Category: Health

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Health

Trouble sleeping?

It’s been a month since I arrived in Costa del Sol, Spain, and I’m still amazed by this beautiful place! And watching the snowy weather reports from back home in Canada, I realize we chose a good winter to travel here.

This week, I have another great article for you… This is the best collection of information I’ve ever found about insomnia, all in one place. It discusses the different types of sleeping problems, common causes, and what you can do to get back to a good night’s sleep.

In fact, I think it’s worth reading even if you don’t have problems sleeping – you may find things you can do (or avoid!) that can improve your sleep further or avoid problems developing in the future.

Here’s the link: https://betterhumans.coach.me/how-to-recognize-and-cure-any-insomnia-symptom-661ebfd119f9 Happy reading!

PS… The photo above is Benalmadena Pueblo, a beautiful village halfway up the mountains, near where we are staying. Note the quiet street and great blackout shutters on the windows… I’m sure they get a good night’s sleep there!

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Health

Going Off Antidepressants

Benalmadena Beach

I’ve had a busy week here in Spain, so not much time to research and write a blog Well, really I’ve been visiting outdoor markets, watching Flaminco dancing, and exploring nearby villages of Mijas and Arroyo de la Miel… busy having fun!

But I did spend one morning reading, and came across an excellent article about antidepressants from Harvard Medical School that I’d like to share. It discusses how the medications work, how long they should be taken, why they can cause withdrawal symptoms, and what to do when you decide (in discussion with your doctor) that it’s time to stop taking them.

Doctors will sometimes recommend continuing antidepressants for years to prevent depression in those who have had multiple severe bouts. But 6 months of treatment is often considered long enough for a first episode. Side effects, like drowsiness, insomnia, headache or sexual dysfunction, that are tolerable when seeking relief from depression may become bothersome and unacceptable once a person is feeling better.

Withdrawal effects that are known to sometimes develop when discontinuing antidepressant medications — called “antidepressant discontinuation syndrome” — can easily be confused with a return of depression itself. Working closely with a doctor while gradually decreasing the dose of the antidepressant is important. A doctor will monitor to ensure any new symptoms are caused by withdrawal and not a return of depression. A gradual taper of the medication will often be prescribed to help to minimize any withdrawal effects. Occasionally a return to a previous, slightly higher dose will be used to ease symptoms before gradually decreasing again.

As a compounding pharmacist, I have made capsules of strengths between those commercially available to allow a more gradual dose decrease in sensitive individuals. But often withdrawal can be managed by using tablets that can be cut, liquids that can be measured in small amounts, or by switching to longer acting medications that are cleared from the body more slowly.

If you, or someone you know, is considering stopping a long term antidepressant medication, I’d encourage you to read more about going off antidepressants here And be sure to work closely with your doctor and your pharmacist to ensure this change is accomplished safely and as comfortably as possible.

Reference:

Harvard Health Publishing

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Health

8 Tips for a Healthy Holiday

Merry Christmas to all my readers!

I thought I’d share a few tips for a healthy holiday with you for my Christmas blog…

  1. Keep moving

  2. Have a plan

    • As I always like to say, “everything in moderation”. So, enjoy the special holiday goodies, but make a plan to avoid excess. Your plan could be to take half a piece, or to sample only a certain number of treats to limit your intake. Try to stay aware of how much you’re having.

  3. Stay hydrated

    • Sometimes you’re thirsty, not actually hungry.

    • Alternating drinks with a glass of water helps to moderate alcohol intake too. It’s easiest if you fill your wine or drink glass with water so you won’t be tempted to refill your drink before you’ve finished your water break.

  4. Make lists

    • The holidays can be a hectic time. Making a “to do” list is a good way to reduce the stress of worrying that you’ll forget something important.

  5. Forget perfection

    • The holidays are a time for enjoying time with family and friends. When entertaining, plan to make it casual. Do a “pot luck”, ask for help when you need it, and make cooking and decorating a group activity.

  6. Exercise early in the day

    • I have a little routine I try to do each morning. Especially during the holidays, something to do can easily crop up later in the day, thwarting your plan to exercise.

  7. Plan outdoor activities

    • Even if you have a house full of guests, an after dinner walk or other outing gives everyone a change of scenery, fresh air and some exercise. And any elderly or unwell guests will have a peaceful break while the rest of you are out!

    • We always have a “beach walk” after Christmas dinner… and our doggie visitors love it too. (All 3 of my children have dogs… we had 5 dogs here one holiday!).

  8. Only indulge for the day

    • Splurging on one day will never make or break your fitness plan – as long as you keep it to a day or two and not a whole month of indulgence! Enjoy the holiday with all its special treats (in moderation) then get back to your healthy life plan!

