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Bushfires and Asthma

It’s sad to see so many bushfires burning across NSW right now =( I take my hat off to all frontline servicemen and women whom are doing their best for us including fireys, paramedics, chopper pilots, doctors, nurses, the SES, and many others!

Today’s topic is on asthma.

If you’re a carer for the elderly, or young kids, or simply have asthma yourself, NOW is the time to check that you have your medications handy and your asthma action plan handy.

ASTHMA ACTION PLAN

Sample Asthma Action Plan that your doctor can tailor to each individual’s needs

ASTHMA ACTION PLAN 2
Sample Asthma Action Plan from the National Asthma Council Australia

 

Now being techy, I hate carrying pieces of paper around in my pocket or wallet so there’s now a digital Asthma Action Plan! Simply go to http://www.asthmabuddy.org.au/ sign up and then fill in your details (this step is best done with your doctor).

 

Medications come in two varieties: relievers (for asthma attacks) and preventers (everyday use).

Ensure you at least have your Ventolin (other names include: Asmol, Salbutamol) with you at all times during this bushfire season as strong winds can bring smoke and fine dust (particulate matter) from kilometres away into your home or work. On this note, it’s a good idea to stay indoors where there is air conditioning with recycled air and to minimize outdoor activity especially on hazy days. When driving, switch on your A/C and recycle the air there too.

 

VIDEO: Below is a video I shot last year for a mum on Instagram whom wanted to know what the signs are of worsening asthma:

I recommend everyone adults and children alike to always have a spacer device with their Ventolin. Reason being: it makes the puffer work almost 90% better (almost as good as using a nebuliser, but minus the hassle).
VIDEO: How-To use an asthma Spacer device for greater effectiveness of your puffer
Useful Links:
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Daily Dose Ep22: Slip Slop Slap

 

(Update: I now know what the slap is for…and no it’s not dirty!)

For fun in the sun this summer, remember to protect your family! 

The 80s slogan is:

  • Slip: on a shirt
  • Slop: on some sunscreen
  • Slap: on a hat
  • (Wrap on sunnies)

In babies under 6 months we don’t recommend excessive use of sunscreen, opt for clothing and shade

In kids under 12 years go for zinc based sunscreen as this way less chemicals absorb into their skin

Finally for adults we can use whichever sunscreen that has at least SPF30+ brands 

Remember to reapply after playing in water or after 2hrs of activity.

  

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Yellow Fever Vaccine

Yellow Fever gets it’s name from the yellowing of the skin, known as jaundice

What is Yellow Fever?

Yellow Fever is a viral infection spread by mosquitoes often in the South American and African continents.

It is potentially lethal as it can harm many functions on our body from heart to kidneys.

In the early days when there was no vaccine, many people travelling into the tropics died of it.

Thankfully there is now a vaccine called Stamaril (Australia) to prevent it.

Why Get It?

It’s a travel requirement for most countries that upon entry you show a vaccination certificate proving you’ve been vaccinated for Yellow Fever…IF….you’ve been travelling to Africa or South America in the last six (6) days.

Strict policy I know, but it’s to prevent international spread of the disease across borders.

If you don’t get it, they’ll most likely detain you in quarantine for 6 days to confirm your free of the disease and/or make you get vaccinated before entry.

Who Needs It?

Everyone over the age of 9 months

How Do You Get Protection?

Only a limited number of medical centres are Approved Yellow Fever Vaccination Centres. Here is a list of them (Scroll to bottom of page): Approved Centres in Aus

What Else Can I Do? Avoid Mosquitoes

The following measures can minimize exposure to mosquitoes-the culprits behind Yellow Fever spreading:

  • Applying insect repellant containing DEET or picaridin
  • Wearing long-sleeved clothes when outdoors
  • Avoid perfume/cologne as these can attract mosquitoes
  • Keep doors and windows closed at night
  • Drape a mosquito net over your bed to act as a physical barrier

What Other Vaccines Might I Need?

A great website I use often is: https://www.travelvax.com.au/

You simply punch in the destination country and it’ll give vaccine recommendations as well and current alerts for that region e.g. wild weather warnings, disease outbreaks etc..

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DAILY DOSE EP5: FLU SHOTS

BOOK YOUR SHOT TODAY

BOOK YOUR SHOT TODAY

WINTER IS COMING

Winter season is almost in full swing: protect your family, your kids, your elder folks through herd immunity.

HERD IMMUNITY

Herd immunity, a concept from pack animals like bison, is the concept of protecting the vulnerable within the middle of the pack by having those on the outside a.k.a. vaccinated adults while vulnerable children and elderly are inside the circle protected against the flu virus.

