Important signs & symptoms

Have you ever had a conversation with a health care professional and been confused when they ask you about your signs and symptoms? Not sure of the difference between the two terms? Let us explain. A sign is something that can be seen or measured by another person—such as a high blood pressure reading, or a fever temperature. A symptom, on the other hand, is something that is detected only by the person who experiences it—such as ringing in the ears, dizziness, or pain.

Symptoms fall into three categories:

• Remitting: symptoms that improve or go away completely
• Relapsing: symptoms that go away for a while but then return
• Chronic: symptoms that last for a long time

Some people see a healthcare provider when they first notice a sign or symptom. Others may wait some time or try to solve it by themselves. However, some health issues do require medical attention and not getting help quickly might complicate the treatment. Think of a small cavity, which a dentist can treat and should have no complications. But if left untreated an infection might set in, and root canal could become the only solution. So, don’t wait, if you think something might be wrong, consult a health professional to find out what your next steps should be.

Important symptoms to watch out for:

Some symptoms may point to a problem that could be more serious, so it’s important to know what they are and what they can point to. If you experience any of the following symptoms, you should not wait to seek medical attention.

• Unexplained weight loss: A loss of more than 5% of your body weight without explanation like a change in diet or exercise level, could be the result of a serious underlying health condition.
• Swelling of the legs without an injury: If your legs swell when you haven’t injured them, it could be due to something as simple as sitting too much or standing for too long, but it could also be due to something more serious, such an issue with your veins or kidney disease.
• Chest pain: Pain in your chest or upper abdomen could signal a problem with your heart, lungs, or musculoskeletal system. Also, pain that extends to your jaw or upper back may be symptoms of a heart attack and requires immediate medical attention.
• Unusual bleeding: If you notice blood where it should not appear—such as in your urine or in a bowel movement, when you vomit, or when you cough. There are a number of conditions that could cause this so do not wait to get medical attention.
• Sores or wounds that don’t heal: Any sore or wound on your skin that doesn’t heal within three months or one that continues to reappear could signal an infection or diabetes.
• Weakness, numbness, tingling, facial droop: If you experience this combination of symptoms, you could be suffering from a stroke. Seek medical help immediately.
• Difficulty breathing or shortness of breath: Shortness of breath could indicate asthma but could also be caused by something more serious like an issue related to your heart or blood clots. If your normal breathing pattern changes, it could signal a significant problem. For example, do you get short of breath easily when you climb a flight of stairs, or do you wake up in the middle of the night coughing and gasping for air? If yes, you need to see a doctor.

Know your body

Pay attention to your body and learn to recognize when something unusual is happening, because it could be a sign or symptom of a more serious health issue. It is helpful before talking to your pharmacist, doctor, or other healthcare professional, to write down some details of what you are experiencing.

Consider these questions: When did the symptoms first start? Have you experienced these symptoms before? Have you consulted a doctor about this in the past? Have you tried anything that helped or didn’t help? Then call or visit your local London Drugs pharmacist. We can help you decide what the next steps are and may recommend or prescribe treatments for many common symptoms as well. However, if you are experiencing any serious symptoms, be sure to call 911 or seek immediate medical attention.

Our weather changes throughout the year, and this can affect how our skin responds to both the air temperature and the amount of moisture in the air. Therefore, our skin care routine and the products we use must change, too. What works well during the summer months may not work well in the winter. Are you prepared for the coming winter months?

How winter affects our skin

As we move through the year, it is important to make sure our skin care routine fits with the conditions of each season.  We should be aware of how cold temperatures and dry winter air affect our skin, that harsh winter winds can strip away moisture from our skin, and how snow and ice can increase damage from the sun’s harmful UVB rays.

While it isn’t necessary to change every product we use each season, it is important to understand what effects winter weather can have on our skin and what we can do to protect our skin when it is more vulnerable. Studies have shown that colder temperatures in the winter and the decreased amount of moisture in the air cause our skin to become drier, itchier, and more easily irritated. Additionally, the increased use of indoor heaters and fireplaces can cause our skin to lose even more moisture. Our body tries to protect itself from these changes by increasing the thickness of the top layer of our skin to reduce the amount of water loss. In addition, when we are exposed to extreme cold temperatures, the blood vessels in our skin constrict, which can reduce the amount of oxygen in our skin.

