#ASKdP Issue 3 June 2016

ISSUE 3

FREE

JUNE 2016

#ASKdP

YOUR ALL-IN-ONE SOLUTION

Only available from your pharmacist Alw ays read t he leaflet

www.dearPHARMACIST.info #ASKdP PAGE

P C 1 6 8 2 0 1 5 D a t e o f P r e p e r a t i o n - December 2015.

#ASKdP Features Page 4 Blog by Carol Smillie Diary of a Menopause Page 8 & 9 Transform your health using four pillars; Diet, Exercise, Lifestyle, Monitor Page 10 & 11 Steve & Marita's weight loss journey Page 13 Pharmacy Heroine Karen Clarke Every care has been taken to put this publication together.

There may be some errors unnoticed. If you see any please be reassured that they were an oversight. Feel free to bring these to our attention as we are always looking at improving this publication. email: ASKdP@dearPHARMACIST.info

Summer is here. Which brings us the joys of Hay Fever. You don't need to suffer, learn more from our quick guide on page 15. A simple chat with your pharmacy team could help reduce your symptoms of hay fever with the right recommendations to suit you, and your lifestyle.

Remember: There are many services that are available at your local community pharmacy. These include: ∞ Stop Smoking Services ∞ Weight Loss Clinics ∞ Health Checks ∞ and much more Don't forget to visit your local community pharmacy today!

Sunil K. Kochhar

Consultant Pharmacist for dearPHARMACIST.info

Blog by Carol Smillie Diary of a Menopause : https://www.diarydoll.com/blog/2016/carol-smillie-diary-of-a-menopause/ Pamela Windle : http://smarterchange.co.uk Carol Smillie : www.diarydoll.com Twitter @carolsmillie1 / @DiaryDoll "Much as I like to think of myself as eternally 25, much as I spend money on dyeing my hair, straightening my teeth, eating as healthily as I can be bothered, there is no way that I can change the fact, that at 54, I am well and, truly slap bang in the menopause." Carol Smillie Now, this was not a word I had even heard of until the last decade or so.

My mother never discussed it, my two older sisters never mentioned it, so it’s hardly surprising that I knew virtually nothing about it until I was teetering on the edge of peri-menopause (that’s the bit before it, to you and me)

Pamela is a hypnotherapist and wellbeing specialist based in Nottingham, and given our logistical differences, we set up a weekly video call, to try a 7 week programme to see if I could really make a difference to my menopause by making a few small changes to my life.

As with most female fertility phases, there isn’t much of an upside, in fact the only one I could think of, is waving goodbye to Aunt Flo, no more Now, my close friends will tell you that I am not periods, hurrah! a gym bunny, eat not nearly enough fresh fruit or vegetables, and have never been on a diet.

In her place comes along tiredness, sweating, occasional flooding, itching, vaginal atrophy, middle age spread and anxiety (am I selling it to you?)

Over the years I have managed to maintain the illusion of being fit and healthy, but only I know Some of us may experience all, or none of the above, and thankfully my the truth. symptoms are minimal. Sadly, my Mum is no longer alive to ask what I am likely to feel, but the camaraderie of good friends, and Google, have Given my Scottish, gritty realism, I’m also not served me well so far. one to go in for chanting, cross legged cringey deep breathing techniques or as I see it, general Intrigued , I wanted to find out more, and came across a lady called hippy mumbo jumbo, but I needn’t have Pamela Windle at Smarter Change. worried.

What I do however, have in my favour, is that I very rarely drink alcohol, I have never smoked cigarettes, and I am no party animal (shhh, don’t tell anyone) I wanted to make sure that the changes I made were realistic, and doable, yet allow me to see the changes I wanted.

We had a great time, Pamela and I, and the more she got to know me, the better the programme worked. I changed my breakfast cereal & toast routine to granola, and immediately felt fuller long after everyone else was taking their lunch break.

I made fresh fruit smoothies with soaked chia seeds, she set me a 10min exercise routine that even I could do, and put Epsom salts in my bath to ease the flushes. Understanding what was going on in my body was a revelation, and although my symptoms were mild compared to some, I really felt a difference.

