Eczema

We had our second baby in March, a daughter, so it's been awhile since I've managed to find time to write a new post.

Thought I'd restart by doing something short and sharp on eczema. Eczema is a type of chronic dermatitis that usually affects people with a family history of eczema, asthma and/or hayfever. The main signs include dry, red and itchy skin and it can vary in severity from mild redness or itching to weeping and infected blisters.

Eczema  is very common, especially in babies, but 50% of babies grow out of it by the time they are two years old, and 85% by the time they are five.

The main rules for looking after eczema are:

1. Moisturise

Keeping skin nice and moist helps to decrease itching and dryness. Moisturisers should be applied liberally at least twice a day, including after bathing. There are literally hundreds of different moisturisers available, but perfumed products should be avoided. Our pharmacists at Berwick Pharmacy can assist you in choosing the right one.

2. Avoid soap

Soap can be very drying on the skin so it is better to use specially formulated soap substitutes, available from Berwick Pharmacy. Try not to have the water too hot in the shower or bath as this can increase dryness and itchiness.

3. Medications if needed

The most common medication used to treat eczema are corticosteroid creams. These vary in potency, with some available from Berwick Pharmacy over-the-counter whilst others require a prescription from your doctor. Chat to our pharmacists to discuss your options.

Other medications such as oral antihistamines, other skin preparations or even immunosuppressants may also be useful. Speak to your pharmacist or doctor about these.

If the skin becomes infected (look for crusts which are often yellow and weeping of the area), see your doctor as your may need a course of antibiotics.

4. Avoid triggers

If you are able to identify triggers that make your eczema worse, it makes sense to avoid these. Some triggers include stress, cat and/or dog hair, overheating (either from showers or baths, ducted heating or electric blankets) or chemicals (wear gloves if handling chemicals or detergents). It's often better to wear cotton clothing and to try and limit clothes with synthetic fabrics or wool which can be scratchy against the skin.

5. Try to avoid scratching

This can be super difficult, but it may be useful to try and relieve itching by using cool compresses or covering the skin. Ensure you keep your nails short and you may even need to wear cotton gloves while you are sleeping.

So if you or someone in your family has eczema, pop into Berwick Pharmacy to speak to our pharmacists and pick up your free Self Care Card.

References and further reading

Eczema and Dermatitis Self Care Card, Pharmaceutical Society of Australia, published February 2011

Eczema (atopic dermatitis) Fact Sheet, Better Health Channel, published June 2012 (accessed online 4 July 2012)
Knowing Your Child's Eczema, Royal Children's Hospital website
Eczema Association of Australasia Inc website

Croup

Recently, lots of children that we know have been diagnosed with croup. They are all toddlers which is not surprising since croup is most common between children aged six months to three years old. One of my friends said that her two year old son said, "Mummy, I can't breathe," and it absolutely petrified her.

Croup is a relatively common respiratory infection which usually starts with a cold. It is usually caused by infection from a virus, but can also be due to a bacteria. Like colds, it is spread in droplets via sneezing or coughing or touching a surface which has been contaminated with the virus.

Croup is basically an inflammation of the airways which makes it difficult to breathe. The reason it affects children is that they have narrower airways than adults, so any further restrictions on these airways can be quite serious. It is more likely to occur when it is cold, particularly during the night. The symptoms are a barking cough, a hoarse voice, a noisy high-pitched sound when breathing (this is called stridor) and can progress to difficulty breathing.

In severe cases, croup can cause your child to stop breathing so you should see a doctor urgently if you are concerned (go to the Emergency Department of your nearest hospital if it is after hours). Some symptoms which warrant immediate medical attention include:

• Difficulty swallowing.
• A sudden attack of coughing.
• Unusual noises while breathing. This can include stridor or a snoring sound when breathing out.
• If you notice a 'caving in' of the chest when trying to breathe in. 
• An increase in the rate of breathing or any difficulty breathing (especially if they stop breathing for more than ten seconds at a time).
• A bluish tinge to the lips or fingernails.
• A rapid heart rate.
• If your child is restless, anxious, sweating, abnormally drowsy and can't be woken, or has a high fever (38.5 degrees celcius or higher).

If the croup is mild and none of the above symptoms are displayed, ensure your child keeps well hydrated with frequent drinks, try and keep the room reasonably warm and offer lots of cuddles and reassurance to your child. You can also give paracetamol, but ensure you give the correct dose for your child's weight. Mild croup will usually go away on its own within 48 hours, but may last up to a week.

If the croup is more severe, your child may require medication. Croup is usually caused by a virus so giving antibiotics won't help the infection or the symptoms. Your doctor may prescribe a few doses of a corticosteroid such as dexamethasone or prednisolone, which will help reduce the swelling of the airways and make it easier to breathe. These can be given either in tablet or liquid form. If admitted to hospital, doctors may prescribe adrenaline which is breathed in via droplet form through a mask and nebuliser. This will also help with the breathing.

