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WHAT YOU NEED TO KNOW ABOUT

SKIN CANCER ADVICE ON MANAGING PAIN PHARMACIST ADVICE ON

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People First contents

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Skin Cancer Dr. Hister looks at the different types of skin cancer, an alarming health concern.

5

Summer Safety Save on products that will help you have a healthy summer.

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Pain Management Peoples Pharmacist Ian Lloyd provides various options for effectively managing pain.

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Save On Pain Relief Great selection of quality pain relief products from Peoples.

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What you need to know about swimmer’s itch, a rash caused by parasites found in freshwater lakes.

Protect, Protect Page 5 Be safe and protect yourself against the harmful sun rays.

Pharmacist Recommended

12

Walk For ALS Moments from the Peoples Drug Mart Walks for ALS.

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Eat to Win Darlene Booth on the nutrition required to fuel a sporty lifestyle.

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Red Dragon Potato Salad Brand new feature recipe From Company’s Coming Healthy Family Recipes.

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SKIN CANCER This article is supposed to be about “skin cancer”, and although I would never argue or even quibble with the wise, astute, knowledgeable and amazingly handsome editor who assigned me this topic (and who quite coincidentally, is also the guy who pays me for writing these things), I do have to make the point that to me, the term “skin cancer” is a bit misleading because it implies that there’s only one prevailing type of cancer that affects the skin, and that is decidedly not the case. In fact, a cancer of the skin is the same as a cancer in any organ (which is a good time to remind everyone that “the skin” is the answer to the question, “What is the largest organ in the body?”, an answer that for reasons I will refuse to go into men never seem to guess until they’ve received multiple hints, although women nearly always get it right away). In other words, just like there are at least several kinds of breast cancer (although they are also often herded together under the single label of “breast cancer”), and there are several types of bone cancer, and several types of thyroid cancer, etc., there are also several types of skin cancer, with three types particularly standing out. The most common form of skin cancer is known as a basal cell carcinoma or BCC. Although it can take several different guises, a BCC is most often described as a shiny “pearly” bump or lump on the skin. BCCs are much more common in fairer-skinned

Dr. Art Hister

individuals, especially on areas that have been exposed to lots of sun over a number of years – on the face, especially the nose and lips, on the legs, on the scalp, etc. – but a significant number of BCCS are diagnosed in areas that were not exposed to much sun, which has led some experts to conclude that there must be a genetic propensity in some people for this type of cancer. Happily, BCCs have a few good things going for them (if you can ever say that a cancer has a good thing going, of course): BCCs are usually slow-growing, the vast majority are amenable to “simple” surgery (an oxymoron, to be sure) that removes the tumour and the tissue around it (although BCCs and surgery for them can sometimes result in significant damage to the skin in that area), and best of all, BCCs metastasize only rarely, which is why, happily, there is a very low likelihood of a BCC killing anyone. That said, as with all cancers, even ones that are not seemingly overly aggressive, all BCCs should be followed up carefully for years after they were diagnosed and treated especially since BCCs have recently been linked to a higher risk of cancer in other areas of the body (see below). The second most common type of skin cancer is known as a squamous cell carcinoma (SCC), and it usually shows up as an ulcerated area of skin that bleeds easily, what you might refer to as a sore that doesn’t clear up, and one that usually expands slowly. SCCs also occur most commonly on sun-exposed Continued On Page 11