While many people associate winter weather with problems such as coughs and colds, often the first place we notice the effect that cold weather has on our bodies is on our skin. Dry, chapped lips and cracked skin on exposed areas such as our hands and fingers can occur very quickly during the winter. While dry skin can vary significantly in how it affects people, common signs include cracks, flaking, itching, redness, rough patches, stinging, and being especially sensitive to touch.

Keeping skin hydrated is essential in preventing dry skin damage. Fortunately, there are steps we can take to protect our skin from these harsh winter conditions. Here are some suggestions:

• Adding moisture to your indoor air with a humidifier can help.
• Choose gentle, fragrance-free cleansers and moisturizers that don’t contain harsh chemicals.
• Using an ointment or a cream to moisturize your skin is often a better choice than a lotion, because these thicker products can be more effective and less irritating.
• Limit showers and baths to less than 15 minutes, wash in warm not hot water, and moisturize your body immediately after washing to keep the moisture on your skin.
• Wear sunscreen all year long, even in winter. Snow and ice can cause the sun’s rays to reflect back on your skin, hitting it from additional directions.
• Don’t forget to moisturize your lips.

If you need help selecting appropriate products or understanding how to use them, speak with our London Drugs Pharmacists. Or if shopping in the cosmetics department, ask one of our Beauty Advisors for assistance. We are here to help you.

With the holiday season right around the corner, for many people that means parties, festive dinners, and more rich food, caffeine, and alcohol than they normally consume. Then, after all the celebrating, many people relax on the couch—and that creates the perfect recipe for heartburn and indigestion. Heartburn (sometimes called GERD or gastroesophageal reflux disease) is a burning sensation in the chest that occurs when stomach acid flows back up the esophagus, the tube that carries food to the stomach. Indigestion (also known as dyspepsia) refers to a cluster of symptoms that occur together, causing pain in the upper abdomen, an uncomfortable feeling after eating, or feeling full after not eating much. Fortunately, with a little planning you can prevent these problems from spoiling your holiday.

Heartburn

Heartburn can result from a number of factors including stress levels, the type and amount of food you eat, the quantity of alcoholic beverages consumed, and even lying down too soon after eating.

If you are prone to heartburn, try the following tips:

• Avoid spicy foods, foods that are fatty and fried, mustard, tomato products, citrus fruits, peppermint, chocolate, and other foods that you notice trigger your heartburn symptoms.
• When you are thirsty, choose water and avoid (or at least limit) alcohol, liquids that contain caffeine, and fizzy beverages such as soda pop.
• Pay attention to portion sizes. Eat smaller amounts spaced apart rather than filling a large plate with food and eating it all at once. This will help prevent stomach acid from building up and flowing back up into your esophagus.
• Don’t nap right after eating. Lying down soon after eating can increase heartburn symptoms.
• Try to eat at least two or three hours before bedtime, and elevate the head of your bed 15 to 20 cm (6 to 8 inches) to prevent stomach acid from flowing back up. Simply piling up pillows under your head is not enough. It is important to actually raise up the top of the bed frame.
• Ask your London Drugs pharmacist for help. We can check if your other medications might be causing your symptoms. We can also recommend or prescribe medications to prevent and treat your heartburn or upset stomach, too.

Indigestion

Indigestion is the name for a type of upset stomach that causes a variety of symptoms in your upper abdomen. Each person who experiences indigestion may have slightly different symptoms, but common ones include:

• Feeling full after eating only a small portion of your meal.
• A feeling of uncomfortable fullness that lasts longer than it should after a meal.
• Mild to severe pain or a burning sensation in the area between the bottom of the breastbone and the bellybutton.
• Nausea, the feeling that you need to vomit.
• Less common symptoms include belching and actually vomiting.

The steps that can help prevent heartburn can also help prevent indigestion. It can also help to wear loose clothing around your middle.

