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

Migraines hurt. This is a gross understatement for those who are afflicted by these vicious headaches. I thought about migraines when a patient asked if there were any vitamins that could help. She had tried avoiding all migraine triggering foods, wine, aged cheeses, caffeine withdrawal, chocolate, MSG, shell fish and cow’s milk, with no luck. A few medications to help prevent migraines proved unhelpful. I always have a few options that can help with migraines. The best supplement options are magnesium and vitamin B2.

What causes a migraine and why does it hurt so much? The exact cause of migraines is not known, but researchers have a few ideas. One theory involves a three-step process. The first step is referred to as “initiation”; in this step something begins the migraine chain of events. It could be stress, food allergies or other triggers. During the second step, called “prodrome”, the body responds to these triggers by releasing blood vessel constricting substances. This causes a reduced blood flow in certain parts of the brain. It is believed this blood-flow reduction may cause the ‘aura’ that is experienced before a migraine headache attack. The third or “headache” step is where your body responds to this reduced blood flow by causing rapid blood vessel dilation. This increased blood flow might cause the pounding sensation that is felt during a migraine. This is a very simplified version of what is thought to happen. The process of trying to condense an entire theory, which is written in medical science-speak, into real English, makes my head hurt.

What are the symptoms of a migraine? They are not very pleasant. As well as the severe throbbing pain, they may include sensitivity to light and/or noise and nausea and/or vomiting. When should you contact your Doctor about your migraine? There are a few warning signs that should alert you to seek urgent medical attention:

  • A very sudden headache “thunderclap”
  • A headache after a blow to the head
  • A headache with other seemingly unrelated symptoms, such as: numbness, vision changes, slurred speech, unusual confusion or weakness.
  • An very different type of headache than is usually experienced
  • A headache with symptoms of fever, stiff neck, drowsiness, vomiting and confusion.

The mineral magnesium has also shown to be helpful in reducing the frequency of migraine headaches. Often people who regularly suffer from migraines tend to have lower amounts of magnesium in their bodies. I tend to recommend up to 500mg of magnesium citrate to help prevent migraine headaches. Side effects are rare, but higher doses of magnesium tend to have a laxative-like effect. Other side effects include low blood pressure, thirst, fatigue and muscle weakness. There are some possible drug interactions with magnesium. Ask your Heart Pharmacist if higher doses of magnesium are safe to take with your medications. I feel this option should be seriously considered by anyone who regularly gets migraine headaches. It is thought that low magnesium is a major, unrecognized health concern. Luckily for my patient, taking extra magnesium reduced her frequency of migraines significantly.

Did you have a question for our Heart Pharmacists? Your question might be featured in this article. Head over to HeartPharmacy.com and contact us with your question. Or send your questions to [email protected]




AuthorDanielle Cooper

This topic came to me during our Heart Pharmacist weekly telephone meeting. One of our patients was experiencing leg pain and fatigue that occurred during the day, but worsened at night. Leg cramps is not an uncommon issue with patients, but this one had an uncommon solution.


Leg cramps, especially at night, can be excruciatingly painful. Usually after a few minutes with gentle stretching and massaging the muscle cramp will subside. Sometimes, this is not always be the case and leg pain can continue into the next day. Generally this is something that can be treated by your local Heart Pharmacist. A Physician visit is rarely required, unless the pain persists or seems to be point sensitive.

A Pharmacist bag of tricks for leg cramps are simple and is usually effective. The first solution is to increase your intake of calcium. I generally recommend chewing a TUMS calcium antacid tablet before bed. Calcium can be quite helpful for reducing leg cramps at night. If you want to go one step further, have a small glass of tonic water before bed. The small amount of quinine in tonic water can also help with leg cramps.

If this doesn’t work I recommend taking a magnesium supplement at bedtime. Often calcium and magnesium can be found in a combined tablet. Magnesium is also a good muscle relaxing supplement. Some patients also mention that it can sometimes help them fall asleep. Check with your Heart Pharmacist to see if calcium and magnesium are right for you. Especially if you are taking antibiotics or medications for osteoporosis.

Potassium is also helpful for muscle cramping. This is usually more of a solution for high intensity athletes exercising under warm weather conditions.  A common home remedy is to have a banana before bed to help with leg cramps. Increasing your fruit intake for any reason is a good idea. However your body is generally good at ensuring it has enough potassium to fulfill its needs. If your leg cramps rapidly goes away after increasing your intake of bananas, you might want to bring this to the attention of your Physician.

