July 2011 Magazine

People First

Helping People Live Better Lives

Looking at Life Sunny Side Up

Supplements for Seniors Dr. Hister On Managing

Asthma How Fibre Can Reduce Your Cholesterol Company’s Coming Recipe

Vol. 11 No. 7

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People15 First

4

Dr. Hister discusses the treatment options for Asthma, a condition that affects over three million Canadians.

contents

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4

Asthma

Supplements For Seniors If you’re a senior, you can’t miss Peoples Pharmacist Ian Lloyd’s article on choosing the right supplements for the golden years.

7

Vitamins & Supplements Great selection of healthy choices from Peoples Pharmacy.

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Pharmacist Recommended The benefits of psyllium fibre and how it may reduce your bad cholesterol level.

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Sunny Side Up Darlene Booth provides helpful tips on how to look at the bright side of life.

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Wild Rice Fennel Salmon Brand new feature recipe from Company’s Coming 30-Minute Diabetic Cooking.

Helping People Live Better Lives

Dr. Hister

Managing Menopause Asthma The great thing for someone who suddenly awakens from a deep sleep in a cold sweat at 4 AM when he realizes that, “OMG, the deadline for my article about new information about asthma is 9 AM tomorrow”, is that all you really have to do before 9 AM is Google “health news, asthma” and presto, dozens of new interesting studies will pop up on your screen, not, of course, that an author as dedicated and as far ahead of deadlines as me would ever leave anything to such a mad scramble, of course.

But the point here is that thousands of research labs around the world are continuously working on varying aspects of asthma – how to diagnose it earlier and better, how to prevent it, how to improve treatment – and the researchers are only too happy to publish their findings regularly (to be fair, it’s the only way they can attract more funding, and even nerdy researchers want to eat), so we’re constantly waking up to new and important changes in our knowledge of asthma, and that has key implications for the roughly 8-10 % of the population that suffers from this reversible airway constriction (although I should note that lots of experts believe the rate is actually significantly higher because many cases are not diagnosed adequately).

So, for example, in the week before this col-

umn was put together (and no, not at 9 AM the day it was due but well ahead of time, at least 3 hours ahead anyway), the major article in the New England Journal of Medicine, the bible of medical publications that only publishes the crème de la crème of medical studies, concerned a new strategy to prevent asthma (see below), while that week, too, the leading release from the US Centers for Disease Control in its morbidly-named Morbidity and Mortality Weekly Report was a survey that found that US asthma rates have risen significantly the last few years in all demographic groups (this is likely true in Canada, too), although no one knows why, especially since, CDC experts added, air quality has improved substantially so you’d think that asthma rates should be plummeting instead of going up.

Anyway, all this is to say that our views and our insights about asthma change regularly although that’s actually nothing new.

In fact, when I started in this business, in an era when the practice of medicine was still in its equivalent of roll-top desks and horse-drawn buggies, asthma was considered a condition in which the main problem was that the airways (the bronchi) were provoked into spasm by various irritants such as dust, pollen, animal dander, viral infections like colds and flus, stress, exercise, certain fumes, moulds, cold air, Continued On Page 11

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Ian Lloyd

Pharmacist, Peoples Pharmacy

Supplements for Seniors I like the phrase, “If you don’t make time for health and fitness now, you will be forced to make time for sickness later.”As the body matures, maintenance becomes a difficult undertaking. It is not for the faint of heart.

Many of the health concerns faced by seniors today didn’t begin last week. Heart disease develops slowly over years, and the acute symptoms may take dozens of years to show up. An active lifestyle and proper nutrition are best for maintaining a healthy body. Supplements can also assist in keeping our bodies healthy.

My favorite supplement for everything and everyone, both young and old, is a good multi-vitamin. If you only do one thing for your health, make sure you take a multivitamin. The cost per day is less than most people pay for car insurance and its health benefits are too numerous to mention. I could go on and on about how people who take multivitamins have lower rates of infection, heart disease and cancer, but I won’t. I only have one page to fill.