WHY DO THIS

Why do this? Kids under 6 months are too young to get the vaccine, and some elderly people may forget to get a flu shot. Not surprisingly also, these are the most vulnerable groups in our community.

HOW TO GET THE SHOT

So protect your family today, come in, roll up your sleeve, the flu shot is just $19.95 and for 20 minutes of your time.

xoxo @coachvien

BOOK YOUR SHOT TODAY

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Gang of Cysts (Ganglion Cysts)

*That aforementioned word-root is inaccurate*

In fact I don’t know why ganglion is part of the name and even went to the urban dictionary in vain

Ganglion cysts are benign (harmless) lumps of lubricating fluid found around joints (think moving parts) like hands, wrists, knees, ankles, and feet.

Believed to occur as a response to micro-trauma e.g. dancer’s feet and called an “internal blister”. The trauma leads to a leakage of lubricating tendon fluid. Think of it like a car engine leaking oil…except

Ganglion cysts are usually harmless but sometimes causing aching or pain when pressuring an underlying nerve or when moving a joint.

Oddly it affects women mostly between the ages of 20-40.

Signs and Symptoms

-large lump/multple small lumps soft to the touch

-apparent muscle weakness

-aching when moving the joints

Given a couple of months these things will go away

Options are to : A) wait it out B) Aspirate with a fine needle, and C) surgically cut it

Unfortunately ganglion cysts can sometimes recur for which we must simply repeat the aforementioned options.

 

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Urinary Tract Infections (UTIs) in Men

UTIs are a common occurence in women but what about men?

Young men are 30x less likely to suffer this problem but as men age past 50, the occurance rates catch up to that of women.

In fact a UTI in men is viewed at more seriously than if it were in women purely based on the physical differences between the two sexes. Men have a longer urethra (passage for urine), men also have greater distance between rectum and urethra (bacteria have less chance for cross-contamination). Thus a UTI in men is rare and when noticed, is treated with a higher level of suspicion for reasons I’ll get into shortly.

What are the symptoms of a UTI?

  • burning pain when urinating
  • frequency: running often to the toilet
  • urgency: sudden urges to pee
  • blood in urine (slightly pink)

UTIs are an umbrella term that covers infections stemming at different locations including: the urethra, bladder, kidneys, prostate. As such, the symptoms can vary and this helps doctors on their diagnosis.

Symptoms of a more serious infection:

  • dribbling urine (could be sign of blockages at prostate)
  • pain in pelvis
  • chills
  • side/flank/back pain
  • fever
  • nausea and vomitting

Bacteria have a knack for spreading. They will spread given the food and the path. Unfortunately for men and women, the path is through the urethra, into the bladder, across to the prostate and epididymis, and even up to the kidneys via the ureters. Have I lost you?!

Don’t fret. It’s rare that these things happen but here’s my rule of thumb: if you’ve got flank pain and fever, its probably spread to your kidneys. If you’ve got pain in the pelvis and dribbling at the urinal, it’s probably in the prostate. See your GP either way.

Word of warning: men get familiar with the “digital examination”. I’ve been there before lool. It’s when doc puts on his latex gloves with a snap, lubes up, then inserts his/her finger into your butt hole to feel for the prostate. Men as we age our prostate can enlarge putting undue pressure on the outflow of urine. Sometimes the prostate can become cancerous and this is one one for docs to keep a finger on the pulse. Ahem.

Treatments:

Antibiotics. Whilst this sounds straightforward enough, there are a spectrum of bacteria (sometimes even viruses) and so a urine and blood test are required to know what the culprit is before a doctor can prescribe anything.

Treatment is usually for 7 days.

Things your doctor ask you:

Do you have:

  • a history of diabetes?
  • nocturia (peeing at night)
  • prostate issues
  • urine sample
  • blood sample maybe

Know your own risks

  • Are you immobile? patients stuck in bed often find their bladders filling up and overtime the stagnant urine can foster bacteria.
  • Dehydrated? Drink one too many cups of coffee? Coffee has a diuretic effect causing build up of urine in the bladder too
  • Uncircumcised men can potentially harbour bacteria under their foreskins
  • Engage in unprotected anal sex? Use a condom
  • Aged 50+ and Male? Your prostate enlarges with time and can put undue pressure on your urethra causing backlog of urine
  • Finally Go when you feel the urge to go. Holding back on urinating puts you at risk too

Alright men, remember if you have ANY symptoms, get it checked!

xoxo

Vien

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Hand Foot Mouth disease

This is a condition that I personally have had but never really thought twice about until I saw it first-hand in the pharmacy.

