Q & A

Life is so stressful! First the pandemic and now this recession – OMG – even sex is not pleasurable. What can you suggest?

As a pharmacist working in the community, I see many patients that have anxiety, depression, along with sexual dysfunction. The reasons “why” are not always simple or straightforward. Many things effect sexual pleasure and function, including both physical and mental health, as well as social, cultural, religious, and spiritual reasons.

The first thing to consider is illness. Sometimes diabetes or high blood pressure can first reveal itself in the bedroom; by effecting the quality of an erection or blood flow to the vulva area, which in turn can feel/look like less desire. Having your blood pressure checked and your blood sugar level checked would be an important first step.

Any illness, for that matter, can distract a person from enjoying sex; whether it is an infection or a stomach ulcer or even diarrhea or constipation – anything that is not quite right can be a pleasure distraction. For this reason, I think it’s important to ask: “What is it that is getting in the way of pleasurable thoughts and feelings?” The answer to this question may lead to many, many more questions and possible reasons why.

Now, with respect to mental health issues, there are numerous things that get in the way of sexual arousal and performance: depression, anxiety, schizophrenia, bipolar illness, and even obsessive compulsive disorder (OCD). Managing symptoms of any mental health condition would be an important first step towards improving your sexual satisfaction. Of course, treating mental health can take some time but it’s important to consider sexual health alongside as well. Untreated mental conditions can cause sexual difficulties and so can TREATMENT for mental health. It’s really important to have this conversation with a healthcare person that is trained and knowledgeable in sexual health to help you decide what is best for you.

Now, if we just focus on anxiety (from the pandemic, recession, or any other life stressor) as the cause or distraction in the bedroom, it still is not a simple process. My understanding is that anxiety can add to (facilitate) OR take away from (inhibit) sexual arousal. Anxiety is complex and there needs to be further research as to why and how anxiety effects sexual arousal and ultimately sexual function.

In this case, assuming that anxiety has a negative effect on sexual pleasure we can start by de-stressing about the things in life that we cannot do anything about. (Easier said than done – I know.) But, we need to start somewhere. One step could be to make an appointment with me to have a conversation. I am currently working on completing my Certification in Sexual Health and feel well equipped to help in this area.

If you want to try a few things yourself – only IF none of the above illnesses, conditions, or any infections are being considered (aka. nothing needs medical attention), then you could consider: yoga, meditation, exercise, decreasing caffeine intact, quit smoking, decrease alcohol intact, decrease recreational drug use, get enough sleep, talk to your partner, reserve a time and place for sexual intimacy, and be kind to yourself.

I recently heard a talk on sexual performance anxiety, and the speaker introduced that idea of “erotic integrity”. What does that mean? It can mean many things, but I take it to mean to appreciate your wholeness and all the parts that make you feel sexy, and use them, live with them, and delight in them.

It also means these three things:

1. You ARE enough.

2. You are NOT broken.

3. Living authentically will result in your very own erotic integrity.

The speaker also gave a lovely analogy with respect to sexual arousal and gender differences:

• Penis owners are more like a microwave – quick to heat up.

• Vulva owners are more like a crockpot – slow and steady to get hot.

I’ll leave you with that.

“I’m nearly 70 years old and worry about breaking a hip, since weak bones run in my family. What can I do to improve my bones?”

It’s important to think about your bones. If they are not broken, it’s rare that bone health comes up in conversation – unless you have a history of osteoporosis, then it becomes an important topic.

Osteoporosis is a common problem that causes your bones to become abnormally thin, weakened, and easily broken (fractured). Women are at a higher risk for osteoporosis after menopause due to lower levels of estrogen, which is a female hormone that helps to maintain bone mass. Men can also be at risk as a result of genetics (family history) or medications that affect bone health.

As we age there is an expected amount of bone loss which is not necessarily poor bone health. It is the measure of MORE than expect bone loss that can indicate osteoporosis. To assess for osteoporosis, a test is often done to measure the density of your bones. This test is performed with dual-energy x-ray absorptiometry or DXA for short. Some people also get blood or urine tests done and these can give information about how fast your bones are breaking down and rebuilding, also referred to as bone turnover.