The best way to prevent croup is via good hygiene, but like colds and other infections, this is not easy and often even the cleanest children contract croup. Wash hands with soap and water regularly, and especially before preparing or eating food and after coughing, sneezing or blowing your nose. Discourage the sharing of cups and eating utensils. Cover mouths after coughing or sneezing. Keep hands away from eyes, nose and mouth. Keep children home from school or childcare if they are unwell.

Croup can be very scary, both for the child and the parents or carers. If you are at all worried or if your child has any of the above symptoms, seek medical attention from your family doctor or a hospital immediately. You are always welcome to give the pharmacists at Berwick Pharmacy a call to discuss any concerns about your family's health.

References and further reading

• Croup Fact Sheet, NPS, published 4 May 2012 (accessed online 9 May 2012)
• Croup Fact Sheet, Better Health Channel, published February 2012 (accessed online 9 May 2012)

Preparing for Pregnancy

I'm in my early 30s so have lots of friends and family who are starting or expanding their families with babies. It's an exciting time in life and so lovely when we get to meet the bubs and watch them grow into little people. There are so many things to consider when having a child. I thought I'd focus on some of the things you can do to best medically prepare yourself and your body for pregnancy.

Firstly, it's a good idea to see your family doctor for a medical check-up. This is particularly important if you are taking any medications as they can cross the placenta into the baby. Some medications are safe, some should be used with caution and some should not be taken at all during pregnancy. By discussing your medications with your doctor before you start trying to become pregnant, you can weigh up the risks and perhaps even change to a medication known to be safe with plenty of time. Don't forget to mention over-the-counter medications and herbal or complementary medicines as these can also affect your baby.

You should also discuss immunisations with your doctor. If you are unsure about what immunisations you have had, you can organise blood tests to check your immunity status. It is important that you are fully immunised against chicken pox, influenza, measles, mumps, rubella, diphtheria, tetanus and whooping cough. If you require any 'live' vaccines such as measles, mumps, rubella or chicken pox, you should wait one month before trying to become pregnant. It is also a good time for any other people who live with you to update their immunisations too as this will reduce the risk of these diseases being passed on to your baby.

It is recommended that women who are intending to become pregnant take 0.5mg of folic acid for one month before pregnancy and at least the first three months during pregnancy. Folic acid has been proven to reduce to risk of neural tube defects such as spina bifida. Some women, such as those with a family history of spina bifida or cleft palate or are taking medication for epilepsy, are recommended to take higher doses. Once again, speak to your doctor.

Some women choose to take a multivitamin either before and/or during pregnancy. Discuss this with one of our pharmacists at Berwick Pharmacy as excess amounts of certain vitamins such as Vitamin A can actually be harmful to your baby.

Iodine is a mineral which helps with the development of the thyroid hormone. Iodine is found is most breads as well as eggs, meat, dairy and seafood. It is also in some pregnancy multivitamins. Women who are pregnant should switch to iodised salt (rather than uniodised salt) when cooking.

No completely safe level of alcohol consumption has been determined for pregnant women. Many women choose to abstain from alcohol completely and some will allow the occasional drink. Keep in mind that there is a higher risk if alcohol is consumed early in the pregnancy, including the time prior to the first missed period. Speak to your family doctor or obstetrician with any concerns.

If you are a smoker, it's the perfect time to quit. Smoking can increase your risk of miscarriage and stillbirth and babies of mothers who smoke are at a higher risk of low birth weight, being born prematurely and Sudden Infant Death Syndrome (SIDS). Our pharmacists at Berwick Pharmacy can discuss options with you to help you to quit.

It's wise to limit your caffeine intake if you are trying to become pregnant as there is evidence that it can decrease fertility. Don't forget that caffeine is also present in some soft drinks and energy drinks. Guarana, an ingredient also often in energy drinks, is not recommended during pregnancy.

If you are pregnant, you also need to be aware of the potential risk of Listeria and Salmonella infection. The risk of catching these bacteria is small, but it can be dangerous if it passes to your baby. Always practice good food handling hygiene and if you are eating reheated food such as leftovers, make sure it is piping hot. Avoid foods such as soft cheeses, cold cooked chicken or deli meats, whole egg, pate, soft serve ice-cream and raw seafood.

It's also worth having a dental check-up prior to becoming pregnant as generally, procedures such as x-rays aren't recommended during pregnancy. If you are planning on having your baby in a private hospital, you should also check your level of health insurance and make sure you are aware of any waiting periods.

So yes, there's lots to think about, but by doing some groundwork in advance, you're giving yourself, and your baby, the best start to life. Pop into Berwick Pharmacy anytime for advice on pregnancy or any other

health issues. We even sell home pregnancy tests for when the time comes.

Here's a cute cartoon I found...

References and further reading

• Immunisation and Pregnancy Fact Sheet, Better Health Channel, published July 2011 (accessed online 22 March 2012)
• Pregnancy and Drugs Fact Sheet, Better Health Channel, published March 2010 (accessed online 22 March 2012)
• Preparing for Pregnancy - Your Health Fact Sheet, Royal Women's Hospital, published January 2008 (accessed online 22 March 2012)
• Food Safety During Pregnancy Fact Sheet, Royal Women's Hospital, published January 2012 (accessed online 22 March 2012)

Epilepsy

March is Epilepsy Awareness Month in Australia, with March 26th 2012 being Purple Day, where people are encouraged to wear purple or have purple-themed events to raise awareness and funds for epilepsy.