Hand Foot and Mouth Disease!

Sounds terrible. In reality not so!

Capture.PNG
Source: Google of course!

What is it?

An infection caused by the: coxsackievirus

How did I catch it?

chances are you (or your child) walked into someone’s sneeze path (lol I made that up but it sounds cool) or contracted it sharing a harmless looking crayon at day-care

It can also spread via the oral-fecal route which is fancy for saying YOU DIDN’T WASH YOUR HANDS!

How do I treat it?

  1. Do not bust the blisters. This will only spread the disease to others!
  2. Fever: give paracetamol or ibuprofen (avoid aspirin in kids)
  3. Hydrate: sores/ulcers in the mouth can discourage kids (and adults) from eating or drinking. Instead offer sips of water or electrolytes e.g. Hydralyte
  4. Wait it out…the virus goes away after 4-7 days. No antibiotics are not effective against viruses. No vaccines exist at this point

How to prevent the contagion?

img_8979-e1525165133104.jpg
Four things to minimize spread: 1) use tissues when coughing/sneezing 2) wash hands before/after eating or using bathroom 3) Minimize sharing of utensils, brushes, and 4) Reduce the kisses hehe
  1. Sneeze/cough etiquette: use a tissue or at the very least sneeze/cough into your elbow
  2. Wash your hands before/after eating, using the bathroom
  3. Minimize sharing of utensils, toothbrush etc as well as kissing (sorry folks!)
  4. Stay at home to cut down spread to others
img_8978-e1525165070249.jpg
The virus incubates for 7 days, then pops up as a rash/lump/blister. Another 7 days pass before they dissappear

Hey if you like these blogs, try our videos-it’s where those last two photos are from.

Here: https://www.facebook.com/canterburylatenight/

 

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Nail Care for Men

If you’re a woman you probably can skip this whole article.

But for us men, read on for the essential nail care!

My promise is I’m not going to bog you down with products and laborious routines.

So basically I had a wife come ask about her husband’s problem nail…

It had broken off almost in half and the nail plate was almost detached….

Ouch!

So what to do?

Here’s the 5 step Guide:

  1. Soak the nail in cold salty water to disinfect
  2. Carefully trim any snags which may catch on clothing
  3. Put on Vaseline or Pawpaw
  4. Cover with a non-stick dressing (avoid sticky bandaids)
  5. Take Nurofen for the pain

Repeat for at least 10 days to allow your skin to regain its strength.

How long till my new nail grows out?

Finger Nails: 6 months

Toe Nails: 18 months

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GERD: Gastro Eosophageal Reflux Disease

Today we had a customer with chest pains complaining that it wouldn’t go away..

Handing me two scripts: one for Gaviscon and another for Somac…I put on my detective hat and asked her about any history of stomach issues starting with the questions:

  • Do you think this is related to any foods you eat? (No I eat very healthy)
  • Do you drink much coffee? (I used to but now just 1 cup a day)
  • Are you bowel motions regular? (Yes, every day)

She appeared lean and told me she is super fit as in: plays soccer twice a week and gyms every other day.

Hmmmm

At this stage it hasn’t quite clicked in my mind yet so I’m digging and digging…I really like solving puzzles like this…someone so young and fit shouldn’t be having symptoms that more often are seen in someone overweight and eats crap.

Now lets not get ahead of ourselves..the doctor has prescribed an antacid and a proton pump inhibitor (PPI). So there must be a diagnosis here…

So now I’m suggesting to her that perhaps it’s worth investigating for bacteria if her symptoms persist. In my mind I’m thinking perhaps it’s Helicobacter Pylori….but part of me is resisting the diagnosis. First because it’s too early..she’s only had persistent chest pain over the last three days…and secondly because she is so young and fit.

To reaffirm this thought…The customer interjects that she’s been on the diet and routine for ages and never has this occurred before.

I suddenly recall a condition called GERD ….not goat…but GERD: gastroeosophageal-reflux-disease. A mouthful I know! It’s basically when people suffer heart burn and chest pains for no apparent reason. Well actually the medical definition is the reflux of stomach contents up the food pipe thereby causing irritation and the physical symptoms of pain. Anyway I never really liked this diagnosis as the treatment always revolved around fluffy ideals like: stress less, lose weight, cut cigarettes, cut alcohol, cut spicy and fatty food. Heck this patient doesn’t have a problem with any of these!

But hang on, she does stress….stress in the physiological sense. She has been exerting herself in soccer matches and at the gym non stop basically….and GERD does have stress as one of the triggers. Still very fluffy but its in the definition……I hold that thought in mind…..