If a DXA indicates too much bone loss or if you already know you are at risk of osteoporosis there are – fortunately – many preventive measures available that can help to maintain or increase your bone density. If you have already been diagnosed with osteoporosis, therapies are also available that can slow further bone loss or even increase your bone density.

OSTEOPOROSIS PREVENTION

Some of the most important aspects of preventing osteoporosis, and for almost all other diseases for both men and women, includes eating a healthy diet, getting regular exercise, and avoiding smoking.

A diet rich in calcium and vitamin D is essential in helping to maintain proper bone formation and bone density. An optimal diet also includes adequate protein and calories as well. It is best to determine what is adequate for you with a trained healthcare professional.

The amount of calcium intake is also important. Experts recommend that premenopausal women and men consume at least 1000 mg of calcium per day from foods, beverages, and supplements. Postmenopausal women should consume 1200 mg of calcium per day from diet plus supplements. However, you should not take more than 2000 mg calcium per day due to the possibility of side effects.

The main dietary sources of calcium include milk and other dairy products, such as cheeses and yogurt, and green vegetables, such as kale and broccoli. A rough method of estimating your dietary calcium intake is to multiply the number of dairy servings you consume each day by 300 mg.

If you don't get enough calcium through your diet including a daily supplement may be necessary. Supplements come in the form of calcium carbonate or calcium citrate. Calcium carbonate works best when taken with food, while calcium citrate can be taken on an empty stomach. If you take any acid-reducing type medication, then calcium citrate is better to take than calcium carbonate. If you need to take more than 500 to 600 mg of calcium in supplement form per day, you should take divide your dose into two and take at separate times of the day.

Experts recommend that men over 70 years and postmenopausal women consume 800 international units of vitamin D each day. This dose appears to reduce bone loss and fracture rate in older women and men who have adequate calcium intake. Although the optimal intake has not been clearly established in premenopausal women or in younger men with osteoporosis, 600 international units of vitamin D daily is generally suggested.

Milk supplemented with vitamin D is a primary dietary source of vitamin D; it contains approximately 100 international units per 8 oz. (236 mL). Other good sources are salmon, orange juice, yogurt, and cereal. If you do not get enough vitamin D from their diet, so a supplement is helpful to reduce your risk of osteoporosis.

Regular consumption of alcohol (more than two drinks a day) can increase your risk of fracture, along with other negative health outcomes. Limiting your alcohol intake is a step towards healthier bones.

Exercise is a great way to reduce your fracture risk by improving bone mass. Regular exercise can also strengthen your muscles, improve your balance, and make you less likely to have a fall that could lead to fracture or other injury. It is recommended to be physically active for at least 30 minutes five times per week. Do whatever you have fun with like dancing, hiking, playing sports, running or even resistance training, cleaning your home, and of course, walking. Anything that gets you moving and your heart pumping a little harder is “activity”. So get doing something and do it often!

If you smoke, you should quit. Smoking is bad for everything, AND it is known to speedup bone loss.

In addition to all the positive changes you can make with the health of your bones, it’s good not to test this. In other words, do what you can to PREVENT falls and injury in your home and in other areas of your daily life. For example:

• Remove loose rugs and electrical cords or any other loose items in the home that could lead to tripping, slipping, and falling.

• Provide adequate lighting in all areas inside and around the home, including stairwells and entrances.

• Avoid walking on slippery surfaces, such as ice or wet or polished floors.

• Avoid walking in unfamiliar areas outside.

• Review you medications to assess for the side effect of dizziness to decreased coordination.

• Visit an ophthalmologist or optometrist regularly to check your vision.

Some medications can increase your risk of osteoporosis. Speak with your pharmacist to establish if you are on any of the following: prednisone, anti-coagulant medications, anti-seizure medications, or a medication for the treatment of breast cancer. You may not be able to stop a medication, but just knowing if you are at an increased risk can help motivate you to make all the other health improvements for the sake of your bones.

