Whelehans Health News

 More than 70 people took the positive step of attending the “Rheumatoid Arthritis” (RA) talk, hosted by Whelehans Pharmacy, Mullingar in conjunction with the Westmeath Branch of the Arthritis Ireland on Wednesday 12^th Oct at the Greville Arms Mullingar. There was an impressive line-up of 4 speakers.

The main speaker was Dr Killian O’Rourke, Consultant Rheumatologist at Midlands Regional Hospital, Tullamore. Dr O’Rourke delivered an excellent presentation which focused on two main areas:-

• Update on Midlands Rheumatology Services to Oct 2016
• Advances in RA treatment

Dr O’Rourke gave an overview of the extensive range of facilities now available at the service in Tullamore. One other really positive development within the unit was the extensive training programme for Midlands GP’s, hosted by Dr O’Rourke. On completion, each GP will have had around 400 hours of Rheumatology related training, which is then immediately relevant at point of first contact for most people (ie) the GP Surgery. This greatly assists with early diagnosis and subsequent quick referral.

New National Electronic Referral Form

To support the many recognised benefits of very early diagnosis, Dr O’Rourke outlined a new referral system of suspected IJD (Inflammatory Joint Disease) for GP’s using the new extremely detailed National Early Inflammatory Arthritis Referral form, developed in association with the charity Irish Society of Rheumatology and the HSE, full patient details along with supporting information (x-rays, pictures, history etc) can be sent electronically to rheumatology departments like Tullamore with a commitment to see referrals within six weeks.

Waiting list for Tullamore Rheumatology Department

Dr O’Rourke gave an update on the current waiting list position for new RA patients with recent improvements now sits at 15 months (down from 30 months), with those awaiting DEXA / MRI now at 12 months. In addition, whilst there has been recent positive progress in staffing levels, he outlined those shortfall areas that still exist to reduce the “waiting list” issue. The rheumatology department have a triage system which allows them to see more urgent cases quickly (eg) newly diagnosed early RA which needs early and aggressive treatment to prevent joint damage.

Risk factors for RA

Dr O’Rourke went on to discuss RA Risk factors. At the top of the group are two primary genetic factors followed by a list of over 12 “Higher Risk” factors….. of note here were:- Female Gender also Pregnancy and 12 months after giving birth; Occupational risks related to dust (mining, oil, woodwork, electrical, asbestos); Lifestyle factors (Smoking, High BMI, Coffee Consumption). Some developing evidence show that there may be a link between gum disease and development of RA.

Dr O’Rourke then gave an insight as to how RA is classified and the various systems that are used to evaluate severity. Two main organisations ACR (American College Rheumatology) and EULAR (European League against Rheumatism) have combined resources to produce a harmonised scoring system that provides some common classification criteria against which presenting symptoms can be measured, scored and which treatment pathway to take based on the outcome. The newly simplified scoring system aims: - Initially to REDUCE Disease activity, which through time PREVENTS structural damage, which then through remission, DECREASES disability. These factors are then translated into the recognised DAS28 scoring system which when used to indicate exactly where an individual lies within the goals above which dictate / prioritise immediacy and type of treatment.

Future of RA treatment

Looking to the future of RA treatment, the audience learned of a variety of current scientific initiatives and advancements that aim to help and assist with the earliest diagnosis of RA, perhaps even long before physical symptoms have appeared.

Gene screening to maximise treatment

Gene screening, currently in use in America, could help predict which drugs would be most effective for a given patient, which then enables the most effective treatment to be used right from the start.  Leading on from this, Dr O’Rourke suggested that at some time in the future, everyone could have their complete genome screened with the result showing what diseases or ailments they may be predisposed to. This is more likely to be reality in the coming years, something that would have been the realms of science fiction 25 years ago.

An RA vaccine?

Again, currently in progress is the possibility of a vaccine to prevent RA. Research in Australia is developing a vaccine to re-educate the immune system and the T-Cells (which currently attack in RA) to act in support of the immune system and prevent attack. Whilst an outcome may be a long way off and hugely expensive currently, it may be reality in within most of our lifetimes.

