Can fish oils increase prostate cancer risk?

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

A recent study by Brasky et al. in the Journal of the National Cancer Institute indicated an increased risk of prostate cancer for men who used omega 3s. This has raised concerns about how safe fish oils are for men.

What the experts say

Many experts have indicated that this study is flawed. The study was not designed to investigate the role of Omega-3 intake on prostate cancer. Fish oil supplements were not used as part of the study. Only plasma Omega-3 was measured, these levels really only reflect the Omega-3 consumption of your last meal and not a true reflection of your Omega-3 consumption.

According to Dr James O’Keefe, Director of the Preventative Cardiology Programme at St Luke’s Mid-American Heart Institute, the study only showed miniscule differences in omega-3 blood levels. The omega 3 levels found in patients’ blood was the equivalent of having no fish intake or fish oil supplementation. Dr O’Keefe explains that previous studies indicated that omega 3 actually has a protective effect against prostate cancer. He says that higher omega 3 levels have consistently and strongly correlated with lower risks of cardiovascular mortality.

According to Professor Clemens von Schacky, a German Cardiologist, “virtually every male gets prostate cancer, provided he lives long enough to get it. Age was not properly handled as a risk factor in the study mentioned.”

Dr Harry Comber, Director of the National Cancer Registry in Ireland, said he was loath to give advice to patients to take action on the basis of a single study. "People should not change their behaviour based on a single study. I would take it with a little bit of caution. It is suggestive but not definitive one way or the other."

Conclusion

It should be noted that the best way to get omega 3 is naturally through your diet. 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. You should only use omega 3 supplements if you do not eat sufficient oily fish or other sources or omega 3 such as flaxseed.

There are facts about omega 3s that seem to be at odds with this study. For example, Japan has one of the highest intakes of Omega-3 fish oil with the lowest incidence of prostate cancer in the world. Ireland has one of the lowest intakes of Omega-3 fish oil yet has a high incidence of prostate cancer. Further studies are warranted.  I would advise men who have a family history of prostate cancer or who are at higher risk or prostate cancer (as indicated by blood tests) are best to avoid fish oil supplements.

The advice in this blog is the opinion of Eamonn Brady; consult with your doctor before making any changes

New Heart Warning for Diclofenac

People with heart problems have been advised against using one of the most commonly prescribed anti-inflammatory drugs. The European medicines watchdog issued a warning in July 2013 stating that diclofenac can significantly increase the risk of heart problems such as heart attack and stroke in those already at risk of these problems. Diclofenac is a Non-Steroidal Anti-inflammatory Drug (NSAID) used as an anti-inflammatory painkiller. Many Irish people take diclofenac for a range of conditions such as back pain, arthritis, gout and headaches. According to HSE statistics*, diclofenac is the 18^th most commonly prescribed drug overall by doctors in Ireland with 568,000 prescriptions issued for diclofenac issued on the medical card alone in 2010. Diclofenac has been the second most commonly prescribed painkiller after paracetamol and the most commonly prescribed anti-inflammatory painkiller.

The Irish Medical Board (IMB) is advising against taking diclofenac if you have heart problems. Brands of diclofenac available on prescription in Ireland include Diclac^® tablets, Difene^® Capsules, Voltarol^® tablets and Catoflam^® tablets.

The IMB are advising doctors not to prescribe diclofenac for patients with a history of heart and circulation problems including heart failure, ischaemic heart disease (eg. Angina, previous heart attack), stoke and arterial thrombosis (eg. blood clots). People who are smokers, are diabetic, have high blood pressure or have high cholesterol should also use diclofenac in caution (even if they do not currently have heart problems) as these conditions increase your risk of heart disease and diclofenac further increases this risk. Research published in 2011 found that patients taking diclofenac were found to have a 40% increased risk of heart problems such as heart attack or stroke compared to those who were not using the drug. However, for most people; diclofenac only causes a slight increase in risk of heart problems

The warning covers diclofenac administered rectally (eg Difene^® suppositories) as well as oral versions mentioned above. The warning does not include topical versions of diclofenac such as creams and gels. Thus topical versions such as Difene^® Gel, Voltarol^® Gel or Difene^® Gel are still considered safe for cardiac patients. However, topical versions should be used in caution with patients prescribed warfarin as even rubbing it onto a small area of skin can increase the effect of warfarin which could lead to bleeds. Diclofenac is still considered to be safe for those without heart problems.