Overall, understanding you risk of osteoporosis, or any health condition, is the FIRST step towards prevention and a healthier lifestyle.

“Occasionally, I get chest tightness but the doctor said it’s not my heart. Can you help me figure out what to do?”

Chest tightness can be scary, and it’s very important to first consider if it IS your heart. Many heart attacks or even heart damage can be avoided or reduced with early medical intervention. I’m so pleased that you have already checked this out with your doctor. So now that you know it’s NOT your heart, let’s see what it may be and what you can do about it to feel more comfortable.

Chest tightness is often caused by muscle tension. You may not even recall lifting something heavy or the moment when it began to hurt. Our body can sometimes delay the feeling of being injured until something as subtle as turning to look over your shoulder will suddenly cause tremendous pain. Muscle pain in your chest may also be generated from your shoulder or from your back.

There are many stretches that can help to alleviate the muscle tension, and the best resource for this is a physiotherapist or a massage therapist. Keep in mind that any stretches that are recommended should be performed on BOTH sides of the body not just the injured side.

Warming up the chest muscles in the morning will help to increase the blood flow to the area to bring oxygen to the tissues and along with other nutrients. A warm shower or bath can easily achieve this. On the other hand, in the evening it is better to use a cool compress or an ice pack wrapped in a towel to decrease any inflammation that your daily activities may have caused. Whether you use heat or cold therapy, keep in mind to only apply it for 15 minutes at a time to avoid causing tissue damage.

Speaking of nutrients, muscles require protein, calcium, magnesium, potassium, Vitamin B1, B5, biotin, iron, phosphorous, and sodium to avoid fatigue and cramping. If your diet is not sufficient to give you all the necessary nutrition for good muscle health, then focusing on food changes would be in order. If expanding your pallet is not possible or you would like the security of knowing you are “covered” then supplements may be a good idea.

Some minerals and vitamins can be tested for through a blood sample to determine if you are in fact deficient or not. The following are usually available through a blood analysis: calcium, magnesium, potassium, iron, phosphorous, and sodium. If any of these minerals are found to be grossly deficient, proper monitoring will be done to ensure a return to normal levels. If there are no significant deficiencies but low normal values, supplements can still be taken safely to see if your muscle discomfort can be improved. Supplementation can still be done safely without a blood test, with modest daily dosing amounts.

Adequate protein is vital for muscle and organ repair and maintenance. The amount of protein that you need depends on your physical activity level and your body size. Roughly calculated, a sedentary person needs 1/2 gram of protein per pound of lean body weight. Your need for protein increases as your activity level increases and as your muscle mass grows. So if you are working out regularly, you may need 1 to 2 grams of protein per pound of lean body weight. There are many nutrition apps that you can use to calculate what you current protein intake is and adjust your intake accordingly.

“I hear a lot about using ‘pot’ for pain, but I don’t want to get high. Do you think I should try some for my pain?”

Since recreational cannabis was legalized, there has been a huge buzz about all the potential medicinal benefits from cannabis, CBD, and THC. Few of them are true, most of them are not. Although many of the employees at the recreational stores like to discuss the health benefits of cannabis, they are not allowed to do so since they are not healthcare professionals. So, it is important to get advice from your trusted healthcare provider before deciding what product to use to treat your pain.

Before deciding what the best option for your pain is, we need to determine what kind of pain that you have: nerve, muscle, bone, or other. It will be important to review how and when the pain began, and what you have already tried for this pain. What has worked well? What has worked a little? What has not worked? Did you experience any adverse effects from any medications that you tried for pain? Do you have any allergies or sensitivities to medications? What forms of medication do you prefer to take: liquid or tablets? Will you be able to take a pain medicine several times a day or would you prefer only once or twice a day? Do you have a budget that needs to be respected? Do you have insurance that pays part of all of your medication costs?