The crazy period flooding incident in the beach bar toilets on holiday however, will stay with me for a long time to come ... #CS

"If you are feeling the effects of the menopause, don’t sit in silence, there’s a wealth of information both at your fingertips and from your pharmacist to make things easier, so go and seek help!" Carol Smillie

Menopause: NEXT Sunil Kochhar, Consultant Pharmacist for dearPHARMACIST.info, explains What to expect, plus Hints & Tips www.dearPHARMACIST.info #ASKdP PAGE 4

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Any questions on menopause?

Visit www.dearPHARMACIST.info for an on-line chat with a pharmacist today

What to expect, plus Hints & Tips

by Sunil Kochhar Consultant Pharmacist dearPHARMACIST.info

Women believe menopause is a life sentence of pain and misery. They dread it for decades and when it hits they are left feeling the good times are behind them. But this is not true.

Menopause does have a few advantages; such as no longer have to worry about pregnancy after sex.

What we mean to say is menopause doesn’t have to be a life sentence of discomfort. But it’s not always an easy transition.

That’s why your pharmacy team is here: we have the expertise to recommend treatments, products, and a positive outlook so you can continue living a healthy, happy, and active lifestyle while you enter menopause.

How to know if you’re menopausal?

Menopause can develop when a woman is in her 40s or 50s.

Often, tests aren’t required to diagnose you with menopause.

Signs, symptoms and age are enough to know you’re menopausal. However, if you’re still sceptical you can have a discussion with your pharmacist. They will ask you several questions including, but not limited to: When was your last period?

Are you still having periods, regularly or not?

How often do you experience bothersome symptoms such as hot flushes?

From there, your pharmacist will discuss options for treatments depending on your answers, developing symptoms, and severity of symptoms.

What are the causes of menopause?

Several situations can lead to menopausal development: Less oestrogen and progesterone: As we age, the body decreases oestrogen and progesterone production. This usually begins in our 30s. Menstruation declines, as does fertility. Once you hit your 40s, menstrual cycles become disorganized: heavy periods, light periods, longer periods or shorter period durations, etc. Then, eventually, they stop altogether. This process is the most natural progression into menopause.

Chemotherapy and radiation treatments: Menopause can be a by-product or triggered by these treatments. However, it’s not guaranteed. Birth control and contraceptive pills should still be used following chemotherapy and radiation treatments.

Total hysterectomy and bilateral oophorectomy: A hysterectomy, where the uterus is removed but not the ovaries, doesn’t cause immediate menopause. However, a total hysterectomy and bilateral oophorectomy where both uterus and ovaries are removed can cause instant menopause without warning. Periods come to a complete stop and symptoms of menopause begin.

What are common symptoms of menopause?

Symptoms can appear over months or years prior to menopause, known as perimenopause. Symptoms vary but the most common are: Hot flushes Night sweats Mood changes Trouble sleeping Thin hair and bones Weight gain/slowed metabolism Irregular periods Vaginal dryness

It’s also common for periods to become irregular. Periods may happen one month, then skip for two months, then begin the following month. This is normal. But even with irregular periods, you can still be fertile enough to become pregnant.

Some women may have regular periods up to their last period (signally menopausal start). In this phase, it’s recommended to see your pharmacist to discuss treatment options, as well as symptom control.

Track your symptoms and how often you experience them in a notebook, so when you go to talk your pharmacist, you know when and how often the symptoms have been.The pharmacist will go through this with you in a private consultation room.

How can pharmacists help with menopausal symptoms?

There are both prescribed and home remedy treatments available for women with menopause. Here’s a look at a few: Hormone therapy: If you’re prone to hot flushes, hormone therapy is the recommended treatment to limit the duration and intensity of them. You may only need a low dosage to feel relief. If you did not have a hysterectomy and still have your uterus, you’ll also be prescribed progesterone along with oestrogen.

Vaginal oestrogen: For vaginal dryness, vaginal oestrogen is applied directly to the vagina with creams or pessaries. The vagina absorbs the oestrogen to alleviate dryness, urinary issues, and potential pain during intercourse. There are several lubricants available from your local community pharmacy. Just ask your pharmacy team.

