mucositis coding scale by cdc.gov /nchs / ppt /icd9 / att_mucosit s sept05.ppt

Cancer Treatments, Mucositis & Mouthwash

Oral mucositis (inflammation of the mucosa lining of the mouth) and mouth of ulcers is a widespread and potentially serious consequence of high-dose chemotherapy and radiotherapy.

Symptoms, which may include altered taste perception, sores, and varying degrees of pain, usually appear 4 to 5 days after chemotherapy or radiotherapy treatment initiation.

A compounding pharmacist can formulate a specialised preparation such as a mouthwash to help manage the discomfort. There are various formulations that pharmacists can use based on the experience and needs of the individual physician and patient respectively.

Mucositis, painful inflammation and ulceration of the mucous membranes lining the digestive tract, can involve both the oral tract and the gastrointestinal tract. Oral mucositis is a widespread and potentially serious consequence of certain high-dose chemotherapy and radiotherapy treatments. It is a devastating consequence of cancer treatment for patients, who then find it extremely difficult to perform simple, everyday mouth-related activities, including chewing, biting, talking, swallowing, drinking, and sipping.

Oral and gastrointestinal mucositis affects up to 100% of patients undergoing high-dose chemotherapy and blood stem-cell transplantation and 80% of patients with malignancies of the head and neck who are receiving radiotherapy. Mucositis also affects a wide range of patients receiving chemotherapy.

Causes of Mucositis

About 5% to 15% of all patients undergoing cancer treatment experience mucositis. TABLE 2 details the grades of oral mucositis as defined by the World Health Organization (WHO). In grade 3 oral mucositis, the patient is unable to eat solid food; in grade 4, the patient is also unable to consume liquids. Radiotherapy to the head and neck or to the pelvis or abdomen is associated with grade 3 oral mucositis in more than 50% of patients. Among patients undergoing head and neck radiotherapy, pain and decreased oral function may persist long after the conclusion of therapy. HIV infection may cause oral thrush.

Oral mucositis is characterized by damage to the epithelial or lining cells mouth and throat. Epithelial cells normally serve as a barrier between the inside and outside of your body and protect it from viruses.
Because of their relatively high turnover rate compared with cells in other organs, epithelial cells are particularly susceptible to the damaging effects of radiation and chemotherapy. A reduction of the saliva barrier, disruption of epithelial cells, thinning of the epithelium, and ulceration also occur. Other conditions can contribute to oral mucositis, including oral infections and trauma or irritation.

Symptoms

Cancer patients who are undergoing chemotherapy usually develop symptoms of oral mucositis 4 to 5 days after treatment is initiated. A peak is reached at around day 10, followed by slow improvement over the course of a few weeks. Radiotherapy-induced mucositis, which usually appears at the end of the second week of treatment, may last for 6 to 8 weeks.

As a result of epithelial-cell death, the lining of the mouth thins sloughs off and becomes red, inflamed, and ulcerated. Ulcers range in size from 0.5 cm to greater than 4 cm. Oral mucositis can be extremely painful; the degree of pain, often described as a burning sensation, is usually related to the extent of the tissue damage. As a result of the pain, the patient may experience trouble speaking, eating, or even opening the mouth.

Alterations in taste perception are common, especially in patients receiving radiation therapy to the neck and mouth. An altered sense of taste is a temporary condition that occurs because of effects on the taste buds located mainly in the tongue. Common complaints are that food tastes too sweet or too bitter or continually has a metallic taste. In some cases, only partial recovery of taste occurs. Severe pain and the inability to chew, swallow, or talk may ultimately lead to dehydration and malnutrition. The lack of saliva can cause tooth caries, loss of fillings, mouth ulcers, and pain, as saliva has a cleansing effect on the mouth and controls bacteria.3
Pain and loss of taste perception make it more difficult to eat, which frequently leads to weight loss. Infection of the sores or ulcerations by a virus, bacterium, or fungus can occur. About half of all patients receiving chemotherapy develop severe oral mucositis that may require modification of the patient’s cancer treatment.

Treatment

For patients undergoing chemotherapy, radiotherapy or preventive strategies should be started before the cancer treatment. These include:

  • a pretreatment dental examination
  • good oral hygiene such as cleaning the mouth every 4 hours and at bedtime
  • brushing the teeth with a gentle toothbrush two or three times daily and a non-detergent toothpaste,
  • flossing between the teeth
  • using an alcohol-free mouthwash.

If saliva dries up the patient could:

  • use artificial saliva (ask your compounding pharmacist) or
  • chew sugar-free gum

If the mucositis develops and is painful the patient could:

  • Use a special mouthwash formulated by a compounding pharmacist depending on your specific symptoms that may include an anaesthetic, an antiseptic, an antifungal, a barrier protection agent, an anti-inflammatory or an anti-viral.
  • Drink plenty of liquids – at least 3 litres per day
  • Avoid alcohol
  • Avoid citrus fruits, tomatoes, acidic foods, alcohol, and hot foods that can aggravate mucositis lesions.
  • Eat food that is soft, non-spicy, pureed, or in liquid form. Harder foods should be treated to make them soft and easy to eat.
  • Refrain from smoking.
  • Suck ice cubes. This is a simple, but often effective, method

Compounded Preparations

Your compounding pharmacist can discuss the various ingredients that can be incorporated into a mouthwash depending upon the various symptoms being managed. In addition, they can flavour a custom mouthwash according to the patient’s individual preferences.

Alternatively, the medicines may be compounded into an ice-block, paste or lollipop and can be flavoured.

Fresh Therapeutics Is A Trial Site For The Australian Government Take Home Naloxone Pilot

Take Home Naloxone Pilot

The Australian Government is investing $10 million in a take-home naloxone (THN) pilot in New South Wales, South Australia, and Western Australia. This pilot is commencing on 1st December 2020 and will continue until the 28th February 2021

What is Naloxone?

