the good and the bad - costco · how to keep excessive sweating (hyperhidrosis) at bay 14...

SPRING//SUMMER 2018

The Healthy Living Magazine for Costco Members

THE GOOD AND THE BADKeeping your carbs and insulin in balance 8

1www.costcopharmacy.ca

WELCOME READERS! With warmer weather just around the corner, it’s the perfect time to get out of your old winter habits and blossom into a healthier version of yourself. As you plan for patio season and outdoor activities, set aside some time to look through the pages of this issue. Inside, you will find a variety of health-related articles with informative and useful content to keep you feeling healthy and at your best.

If you’re one of the 3.5 million Canadians living with diabetes, read our cover story on page 8 to learn about carbohydrate counting and how you can get your blood sugars back on track. Sticking to your medication schedule can be a challenge. Our article on page 14 provides everyday tips to help you remember to take your medicines as prescribed. While planning vacations are always a big part of the season, if you have fibro-myalgia, pain and muscle stiffness can get in the way. Read our article on page 6 to learn more about this condition and about preventing flare-ups so that you can enjoy the warmer weather.

We hope you enjoy reading our magazine and wish you all a safe and happy summer.

2 Feel good in your skin Psoriasis: challenges and solutions

4 The sweet truth about sugar Navigating through different options

6 A puzzling condition Shedding some light on fibromyalgia

8 Carb counting An effective way to keep your blood sugar levels under control

10 Staying healthy after 50 Preventative measures that can help you stay healthy

12 Don’t sweat it How to keep excessive sweating (hyperhidrosis) at bay

14 Medication non-adherence The consequences of non-adherence and finding

practical solutions

16 A common brain disorder called epilepsy Weighing the treatment options

THE WELLNESS CONNECTION

Editor and Director of Professional Services, Costco Pharmacy Joseph Hanna, B.Sc. Phm., CDE, CGP, RPh.

McCann Pharmacy Initiative Writers – Vijay Sarma, Hons.B.Sc.Pharm/Toxicology, B.Sc. Phm., RPh. Vanja Adzovic, PharmD, RPh.

Reviewer – Sandra Carey, B.Sc. Phm., RPh.

Reviewer and Costco Professional Services Pharmacist Nancy Bazzi, Pharm. D., RPh. , CDE

Copy Editor Caroline Szpak

Art Direction and Production Design Lee-Ann Hall and Allison Prindiville

Publishing Project Manager Julie Kinnear

Publishing Coordinator Isabel Trottier-Levasseur

Production Specialist Élaine Émond

We welcome your feedback on this magazine. Send an email to [email protected] semi-annually by Costco Wholesale Canada Ltd. (“Costco”) Copyright © 2018.All editorial rights reserved. All articles are medically reviewed and approved by McCann Pharmacy Initiative prior to publication.McCann Pharmacy Initiative is solely responsible for the content of all articles and educational material unless otherwise indicated.The information in this magazine is intended as an educational aid only, not as medical advice for individual conditions or treatment. This information is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor or pharmacist before taking any prescription or over-the-counter drugs (including any herbal medicines or supplements), or following any treatment or regimen. Only your doctor or pharmacist can provide you with advice on what is safe and effective for you. You should consult your health care professional if you are making significant health-related changes.Neither Costco nor McCann Pharmacy Initiative is liable for any claims or actions or damages that the reader may have through reliance on the magazine’s content respecting the reader’s health.®*Registered trademark of Price Costco International, Inc. used under license.TM Kirkland Signature is a trademark owned by Costco Wholesale Corporation and is used under licence in Canada.178073-18

Cover/Contents photography: © RomarioIen

SPRING //SUMMER 2018

Distribution of this magazine has been funded in part by the following sponsors. This funding is independent of the care you receive as a patient of Costco Pharmacy.


SPRING//SUMMER 2018


THE GOOD AND THE BADKeeping your carbs and insulin in balance 8

178073-18_Wellness-Spring-Summer.indd 1 2018-01-10 3:03 PM

Costco Pharmacy Prescriptions by mail*Costco Pharmacy prescriptions by mail offers an easy and cost-effective way of ordering your prescription medications.

* Delivery is available in all of Canada, except in the provinces of Quebec and PEI, and in the territories.

TM Expedited Parcel is a trademark of Canada Post Corporation.

Prescriptions and medication refills can be ordered online at costcopharmacy.ca, 24 hours a day. Your order will be delivered to your home via Canada Post Expedited Parcel™. Shipping is FREE and you will receive your prescriptions in three to five business days.

To transfer, refill or submit a new prescription, visit costcopharmacy.ca and follow the simple instructions.

www.costcopharmacy.ca 32 The Wellness Connection Spring // Summer 2018

MORE THAN 1 MILLION CANADIANS live with psoriasis.1 It is a skin disease that can impact a person’s quality of life far beyond cosmetic and physical aspects.1 Psoriasis is one of many skin conditions and may be difficult to tell apart from other rashes and itchy spots. Here is a quick guide to help you recognize and understand psoriasis, its symptoms and the treatment options.