There are medications available to relieve indigestion. Some are available over the counter, but others require a prescription. These include antacids, H2-receptor antagonists (H2-RAs), proton pump inhibitors (PPIs), or Helicobacter pylori therapy antacids, H2-receptor antagonists (H2-RAs), proton pump inhibitors (PPIs), or Helicobacter pylori therapy.

During these busy holiday times you do not have to line up for a walk-in clinic or wait for a family doctor appointment.  Visit your local London Drugs pharmacist to assess your symptoms. Your pharmacist can offer tips for prevention, recommend non-prescription treatments, write prescriptions for medications, or refer you to a doctor for further follow-up if your symptoms are unusual or more serious.

For more information about what pharmacist prescribing services are available in your province, visit https://pharmacy.londondrugs.com/pharmacy-services/pharmacist-prescribing-services.

And remember, your London Drugs pharmacists are always happy to answer your questions.

GLP-1 agonists & diabetes

Some people with type 2 diabetes can manage their condition and reach their target blood glucose levels through healthy eating and being physically active, but most also need either insulin or other medications to help lower their blood glucose to their target levels.

The first medication doctors often prescribe to control blood glucose, along with healthy lifestyle habits, is metformin. But for some people metformin does not work well enough to lower their blood sugar, or they are not able to take it because of side effects or other reasons.

Among the categories of other glucose-lowering medications for type 2 diabetes are GLP-1 agonists, also known as glucagon-like peptide-1 receptor agonists, and these drugs differ in the way they are administered, including a daily oral tablet, a daily injection, or a weekly injection. Examples you may have heard of for diabetes management in Canada are semaglutide (Ozempic®, Rybelsus®), dulaglutide (Trulicity®), tirzepatide (Mounjaro®), or liraglutide (Victoza®). There are also GLP-1 agonist products available in Canada that are designed specifically for weight loss, including liraglutide (Saxenda®) and semaglutide (Wegovy®).

GLP-1 agonists generally work by increasing your body’s response to blood sugar in the foods you eat. They affect two hormones created in your pancreas. They increase insulin release (a hormone that helps lower blood glucose by moving it out of your blood stream and into your cells to be used for energy), and they decrease glucagon release (a hormone that raises blood sugar). These medications also slow the emptying of your stomach into your intestines, so you feel full longer, less glucose is released from the foods you eat, and your appetite is suppressed.

Drugs in this category have gained a lot of attention, because of their side effect of relatively fast weight loss. Some sources claim up to 20% body weight loss per year. But all medications have potential side effects. Read on to learn more.

WHO SHOULD TAKE GLP-1 AGONISTS?

The decision about which diabetes medications are best for you depends on a number of factors, including your blood glucose readings, your symptoms, and other health problems you may have.

While GLP-1 agonists are generally considered safe and effective, they are not right for everyone. Your doctor may recommend a GLP-1 agonist for you if:

• Metformin isn’t reducing your blood glucose level enough, or if it unsafe for you to use it.
• Your A1C level is higher than your target level.
• You haven’t reached your A1C goal (a measure of your three-month average blood sugar level)

and you have additional health conditions such as atherosclerosis (a buildup of fats, cholesterol, and other substances on your artery walls), heart failure, or kidney disease.

BENEFITS AND SIDE EFFECTS

Like all medications, GLP-1 agonists can have both benefits and side effects. In addition to helping you manage your blood glucose, they may:

• Help you lose weight, which can help you manage your blood glucose
• Reduce your risk of heart disease and kidney disease
• Lower your blood pressure
• Improve the levels of cholesterol and triglyceride in your blood
• Improve fatty liver disease
• Delay the progression of diabetes-related nephropathy (nerve damage)

When you begin the medication or your dose increases, the most common side effects are mild to moderate nausea, diarrhea, constipation, abdominal pain, or vomiting. Starting on a low dose and increasing slowly can help with this. Other side effects may include dizziness, headache, indigestion, and infections. Some rare, but serious, side effects are also possible, such as inflammation of your pancreas, vision changes, hypoglycemia (low blood sugar), kidney problems, gallbladder problems, possible thyroid tumours, or serious allergic reactions.