Naloxone is a drug that reverses the effects of an opiate and can therefore reverse an opioid overdose. It can be injected or delivered through a nasal spray.  In the THN pilot, naloxone (as either Naloxone Hydrochloride (DBL), Naloxone Juno, Nyxoid and Prenoxad) will be available for FREE to people who are at risk of, or who may witness, an opioid overdose. No prescription will be required for the drug.

How does Naloxone work?

Naloxone reverses the effects of opioid drugs, albeit temporarily. This works by displacing the opioid molecules already within the person’s system in the brain and body. During an opioid overdose, drugs fit into receptors and brain signals are therefore blocked. This leads to a slowing or complete failure in breathing. The person may then fall unconscious. However, once naloxone is administered, it fits more strongly into the receptors within the brain and body causing the opioid molecules to be displaced for a time. The brain signals can then resume as normal, breathing will continue, and the person should then regain consciousness. 

What to do if you carry Naloxone with you?

Carrying naloxone with you regularly is always a good idea if you are an opioid user, or if you are regularly around an opioid user. This could be a family member, spouse, close friend, etc. Ensuring that you are stocked on naloxone that is in date is imperative, in case you ever need to administer it. You should set a reminder on your calendar or phone around one month before the naloxone is set to expire. This will give you enough time to arrange for and pick up a replacement.

When do you use Naloxone?

If you know for a fact that someone has overdosed from an opioid drug, then you should administer naloxone. Even if you only suspect they have done so, it should also be used. You should also remember to call an ambulance as quickly as possible. If there are two of you there with the person, one of you should administer while the other calls the emergency services. Even if the person wakes up, you should still call the ambulance, as they could fall unconscious again at any moment. However, always be aware of your own surroundings, stay safe, and keep in mind that they may be aggressive if they do regain consciousness. 

Why is this trial happening?

Unfortunately, throughout Australia, Opioid use is a major cause of both hospitalisation and death. Therefore, the Australian government has now decided to make an active change in order to treat and improve the issue. The following statistics outline just how serious the problem is in this part of the world:

  • Every single day, three people die from drug-induced deaths involving opioid use in Australia, while nearly 150 hospitalisations and 14 emergency department admissions involve opioids across the country.
  • More than 110,000 Australians are currently struggling with opioid dependence.
  • In 2018, 1,740 people died from drug-induced deaths, with opioids present in 1,123 of those deaths (64%).

At Fresh Therapeutics Compounding Pharmacy, we will be offering Naloxone FREE of charge to people prescribed opiates, people that use illicit opiates or people who may witness a person overdosing on opiates. As well as this, we will also be providing clean needles from our needle exchange to those who inject opiates.  

If you are not sure if a drug you or a family member is taking is an opiate, ask our pharmacists or call us on 0292816816

What is an opioid overdose or adverse reaction to opiates?

A person who has taken either a large amount of opioids or some strong opioids can overdose or experience an adverse reaction. They may be:

  • unconscious
  • unresponsive
  • awake, but unable to talk
  • vomiting
  • making choking sounds, or a snore-like gurgling noise

They may also have:

  • stopped breathing or have slow, shallow or erratic breathing
  • bluish-purple skin (in lighter-skinned people) or greyish or ashen skin (for darker-skinned people)
  • a limp body
  • a pale or clammy face
  • blue or purplish black fingernails and lips
  • slow, erratic or no pulse (heartbeat)

If someone at risk is making unfamiliar sounds while ‘sleeping’, try to wake them up in case they have overdosed.

Steps For Opioid Overdose Response - Fresh TherapeuticsPreventing and responding to opioid overdose - Fresh Therapeutics

 


Who is at risk of an opioid overdose or adverse reaction to opiates?

People who are dependent on opioids are at higher risk of an overdose if their tolerance to the drug is reduced. This can happen if they stop taking opioids for a while (for example if they have been in drug rehabilitation or in prison).

Other risk factors include:

  • using opioids in high doses with other sedatives — for example, benzodiazepines, 
  • some medical conditions — for example
    • depression
    • HIV
    • liver disease
    • sleep apnoea
    • lung diseases, such as chronic obstructive pulmonary disease or pneumonia
  • living in a home where opioids are stored

 

What to do if you witness a person having an opiate overdose?

If you witness someone having an opiate overdose this is what you do:

1. Check for signs of overdose

Approach with care. Check for dangers, such as injecting materials that might be lying around

Check for a response, to see if the person is conscious. You can:

  • shout their name
  • gently shake their shoulders
  • talk loudly into their ear
  • rub their breastbone (sternum)
  • pinch their ear or the bed of their fingernail

Check airways and breathing

Clear the mouth and nose of any blockages

For 10 seconds, check for breathing — is the chest moving? Can you hear breathing sounds? Can you feel breath on the cheek?

 Check for signs of overdose, such as:

  • no response to touch or sounds
  • slow, uneven breathing or no breathing
  • snoring, gasping or gulping
  • blue or purple fingernails or lips

2. Call Emergency Services ‘000’

  • Always call for emergency services immediately, even if the person wakes up.

NALOXONE is not a substitute for emergency medical care or basic life support (such as CPR).

Put your phone in loudspeaker mode if possible, in order to keep your hands free.

Give emergency services as much information as you can, including:

  • your exact location and postcode (if known)
  • what substances you think the person may have taken
  • whether they are conscious and breathing
  • that you plan to give Naloxone

3. Administer Naloxone

Our pharmacist will show you how to administer the Spray or Injection. Peel off the back of the container before taking out the spray itself. With the person lying flat on their back, support the back of their neck and tilt the head back. Remove anything that is visibly blocking their nose. Hold the spray with a finger on either side of the nozzle and your thumb on the bottom of the plunger. Never press it before use. You do not need to test it or prime it. Insert the nozzle of the spray bottle into one nostril, it does not matter which you choose. Press the plunger until you hear a click sound, this will tell you that all of the dose within the bottle has been administered. Take the nozzle away from the nostril. Remember which nostril you administered into in case you need to re-administer into the second nostril later.