What is psoriasis?Psoriasis is a chronic (long-lasting), non-contagious, inflammatory skin condition.1,2 Normally, new skin cells “replace” the old ones at a healthy pace. In psoriasis, new skin cells pile up on top of each other too quickly and mix in with the older skin cells on the skin surface.2 This leads to thickening of the skin and other uncomfortable symptoms.1

While there are different types of psoriasis, the most common one, which affects 80% to 90% of those diagnosed, is plaque psoriasis. It appears as thick, raised, red patches with flaking silvery scales and defined borders.1,2,3 These patches, also called plaques, may itch or feel sore and may also crack and bleed.1,2

While the plaques can vary in size and may appear anywhere on the body, the elbows, knees, scalp, chest, palms, feet and lower back are the most common spots.1,2 The plaques tend to appear symmetrically—in other words, in the same place on the right and left sides of the body.2 The symptoms often go through cycles where they worsen (flare up), and then improve.1,2 Depending on the severity of the condition, psoriasis can also impact a person’s emotional and social well-being, affecting relationships and self-image.3

What are the causes and are you at risk? Psoriasis is considered to be an autoimmune disease. This is when your immune system creates an inflammatory response against your own body and in this case, against your skin.1,2 It affects people of different races and genders, but is more common among adults.2,3 It commonly starts between the ages of 16 to 22, but may also appear in older adults.3 While the exact cause of psoriasis is not

known, having a blood-relative with this condition may increase your risk of having it.1,2 Certain triggers can also make psoriasis worse. These triggers include skin injury, infection, stress, dry or cold weather, and too much sunlight exposure.1,2

How is it diagnosed and treated?In most cases, it will be enough for your doctor to ask about your symptoms and examine the plaques.3 In rare cases, a diagnosis of psoriasis may require a skin biopsy (sample of your skin to be taken for further examination).3

Since psoriasis is a chronic condition, the main goal of treatment is to reduce the symptoms and prevent them from affecting your quality of life.3 The table below highlights the treatment options available for people suffering from psoriasis. They work by slowing down skin cell turnover, so that new skin cells don’t pile up on top

of each other. Some treatments may also reduce an overactive immune system that may cause inflammation. Your doctor can determine which will be best for you based on the severity of your symptoms.1,3

Sometimes the chosen treatment may not be effective enough, so your doctor may adjust and change the recommendations as needed. With many options available, it’s possible to personalize the treatment to target your specific symptoms. This may require combining two or more different treatment options to ensure the best results possible.1

Sun safety is important in psoriasis management Though exposure to the sun can help with psoriasis symptoms, too much sun can worsen your symptoms, lead to skin damage, early aging, and even skin cancer.1,5 Plus, some psoriasis medications can make your skin more sensitive to sunburns. The

usually recommended sun safety tips such as covering up, wearing sunglasses, and avoiding indoor tanning beds should be followed.5

Living with psoriasis symptoms can be challenging both physically and emotionally. If you or a loved one is suffering with this condition, speak to a dermatologist. Feeling good in your own skin is just around the corner.

References1. Canadian Dermatology Association. Psoriasis.

Retrieved from: dermatology.ca/public-patients/skin/psoriasis/

2. NIH. Questions and Answers about Psoriasis. Mar 2017. Retrieved from: www.niams.nih.gov/health_info/Psoriasis/default.asp

3. Kim WB, Jerome D, Yeung J. Diagnosis and management of psoriasis. Canadian Family Physician. 2017;63 Retrieved from: www.ncbi.nlm.nih.gov/pmc/articles/PMC5389757/

4. Ely JW, Seabury MS. The Generalized Rash: Part II. Diagnostic Approach. American Family Physician. 2010;81(6) Retrieved from: www.aafp.org/afp/2010/0315/p735.html

5. Canadian Cancer Society. Being safe in the sun. Retrieved from: www.cancer.ca/en/prevention-and-screening/live-well/sun-and-uv/being-safe-in-the-sun/?region=on

Did you know Psoriasis can be confused with eczema (atopic dermatitis) as both appear similarly on the skin. In eczema, however, the lesions are not covered with dead skin, hence the plaques do not appear silver or whitish as they may in psoriasis.1,2,4 Also, eczema can have a more intense itch.

Type of treatment Examples About

Topical (applied on the skin)

Corticosteroids, vitamin D and A products, and coal tar products

Available in a variety of potencies/strengths and are often used for mild to moderate symptoms.

Available in the form of creams, lotions and ointments. Lotions are ideal for hairy areas like the scalp. While ointments are greasy, they can help with very dry skin.

Some lower-strength steroids are available without a prescription.

Internal medication (works inside your body)

Methotrexate, acitretin, cyclosporine, adalimumab, infliximab

Available in the form of tablets, capsules and injections.

Often reserved for more severe cases.

These are prescription medications.

Light therapy Narrow band UVB phototherapy: involves a UV light that goes beyond the first layer of the skin

PUVA therapy: involves combining a drug called psoralen and exposure to a UV light. Psoralen makes the skin more sensitive to the UV light, thus making it more effective

When guided by a dermatologist, sunlight exposure seems to improve psoriasis symptoms by slowing down skin cell turnover.

Feel good in your skinChallenges and solutions for psoriasis sufferers

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What is sugar? Sugar is a carbohydrate that adds sweetness to foods and drinks. There are many different types of sugar, but as they break down in the body, they all become glucose, which is a source of energy. Making sugar is a process of extracting it from plants containing naturally high concentrations of it, such as sugarcane or sugar beet. Sugar can also be made from palm, coconut and other plants. Some sugars are processed for longer periods of time and all the minerals and vitamins that naturally occur in the plant are removed. Such is the case with the white sugar (table sugar) that most of us are familiar with.2 Some other examples of sugars are brown sugar, raw sugar, honey, agave syrup and stevia. Most of these have approximately 15 to 20 calories per teaspoon. Stevia is calorie-free.

Sugars we consume can be divided into two categories:

• Naturally occurring: in fruit, vegetables and dairy• Added: in desserts, candy and beverages

Foods with naturally occurring sugars are often a part of a healthy diet because they also provide fibre, vitamins and minerals. But we are often eating too much additional sugar that is hidden in processed products or added to our foods and drinks on a daily basis.3 These are usually refined sugars, such as white sugar and high-fructose corn syrup. Consuming it in excess can cause health problems.3

What about artificial sweeteners? Artificial sugars (sugar substitutes) are chemically produced and are usually hundreds of times sweeter than regular sugar, but are essentially calorie- and carbohydrate-free, making them a popular choice for people with diabetes.3

Any dietary changes, such as switching to a new sugar or sweetener, should be discussed with your dietitian, especially if you have a health condition that’s impacted by sugar. For example, while aspartame is suitable for people with diabetes, it can cause serious health issues in people with a genetic condition known as phenylketonuria.4

You may have heard the controversy about some artificial sweeteners causing cancers and other illnesses. However, researchers have been unable to confirm these reports through clinical studies and Health Canada considers them generally safe.

