This week's article came from a patient medication meeting. This patient was concerned that her levels of iron were dropping, despite her regular iron supplementation. She was wondering if her medications or diet were causing this low iron status. After a sit down with her Heart Pharmacist we did find a potential cause. It involves the fact that certain minerals require stomach acid for absorption. This is of interest for anyone who is taking medications to reduce the amount of acid your stomach produces.

Our patient was taking a medication to help treat ongoing heartburn. In her case, she was taking a medication called a PPI (proton pump inhibitor). Medications in this drug family include Losec, Pariet and Nexium. These medications help to reduce the amount of acid produced by your stomach. For many people these medications can reduce symptoms of heartburn or gastric distress. With reduced stomach acid and symptoms of heartburn gone, why would there be an issue? This is a good question. Our bodies still need stomach acid for digestion and absorption of certain vitamins and minerals.

There are certain nutrients that require stomach acid for proper absorption from the gastrointestinal tract. The most notable are the macro minerals, calcium, iron and to a lesser extent magnesium and zinc. Vitamin B12 can sometimes be an issue as well. This is why taking PPIs is associated with an increased risk of osteoporosis. Your body requires stomach acid to make calcium more absorbable. If you can’t absorb calcium, you might be at greater risk for osteoporosis. This is why I recommend my patients that are taking a PPI to take adequate vitamin D (2000iu per day) and calcium citrate. Calcium citrate has better absorption for people taking a stomach acid reducing drug.

Iron is another story. There are many factors that interfere or enhance the absorption of iron. Things that help iron absorption are healthy stomach acid and vitamin C. Things that reduce iron absorption are low stomach acid, food, wheat and other grains, other minerals and tea. So you can see many factors work against iron absorption. So talk with your Heart Pharmacist to see if there is a way to help increase your iron absorption or if iron conflicts with your current medications.

If you are low in iron and your Physician or Pharmacist recommends that you take more, here are few tips we offer our patients. In theory, iron is best absorbed on an empty stomach, but this might cause some distress. In which case, take with a small meal or snack. If you can tolerate taking iron before bed, that is optimal. Watch out for iron’s four main side effects: stomach upset, constipation, constipation and a fourth which I seem to forget. Right, the fourth is also constipation. If this happens, don’t take your iron for a few days and regularity should return. For some people, constipation can be lessened by taking it every other day or twice weekly. Also take your iron supplement away from breads and cereal and tea. Also with iron absorption you do get what you pay for. The most expensive naturopathic and heme-based iron formulations are better absorbed, but their cost is significantly more.  Do not take iron at the same time as other vitamin supplements or antacids.


AuthorDanielle Cooper

June is usually a month of sun, gardening and planning for vacations. Not for your Heart Pharmacist. June is stroke awareness month. I think every month should be stroke awareness month. It is thought that over 12,000 deaths a year are attributed to strokes. What shocked me was that 10% of all stroke deaths occurred in people under 65 years old. This is why all months should be stroke awareness month. Let’s look at the signs of a stroke and what you should do.

How can you tell if you or someone you know might be having a stroke? There is a very handy word you learn about the signs of a stroke. It is called F.A.S.T.

F- Face. Is one side of the face drooping or does not look right

A- Arms. Often a person who is having a stroke can not raise both their arms at the same time

S. Speech. Is the person's speech slurred, jumbled or are they unable to speak?

T. Time. Speedy treatment is essential. Time to call 9-1-1 right away.

Don’t worry if you forget this word. It is written on the side of every BC ambulance.

There is often some question as to whether you should give an aspirin to someone you suspect is having a stroke.  The current thought is that you should NOT give an aspirin. It is recommended to give aspirin for heart attacks but NOT for a stroke. This is because there are two types of strokes and it is hard to determine which type a person might be having. There is the ischemic stroke where a blood clot has obstructed blood flow in the brain. Then there is the hemorrhagic stroke. This later type of stroke is where a blood vessel has ruptured and blood is leaking out. Giving a blood thinning aspirin to someone with a hemorrhagic stroke might complicate treatment. So only give aspirin for heart attacks, chew one regular strength or two low dose aspirins. Just in case you forgot.

What is a T.I.A.? Some people call them mini-strokes. TIA stands for Transient Ischemic Attack. This is caused by a blood clot partially blocking or only temporarily, an artery . Many people recover fully from these events so they might be tempted to think that they are no big deal. This is not a good idea. Think of a TIA as a “warning stroke”. Something is not going well with your blood circulation in the brain and should be brought to the attention of your Doctor promptly. A TIA could suggest that a full stroke might occur in the near future.