Cannabis based painkillers

To conclude, another therapy currently under evaluation (and common practice in many countries) is the use of Cannabis based Medicine (CBM) to treat and alleviate the symptoms of RA. Dr O’Rourke gave examples from USA and Israel of how CBM treatment has been proven to reduce and eliminate pain in RA. Medicine is administered primarily through tablets or sprays so that the purity and dosage can be guaranteed, CBM has been shown in clinical trials to reduce symptoms across a range of “traditional” RA measures. Cannabis based painkillers have been shown to have significantly less side effects than many traditional painkillers. Dr O’Rourke pointed out the CBM is not currently available in Ireland in any form.

Other health professionals

Next up was a presentation from Dr Siafullah Khan from Mullingar Dental Centre. Dr Khan is qualified in Special Care Dentistry. Dr Khan gave an overview of how Special Care dentistry can be of benefit to those with Mental or Physical challenges. He mentioned that something as simple as scheduling the “right” appointment time can be helpful for those that may, for instance, experience stiffness in the morning, making an afternoon appointment a better option.

Kevin Conneely, Chartered Physiotherapist from Health Step Physio based at Whelehans Pharmacy suggested that physiotherapy treatment can help maintain or increase range of movement for those with mobility issues. Physiotherapy can also help people understand the limitations that RA presents, which in itself can be a benefit in helping people help themselves.

To conclude, the final speaker of the evening was Eamonn Brady, MPSI, Pharmacist at Whelehans Pharmacy who gave an initial overview of medications used to manage RA. So, initially, looking at medication to reduce pain and then drugs aimed at slowing down the progression of the disease, pointing out that whilst there is no cure for RA, the correct and appropriate use of medication can have a significant positive effect on living with the condition. Supporting Dr O’Rourke earlier position that the earliest possible diagnosis is ideal and then the initial introduction of DMARD’s (Disease Modifying Anti-Rheumatic Drugs) to slow disease progression.

Eamonn highlighted that paracetamol is rarely effective against the pain of RA but may be used to augment other pain killers while waiting for longer term solutions like DMARDs to work. He cautioned however against the long term use of codeine based medications such as tramadol and Solpadeine^® and potential addiction risks.

Moving on to discuss NSAID’s (Non-Steroidal Anti-Inflammatory drugs), Eamonn indicated that whilst these offered relief, they would not affect the progression of RA and should not be used longer term. Giving examples such as diclofenac and etoricoxib, Eamonn stated that these should not be given to patients with heart problems or who had a high stroke risk.

Eamonn went on to discuss DMARD’s in more detail, giving an overview of how they work and, as they slow down the progress of the disease, the benefit of early referral. DMARD’s treatment can only be initiated by consultant, so, some of the initiatives mentioned earlier by Dr O’Rourke to speed the process of GP – Consultant referral will help massively.

Commonly used DMARDs include methotrexate, hydroxychloroquine and sulfasalazine. They can be slow to work, however Eamonn stressed the need to maintain the treatment as it can take some time to find the right one and for the benefit to materialise. A key point regarding Methotrexate was that it should only be taken weekly.

To conclude Eamonn discussed the various Biological treatment injections available. Traditionally, these would be a “last resort” for those with severe RA, however, with medical advances, these are now being promoted earlier to improve response to treatment overall. Mostly given by sub-cutaneous injection, can biologics can be used in conjunction with DMARD’s if needs be. In Ireland, Enbrel^® and Humira^® would be the most commonly used biological brands. More than 650 RA patients now take biological treatment at the Midlands RA Service.

Local Support

Westmeath Branch of Arthritis Ireland supports a vibrant community of 17,000 people living with Arthritis in the County.  The committee is made up of people living with arthritis so they understand the challenges that a chronic condition brings.  Your local committee are here to support you and offers a wide range of activities, information and training that will help you to live well with arthritis. If you have any further queries, Westmeath Branch contacts are: Margaret Egerton, Chairperson 0857587171 or Secretary 0871413225 (Branch Phone). You can follow the Westmeath Branch of Arthritis Ireland on Facebook.

Check www.arthritisireland.ie or Locall 1890 252 846 for more information

You may have to accept that sometimes medicines, physical therapies and other treatments cannot relieve all of your pain. Pain may limit some of the things you do, but it doesn’t have to control your life. There are many techniques you can use to cope with pain so you can go on living your life the way you want to. Your mind plays an important role in how you feel pain. Thinking of pain as a signal to take positive action can help turn it to your advantage. Also you can learn ways to manage your pain. What works for one person may not work for another, so you may have to try different techniques until you find what works best for you.