After reviewing your pain and medication history, we can go to the next step: does cannabis have any evidence for helping your pain? Studies have shown that medical cannabis has helped to reduce nerve pain (by 38%) and end-of-life pain (by 30%). There is very little evidence for any other types of pain relief benefits. Even though cannabis, including CBD, has been reported to treat many types of pain there is still very little validated evidence to date.

That being said, if you have no contra-indication for using cannabis or CBD, it may be worth a try. Again, speaking with a trained healthcare professional is important to ensure any potential drug interactions are avoided or investigate any other reasons that you should not try cannabis or CBD.

The side effects that are important to be aware of and potentially require management are low blood pressure, dizziness, memory problems, sleepiness or feeling high (mostly with THC content), muscle twitching, feeling unhappy, numbness, feeling disconnected (with THC content), and trouble speaking (with THC content). When using a predominantly CBD product, these side effects may be minimal. If you are taking any other medications for pain or mood, these side effects may increase and become more bothersome.

Medicinal cannabis is available in predominantly CBD, a blend of CBD/THC, and predominately THC. Depending on the side effects and other possible conditions along with the pain condition, the best choice of product would vary. Most patients find it comfortable to start with a CBD product, whether from cannabis or hemp, to minimize the “feeling high” or dizziness side effect. CBD is available in capsules or liquid and is usually taken more than once a day, even up to 4 times daily.

To obtain medicinal cannabis, you will have to see a prescriber to get something what is called a medical document, which is essentially a prescription for medical cannabis. This document is then sent to one of Canada’s federally regulated licensed producers, of which there are many to choose from. You would then order online or over the phone once all your information is confirmed. The medical document has to be renewed every 3 to 6 months with your prescriber.

CBD is also a component of the hemp plant, which differs from cannabis in that it has nearly no detectable THC. This type of product is typically available in an oil format with a defined amount of hemp derived CBD per bottle. There are less studies available to validate the use of hemp CBD for pain, or any other condition, but it has a benefit of having very little adverse effects. An important precaution would be due to an allergy to any of the plant constituents.

Having a good safety profile makes it possible to use with almost all patients, starting at a low dose and increasing to establish if any pain reduction is experienced. As written above, the research into CBD from hemp is limited, but there is an interest in using it for treating menstrual problems, constipation, skin conditions, and even obesity.

If you decide that cannabis or hemp is not a reasonable option for your pain, there are many other options to consider. Starting with lifestyle modifications like weight management and physical activity; nutritional intake; alcohol use; tobacco use; and the level of stress in your life. Often pain can improve with some attention to what you do in your daily living activities.

There are also a handful of supplements that have some evidence for reducing pain, namely glucosamine, chondroitin, devil’s claw, turmeric, magnesium, potassium, calcium, and topical camphor and capsicum. In addition to supplements, there is some benefit seen with chiropractic care, physiotherapy, massage therapy, acupressure, and acupuncture.

Of course, there are many different prescribed medications, including anti-inflammatories, narcotics, and many novel treatment options with medications that decrease nerve pain sensitivity. So again, it is important to establish exactly what kind of pain you have to properly treat it.

As you can see that are many other ways to help treat pain, meeting with me or another healthcare provider trained in pain management would be vital to establishing a customize pain treatment plan.

“I want to get off my prescription sleeping pills. How can you help me?”

Taking a prescribed sleeping pill can be a lifesaver during a time of loss or huge life adjustment, but they are not intended to be used forever. So, I’m glad that you have decided to come off of your sleeping medication. Together we can plan for an easy transition to sleeping naturally.

Once I review your complete medication and medical history, we can start by slowly decreasing the dose of your current prescription for sleep. Depending on the strength of your medication, we sometimes need to change to a slightly different version of your medication to facilitate a slower and more gentle tapering down of the dose. The highest success of coming off of a sleeping medication is when you do it very slowly. It may feel too slow at times, but trust me it will be the easiest on you and have the best long term success.

Occasionally, it may also be desired to switch to a natural sleeping aid, like valerian root or L-tyrosine as an intermediate step towards sleeping unassisted. Please be assured that many natural remedies can be used safely long term, but not all. Also, many herbal and botanical sleep remedies CAN interfere with other medications that you may be taking. These are specific details that we can review together during a personalized appointment.