Sometimes we think of sleep as a trivial matter. However, lack of quality sleep, and its consequences (such as daytime sedation), have a great impact on society. It has been reported that sleepy and/or fatigued drivers are responsible for 4% of the fatal car crashes and about 20% of the non-fatal car crashes. Seniors often, and even some youngsters, have occasional bouts of insomnia.

There are many non-prescription and herbal options to help with sleep at your Peoples Pharmacy.

One of the most popular, and effective, natural sleep remedies is melatonin. Melatonin is a hormone that is produced by the pineal gland as the evening approaches.

This hormone is produced as light decreases, but is blocked when things become brighter. The role of melatonin is to lower body temperature and chemically produce sleepiness. For some people, melatonin can be very helpful to produce a good night’s rest. Melatonin might

not be for everyone. You should talk to your Doctor or Peoples Pharmacist before starting melatonin. This supplement can interfere with blood thinners, sedatives, antidepressants, and immunosuppressants.

The mineral selenium comes to mind when I think of senior men and their health. A lower intake of this mineral has been associated with an increased risk of prostate cancer. Selenium is one of the main parts of an antioxidant enzyme in your body called glutathione peroxidase. Low levels of this enzyme are very common when there is little selenium found in the local soil. Some studies have shown that when people who lived in selenium-deficient areas were given selenium supplements, their risk of developing certain cancers declined. The usual dose is about 50mcg per day, but no more than 400mcg/day. Taking too much can cause selenium-toxicity symptoms such as nausea, depression, and nervousness. The best dietary sources of selenium include nuts, unrefined grains, brown rice, wheat germ, and seafood.

But the amount of selenium in these foods may be difficult to predict, because their selenium content is dependant upon the soil they were grown in. It is unlikely that people will get too much selenium from their diet, in fact, the opposite might be true.

Another major health concern for older men is an enlarged prostate or benign prostatic hypertrophy (BPH).

BPH is a non-cancerous enlargement of the prostate gland and can cause various symptoms associated with the interruption of normal urinary flow. The most helpful supplement is Saw Palmetto. This little shrub is found primarily in the southern parts of our continent, mainly Florida. It is a concentrated form of the berries that is used in supplements. The usual dose is 160mg, twice a day, of an extract that contains at least 90% fatty acids. It may take several weeks before you notice the effects of this Continued On Page 8

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Ian Lloyd...Continued From Page 6

herbal product. One study found that this herbal product worked as well as the drug finasteride, for helping to relieve symptoms of BPH. Those who use Saw Palmetto rarely experience side effects. One important thing to know is that Saw Palmetto will not interfere with a PSA Test. PSA, also called Prostate-Specific Antigen, is a test to determine if one has prostate cancer. Ask your Peoples Pharmacist if Saw Palmetto is the right product for you.

What if one day you couldn’t see; or even worse, what if the vision loss was gradual, so you knew it was coming? This is the reality of macular degeneration, the progressive damage of the part of the eye which is responsible for sharp, central vision. After years of wear and tear, seniors often have issues with eye health.

There is a supplement that has been shown to help prevent AMD. A high potency multivitamin was shown to help AMD in the National Eye Institute’s Age-Related Eye Disease Study (AREDS). In this large study, people with and without AMD took a multivitamin containing zinc, beta-carotene,

vitamin C, and vitamin E. What the researchers found was that there was a risk reduction of 27% for vision loss in people who had advanced AMD, and a risk reduction of 25% for the progression of AMD to a more advanced stage of this disease. In people with no or early AMD there appeared to be no benefit.

Two other important supplements for eye health are lutein and zeaxanthin. They are the primary pigments found in the macula and are thought to protect the retina from ultraviolet sunlight. Studies have shown that people with a higher dietary intake of lutein and zeaxanthin, have a lower risk of developing macular degeneration.

