Dementia

Dementia is an umbrella term used to describe various conditions which damage brain cells and lead to a loss of brain function over time. Dementia causes a progressive decline in a person’s mental functioning. It is a broad term, which describes a loss of memory, intellect, rationality, social skills and normal emotional reactions. The symptoms of dementia develop gradually over a period of years. The progression of these diseases is largely unpredictable for each individual.

Facts in brief

Dementia has a life changing physical, emotional and mental impact on the affected person and their primary carer and family. There are more than 100 conditions that cause dementia. While the risk of dementia increases with age, it is not a natural part of ageing. Dementia affects approximately one in 20 of people aged over 65 years. This rises to one in five in the 80 plus age group. While it is comparatively rare, dementia can affect younger people. There are approximately 3,800 people under the age of 65 with Younger Onset Dementia in the Ireland. A person with dementia will live for an average of four to eight years, depending on their age at diagnosis. Alzheimer's disease, the most common cause of dementia in Ireland, accounts for more than 50% of all cases; the second most common form is vascular dementia, which may be preventable.

Risk Factors
The risk factors for Alzheimer's disease include increasing age being female, family history, head injury, Parkinsons, hypothyroidism, exposure to dietary aluminium, cardiovascular disease, smoking and high alcohol intake

Health maintenance

As Alzheimer’s disease progresses, various conditions develop that may lead to death, such as septicemia, pneumonia and upper respiratory infections, nutritional disorders, pressure sores, fractures, and wounds. In the early stages of Alzheimer’s disease, health maintenance activities should be encouraged including exercise, the control of high blood pressure and other medical conditions, annual immunization against influenza, dental hygiene, and the use of eyeglasses and hearing aids as needed. In later phases of the disease, it is important to address basic requirements such as nutrition, hydration, and skin care.

Diagnosis

There is no straightforward test for Alzheimer’s Disease so diagnosis is difficult, particularly in the early stages. Diagnosis is usually made by excluding other causes such as infection, vitamin deficiency, thyroid problems, brain tumour, depression and the side effects of drugs which all can produce similar symptoms. Diagnosis involves a variety of medical assessments and observations. Assessment usually includes a mini mental state examination (MMSE). Specialists can only make a probable diagnosis. However, clinicians with experience in memory loss are able to diagnose AD to within 80-90% accuracy.

Medication

Medication can slow down progression of AD but is not a cure. Medication should be used in conjunction with non-drug treatment options. For more information on non-drug options, call into Whelehans or discuss with your GP. Four drugs are approved for treatment of dementia in Alzheimer’s Disease (AD) in the UK and Ireland. These are donezepil (ARICEPT^®), galantamine (REMINYL^®), rivastigimine (EXELON^®) and memantine (EBIXA^®). The first three are cholinesterase inhibitors and memantine is a NMDA receptor antagonist. All of these drugs must be started under specialist care. All these drugs now have less expensive but equally effective generic equivalents. These treatments can help improve a person’s memory and enable the person to retain new information for longer. The most common side effects are nausea, vomiting, diarrhoea and anorexia. These can be a particular problem because many people with AD loose weight. However,these side effects wear off after a few weeks in most people. 

Studies have demonstrated modest improvement in cognitive symptoms with cholinesterase inhibitors. Some studies demonstrated a beneficial effect for up to two years after starting treatment. There are no studies of longer periods of medication but most patients can expect that, in time, they will stop responding to treatment as the disease progresses. If the effect wear off, some prescribers recommend a ‘drug holiday’, for example the drug is stopped for six weeks and then started slowly again.

Donepezil has demonstrated in the short term (six months) a beneficial effect on mood and behaviour. Rivastigmine is licensed to treat dementia in Parkinson’s disease. Exelon 4.6mg/24hr transdermal patch and Exelon 9.5mg/ 24hr transdermal patch have been recently launched. The initial dose is 4.6mg/24hr for a minimum of four weeks, and if tolerated, can be increased to 9.6mg/24hr which is considered the recommended effective dose. The rivastigmine patch is considered to have fewer side effects than the capsule version.  Of the four drugs available memantine is the only one licensed to treat moderate severe AD.

There are no guidelines to recommend one drug over another. Donepezil and modified release galantamine only need to be taken once a day which is convenient. Rivastigimine and memantine need to be taken more often though memantine is often given as a single dose in the morning (ie) 2 x 10mg memantine tablets in the morning. There is also insufficient evidence to support the use vitamin E in AD. Further studies are required to test the benefits of Ginkgo biloba.