It is important to review the initial reason ‘why’ you started sleeping medication to begin with. Does this condition still exist? Do you need help with managing sleep apnea for example or do you need grief counselling? Do you have restless legs? Do you have pain during the night? Does your partner snore? Is your bed uncomfortable? Is the temperature in your bedroom uncomfortable? Do you live on a noisy street? Are there bright lights shining into your bedroom? There are many reason why sleep can be difficult, so reviewing all of these factors for you specifically, may reveal a helpful solution.

There are many lifestyle adjustments that can also improve sleep or at least prevent sleeplessness. Reducing caffeine consumption in the later part of the day; limiting “screen” time prior to bedtime; avoid rigorous exercise in the evening; and even minimizing stressful conversations before bedtime can all improve your quality of sleep. Reading a hand-held book or having a warm bath can also help get you ready for sleep, as can having a structured bedtime routine.

Sometimes poor sleep can be a result of mineral or vitamin deficiencies, so this is a good factor to consider and correct for. Magnesium, potassium, and B Vitamins may help improve sleep if you are found to be deficient in these.

Sometime sleep can be more complex than we imagine. There are do-it-yourself sleep studies available that may be useful. With easy to follow instructions, you can use the system and have your sleep analyzed by a professional sleep consultant. You would be provided with a report detailing any problem areas that are discovered, and recommendations or possible solutions for a better sleep. Contact me for more information on this type of sleep study.

In addition to all the above suggestions, it is also important to review if there are any medications that are prescribed or that are over-the-counter and any other substances that you may be taking to assess if they may be causing sleep disturbances. A detailed medication review can be conducted during a one-on-one appointment with me, either in person or online.

“My brother just had a heart attack, and my father died young of heart disease. Can you help me avoid following in their footsteps?”

Heart disease is scary, especially if it is common in your family. Be assured that there are many things that you can do to decrease your chance of having a heart event. You may not be able to change your genetics or your age, but some risk factors for heart disease are what we call modifiable or changeable.

The first step is to review if you currently have any symptoms of heart disease, which can include elevated blood pressure and cholesterol, or even signs of diabetes is something important to consider. All of these conditions can increase your risk of having a heart event. Keeping your blood pressure and cholesterol in the normal range – or better – can improve your health tremendously. Reducing your chance of getting diabetes is also important. If you already are being treated for high blood pressure or high cholesterol or diabetes, it is crucial to take your medications as prescribed. If you are having difficulty doing this due to cost, side effects or other reasons, speak with a trained healthcare provider about possible medication changes.

So here are the things in life that you CAN modify to reduce your risk of a heart attack or an event: your weight, your level of stress (or at least how you respond to stress), your current physical activity, what you eat, your salt intake, and what you drink or smoke. All of these things you can use to your advantage to improve the health of your heart and many other areas of your life - all at the same time.

Being overweight or obese, has a bad effect on your heart, because your heart needs to pump a lot harder than it was designed to do. By losing weight – any amount of weight – you are being kind to your heart. Of course eating whole foods that nourish your body and give you energy are key to a healthy body and a healthy weight. What you eat is just as important as how much you eat. Eating organic foods whenever possible is also a positive move towards reducing possible toxins that can be ingested through the foods that you eat. Speaking with a trained healthcare professional may be beneficial if you are concerned about how to eat well.

Stress is not good for mental health and also not good for heart health. Stress can increase your blood pressure which has a negative effect on your heart – by making it work harder. Increased levels of stress, also causes an increase various hormones that move you into a “flight or fight” mode, which can put an extra burden on the entire body. Finding the areas in your work or home life that cause you stress is an important step towards a healthier heart. Eliminating the things in life that are stressful is the best option but when you cannot do that, then next best attempt is to build in de-stressing activities into your day, or to take medication to reduce stress.

De-stressing activities look like meditation, yoga or a leisurely walk; fun hobbies like knitting, painting, or reading; a relaxing massage; listening to music; or even talking with a friend. Doing any of these things on a daily bases will make your heart happy!