A sweet choiceFor the most part, added sugars are high in calories while having no health benefits, so it’s best to reduce or avoid added sugars. Try making your own meals and desserts and substitute sugar with fruit, sweet cereal with oatmeal, and juices and pop with tea and water whenever possible. Also, get in the habit of reading nutrition labels and aim for foods that are lower in sugar and higher in fibre.

Note: Look at % Daily Value (DV) and keep in mind that:

• 5% DV or less of total carbohydrate per serving is low

• 20% DV or more of total carbohydrate per serving is high

It’s easy to turn to a delicious treat when you’re having a sweet craving, but it shouldn’t take the place of a nutritious healthy meal or snack. Take control of your health and eat nutritious foods that are low in added sugar whenever possible. Like everything in life, moderation is key.

References1. CBC News. Lower sugar intake to less than 5% of daily calories, WHO says.

Mar 5, 2014. Retrieved from: www.cbc.ca/news/health/lower-sugar-intake- to-less-than-5-of-daily-calories-who-says-1.2560639

2. Canadian Sugar Institute. Cane Sugar Refining. Retrieved from: www.sugar.ca/Nutrition-Information-Service/Educators-Students/Purification-of-Sugar.aspx

3. Eat Right Ontario. Kids, Sugar and Healthy Eating; What you need to know about sugar. Oct 9, 2016. Retrieved from: www.eatrightontario.ca/en/Articles/ Childrens-Nutrition/Healthy-Eating-and-Healthy-Weights/Kids,-Sugar-and-Healthy-Eating.aspx and www.sugar.ca/Nutrition-Information-Service/Educators-Students/Purification-of-Sugar.aspx

4. Dietitians of Canada. Sweet Advice on Sugar Substitutes. Mar 6, 2017. Retrieved from: www.dietitians.ca/Your-Health/Nutrition-A-Z/Food-Safety/Artificial-Sweeteners.aspx

IT’S HARD TO BELIEVE that the average Canadian consumes 40 kg of sugar per year, or approximately 26 teaspoons per day. This is double the recommended limit of 10% or less of calories obtained from sugar.1 Eating too much sugar can lead to heart disease, stroke, obesity, diabetes and cavities. While sugar is naturally found in many foods, it’s often added to other foods as well. Here’s more on sugar and satisfying your sweet tooth the right way!

Nutrition FactsPer 90 g serving (2 slices)Amount % Daily Value

Calories 170 Fat 2.7 g 4 %

Saturated 0.5 g 5 %+ Trans 0 g

Cholesterol 0 gSodium 200 mg 8 %Carbohydrate 36 g 13 %

Fibre 6 g 24 %Sugars 3 g

Protein 8 gVitamin A 1 %Vitamin C 0 %Calcium 2 %Iron 16 %

Navigating through the options

The sweet truth about sugar

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ACCEPTABLE DAILY INTAKE OF ARTIFICIAL SWEETENERS (mg/kg of body weight) 40 mg 9 mg 5 mg

www.costcopharmacy.ca6 The Wellness Connection Spring // Summer 2018

Did you know Coping with pain from fibromyalgia is difficult, but it can be managed. By consulting with health experts who specialize in pain treatments (e.g., in pain clinics), you can learn ways to cope with sudden pain flare-ups and improve your quality of life.

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What can be done to feel better?The main goals of fibromyalgia treatment are to reduce pain and improve function. Treatment requires a joint effort involving your doctor, a physiotherapist, an occupational therapist, possibly a behavioural therapist and most importantly, yourself.4 Other goals may relate specifically to your current health and to activities you may want to get back to doing.

Can medication help?To help manage fibromyalgia, there are a number of medications that may help with pain, sleep and mood. The table below provides a quick summary of some of the options that your doctor or pharmacist may discuss with you.

Medication options used to treat fibromyalgia pain:2, 3, 5

Type of Medication Examples Comments

Antidepressants Amitriptyline

Duloxetine

Recommended as first choice for people who suffer from fibromyalgia and depression or anxiety. Also improves sleep.

Muscle relaxants Cyclobenzaprine Promotes sleep.

Anti-epilepsy drugs Gabapentin

Pregabalin

May also help with sleep, since drowsiness is a potential side effect.

Although pain relievers such as acetaminophen (Tylenol®) and ibuprofen (Advil®) may be suggested for treatment of fibromyalgia pain, they may not be effective. It is important to understand that depending on your medical history and risk factors, some of these options may not be the best options.2 Consult with your Costco pharmacist about the most suitable treatment for you.

Can a physiotherapist or counselling help me cope?While a variety of medication options are available, living well with fibromyalgia often involves a combination of medication and lifestyle changes.

By visiting a physiotherapist, people with fibromyalgia can learn exercises that improve strength, flexibility and stamina.3 As it is challenging to eliminate the pain associated with fibromyalgia, a good treatment plan helps to restore function through participation in activities that promote independence and lower stress.2 Counselling can go a long way to reduce the negative impact of fibromyalgia on health and well-being.2 Behaviour therapy is sometimes used to help reduce fear of pain and activity.2 Also, by participating in self-help groups, fibromyalgia sufferers may feel more comfortable sharing their experience with people who are in the same situation and can listen and provide support.1

As you work towards feeling good again, a gradual exercise program is recommended with activities suited to the your abilities and goals.2 Adjusting your work environment can also help you avoid activities that can trigger pain. An occupational therapist is a good partner to provide guidance on making specific changes so you can perform tasks with less stress on your body.3 People sometimes turn to alternative therapies such as yoga, meditation, acupuncture and massage therapy.3 Although there are many people who seek out these alternative methods for their symptoms, they may not be as effective as the other options mentioned above.2

Fortunately, fibromyalgia is now recognized as a medical condition that can severely impact a person’s quality of life. With a variety of options available for fibromyalgia symptoms, talking to your health care provider can help you narrow down suitable treatments. While fibromyalgia can be challenging to understand and the treatments complicated, living a healthy, productive life is within your reach.