I loop around to the fact that she drinks coffee and ask her:

What time do you have it? (Timing is important see..) What do you know? She has it at 7.30AM-first thing in the morning BEFORE her Weet-bix; which by the way is my favourite breakfast cereal (with honey).

Suddenly I have a light bulb moment! Hang on….if she has coffee, it’s most likely to have gradually irritated her stomach lining to the point of inflaming it.

To test this hypothesis of mine, I ask her questions to see if there are OTHER signs of inflammation:

Do you suffer from break outs (aka acne) or cold sores ever?

Legit as soon as I said that I noticed what looked like a cold sore on the corner of her top lip. She says…YES! I have two cold sores, one right here as you can see (points) and three ulcers at any one time over the last few weeks!

BINGO!

I excitedly explain to her that despite her diet being on-point, the fact that she is under so much physical strain means perhaps her body is running a deficit of nutrients during those exact times….and as such is manifesting these symptoms in her mouth: ulcers and cold sores AND the stomach pain.

It makes sense when you think about the body’s fastest growing cells being those lining your stomach, and the skin in your mouth and hair on your head. Those undergoing chemo often lose their hair first and suffer terrible nausea as these cells are the most demanding in terms of nutrients and so if supply cannot keep with demand…you have problems.

if supply cannot keep up with demand…you have problems.

Before I get to what I finally recommended her lets touch on GERD….

GERD is represented by symptoms of

  • acidic taste in the mouth
  • heart burn
  • bad breath
  • chest pain
  • vomiting

Alarm symptoms that demand immediate GP attention include:

  1. difficulty swallowing
  2. bloody stools
  3. weight loss
  4. anaemia

So to my final recommendation:

I told her to start a multi-vitamin.

Guess what: she just started one that day!

Good on her! I told her to continue that as the extra nutrients will act like a buffer especially during times of physical stress (soccer/gym).

Think of it this way: if the recommended dietary intake of Vitamin C is 75mg daily and she obtains this through her diet..fantastic. But what happens when you are training 7 days a week? You’re probably going to need more in reserve. Hence why I suggested she start that multi-vitamin, to increase her reserves.

Go for goal!

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Constipation: How to fix chronic constipation

The following is the script to the podcast :

https://anchor.fm/e/d38bdc?at=1358881

Young lady suffering a slow tract for 5
yrs…holddd up! what’s a slow tract i hear
you say!

it’s when you cant shit! A simple test: what
you eat generally exits within 2 days..if it
takes 3 or more days to pass..you’ve got a
slow gut. Caveat…must be ongoing for
6months+ your norm will be different to my
norm….some go three times a day…others
go every THREE days..

who cares i hear you shout! You’re right!
you’re more concerned about the blating, the
nausea, the stomach pain!

but plz, let me drop some knowledge:

technical term for it is when your colonic
transit time (CTT) is >48hrs, as measured by
swallowing a radioactive dye and seeing how
long it passes through.

For px with STC, laxatives dont work well
and neither does more fibre in the diet.

About 1 in 10 poeple with constpiatoin will
suffer the type known as a slow tract. The
other kind of constipatoin is where there
are obstructions. i shouldnt laugh here but
that sounds kinda funky…rectal
obstructions

 

Why does this even happen? is it cos you eat
a shit diet? I went in hunt of the answers

Reasons..
1) obstructions….maybe the theres a
prolapse of the rectum,
2) slow colon (colonic inertia)
3) IBS
4) psychological stress
5) nerves being numb

 

STC confirmed by nuclear transit
study..basically u swallow some radioactive
barium and monitor its progress from mouth
to anus…fun days

Another method is the popular Wexman
Questinnaires which asks: how often u go,
pain level when you shit,
did you go fully or half way,
pain in stomach,
time to shit, how much help did u need to
shit-im talking laxatives,
how long uve been constipated, how many
unsuccesful attempts at pooping.