This will be my last blog for 2018 and I plan to take a little break for a while. My book about balancing hormones is ready to self-publish and I have a big learning curve ahead of me (that I’ve been putting off for far too long). And my hubby and I are planning a trip to Spain for 3 months…

So, have a wonderful holiday season and all the best for 2019… and I’ll write from time to time when I find a topic that’s especially interesting!

Reference:

US News-Health

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Health

Exercise: An ideal "prescription" for chronic disease

“If it was a pill, exercise would be a trillion-dollar money-maker prescribed to everyone.” Dr. Scott Lear, heart disease prevention researcher at Simon Fraser University, British Columbia, Canada.

A prescription for exercise?

Exercise is so effective at preventing and treating some chronic diseases, doctors are being encouraged to write prescriptions for it… Exercise decreases the risk of many diseases, including heart disease, stroke, Type 2 diabetes, depression (as discussed in last week’s blog ), and many cancers. Here are a few statistics for lowering chronic disease risk, as quoted on the website, Moving Medicine (a beta site being developed to encourage doctors to “prescribe” exercise to their patients):

  • Type 2 diabetes -40%

  • Cardiovascular disease -35%

  • Falls -30%

  • Dementia -30%

  • Depression -30%

  • Joint and back pain -20%

Physical activity is as important for health as many medications, but without the side effects. Humans were made to move, and inactivity is believed to be as harmful to our health as cigarettes. But, the more affluent our society becomes, the less we tend to move.

Who needs this prescription?

A global study of activity found that, on average, more than one-quarter of adults worldwide are not getting enough physical activity. And high-income Western countries (like us in North America) have inactivity rates twice as high as those of poorer countries, over 50% in some areas.

And women tend to be less active than men – up to 20% less in some countries. A 2017 survey published in Health Reports found that only 2% of girls aged 12-17 met the Canadian Movement Guidelines that include adequate sleep and at least 60 minutes of moderate to vigorous activity. A Dalhousie University study noted that teenage girls are concerned about appearances when they exercise: they worry about being pretty but natural-looking, thin but not too skinny, fit but not too muscular. Their responses in the study suggest that outdoor activities can provide an important venue to feel comfortable, safe and confident doing physical activity, compared to a gym setting where, as self-conscious teenagers, they felt they needed to be more concerned about clothing and appearances.

How to get more people moving…

Community infrastructure can influence activity in the young and old. Open spaces, like parks and walking/biking paths, provide enjoyable and convenient opportunities for physical activity. A visible example is the throngs of people who use the skating oval added to the Commons in downtown Halifax. You can even borrow skates and helmets there for free!

High quality public transport and incentives to use it rather than motorized vehicles can result in an overall increased population activity being incorporated into daily routines for those who use the systems. I noticed a marked increase in my activity level when using public transit while travelling in Europe, just by walking to and from the nearest system access.

With statistical evidence that inactivity is worsening in too many areas year by year, and with a corresponding increase in chronic diseases like diabetes and heart disease, it is time to think seriously about ways to increase physical activity levels across populations.

So, if you want to reduce your chances of developing a chronic disease as you age, look for ways to incorporate more exercise into your day, and it doesn’t have to be a session at the gym. Remember that ten minutes of activity three times a day is considered equal to a single 30-minute session. Park farther away from the door when doing errands or take the stairs instead of the elevator – it all adds up. My husband and I enjoy a daily 25-minute walk to check our mailbox most days and climbing up and down the stairs in our 3-story house adds to the daily total.

How much should you exercise to benefit?

The World Health Organization guidelines for physical activity recommend a minimum of 150 minutes per week of moderate-intensity activity like brisk walking, biking or dancing… or 75 minutes a week of vigorous activity like jogging or playing an active sport. If you have a chronic disease, check with your doctor first, start slowly and increase activity gradually. You can expect a few sore muscles as you begin but stop exercising and contact your doctor right away if you experience any chest pain or other alarming symptoms. Any exercise that makes it difficult to speak is likely too intense and could be a risk to your immediate health. Specialized exercise programs are available in some areas to help those with chronic diseases, such as heart disease or back problems, to get started safely. The cardiac rehab program my husband took after his heart attack 14 years ago was a game-changer, and we’ve worked to keep up our activity level since then.

So, don’t be surprised if your doctor gives you an unusual prescription…

In addition to the Moving Medicine program in UK mentioned above, Canadian medical schools are also revising their curricula to teach future doctors about the benefits of exercise to prevent and treat chronic diseases. It’s better and less costly to prevent diseases than to treat them!