Low dose anti-depressants: Certain brands linked to selective serotonin reuptake inhibitors (SSRIs) have the potential to reduce the severity of hot flushes. They’re also prescribed when a woman can’t take oestrogen tablets, rings, or creams related to health issues. They also work for women who need a lowdosage anti-depressant for moods.

Medications for osteoporosis prevention: Bones can become weakened when the menopausal phase occurs. Several medications exist to help manage or prevent osteoporosis. Talk to your pharmacist and they can recommend a specific kind.

This part of the menopause is often forgotten by many women.

It's important to prevent future issues by using preventative measures.

Home remedies include:

Hot flush relief: It’s best to try and note what triggers your hot flushes. It could be a combination of foods, drinks, or locations.

Dressing in light layers or with minimal blankets during sleep can reduce the severity of hot flushes. A great tip is to use your smart phone calendar to keep a record, that way you'll always have to hand information to discuss with your pharmacist.

Less alcohol and caffeine: Drinking less of the two will help you sleep easier during the night. Combined with the light layers and sheets, you’ll sleep better. Your sleep cycle is important to reduce other symptoms during the day time.

Balanced diet: Eating a balanced diet of fruits, vegetables, and protein can help your body get the proper nutrients and minerals needed. This is especially helpful for keeping hair and bones strong.

Kegel exercises: Strengthening the muscles in your pelvis can help prevent urinary incontinence, which can be a by-product of menopause. Your community pharmacy has lots of solutions to keep your confidence up if you suffer.

Do remember: If you’re showing signs of perimenopause or you’re already menopausal, you have plenty of options to decrease the severity of symptoms and discomfort. You may feel overwhelmed by the options and choices available, so having a consultation with your pharmacy team can drastically help.

Ask for a private consultation with your pharmacist today. #ASKdP

www.dearPHARMACIST.info #ASKdP PAGE 6

Thirsty?

Family History?

Frequent Urination?

Overweight?

Tired?

Diabetic?

A simple blood test (HbA1c) will determine your diabetic status Ask your local community pharmacy or visit www.dearPHARMACIST.info

The 4 Pillars to Transforming Your Health Well, well, well… How far we have come. And by ‘we’ I mean the human race. We’re no longer hunter gatherers, having to commute 10 miles a day by foot in the search of edible foliage and game. And this has great benefits, right? We have lower risk of being eaten by lions, we have more time to watch our favourite TV series and have shown fantastic ability to innovate in every possible way to reduce our physical and mental efforts. With everything from TV Remote Controls, to cars and microwaves; we can greatly reduce our energy expenditure. And also increase our energy intake. It would have taken our ancestors around 48 hours to consume the same amount of sugar that we can consume in an evening from a bottle of coke, from it’s natural form, sugar cane. High calorie foods, mass produced, mean that we don’t have to catch our food anymore.

We can have it ordered to our door step.

But what happens when we take a species, which has evolved to not only adapt to, but also benefit from an environment that requires physical effort and natural foods, and place it in today’s society?

The answer is, a lot.

Junk food, especially deep-fried, contains carcinogenic compounds, meaning they alter our DNA leading to a higher probability of cancer The increase in dietary sugar can tire our pancreas and liver, leading to type 2 diabetes.

A huge reduction in exercise in comparison to what we’re designed to can give rise to obesity, heart disease, joint disease.

As well as this, exercise causes the release of “feel good hormones”. Their absence can predispose depression.

So today we have a newer problem. A modern problem. Lions have been replaced by heart disease. Starvation has been replaced by type 2 diabetes and obesity. Fight the lions by building the 4 pillars of health.

Diet

Exercise

Lifestyle

Monitor

Healthy eating; healthy levels of exercise; reduce stress and bad habits; monitor your change.

So let us give you a bit of advice to make sure you can take a step in the right direction. www.dearPHARMACIST.info #ASKdP PAGE 8

[DIET] Diet is a bad word. It creates a perception of boring, bland food that leaves you hungry. Let’s leave this misconception at the door. Learning to cook healthy food can be a great way to increase your nutrition and satisfaction at the same time. Go to www.imunchsnacks.com/category/recipes, www.precisionnutrition.com/blog/recipes for some great examples.