 

//////////////////// clinical trials///////

 

lets move onto the clinical trials. Now be
forewarned that some of these experiments
will sound very wacky….like real wacked.
eating poop kind of wacked. But im getting a
head of myself…lets start with the more
acceptable studies done.

three entrepreneurials scientists stuck
electrodes to childrens belly buttons and
found that after six months, with one hr of
stimulation daily…that the kids started
pooping more…gosh hardly exciting to be
hooked up to some electrodes when u just
wanna go play in the sandpit.

http://onlinelibrary.wiley.com/doi/10.1111/n
er.12734/full

Another group in Britain did a similar thing
but found no benefit…mind you they were
sticking the electrode to the soles of the
feet….kind of sounds farfetched, we’re
trying to fix something at the buttocks not
the feet…but if you look at the nerve path
it does seem to converge at the spinal cord
level.

http://onlinelibrary.wiley.com/doi/10.1111/c
odi.13388/full

An australian bunch did a similar thing but
placed the electrode pads on the tail bone
area and found this to be somewhat
effective. The real issue is the effect
didnt last too long after stopping therapty.

http://www.nobleresearch.org/Content/PDF/16/
2399-8199.2017-1/2399-8199.2017-1.pdf

By now you’re probably thinking, gosh
scientists sure like to zap things…first
Pavlov’s dogs and now kids…rest assured,
things get real wacked now…

///////wacked up research/////

FMT? Fecal microbiota transplantation. The
process of donating someone elses poop and
putting it into your stomach. WTF?! Yep
there woudl be a donor who would rock up on
the day of the experiment, dump a shit, then
scientists would whizz it up in a blender
and pump it via a nose tube into actual
patients.Bat shit crazy!
And if u were wondering, the amount of shit
used was 100g blended in 500mL of saline.
that’s half a litre of brown stuff.
Not surpringly, side effects included:
venting, nausea, abdominal pain and
diarrhoea. what’s venting? i had to look it
up. it says here: a vent is an opening such
as one that discharges pus like the anus.
hmmmm

an opening permitting the escape of fumes,
liquid, gas or steam

So the verdicT? about a 30% improvement…an
increase in number 2s, softer shit, faster
transit times (this is the bus timetable but
the time it takes to pass out some feces

http://journals.plos.org/plosone/article?
id=10.1371/journal.pone.0171308

//////////////////////average Joe and
probiotics//////

 

OKAY so whats the average Joe do when he
listens to all this…well basically if you
wanna avoid constipation…ensure you
actually drink water each day, have fibre in
ur diet from food sources like fruits and
vegetables and add a yoghurt to your routine
as this has been shown to help gut motility.

Now on the topic of yogurt, we all know that
yoghurt contains beneficial bacteria called
probiotics…well

China scientists are pumping real
interesting research on this area. In
fact…at the time of writing my notes…I
had a Eureka moment! Lots of laxatives are
exported to china each day…if you work in
pharmacy you’ll notice this too…things
like Nulax sell like hot cakes! Could it be
something in the water?…a topic of another
podcast no doubt!

 

///////////////HOW do these critters affect
us?///////////

One example are:

methanogens..these methanogens are elevated
in harder stools and correlated with
farting…true enough we all learned in
science lab that methane gas is that partly
the gas found in fart.

another example are the byproducts of
probiotics….

SCFAs and Bile acids….these were shown to
stimulate serotonin receptors in the gut
producin muscle contractions! so how do we
get more of these two acids? more fibre! and
for the case of Bile acids….healthy fats!
hohoho sounds like a healthy balanced diet
to me!

 

A fun point of this research was that the
poop belonging to a group of chemicially-
induced constipated rats were pumped into
stomachs of healthy rats….in turn causing
the healthy rats to be constpiated!

https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C5428802/

now……Taking a slight tangent in our
thought processes

Perhaps its the degeneration of nerves in
the gut that is responsible for slow tract
constipation! kinda like neurodegenerative
disease like Alzheimers and Parkinsons?!
Again a third group of Chinese researchers
took biopsies of peoples lower guts and
examined it under powerful electron
miscroscopes.
They found that in one 69yo woman..that her
nerves had shrivelled up into whats known as
a vacuole and is possibly why she has taken
laxatives for the last 6 yrs!! They rkn that
the same nerves that can be damaged during
child birth are the ones damanged in this
69yo.

https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C5369939/

 

///////// in closing////////
To close of this podcast…i’d like to
return to our original customer’s anxieties
and would just like to say that her
condition is a rare one, and isn’t something
to laugh about….its quite
debilitating….it affects one’s social
life, causings much psychological and
physical distress…..To this friend, I
would say that getting a good doctor on your
side who is willing to try different
approaches to this riddle is key. Very key.
as there are alot of doctors who will just
shrug this into the “too hard basket”.

for the average person, the key take aways
are to eat a diet filled with fibre and
healthy fats along with fermented foods that
are high in probiotics like yoghurt kimchi,
pickles, kombucha etc…

As I mentioned earlier, the probiotics eat
the fibre to product beneficial SCFAs and
bile acids which promote a regular bowel
movement.

Now how many times have you heard this said?
HEAPPPS….well now you have the science to
back it up. Enjoy..