(Please note that underlined phrases above and in the references are links to the source of the information)

References:

Exercise is Medicine, and Doctors are Starting to Prescribe It, The Conversation

Prescribing Movement (UK website under development to encourage doctors to prescribe exercise)

Girls and Women Need More Time in Nature to be Healthy

Worldwide Trends in Physical Inactivity 2001-2016

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Health

Why Are Strokes Worse in Women?

Each year in Canada, about 32,000 men and 30,000 women have a stroke. But one-third more women die from stroke: 59% compared to 41% of men. Women’s disability from stroke is more severe too — almost twice as many end up in nursing homes, compared to men.

Why is this? Stroke treatment, awareness and research has increased over the past 20 years but fewer women are involved in the studies, so the reasons are not well understood. However some researchers have thoughts on what some of the reasons might be…

Risk factors for Stroke

First, researchers found that seventy percent of women don’t know any of the risk factors for stroke. They could be at increased risk but they don’t know it, and don’t do anything to prevent it. Time for more public education directed at women. So, read on, ladies (and gents too…)

Some risk factors can’t be controlled: increased age, family history, being of South Asian, African or Indigenous descent, or just being female! Other risk factors can be changed, like high blood pressure (an important one!), diabetes, unhealthy diet, physical inactivity, unhealthy weight, smoking, stress and excess alcohol.

High cholesterol is often included in risk factors for stroke: it’s accepted as being a risk factor for heart disease, and established heart disease puts you at higher risk of a stroke. But low cholesterol was identified as a risk factor for bleeding stroke in Japan decades ago, so there’s some controversy about this one. Read my earlier blog, The Cholesterol Controversy, for more information on that ongoing discussion.

Atrial fibrillation, an irregular beat in the upper part of the heart, is another important risk factor for stroke. In this condition, blood tends to pool in the upper chambers of the heart instead of being sent through to the lower chambers, promoting formation of blood clots that can later be sent to the brain, causing a stroke.

Women are also at increased risk of stroke during pregnancy (3 times increased risk), during the menopausal change and in their elderly years. So, although stroke is more common in older women, it can occur in adult women of all ages. Both birth control pills and hormone replacement therapy can increase risk of stroke, just as our own hormones do during pregnancy, by making blood clots form more easily. Blood clots are at the root of the majority of both strokes and heart attacks. Some people refer to a stroke as a “brain attack” because the process is often similar.

What exactly is a stroke?

There are two main types of stroke plus a few other less common types:

  1. Ischemic stroke, where a blood clot or other type of material blocks an artery in the brain. This accounts for 90% of strokes.

  2. Hemorrhagic (bleeding) stroke, where a blood vessel in the brain bursts, allowing blood to leak rather than travelling to supply an area of the brain.

  3. Transient Ischemic Attack (TIA), is caused by a small clot that temporarily blocks an artery in the brain, giving temporary symptoms. Sometimes it precedes a major stroke.

  4. A tumor, infection or brain swelling from an injury can also cause a stroke in rare occasions.

Signs that a stroke is happening

A Heart and Stroke Foundation survey found that only 60% of women knew exactly what a stroke is, and only 8% knew all 3 signs that a stroke was occurring. Use the acronym FAST to remember them:

  • Face – Is it drooping?

  • Arms – Can they raise both?

  • Speech – It is slurred or jumbled?

  • Time – Time to call 9-1-1 right away!

Act FAST because the quicker you act, the more of the person’s brain you save!

Poorer outcomes in women

The emergency treatment for a stroke is to unblock the artery (for a blood clot stroke) or to stop the bleeding (for a bleeding stroke). Because brain damage is caused by lack of blood to an area of the brain, the more quickly the artery is unblocked (or the bleeding is stopped), the less damage and disability that will occur.

But women’s stroke symptoms are not always as clear as those in men, so strokes are sometimes not identified as quickly. Cases diagnosed as a TIA (a temporary stroke) in some women have later been discovered to be a full stroke. Studies have found, on average, women receive treatment more slowly than men.

Researchers looked at the “door to needle” time – the amount of time from when women arrived at hospital until she received an injection of a clot-busting drug to open the blocked artery in an ischemic stroke. On average, this time was 12% longer in women. Women are also less likely to be sent for the specialized surgery to remove a blood clot. And more women live alone, so often no-one is there to help them call for emergency transport to hospital when a stroke occurs.

Recovery from stroke is possible

The good news is that the brain can continue to recover and improve for several years after a stroke, if you do have one. Rehab and physiotherapy services can help improve function and mobility greatly. And the harder you work, the better your results.