References1. Canadian Women’s Health Network. Fibromyalgia. 2012 Retrieved from:

www.cwhn.ca/node/40784

2. Fitzcharles, M.A., et al., 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary. Pain Res Manag, 2013. 18(3): p. 119-26

3. The Mayo Clinic. Fibromyalgia. 2017 Retrieved from: www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780

4. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Fibromyalgia. 2014 Retrieved from: www.niams.nih.gov/health-topics/fibromyalgia#tab-overview

5. Canadian Pharmacists Association, L. Arman, et al.,CTC 2017. 2017, Ottawa, Canada: Canadian Pharmacists Association. p. 1094-1106

It’s not all in your headShedding some light on fibromyalgia

ARE YOU HAVING TROUBLE sleeping because of muscle pain? Are you feeling tired for no apparent reason? You may have a chronic condition called fibromyalgia.1 It affects between 2% to 3% of Canadians,2 the majority of whom are women between the ages of 20 to 50. However, men, teenagers and children can also be affected.1

At times, people who have fibromyalgia are made to feel that their symptoms are “all in their head.”3 Although it is typical for a person to occasionally have pain and/or fatigue, when these symptoms occur more frequently without an apparent reason and affect a person’s quality of life, they should be investigated. For some people, these symptoms can also take an emotional toll, leading to anxiety and depression.1

The good news is that fibromyalgia is manageable. There are ways to help manage the pain and keep up with routine activities such as work, housekeeping, childcare or hobbies.1

What are the symptoms and how can it be diagnosed?People with fibromyalgia have a general feeling of pain all over their body and a lack of energy. They tend to describe their pain as a dull ache on both sides of the body, as well as above and below the waist, usually lasting for at least three months.3 People who suffer

from fibromyalgia may also have difficulty sleeping or focusing on mental tasks.3 The symptoms can vary from one person to another, even changing on an hourly or daily basis. Because pain and fatigue are symptoms that are common to many other conditions, diagnosing fibromyalgia can be a challenge. A physical exam and lab tests are often done to rule out other conditions first.2 Other tests for fibromyalgia may include a tender point exam to determine the number of tender points on 18 specific spots on the body and a questionnaire on symptoms and how they affect the person’s ability to function daily.3

What causes it?In some people, fibromyalgia often develops with no apparent cause. In others, it may appear after a traumatic experience such as an accident, stress or hormonal changes.1 Even the experts do not fully understand the exact cause of fibromyalgia. Research is being done to answer some of the puzzling questions around this condition.

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98 The Wellness Connection Spring // Summer 2018

COVER STORY

*Note: Since dietary fibre does not raise blood glucose, it’s subtracted from the total carbohydrate content.

THERE ARE MORE THAN 3.5 MILLION Canadians living with diabetes, and this number is estimated to increase to 5 million by 2025.1 Having diabetes may make daily meal planning more challenging, especially if you are using insulin. Fortunately, there is an effective way to help keep your blood sugar levels under control and find a perfect balance between the carbohydrates you consume and your insulin dose. Carbohydrate (carb) counting is a flexible and effective way to plan your meals to keep your diabetes under control. It focuses on counting the amount of carbs you consume in a meal or snack and matching that to your insulin dose so that your blood sugars stay in balance. While it may seem confusing at the beginning, once you get the hang of it, it can lead to better diabetes management, and you’ll find it easier to fit a wider variety of foods into your diet.2 In this article, we will look at carb counting in more detail and explain how you can incorporate it into your daily diabetes treatment plan.

The role of carbs and insulin in diabetesDiabetes is a condition in which your body does not properly control the amount of sugar in the blood, often resulting in blood sugars that are too high. It is caused by not having enough, or not responding to insulin to meet the needs of your body. Insulin is a hormone that acts as a “key” that allows the blood sugar to enter the cells of the body where it can be used as energy or stored for future use. If not managed properly, diabetes can, over time, affect your quality of life and possibly lead to heart, kidney, eye, blood vessel and nerve damage.2

People with diabetes may be prescribed insulin to help manage their blood sugar. This is typical in type 1 diabetes (where no insulin is produced by the pancreas), but may also apply to some people with type 2 diabetes (where some insulin is still produced). The two general categories of insulin that are often prescribed are called basal and bolus insulin.2 Basal insulin works slowly and for a longer time to keep blood glucose levels in the “normal” range between meals and overnight, while bolus insulin works quickly to even out blood sugar soon after meals.2

Carbs are found in many foods, such as fruits, vegetables, grains and dairy, and are an important part of a balanced diet. When you eat carbs, your digestive system breaks them down into sugar. Since carbohydrates have the greatest effect on your blood sugar level, carb counting allows for flexibility with meal planning and improving blood sugar control.

STEP 1 Meal planning The first step to carb counting is creating a healthy and balanced meal plan that gives you more information on how much carb, protein and fat to eat each day. A registered dietitian can guide you through this process and set carbohydrate goals in grams for each meal and snack. In general, the percentage of total daily energy from carbs should be between 45% and 60% based on a 2,000-calorie-a-day diet. This represents an intake of about 225 to 300 g of carbs daily. You can also check out the “Beyond the Basics” tool on the Diabetes Canada website (diabetes.ca) to learn more about meal planning and learning to create one on your own.