There was a similar warning a few years ago for another class of prescription only anti-inflammatory painkillers called COX-2 NSAIDs. COX-2 NSAIDs include brands like Celebrex^® and Arcoxia^®; these too must be avoided in people with heart problems.

 
Anti inflammatory painkillers that do not have a major cardiac warning (as of yet) include ibuprofen, meloxicam, naproxen and meloxicam. Hence doctors may consider prescribing these in cardiac patients where analgesia is required. Ibuprofen is available over the counter without prescriptions (eg. Nurofen^®) but I would not advise people with heart problems using Ibuprofen without first consulting with their pharmacist or doctor; this is because it can cause problems like raised blood pressure which can put pressure on the heart. Anti-inflammatory medicines must be used with care for other reasons too and should not be used long term (unless under supervision of your doctor). Apart from potential heart problems, they can cause stomach ulcers, trigger asthma attacks in asthmatics and should be avoided by those with kidney problems.

By Eamonn Brady MPSI

 *HSE Primary Care Reimbursement Service. Statistical Analysis of claims and payments 2010.

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

Can Omega 3 and Omega 7 relieve Dry Eyes?

I recently wrote about dry eyes in my blog. As a result of this I got a number of enquiries on the benefits of omega 3 or omega 7 to relieve dry eyes. Hence I revisit this topic.

Omega 3 Oils

Studies indicate that a diet rich in Omega 3 oils can reduce the risk of developing dry eye and also ease symptoms. Omega 3 fatty acids are primarily found in oily fish such as salmon, mackerel, herring, sardines and pilchards. We should eat two portions of fish per week, one of them oily. Flaxseed oil which is also known as linseed oil is also a good source of omega 3. For people who do not eat sufficient fish oils, I recommend a fish oil supplement called MorEPA^® as it contains the highest level of pure omega 3 fatty acids (EPA and DHA) of any fish oil supplement.

Can Omega 7’s relieve dry eyes?

Omega-7 fatty acids help boost the immune system and (like omega 3) reduce inflammation. Their main benefits are their ability to reduce dryness in membranes of the body. I got introduced to Omega 7 in the last year by a pharmacist colleague of mine who mentioned that many of his patients found it helped relieve dry eyes. I recommended it to a few people suffering from Sjögren’s syndrome (an inflammatory condition that causes severe dry eyes) and they got a benefit of it. In Whelehans Pharmacy, we stock the PharmaNord brand of Omega 7 capsules. Omega-7 fatty acids are derived from berries of a shrub called sea buckthorn which originates in the Himalayas. It has long been used as part of traditional Chinese medicine.

Relieving Dry Eyes                                                                                                                               
One clinical study conducted on one hundred men and women aged 20 to 75 experiencing dry eye symptoms demonstrated the benefits of omega 7. For 12 weeks, half the participants took an omega 7 supplement. The group who took the omega 7 supplement experienced less redness and burning sensations than the group who took the placebo.

Omega 7 has produced positive results in studies of women with Sjögren’s syndrome. In one double-blind, placebo-controlled study, 24 women aged 35 to 66 took an omega 7 supplement or a placebo for 12 weeks. The omega 7 supplement gave relief to itch, pain, dryness and burning sensations in the mucosal tissues experienced by those with Sjögren’s syndrome. Omega 7 is not a cure all for dry eyes, however taking it as a supplement may give some relief. Supplements are not meant as a substitute for medical assessment and should not replace prescription medication.