Now before you all head off…if you enjoyed
this podcast, please leave a commment, pass
it onto a friend who may benefit, show us
some love!

 

 

 

Wexman scale:
https://pdfs.semanticscholar.org/9c30/96521a
00e759a1cd345b6aec3ee88a9fc9e2.pdf

 

phyla Bacteroidetes, Firmicutes, and
Actinobacteria. Bacteroidetes:Firmicutes
ratio, and negatively related to Akkermansia
and Methanobrevibacter abundance.
unclassified_Ruminococcaceae, Alistipes,
and Oscillibacter were negatively correlated
with the mean stool frequency3

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Question of the Day: Should I stop my Acne medication?

Question Of The Day! 

 
Latif asks: should I stop my isotretinoin?
 
Disclaimer: if you are on any prescribed medications, speak to your doctor before you start/stop anything.
 
Isotretinoin better known under the guise of Roaccutane, Oratane, Accutane etc… it’s a wonder for severe cystic acne and many other skin conditions.
 
What concerns us in today’s question is that Latif was getting stomach aches about 6 days into using it and needed to know whether to be concerned or not.
 
Vien’s Answer: I said look probably a good idea to stop it and speak to your doctor the following Monday. In the meantime I did some digging around and basically found the following:
 
1) there is a long history of associations of isotretinoin and stomach issues like irritable bowel disease (IBD); a form in inflammation in the gut
 
2) whether there are links to Crohn’s disease (a much more severe form of inflammation that continually relapse) we cannot say for certain
 
3) some people have even gotten IBD AFTER stopping isotretinoin which may suggest a dormant form of IBD which may have been triggered by the drug.
 
4) It isn’t practical to check every single person for signs of inflammation so common sense should say: be more cautious if you have a family history of gut issues; if you take non-steroidal anti-inflammatories e.g. Nurofen, aspirin; and if you smoke.
 
Summary: before starting isotretinoin, review your medical history thoroughly with your doctor. If you notice anything out of the ordinary, err on the side of caution and tell your doctor!
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Apple Cider Vinegar (ACV)-Does it actually do anything?

“One might think that fresh lemons and limes and raw organic apple cider vinegar are acidic, but they actually become alkaline when consumed.”

What a non-sensical claim! Before I get into the details of this, I’d like to say that after spending almost 12hours looking at material online regarding apple cider vinegar (ACV), I haven’t found any shred of evidence to show of it’s 20+ health benefits.

origins

ACV is basically apple pulped up, placed into wooden barrels and allowed to ferment. Much like the process of making wine, alochol is formed by this process. ACV however requires one further fermentation cycle to then produce the acetic acid aka “vinegar.” In fact, vinegar is French for “wine gone sour.”

 

Cider-making process in France.png
Microorganisms in Fermented Apple Beverages: Current Knowledge and Future Directions by Fabien J. Cousin and others.

Now before anyone gets upset, I’ll state clearly that a lack of evidence does not equate a lack of effect. A lot of drugs lack evidence for their effects/side effects until years down the track. In the case of the humble ACV, it’s been around since ancient Egypt times-analysis of urns have revealed traces of acetic acid. Ironically, anything left for that long would go “off” (ferment).

Now the purported benefits of ACV range from the mundane to the fantastical: antibacterial, reduces blood pressure, antioxidant, reduce sugar levels in diabetics, reduce cholesterol, improve brain function, relieve acid reflux, treat warts, treat cancer, treat bad breath, treat gout, treat urinary tract infections, and of course treat head lice.

 

Basically summarised, it can detox, help digest, and improve your energy levels. But does it really?

Rather than repeat what other reputable sources already mentioned on this topic, I will simply provide a summary of it below and provide links to a few reputable sources of information (see below).

 

Stated Health Claim Believable or Not?
Antibacterial Believable: acetic acid at concentration of 3% have been tested. Household vinegar is typically 5% (1)
Reduce blood pressure No studies found
Antioxidant Perhaps: like most plants, there exists phytochemicals (aka bioactive substances) that may defend against free radicals. There are thousands of these in nature and we can’t be sure which is what
Reduce diabetes Unlikely: there was a study on 30 people (FYI a good study requires thousands of people to have enough power). Ten were diabetes, ten were non-diabetics, and ten were pre-diabetic. After about a month of ACV, there fasting sugar levels were slightly lower.  These sorts of studies are too small for drawing conclusions. They also don’t look at factors like participants changed diets whilst in the program. (2)
Brain function No studies found
Acid reflux No large studies done. One was a doctoral thesis project consisting of a handful of volunteers with no conclusive answer.
Warts No studies found. Warning: chemical burns can occur with even standard 5% ACV despite being a weak acid. See images below.
Arthritis No human studies found. One study on arthritis-induced rats showed no effect. Link below
Antifungal One study on denture-associated candida showed it had some effect
Antidandruff Folk remedy but otherwise no studies found
Probiotic Whilst there does exist plenty of probiotics in ACV, there were no human studies on the benefits.