Ways to manage your arthritis pain:

• Make sure you are making the most of your medicines and physical therapies
• Visit your doctor regularly to make sure you are getting the best treatment for your arthritis symptoms.
• Take care of your body. Exercise to improve your fitness and strength, eat a healthy diet, and get a good night’s sleep every night.
• Use heat and cold treatments for extra pain relief. A warm bath or shower, or a heat pack placed over a painful joint for 15 minutes, can provide effective pain relief.
• An ice pack may reduce swelling and relieve pain in the same way. Ask your doctor or physiotherapist which type of treatment (hot or cold) is best for you
• Find some distraction techniques that work for you. These may include exercising, reading, listening to music, or seeing a movie. Anything that focuses your attention on something enjoyable, instead of your pain, will help you.
• Learn some relaxation techniques. When you are stressed, your muscles become tense, making pain feel more severe. Relaxation techniques such as meditation or deep breathing help decrease muscle tension.
• Ask your physiotherapist about transcutaneous electrical nerve stimulation (TENS). A TENS machine applies very mild electric pulses via small electrodes (pads) to block pain messages going from the painful area to your brain. TENS can be very useful for longer-term pain but does not work for all people. You should see a physiotherapist to trial a TENS machine, and to learn how to use it correctly.
• You may find massage and acupuncture useful to help control pain and improve relaxation.

Educate yourself about your condition

Whelehans Pharmacy, in conjunction with Arthritis Ireland (Westmeath Branch) are hosting a Rheumatoid Arthritis Information event this week (Wednesday Oct 12^th at 6:45pm) in the Greville Arms Hotel in Mullingar. Admission is free.

The guest speaker for the evening will be an expert in this field, Consultant Rheumatologist from Midland Hospital Tullamore, Killian O’Rourke MD MSc FRCP FRCPI. Dr O’Rourke will give first hand information on the condition along with tips on what you can do to help you help yourself including information about surgery and aftercare for those thinking of going down this line. He will take questions from attendees.

Chartered physiotherapist Kevin Conneely MISCP of HealthStep Physiotherapy Mullingar will discuss the role of physiotherapy in Rheumatoid Arthritis (RA), such as the benefits of manual therapy, the importance of a tailored and comprehensive exercise program.  The final speaker is pharmacist Eamonn Brady MPSI who will discuss medication.

This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans

For those of you that are Pinterest obsessed, I’m sure you have a tonne of “hairspiration” pics pinned to your boards! Getting long, lustrous locks isn’t an easy task to accomplish, but nourishing your body from the inside is the first step you need to consider!

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Viviscal^® also have extra strength supplements especially for men worried about fine or thinning hair, while they won’t replace hair that has already been lost, they will strengthen the remaining hair and help add volume.

The Viviscal range is available in Whelehans Pharmacy

Written by Trish Wallace, Beauty Consultant at Whelehans Pharmacy Mullingar. For skincare and makeup tips and advice including free consultations, call in to Whelehans or call us at 04493 34591 or check www.whelehans.ie

Ask your Pharmacist  - Eamonn Brady 

 Because arthritis can get worse if left untreated, you need to see your doctor as early as possible to get a proper diagnosis. This will help you understand your arthritis and develop a plan for managing it. Early diagnosis and treatment will mean you can get early treatment to prevent serious irreversible joint damage and will limit the effects of arthritis on your life and help you stay active and independent.

What to expect when you go to the doctor?

When you first visit your doctor, you will be asked a number of questions about your symptoms including:

• How long have you experienced pain?
• Which joints are affected?
• When do you experience pain and what seems to cause it?
• What makes the joint feel better or worse?
• Does anybody else in your family have arthritis or joint pain?

What are the different types of tests?

There is no single test for arthritis, and diagnosis can be complicated. Your doctor will ask you about the difficulties you’ve been having, examine your joints and skin, test your muscle strength and take a full medical history. They may then refer you for tests to get a better picture of what is going on.

These may include:

• A rheumatoid-factor test which tests for an antibody that is found in most people who have rheumatoid arthritis. If the test is negative, your doctor may want to repeat it 6 months to a year later. However, you can have a negative test but still have rheumatoid arthritis.
• Anti-CCP, which stands for anti-cyclic citrullinated peptide antibody, is a blood test which helps your doctor confirm a diagnosis of inflammatory arthritis.
• Blood tests such as the Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP), which measure the level of inflammation in your body.
• Other blood tests and a urine test to make sure that you are otherwise healthy before you are put on medication.
• Synovial fluid analysis - to rule out other diseases.
• X-rays, ultrasound and MRI scans - to help your doctor determine the degree of joint and bone damage and to measure the progress of your disease.