Alternatively, you can watch these handy videos:

Nasal Spray: https://www.medicines.org.uk/emc/product/9292/video

Injection: https://www.youtube.com/watch?v=pXebC1rLsqw

4. Put the person into the recovery position

Putting someone in the recovery position can improve their condition until the emergency services arrive. However, we appreciate that many people do not know exactly how to put an unconscious person into this position. Place the person’s nearest arm up at a right angle to their body, in a bent position. Then pull their far arm across their chest, placing the back of their hand against their opposite cheek. Get hold of their furthest leg above the knee, lift it, and roll them towards you until they are on their side. Then use their hand to support their head and bend their top leg at the hip and knee.

CALL our pharmacists at Fresh Therapeutics for more information

5. Monitor until help arrives

Stay alongside the person and monitor their breathing, watching for any signs of improvement. Also, monitor their ability to respond to your sound and your touch.

If the person in question is not conscious, nor breathing normally, then now is the time to administer basic life support, but only if you are trained to do so. This includes things such as CPR.

The most important thing is to constantly be aware. Even if the person wakes up, that is no reason to let your guard down, as they could easily fall unconscious and stop breathing again.

6. What to do if there is no response

If you have gone through the above five steps and there has been no improvement after two or three minutes, or the symptoms return, use a brand new spray in the next nostril. Keep the person in the recovery position while you do this.

7. Remember your own safety

If the person in question is dependent on opioid drugs, you must be careful of the acute withdrawal symptoms that some sprays may cause. If and when a person regains consciousness after using the spray, they may act with aggression for a period of time. Keeping your own safety in mind is always imperative. Symptoms of acute withdrawal can include things such as nervousness, irritability, sweating, shivering, runny nose, fever, sneezing, nausea, vomiting, diarrhoea, aches, cramps, and more.

8. What to do once the ambulance

The first thing you should do is inform a member of the emergency services that you have administered a spray, before telling them which spray it is and handing them a sample bottle of it. If you forget to do the above, you should still hand the used bottles over to a pharmacist or healthcare professional in order to arrange proper disposal and replacements.  Never put the sprays into water waste. Never throw the spray bottles in with your household waste or recycling.

 Training Card for Patients and Carers - Fresh Therapeutics What is Nyxoid - Fresh Therapeutics

 

Check for signs of overdose - Fresh Therapeutics Training Card for Patients and Carers - Fresh Therapeutics


Compounding Pharmacy Australia | Customised Medication

What is a Compounding Pharmacy?

Sometimes a “one-size-fits-all” approach to medication does not work for everyone. It means that patients’ needs are not met by a traditional dispensing pharmacy. We have the ability to compound products tailored to suit the needs of our customers, giving them access to the best medicine for their personal needs. 

You’re likely to visit a pharmacy when you need to pick up your prescriptions, but have you ever visited a compounding pharmacy? 

Most people don’t know the difference between a regular and compounding pharmacy. A compounding pharmacy is a speciality pharmacy that can make a medication prescribed by a doctor, for patients that cannot use a commercially manufactured medication. Often, a compounding pharmacy is used for people with allergic tendencies or for those that are very young and need a small dosage of a certain medication. 

Unlike ordinary pharmacies that sell manufactured medicines, a compounding pharmacy will compound (mix) and package your prescription onsite – we often say “make it up from scratch”. Compounding is the process of making a medication from raw ingredients that are either not readily available on the Australian market, currently out of stock or were not manufactured in the precise dose and/or dosage form that you have been prescribed. 

Working with your doctor, compounding allows our pharmacists to customise the strength and dosage of a medication according to your individual needs.

Compounding pharmacies will only issue medications that are obtained via a prescription from a medical doctor. This is a safe and reliable way to obtain customised medications. They are individualised for the patient and not administered as a set and predetermined dose like commercial medications.  Some compounding pharmacies undergo an extra quality assessment to provide consumers with confidence that the product has been compounded to compounding standards.  The Pharmacy Boards around Australia are currently reviewing their assessment of compounding pharmacies in an effort to improve the standards of delivery of compounded medicines.

How can someone know if compounding is the right choice for their medication or supplements?

There are many situations where compounding medicine can be helpful. Compounded medications can be great for people who cannot swallow pills, such as the elderly or young children, and need an alternative form such as a cream or liquid. Many people are allergic or sensitive to particular ingredients in mass-produced medications, and these can be removed in a compounded medication. 

A compounding pharmacy can also create custom doses for someone who needs larger or smaller doses than the ones that are mass manufactured. In addition, compounding is worth looking into for pet needs, as the medication will be compounded specifically for your animal. 

Overall, compounding is the perfect solution for anyone who cannot tolerate mass-produced medications for any reason. It may also minimise side effects because a compounding pharmacist can help a patient get the appropriate dosage needed whilst removing any ingredients that pose a problem for that patient such as lactose, colouring agents, gluten or preservatives.

There are so many prescription medications available. Why do we need compounded medications?

Some medications are only available by compounding. For people with strict dietary and allergy requirements, compounding the medicine may be the only option. Also, compounding pharmacies cater to medication that has been discontinued or is no longer being manufactured in bulk. 

 

What is involved in compounding medication? 

  • The dosage compounded is tailored exactly for the patient
  • Medication compounded can come in many forms including patches, chewable’s, suppositories, mixtures, rapid dissolve tablets,  or gels
  • The medicine can be compounded free of problem-causing ingredients like certain preservatives, alcohol or lactose that may cause an allergic reaction 
  • The medicine can be compounded in a vegan (eg. cellulose) capsule instead of an animal-sourced capsule (eg. gelatin)

Can I buy compounded medication without a prescription?