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PAIN MANAGEMENT Everybody hurts sometimes. This is my favourite line to help describe pain. According to a study published in 2013 by the Mayo Clinic, medical conditions involving pain were the top reasons for visiting your family doctor. In a perfect world, no one would hurt. We all know this world is not perfect and the pain relief aisle of your local Peoples Pharmacist is fully stocked. There are quite a few choices: ASA, acetaminophen, naproxen, ibuprofen, topical rubs and liniments. So which pain reliever should you use? Let’s look at the different options in the pain relief aisle to see which one might be best for you. In general, there are two types of pain; acute and chronic. Acute pain is the type with which we are most familiar. Acute pain is usually short lived and has an easily observed cause. You stubbed your toe or burnt your hand on the stove. The other type of pain is called chronic pain. This type of pain is usually experienced for longer than 3 months. Treatment of chronic pain can be very difficult for physicians. There are many reasons for this; the first is that it can be hard to find the right medication for a patient. Today, there are many excellent options to help treat pain, but the problem is finding the right balance. Medical science can easily make your pain go away; unfortunately, it can also make you very drowsy, constipated and confused. All

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Ian Lloyd Peoples Pharmacist

people are different, so there is a lot of trial and error when trying to find the right type of pain medication(s). Why do we need pain? It may seem obvious to say this, but pain has an underlying reason. It is our body’s way of telling us that something is not right. Until the cause for this sensation is found, it should not be ignored or suppressed. The cause of most aches and pains can be identified. You might have strained your back by lifting a heavy box or you could have stubbed your toe. Pain that comes on suddenly, or has no apparent cause, should be brought to the attention of a health care professional as soon as possible. This is a warning from your body; listen to it. Pain relievers come in two general forms, topical (applied to the skin) or oral (taken by mouth). There are four main types of over the counter oral pain relievers in Canada; ASA, acetaminophen, ibuprofen and the now available naproxen. They work very similarly, but they all have their slight differences. The most popular pain relief option is acetaminophen (Tylenol). It is known to help reduce the sensation of pain, but it does not reduce inflammation. The other over the counter pain relievers (ASA, ibuprofen and naproxen) have the benefit of reducing inflammation as well as all pain. Medical science Continued On Page 8


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Ian Lloyd...Continued From Page 6

is still not sure exactly how acetaminophen works. One theory is that acetaminophen can affect the (sorry big words to follow) endogenous cannabinoid system. These naturally produced cannabinoids play a role in your body's perception of pain and acetaminophen helps them work better. These cannabinoids are similar to the euphoric and pain relieving chemicals found in cannabis (Marijuana). The other form of pain relievers are those that are rubbed on the skin (topically). These products fall into two main categories, topical Non-Steroidal Antiinflammatory Drugs (NSAIDs) and counter-irritants. Topical NSAIDs will seep through the skin and act similarly to their ‘by mouth’ companions, but generally they tend to act only where they are applied. These topical products are very advantageous if only a specific part of your body hurts, like a shoulder or knee. Most of the over the counter topical pain relievers contain a product similar to ASA. One brand of topical pain relief, that I recommend often, con-

tains the NSAID diclofenac. The product is made with a special cream that allows the pain reliever to seep into the skin quickly; this provides rapid pain relief. The side effects and warnings for these are similar to oral NSAIDs, but they are not as big a concern because the doses used are much lower. You can also get a much stronger version from your Peoples Pharmacist who specializes in pharmaceutical compounding. Some Peoples Pharmacies may have the facilities to compound these topical pain relievers and other specialized products. One herbal remedy I recommend for acute pain relief is arnica cream. I find this plant extract works well to reduce the pain from sore and aching muscles or joints. It also works very well to help bruises heal. Our Pharmacy prepares a topical arnica and magnesium cream that works well for relieving sore muscles and joints. There is also a homeopathic pain relief cream called Traumeel, that can be quite effective. Continued On Page 10

Shingles Vaccinations The shingles vaccine protects against herpes zoster, more commonly referred to as shingles. Shingles are caused by the varicella zoster virus, which also causes chickenpox. The vaccine is approved by Health Canada. The shingles vaccine is the best way to protect you from getting shingles. The vaccine has been shown to reduce the risk of getting shingles by 50%. For those who still get shingles after being immunized, the vaccine can reduce pain, including the type of pain that lingers after shingles. Talk to your doctor or Peoples Pharmacist today to find out how to help protect yourself against shingles and if the shingles vaccination is right for you.