This article is shortened for this Health Blog.. More detailed information and leaflets is available in Whelehans or check www.whelehans.ie

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Arthritis: Can natural medicines help?

Self-help

• Find a balance between exercise and rest. Swimming is an excellent activity because it strengthens your muscles and joints without putting any strain on them.
• Losing excess weight will reduce the pressure on your joints.
• Try to eat a healthy, balanced diet and cut down on saturated fats.
• A hot water bottle is useful when joints feel stiff and painful; try an ice pack if they are hot and irritated.

Natural medicines: are any effective?

As a pharmacist I am often asked what natural medicines are beneficial to those living with arthritis including the likes of Osteoarthritis (the most common type of arthritis and caused by wear and tear) and Rheumatoid Arthritis (the most debilitating form of arthritis caused by severe inflammation of the joints). For today’s talk, we don’t have the time for me to discuss all natural medicines but I will discuss a few of the most popular ones. There are thousands of natural and herbal pain relief products marketed in magazines, newspapers, the internet, health food shops etc. and most have little or no evidence and are gimmicks to help you part with your money (as when you are in constant pain you will try anything to try relieve it). My main advice, before try any alternative, natural or herbal product, check with a health professional like your pharmacist or GP first as they will advise you if there is any evidence of effectiveness and more importantly on any interactions with other medicines you are taking or potential side effects.

Omega 3 Fish oils

·         Fish oil is recommended for a healthy diet because it contains the omega-3 fatty acids, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), precursors to eicosanoids that reduce inflammation throughout the body.

·         Because of their anti-inflammatory effect they tend to be more beneficial to those living with Rheumatoid arthritis rather than Osteoarthritis.

·         Omega 3 fatty acids are primarily found in oily fish such as salmon, fresh tuna, mackerel, herring, sardines and pilchards. We should eat two portions of fish per week, one of them oily.

• I am often asked which Omega 3 supplement is most effective for reducing inflammation and helping ease arthritis type pain and swelling.
• One I find good results with is an Omega 3 product on the market called “Lyprinol^®”.
• It appears to demonstrate quite a powerful anti-inflammatory effect and comes with none of the fishy taste associated with traditional fish oils and side-effects commonly seen with steroids or prescription anti-inflammatory medication such as NSAIDs (eg) ibuprofen, diclofenac, naproxen
• Lyprinol^® comes from the New Zealand Green Lipped Mussel, which has long been recognised by the Maori people for its nutritional qualities. Lyprinol^® is said to be 200 to 300 times more inflammatory action than other fish oils and flax seed. As a result, Lyprinol^® has been shown in research to be beneficial for arthritis and joint pain.

Flexiseq^®- a new drug free gel for Osteoarthritis

Is it worth trying?

Flexiseq^® is new drug-free joint pain gel for osteoarthritis. Flexiseq^® has got a lot of attention due to comments from the likes of Arthritis Ireland and experts.

Flexiseq^® was researched and developed in Germany for the management of pain and joint stiffness in patients with osteoarthritis. Flexiseq^® is a gel containing nanostructures called Sequessome™ vesicles, which are able to cross the skin and target sites of pain when rubbed in. Once inside the joint, Sequessome vesicles accumulate on the damaged cartilage forming a lubricating layer.

Research shows is benefits in relieving pain with comparable efficacy to celecoxib, a leading prescription drug used for treating osteoarthritis pain. Daily application in the morning and evening can potentially give improvement in joint pain in as little as two days.

Medical device…not a drug

Flexiseq^® is registered as a medical device; thus Flexiseq^® does not contain any pharmaceutically active ingredients meaning it doesn't contain any drugs that might interact with medication you may be taking for pain or any other ailment.

John Church, CEO of Arthritis Ireland said “We welcome any new innovative approach to making life easier for the 450,000 people living with osteoarthritis in Ireland.”

Professor Philip Conaghan, from the University of Leeds, and lead author of a major study published in the British medical journal called Rheumatology said: “Many living with chronic osteoarthritis pain can’t take or can’t tolerate current oral analgesics because of side effects.  Referring to his study involving Flexiseq he said “the new study is interesting because it suggests that a novel topical therapy, that doesn't include a topical anti-inflammatory drug, may help osteoarthritis pain”.