Educate yourself about your condition

Whelehans Pharmacy, in conjunction with Arthritis Ireland (Westmeath Branch) are hosting a Rheumatoid Arthritis Information on Tuesday Oct 12^th at 6:45pm in the Greville Arms Hotel in Mullingar. Admission is free.

The guest speaker for the evening will be an expert in this field, consultant orthopaedic surgeon from Midland Hospital Tullamore, Killian O’Rourke, MD FRCS (Ortho). Dr O’Rourke will give first hand information on the condition along with tips on what you can do to help you help yourself including information about surgery and aftercare for those thinking of going down this line. He will take questions from attendees.

Chartered physiotherapist Kevin Conneely MISCP of HealthStep Physiotherapy Mullingar will discuss the role of physiotherapy in Rheumatoid Arthritis (RA), such as the benefits of manual therapy, the importance of a tailored and comprehensive exercise program.  The final speaker will be pharmacist Eamonn Brady MPSI who will discuss the medication used to treat and control Rheumatoid Arthritis.

Thank you to Arthritis Ireland for some statistics and information used in this article. Check www.arthritisireland.ie or Locall 1890 252 846 for more information

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

ASK YOUR PHARMACIST

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

 Question

I noticed you previously discussed bulimia in the Westmeath Examiner. I am beginning to suspect my teenage daughter may be suffering from anorexia. Can you tell me what are the signs and symptoms? MD, Meath

Response

The main psychological feature of anorexia nervosa is the extreme overvaluation of shape and weight. People with anorexia also have the determination to tolerate extreme hunger and self-imposed weight loss. Food restriction is only one aspect of the practices used to lose weight. Many people with anorexia use over-exercise and over-activity to burn calories. They often choose to stand rather than sit; generate opportunities to be physically active; and are drawn to sport, athletics, and dance. Purging practices include self-induced vomiting, together with misuse of laxatives, diuretics, and “slimming pills.” The practise of “body checking” is another feature of many anorexia sufferers; this involves repeated weighing, measuring, mirror gazing, and other obsessive behaviour as reassurance that they are still thin. Losing weight becomes an addiction and like any addiction the point of complete satisfaction (with one’s weight in the case of anorexia) is never attained. Eating becomes an “evil” thing in the eyes of the sufferer. In this way, it is not that dissimilar to other addictive or psychological type disorders such as alcoholism, drug addiction, gambling addiction etc. Initially the person is able to lead a fairly normal life. It is often only in the end stages when the person becomes so physically and psychologically unwell that it is obvious there is a problem and the person can no longer lead a normal life.

It falls to family members and primary care services (eg. patient’s GP) to recognise and manage relapses as well as first episodes of the illness. General practitioners may need support from a specialist in eating disorders, and early referral for more detailed assessment and advice gives the person the message that their illness is of genuine concern.

Physical signs of malnutrition and purging apart from a low weight include thinning hair, swelling of the salivary glands which shows as a swollen face, enamel erosion, hypothermia, bradycardia, the growth of soft downy hair on face, back and arms, dry skin, low blood pressure, cold hands and blue or uneven colour in extremities such as hands or feet, insensitivity to pain, constipation, amenorrhoea (lack of periods in women) and shrunken breasts.

BodyWHYS

Bodywhys is a national voluntary organisation supporting people affected by eating disorders in Ireland. They provide support and education through volunteers as well as providing support and advice through their helpline as well as online support through their website (www.bodywhys.ie). For more help and information, you can lo-call Bodywhys at 1890 200 444 or e-mail info@bodywhys.ie. 

Upcoming Positive Mental Health Event

Whelehans Pharmacy in conjunction with Good2Talk Counselling Service are holding a positive Mental Health Event in the Greville Arms in October which is geared towards younger people. A number of experts in mental health will discuss problems faced by younger people and will aim to give practical tips and advice on how to cope with the challenges faced. Young people and their parents are welcome to attend. This will be of interest to schools and people working with young people on a daily basis. I will have more details in the Examiner in the coming weeks.