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

 

This article is shortened for my blog. More detailed information and leaflets is available in Whelehans or www.whelehans.ie

Dry Eyes

Symptoms of dry eyes can include irritation and redness, itchy eyes, burning eyes, blurred vision (that improves with blinking), excessive tears (eye tries to over compensate) and the sensation of grit in the eyes.

People can find that dry eye symptoms are fine in the morning (as the eyelids have been closed overnight and tears do not evaporate) but gets worse as the day goes on as the eyes are exposed to the elements and evaporation of tears increases. The most common treatment for dry eyes is artificial tears that are available over the counter in pharmacies.

 Causes

Some medical conditions cause dry eye including hayfever, arthritis, thyroid conditions, vitamin A deficiency, Parkinson's disease and Sjögren syndrome.

Ageing

Dry eye mostly occurs as a part of the natural ageing process. It affects about a third of people over 65 and is 50% more common in women than men.  Hormonal changes during menopause can also cause eyes problems in women.

Physical problems

Eyelid issues can include blocked meibomian glands which produce the protective oily layer of the tear film or damage to the tear producing glands. Blepharitis which is inflammation of the eyelids can cause blockage of the oil producing glands. Causes of blepharitis include dry skin conditions like seborrhoeic dermatitis (similar to dandruff) and rosacea.

 Medication

Some medicines can cause dry eyes including oral contraceptives, decongestants (used to unblock the nose), diuretics (used to reduce blood pressure and reduce fluid), anti-histamines, beta blockers (used for heart problems and high blood pressure), some older anti-depressants (eg tri-cyclic antidepressants) and anti-inflammatory medicines.

Contact lenses

Contact lenses increase the risk of dry eyes, especially if kept in too long. Water-based lenses tend to absorb moisture from the tear film; this reduces the quantity of remaining tears. Using higher moisture or silicone hydrogel contact lenses reduces dry eye issues.

Sjögren syndrome

Sjögren syndrome is an autoimmune inflammatory condition in which the body’s white blood cells attack other cells in the body. Dry eyes and mouth occur in 95% of cases. Most people with Sjögren syndrome need artificial tears on a regular basis.

 Other causes

People working on screens for long periods at a time tend to blink less frequently. This allows tears to evaporate more readily which can lead to dry eyes. Smoking or exposure to smoke from a smoker can irritate the eyes and cause dryness. Similarly, air pollution (eg. exhaust fumes) can cause the problem.

 Tips for easing dry eyes

 Avoid constant exposure to air conditioning and central heating. Avoid draughts. Humidifiers may help. Blink more frequently if you work on a computer screen or read for long periods.

Treatment

 Many cases of dry eyes is caused by medication (both prescription or over the counter) such as anti-histamines, blood pressure medication, some anti-depressants anti-inflammatory medicines. Where medicines are causing severe dry eye problems, you can discuss with your doctor or pharmacist if there are alternative options that do not cause the problem (eg. newer anti-depressants do not cause as many dry eyes issues). In some cases there is no safe alternative. In these cases, artificial tears are the only effective treatment option.

 Artificial tears

Your GP, pharmacist or optician can advise on drops, ointments and gels. They are available without prescription at your pharmacy. They replicate the role of natural tears. Drops are often used during the day (eg. three times daily) and an ointment or gel is used at night as they are thicker and tend to last for longer while you sleep. There is no evidence that one brand is any more effective than the next; though preservative free versions are recommended by some eye specialists to reduce the risk of preservative causing irritation (though these are more expensive). Contacts lens should not be used with artificial tears; if they must be used, use preservative free artificial tears and hold off inserting contact lens for 30 minutes after using the artificial tears. Always use artificial tears at a different time from other prescribed eye drops (eg. glaucoma drops, antibiotic eye drops) as the artificial tears will dilute or wash away the other drops. Artificial tears are available on the Medical Card Scheme and the Drug Payment Scheme with doctor’s prescription.