Secondly let’s apply some rules of thumb to your eating habits: Stick to food that looks like it could have been dug up with a stick or killed with a stick (natural food. That’s chicken breast over chicken nuggets; broccoli over coleslaw).

Eat until you’re 80% full. Get down from the table feeling you could have eaten more.

Fill up half of your plate with multi-coloured veg. It will ensure a balanced nutritional intake of vitamins and minerals.

We also have a nutritionist on board who can help with tailoring our diet to your needs; whether that be weight loss, weight gain or general health. And dearPHARMACIST also provide Lipotrim, a weight management programme that is pharmacist lead, to help you to lose weight.

[EXERCISE] Exercise is a tool; not a burden. Too many of us automatically assume that exercise has to be in a gym, class or sports setting. Think of exercise as two things; moving and raising your heart rate. The more you move and raise your heart rate, the more calories you’re burning.

So now what can we consider exercise? Dancing, hiking, running, bike rides with the family, swimming, trampoline etc. Move and raise your heart rate. And even specify it to your personality. I’m highly competitive with a short attention span. It’s no wonder I chose boxing, a sport consisting of 4 x 2 minute rounds, for my sport.

Our personal trainers are constantly working to tailor their exercise programmes to their clients.

We understand that one size doesn’t fit all and there are more than one ways to skin a cat. The way we train our clients is therefore very diverse to help them to achieve their goals.

[LIFESTYLE] This hurdle takes making consistent, gradual changes. You’ll most likely know your bad habits, but let me list some common examples below Waiting too long between meals Drinking too much alcohol at the weekend/ even during the week Being inconsistent with planning your meals and exercise Write yours out and come up with the simplest way to counteract them.

Focus on just one habit per week. For example, in relation to above: Have healthy snacks like sliced veg, hummus, fruit etc. available to you Dilute your alcohol consumption with diet soda (half and half) Plan and prepare your meals every Sunday (this will actually save time during the week) [MONITOR] Monitor the above. Both Revitalize and dearPHARMACIST have some fantastic services, as well as tools, to enable you to do so.

Weight Loss; can we write you a plan or even deliver some healthy snacks to your door (www.imunchsnacks.com) Diabetes testing using advanced techniques that are far more sensitive than a fasting glucose test Health checks; analysing how fit you are in relation to the average person and if you’re at risk to diseases such as heart disease or diabetes Nutrition; how can we improve your nutrition to achieve your goals OR is the regular bloating and lethargy a sign of intolerance?

Keep your food natural, your body active and constantly ask yourself if there’s any more you could be doing, or anyone you could be asking, to make you a healthier, fitter, stronger version of yourself Stay healthy! #ER

Steve and Marita are partners who have both been on the Lipotrim programme this year - Their stories and motivations are very different and both inspiring to anyone considering losing weight WHAT IS LIPOTRIM? Lipotrim is a specialised weight management programme that is run by pharmacies across the UK and Ireland. It is based on total food replacement in the form of shakes.

These have been developed by qualified nutritionists and experts in weight management. The unique shakes keep you healthy while losing weight by providing the full range of nutrients your body needs for a normal, active life. When you join the programme your pharmacist will give you weekly support to help you reach your desired weight.

Steve's Story Four years ago I had a heart attack. I was only 45 and it was totally unexpected. I was slightly overweight but the main problem seems to have been that I drank too much coffee. I did put on a bit of weight after the heart attack, as I was cautious about doing any heavy exercise, and my day job is a driver so I am basically sedentary. We got a dog which I walk for two and a half miles at least five nights a week and I purchased a multi gym. I don’t drink or smoke and I eat healthily at home; Marita makes everything homemade and from fresh produce, but despite that I was 15 stone 3lbs which is obese for a 5ft 10in man.

I have tried to lose weight over the years and been on several different diets, none of which have worked for me. What spurred me on to try again was a phone call at Christmas from my father.