Another helpful tip requires a bit of training. It is common in the night to stretch your legs when you shift around. A natural tendency is to stretch by pointing the toes. Pointing the toes can lead to muscle cramping. If you do stretch your legs stretch by pushing your heels down and pulling your toes closer to your shins. The opposite of pointing your toes. Sometimes a warm bath before bed can also relax stiff muscles. Add a bit of Epsom salts (magnesium) to your bath water.

In this case, our patients leg cramps were caused by a medication. Medications called ‘statins’ are commonly prescribed to help lower cholesterol. Elevated cholesterol is a modifiable risk factor for heart disease. However a common side effect with statins, along with stomach upset, is muscle pain. In this person’s case, stopping or switching their statin was not a preferable option. Another oddball side effect of statins is to reduce the amount of a substance called Co Enzyme Q10 (CoQ10) in the body. CoQ10 is used for energy production is muscle cells, and a deficiency can manifest itself as muscle fatigue or aching. We recommended taking CoQ10 100mg daily. The leg cramps improved and decreased in frequency to make our patient happy. Ask your Doctor or Heart Pharmacist if CoQ10 would be right for you and your medications.

Did you have a question for our Heart Pharmacists? Your question might be featured in this article. Head over to HeartPharmacy.com and contact us with your question. Or send your questions to [email protected]





AuthorDanielle Cooper

Pharmacists talk and Pharmacists listen. This is certainly not a surprise to our patients. Our Heart Pharmacists discuss new information that we have learned during our weekly morning meetings. Some of things we discuss might actually be of interest to our patients. From time to time I will include these pearls of wisdom in my articles. They might not be pearls but certainly shiny rocks.

The first bit of useful Pharmacy information came from Dr. Google. One of our patients asked, “I heard that my diabetes medication can cause nerve damage”. Dr. Google is great for vast amounts of unfiltered knowledge. Where a Pharmacist can help is to determine when this information applies to you.

Part of this patient’s statement is true. Do you remember an article about drug induced nutrient depletion that I wrote last fall? No worries, if you forgot, I will refresh your memory. In this patient's case, they read about a potential side effect of metformin. Metformin is a common medication to treat diabetes by lowering blood sugar. The most prevalent side effects of metformin are stomach related: constipation, gas and heartburn. However, one of the long term side effects of metformin is that it can deplete your body of vitamin B12. This side effect of metformin was first noticed in 1969. It was found that patients who were taking metformin had difficulty absorbing vitamin B12 from their diet.

As you can imagine, vitamin B12 is rather important to your body. Vitamin B12 is used to make red blood cells, maintain healthy nerve cells and protect against osteoporosis. Not surprising, symptoms of low levels of vitamin B12 include fatigue, confusion, tongue sores and tingling in the hands and feet. Some people have difficulties getting enough of this important vitamin from their diet. The most notable are vegetarians/vegan, people over the age of 60 and those taking medications to reduce stomach acid. So bringing us back to the patient's question: yes metformin can deplete the body of vitamin B12. If vitamin B12 deficiency is not treated then, yes, long term nerve damage is a possibility. Oddly some of the long term complications of diabetes include nerve damage and dementia. Didn’t those same issues occur with Vitamin B12 deficiency?

So what did we decide to recommend for this patient? The first was to have a blood test to determine if there was indeed any vitamin B12 deficiency. The next step was to recommend a high dose sublingual (under the tongue) form of this vitamin. Vitamin B12 can be absorbed from under the tongue, this will overcome any stomach absorption issues. Vitamin B12 doses for sublingual tablets are quite high, in the 1200mcg to 2000mcg range. This seems very high when the recommended daily intake for this vitamin is around 3mcg. Doses this high are safe as you only absorb about 1-2% of this amount. As a final option there are vitamin B12 injections, this option certain overcomes stomach absorption issues. Your local Heart Pharmacist can be a great source of health information, all you need to do is ask.

Any discussion about Vitamin B12 is not complete without mentioning the two forms that can be found on pharmacy shelves: cyanocobalamin and methylcobalamin. Most supplements and injections contain cyanocobalamin which your body readily converts to the active methylcobalamin form. Sometimes people express concerns about the fact that cyanocobalamin does contain cyanide, albeit in microgram doses, which is quite safe. What might come as a shock to people is that cyanide is naturally occuring, our most familiar sources are spinach and apple seeds. If fact there is far more cyanide in apple seeds than in vitamin supplements.





AuthorDanielle Cooper