Taking other diabetes medications along with a GLP-1 agonist may raise your risk of hypoglycemia. It is important to understand that the weight loss effects are usually only sustained while taking the medication, and the weight can return when the medication is stopped.

While taking a GLP-1 agonist, you should see your healthcare provider regularly to assess how well the medication is working. You should also contact your provider if you:

• Develop bothersome symptoms
• Don’t think it is working to manage your diabetes
• Are thinking about stopping the medication
• Become pregnant or are thinking about getting pregnant

ARE GLP-1 AGONIST MEDICATIONS RIGHT FOR YOU?

Managing diabetes is not a one-size-fits-all plan. Treatment will vary from person to person depending on many factors. If you are considering a GLP-1 agonist medication, like Ozempic, you may want to discuss the following with your healthcare team:

• How close am I to reaching my A1c goal? Could a GLP-1 agonist help me meet that goal?
• How does a GLP-1 agonist differ from the medicines I am currently taking to manage my diabetes?
• What kind of benefits and side effects can I expect?
• What dosage form is right for me? Injection or tablets? Weekly or daily?
• Am I covered on a provincial or private insurance plan for this type of medication?

If you have any questions about managing your diabetes or about any of the medicines you take, your London Drugs pharmacists are available to guide you.

If you’ve ever travelled to a distant country, chances are you suffered from jet lag. Jet lag makes it hard to sleep when traveling across time zones, especially when going east. The more time zones you cross, the worse jet lag can be. Everyone has an internal body clock that keeps track of day and night. When this clock doesn’t match your destination time, you might feel sleepy during the day or have trouble sleeping at night. This is jet lag.

Studies show that about 70% of international travelers experience jet lag either “fairly often” or “always”. While there’s no clear link between gender and age, older adults might have fewer problems with jet lag. Several treatments can help people adjust faster to their destination time; these are listed below.

1. Melatonin – This natural sleep aid is available over the counter. A dose of 3mg to 5mg taken 30 minutes before bed usually works well, and regular tablets might work better than slow-release ones. You can take it for up to 5 days after arrival. While it has few side effects, check with a doctor before giving it to anyone under 18 years old. Consult with a pharmacist to make sure it is safe for you if you take other medications or have medical conditions.
2. Prescription drugs – While sleep medications are available, we don’t recommend them for most people. They can cause daytime drowsiness, be addictive, and affect memory.
3. Light therapy – This helps you feel more awake. You can spend time outdoors in bright sunlight or use a light box (SAD Light). For light boxes, 3000-5000 lux is usually enough. Natural sunlight is usually over 10,000 lux.
4. Caffeine, either in tablets or coffee, can help an adult stay awake when needed. Check with a pharmacist to determine if caffeine tablets are safe for you, especially if you take other medications or have medical conditions.

Here are some tips to manage jet lag.  Mobile apps can also help you time these treatments.

• Try to eat meals at local times, like having dinner at night in your new time zone. Avoid exercise right before bedtime.
• For trips less than 3 days, there isn’t much time to adjust. You might want to stay on your home time instead of changing to the local time, but this isn’t always possible if there is a large time difference.
• For trips longer than 3 days, try to stay awake and sleep at specific times. For example, if you are:
  • Flying East up to seven time zones (like Vancouver to London), try getting up one hour earlier and going to bed one hour earlier each day, starting 3 days before leaving. After arrival, take melatonin 30 minutes before bedtime. Speak to a pharmacist or doctor to make sure melatonin is safe for you.
  • Flying east more than seven time zones (like Vancouver to Paris), seek morning light at your destination and avoid bright light in late afternoon or evening for the first few days.
  • Flying west, try to stay awake using bright light until bedtime, but no later than 11pm. Melatonin isn’t usually needed unless you cross more than 12 time zones (like Vancouver to Mumbai).

If you use insulin, you might need to adjust your mealtime and bedtime doses. This depends on your type of insulin. Talk to your doctor or diabetes educator about this. Remember to check your blood sugar levels more often, as your diet will likely change while traveling.