He urged me to talk to my youngest brother who has just turned 40 and is seriously overweight at 22 stone. Our middle brother died two years ago of a heart attack at only 45 years old, so my To find your nearest participating father is obviously concerned for our health. My brother took some pharmacy visit www.lipotrim.info persuading to go on a diet and the only way I could make it happen Or pop in to your local community was to set up a bet that I could lose more weight than him. He told pharmacy for more information me his doctor had suggested Lipotrim and I resolved to find out about it and see if it could work for me.

After some research online, and watching the Lipotrim DVD, I found Regent Pharmacy, which is only six miles away, and commenced the programme. I haven’t looked back. It has been fantastic. I haven’t had any problem not eating food and in fact have enjoyed it. A particular issue I have is an undiagnosed stomach problem which causes me considerable discomfort from bloating, indigestion, gastro belching, reflux, stomach cramps and constipation. The doctors do not know what is wrong despite numerous tests and investigations from three consultants. All we do know is that when I am on Lipotrim I am symptom-free, which is such a relief. I get constipation but that is a common symptom for people on diets and easily relieved.

The first week on Lipotrim is tough but mostly because you need to break the habit of eating. I haven’t found it that difficult and have not felt hungry. At work I sit down with colleagues eating their meal whilst I have my shake and at home my two daughters are eating normally but it hasn’t bothered me at all. I admit the relief of being symptom-free from my stomach complaints is a major incentive.

I stayed on Lipotrim for seven weeks by which time I had lost 3st 1lb. I lost 8lb in the first week alone. I came off the diet as I had already reached beyond my target weight of 13 stone and we had a planned family gathering to attend. I went on the maintenance diet for about five weeks and then back to normal eating for four weeks but despite such a great weight loss, and putting six pairs of trousers away as too big (even with a belt!) I feel fat and that there is more to lose. I have put myself back on Lipotrim with an aim of getting to 11½ stone.

I think Lipotrim is brilliant - it worked for me when all the other diets I tried didn’t. Also I have high blood pressure and that has lowered and I no longer get aches in my knees. Plus of course I did win the bet with my brother!

www.dearPHARMACIST.info #ASKdP PAGE 10

Marita’s Story I started on Liprotrim about 3 days after Steve. I did have weight to lose but I did it mainly to support him.

The results have been amazing and I am determined to stick at it until I reach my goal weight..

I am vegetarian and eat a mainly fresh food diet so at first I did find it a bit of a struggle coming to terms with Ketosis occurs if you do not consume enough the artificial tastes and flavours but eventually I settled calories to provide energy for the normal on a routine I liked of 2 chocolate shakes a day, and a function of the body. If there is not enough coconut or peanut butter flapjack at lunch time. I find energy from food then your body burns fat the flapjack at lunch time breaks up the monotony of instead. To do this it makes Ketones. Ketosis not eating. normally kicks in after 3-4 days of eating less

than 50 grams of carbohydrates a day. Ketosis As Steve mentioned I cook all the family meals as he is key to the Lipotrim diet. works long hours and is often not at home at meal times. At first I found it difficult not to clear the children’s plates after they had finished but once the weight started coming off I found that a really good Find out more by visiting www.lipotrim.info incentive to not pick. As soon as you eat anything the cycle of ketosis is broken and you have to start again.

I have not been as disciplined as Steve and have stopped and started the diet a few times. I have had the urge to eat an apple and have succumbed which sets you back a week. However it is great having Steve there to support me. We have our shakes together at weekends and one evening we went to a 40th birthday celebration and were able to just sip fizzy water. We felt great because by that time we had lost a lot a weight.

I had lost a stone and was able to wear a pair of leather trousers.

I became despondent after 5 weeks when the weight loss slowed down for me but not for Steve. At the beginning it was really noticeable and I enjoyed people’s comments. At my weekly meeting with Sunil, our pharmacist, he explained that it is harder for women to lose weight than men and also that the strong painkillers I am on for an old spinal injury inhibit weight loss. He has supported me to continue and I have managed to lose almost 2 stone with a target of ½ stone more. I am down 2 dress sizes and feel so much better.