If you and your health care provider decide that a medication for stress is needed, there are many options. Some possible treatments could include anti-anxiety medications or anti-depressants, both are good choices for decreasing stress and improving your heart health. Of course, not all medications are appropriate for everyone. Your genetics, or DNA, can determine which medications – whether for heart disease or mental health – will work appropriately and not cause excessive side effects. The name given to this area of genetics is called pharmacogenetics; and it is the science of measuring the genes that code for enzymes that are responsible for drug metabolism and for determining the possible effectiveness of drug treatment. A pharmacogenetics test is available as a tool to provide information for personalized prescribing of medications for many different conditions, including heart disease and mental illness.

Now, if you have no current risk factors for heart disease and you want to focus on preventing illness and maintaining wellness, there are strategies to follow to get you on the right path. As I mentioned above, good nutrition and exercise are vital for the maintenance of health; and occasionally supplementing with vitamins, minerals, or natural products can help. There are many choices and it can be confusing, so it’s best to discuss the right supplement options for you with a trained health care professional. Just because something is “natural” it does not mean it is perfectly safe.

As you can see, there are many ways that you can reduce your risk of heart disease and avoid following the family pattern. Making an appointment with a trained health care provider may be the best approach to equip you with customized solutions that will work for you.

“I feel anxious all the time but I don’t want to go on anti-depressants. What can you recommend?”

It’s important to realize that everyone gets anxious now and then, and that it is perfectly normal and reasonable. Sometimes life can present us changes that we are not ready for, and this alone can cause stressful and anxious thoughts.

When you are anxious you may not think of it as a sign of depression, but it often is related to mental health changes that occur commonly alongside “depression”. You can certainly have anxiety without depression and that can be treated short term with a medication to calm you down, but if it is longstanding anxiety then typically a daily medication is the most beneficial. Reviewing all your symptoms with a healthcare professional will be helpful in determining what the best approach to treatment will be.

The next important point is that sometimes anti-depressants ARE the best option. When someone is anxious, it can interfere with activities of daily life – like work, play, and responsibilities. Often it is this interference with ‘life’ that causes the most grief not the initial anxious thoughts. Starting on an anti-depressant that can avoid a downward spiral is a very good decision for you and anyone in your life that is depending on you.

If you decide that a prescribed medication sounds like the best option for you, I can help you and your prescriber chose the best one for you. Not all anti-depressants are equal, and one class or type of medication may be better for you personally than another. Choosing the best anti-depressant will depend on many things, like your medical history, other medications used, allergies, and current symptoms. It is also important to consider genetics when prescribing anti-depressants, as this is a group of medications that relies heavily on liver enzymes to metabolize them or even to make them effective in your body. These liver enzymes are subject to genetics, and may be more or less effective based on your personal family tree.

Before choosing a medication for depression or anxiety, it is useful to know if another family member has been on similar medication and to know how they responded. Knowing the experience of a relative can give a clue as to how you will personally respond to mediation. Genetics can also be determined with a DNA test that gives specific details on your liver enzymes and how effective they will be with regards to medications. A genetics test of this type can be extremely useful to help avoid inappropriate prescribing, to minimize side effects of medications, and ultimately to predict what the BEST medicine will be for you. We often call this ‘personalized prescribing’.

If a prescribed medication is not what is needed at this time for stress, anxiety, or depression, there may be other treatment options available. Having a detailed conversation with a trained healthcare professional will help you to choose an alternative treatment for your anxiety and possible depression.

Herbal or botanical supplements can often be of benefit in reducing symptoms of stress and anxiety. Many herbal supplements can be safely taken when prescribed appropriately with consideration to other medications or supplements that you may already be taking. It’s important to know that just because something is ‘natural’ it doesn’t mean it is safe for everyone. Natural products can still cause dangerous side effects, and can interfere with prescription medication and other supplements.