Glucosamine and chondroitin supplements

Glucosamine and chondroitin supplements have traditionally been used to provide pain relief for osteoarthritis pain. These chemicals are found naturally in cartilage and are thought to improve the condition of damaged cartilage in osteoarthritis. They may also slow down thinning of the cartilage. However, there is not enough evidence yet to prove that glucosamine and chondroitin help osteoarthritis. In fact, NICE (National Institute of Clinical Excellence) who advice the NHS in the UK on what medicines are effective, cost effective safe etc., advise that glucosamine and chondroitin supplements should not be allowed on NHS prescriptions due to little evidence of their efficacy. The HSE has followed NICE’s advice and Glucosamine  was  taken off the GMS list in 2012 (meaning it was no longer covered by the medical card) with the HSE citing lack of evidence of effectiveness as the reason to no longer allow.

Lyprinol^® and Flexiseq^®, Glucosamine etc. are alternative therapies; they should not replace conventional treatments prescribed by your doctor. It can complement other arthritis treatments. Always consult your doctor. 

 

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591.

 

 

Breast Cancer….what do you know?

The word “Cancer” still strikes fear into the hearts of most people. Historically, once diagnosed the thought was that the illness is terminal. However, through the development of skills and knowledge, along with many campaigns focussed on raising awareness, promoting lifestyle wellbeing, self-checking leading to early detection, survival rates for most types of cancer are increasing.

October is Breast Cancer Awareness Month

October is Breast Cancer Awareness Month; to mark this Cancer Support Sanctuary LARCC in conjunction with Whelehans Pharmacy held a Cancer Information Event in Whelehans Pharmacy on Tuesday October 13^th. As part of this event, pharmacist Eamonn Brady gave a talk on “Breast cancer prevention, care and aftercare” to a full pharmacy. Ger Connaughton from LARCC was “delighted so many ladies called in for a consultation with LARCC staff throughout the day and many booked in for LARCC’s breast care and other cancer services in the coming weeks”. Bernie McHugh from LARCC explained that “while LARCC advertise their services, many people in Westmeath do not realise the full extent of the cancer support services on offer from us on your doorstep (at LARCC’s premises at the Friary in Multifarnham). As well as offering a range of call-in support services to people diagnosed with cancer and their families, LARCC is the only residential cancer care provider in Ireland. Most of our services are free of charge as we cover most of the costs through the kind support of fundraising events and donations. Events like our recent awareness event in Whelehans pharmacy are a great way of informing people of our services.”

Self-checks can save your life

Breast cancer is the second most common cancer in women after skin cancer; every 3 hours a woman in Ireland is diagnosed with breast cancer. One of the main messages that came from the cancer awareness event was that if cancer is caught early, most people survive. 80.6% of all women diagnosed with breast cancer survive for 5 years or longer (and survival rates continue to increase every year). Early detection is the key to survival. Eamonn Brady, pharmacist from Whelehans Pharmacy emphasised during his cancer talk that “Self-checks for breast cancer are vitally important; 74% of Irish women with breast cancer discovered the lump themselves. You know your body better than any doctor does.”

What to check for?

Approximately 80% of breast cancers occur in women over 50 years. If you do notice any change in your breasts, see your GP as soon as possible. Pain isn’t usually a sign of breast cancer. If you have pain in one or both breasts, rest assured it’s probably due to hormonal changes, a benign cyst, a ligament strain or another condition; however it is important to get unexplained pain checked by your GP. More common warning signs of breast cancer include a palpable lump, a change in the size or shape of the breast, puckering of the skin, nipple changes (like scaling or discharge), or increased warmth. A mammogram (X-ray of the breast) is the most common way to check for breast cancer.

A breast prosthesis explained

Surgical removal of the full breast or part of the breasr (mastectomy or lumpectomy) is one of the main treatment techniques for breast cancer. The surgery can leave the breast scarred and a different shape and size than prior to surgery.  A breast prosthesis is an artificial breast which is worn after the mastectomy. It helps balance the body and allows a bra to fit naturally on the side of the mastectomy and prevents potential problems such as back and neck pain and shoulder sagging downwards which can lead to aches and pains. In Westmeath, LARCC provide a specialist prosthesis and bra fitting service for women who have undergone breast surgery; find out more by calling LARCC at 1890 719 719. LARCC have a specialist fitting room at their premises in Multifarnham.  LARCC’s confidential service provides you with access to a comprehensive range of products and clothing through the support of qualified consultant fitters; many of the products are covered on the medical card and by health insurers.

Manual Lymph Drainage

If lymph nodes removed as part of the surgery or damaged during chemotherapy/radiation, lymphedema (swelling of the hand and arm) may occur, even years after treatment.