Osteoporosis is a great concern for seniors, both women and men. Adequate calcium and vitamin D intake are very important in the prevention and treatment of osteoporosis. Women over the age of 50 should get at least 1000mg of elemental calcium per day. While this is possible without supplements, taking extra calcium in the form of supplements can ensure you get this amount. I am often asked which form of calcium is best. The best form of calcium is the kind that you remember to take. It is true that calcium citrate is slightly better absorbed than calcium carbonate, but the difference is not very significant. Adequate vitamin Continued On Page 10

Medication Review Service Are your medications working effectively for you?

PEOPLES PHARMACY has the answer for you with the new Medication Review Service. This free service is an in-person private appointment with a Peoples Pharmacist.

Medication Review Includes: • Detailed analysis of all medications (prescription and overthe-counter), vitamins and supplements to ensure safe and effective use.

• In-depth consultation to improve health outcomes by helping resolve any issues that have arisen due to your medications.

Speak to a Peoples Pharmacist about scheduling a free medication review.

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pharmacist recommended Health & Wellness Information From Your Peoples Pharmacist

How Fibre Benefits Your Cholesterol Level Dietary fibre is found exclusively in plant foods. It serves as the structural framework in plants and is one of the most abundant compounds in nature. Fruits, vegetables, wholegrain breads and cereals, nuts, and legumes (such as dried beans, lentils, and peas) are all sources of fibre in the diet. Fiber is beneficial for a number of reasons. It helps improve intestinal health, prevents heart disease and some cancers, reduces blood pressure, regulates blood sugar, and aids in weight control.

Fibre can be either insoluble or soluble, although most fiber-containing foods have both. Insoluble fibre speeds up the movement of food through the intestines and promotes regularity. Insoluble fibre can be found in whole-grain foods, wheat bran, many vegetables, and fruit with skin. Soluble fiber -- also called viscous fibre -- dissolves when mixed with water and becomes a gel-like substance, slowing down the movement of food through the small intestine. Sources of soluble fibre include oats, peas, beans, apples, and citrus fruits; one serving of any of these foods provides about one to three grams (g) of soluble fibre.

Evidence suggests that soluble fibre is more effective at lowering cholesterol, but both types of fibre are important for your health.

One of the ways soluble fibre may lower blood cholesterol is through its ability to reduce the amount of bile reabsorbed in the intestines. t works like this: When fibre interferes with absorption of bile in the intestines,

the bile is excreted in the feces. To make up for this loss of bile, the liver makes more bile salts. The body uses cholesterol to make bile salts. So in order to obtain the cholesterol necessary to make more bile salts, the liver increases its production of LDL receptors.

These receptors are responsible for pulling cholesterol out of LDL molecules in the bloodstream. Therefore, the more bile salts are made from the liver, the more LDL cholesterol is pulled from the blood.

Research has shown that increasing soluble fibre by 5 to 10 g a day reduces LDL cholesterol by about five percent. Oat bran and oatmeal, as well as psyllium and barley, are rich in beta-glucan, a soluble form of fibre, which has been shown to lower total cholesterol and LDL cholesterol.

The best way to increase fibre in the diet is to eat more fruits, vegetables, whole grains, and legumes. Fiber supplements are an option if your daily diets does not involve the above, but because supplements are concentrated forms of fibre, it's best to start slow. Switching from a low-fibre to a high-fibre diet should be done gradually to avoid intestinal discomfort.

Speak to a Peoples Pharmacist about fibre and how it can help imrpove your health and wellness.

peoplesdrugmart.com People First 9

Ian Lloyd...Continued From Page 8

D intake plays a more important role in calcium absorption than which form of calcium you take .

Vitamin D is essential for calcium absorption and bone formation. Your body can manufacture its own vitamin D when exposed to sunlight, but this may not happen during the winter months or when you are stuck indoors. The more I read about vitamin D, the more I take. My personal recommendation is that everyone should take 1000-2000IU per day. I currently take 3000iu per day and my 5 year old takes 1000iu per day.