However, women have been found to be 2 to 3 times more likely to have a poor outcome from rehab after a stroke than men. Experts suspect that women may have more difficulty getting to therapy sessions, or return to family and work responsibilities before they are fully recovered, but we need more research to find out why women don’t recover as well as men. Then we can work to change these factors and help women to better stroke recovery.

Conclusion…

So, know your risk factors for stroke, and work to reduce your risk. Know the FAST warning signs for a stroke and act quickly to get treatment to reduce damage to the brain: call 9-1-1-! When the ambulance arrives, tell them you think you might be having a stroke, even if the signs are not completely clear. Symptoms are not always as clear in women as in men.

If you do have a stroke, know that rehab and physio exercises will help you improve, and you can keep improving for several years. But you have to do the work, take the time, and stay determined to heal and recover as much as possible. The brain can reorganize itself and make new connections, but you need to stay in training mode to make it happen!

Read the link below (“Lives Disrupted”, for stories of women of all ages who have recovered well from stroke and returned to normal life…

References/Resources:

Lives Disrupted: The Impact of Stroke on Women

FAST signs of stroke

Types of stroke

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Book review Health

Are You a Napper?

“In a perfect world, all humans would nap”…Sara Mednick, PhD; nap researcher and author.

My grandfather always had his “snooze” after lunch; my husband loves his naps, and will snatch 15 to 30 minutes whenever he feels the least bit tired. But I rarely have trouble sleeping at night, so I’ve always felt I didn’t need a daytime nap. And I didn’t want to “waste” the time…

Then I stumbled across Sara Mednick’s book, “Take a Nap! Change Your Life” She, too, didn’t believe in naps but was amazed at how much better she felt afterward when, exhausted, she succumbed one afternoon. Being a sleep researcher, she decided to investigate what science tells us about daytime napping. Finding essentially no nap research, she decided to investigate herself. This developed into a career of nap research! Here’s some of what I learned from her book.

Essentially all other animals take daytime naps – they call this “multi-phasic” sleep. In Europe, the daytime “siesta” is part of the culture, although they are gradually succumbing to the North American idea of pushing through the day, regardless how tired. I’ve been surprised more than once at finding a shop closed at mid-day, especially in smaller towns and villages. But now I understand it better… and I should have been napping myself at midday, not shopping!

The early afternoon “slump” in energy has often been blamed on what we ate for lunch or simply overeating. But it’s really part of our Circadian (daily) rhythm, a pre-programmed mini-dip in energy, and a signal that it’s time to nap. A 20 to 30 minute sleep, about 6 hours after morning waking is beneficial for alertness, mental ability and overall health. Our brains are programmed for it.

And, in case you feel silly about napping, you should know that some of the greatest minds benefited from regular naps: Leonardo da Vinci, Isaac Newton, Napoleon Bonaparte, Albert Einstein, John F. Kennedy and several other presidents, and Winston Churchill. Think of it as a new wellness technology… although it’s really nothing new. We’re just finally doing proper research to learn about it.

Sadly, the trend in recent years has been toward longer work hours. I remember talk of a four-day work week years ago, but it never happened. With rising housing costs in large cities, many have moved to the fringes for affordable housing, and the longer commute to work compounded with longer work hours can often result in less time for sleep.

Although many of us depend on caffeine to get through the day and we have medications for sleep disorders like narcolepsy, no drug has yet been invented that is a substitute for sleep, scientists say. Sleep deprivation has many detrimental health effects, including increased heart disease and stroke, increased car accidents, decreased immune function, decreased sexual function, premature aging, obesity, diabetes, irritability, depression, and all the symptoms of stress. Researchers say we may be confusion the symptoms of fatigue with the signs of stress. Both increase blood levels of the stress hormone, cortisol, that causes all of these effects.

The simplest solution is to incorporate naps into the our day! Science tells us there are at least 13 good reasons to nap (and 13 is my favourite number) :

  1. Increased alertness – A brief daytime nap can increase alertness by as much as 100%.

  2. Speed up motor performance – Improved coordination after a nap can mean fewer accidents.

  3. Improve your accuracy – Your boss will be happy you’re making fewer mistakes, and better decisions

  4. Look younger – Naps increase growth hormone production, which can result in improved skin texture and tissue regeneration. Naps are truly “beauty sleep”

  5. Improve your sex life – Daytime napping can increase sex drive and function. Nap now, love more later…

  6. Lose weight – Sleepy people crave high fat, high sugar foods more than people who are rested. Naps can also help you produce more growth hormone that reduces body fat.