No. Compounded medication acts in the same way as traditional medication. If the active ingredient in the medication can only be prescribed by a doctor then you must obtain a prescription in order to be able to purchase the compounded medication. Most compounding pharmacies (including Fresh Therapeutics Pharmacies) require a prescription for any medicine that is compounded. 

Can I have my prescription medicine compounded if it is cheaper to have it compounded?

No. In Australia, it is illegal to compound and sell medicine that is already produced by a pharmaceutical manufacturer.  Only medicines that are not available by a commercial manufacturer and prescribed by a doctor registered in Australia can be compounded.

I want to visit a compounding pharmacy. Where do I find one?

Your GP will be your first point of contact when it comes to prescription medicines to be compounded. There are many compounding pharmacies in Sydney. Get in touch today. 

What is the difference between a pharmacy and a compounding pharmacy?

Commercially available medications are manufactured by pharmaceutical companies in mass quantities for the general population with no specific patient in mind. Compounded medications are ordered by a physician, individually prepared by a compounding pharmacist and made specifically for a person’s unique medical needs

 

How long does it take to compound my medication?

The wait time varies depending on the complexity of the prescription required for compounding. Usually, the medicine can be compounded within a day. However, if an ingredient needs to be ordered, the process can take several days so it is best to check with your Compounding Pharmacy. If you need a repeat of a compounded medicine, it will need to be compounded again, as every medicine is bespoke and created to tailor for each specific patient. 

 

As experienced compounding pharmacists, we have outlined the benefits for compounded medication.

Various Forms
Sometimes, patients may need their medication in a different dosage form. For instance, some people who have difficulty swallowing tablets or capsules may find it easier to take their medication in liquid form. Some medications can be also compounded in cream or gel forms and the medication is absorbed through the skin. As a compounding pharmacy, we can offer medicines in various forms depending on the best solution for you!

Discontinued Medications
When large manufacturers discontinue production of a certain medication, they make it hard for the patients who still need these medicines. Compounding pharmacists play an important role in providing access to discontinued medications by compounding pharmaceutical-based ingredients in order to ensure that patients get the critical care they require. Compounding pharmacies have access to the quality tested pharmaceutical ingredients and can fill the prescription using the latest research, quality control process, and techniques that help meet the individual patient needs. If you want to learn more about discontinued medication, get in touch with us.

Easy to Use
Some medications taste extremely unpleasant, making it challenging for the patients to take them as directed. A compounding pharmacist can customise the prescription from scratch with the patient’s flavour of choice. This is especially handy when dealing with patients who may refuse medication, like young children, elderly patients, or even pets.

Allergy-Friendly
We understand that each individual is unique and complex. Many of our patients have issues with allergy, sensitivity, intolerance to dyes, lactose, gluten, fructose or alcohol. These can cause unwanted reactions when taking a certain medication. In other cases, traditional manufactured medications may contain preservatives that cannot be tolerated by the patient because of sensitivities or allergies to these substances. A compounding pharmacist can make a formula without the offensive ingredients, so a patient can still get the right treatment.

Unique Services
When it comes to compounding, identifying our patients’ needs is our top priority.  What flavour of an oral medicine would they prefer? Can we compound the medicine in a different sized capsule? Can the medicine be safely delivered through the skin, under the tongue, through the nose or maybe through the vagina? Can we safely combine several medicines in one capsule?  What side effects are our patients dealing with? What questions might they have when they take their medicine? We often do a lot of research to source the active ingredients, determine a formula and develop the method to compound the medicine. As a compounding pharmacy, we offer patients a service they can’t receive at most other pharmacies. 

 

Compounding pharmacies are often unheard of. If you have any specific medical or allergic requirements, speak to your GP about compounding your medicine and how it can help you. Alternatively, we have trained pharmacists onsite that are more than happy to give you reputable advice. 

For your customised compounded medication, including health plans or advice about prescription medicines, get in touch with our friendly and knowledgeable compounding pharmacists today. Visit one of our stores today or call us on 02 9389 3168. 

Atrial Fibrillation Awareness Week

Don’t let a stroke be your first warning:
Let our pharmacists at Fresh Therapeutics check your heart heartbeat during Atrial Fibrillation Awareness Week

Local residents are being urged to take advantage of a free testing station at Fresh Therapeutics Broadway and Bondi this week to check whether they have an irregular heartbeat known as atrial fibrillation, which dramatically increases the risk of stroke.

This screening initiative is part of a national awareness campaign developed in response to alarmingly low levels of testing for an irregular heartbeat that increases the risk of stroke five-fold.

A nationwide survey of 550 people aged 65 and over has found that only one-in-three older Australians have discussed their heart health with a doctor in the past 12 months, and only one-in-ten has discussed atrial fibrillation as a risk factor for cardiovascular disease in this period.[1]

This finding is of concern to experts who say that new medical guidelines recommend routine screening of people aged 65 years or older for atrial fibrillation. These guidelines state that one-in-ten strokes occur in people with previously undiagnosed atrial fibrillation.[2]

“The research shows that on average, older Australians see a doctor six times a year which provides plenty of opportunity to discuss and detect an irregular heartbeat,” said Tanya Hall, CEO of leading patient support group Hearts4Hearts

Ms Hall, an atrial fibrillation patient herself, is advocating for pulse and heart rate testing to become routine for people aged over 65 years when seeing their doctor.

When undiagnosed and untreated, an irregular heartbeat can cause blood to pool in a chamber of the heart and form a clot that can travel to the brain, causing a devastating stroke.

Fresh Therapeutics is urging local residents, particularly those aged over 65 years or with existing heart conditions, to take advantage of the free testing station or make an appointment with their doctor.