Before starting any new medication or supplement, even if it’s natural, consult your doctor or pharmacist to ensure the product and dosage are safe and suitable for you. You can also reach out to your London Drugs pharmacist by phone if you have any questions while you’re away.

Enjoy your trip!

1. Diabetes Canada. (n.d.). Air travel. Retrieved November 17, 2024, from https://www.diabetes.ca/learn-about-diabetes/your-rights/air-travel

2. Cathy A. Goldstein. MD. (n.d.). Jet lag. UpToDate. Retrieved November 17, 2024, from https://www.uptodate.com/contents/jet-lag

If you recently received a diagnosis of type 2 diabetes (the most common form of the condition), you are probably wondering how your life will change and what you need to learn to stay as healthy as possible and prevent complications. The first thing you need to do is to learn as much as you can about diabetes and how to reduce your risk of complications. Here are some key factors that affect diabetes management that should be on your list of things to learn about.

Nutrition: What you eat, how much you eat, and when you eat it play an important role in managing your blood sugar (also known as blood glucose).

Physical Activity: Getting regular physical activity helps lower blood glucose levels, control weight, improve fitness, and relieve stress.

Weight Management: Achieving and maintaining a healthy weight is very important in managing type 2 diabetes and improving health outcomes.

Stress Management: Learning how to manage your stress in healthy ways will make it easier for you to manage your diabetes. Healthy options include speaking with a counsellor, practicing meditation or mindfulness, engaging in yoga or tai chi, or exercising.

Blood Pressure Management: People with diabetes should generally try to keep their blood pressure below 130/80 to reduce risks of eye disease, heart disease, stroke, and kidney disease.

Medication Management: Some people with prediabetes or mild early type 2 diabetes may be treated with changes to diet and physical activity alone, but many people require oral medications, insulin, or other injectable medicines to control their blood glucose level. It is common for people with diabetes to be prescribed a combination of medications to lower blood glucose plus others to prevent complications due to high blood pressure, high cholesterol, or other conditions.

Blood Glucose Testing: Measuring and tracking your blood glucose level is a critical step in managing diabetes. When blood glucose is high, the risk of damage to your blood vessels and organs increases. Knowing how different factors affect your blood glucose will let you and your healthcare team know when you may need to make changes to your diet, activity level, or medications to help you achieve your target glucose levels.

This may seem overwhelming at first, but you don’t have to do it all on your own. There is a whole team of health professionals available to help you learn what you need to know to lead your healthiest life.

YOUR DIABETES TEAM

In addition to your doctor, and possibly an endocrinologist, there is a team of healthcare professionals who will work together to help you, and each has a particular area of expertise.

 Pharmacist: Your London Drugs pharmacists are an important part of your team and are the most accessible healthcare professionals. They are available to answer questions about your diabetes or other medical conditions, usually without an appointment, even in evenings or on weekends. Pharmacists are medication experts and will help you understand the purpose of your medications and how to take them. They can work with your doctor to manage your medications to reduce side effects and improve efficacy. Other members of the pharmacy team can teach you about blood glucose monitors and insulin delivery devices and how to safely dispose of used needles or testing supplies.

Certified Diabetes Educator (CDE): London Drugs CDE pharmacists have additional specialty education to help patients learn about and manage their diabetes. They can help patients develop an overall diabetes care plan, manage medications for effectiveness and address any concerns, adjust insulin doses, advise how to prevent and treat hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose), plus they can provide advanced training on blood glucose monitoring devices. Talk to your pharmacist to find out if this service is available in your area.

Dietitian or Nutritionist: Food and diet experts can teach you how different types of foods can affect your blood sugar, blood pressure, cholesterol, and overall health. They can provide meal plans or guidelines for healthy eating choices and timing of meals. Check with your doctor or pharmacist about how to contact a dietician or nutritionist in your area.

Podiatrist: People with diabetes need to pay special attention to their feet. A podiatrist is a doctor who specializes in detecting and treating foot and lower leg problems such as nerve damage, joint problems, blood vessel damage, and infections. Diabetes can cause reduced blood flow or nerve damage that can lead to infections that don’t heal. Be sure to have any foot concerns looked at immediately.