  7. Reduce risk of heart attack, stroke and diabetes – Fatigue results in increased cortisol production, and this leads to increased blood pressure, heart attacks, stroke and other cardiovascular disorders and increased blood sugar.

  8. Improve your stamina – Naps give you extra energy for running a marathon or staying alert at meetings. A nap can make the second half of your day just like a brand-new day!

  9. Elevate mood – Lack of sleep makes you cranky.

  10. Boost creativity – Naps help your brain create connections needed for a fresh burst of creativity.

  11. Reduce stress – Naps can lower cortisol and make you a less-stressed, calmer person.

  12. Improved nighttime sleep – Contrary to some sleep advice, research shows a midday nap can actually improve your nighttime sleep. Going “beyond” with fatigue can rev you up so you’re too “wired” to fall asleep when you have the chance.

  13. It feels good! – Millions of nappers (and essentially all animals) can’t be wrong…

So, create opportunities for a nap during your day, ideally about 6 hours after you wake up in the morning. You’ll feel better, be healthier, increase your productivity and make better decisions. Even your boss should be interested – introduce him/her to the science of napping!

Further reading:

Take a Nap! Change Your Life: The Scientific Plan to Make you Smarter, Healthier, More Productive (Amazon.com or Amazon.ca )

Note: I have no affiliation with the author or seller of this book…just sharing a book I enjoyed reading and learned from!

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Health

9 Ways reading makes you smarter

I have always loved reading… I was one of those kids who read with a flashlight under the covers when I was supposed to be going to sleep. One of my favourite features of the Kindle Reader I have now is that I can read it in bed without a flashlight…

As a practicing pharmacist, virtually all of my reading was non-fiction, learning information that would help me be a better pharmacist. But I always loved novels, especially historical ones and those about another culture or a country I’d never visited. Now I try to balance my reading between fiction and non-fiction.

So you can imagine how pleased I was to find an article based on science about the many ways reading fiction is good for your brain… couldn’t wait to share it with you!

Science-based ways reading improves brain function:

  1. Improves ability to detect and understand social cues This skill is known as “Theory of Mind” and helps us to interpret the actions and body language of others. If you’re a fan of “Big Bang Theory”, think of Sheldon, a character who reads only scientific literature and has great difficulty understanding the emotions of others and subtleties in language, such as sarcasm. Well-written literary fiction will “show” not “tell”… emotions are shown through actions of the character rather than describing the emotion itself (for example: if a character “storms from the room” the author doesn’t need to say he is angry).

  2. Increases empathy Fiction allows the reader to get in touch with the characters’ thoughts and feelings, imagining other realities and how they might feel in that situation themselves. Readers of fiction scored better than non-fiction-only readers on a test to guess a person’s feelings when shown only a photo of their eyes.

  3. Sharpens memory and engages imagination Simple 3-word phrases, like “red leather purse” were enough to activate the hippocampus, a center in the brain for memory, in functional MRI tests. When reading fiction, the reader needs to consider both what is being said and what is not said. Often spaces need to be filled in using the imagination. I have often described a good book as a “movie in your mind”, with pictures created by your imagination using cues and descriptions in the book. Unlike movies and television, where all the details are provided, books require the reader to create the pictures and “hear” the voices. And most books last much longer than the average TV show, requiring you to remember details from the beginning that may turn out to be important later on…

  4. Improves decision making and emotional processing Modern scanning techniques have shown that reading stimulates key areas of the brain. Any time you exercise part of your brain, it responds by creating new connections between brain cells to increase function. These are the areas of the brain that light up when reading:

    1. Prefrontal cortex – area for decision making and recall

    2. Lateral temporal cortex – area that deals with emotional association and visual memory

    3. Hippocampus – long term memory processing

    4. Parietal lobe – understanding emotions and interpreting sensory information

    5. Posterior cingulate cortex – memory recall

  5. Can create effective self-reflection Poetry, especially “high poetry”, such as works by Shakespeare, Wordsworth or Dickinson, activates “autobiographical” memory, your episodes of personal memories of experiences, objects, people and specific events experienced at a particular time and place. Poetry encourages reflection on these episodes to apply personal meaning and understanding to the poetry.

  6. Creates serious “mind building” Reading-connected activity in areas of the brain associated with comprehension continues for as long as 5 days. This “shadow activity” is similar to what occurs with muscle building. Reading is like lifting weights for your brain!

  7. Improves vocabulary and verbal skills Language constantly evolves. Different authors write in different ways, using different language, exposing you to more words used in a wide variety of ways. Reading a variety of authors teaches new ways of explaining ideas or creating images with words. There is a direct correlation between good verbal skills and reading. Even reading non-fiction can expand your vocabulary while you acquire new information.