Ginkgo biloba is a popular choice to help improve memory and cognitive function. I have one small caveat; when you take a product to improve your memory, you might not notice great improvements. In studies, ginkgo (when taken with ginseng) has been shown to improve memory by about 8%. It may be difficult to tell if you are 8% smarter than last month. What I notice is, when I regularly take gingko, I stutter less. This is not a big change, but it is noticeable. The most common dosage of ginkgo is between 40-60mg three times a day, with a maximum dose of 240mg/day. Most products on the market are standardized to contain 24% flavone glycosides and 6% terpene lactones. I don’t recommend the non-standardized preparations, such as teas or tinc-

tures, because their potency may be significantly lower.

Ginkgo, as well as garlic and ginseng, share a notable drug interaction. They all enhance the effects of blood thinning medications. This is very important. If you are taking medications to thin the blood, like warfarin or higher doses of aspirin, these herbals may make your blood too thin. This may put you at risk of bleeding complications. This is one of the reasons why it is important to tell your Doctor or Peoples Pharmacist if you are taking herbal supplements or vitamins.

Getting older is a tough racket. The “Golden Years” can be a glorious time filled with such activities as spoiling grandchildren, traveling and volunteering. It can also be a time of greater health concerns.

For young and old, the same general health advice always applies; get lost of rest, eat well, exercise regularly and laugh a lot.

Oh! I almost forgot. Don’t forget to take your multi-vitamin.

Written By Ian Lloyd, Pharmacist & Chartered Herbalist, Peoples Pharmacy

Don’t Play A Guessing Game With Your Daily Medications Many people today are on more than one medication and when you combine this with a busy and active life, it can lead to the confusion of properly taking your medications. Medication non-compliance is a major concern and accounts for approximately 25% of all hospital admissions among seniors.

Peoples Drug Mart and Peoples Pharmacy offer a medication compliance program called “Med Manager”. The Med Manager is a medication compliance card that conveniently organizes your medications for a full week and helps you easily identify what medications are to be taken at what time of the day.

Talk to your Peoples Pharmacist about the convenient Med Manager program.

10 People First peoplesdrugmart.com

PEOPLES PHARMACISTS

Dr. Hister...Continued From Page 4

some medications, smoking, and several other factors, which in turn produced the characteristic asthma attack symptoms of wheezing, coughing, and shortness of breath.

So, all the treatments back then involved bronchial anti-spasm medications, most notably those ubiquitous blue Ventolin (generic name is salbutamol) canisters that all asthmatics were strongly urged to keep on hand (with spares tucked away in case the canister you happened to need that moment suddenly went empty on you) and all asthmatics – like me - were also told to use those “rescue” or “reliever” puffers generously in order to control their symptoms.

A bunch of years ago, though, somewhere around the time medicine entered its more advanced state equivalent (I’d say) to the era of pill-box hats and polyester suits, researchers determined that in asthma, as in so many other chronic health problems, chronic inflammation plays a vital role, too, and that led to a change in thinking about how to deal with asthma, namely, that controlling the airway inflammation is better – in fact, it may be vital - for an asthmatic than merely treating bronchospasm as it flares.

So, now, in our modern era of I-phones, Ipads, and I-don’t-know-what-else, asthmatics are told that they should aim vigorously to prevent airway inflammation by taking drugs called preventers, which have consisted nearly entirely of steroid (cortisone) sprays, and to reserve the use of their rescue drugs for when the preventers are not doing their job. (In fact, since nothing should be formulaic about asthma, every asthmatic should have a detailed plan worked out with their doctor as to which drugs to use and when to use them).

One of the problems with preventer puffers, however, is that although they work well in studies, they are not nearly as effective in the real world (one major reason: many asthmat-

Helping People Live Better Lives A Health & Wellness Professional.

Besides being your community’s medication expert, your local Peoples Pharmacist is a trusted source on a wide variety of health and wellness issues and other health concerns.

Navi Kandola

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A Partner In Your Community.

Peoples Pharmacies are locally owned and operated by members of your community. Our focus is personal health care and community support that builds strong and healthy communities.

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We Can Help Reduce Everyday Strain On Your Busy Legs.

Select Peoples Drug Mart and Peoples Pharmacy locations offer compression stocking and fitting services which help treat painful venous leg disorders.