Atrial fibrillation-related strokes can be prevented, but diagnosis remains the critical first step. It is estimated that one-in-four strokes occur in people with atrial fibrillation.

“We don’t want a stroke to be the first time any Australian discovers they have an irregular heartbeat. Pulse and heart-rate testing is quick, it’s simple and could ultimately save lives.”

Experts say that early diagnosis of atrial fibrillation must be matched by long-term use of medication that can reduce the risk of stroke by up to 70 per cent.

A new analysis produced for Hearts4Heart reveals that around 25 per cent of people prescribed anticoagulation medicine to prevent stroke discontinue therapy within 12 months.[3]

At Fresh Therapeutics we take the time to explain to our patients with atrial fibrillation why they have been prescribed an anticoagulant and why they need to continue to take this medication over the long term.

During Atrial Fibrillation Awareness Week (16-22 September 2019) we highlight the need for early diagnosis of an irregular heartbeat and appropriate long-term use of stroke prevention therapy.

References

1. YouGov Galaxy. National Poll of 550 Australians aged >65 Years. August 2019

2. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018

3. Prospection. NOAC Prevalence. PBS 10% Data Set. July 2019.

Chronic-Pain-Week-Australia_Compoinding-Chemist Broadway and Bondi

National Pain Week – Chemist Broadway & Bondi

This week is National Pain Week when we look at the burden of pain, in particular chronic pain, on the community.

Chronic pain is pain that lasts for 3 months or more after the normal healing time. Unlike acute pain, which usually resolves when the underlying cause heals or is treated, chronic pain is a complex condition associated with changes to the way the brain perceives pain.

This Brainman Video explains the difference between acute and chronic pain

Because chronic pain is different to acute pain the medications that are used are different. Many people in Australia develop medication problems because they continue to use medicines helpful for acute pain such as opiates (eg codeine, tramadol, morphine) that may eventually make chronic pain worse.  Opiates can cause severe constipation, dizziness (leading to falls) and respiratory depression. For certain people opiates are highly addictive and when combined with other medicines can cause death.  In some people continuous use of opiates can lead to “hyperalgesia” or more pain which is why they are not always the best option for managing chronic pain.

Managing chronic pain is much more than managing medicines. It involves looking at lifestyle issues that may be aggravating pain such as insomnia, lack of exercise, stress, poor diet, smoking, alcohol use.  It also involves learning how to manage flare ups and how to pace yourself to minimize pain.

At Fresh Therapeutics we try to work with the person suffering from chronic pain and their GP, physiotherapist and mental health professionals to produce the best results for the person living with chronic pain.  We offer a  Chronic Pain Medscheck service to eligible patients where we:

  • Discuss any of your pain concerns
  • Ensure your medicines are working for you
  • Work with you to create an action plan for improvement
  • Help you gain an understanding of your pain journey

Chronic-Pain-Week-Australia_Compoinding-Chemist Broadway and BondiWe also use material developed by NSW Health and the Agency for Clinical Innovation that can be accessed on the internet – https://www.aci.health.nsw.gov.au/chronic-pain/chronic-pain The website is designed to help people gain a better understanding of  pain. information to enable people to develop skills and knowledge in the self management of pain in partnership with healthcare providers.

We also refer to the Chronic Pain Australia a self-help organisation that helps people engage with others suffering from chronic pain http://chronicpainaustralia.org.au

For some patients taking medicines orally can cause more problems.  We have  pain specialists that ask us to compound certain pain medicines in a “transdermal” cream or gel. We can combine several drugs in the one cream. These are designed to have a local effect and minimise whole of body side effects.

Glaucoma Help Compounding Pharmacy

Glaucoma Health Message at Fresh Therapeutics

There are so many conditions that we need to be alert to as we chat with our patients about their health.

Just a simple “How are you feeling today” can identify someone who is struggling with depression or thoughts of ending their life. Is anyone in your family being treated for glaucoma? can be the trigger to get a person to have an eye check for glaucoma a highly preventable disease.

This is why we have decided at Fresh to have a weekly health message that our staff will ask of our customers in an effort to discuss some preventable condition.

 

Last month we featured Glaucoma with the following questions:

Questions on Glaucoma Do you have family history of glaucoma?

First degree relatives (parents, siblings, children) are at greater risk – having an almost 1 in 4 chance of developing glaucoma in their own lifetime. The risk increases to 56% if the relative has advanced glaucoma.

Questions on GlaucomaAre you of Asian or African descent?
Questions on GlaucomaDo you have high eye pressure? (your optometrist can check)
Questions on GlaucomaDo you have myopia? (near sightedness)
Questions on GlaucomaDo you experience migraines?
Questions on GlaucomaHave you been on a prolonged course of cortisone or prednisone medicine?
Questions on GlaucomaHave you had an eye operation or eye injury?
Questions on GlaucomaDo you have a history of high or low blood pressure?

If our patients answered yes to any of these questions we encouraged them to see their optometrist as they would be more likely than those answering no to develop glaucoma. Left untreated glaucoma can lead to irreversible blindness.

For our patients that have already been diagnosed with glaucoma we ask:

Questions on GlaucomaHave you told your family members you have glaucoma? Encourage first degree family members to have eye health check from the age of 35
Questions on GlaucomaHow do you remember to use your drops every day? Non-adherence to the glaucoma eye drops can lead to blindness
Questions on GlaucomaHow often do you have your eyes checked – regular check are necessary to monitor progress of the disease and prevent blindness
Questions on GlaucomaHas your ophthalmologist discussed Vitamin B3? Recent studies at the University of Sydney have shown that Niacinamide (Vitamin B3) may prevent blindness.