 Punctal occlusion

This is done by a specialist and involves reversible blocking of the punctual ducts to block the release of excess tears (which occurs due to the eye trying to over compensate). The tear duct plugs used can be either semi-permanent (silicone) or dissolvable. Punctal occlusion does not work for everyone and should only be considered when artificial tears fail to work. 

Can omega 3 or omega 7 help?

Studies indicate that a diet rich in Omega 3 oils can reduce ease dry eye symptoms. I have seen cases of omega 3 supplements helping people suffering from dry eyes. For people who do not eat sufficient oily fish, I recommend a fish oil supplement called MorEPA^® as it contains the highest level of pure omega 3 fatty acids (EPA and DHA) of any fish oil supplement. Some people find and there is some evidence that Omega 7 supplements relieve dry eyes; I will discuss Omega 7 in more detail next week in my blog. Supplements are not meant as a substitute for medical assessment and should not replace prescription medication.

This article is shortened for my blog. More detailed information and leaflets is available in Whelehans or www.whelehans.ie

24 Hour Blood Pressure Monitor

High Blood Pressure is a silent killer

 

Did you know that every hour, a man, woman or child dies from heart disease and stroke in Ireland? High blood pressure is a major reason for these premature deaths.

If you have been diagnosed or suspected of having high blood pressure, it is important you get it monitored with a 24 hour blood pressure monitor. Whelehans Pharmacy in Mullingar can now fit you with a 24 hour blood pressure which you can now wear while undertaking normal daily activities. You can book the service by calling 04493 34591.

 

Why get a 24 hour blood pressure check?

 

A 24 hour blood pressure monitor provides a more accurate measure of blood pressure than a single measurement. It shows how your blood pressure changes throughout the day and more importantly at night. It helps your doctor and pharmacist ensure your blood pressure is under control. If you are already taking blood pressure medication, our 24 blood pressure monitor will show if you are getting the full benefit of the blood pressure medication you must take.

 

Blood pressure-the silent killer

 

According to latest statistics, high blood pressure causes 54% of stroke and 47% of heart disease worldwide. High blood pressure is often called the silent killer with many people not realising they have it until it is too late, for example after they have suffered a stroke or heart attack.

 

How do I measure my blood pressure accurately?

 

Research indicates that the most accurate form of blood pressure measurement is to get it measured over a 24 hour period. Because high blood pressure rarely has any symptoms, the only way to tell you have this condition is to get your blood pressure measured accurately. Health experts in the UK now advise not to commence on blood pressure medication until you get a 24 hour blood pressure check.

A 24 hour blood pressure monitor could save your life

Contact Whelehans Pharmacy today to arrange getting your 24 hour blood pressure checked, it could save your life. Whelehans 24 hour Blood Pressure service costs €50. We simply fit the monitor in the morning, you wear it for 24 hours and when you come back the next morning we will have your results.

Whelehans Pharmacy, 38 Pearse St, Mullingar (opposite the Greville Arms Hotel). Tel 04493 34591. Web. www.whelehans.ie

Chronic Daily Headaches

If you take painkillers for longer than 15 days (3 days for codeine) you run the risk of getting medication-overuse headaches. The headaches caused by painkiller overuse last an average of four or more hours. What happens is that after taking a painkiller for headaches for a prolonged period of time, your body becomes used to the painkillers. A 'rebound' or 'withdrawal' headache then develops if you do not take a painkiller within a day or so of the last dose. When the effect of each dose has worn off, a further withdrawal headache develops, and so on. A vicious circle develops. This phenomenon only seems to occur when taking painkillers for headaches; it does not seem to occur when taking painkillers regularly for other conditions like arthritis.

Medication-overuse headache is the third most common cause of headache after migraine and tension-type headache. About 1 in 50 people develops this problem at some time in their life. It can occur at any age but is most common in people in their 30s and 40s. It is more common in women than men. The headache of medication-overuse headache is often described as ' overwhelming' and tends to be worse first thing in the morning, or after exercise. It may be a constant 'dull' headache with spells when it gets worse.