STEP 2 Carb countingNext, you will need to count the amount of carbs in the foods you consume at each meal and snack. You can often get the carb content of a food from reading the Nutrition Facts Table on the label. For foods without a label, such as fruits and vegetables, you can get this information by using an online carb tracker tool or a food composition book. In general, grains and starches, fruits and milk and alternatives have about 15 grams of carbs in one serving while most meat and alternatives, vegetables and fats have little to no carbs. To accurately count carbs based on portion size, consider using measuring tools such as a food scale or measuring cups.

Let’s say you’re planning on consuming a turkey sandwich and two cookies for lunch. In the left side bar is an example of counting the total carb content for this meal.

STEP 3 Insulin to carb ratio This tells you how many grams of carbs will be covered by one unit of mealtime insulin. Only mealtime, bolus insulin

is considered because this is

the insulin that’s used to cover a carbohydrate meal or snack. Since sensitivity to insulin depends on a number of factors, insulin to carb ratios often vary from person to person. For example, people with type 1 diabetes who are very sensitive to insulin may only require one unit of insulin to cover 20 grams of carbs (ratio of 1:20), whereas others who are less sensitive to insulin, such as those with type 2 diabetes or those who are overweight, may have ratios of 1:5.

Your doctor or diabetes expert can estimate this ratio best based on your daily insulin requirements and other factors.

Going back to the previous example, if your insulin to carb ratio is 1:10, for a 64 gram carb meal, you will need about six units of mealtime insulin (64 g /10 g = 6.4 units) to cover the carbs in the meal. Keep in mind that your ratio may change with weight loss or gain, and any changes in fitness level.

Although counting carbs allows for greater flexibility in your diet, it doesn’t mean that you can abandon a healthy lifestyle and eat as many carbohydrates as you like. With the right balance of carbs and insulin, carb counting can help you obtain healthy, stable blood sugar levels and minimize your risks for future complications.

References 1. Diabetes Canada. Diabetes statistics in Canada.

Retrieved from: www.diabetes.ca/how-you-can-help/advocate/why-federal-leadership-is-essential/diabetes-statistics-in-canada

2. Diabetes UK. Carb Count: An introduction to carbohydrate counting and insulin dose adjustment. 2011. Retrieved from: www.imperialendo.co.uk/carb2012.pdf

3. Yale University. Diabetes: Carbohydrate Food List. Retrieved from: www.diabetes.yale.edu/diabetes101/Nutrition/Carbohydrate%20Food%20List_120799_284_15002_v1.pdf

4. Canadian Diabetes Association. Beyond the Basics: Basic carbohydrate counting for diabetes management. Sep 2008. Retrieved from: www.diabetes.ca/CDA/media/documents/clinical-practice-and-education/professional-resources/carbohydrate-counting-resource-english.pdf

COUNTING CARBS 3,4

2 slices of bread (15 g per slice)

30 g

Turkey breast (no carbohydrates)

0 g

1 slice of cheese

0.5 g

½ of a tomato

3.5 g

Lettuce (negligible amount of carbs)

0 g

17 g of carbs minus 2 g of fibre*

(PER COOKIE)

15 g

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64 g

CARBOHYDRATES

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Age-appropriate vitamins and mineralsYour bones are continuously undergoing breakdown and renewal, which is a natural process in maintaining healthy bones. As we get older, this process changes such that the building of bone slows down and the breakdown continues; this imbalance results in increased bone loss.2 In post-menopausal women, this can be worsened by lower levels of estrogen, which would normally have helped with calcium absorption.1 Loss of bone density can cause osteoporosis, where bones become weak and more prone to fractures.2 Vitamins and minerals required to keep your bones strong include:

• Calcium: a mineral with many important roles, including building strong bones and teeth (also involved in heart function)1

• Vitamin D: key in maintaining healthy levels of calcium and phosphorous in the blood. Involved in strengthening bones, as it also helps with calcium absorption1

While it is recommended to get your calcium from food sources, this may not always be possible, and a supplement may be required. The recommended amount of “usable” or “elemental” calcium (through food and supplements) for those over 50 is 1000 mg to 1200 mg per day (approximately 3 to 4 glasses of cow’s milk).3

Your body makes vitamin D from sunlight, but Canada has short summers and long winters, during the course of which you may not be producing enough of this sunshine vitamin.2 Since the need for vitamin D increases after 50, and it is often difficult to get enough vitamin D from food alone, a supplement is suggested.3

To meet your vitamin D needs, Osteoporosis Canada recommends supplementing with 1000 IU/day, in addition to eating vitamin-D-rich foods such as cow’s milk, salmon and egg yolk.3

How does my ability to fight disease change in my 50s?Your immune system is responsible for protection against bacteria and viruses that can cause disease.5 Vaccines contain dead or weakened germs that when taken, help your immune system recognize

Did you know Pharmacists are able to administer flu shots and the shingles vaccine, among several other vaccines, when they dispense your vaccine prescription, saving you a trip back to the doctor’s office. See your Costco pharmacist for more information.

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and fight specific bacteria and viruses if you encounter them in the future.5 While some vaccines provide lifelong protection, others require booster shots to maintain immunity. They can help to protect you from getting sick and spreading the infection to those around you.5

In your 50s, your immune system can get weaker, and diseases such as the flu can make you more sick than before.5 You may be at a higher risk for:5

• Herpes zoster (shingles): caused by reactivation of the Varicella zoster virus (the chickenpox virus); can result in painful skin rashes and blisters, usually on one side of the body

• Influenza(flu):caused by the influenza A or B virus; can result in fever, chills and muscle pain

• Diphtheria: caused by Corynebacterium diphtheriae bacteria; can result in trouble swallowing and nerve damage

• Tetanus (lockjaw): caused by Clostridium tetani bacteria; can result in jaw stiffness, painful muscle spasms and even death

The good news is that shingles, the flu, diphtheria and tetanus are vaccine-preventable diseases.2

• The shingles vaccine can be given to adults starting at age 50, especially in those with a history of herpes zoster disease.2

• The flu shot is recommended every fall for those 6 months of age and older.2

• A combination tetanus and diphtheria booster is recommended every 10 years.2

Regular screening While a healthy diet and regular exercise can help keep you healthy, regular visits to your doctor and screening tests can help detect current medical conditions, and assess your risk of future disease. According to the College of Family Physicians of Canada, this list outlines some common screening tests recommended for healthy men and women aged 50 and over.4 Depending on your risks and if you have a chronic condition, your doctor may recommend earlier or more frequent testing, or a different test not listed here.

