
• Signs of a bacterial infection are present (e.g. weeping, pus, yellow crusts, blisters).
• Baby has a fever, is very unsettled or is not feeding as well as usual.

If you’re in the area, please pop in and have a chat with the pharmacists at Terry White Chemists Berwick about all your health, and especially baby needs. The four owners are all pharmacists (and have 7.5 kids between them, ranging in age from their mid-twenties to one due in September!) and two of the other pharmacists are also mums. All our pharmacists would be pleased to help you choose the right products to help clear up and prevent nappy rash. And don’t forget to ask for a free Self Care Card to take home. They contain helpful information and tips and are available on a range of health topics, including nappy rash.

References and further reading

• Nappy Rash Self Care Card, Pharmaceutical Society of Australia, published February 2011
• Nappy Rash Fact Sheet, Better Health Channel, published 2011 (accessed online 26 July 2011)
• Nappy Rash article, Professor Frank Oberklaid and Dr Leah Kaminsky, Raising Children Network (accessed online 26 July 2011)
• Rash Decisions - Why Does Using Cloth Nappies Help Prevent Nappy Rash?, My Green Nappy (accessed online 26 July 2011)

Introducing...

Hello and welcome to the Terry White Chemists Berwick Pharmacist Blog. Our goal is to provide you with information and general advice on health-related issues...the sort of stuff you can have a chat to your friendly local pharmacist about, but from the comfort of your own computer (or mobile phone or iPad or other device, if you’re tech-savvy).

The information provided will be researched and published in good faith, but please remember that it is general in nature and we can’t advise on individual cases. As always, if you have any health concerns, contact your local pharmacist or family doctor, or call 000 (or your country’s relevant emergency telephone number) in emergency cases.

I guess I should introduce myself.

My name is Kelly and I’m a pharmacist who works in a large metropolitan teaching hospital network in Melbourne. For the majority of my career (and I’ve been a pharmacist for almost ten years now...yikes! Where did the time go?), I’ve worked in hospital pharmacy, but I’ve also spent some time working in community pharmacy. My husband Darren (who is also a pharmacist and one of the owners of Terry White Chemist Berwick) and I also spent two years based in England where we worked as hospital pharmacists and spent any spare time and money that we had on travelling.

Right now I work part-time at the hospital and am kept very busy raising our gorgeous 19-month old daughter, The Munchkin. I used to think being a pharmacist was a hectic and rewarding job, but since becoming a mum, the words hectic and rewarding have both taken on a whole new meaning!

I must confess that I had never even considered writing a blog until I was asked to do so by Darren, Chris, Pete and Grahame, the owners of Terry White Chemists Berwick. To be honest, I was quite petrified by the idea initially (and still am, a bit)! But then I did a bit of a search to see what other pharmacist blogs exist out there, and was surprised to see that there wasn’t much, and especially not in terms of actual health advice.

So in-between my hospital pharmacist job and mummy job, I have agreed to give this blogging shenanigan a try. Not that there’s very much “in-between time”! If you want a job done, give it to a busy person, right?

I’m really excited about this and as I’m completely new at it, I’d love to hear your thoughts and comments and especially suggestions on what you would like to read. Don’t be afraid to tell me the truth...gulp...I can take it!

If you’re in the area, please pop into our store at 51 High Street, Berwick (we also have one at Eden Rise Shopping Centre) to say hello to our friendly and knowledgeable staff and experience our exceptional customer service for yourself. We’re sure you’ll be impressed by our great range of health and beauty services. We have male and female pharmacists, of all different ages and backgrounds, with many years of both pharmacist and life experience between them, who would love a chat. And there are times when a coffee and cake at Gallery Cafe, a massage at Indulge at Berwick, our beauty salon, or a mini-makeover at the Estee Lauder, Chanel, Clinique or Napoleon Perdis counter, can make you feel better than any tablet!

We'd love for you to visit our website and make sure you browse our online store if you're looking for a gift for yourself or a special someone.

Thanks for stopping by. The team at Terry White Chemists Berwick and I all look forward to seeing more of you!