You can also go to the Glaucoma Australia web-site where there is a Risk Calculator and more information about Glaucoma

Chronic Pain - Compounding Chemist

Chronic Pain And How Compounding Chemist Broadway Can Help

Need help managing Chronic Pain? Spend 45 minutes with our pharmacist FREE of charge

Pain is the most common reason that people seek medical help, yet it remains one of the most neglected and misunderstood areas of healthcare. 1 in 5 Australians lives with chronic pain and this rises to 1 in 3 people over the age of 65.

Chronic pain is Australia’s third most costly health burden. More than 50% of people with chronic pain are under-treated.

There is often a lack of access to appropriate advice and support on chronic pain in the community, and it is difficult for patients to access effective treatment that is timely and affordable. Community pharmacists see patients on a regular basis without the need for an appointment. As such, pharmacists are ideally placed to provide a patient-based solutions to support people who are suffering from chronic pain.

At Fresh Therapeutics we have been chosen to participate in a new Trial evaluating a Chronic Pain MedsCheck service. The primary objective of this Trial is to determine if this service is able to prevent the incorrect use and/ or overuse of pain medication, increase your  pain medication health literacy, improve your ability to self-manage  chronic pain and improve your overall quality of life.

To be eligible to participate in the trial you must:

  • be taking medication (prescription or over the counter) for chronic pain for three months or greater, and
  • be aged 18 years or over
  • a holder of a valid Medicare and/or Department of Veterans’ Affairs (DVA) card
  • be living at home in a community setting
  • have not received a MedsCheck, Diabetes MedsCheck, Home Medicines Review (HMR) or Chronic Pain MedsCheck in the previous 12 months in the recruiting pharmacy, and
  • not be a current client of a recognised Pain Management Service.

If you consent to participate in the trial, you will be required to attend two in-pharmacy consultations at an agreed date and time.

Each consultation with your pharmacist will involve them asking you questions to learn more about the type of chronic pain you are living with, the medications you are taking to help manage the chronic pain and other activities which increase or decrease the pain. This will always be done in a private consultation room with your pharmacist.

Your pharmacist who has undergone specific training for this service will enter your answers into the pharmacy computer, and a score will be generated by each answer which will then be used by your pharmacist to identify the impact chronic pain is having on your life. This will help us provide you with the most suitable education, information and/or referrals.

Specifically at the initial consultation (which is expected to take about 45 minutes), the pharmacist will review the medications you are currently taking to manage the pain and may suggest some changes. We will also work with you to develop an action plan to help you better manage the chronic pain.

Six weeks after the initial consultation you will be telephoned for a follow up interview by phone. This is expected to takeabout 30 minutes.

Three months after your initial consultation there will be another consultation in the pharmacy that is expected to take30 minutes.  Here we will review your action plan and modify any aspects of the plan that aren’t working for you. Your pharmacist will also ask you some questions to understand whether any of their suggestions have helped you better manage the chronic pain.

If the chronic pain score shows that your pain is considered severe, your pharmacist will provide you with a referral to your GP for further investigation. If you do not have a regular GP, we can help organise an appointment for you with a local GP.

If you are suffering from Chronic Pain and would like to participate in this Trial please call us on 92 816 816 and we will make an appointment.

Woman using Inhaler - Fresh Therapeutics promotes Asthma Week

Fresh Therapeutics promotes Asthma  Week 1st – 7th September

This Asthma Week, Fresh Therapeutics is helping Asthma Australia to bust the myths about Asthma.

Asthma is a condition that affects most Australians, two-thirds in fact! Despite this, there are many misconceptions about this chronic disease.

We want everyone in the community to know about asthma, good asthma control and prevention.

We want everyone in the community to be empowered to take steps to prevent and treat their asthma and to educate others.

This Asthma Week, Busting Asthma Mythsfocuses on five facts about asthma along with new data on Australians perceptions and misperceptions about asthma.

AA-NAW_Checklist_A4_Side2-PRINT_R

AA-NAW_Checklist_A4_Side1-PRINT_R-1

 

FACT ONE

Asthma Impacts Most AustraliansTwo-thirds of Australians are impacted by Asthma. Most people know 1 of the 1.25 million Australians who have been diagnosed with asthma.

FACT TWO

Asthma is a long term disease. Asthma can develop at any age. Most people don’t grow out of asthma – even though 1 person in 4 may think that – but it can be managed with medication.

FACT THREE

Asthma  is a life-threatening disease

More  than 400 people die because of asthma  each year. The right medication, knowledge, and a written Asthma Action Plan can help keep asthma under control.  Almost 1 person in every 3 don’t realise asthma is life-threatening.

FACT FOUR

Asthma triggers are varied and include pollen, smoke, physical activity and exercise, colds and flus and thunderstorms

Most people know that asthma has many common triggers including pollen, smoke, physical activity, and viruses.  But are you 1 out of 2 Australians who know that thunderstorms can trigger asthma flare-ups? Everybody experiences asthma differently.

FACT FIVE

Using an Asthma Preventer every day  is the bets way to reduce asthma symptoms and flare-ups

Using a preventer each day reduces symptoms of asthma ad flare-ups for most people.  These medications mimic the body’s natural response.  Only 1 in 4 people under 24 years old knows this.  Preventers are the mainstay  of asthma management and we want everyone to know.

ASTHMA CHECKLIST

People often treat their asthma as a short-term condition that comes and goes when  they have asthma symptoms. But, asthma is a chronic (long term) condition that’s always there, even when they don’t have symptoms.

Follow the Asthma Australia asthma checklist to ensure you’re taking the right steps to live well with Asthma.