Codeine is the most common cause of chronic daily headaches

Codeine is the worst culprit for chronic daily headache. Painkillers such as Solpadeine^® and Nurofen Plus^® which contain codeine can bring on chronic daily headaches after only three days of use. There is a serious problem in Ireland of people becoming dependent on Solpadeine^® and Nurofen Plus^®, with many people feeling they cannot “function” properly without taking a headache pill.

How to break out of the cycle of chronic daily headaches

After stopping the regular use of painkillers, you are likely to have worse and more frequent headaches for a while. However, the frequency of headaches should then gradually return to 'normal'. Some people also feel sick, become anxious, or sleep badly for a few days after the painkillers are stopped. Unfortunately, these headaches and other withdrawal symptoms must be tolerated until the painkillers are 'out of your system'. Your pharmacist or doctor can help overcome this vicious circle.

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

Parkinson's Disease

This article was shortened for my blog, a longer version can be found at www.whelehans.ie or call in to Whelehans pharmacy Mullingar

Parkinson's disease is a long-term disorder of caused by the degeneration of dopamine generating cells in the mid-section of the brain. Its cause is unknown. Symptoms gradually worsen over time. The main symptoms are stiffness, shaking (tremor) and slowing of movement.  There is no cure but treatment can slow down its progression and can provide good relief of symptoms for several years in most patients. Modern treatment options means that people with Parkinson’s can have a normal or near normal life expectancy.

 

Profile of patients

Parkinson’s usually develops in people over the age of 50 and is rare in people under 50. It affects about 5 in 1,000 people in their 60s about 40 in 1,000 people over 80. Men are one and a half times more likely to get Parkinson’s than women.

 

Causes

With Parkinson’s, cells in the substantia nigra (the main messaging area in the brain for controlling muscles) become damaged and die over time. Dopamine, the main neurotransmitter becomes depleted due to degeneration of this area which causes Parkinson symptoms.

 

Symptoms

The three main symptoms are slowness of movement, stiffness and tremor.

 

Slowness of movement People may mistake this as a normal part of aging which means diagnosis is delayed in many cases. With time, normal walking becomes difficult and Parkinson’s patients often develop a 'shuffling' type of walk with difficulty in starting, stopping, and turning.

 

Stiffness of muscles (rigidity) is when the muscles become tense with the arms and legs tending not to swing as easily.

 

Tremor is common symptom of Parkinson’s. Not all patients with Parkinson’s have tremor. About 30% of Parkinson’s patients do not suffer from tremor initially but it always develops as the condition progresses.  It usually affects the fingers, thumbs, hands, and arms but can affect any part of the body. Tremor is worse when resting.

 

The speed in which symptoms become worse varies from person to person. It can take several years before symptoms become bad enough to affect routine tasks and quality of life. Other symptoms which can develop include difficulty with balance and posture. Further symptoms include inability to perform facial expressions like smiling or frowning; reduced blinking; difficulty with fine movements such as using a scissors, tying shoelaces, opening and closing buttons, zipping up and difficulty with writing (handwriting tends to become smaller). There can be a slowdown in speech leading to a monotone voice and swallowing difficulties can develop leading to pooling of saliva in the mouth.

 

Treatment

There is no cure for Parkinson’s but treatments can ease symptoms and slow progression. It can take 8 to 10 weeks from the start of treatment before the patient notices improvement in symptoms.

 

Levodopa

Levodopa tends to give a good improvement in symptoms. Levodopa is converted to dopamine in the brain. The dose is started low but tends to be increased to control symptoms. Levodopa is always used in combination with another medicine to prevent side effects (either benserazide or carbidopa). Brands available include Madopar^® and Sinemet^®. Side effects from Levodopa tend to be rare at low doses. Nausea is the most common side effect. Other side effects which may occur include vomiting, dizziness, low blood pressure; however these often ease after a few days of use. Levodopa can also cause movement disorders (head nodding, jerking and twitches) if used at too high a dose. The effect of Levodopa tends to wear off over time, usually over a period of 3 to 5 years.