Studies in carp fish show that using ACV in combination with other probiotics may boost the immune system. Whether this relates to humans is unknown.

Helicobacter pylori Studies show that taking ACV with triple-therapy did not show benefit towards H. pylori eradication

What’s my take on it? Drink it for it’s likely beneficial probiotic effects. Always dilute it with a glass of water-add honey to taste. Ignore all the other “benefits.”

 

References

  1. Antibacterial effects of ACV
  2. Vinegar improves insulin
  3. Mother Earth-make your own ACV
  4. superFoodly’s analysis of ACV
  5. Dr Mercola’s analysis of ACV
  6. Science behind why pH won’t budge
  7. Fish fed ACV+probiotics
  8. Helicobacter pylori eradication with ACV
  9. Probiotics in ACV
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Spinning out-You too have Vertigo?

Dim asks: “I have vertigo, what medications are available apart from Serc (betahistine)?”

*Couple of scrap notes from my research on Vertigo..

Almost 25% of the elderly have dizziness lasting more than one month.

Targets for therapy:

  1. hallucination alleviated through vestibular suppressants eg anticholingerics, benzodiazepines, or antihistamines
  2. Nausea and vomiting plus anxiety alleviated through antidepressants
  3. Enhance vestibular compensation through physical head exercises

Armamentarium:

  • benzodiazepines
  • histamingerics
  • Sympathomimetics
  • Calcium channel blockers
  • Steroids methylprednisolone
  • repositioning maneuvers

Differential diagnoses:

  • psychiatric
  • motion sickness
  • otitis media
  • cerumen impaction
  • herpes zoster (shingles)
  • seizures

Risk factors (elderly syndrome? like falling, delirium, incontin)

  • anxiety
  • depression
  • hearing impairment
  • taking more than 5 medications
  • postural hypotension
  • balance impairment
  • past heart attack

Dizziness shouldn’t be taken lightly (even though the majority of cases resolve on its own) as there is greater morbidity associated such as: increased chance of falls, having a stroke, ending up in nursing home care.

Types of dizziness:

  • paroxymsal positional
  • acute vestibular neuronitis/labyrinthitis
  • Menieres+tinitus
  • migraine
  • anxiety disorders
  • vertigo
  • presyncope
  • disequilibrium
  • peripheral vs central vertigo
  • and the list goes on!….

A simple screening test to separate dizziness requiring medicines and those that require further checkup is if the dizzy spell lasts less than one minute or if it lasts for hours to days. The latter you would consider trial of certain medications and following this further medical treatment should it not improve.

Causes:

  • Ototoxic: some medications can be toxic the little hairs in our ear leading to permanent hearing loss and dizziness.
  • Multi-system impairment: data shows that elderly people suffer more dizzy spells than young people. We’re not sure why but perhaps a combined deterioration in visual acuity, muscle strength, hearing ability, etc is the reason; much like in dementia and falls.
  • Viral infections: of the inner ear leading to inflammation of the vestibular nerve causing mixed signals at the brain.

Tests

American guidelines do not recommend any lab tests except for:

  • Audiometric tests: when suspecting hearing loss
  • Brain imaging: when suspecting tumor or stroke
  • MRI: when suspecting acute vertigo with hear loss

Treatments

Type of dizziness Treatments
Labyrinthitis (inflammation of inner ear) Triggered by cold or flu virus, therefore goes away on it’s own. In resistant cases: vestibular suppressant + vestibular rehabilitation
Ménière’s disease No cure. Just relieve symptoms with: a low-salt diet, and/or diuretics
Vertiginous migraine Dietary changes, a tricyclic antidepressant, and a beta blocker or calcium channel blocker.
Vertigo with anxiety Slow introduction of selective serotonin-reuptake inhibitor (SSRI)

 

 

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Weight Loss with Saxenda

Today’s blog post is brought to you by one of our female customers who is struggling to lose extra flab around the belly. Sound familiar?

Well to make matters worse for this lady she has PCOS aka Poly Cystic Ovarian Syndrome. It’s a terrible cluster of issues leading to:

  • irregular periods or none at all
  • pimples
  • hair loss on head/hair overgrowth on arms and body
  • infertility
  • high cholesterol
  • diabetes
  • weight gain

It’s thought to be a genetic problem in the ovaries and its tough as hell to fix.