Your health needs may change as you move through each decade of life, but knowing this as you enter your 50s can empower you to take the necessary steps to staying healthy. Maintaining a healthy lifestyle and getting regular checkups will help you embrace your 50s and keep you strong, active, and at your best.

References1. American Association of Retired Persons. AAARP

Health. Retrieved from: www.aarp.org/health/

2. Seniors and Aging – Osteoporosis. Accessed from: www.canada.ca/en/health-canada/services/healthy-living/your-health/diseases/seniors-aging-osteoporosis.html

3. Osteoporosis Canada. Retrieved from: www.osteoporosis.ca/

4. The College of Family Physicians of Canada. Preventative Care Checklist Forms. Retrieved from: www.cfpc.ca/ProjectAssets/Templates/Resource.aspx?id=1184

5. Health Canada: Vaccination for Adults, accessed from: www.canada.ca/en/public-health/services/vaccination-adults.html

Learning more about your health after 50

Healthy AGING

YOU MAY HAVE HEARD the phrase “With age comes wisdom.” When it relates to your body, however, older age may also mean your risk for some diseases are increased. But getting older doesn’t automatically mean poorer health.1 The following is a guide outlining some important screening tests and preventative measures that can help adults over 50 stay healthy and maintain the life they want.

FOR HIGH BLOOD PRESSUREBlood pressure reading: at each appointment and at home

FOR HIGH CHOLESTEROLBlood tests:Cholesterol levels are generally measured in men and women over 40, and measured again every 1 to 5 years, depending on risk factors

FOR DIABETES (high blood sugars) Blood tests:Fasting blood sugar and/or A1C measurements (3-month average of your blood sugars); the frequency depends on your health status and risk for diabetes

FOR OSTEOPOROSIS Bone density scan: a type of x-ray to determine the density of the bones and potential for fractures. It’s recommended for all men and women 65 years of age and older and may be recommended in younger individuals with risk factors for fractures

FOR COLON CANCER Fecal immunochemical testing (FIT) or a fecal occult blood test (FOBT): detects blood in your stool sample, and is recommended every 2 years

FOR BREAST CANCER Mammogram: uses x-ray to see signs of breast cancer, and is recommended every 2 years

FOR CERVICAL CANCER Pap smear: uses a sample taken from the cervix to screen for cancer. Recommended every 3 years. Screening may no longer be needed after age 70

FOR BENIGN PROSTATIC HYPERTROPHY (BPH)Digital rectal exam (DRE): is generally recommended in men over 50 and who show signs of an enlarged prostate

FOR PROSTATE CANCERPSA test: simple blood test in which higher levels of PSA may indicate a prostate condition or cancer (only recommended for men 40 and over with a higher risk, including family history)

Screening test recommendations

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odour.4 Higher-strength antiperspirants (e.g., Drysol) can be tried next if sweating is still an issue.

• Physical or surgical treatments: Through a process called iontophoresis, reduction of sweat may be achieved by the delivery of low-level electric current to the hands and feet. Although it’s a generally safe procedure, it’s not recommended for pregnant women or those with a pacemaker. Surgical options are also available but are usually reserved for people who have failed the options above.5

If excessive sweating is getting in the way of your day-to-day activities, talk to your doctor or pharmacist. They can help you find answers and get you back to the life you want.

References1. International Hyperhidrosis Society. Know sweat. What is hyperhidrosis? Retrieved

from: www.sweathelp.org/home/types-of-hyperhidrosis.html#

2. Canadian Dermatology Association. Hyperhidrosis. 2017 Retrieved from: dermatology.ca/public-patients/skin/hyperhidrosis/

3. National Health Services UK. Hyperhidrosis. June 1, 2015 Retrieved from: www.nhs.uk/conditions/excessive-sweating-hyperhidrosis/

4. International Hyperhidrosis Society. Tips for Best Results-OTC. Retrieved from: www.sweathelp.org/hyperhidrosis-treatments/antiperspirants/tips-for-best-results-otc.html

5. Mayo Clinic. Hyperhidrosis Causes. Aug 8, 2015 Retrieved from: www.mayoclinic.org/diseases-conditions/hyperhidrosis/basics/definition/con-20030728

Why do people get hyperhidrosis and how does it affect them?People may sweat too much without any particular reason. It may also happen because of certain medical conditions (e.g., infection, diabetes), medications (e.g., some antidepressants), or even hot flashes in menopausal women. It can involve the underarms, palms, feet and face. Your doctor or pharmacist may be able to help you figure out what is causing your excess sweating.

Sweating more than normal, whatever the cause, can get in the way of daily activities and may also be embarrassing. Those who suffer from hyperhidrosis may keep to themselves, and spend a lot of time dealing with their sweat by frequent showering and changing their clothes.