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VICTORIA • 1282 Fairfield Rd. • 3643 Shelbourne St


pharmacist recommended Health & Wellness Information From Your Peoples Pharmacist

Swimmer’s Itch Swimmer's itch is a temporary, itchy rash caused by small worm-like parasites called schistosomes. These small worms are found in many lakes and ponds in B.C., usually in the warm summer months. These parasites penetrate the skin of humans and cause an allergic reaction in some people which is characterized by an a patchy red pinpoint skin rash. Humans pick up these parasites from infested freshwater lakes and ponds. When they come into contact with humans, the parasites attach themselves to the skin, but do not penetrate until the water droplet they are in evaporates. Who gets swimmer’s itch? Approximately one third of people who come into contact with the parasite will develop swimmer’s itch. People who come into contact with swimmer’s itch are those who swim or wade in infested water. This itching rash can affect anyone, regardless of age or sex. Children, however, are more often infected due to their habits of alternately playing in the water and then on the beach until the water evaporates. Swimmer’s itch is only contracted from infested water; it cannot be spread from one person to another. Is it possible to prevent swimmer’s itch? It is relatively impossible to avoid coming into contact with this parasite if you are swimming in an infested lake. Before going into any lake, find information about the lake by speaking with other people there and with local health officials. It is, however, possible to prevent them from burrowing into your skin and causing a rash. The best way to prevent a swimmer’s itch infection is to have a shower and then dry off immediately after leaving the water. Showers, unfortunately, often aren’t available at a lake unless you have a summer home there. It is sufficient, however, to simply dry off vigorously with a towel when you get out of the water. Applying suntan oil prior to swimming can also help to prevent the parasites from sticking to your skin and it will also protect you from the sun while swimming.

What are the symptoms of swimmer's itch? The degree of symptoms will depend on how many parasites get on to your skin, and how sensitive you are to them. Symptoms also tend to get worse with repeated exposures. Swimmer's itch ranges from just a mild irritation to a very severe, itchy red rash. This may become badly infected from too much scratching. When a person starts to dry off and the parasites start to burrow into the skin, a tingling feeling may begin almost right away. Small, pin-point sized red spots will appear, which grow into larger red rashes within several hours. As these red spots grow, the tingling feeling becomes a strong itch, which feels like a nettle's sting or an insect bite. How long do the symptoms last? The itching feeling will gradually get worse, and it may last 2 to 5 days or as long as 2 weeks before fading away slowly. Too much scratching can cause severe pain and swelling or other skin infections. Repeat infections are usually worse because people become more sensitive to the parasites and develop stronger allergic responses each time. How is swimmer’s itch treated? There are a number of steps you can take, which may reduce some of the itchiness. Check with your doctor or Peoples Pharmacist about treatment. Commonly recommended treatments and advice include: • Avoid scratching. • Apply plain calamine lotion. • Take antihistamines, especially at bedtime. These are not recommended for children under 6 years of age. • Take shallow, lukewarm baths with three tablespoons of baking soda in the water. • Take colloidal oatmeal baths. • Apply cool compresses. Check with your Peoples Pharmacist before taking an antihistamine because some can make you drowsy and others can interact with other medications you might be taking. peoplesdrugmart.com People First 9


Ian Lloyd...Continued From Page 8

Chronic pain can be very difficult to treat due to the misconceptions about this condition. You might not be aware of this, but untreated chronic pain has a number of complications. Long term pain can lead to depression, anxiety, insomnia and inactivity. That is why it is important to talk to your doctor or Peoples Pharmacist about chronic pain. It might seem brave to be stoic and live through it, but the condition could become worse and harder to treat. The main misconception that people have about the medications used to treat pain is the idea of addiction and potential side effects. Side effects from pain medications can be managed and might not seem too bad once the pain is under control. The next concept to learn is the difference between addiction and dependance. Whenever you take a medication for a long period of time, your body develops a dependence upon it. It does not matter which disease you are treating; high blood pressure,