Often vitamin or mineral supplements can relieve mild symptoms of stress. It’s important to review food intake to assess if there may be a deficiency in an essential nutrient, as well as considering other illnesses that may make it important to consume more or less of some things to maintain the best health.

Along with the importance of healthy eating, hydration is also a vital part of health – for your digestion and your emotional wellness. Drinking water daily will ensure that your digestive tract is cleansed, your electrolytes (sodium and potassium) are at an appropriate balance, your muscles work their best, and your heart and blood flows properly. Other fluids that you drink can also be helpful, but some may not have a positive effect on your health.

Exercise and daily activities are also an important step towards reducing stress and anxiety, and to increase wellbeing. Reviewing what you do daily for physical activity and the energy level that you currently have, will be helpful in building a plan how you can help improve your quality of life as far as mood goes, but also for all areas of your health.

How you sleep, how much you sleep, and when you sleep are important aspects of your lifestyle that can have an influence on your emotional health. Examining sleep patterns (sometimes called ‘sleep hygiene’) can give clues to areas that may need attention to help improve mood and minimize anxiety.

Similarly, relaxation techniques can be an area of daily living that can have a positive influence on mood, and general wellbeing. There are many ways that you can relax your mind without sleeping. For example: meditation, massage therapy, floatation therapy, yoga, Thai Chi, and breathing exercises to name a few. Any of these can be a great addition to daily or weekly activities to help reduce stress, anxiety, and depression. A little bit of relaxation goes a long way.

Although there may be many treatment options to help improve mental health, it is very important to discuss with a trained medical professional to get the advice that is best for you personally. As well, it’s vital to be safe and free of harm – even self-harm. Asking for help can be uncomfortable but an important first step if you feel out of control or desperate.

“My nose is always running and I’ve tried every antihistamine on the shelf! What can I do?”

How long has it been happening? Which antihistamines have you tried? Make sure it’s an antihistamine and not just a decongestant.

How many times a day have you been taking it? If it’s an antihistamine and you’ve been taking it for a while (determine level of chronic-ness), what dose have you been taking?

Allergists and specialists can say take up to 4 even when the packet says 1 a day, can possibly improve the effects of it if the base dose isn’t working

If it’s at specific times, or specific to the seasons ___

What are you doing when it’s running? Is there a physical action you’re taking or the way you’re breathing — holistic view

What other medications are you on, could it be a side effect. Antihistamine recommendations could be interfering with what you’re taking, consult your doctor or a pharmacist with your specific situation

Is it an allergy? May or may not be

Base

Why does my nose run?

There are many reasons your nose could be running. Usually, it’s a result of allergies, but it could also be due to a cold, Covid symptoms, nose polyps or other blockages, or even as a result of other medications that you’ve been taking. If you’ve noticed that the runny nose happens in a predicted fashion when exposed to certain animals or fragrances or during certain seasons, then it is likely an allergy. Whenever possible, it is best to try to avoid the exposure to what triggers your allergy symptoms, but when this is not possible and antihistamine can be effective.

It’s is important to determine if the products that you have been already trying are actually antihistamines or are they cold remedies. Confirming the effective dose of the antihistamine is also very important. Most non-drowsy over the counter antihistamines are typically dosed once per day, but the specialist often increase that dose several fold to improve the effect. Caution: taking more than 1 non-drowsy antihistamine per day will no longer be non-drowsy; rather it will likely cause drowsiness. It is recommended that all additional doses be taken at bedtime. Before increasing the dose of your antihistamine, please consult with me or your local pharmacist.

It is very important to ensure that all your medications (prescribed or over the counter) be safe taken altogether. A thorough medication review is helpful to determine any possible drug interactions or untoward side effects, especially if something IS causing your ongoing runny nose.

Nasal irrigation is another treatment for a chronic runny nose, also known as a neti-pot. Rinsing your nasal passages can help release some of the secretions and to relieve any dryness that you may be experiencing. It is a bit odd to be pouring saltwater down your nose, but it is quite refreshing once you get used to it.

