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)

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

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

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)