  8. Slows mental aging Reading is a constant mental exercise for all ages. Word imagery, metaphors, philosophy, abstract ideas and creativity challenge and activate the brain. Lifelong readers demonstrate better processing and understanding of sentence structures, comprehension and memory as they age.

  9. Encourages learning from the content you read Non-fiction teaches ideas and facts but well-written fiction can also teach about other cultures, geographical areas, ideas, history and more through story and setting. The key is that the author does the required research to provide accurate details, even though the story line may be fictional.

So, never feel that a good novel is a waste of time. Enjoy imaginative stories along with inspiring non-fiction, knowing that it all keeps your brain active and continuing to develop throughout your life.

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Health

Marijuana — Now Legal for Medicinal and Recreational Use in Canada

Marijuana became legal for adult recreational use in Canada on Oct 17th, as I’m sure you’ve heard on the news. The Canadian Government’s goal is to control use, eliminate the illegal trade, prevent use in minors and, of course, collect taxes.

But I’d like to talk about the other side of marijuana — medicinal use. In Canada, marijuana use for medicinal purposes has been legal for 17 years but it’s only supplied through government sources, essentially mail order. Pharmacies are still not permitted to distribute or help clients with this medication and many doctors do not prescribe it, and this has lead to a fracturing of the usual medication system designed to prevent drug interactions and problems.

Another downside, besides the inconvenience of mail order, has been the stigma of using what was, until now, an illegal substance. I know of patients who would have benefitted from it, according to current studies, but were afraid to try a medication that had been described to them as a “drug of abuse”, worried they might become “addicted” while their doctor prescribed opioids or other prescription drugs instead.

Medical uses of marijuana

While marijuana is currently not a first-choice treatment for any condition, scientific evidence has shown it works for chronic pain, nausea and vomiting caused by chemotherapy, spasms caused by MS, and treatment-resistant epilepsy. There is also discussion around the possibility it may help decrease the opioid problem, now at crisis level in many countries, by substituting marijuana for this more dangerous class of medications. I know of patients who have successfully made the change from opioids to marijuana and now experience good or better pain relief with fewer side effects.

There are many active components in marijuana, known as cannabinoids — at least 113, according to official Health Canada information, and as many as 400 different ones, according to other references. The two most active cannabinoids are THC (tetrahydrocannabinol) and CBD (cannabidiol). Most medicinal marijuana contains more CBD, the chemical that is active for pain and reducing muscle spasms) and less THC (which creates the “high”). Products can now be produced that contain virtually no THC for medicinal use. These products are considered safer than opioids and have fewer side effects than anti-inflammatory analgesics (known as NSAIDS).

Currently healthcare professionals are divided regarding whether access to medical marijuana should be integrated into the current medicine supply system. Many are not well educated on its actions and side effects, as they have had little or no contact with medical marijuana. Your doctor and pharmacists may not be able to advise you whether you would benefit from this medication unless they have taken the initiative to educate themselves. Currently there is little incentive for pharmacist to become involved, as they are not permitted to help even clients with legal permission to use marijuana. Last year, a young pharmacist lost her licence temporarily for helping one of these clients solve a problem with his medical marijuana — a tragedy, in my opinion.

Is it OK to self-medicate?

With marijuana now available for recreational use, it has also become available for patients who may decide to self-medicate. This is certainly not an ideal situation When something is affecting your health, it’s always best to get a proper diagnosis and discuss treatment options with your doctor or nurse practitioner. Like any medication, medical marijuana use needs to be monitored, to ensure it will be used in the safest manner possible, at the correct dose, in the ideal formulation, and that interactions with other medications or diseases will be avoided.

For example, smoking marijuana has all the same risks of lung problems that smoking tobacco does, and would aggravate lung diseases like asthma. While occasional recreational smoking may run lesser risk, smoking marijuana every day for medicinal use is understood to be as dangerous as a tobacco habit. Inhaling marijuana gives quick onset of effects (within seconds to minutes) but the effects do not last as long (usually 2 to 4 hours), requiring frequent dosing. Other forms, such as oral (swallowed) or sublingual (placed under the tongue) can last up to 12 hours, making them more suitable for medication use for patients with chronic diseases.

Can marijuana be habit-forming?

Humans produce their own cannabinoids, just like we produce our own opioids, and these drugs work by attaching to receptors in our brains for the substances we normally produce. When this happens, our brains change to compensate for the extra stimulation from the introduced drug. When these drugs are stopped, it can take some time for the brain to revert back to its usual function and this results in withdrawal effects that are generally opposite to the effect of the drug.