Visit your Doctor for an asthma review

With your doctor:

  • Assess your current level of asthma control
  • Make sure you are on the right medicines to manage your asthma (eg. A preventer)
  • Check your inhaler technique
  • Ensure your written Asthma Action  Plan is up to date

With your Fresh Therapeutics pharmacist

  • Ask about a spacer
  • Check your inhaler technique – up to 90% of people are thought to use their inhaler incorrectly
  • Ask about how to manage any nasal symptoms effectively
  • Ask about a script reminder service (Medadvisor) to ensure you do not run out of preventer
  • Get the Asthma and Asthma Medicines Self Care Fact Cards with the Asthma First Aid Plan that you can keep on your fridge

Take the Asthma Control Test

If you have experienced any of the following in the last four weeks it indicates your asthma may not be under good control

  • Daytime asthma symptoms more than 2 days per  week
  • Need for reliever medication more than 2 days per week
  • Any limitation on activities due to asthma symptoms
  • Any asthma symptoms during the night or on waking

Or get your Asthma Score by taking the Asthma Control test online at  www.asthmaaustralia.org.au

Preventer – every day even when well

Most adults with asthma should have preventer medication.  Daily use of a preventer is key to keeping well. Regular use of your preventer makes the airways less sensitive, will reduce your symptoms and should prevent remodelling or thickening of the airway tissue.

Check your inhaler device technique regularly

Research has shown up to 90% of people with asthma use their inhalers incorrectly, which  means the complete dose of medicine may not be getting into the lungs. Ask you doctor or pharmacist to check you are using your inhaler medication device correctly.  You can also watch inhaler technique videos at https://www.nationalasthma.org.au/living-with-asthma/how-to-videos

 Get a written Asthma Plan

With your doctor, develop and follow a written Asthma Plan for:

  • Better controlled asthma
  • Fewer asthma flare ups
  • Fewer days of school or work
  • Reduced reliever medication use
  • Fewer hospital visits

Learn Asthma First Aid

Get your Asthma Fact Card from Fresh Therapeutics or download the Asthma First Aid app from the iTunes store or Google Play.

For asthma information and support call the 1800ASTHMA helpline (1800 278 462) or visit asthmaaustralia.org.au

Two-thirds of Australians are impacted by asthma. Most people know 1 of the 2.5 million Australians who have been diagnosed with asthma. You probably know someone with asthma.

Incontinence laughing and leaking

Incontinence is no laughing matter

This year, World Continence Week is 18 to 24 June and the Continence Foundationof Australia awareness campaign Laugh Without Leaking, will be using humour to overcome the stigma of incontinence and get people talking about their bladder and bowel troubles.

5 million Australians are affected by incontinence.Incontinence laughing and leaking

Incontinence describes any accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal or bowel incontinence). It may cause distress as well as being a hygiene problem. However, incontinence can be managed and treated.

If you have experienced this problem, you are not alone. Incontinence is a widespread condition. It can range from ‘just a small leak’ to complete loss of bladder or bowel control. In fact, 5 million Australians have bladder or bowel control problems for a variety of reasons.

It is likely that the true number of people affected is much higher. Many people do not tell their doctor or pharmacist about their incontinence, due to embarrassment. Some people mistakenly think that incontinence is a normal part of ageing or that it cannot be treated. If you experience bladder or bowel control problems seek help, as the symptoms will not go away on their own and may worsen over time.

Urinary incontinence is quite common and often associated with pregnancy, childbirth, menopause or some chronic health conditions. It can range from a small dribble when you cough or laugh, to large flows of urine. Stress and urge incontinence are common types of urinary incontinence.

People with poor bowel control or faecal incontinence have difficulty controlling their bowels. This may mean they pass faeces or stools at the wrong time or in the wrong place. They may also pass wind when they don’t mean to or experience staining of their underwear. About 1-in-20 people experience poor bowel control. It is more common as you age, but many young people also have poor bowel control. People with poor bowel controlalso often have poor bladder control.

Treatment depends on the type of incontinence. It is therefore important that a continence assessment is conducted by a professional so an appropriate management plan can be developed. Lifestyle changes may significantly help some types of incontinence and these include:

  • Drink about 6–8 cups of fluid each day (1.5–2 litres of water) spread evenly throughout the day, unless otherwise advised by your doctor. To avoid disruptions to your sleep, drink a little less in the evenings.
  • Reduce the number of drinks containing caffeine (e.g. tea, coffee, hot chocolate and cola) as this can increase urge incontinence.
  • Avoid constipation by maintaining a healthy balanced diet that contains plenty of fruit, vegetables and fibre.
  • Lose some weight if required, as a modest amount of weight loss can improve urinary incontinence.
  • Aim for 30 minutes of exercise most days.
  • Do pelvic floor exercises to strengthen the pelvic floor muscles.
  • Go to the toilet only when you need to, rather than ‘just in case’.
  • Go to the doctor if you think you have a urinary tract infection.

The Continence Foundation of Australia (CFA) provides resources and information for the public, including the National Continence Helpline (Ph. 1800 33 00 66). This Helpline is a free service staffed by continence nurse advisors who can provide information, education and advice to people with incontinence or those caring for someone with incontinence.

At Fresh Therapeutics we have CFA brochures and the Pharmaceutical Society of Australia’s Self Care Fact Cards Bladder and Urine control, Pelvic floor exercises, Fibre and bowel health, and Urinary tract infection. We also provide information about the Commonwealth Government’s Continence Aids Payment Scheme that helps cover some of the cost of products that help people manage incontinence.

 

We recommend and stock the Molimed® range of continence products. We also stock aids to assist with pelvic floor exercises such as the Epi-No® Childbirth and Pelvic Floor Trainer, the KGoal® Pelvic Floor Trainer and the Elise® Pelvic Floor Exerciser.

are you tick prepared

Are You Tick Prepared?

It’s tick season on the eastern seaboard of Australia and with school holidays approaching are you tick prepared?

The most important tick in Australia is the Paralysis Tick, Ixodes holocyclus, and over 95% of tick bites in Eastern Australia are due to this species.
Distribution of the Australian Paralysis Tick

Distribution of the Australian Paralysis Tick

The Paralysis Tick is most common in moist, humid coastal areas with abundant native animals that serve as hosts for the tick. Long grasses and bushland provide ideal environments for ticks, and if you live close to these areas, it is not uncommon to have Paralysis Ticks in your garden. This tick has a distinct seasonality; the larval stage is most active during the autumn months, the nymph during winter and the adult during the spring.