Optometrist: Diabetes can cause damage to the small blood vessels of your eyes, leading to impaired vision, cataracts, glaucoma, or other problems. Schedule regular screening appointments with your eye doctor to reduce your risks.

Dentist: People with diabetes have a higher risk of gum disease and cavities. Regular checkups and cleanings are important for everyone.

Others: Depending on your needs, other specialists and service providers may be added to your team. Be sure to inform each member of your team who else is involved in your care so they can work together to help you succeed in your health goals.

If you have any questions about diabetes prevention or treatment for yourself or for a loved one, speak to your London Drugs pharmacist. We are here to help you anytime.

Throughout our lives, our body keeps our bones strong by replacing old bone cells with new bone cells, but as we age this process slows down and we gradually lose more bone than we make. When bone loss occurs more rapidly than normal, bones become thin and weak, a condition called osteoporosis. When bones are severely weakened, something as simple as a fall from standing height can lead to a cracked or broken bone (called a fragility fracture), which can cause disability and sometimes even lead to death.

WHAT IS YOUR RISK?

To prevent osteoporosis and the consequences it can cause, it is important to understand what your risk of thinning bones is. This is analyzed in several ways. A bone mineral density (BMD) scan is a painless test performed at an imaging lab that measures the density of your bones. It can tell whether you have osteoporosis now or how likely you will be to develop it in the future. Doctors often combine the results of a BMD test with an assessment of your risk factors to provide a more accurate way of predicting your risk of a fracture.

There are two tools available to help doctors make this assessment. THE CAROC TEST considers your BMD test score along with your age, gender, fracture history, and steroid use to determine your risk of a fracture within the next ten years. THE FRAX TEST takes into account the same factors as the CAROC test, but it also looks at your BMI (weight-to-height ratio), if you have any health conditions that contribute to bone loss, if either of your parents had a hip fracture, if you are a smoker, and how much alcohol you consume. Because it includes many more risk factors than the CAROC test, the FRAX test can be used without a BMD score.

REDUCE YOUR RISK

Adopting certain healthy lifestyle habits can help prevent, delay, or reduce bone loss, which can offset the complications associated with osteoporosis.

Here are some helpful pointers:

EXERCISE: Regular physical activity that involves resistance training along with weightbearing aerobic exercise can help build and maintain bone strength. Exercises such as yoga and Tai Chi that focus on balance can help people who are at risk of falling.

CALCIUM: This mineral is essential for healthy bone development. Good sources include dairy products, calcium-fortified beverages, and legumes such as soybeans and chickpeas. If you don’t get enough calcium from your diet, calcium supplements might be a good choice for you and are available as liquid, chewable tablets, gummies, or regular tablets. Most adults require 1000mg to 1200mg of calcium per day. A cup (250mL) of milk, ice cream, or yogurt or 2 ounces (60g) of cheese contains about 300 mg of calcium.

VITAMIN D: The body needs vitamin D in order to absorb calcium, so it is important to make sure you get enough of it. Sun exposure can help our bodies naturally produce our own vitamin D, but in northern countries like Canada, adding vitamin D from food or supplements is often required to ensure we get enough. In Canada, cow’s milk and margarine must be fortified with vitamin D. It can also be found in some fortified beverages including milk-alternatives and some orange juices, fatty fish such as salmon, fish liver oils, and egg yolks. Adults 50 years and over require 800 IU to 2000 IU of vitamin D per day. Vitamin D supplements are available as concentrated drops, chewable or regular tablets, tablets that dissolve under your tongue, gummies, and liquids.

TREATING OSTEOPOROSIS

If you have a high risk of fracture, your doctor will probably recommend treating your osteoporosis with medication in addition to making healthy lifestyle choices. Medicines used to treat osteoporosis fall into two main categories that either slow down the removal of old bone cells or increase the formation of new bone cells. Some osteoporosis drugs are taken by mouth; others are injected under the skin or delivered by IV infusion into a vein. Your healthcare team, including your pharmacist, can discuss each medication and help you decide which treatment and prevention plan is best for you.