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

Head lice and nits

It's been a long time between posts, but with school going back, I thought my first topic for 2012 should be head lice. Ugh, my head gets itchy just thinking about it. I still remember being back in primary school and queueing up to see the "nit nurse", just hoping that I wouldn't be one of the unlucky few who were pulled to one side after nits were found in their hair. Luckily, I never had head lice as a child, but it appears to be much more common these days.

Head lice, or nits, are small, wingless insects that live, breed and feed on the human scalp. They can resemble dandruff and can be found either on the scalp or the hair itself. Although people tend to think of itchy scalps when they think of head lice, about half the people who have head lice never scratch their head. Other signs to look for are the eggs which are generally at the base of the strand of hair and are difficult to dislodge, or moving lice on the scalp or hair. The lice themselves are usually about 2-3 mm long and can range in colour from greyish-white to reddish-brown. Some people also get sores on their scalp from the itchy bites which may become infected.

Because the lice do not have wings, they cannot jump or fly from one person to the next. They spread by head-to-head contact, such as hugs or close playing. If you know someone with head lice, it's important to also notify people who may have had head-to-head contact with them so they can also be checked.

The best way to check for head lice is to use the wet combing method.

1. Apply hair conditioner (any type or brand) to either wet or dry hair, covering the entire length and detangle with a regular hair comb. The conditioner makes it difficult for the lice to cling to the hair or crawl.
2. Divide hair into 3-4 cm sections and use a fine-toothed lice comb (available from Berwick Pharmacy) to slowly and carefully comb the hair all the way from the scalp to the ends.
3. After each stroke, wipe the comb onto a paper towel until clean. Check the paper towel for any lice or eggs.
4. Comb each section of hair through at least twice before thoroughly rinsing the hair.

You can also use the above wet combing method to treat head lice, but it needs to be done every second day for at least ten days in a row after lice or eggs are found. There is no need to treat head lice unless lice or eggs are actually found. If multiple members of your family are found to have head lice, make sure you treat everyone at the same time to prevent reinfection amongst each other.

Berwick Pharmacy carries a wide range of products to treat head lice. They range from shampoos and conditioners to lotions, sprays and mousses. We also stock herbal products to treat head lice. All head lice treatments must be applied to all parts of the hair in order to kill the lice and must be used twice, seven days apart. This ensures that not only the lice, but any eggs, are also killed. It is very important to read and follow the directions carefully as they can differ between products and correct use means a much higher chance of effective treatment. Do not shampoo the hair before using the treatment. Afterwards, hair should be dried with a towel as the heat from a hairdryer can prevent the product from working effectively. Special care should be taken if you are pregnant or breastfeeding, under two years old or have any open scalp wounds, allergies or asthma. Speak to our pharmacists who can advise on which product is best for you and your family.

Resistance to head lice treatments is unfortunately becoming more common so sometimes you may need to try a different product to ensure the hair is rid of lice. Once the treatment is complete, use the wet combing method the following day to ensure the lice are dead. If not, it is likely that the lice are resistant to that product and the active ingredient in it, so speak to your pharmacist about finding an alternative.

If your child has head lice, you should advise the school as well as any close contacts so they can be checked and treated. Children can return to school after their first treatment, but don't forget that they will still require a second treatment one week later.

In addition to treating the hair, towels, sheets, pillow cases and headwear such as scarves and hats should also be washed in hot water (at least 60 degrees celcius) or dried in a clothes dryer for at least 15 minutes. Combs and brushes should be placed in hot water (again, at least 60 degrees) for at least five minutes after combing through hair with head lice. Items such as bicycle helmets which cannot be washed should be placed in a sealed plastic bag for at least two weeks.

Advice to prevent catching head lice includes keeping long hair tied back and not sharing hats, brushes or combs. It is still relatively common though so some parents find it useful to check their children's hair every week using the wet comb method in order to catch it early.

Make sure you drop into Berwick Pharmacy to speak to our pharmacists if someone in your family has head lice. We can show you our wide range of head lice treatments and help you decide which one is best for you. We also have free Self Care Cards which you can take home with lots of useful information. Our staff would love to help you get rid of this common, but frustrating condition as quickly and easily as possible.

Here's a cute cartoon I found online...

References and further reading

• Head lice (nits) - treatment and control Fact Sheet, Better Health Channel, published August 2011 (accessed 31 January 2012)
• Head Lice Self Care Card, Pharmaceutical Society of Australia, published April 2011

• Centers for Disease Control and Prevention website