There are many ways to reduce your risk of having a stroke. The greatest benefit comes from stopping smoking, getting to a healthy weight, make healthy food choices and reducing your intake of caffeine and alcohol. Another way to prevent strokes, or heart disease, is to check your blood pressure regularly. Untreated high blood pressure is perhaps the greatest risk for your cardiovascular system. Check your blood pressure at any Heart Pharmacy. And don’t forget about F.A.S.T.


AuthorDanielle Cooper

It happens every year; it causes people's’ eyes to water, induces lots of frustration and maybe even a few sleepless nights. No, it is not the yearly filing of income tax. It is seasonal allergies. Normally, we associate allergy symptoms with runny noses, sneezing, and watery eyes. It can't be that bad, right? If these symptoms lasted for only one day it might be manageable, but these symptoms can last for up to 4 months. Sometimes people with allergies suffer from headaches, sinus pain/infections, and constant fatigue. This month, I will discuss non-drug measures to help soothe those allergy symptoms.


One natural solution to help treat allergies is simple: avoidance. How can one avoid allergens that are everywhere? Stay indoors all day in a bubble? No, there is no need to be this drastic. It is true that we spend most of our time at home. We also spend the most of that time in our bedrooms: this is where you start. We spend almost 8 hours a day in our bedroom, so it should be an allergen-free sanctuary. Pets should not be allowed to spend extended amounts of time in this room. While pets themselves might be allergenic, they can bring in allergies stuck to their fur. And speaking of fur, we should wash our fur in the evenings. What I meant to say is that during the day, allergens (pollens, dust) might get trapped in our hair. Before bed, have a quick hair wash or run a damp washcloth through your hair to remove any allergens. This sounds like a trivial suggestion, but every little bit counts for allergy sufferers.

The carpets should be vacuumed, with a vacuum cleaner that uses a HEPA filter, and surfaces should be dusted regularly. If possible, an air filtration device should be kept in the bedroom. Change sheets regularly and wash them in hot water to kill any dust mites. Cover mattress and pillows in dust proof covers. During the day, consider covering your entire bed with a sheet. At night, remove this sheet and put it in another room. This will help to keep the dust, pollens and other allergens off your bed.   

I am also a big fan of using a neti pot or Neil Med nasal rinse. This little squeeze bottle delivers about a cup of saline into the sinus cavities to clean out any mucus. Along with this it can flush out any allergens. While this might not sound appealing, it can be very helpful. I use mine whenever I have bad allergies or a cold. With regular use, it helps reduce congestion associated with seasonal allergies. In fact, some specialists and family Physicians are recommending their patients use this Neil Med product. In some cases, these practitioners prescribe a steroid solution to add to this rinse for enhanced anti-inflammatory and allergy relief.  

Another idea is to watch the newspapers or weather channel for your local pollen count. This might help you plan your week in order to avoid days when your allergies might be at their worst. This may be especially helpful of people who exercise outdoors. Another tip, my wife mentioned to me, is the miracle of the Vicks inhaler and Tiger Balm. At night, when symptoms might be bad, place a LITTLE bit of Tiger Balm under the nose. The aromatic vapors will help to keep the nasal passages open so you can rest better. Also, keep a glass of water by your bedside, in case you wake up with a dry mouth in the middle of the night. This happens quite often with people who have allergies.  


AuthorDanielle Cooper

Take a hike, it’s good for you. Maybe I should rephrase that sentence. Regular exercise in Victoria’s beautiful surroundings can have many health benefits. I think that sounds a bit better.  Grammar aside, there are many benefits from getting regular exercise in the great outdoors. In this article I shall mention some of the health benefits of walking you might not have thought about.

Can walking in a park make you happier? Most of us believe this, but now there is science that provides proof. A team from Stanford University published a study in the July 2015 issue of the  Proceedings of the National Academy of Science called, “Nature experience reduces rumination and subgenual prefrontal cortex activation”. This is quite an impressive headline that boils down to “walking in nature can make you happier.” These researchers scanned the brains of people who walked in a park, or in a high traffic urban setting, for 90 minutes. The people in the park showed decreased activity in a region of the brain associated with depression, compared to those that walking alongside busy traffic.  