Manual Lymph Drainage (MLD) redirects fluid from swollen areas to healthy lymphatic vessels, transporting it back to the normal circulatory system. Specialist MLD therapists exerts different intensities of hand pressure to increase activity of normal lymphatic vessels and to encourage the fluid away from congested areas by bypassing ineffective or injured lymph vessels. The treatment is very gentle and a typical session will involve drainage of the neck, trunk, and the affected extremity (in that order), lasting approximately 40 to 60 minutes. Specialist bandages and sleeves may be recommended by the therapist. LARCC offer MLD with their highly skilled therapists who see their clients on a pre-arranged appointment basis. There is a waiting list for this service

For specific advice and information on LARCC services, contact Cancer Support Sanctuary LARCC at 1890 719 719 or check www.cancersupport.ie

For comprehensive and free health advice and information call in to Whelehans, dial 04493 34591 or log on to www.whelehans.ie. You can also e-mail queries to info@whelehans.ie. Find us on Facebook

Headlice

Wetter and colder winter weather means cases of headlice increase we spend more time indoors in close proximity. Head lice (Pediculus capitis) affects only humans, and cannot be passed on to, or caught from animals. Head lice are common in schoolchildren, particularly between the ages of 4 and 11, but anyone with hair can catch them.  The lice are small wingless insects that feed on blood obtained by biting the scalp.  These bites tend to be itchy and this itchiness is caused by an allergy to the lice.  Female lice lay their eggs at the hair roots, particularly near warm areas behind the ears and at the back of neck. These eggs appear as white or white coloured grains and are best removed with a fine comb while the hair is wet. 

SYMPTOMS

Infestation often causes itching of the scalp, but may also go unnoticed.  If you suspect head lice, check the base of hairs for eggs and comb the hair over a piece of white paper and the lice will appear as pink or brown specks. Sometimes an infestation is marked by tiny red spots on the scalp.  Lice may be visible in the hair behind the ears and at the nape of the neck as these are favourite spots for infestations.   

CAUSES

Head lice are transferred by close hair-to-hair contact.  They cannot jump, fly or swim, but walk from one hair to another.  It is a misconception that head lice infestation is as a result of dirty hair and poor hygiene.  

TREATMENT

Lice can be a persistent and recurring nuisance, so it is important to treat them quickly and thoroughly. If one member of the family needs treatment it is important to check the rest of the family and treat if live lice are seen.

WET COMBING METHOD

Wet combing, is used to remove lice without using chemical treatments.  This method is helpful because head lice are growing increasingly resistant to insecticides used to remove them.  The following steps are best to follow:

·         Wash the hair as normal using an ordinary shampoo.                                               

·         Apply conditioner liberally to wet hair (this causes lice to lose their grip on hair).

·         Comb the hair through with a normal comb first. With a fine tooth nit comb (available in pharmacies), comb from the roots along the complete length of the hair and after each stroke check the comb for lice and wipe it clean.  Work methodically over the whole head for at least 30 minutes.

·         Rinse the hair as normal.

·         Repeat every three days for at least two weeks.

MEDICATED LOTION OR RINSE

Only use a lotion if you find a living (moving) head louse. Apply the preparation according to the instructions, and remove the lice and eggs with a fine-toothed nit comb.  Treatment should only be done once and then repeated seven days later. There is no need to wash clothing, or bedding, if they have come into contact with head lice.  This is because head lice quickly die without a host to provide warmth and food.

There is a vast array of insect repellants available in pharmacies. In recent years easy to use treatments such as Lyclear^® Crème Rinse (contains lice comb in pack) are proving popular as they involve only a 10 minute treatment. Lyclear^® Crème Rinse can be used on children over 6 months. Lyclear has a pleasant smell and is suitable for asthmatics.

ELECTRONIC LICE COMB

RobiComb^® is an example of an electronic lice comb. It detects and kills lice without the need for chemicals. It uses an AA battery.  

PREVENTION

The best prevention is normal hair care and checking yours and your family's hair and scalp periodically.  If your child has long hair, tie it back as this helps to reduce the likelihood of contact between their hair and that of an infected child. Regular combing of hair using the “wet combing” method (see above) can help with early detection as well as treatment. Repellants (available in pharmacies) may help to prevent head lice but effectiveness is unclear.

 

For comprehensive and free health advice and information call in to Whelehans, dial 04493 34591 or log on to www.whelehans.ie. You can also e-mail queries to info@whelehans.ie. Find us on Facebook