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anxiety or pain. Once the medication is stopped, the body's functioning may return to the way it once was. This may not be desirable nor pleasant. In contrast, addiction usually involves poor lifestyle choices and using medications inappropriately. I ask my patients two questions concerning the possibility of addiction and their answers usually alleviate their concerns. The first is, “What is this medication used to treat?” The second is, “If you no longer require treatment for this condition, would you continue to take the medication?” Everybody hurts sometime. I admit this is a very brief article about pain relief. The Victoria Hospice Society produces an excellent book about chronic pain relief and its complications that is over 600 pages long. If you have any questions you should ask your Peoples Pharmacist or physician. Pain is real, but it does not always have to hurt. Written By Ian Lloyd, Pharmacist & Chartered Herbalist, Peoples Pharmacy

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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 and safe Med Manager program.

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Dr. Hister...Continued From Page 4

areas of the body (are you getting an idea about why dermatologists simply loathe the sun?), especially the scalp, the lip, and the legs, although it’s very important to keep in mind that SCCs can turn up anywhere, so any sore that doesn’t clear up or indeed any sore that worries you unduly should be checked out, but before you start to worry even more about a spot or two that you’ve been watching somewhat carefully for years, be assured that most such lesions do not turn out to be cancerous, although it never hurts to be careful. Happily SCCs also respond well to local surgery, although some SCCs (and a few BCCs, too) may require other forms of anti-cancer therapy besides simple surgery such as radiation therapy or even chemotherapy. SCCs have a higher tendency to metastasize than basal cell cancers do, so they too need to be followed carefully after diagnosis and treatment, especially since, as I alluded to earlier, according to a couple of recent very large reviews involving nearly 180,000 men and women, anyone who has had a skin cancer diagnosis – either a basal cell carcinoma or a squamous cell carcinoma - has an up to 25 % higher risk of being diagnosed with a cancer in another area of the body, meaning that if you’ve had skin cancer, you not only need to be watchful about it recurring, you should also be extra careful to know about which other cancer screening recommendations apply to you. Which finally brings me to discuss malignant melanomas (MMs), cancerous changes that occur in cells known as melanocytes, the colour-producing cells of the skin, and which also occur most often on sun-exposed areas such as the legs and the back, but again, they can occur anywhere, even internally. MMs are more common in older individuals, but they can show up at any age, and unfortunately, according to a recent report in the journal, Pediatrics, the rate of MM seems to be increasing in younger Americans (it’s very likely to be the same up here as well), and interestingly, a large number of these recent malignant

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Dr. Hister...Continued on Page 13

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Peoples Drug Mart B.C. & Yukon Walks For ALS

Thirteen of the sixteen Peoples Drug Mart WALK for ALS have successfully happened and over a quarter of a million dollars has been raised so far. A big thank you to all the walk participants and sincere appreciation for the hard work put in by the walk volunteers and walk co-ordinators. The sixteen walks are more than a fundraising event • It is a celebration of hope for those living with ALS. • It is a celebration of lives lived for the family and friends of those who have lost their lives to the disease. • It gives participants the chance to share and connect with other families who have been affected by the disease. • It serves to increase awareness of and support for ALS. With increased awareness comes increased financial support which will enable people living with ALS to have the services they need to live with independence, dignity, and choice. ALS (Lou Gehrig’s disease) is a paralyzing, life-ending condition with a prognosis of 2 - 5 years of life. ALS attacks and kills the motor neurons in the body, denying you the ability to move, to speak and finally to breathe. It has no known cause, no effective treatment or cure yet. ALS Society of BC provides equipment and support services for people living with ALS in BC and Yukon, and funds breakthrough research towards treatments and a cure. 0% of walk funds are invested in vital research to find an effective treatment and a cure for this devastating disease Peoples Drug Mart is proud to be the presenting sponsor of the B.C. & Yukon Walks for ALS and are very appreciative of the hard work performed by the many walk volunteers. Join us in the fight against ALS. Upcoming Peoples Drug Mart Walks for ALS September th Dawson Creek September 15th Victoria September 29th Whitehorse For more walk information: www.alsbc.ca