You should also take your children, or grandkids, for a walk; it is good for their bones. This idea is backed by science too. Researchers at Oregon State University, found that children who got regular weight bearing exercise had stronger bones than sedentary children. You might not be aware of this but 60% of the risk of developing osteoporosis in adulthood can be attributed to lack of bone density created in childhood. How much exercise is needed per day? These researchers felt that 40 to 60 minutes at any point throughout the day was good. This is consistent with Health Canada recommendations for physical activity.

Regular exercise for children can also make them smarter. Again, this statement is backed up with science. In Sweden, researchers tracked the physical activity and academic achievement in twins. Apparently there is a large registry of twins in Sweden which provides all sorts of interesting health information. What they found is that regular physical exercise between the ages of 15-18 years lead to greater cognitive performance at age 18.

So now that you are in the great outdoors, had a lovely walk around the inner harbour, why would you need to have your blood pressure checked? As always, science has a great reason. Researchers from the Indiana State University, found that 18% of patients screened at community events were found to have undiagnosed high blood pressure. So stop by the Heart Pharmacy booth and have your blood pressure checked by one of our Pharmacists. While you are there, ask to try our portable fingertip electrocardiogram device called Kardia. Undiagnosed atrial fibrillation, a type of irregular heartbeat, is a significant risk factor for strokes. This Kardia device can determine if you might have atrial fibrillation in under 30 seconds.

Make health your priority. We look forward to seeing you on Sunday May 6th, at Fisherman’s Wharf Park for the 7th annual Hike for Hospice. It’s not really a hike, more of a 3.5 km scenic stroll around Victoria’s Inner Harbour. The hike begins at 10am.  Hopefully we will see lots of you there. Don’t forget to wear your sunhat and put on sunscreen lotion.

AuthorDanielle Cooper

May is asthma month. As a certified asthma educator, this topic is close to my heart. Asthma affects more than 3 million people across Canada. It is thought to be the most common disease and the leading cause for children missing school. There are lots of other statistics I could tell you, but I won’t.  The good news is that asthma is treatable and your Pharmacist can help in the simplest of ways.


But first let’s discuss what asthma is. By definition, asthma is a reversible constriction of the airways associated with inflammation and increased mucus production. People who don’t have asthma might find it difficult understanding what an asthma attack feels like. Breathing through a larger drinking straw is a pretty good simulation. The symptoms of shortness of breath, coughing and wheezing can be very frightening.

Asthma symptoms generally get worse when exposed to allergy ‘triggers’. The classic example of this is someone that has an allergy attack when a cat jumps on their lap. This is an oversimplification of the situation, triggers can be anything that irritates the airways. It could be pet dander, pollens, food, dust or strong aromas. Ironically, as I write this article the person sitting next to me had asthma like symptoms from walking in the cold air. One of the mainstays of asthma treatment is to avoid asthma triggers, which is easier said than done. If nothing else, keep the bedroom as clear of allergens as possible using a HEPA air filter and keeping the door closed.

So how can your Heart Pharmacist help with asthma treatment? They can ensure that you use your asthma inhaler medications properly. This might seem simplistic, but studies have shown that only 12% of asthma patients use their inhalers correctly. That means that of the ten asthma patients I see a day, only one patient uses their inhaler correctly. Pharmacists are ideally situated to help ensure asthma patients improve their inhaler technique. Even slight improvements can lead to better outcomes.

These inhaler devices are meant to be easy to use, but they are not perfect. And over time patients can forget important steps so their technique may get worse. Last week I spent 20 minutes with someone making sure they used their inhaler correctly. If you think that healthcare professionals are any better, think again. In one study only 15% of doctors could demonstrate the use of an asthma inhaler properly. If they worked in the emergency department, that success rate dropped to 9%. Clearly lots of work needs to be done to ensure patients, and health care professionals know how to use asthma inhalers properly.

Check in with your Heart Pharmacist for inhaler training. Even if you are sure you are using your inhaler correctly, it is always good to double check. I don’t like to recommend it but if you are pressed for time, look to the internet for proper technique videos. Most pharmaceutical companies websites have videos that demonstrate proper inhaler technique. You could also look at YouTube for instructional videos. While this is not as good as a Heart to Heart meeting, it can help make your asthma treatments more effective. Ask to book an asthma inhaler training session with your Heart Pharmacist.


AuthorDanielle Cooper