While it is difficult to tell what a normal amount of sweat is, if you find yourself experiencing the following situations, you may be suffering from hyperhidrosis:3

• Sweating more than normal at least once a week for no apparent reason

• Excessive sweating is interfering with your daily activities, including your job and social life

What can I do if I have hyperhidrosis?People often do not recognize excessive sweating as a condition that can be treated. In fact, more than half of people who have hyperhidrosis don’t seek advice on their condition from a health care professional.2 The good news is that treatment options are available that can help control excessive sweating.3 Your doctor or pharmacist can provide advice on the following treatments:

• Lifestyle changes: Bathe regularly with soap and water and wear light fabrics (e.g., cotton) that are breathable and won’t trap sweat. Wear socks and shoes made of natural materials. Rotate shoes regularly, change socks often and air your feet as much as possible. Consider the use of underarm liners or shoe inserts to absorb sweat. Limit spicy foods, alcohol and hot drinks (e.g., tea and coffee) since they can trigger sweating.

• Medications: Non-prescription (over-the-counter) antiperspirants are often recommended first. Antiperspirants have ingredients to help stop sweat, whereas deodorants mainly help with

Using antiperspirants4

• A single application is most effective if used prior to bedtime (may depend on the product)

• Apply to dry skin only to avoid irritation

• For a sweaty face, consider applying along your hairline

• For sweaty feet, aerosol products are particularly useful

SWEATING IS A NATURAL PROCESS that cools our body and prevents us from overheating.1 However, excessive sweating, also known as hyperhidrosis, is a condition in which the body sweats more than necessary to regulate body temperatures. It is a common condition affecting about 950,000 Canadians.2 If you think you’re suffering from this condition, there are ways to identify and manage it.

IT’S EASY!

Have your prescription bottle(s) ready

Dial the Costco Pharmacy telephone number printed on the label Follow the instructions carefully to place your order

Wait to hear when your prescription will be ready for pickup and simply hang up when you are done

CostcoPharmacyOrder your prescriptions by phone Call 24 hours a day, seven days a week and pick up your prescriptions at your convenience.

Visit costcopharmacy.ca to learn more.

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excessive sweating

(hyperhidrosis) at bay

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Reasons for medication non-adherence Failing to take your medication as prescribed and not following the advice of your prescriber may be due to many factors, including:2

• Forgetfulness• Major life changes or

financial limitations • Reading level or language barrier • Complex treatment and/or

misunderstanding the illness (e.g., stopping the medication when symptoms go away)

• Fear of side effects or not believing the medication will work

• Other health issues (including mental health or behavioural problems)

DRUGS To make it easier to take your medications, try Costco Pharmacy’s prescriptions by mail service. Your new prescriptions and refills can be ordered online, 24/7 through the Costco Pharmacy at www.costcopharmacy.ca. Simply create an online account and request to have your prescriptions transferred. If you’re visiting your doctor’s office, ask him or her to fax in any new prescriptions to the mail-order pharmacy. Once your order wis received, it will be shipped securely (at no additional cost) to your home in three to five business days.

How to store medicationProper storage of medication is just as important as taking your medication as prescribed. A medication that is not stored correctly may not work well.4 Read the label carefully and store your medication as instructed.

Things to remember:• Bathroom cabinets are not a

good place to store medication due to temperature and humidity changes. Keep your medications in a cool dry place, away from children and animals.

• Some medications, like insulin and liquid antibiotics, require special storage, such as refrigeration (for example, between 2 °C and 8 °C). Most insulins are only stable for 28 to 30 days at room temperature (15 °C and 25 °C).

• Return unused, expired or damaged medication to your local pharmacy for proper disposal. Do not throw your medication in the garbage or flush them down the toilet as they can be harmful to the environment.

Medication can help you get healthy and stay healthy—but it won’t help if you don’t take it! Choosing to stay on track with your medication treatment is an important commitment that will help ensure you are in charge of your own health and well-being.

References1. Mary De Vera, PhD for BC Medical Journal.

How do you solve a problem like medication non-adherence? Retrieved from: www.bcmj.org/blog/how-do-you-solve-problem-medication- non-adherence

2. British Columbia Pharmacy Association (BCPhA). Clinical Service Proposal. Medication Adherence Services. Retrieved from: 72.4.147.202/uploads/Medication_Adherence.pdf

3. U.S. Food & Drug Administration. Why You Need to Take Your Medications as Prescribed or Instructed. Retrieved from: www.fda.gov/drugs/resourcesforyou/specialfeatures/ucm485545.htm

4. Ontario Pharmacists Association. Tips for proper storage of medications. Retrieved from: www.opatoday.com/medication-storage-tips

Understanding medication non-adherence and finding practical solutions

DON’T WORK FOR PEOPLE WHO DON’T TAKE THEM

APPROXIMATELY 50% OF

PEOPLE with a chronic

disease may not be taking

their medication regularly or as

prescribed.1 Non-adherence,

or not taking your medication

as advised by a medical

professional, can result in the

worsening of a disease, health

complications, lower quality of

life, significant expenses and

even death.2 While there are

many barriers to adherence,

there are helpful techniques and

tools that can help you stay on

track when it comes to taking

your prescription and non-

prescription medication.

Non-adherence is a complex health issue. The first step to finding a solution is stopping the “blame game” and realizing the importance of regular, open communication with the health professionals you trust. Once you make a list of what is “getting in the way” of taking your medication as prescribed, you can start searching for solutions to overcome these challenges and improve your health.

Talk to your pharmacistYour pharmacist can play a vital role in the success of your treatment. Pharmacists can offer, at no charge to you, a thorough medication review to help you get the most benefit from your prescription and non-prescription medications. Call your local Costco pharmacy to set an appointment for a one-on-one appointment with your pharmacist to discuss the medications that you take and any medication-related issues you may have. Understanding your medications is the first step to taking them correctly. Ask as many questions as you can during your appointment or when filling your prescription at the pharmacy to understand the following:

• Medication name and dose• What the medication does• Proper way to take the

medication (how and when) • Warnings, precautions, side

effects and what to do about them

• What you should avoid • When to see your doctor

or pharmacist

Tips that can help you stay adherent Here are a few helpful techniques and tools you can use to follow your treatment plan:3

1. Try to take your medication at the same time each day

Link taking your medication with a daily routine such as placing your medication next to an item you use every day (e.g., your alarm clock or cell phone).