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Dr. Hister...Continued From Page 11

melanomas in young people are occurring in areas that were not exposed to much sun, a surprising trend that might be due, the study’s authors speculate, to the rising use of tanning beds by young people. MMs are thankfully the least common form of skin cancer but they’re the skin cancers that worry doctors most because MMs do metastasize and account for the vast majority of deaths from skin cancer, so it’s very important to recognize an MM, hopefully very quickly after it forms, and to help you do that, dermatologists have devised that famous detection acronym, namely ABCDE. A: asymmetry B: (irregular) border C: (varying) colour D: diameter (greater than 6 mm), and E: evolving (changing in some way, especially if it’s growing). So, any change in your skin that has some of those ABCDE features should be checked out much sooner rather than later. And I know I don’t have to mention this to the very savvy readers of this column, but just in case there’s a new recent not-yet-astute convert to this publication, let me add that anyone – whether they’ve had skin cancer or not - should be “sun smart” by wearing a hat, plus judicious clothing, plus applying liberal doses of sunscreen, and especially by avoiding direct sun exposure at the hottest times of day. And finally a plea from this author: I know you won’t remember much of what you read here but please, please store at least the last two paragraphs in a part of your brain where it will never get lost because remembering what you read there might just save your life, and in case you’re wondering which part of the brain might be most useful to store this in, may I suggest using the same part of your brain where you store memories of great Canuck’s victories – there should be lots of spare room in that area. 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.

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EAT TO WIN Athleticism is greatly valued in our society. While genetics play a role in how easily a talent comes to an individual, most people can gain proficiency in a sport through dedication and perseverance to a training regime. An extremely competitive person might be highly driven to win and stop at nothing short of being “the best.” This drive to find the winning edge will sometimes lead to performance drug use which over long term can have devastating effects overall health. Even though doping is greatly frowned upon in professional sports circles, the human condition is programmed to quest. We are so hopeful that a magic pill can solve our problems that we forget one simple truth. We are what we eat; if we want to enhance our athletic selves, then our diet and lifestyle choices should reflect that philosophy. Sports nutrition is the field of study that optimizes knowledge of an individual’s needs with dietary choices to enhance their athletic performance and recovery. There isn’t a “one size fits all” approach when it comes to sports nutrition; the key is about educating yourself on what a balanced diet looks like and then tailoring it to your activity level. A body builder is going to have different objectives than a marathon runner, but the thread of similarity lies in the basic ingredients that make up an activity efficient diet. Carbohydrates are your most important workout nutrient. Before, during and after your activity, they provide valuable vitamins, minerals and fibre and are easily converted to glucose. Glucose is your prime source of readily accessible energy. Choose nutrient dense carbohydrates in the form of fruits, vegetables and whole grains over highly processed sugars and baked goods. Today’s daily guidelines suggest that for light activity you need -5 grams of carbohydrate for each kilogram of body weight, -8 grams for moderate activity or endurance training, and 8-12 grams for extreme or intense training. Excess carbohydrates are also easily converted to fat so do not overestimate your level of training or you could be packing on extra pounds in spite of your training. For prolonged exercise, carbohydrates also play an important role in maintaining your endurance factor. Depending on your metabolism and intensity level, consuming between 30 – 60