Overusing nasal decongestant sprays can cause chronic stuffiness, so it is very important to never use products like Dristan or Otrivin for more than 3 days in a roll. If you are a current chronic user of any nasal decongestant, there are ways to wean off of them safely.

It may be possible to receive allergy desensitization therapy, depending on the type of allergy that you actually have. These treatments are done in a medically supportive environment to ensure safety.

What is an antihistamine?

How do antihistamines work?

Specifics

Do antihistamines stop my nose from running? / Are antihistamines to stop my nose from running?

Is it only allergies that causes my nose to run? / Are antihistamines the only solution to my allergies?

Super specifics

Can a runny nose be a side effect of medication?

Can the humidity or dryness of the air have an effect on a runny nose?

How do I know if I have a chronic runny nose?

“I’m taking a proton pump inhibitor for my heartburn, but I’m finding it’s just not working anymore. What can you recommend?”

Heartburn can be caused by many things, like foods, stress, and actual damage to the stomach wall or the esophagus. If you have been diagnosed with an ulcer, a condition called GERD (reflux), or any other stomach illness, you should consult with your medical provider for further assessment. Some stomach conditions can cause a thinning of the stomach lining that can expose the blood flow and result in bleeding, which must be attended to immediately. Increase pain could be the first sign of a severe outcome, but if that is not your situation and you are actually taking the proton pump inhibitor (PPI) for more mild discomfort, we may be able to find a better solution together.

It may be possible to adjust or increase the dose of your prescribed medicine. Before doing so, it will be important for me to review all of your medications or supplements so we can avoid any complications or interactions. Also, taking your proton pump inhibitor (PPI) 30 minutes BEFORE eating is important for it to work at its best.

Since there are many foods that can worsen heartburn, I would suggest that you take note of what foods you have eaten when you feel the discomfort. If you discover a theme, then avoid eating that food(s) for a week and see if your heartburn decreases. The time of day you eat, especially a larger meal, is also revealing. Eating large meals and drinking alcohol too close to bedtime can lead to improper digestion and – yes – an increase in heartburn.

One of the biggest contributors to heartburn and other stomach issues is stress. Often your heartburn question may reveal evidence of stressors in your life that need attention. Stress stimulates hormones that help to keep your body going at the high demand that you want. These stress hormones interfere with the proper secretion of stomach enzymes and actual stomach acid production. Helping you find ways to decrease and manage the stress in your life is something I can help you with during a personalized appointment.

Some heartburn is actually due to not enough acid in the stomach. Doesn’t that sound strange, but it is true. There is growing evidence of the harm that occurs when stomach acid is suppressed over a long period of time. Without enough stomach acid, your body can’t break proteins into digestible amino acids, which can lead to multiple nutrient deficiencies that cause health issues down the road.

Now, you may think that acid is a bad thing but you need to breakdown the food that you eat, to enable the nutrients like calcium, magnesium, and Vitamin B12 to be absorbed properly. Acid also helps to kill bacteria and other nasty things that you may ingest without knowing. In fact, people on PPI’s tend to get Travellers’ diarrhea more often than those that don’t take a stomach remedy.

So, the answer to your “quick question” is not so simple, as there are many possible solutions to help you with your heartburn. Meeting together in-person or online is an ideal way to begin to customize a solution that can work for you.

Benefits

• Do you have more than 2 or 3 urinary tract infections a year?

• When you get a urinary tract infection is it very painful?

• Does antibiotic therapy mess up your gut?

Features

If this sounds like you, then an appointment with Dr. Lisa, Doctor of Pharmacy, is the first step towards better urinary health.

• During this ONE hour appointment your medical and treatment history will be discussed along with your lifestyle habits.

• Potential areas of improvement or gaps in care will be identified.

• Other possible treatments will be reviewed, including prescription and non-prescription medications, nutritional and herbal supplements, and alternative options.

• If Dr. Lisa, Doctor of Pharmacy identifies anything that requires a physician referral, further follow-up will be discussed.

• A printed plan of action will be provided as well as ongoing support as needed.

• You will receive an official medical receipt that can be used for private insurance or as a medical expense on your income tax return.