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Pharmacist & Owner, Port McNeill

Dr. Hister...Continued on Page 13

peoplesdrugmart.com People First 11

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Macular Degeneration Dr. Hister Talks About

Metabolic Syndrome

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Earn Points On Your Health Purchases Free Membership Becoming a People First Rewards member is easy. Apply at a participating Peoples Drug Mart or Peoples Pharmacy and you’ll instantly receive your People First Rewards card. You’ll be able to use it right away and start earning free People First rewards.

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Apply For Your Free Card Today! *Due to new B.C. Ministry of Health restrictions, no reward points can be given on the portion of a prescription that is reimbursed by Pharmacare. Please see store for complete details.

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Dr. Hister...Continued From Page 11

ics don’t use puffers correctly, something a pharmacist, by the way, can easily show you how to do), so the happy news from that report in the NEJM is that 2 studies have found that over a follow-up period of 2 years, another class of preventer drugs known as leukotriene receptor antagonists (trade names are Singulair and Accolate) which come in the form of pills were as effective at preventing asthma flare-ups as cortisone sprays were, but more people stuck with the pills regularly in these reports than did with the sprays.

So if you’re the kind of asthmatic either whose asthma is not well-controlled with the preventive strategy you’re using now, or if you just don’t like the idea of taking some form of cortisone for the rest of your life, you may want to ask your doctor about this report and how it may help you.

Which brings me to my final point in this column: since we are constantly finding out new and vital information about asthma, as an asthmatic, there are 3 important tactics you must pursue: 1) Have an easily-understood plan about how to handle your condition 2) Keep persistently bugging your doctor and your pharmacist (in a diplomatic way, of course) about any new data he or she may have, because our ideas about asthma are constantly shifting 3) Follow health news as much as you can By the way, the best way for you to follow that last rule is, and I’m being totally objective here, folks, to regularly watch Global TV’s Health Headlines with, well, it would be embarrassing to me to say who the star and writer and host of Health Headlines is, but hey, trust me, it’s a great health segment. At least my mom thinks so.

PEOPLES PHARMACISTS Helping People Live Better Lives We Help With Thorough Consultations.

Peoples Pharmacists take the time to properly consult and advise you on your best course of action for your medications and health concerns.

Riaz Mapara

Pharmacist & Owner, Coquitlam

We Can Help With Medication Reviews.

Medication reviews are In-depth consultations that improve health outcomes by helping resolve any issues that have arisen due to your medication. Ask about the new medication review service.

Colleen Hogg Pharmacist & Owner, Quadra Island

We Can Help Manage Your Daily Medications.

Talk to your Peoples Pharmacist about Med Manager compliance packaging and how it can safely organize your daily medications.

Tom Lee

Pharmacist & Owner, Vancouver Dr. Art Hister can be heard on CKNW and other Corus Radio Network stations on House Calls on Saturdays at 10 AM, as well as seen on Global TV news on Saturday mornings at 9:20.

peoplesdrugmart.com People First 13

Darlene Booth R.H.N

Sunny Side Up Winston Churchill, a self proclaimed optimist, knew what he was talking about when he said; “A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.” When it comes to personality traits, the ability to view the world through a positive lens is one that I totally resonate with. It is what keeps me engaged in the dance of life and intrigued about what is hiding around each corner.

Walking around wearing rose-coloured glasses is not what I am inferring. Pessimism does serve an important purpose.

Realistically seeing the difficulties that a situation presents and imagining the worse possible outcome can be a healthy strategy as long as it does not induce paralytic hopelessness. Examining potential difficulties motivates me to work harder while moving forward with caution and appreciation for the learning curves. Certainly, some of life’s big challenges have fine-tuned my self-awareness; often it is in the darkest of alleys where I have found my greatest treasures. That is the brand of optimism that I subscribe to.

While pessimism does serve a protective role in life, generally speaking, it is a positive attitude that correlates to increased levels of overall health and longevity. Those who view life with optimism seem to have better coping skills when it comes to stress, are less likely to die from heart disease, suffer less down time with influenza and colds and are generally happier people to be around. Thus, they attract more friends!