This tick is most active during periods of high humidity, especially after rain, and this is when you should take particular care to avoid tick bites.

life cycle of the australian paralysis tick

Life Cycle of the Australian Paralysis Tick
The adult tick is 4mm before feeding on blood and up to 13mm after feeding on blood

A tick attaches itself by piercing its sharp mouthparts into skin. It then injects an anticoagulant (a substance that prevents blood from forming clots) saliva which allows it to feed without the blood clotting. In the case of the Paralysis Tick, the saliva may be highly toxic to some animals and, potentially, humans.

Most tick bites pose no medical problems apart from some localised swelling and redness at the bite site if the tick is removed promptly and properly. However, in some cases, people can experience more severe conditions such as tick paralysis or allergic reactions including anaphylactic shock. Early symptoms of tick paralysis may include rashes, headache, fever, influenza like symptoms, tenderness of lymph nodes, unsteady gait, intolerance to bright light, increased weakness of the limbs and partial facial paralysis. Tick paralysis, while rare, is usually seen in children rather than adults. Allergic reactions can result in swelling of the throat, and may lead to breathing difficulties or collapse. It is important to seek medical attention quickly if such symptoms occur. If you have had similar symptoms in the past after being bitten by a tick, then it is a good idea to always be prepared.

Recently a new syndrome known as “tick-induced mammalian meat allergy” has been described, whereby people bitten by the Paralysis Tick can subsequently develop an anaphylactic reaction to consuming meats and animal by-products such as gelatine. The allergic reactions to meat are typically delayed for 2-10 hours after eating the meat. The allergen in the meat to which people react is called “alphagal”. Some people are so sensitive to alphagal, they react to mammal products, particularly, their milk and gelatine. Any product derived from mammals may cause allergic reactions, making avoidance very difficult as the allergen may be found in a wide range of agents used in medical treatments, as well as in foods.

How to prevent tick bites?

The best way to prevent tick bites is to avoid tick-infested areas.

If this is not possible, wear appropriate clothing such as a long sleeved shirt, long pants tucked into socks and light coloured clothing to make it easier to see ticks on clothes before they attach to the skin.

Before entering possible tick infected environments apply an insect repellent containing diethyl-meta-toluamide (DEET) or picaridin to the skin. The higher the concentration of these ingredients, the longer the product will remain effective. We stock Bushman’s and Tropical Aeroguard at Fresh Therapeutics. “All natural” products aren’t recommended as they haven’t been proven effective.

Be thorough when applying repellents – think of it like sunscreen – if you miss an exposed bit it’s likely to get sunburn – likewise for repellents; they only protect the places they’ve been applied. The repellent should be applied and re-applied according to the manufacturer’s instructions. Clothing treated with permethrin is also recommended. Permethrin wash kits for treating clothes can be obtained from outdoor recreational stores and it is important to follow the label directions. Permethrin-treated clothing is considered the most effective means of preventing tick bite in tick infested areas.

All clothing should be removed after visiting tick infested areas and placed into a hot dryer for 20 minutes to kill any tick that could be still on the clothing. The entire body should be then checked for ticks of all sizes and stages, paying particular attention to areas behind the ears and the back of the head or neck, especially on children. Ticks can take up to 2 hours to actually bite you once they’ve found their way onto your skin and even then may go unnoticed for one to two days before you feel the effects of their bite.

life stages of tick

Life Stages of the Tick
Very small ticks sometimes called “grass ticks” or “seed ticks” are in fact juvenile Australian Paralysis Ticks. These will rapidly grow to adult size at which point they’re at their most dangerous and will then lay up to 10,000 eggs before they die

 

Treating Tick Bites

Watch this video that demonstrates the safest way to remove ticks

Adult Ticks

Kill the tick where it is using an ether-containing spray such as Wartec ® Wartner Freeze Off ® Wart-off ® available at Fresh Therapeutics. Hold the spray approximately 0.5cm above the tick and spray 5 times until the tick is frozen.

Then, either wait for it to drop off or seek medical attention for it to be removed using tick removal tweezers (fine-tipped only) taking care to not squeeze the tick because this would cause tick saliva to enter your body, increasing the risk of tick- induced allergies.

For Adult Ticks: “FREEZE IT DON’T SQUEEZE IT”

 

Nymph and Larval Ticks (may look like a splinter)

  • Dab on a blob of permethrin cream (Lyclear ®) to cover the tick (do not rub in)
  • Leave for three hours and then wipe off

NB: There are limited data regarding permethrin use in pregnancy and it is not known whether it can be present in breast milk. During pregnancy, try to avoid exposure to ticks.

For Nymph and Larval Ticks: “DAB IT DON’T GRAB IT”

 

DO NOT:

  • Use household tweezers to remove a tick – they are too wide at the tips and you will inevitably squeeze the tick’s body forcing toxins into your blood
  • Try to scratch or pull it out with your fingernails. Also, don’t scratch something you can’t see if there’s any chance it might be a tick.
  • Try to burn it with a match or lighter.
  • Apply any sort of substance to it. Lyclear Cream is the only substance that should be used (see below).

If the tick is close to the eyes or genitals don’t attempt to remove it yourself but seek medical assistance.

At Fresh Therapeutics we have what you need to be tick prepared:

  • DEET and picardin Sprays
  • Lyclear ® Cream
  • Freeze off Sprays
  • Tick tweezers

Acknowledgements:
http://www.tiara.org.au/
http://ticksafe.com.au/tick-bite-first-aid/
allergyfacts.org.au/shop/food-preparation-tools/allergen-cards/allergen-card-mammalian-meat