Opioids, for example, cause drowsiness and reduce the perception of pain. When opioids are stopped abruptly after longer-term high-dose use, people often have difficulty sleeping, may develop anxiety and could become hypersensitive to pain. While the brain changes with marijuana seem to be less persistent than those that occur with opioids, resulting in less withdrawal symptoms that with opioids, these can occur after long-term high-dose use. Marijuana withdrawal can result in nausea, anxiety and sleeplessness. Tapering the dose is recommended to avoid withdrawal effects when stopping long-term use, the same as with any medication that affects brain receptors, such as antidepressants, anti-anxiety medications, antipsychotic drugs and opioid analgesics. Further research still needs to be done to identify risks and benefits of long term use for chronic diseases.

In summary, there is still much to learn about marijuana, both for medical and recreational use. Legalization of the substance will encourage more research, reduce stigma for those using it for medicinal purposes, and encourage learning on the part of healthcare professionals. Our best hope, on the medicinal side, is that marijuana may help to reduce deaths and addictions to opioids from both medical and illicit sources while becoming an effective and safer treatment for a range of medical conditions.

References and further reading:

Now that cannabis is legal, let’s use it to tackle the opioid crisis, The Conversation

Cannabis in Canada, Health Canada

Information for Healthcare Professionals on Cannabis and Cannabinoids, Health Canada

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Health

Ever considered keeping a journal?

Ever considered writing a journal? I’m thinking about it… want to think along with me?

There are many reasons to journal. My mom kept one for years, initially about household purchases and expenses – she liked looking back to find out just when we had bought that old couch or how much electricity had gone up in the past year. Eventually, she had records that dated back several decades. In more recent years, she kept track of the weather, appointments, who had visited and anything she wanted to remember. We all said her memory was better than ours, and that probably had a lot to do with her journaling.

A journal can take many forms and can contain anything you want. You may journal for different reasons and your purpose can change over time. The only intentional journaing I’ve done so far has been a travel journal, with the goal of making notes of where we went, how we got there and what we saw and did, in case we went back or wanted to share information with others about that location. Although, now that I think about it, I also kept a journal of sorts while working at the hospital pharmacy, keeping notes in a pocket-sized ring binder on new drug information. Several of the pharmacists there did…we called them “portable brains”!

So, there are lots of types of journals, and plenty of reasons to write daily. But what things should you decide before starting a journal?

  • Why do you want to journal?

    • A journal can be used to capture events and memories, as I did with my travel journal, but it can have several other uses too. Some people use a journal as a processing tool, to help solve problems, for example, by writing out the pros and cons of decisions they need to make or by listing their choices if what to do next on a page. Some use a journal to work out their feelings — when you write down the little things that irritate you, you realize they really are just little things.

    • Others just want to start a daily habit, perhaps as they begin a new stage in life. With the birth of each of my children, I purchased a “baby book” to record all of those wonderful “firsts”. After my third, I continued to record memorable events related to my children, eventually filling up a small journal. My children have enjoyed looking through it years after it was written and, in a sense, it was written as much for them as for myself.

    • Writing daily in a journal can also be used to improve your writing skills. Any practice helps and, knowing the writing is not going to be read or edited by others can give you freedom to let ideas to flow onto the paper or screen.

    • Recording your thoughts can also help improve self-awareness. Journaling can create a time to just think and record those thoughts, if that is your goal.

  • What format do you want to use?

    • Digital

      • While you could simply write in a word processor, such as Word, you might want to consider a dedicated app, such as Day One, Live Journal and many others. Some also allow digital photos to be included, a nice addition to a travel diary, and can sync between devices. These programs offer the advantage of security, as you can password-protect your writing. Some can also be encrypted for further protection, which could be important if you are writing deeply personal honest thoughts that must never be seen by others.

    • Pen and paper

      • Writing in a traditional paper journal slows you down since it’s more difficult to change words written in ink. This requires you to think more before writing, and that may be one of your goals. Many also feel it offers a richer experience, similar to how some people prefer traditional paper books to electronic ones.

      • Paper journals can be kept in a locked drawer for a certain level of security. However, consider whether you care if it is found after you’re gone…

  • What to write?

    • Julia Cameron, author of The Artist’s Way, suggests writing a stream of consciousness — whatever comes into your mind — first thing each morning to stimulate creativity. She refers to these as “morning pages”. This activity can be helpful for writers, to practice allowing ideas to flow onto the page uncensored.