 

Dopamine agonists

Dopamine agonists mimic dopamine.  Ropinirole (Requip^®), pramipexole (Mirapexin^®) and rotigotine (Neupro^® patch) are used most commonly. Initial side-effects are similar to levodopa (nausea, vomiting and dizziness) however side-effects tend to ease within a few days or weeks. Despite being slight less effective than Levodopa, one potential advantage of them as compared with levodopa is that they have less risk of causing movement disorders (described above). A dopamine agonist may be used in combination with levodopa as the condition gets worse. In trials comparing levodopa and dopamine agonists, symptoms of Parkinson’s improved with levodopa by about 40 to 50% as compared with approximately 30% with dopamine agonists.

 

Monoamine oxidase-B inhibitors

Sometimes used as alternative to levodopa for early Parkinson’s. They include selegiline (Eldepryl^®) and rasagiline (Azilect^®). They work by blocking the effect of monoamine-oxidase-B (MAOB) in the brain, a chemical that prevents the breakdown of levodopa and dopamine. Blocking the effect of MAO-B means the effect of dopamine lasts longer. MAOBs are often used in combination with levodopa as the condition progresses.

 

Other medication used for Parkinson's disease

Catechol-O-methyltransferase (COMT) inhibitors have become available in the last 20 years. Entacapone (Comtess^® and also an ingredient in Stalevo^®) is an example. A COMT inhibitor is often added to levodopa (as it increases its effect) when levodopa is not controlling symptoms sufficiently alone or where the effect of levodopa wears off. This is why Stalevo^® has grown in popularity in recent years.

 

Non Drug options

A physiotherapist can advise and help with movement. They will concentrate on posture, walking and exercises, thus maximising the length the person can move and manage independently. An occupational therapist can advise on areas that will make the person’s day to day living easier to manage and will advise on home adaptations and devices which can simplify tasks that become difficult due to the condition. A speech and language therapist can help if difficulties with speech, swallowing or saliva occur; these difficulties normally only occur later on in the condition.

 

Surgery

Surgery will not cure Parkinson’s but may help ease symptoms when medicines are not working well. An example is chronic deep brain stimulation, a technique that involves putting a pulse generator (like a heart pacemaker) in the chest wall. Clinical trials are still underway for this therapy as long-term safety of this surgery is not certain so it is rarely used at the moment.

 

Practical tips

Limit caffeine intake as caffeine can act as a diuretic and increase the frequency of urination. Decrease fluids to either two hours before bedtime, this will reduce waking up at night to use the bathroom. Sleep deprivation can exacerbate symptoms of Parkinson's. At night, a portable urinal and or bedpan can be an alternative to getting out of bed to make trips to the bathroom which can be difficult. The shower area should be fitted with at least two handrails.

 

It is easier to get up from a high chair than from a low couch. Consider using Velcro fasteners instead of buttons; carrying a walking stick when out can increase confidence if unsteadiness is a problem. Use an electric toothbrush and razor to make brushing your teeth and shaving easier. There are many utensils designed for people living with disability which can make everyday chores like eating, preparing food easier, grooming and cleaning easier. Examples include reaching devices, electric jar openers, modified cups and utensils for ease of holding and use, the list is limitless. Ask your occupational therapist or pharmacist for more details.

 

Longer term outlook

Symptoms tend to get worse with time but the speed of progression may vary significantly from person to person. Many do not need treatment initially as symptoms may be relatively mild. When symptoms become worse, medication can give several years of good or reasonable control of the symptoms. It is difficult to predict how quick the condition will progress. Some people may only have mild symptoms 20 years after diagnosis with other being disabled after only 10 years.

Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended

 

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