Everyone knows about epilepsy, right? After all, it is a relatively common disease. It is recognised as the world's most common brain disorder. It is estimated in Victoria alone that approximately 4% of the population, or 220,000 people, will have epilepsy in their lifetime. When I read that figure, I must admit that it was larger than I would have guessed.

I suspect that many people's perception of epilepsy comes from what they have seen on television or in movies. i.e. someone falls to the ground twitching and jerking and frothing at the mouth. Quite dramatic. And while some people with epilepsy can have seizures like that, there are many, many more who don't.

A seizure, or 'fit' as it is commonly referred to, is a sudden, short burst of abnormal electrical activity in the brain. Seizures can last from a few seconds to a few minutes and can cause changes in thoughts, feelings, behaviour or consciousness. Just because someone has a seizure, this does not mean they have epilepsy - it could just be a one-off. People with epilepsy have recurrent seizures.

Epilepsy can be caused by an injury to the brain, a stroke, an infection in the brain, a tumour, other conditions such as Alzheimer's Disease, or genetics. In about half of cases, however, the cause is unknown.

The type of seizure generally falls into one of two groups:

1. Partial or focal seizures - these start in one part of the brain and affect the part of the body controlled by that part. Usually these seizures only last a few minutes. They can either be a simple partial seizure (which can affect hearing, vision, taste, smell or muscle jerks, but the person remains conscious and remembers what happens) or a complex partial seizure (the person may appear vague or confused and show some strange behaviours such as smacking their lips repeatedly).
2. Generalised seizures - these affect most or all of the brain. They can either be absence seizures (where the person appears to have spaced out as if they are daydreaming and may then have some facial twitches) or tonic-clonic seizures (the person's entire body goes stiff before they experience uncontrollable muscle jerking and twitching. They may also have other signs such as drooling of the mouth, groaning and loss of bladder control). If these symptoms last more than five minutes, an ambulance should be called. There are also a few other types of generalised seizures, but these are the two main ones.

Different people may be aware of triggers which make it more likely for them to have a seizure. Common triggers include tiredness, alcohol, caffeine, stress, illegal drugs, menstrual periods, illness, fever, flickering lights or hunger. If you have epilepsy, it is wise to try and identify any triggers and avoid them if possible.

Medications have a very important role in controlling seizures in people with epilepsy. In fact, of people at risk of recurring seizures, more than 60% are likely to achieve complete seizure control with medication within a year.

There are many different medications which can be taken for seizures and often, people need to be on more than one to sufficiently control their seizures. The type or combination of medication chosen will be a joint decision between you and your doctor, but will often be influenced by factors such as the type of seizures, your age, other medications you may be taking and the risk of further seizures.


Just like any other medication, there are possible side effects. And like any other medication, if you find you are experiencing anything unusual, especially when medications are commenced or stopped or changes to your dose have been made, you should speak to your doctor and/or pharmacist. Often side effects are more likely to occur at the start of treatment and will subside after awhile, but sometimes, you may need to be changed to a different medication.


As a general rule, do not suddenly stop taking your medication for seizures. Abruptly stopping them can result in seizures or a medical emergency, as can missing doses. Usually, if your doctor wants to stop one of these medications, they will advise you on how to gradually wean it down to minimise any unwanted effects.


Everyone who takes any sort of medication should also be aware of the possibility of their medication interacting with another medication (including medicines you buy over-the-counter from your pharmacy) or even a herbal product or vitamin. It is always wise to keep a list of your medications with you and check with your doctor or pharmacist to make sure anything new will not cause any problems.

Although many medications have generic brands which are available, in the case of epilepsy, it is advisable that patients stick to one brand of medication and do not swap. Due to the way antiepileptic drugs work, even the slightest variation in the amount of the drug taken appears to cause problems for some people with epilepsy, such as seizures or side effects. Our pharmacists at Berwick Pharmacy can help you make sure that you stick to the same brand.

Epilepsy is very common and can usually be managed with medication and awareness. If you or someone you know has epilepsy, try and identify and avoid triggers for seizures. Make sure you learn about the condition and what to do in case of a seizure. Be aware of your medications and how to take them and avoid abruptly stopping them as well as the potential for any interactions.


Our pharmacists at Berwick Pharmacy can help you find more information about your condition and the medications. Pop in for a free Self Care Card on epilepsy. We can advise on whether other medications or herbal products will interact with your seizure medication. We also sell medico-alert bracelets which can have your personal information as well as stating you have epilepsy to alert medical professionals in case you are unable to communicate with them.

References and further reading

• Epilepsy Self Care Card, Pharmaceutical Society of Australia, published February 2011
• Epilepsy Australia website
• Purple Day website

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)