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Darlene Booth R.H.N

grams of carbohydrates per hour of exercise can help keep you going. Many athletes will use a gel or a sports drink to supply this energy. Within 2 hours after your workout you want to reboot your glycogen stores by taking in 100 - 150 grams of carbohydrates with some protein to help with the recovery and repair process. Chocolate milk has gained a reputation as a good post workout food but cheese and crackers, peanut butter and banana or yogurt and fruit are also good choices. Protein is a building block for muscle and aids in the aprQs exercise recovery and repair process. The best animal proteins are lean meats, poultry, fish, and eggs; vegetarians can choose from whole grains, beans, legumes, nuts and seeds. Many athletes will use a protein powder to help meet their daily needs. Keep in mind that a competitive body builder will have different protein needs than a cycler. A general guideline is between .8 – 1.8 grams of protein per kilogram of body weight per day depending on your activity levels and goals. Fat can be a source of energy in long duration moderate energy sports but is not a readily accessible energy source for sprinting or weight training. Fat is important for hormonal health, healthy skin, hair and brains; dietary fat is also needed for assimilation of fat-soluble vitamins A, D, E and K. Approximately 15 25% of your daily calories should be consumed in the form of healthy fats from fish, nuts, seeds, olives and avocados. Water may be the last nutrient in this list but it is a very important one. Even minor dehydration can have a devastating effect on performance. Given extreme conditions, a body can lose up to a quart of water in an hour so it is important to make sure you are well hydrated before the activity and drink 6 – 10 ounces of water every 20 minutes during exercise. Dehydration can lead to cramping, heat exhaustion and heat stroke. Hydration is a tricky thing to measure but a general rule is that you want light coloured urine, not dark. If you are exercising for an hour or more or tend to sweat a lot, you will want to drink a sports drink to replace lost electrolytes. Even if you are not an athlete, eat like a winner and you will feel that much better for it Good Health to You


Red Dragon Potato Salad

Red Dragon Potato Salad

The nutrient and fibre-rich potato has its time to shine in this vividly coloured recipe with accents of sweet red pepper and chipotle. With its mild spicing, even kids will love this dish. 8 red potatoes, quartered 1 ⁄4 cup (60 mL) roasted red peppers 2 Tbsp (30 mL) pine nuts 1 ⁄8 cup (30 mL) chopped fresh parsley 1 ⁄4 tsp (1 mL) chipotle chili powder 1 Tbsp (15 mL) lemon juice 1 Tbsp (15 mL) grainy Dijon mustard 3 Tbsp (45 mL) light mayonnaise 1 stalk celery, diced 1 red pepper, diced 2 green onions, thinly sliced Place potatoes in a large pot and add cold water until potatoes are submerged. Bring to a boil over high heat, then lower to a simmer. Cook for 20 minutes or until potatoes are tender. Drain and allow potatoes to air dry on a baking sheet. Add roasted red peppers, pine nuts, parsley, chipotle, lemon juice and mustard to a blender or food processor and blend until smooth. Fold in mayonnaise. Set aside. Cut potatoes into 1/2 inch (12 mm) slices. Toss with celery, red pepper and onion. Spoon dressing over mixture and combine, using your hands. Serve cool. Tip:Roasted red peppers can be found at your local grocery store, in canned or jarred forms. You can also make your own by roasting red bell peppers under a broiler or on a grill until charred. Cool peppers in a sealed resealable bag for 10 minutes, then scrape away skin and remove core and stem with a small knife. 1 serving: 280 Calories; 4.5 g Total Fat (1 g Mono, 2.5 g Poly, 0.5 g Sat); trace Cholesterol; 54 g Carbohydrate; 6 g Fibre; 7 g Protein; 135 mg Sodium

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Reprinted from Healthy Family Recipes © Company's Coming Publishing Limited

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Recipes For Good Health

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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 by Peoples Drug Mart stores or Peoples Drug Mart (B.C.) Ltd. Some advertised products are not available in all stores. We reserve the right to substitute products or limit quantities. Prices effective while quantities last. Sale in retail quantities only.


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People First Health Magazine, Vol.13, No. 6

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