2. Keep a medicine calendar and note each time you take your dose

Get your refill a few days before you run out.Ask your pharmacist about synchronizing your refills so that you have fewer visits to make to the pharmacy.

3. Organize your medicines in a pill boxA) Weekly or monthly pill boxes can help

keep your medications together in dosing compartments for time of day and/or day of the week; it can be refilled on the same day of the week or month.

B) Ask your Costco pharmacy to organize your medicines in a blister pack.

These are a monthly supply of your medicines, conveniently organized to remind you when to take each dose. Each package has seven rows for each day of the week, with different time slots throughout the day for breakfast, lunch, dinner and bedtime doses. It helps you keep track of when to take your medicines; you can easily see if a dose has been taken.

4. Use the same pharmacy whenever possible

Using one pharmacy will ensure that your information is in one place. The pharmacist will be better able to manage your medications for your safety.

5. When travelling, bring enough medication to last the entire trip

Pack your medication in your carry-on bag, in case of lost luggage.

Keep your medicines in their original, labelled pharmacy containers with a complete medication review list from your pharmacy to avoid delays through security checkpoints.

6. Download and use an app to remind you

There are many free applications available on your phone to help you track your medications. Try MyMedSchedule®, MyMeds® and RxmindMe.

© Metropolis Marc Fowler

© ayarx oren © Grant Collier


What is epilepsy?The brain is made up of billions of cells called neurons that control our thoughts, feelings and movements by sending electrical messages to each other. Normally, the neurons pass these electrical messages in an ordered way. However, with epilepsy, the neurons send many messages all at once and in a disorganized pattern, which can overwhelm the brain and lead to a seizure.1 Depending on where the seizure occurs in the brain, symptoms can include:

• Unusual behavior (blank stares, grunting) or movement (jerking of the arms and legs)

• Loss of consciousness • Sudden mood changes • Drooling or frothing at

the mouth

There are different types of seizures. Most last less than a few minutes and some symptoms are obvious while others are subtle.

Epilepsy most often starts in child-hood or in seniors, but anyone can develop it at any time. In most cases, the cause is unknown.1 A person needs to experience two or more seizures in order to be diagnosed with epilepsy.

Epilepsy impacts each person differently. Depending on the severity of the seizures, it can lead to:

• Physical injury: Because seizures occur at random times, people with epilepsy are at risk of falling down and injuring themselves.2

• Mood problems: The unpredictability of seizures may result in anxiety or depression.2

• Low self-image: The stigma associated with seizures can lower an individual’s confidence and self-esteem.2

Treating epilepsyThe goal of epilepsy treatment is to stop the seizures with as few side effects as possible. Epilepsy control varies from person to

person, but there are several options available.

Most people with epilepsy take medication every day over a period of years.2 Medication will not cure epilepsy, but it can help control or even eliminate seizures.2 Two out of three people with epilepsy will get control of their seizures with medication.4

There are over 10 medication options currently available to treat epilepsy. Some of these can treat many different types of seizures, while other medications treat only one specific type.

®

®

Preventing and managing the unexpectedRevealing the mysteries of epilepsy

Preventing injury due to seizuresIf someone you know is having a seizure, gently roll the person on one side and put something soft under their head.

DO NOT:3 Try to force something into the mouth of someone having a seizure. This can chip the person’s teeth or even break their jaw.

Restrain someone having a seizure. The seizure will run its course and you cannot stop it.

Most medications for epilepsy need to be taken at least twice a day and, in some cases, up to four times a day.2 Pharmacists can be valuable resources to help manage a person’s epilepsy medication and to offer possible solutions that make it easier to remember to take the medication as prescribed. If drugs are not successful, surgery, a special diet, or other therapies may be tried.5

With many options available to treat epilepsy, a neurologist is often needed to find the most suitable treatment.5 The more knowledge one has about the condition, the less intimidating treatment becomes.1

For more information and advice on how to manage epilepsy, speak to a Costco pharmacist and visit Epilepsy Canada at epilepsy.ca.

References1. Epilepsy Toronto. Epilepsy 101. Accessed October 3, 2017. Retrieved from:

epilepsytoronto.org/about-epilepsy/learn-about-epilepsy/epilepsy-101

2. Schulze-Bonhage, A. Kuhn, A. Unpredictability of Seizures and the Burden of Epilepsy. 2008.

3. Epilepsy Canada. Myths and Misconceptions about Epilepsy. Accessed October 4, 2017. www.epilepsy.ca/myths--misconceptions.html

4. Epilepsy Ontario. What is Epilepsy? Accessed October 26, 2017. Retrieved from: epilepsyontario.org/about-epilepsy/what-is-epilepsy

5. Goldenberg, M. M. (2010). Overview of Drugs Used For Epilepsy and Seizures: Etiology, Diagnosis, and Treatment. Pharmacy and Therapeutics, 35(7), 392–415.

EPILEPSY is a seizure disorder that affects people of all ages, nations and races.1 In fact, one in every 100 Canadians has epilepsy.1 It can affect quality of life, including a person’s ability to work and drive.2 The good news is that epilepsy is treatable and many people can achieve good control of their seizures with medication. ✘

✘

in 100Canadianshas epilepsy.1

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SAVING DOESN’T HAVE TO MEAN COMPROMISING

At APOTEX, we don’t just look out for the well-being of Canadians. We look out for their financial health too. That’s why, for 40 years, we’ve ensured all Canadians have access to quality, affordable medicines.

Ask your pharmacist if there’s a generic equivalent available for your prescription needs.

www.apotex.com

DID YOU KNOW?Generic medications include the same:

active ingredients

efficacy

quality

manufacturing standards

but at a much lower cost than the brand name.

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