Marita’s Top Tips Try to find someone to diet with you and provide mutual support Don’t yoyo diet – follow the routine and stick to it for maximum and quickest results Use the diet to make you aware of your bad eating habits and break them Remove temptation from the cupboards and don’t buy more snacks, crisps, chocolate etc Tell everyone that you are on a diet so that they don’t offer you food Don’t weigh yourself at home- wait for the weekly pharmacist appointment Don’t give up- remember your goal- It is achievable and you will feel so much better

To find your nearest participating pharmacy visit www.lipotrim.info

Aged 40-74?

Find out about our FREE NHS Health Check Even t hough you might be feeling great , if you’re over fort y you may be at risk of heart disease, st roke, kidney disease, diabet es or dement ia.

A FREE NHSHealth Check can help you reduce these risks and make sure that you stay healthy.

Ask your local community pharmacy or visit

www.dearPHARMACIST.info

"One client, over 60, only went for a bowel screening due to me ‘nagging him’ (his words), had first stages of bowel cancer detected" Just like many other pharmacies, Karen delivers NHS Health Checks to her community. Pharmacy teams all over go through health and well-being training, enabling them with knowledge and skills to improve the health of their local communities. However, Karen added an extra personalised screening question that helped save a life!

When #ASKdP interviewed Karen, she said “My mum died of bowel cancer, so I always ask anyone who has a health check, and is over 60, if they have had their bowel screening”. After screening several people in the community, one particular client came in for a health check, and Karen asked the same question. Since the client was part of the local community, each time Karen had an interaction with them in the pharmacy, she would always ask them if they've had the screening.

Karen, who is trained to deliver NHS Health Checks, always makes sure that each reading from the Health Check is explained so that you know exactly what your numbers mean.

Furthermore you'll receive a personalised action plan to improve your health and well-being.

After, what Karen quotes as, “nagged them into it”, he went to get his screening.

“The gentleman had first stages of bowel cancer detected”. Since then the client has undergone treatment and is now clear. Karen added “It made me so happy that I was able to actually stop him, and his family, go through the pain, and stress of cancer, that my mum and family had gone through”. #ASKdP wanted to know what Karen believes is special about community pharmacy. She replied “People seem to open up and engage really well in community pharmacy. Advice is given from the team who are trained, and a pharmacist is available at all times to discuss further concerns, or if clinical advice is required.” Karen added “Many of our clients feel comfortable coming in for advice, and treatment, rather than filling up appointment times with their GP. We always refer to the GP if it’s necessary”.

Visit your local pharmacy for an NHS Health Check today - for more information, and to check your eligibility, visit www.dearPHARMACIST.info

www.dearPHARMACIST.info #ASKdP PAGE 14

Hay fever is increasingly common. Almost a quarter of the UK population is estimated to have been affected. Here is advice that should help you control, and prevent symptoms of hay fever.

Symptoms of hay fever:

There are a number of hay fever treatments available to help relieve your symptoms:

Runny Nose, Blocked Nose, Itchy Nose, Itchy Eyes, Watery Eyes, Sneezing, Nasal Congestion

Allergen Barriers

(these line the nose, blocking allergen contact)

Mast Cell Stabilisers

(these reduce the release of histamine by stabilising mast cells)

Antihistamines

(these block histamine receptors to relieve the symptoms of hay fever)

You could suffer from any of these together or individually

Nasal Corticosteroids (these block the effects of several chemicals the immune system uses in the process of inflammation)

Allergen enters the nose sensitising the mast cells Histamine - a chemical found in some of the body's cells - causes many of the symptoms of allergies, such as a runny nose or sneezing. When a person is allergic to a particular substance, such as a food or dust, the immune system mistakenly believes that this usually harmless substance is actually harmful to the body. In an attempt to protect the body, the immune system starts a chain reaction that prompts some of the body's cells to release histamine and other chemicals into the bloodstream.

White blood cells activate causing inflammation use Nasal Corticosteroids

Untreated inflammation leads to more histamine Use Combinations

Use Allergen Barriers

Sensitised mast cells release histamine Use Antihistamines

Remember to always speak to your pharmacist before you purchase any medicines