    • Michael Hyatt, former publisher, now author and blogger, suggests creating a template to guide your journaling, rather than facing a blank page. To do this, list questions you want to answer each day and leave space for answers

      • For example:

        • What happened in the past day? (records events)

        • What were my successes? (gives a sense of momentum, positive focus)

        • What am I thankful for (promotes gratitude)?

        • How do I feel right now?

        • What have I learned in the past day?

        • What can I do next to move ahead with a project I’m working on (or want to do)?

      • A template can work well to record daily events and to help you focus on what is positive in your life. Also, as you begin, it can be helpful just to get you started each day.

  • When is the best time for you to write? How long do you want to spend writing each day?

    • Regardless of when you decide to write, choose a time of day that is convenient and consistent. A habit is easier to create if you make it part of an established daily routine, for example, with your morning coffee. Leave your journal on your kitchen table or, if you prefer to write at night, on your pillow as a reminder. How long you spend each day depends on your goals — a stream of consciousness journal might be a timed activity, say 15 minutes each morning, while recording thoughts and events while traveling in an amazing country might vary by the day, depending on your activities.

  • How long you want to continue to do this?

    • Commit to a trial period. Realize it may take a while to become a daily habit. Don’t give up after too short an effort and don’t worry if you miss once in a while at first. It may seem a bit difficult as you begin (what to write?), but many people find journaling enjoyable. Don’t be surprised if your journal changes over time — just write what is enjoyable or helpful for whatever stage of life you are in right now!

Categories
Health Public Health

Flu season? Who cares…

You’re healthy. A little flu won’t hurt you. And you hate needles. Why bother with the flu shot? Well, it’s not just about you…

You see, when you get the flu, even just a mild case, you can pass it along to others, and they may not be as healthy as you are. That sweet little old lady in front of you in the grocery line or the young woman in the doctor’s office, that you didn’t know was taking chemo, could be exposed to the virus you just caught because you didn’t get your shot. And they could become very ill because their immune system isn’t as strong as yours. If you don’t get the flu, you can’t pass it on.

Protect the herd…

And, while we’re talking about virus infections, I should tell you about something called “herd immunity”. This term means that if most of the the population (or “herd”) in an area is vaccinated to protect them from a virus, then those who are more vulnerable and those who can’t (or won’t) get a vaccine will be better protected.

But a majority of the “herd” needs to get their flu shot for the effect to make a difference. If too few are protected, then enough people are vulnerable to let an epidemic spread. We’ve seen this lately with some of the childhood vaccines… Diseases like mumps and measles had become quite rare, but in recent years news articles have described local areas and sports teams where groups of people have become sick with these viruses. Untrue rumours on the internet have convinced many parents that there is a connection between the measles/mumps vaccine (MMR) and autism. In spite of having been proven incorrect, articles continue to circulate around the internet about this false connection.

Reactions are rare but…

Most people tolerate vaccines well – the slightly sore arm or mild fatigue that sometimes occurs is nothing compared to a full-force flu. And, in the elderly, the very young, and those with chronic disease or a weakened immune system, it can be life-threatening. People die from the flu every year.

A very few serious reactions to vaccines are reported, due to allergies or sensitivities, and this is why you need to stay for 15 minutes after your shot. If you should have one of those rare reactions, you will receive treatment for it right away. Doctors will recommend that people who have had a serious reaction do not take that vaccine again or that they receive it in a hospital setting. This is another case where herd immunity, ensuring that friends, co-workers and family are vaccinated, can be important.

So do your part to protect yourself and others — find a pharmacy or clinic that gives flu shots. Most pharmacies do now, and they’re free there for most people just as they are at your doctor’s office. Roll up your sleeve and take a deep breath… it’s done in seconds and hardly hurts at all.

And, to feel the injection less, here’s what to do:

  • Relax. It hurts a lot more if the muscle is tight.

  • Ask the person injecting to wait until the alcohol evaporates. It only takes a few extra seconds.

  • Don’t move. You want the needle to go straight in and straight out quickly.

  • Distract yourself. Even taking a deep breath can be enough distraction to take attention away from the injection.

  • Apply pressure right away. Your brain will register pressure instead of pain.

    • Often an injector will press lightly on your arm while giving the injection, for the same reason.

    • They will also make sure the injection is well into your muscle – it hurts less there and works better too.

    • The injector will use a cotton ball to apply pressure. You can take over so they can finish up their paperwork.

  • If the area is sore later, apply a cold compress (a refrigerated ice pack or ice cubes wrapped in a cloth). You can also take a dose of Ibuprofen or Acetaminophen (Tylenol) to reduce soreness at the site of the injection, a common side effect.

So, lots you can do to make your flu shot practically painless!