I can’t say for certain if optimism is inherent at birth or something that is developed in response to one’s environment but I suspect that it is a combination of the two. Some babies are just born sunny side up; it is their intrinsic nature. For others, it may be a skill that will be honed later in life.

Practicing optimism is somewhat like mindfulness training.

It takes a healthy dose of self-awareness and due diligence to the practice of new skills that will help you think and act in a more positive fashion. You can begin to affect change by simply checking in on your thoughts. Nothing fuels pessimism more than negative self-talk. If you find yourself always buying into “Murphy’s Law” or believing that you are destined to lead a life less than you desire, chances are you are riddled

14 People First peoplesdrugmart.com

with negative self-talk. The first step to changing this pattern is to become aware of it and how it makes you feel. Then begin to reframe the negative into a positive. “I can’t do it!” becomes, “I can do it!” Look for solutions instead of focusing on problems and you will avoid the pitfalls of pessimism.

Did you know studies have shown that, if you are feeling blue, you can brighten your mood just by forcing yourself to smile? Try one on and you will experience the body mind connection. We all know how infectious laughter can be, so put on that happy face and fake it until you make it! Hang out with positive people and learn to emulate the language they are speaking. A pessimist might see a problem as overwhelming whereas an optimist will see it as a challenge. Our body postures and word choices really do have an impact on our quality of life.

As with learning any other new skill, becoming more optimistic in life will take time and practice; the more you practice, the more you will benefit. Many people find that the repetition of positive affirmations can be a helpful practice to keep them moving away from negativity. Affirmations are little sayings you can repeat throughout the day whenever you find pessimistic thoughts creeping in. Here are some examples of daily affirmations: 1. I am happy and healthy.

2. I have a lot of energy.

3. My mind is calm and peaceful.

4. I am surrounded by love.

5. My life is successful and harmonious.

Sometimes bad things do happen to good people. Optimists accept responsibility for the things they can change and let go of those things that they can’t. Too often a pessimistic attitude will let a stroke of bad luck become a personal destiny.

If you get laid off from a job, it does not mean you are a failure it just means there is an opportunity to find an even better job just around the next corner. When you adopt a “half full” approach to life, you then are living a life full of open doors and possibilities.

Good Health to You!

Wild Rice Fennel Salmon

ate flavours and A dish with the delic wild rice, barley and fantastic textures of on. Chives add a hearty chunks of salm d freshness. an burst of bright colour

3 cups 750 mL Chopped fennel bulb (white part only) 2 cups 500 mL rt only) Sliced leek (white pa 11⁄2 cups 375 mL Prepared vegetable (or chicken) broth 1 125 mL ite wine ⁄2 cup Dry (or alcohol-free) wh 1 125 mL ⁄2 cup Pot barley 1 125 mL ⁄2 cup Wild rice 1 1 mL ⁄4 tsp.

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Add chives. Stir gently. Makes g lories; 6.0 g Total Fat (1.8 1 cup (250 mL): 248 Ca Carg 25 ; rol ste ole Ch ); 47 mg Mono, 2.3 g Poly, 0.9 g Sat Protein; 148 mg Sodium bohydrate; 4 g Fibre; 21 g

Recipes For Good Health

Wild Rice Fennel Salmon 30-Minute Diabetic Cooking Cookbooks

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*Points awarded on net pre-tax purchases.Certain restrictions apply (check with your local Peoples Drug Mart or Peoples Pharmacy for a complete list of non-eligible medications, services & products).

Some stores may use a manual system with a different reward level.

The articles published in People First are for the general information of the reader. While effort is made to reflect accepted medical practice and knowledge, articles should not be relied upon for the treatment or management of any specific medical concern or problem and People First accepts no liability for reliance on the articles. For proper diagnosis and medical care, you should always consult your family physician promptly. Opinions expressed in sponsored articles by, Dr. Art Hister, Ian Lloyd, and Darlene Booth are paid editorials and are not necessarily shared

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