One of the indirect ways of dealing with PCOS is losing weight which is the focus of today’s blog.

(Other treatment modalities include: metformin, contraceptive pills to rebalance hormones, hormone blockers like clomiphene)

Saxenda is the new kid on the block and is one of three main players. It’s a surprisingly empty field because like anything complex, there is no silver bullet. Diet and exercise help but if you want something more, read on…

Saxenda is a GLP-1 analogue (if you’re a nerd, search it up on Wikipedia) which basically slows down your stomach contents causing you to feel fuller for longer; it also acts at the brain level to alert you to feel that enough is enough; finally, it tells your pancreas to pump more insulin for each meal you have.

It’s an injection done to the thigh, abs or upper-arm ONCE per day (there’s actually another one on the market called Byetta but that’s twice daily with similar results). A pack will set you back $400-500/month (not on the

To be eligible for a script from your GP you have to have a BMI of 30+ (or 27 with diabetes, heart problems, and/or PCOS)

So how long does it take to work? Best results happen at the beginning thankfully…with most of the weight loss during the initial 20 weeks or 5 months. People tend to lose 5-10% of their starting weight.

If you haven’t lost at least 5% by week 12, then chances are it won’t work much further-stop and save your money.

Side effects include nausea and vomiting-50% of people experience this as mild to moderate in severity. In studies people actually have vomited-which ironically for the drug company…is probably a factor in helping with weight loss. Thankfully for us mere mortals it does improve with time. Other side effects can include: irritation, pain, bruising at the injection site. Other things like gall stones and allergies are quite rare.

Risk of pancreatitis (inflammation of pancreas) is very, very rare but hey we don’t know the complete picture because it’s a relatively new drug. There is concern that it may be associated with cancer of the pancreas. Watch this space.

Apart from the weight loss benefits, it also helps to reduce your chances of diabetes by reducing things like your HbA1c  and your sugar spikes after a meal.

I hope this has been informative for our customer and for others like her who are going through PCOS which is a dreadful disease.

As always speak to doc about your personal situation.

Best

xoxo Vien

 

 

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You’ve taken a fall and now you’ve got scars to show Q: What’s the best scar treatment?

This question comes from Iman who asks what scar creams are available apart from Vitamin E and Silicone?

This is an age old question and surprisingly it’s still a new field of dermatology that is yet to be revolutionized.

We’re still using old technology from the 70s aka the humble silicone gel sheets. But that’s because it works.

Scars are bothersome to us humans because they affect our self-esteem in public. Scars can be large, look red, itch like hell, and  feel hard to the touch which can affect our dexterity.

Scarring is the end process of skin healing following trauma be it a cut, burn, graze etc. Skin goes through three stages:

1) inflammation (things get swollen through extra blow flow to the area, pus forms as a by-product)

2) granulation (new blood vessels form, the structural components are laid down) and

3) matrix remodeling (a fancy word for collagen being packed down)

It’s this third stage that causes often gets out of hand and produces excess collagen and hence the raised look of a scar. The story gets worst in the case of keloid scars as they not only regrow but grow beyond the border of the original damage. See images :

 

(Left) Keloid Scars often overgrow the border of the damage site whereas (Right) Hypertrophic scars stay within the border and are less aggressive in growth.

Why do scars even occur? From a cave-man survival perspective…should we ever get a laceration or trauma, the best thing to ward of infection and ensure quick receovery is to have an inflammatory response that tells the body to lay down plenty of collagen to fill up the exposured areas. It’s a biological response. I read somewhere that only certain reptiles can actually rebuild skin to the exact specifications as the original!

So back to humans. Silicone gel sheets are the go-to. They work by occluding (form a protective barrier) the scar and adding hydration. Left on for at least 12hours a day for 6-12months. Downside is the impracticable nature of strapping on a silcone sheet to your body. Especially if it’s on flexure points like elbows or chin.

Compression Garments/Pressure therapy has been proven to reduce the size of scarring especially those across large areas of the body.  They are thought to work by mechanical pressue on the underlying blood vessels thereby restricting blood flow and hence collagen formation at the damage site. Another theory is they provide the shear forces to help re-organize new collagen. The downsides include the tedious nature of putting them on and off-they’re tight!; must be worn for 23 hours each day for up to one year; needs replacing every 2-3 months to maintain their pressure ~25-30mmHg. Here are some photos:

The combination of compression with silicone is superior to either alone and so there are brands they incorporate silicone into pressure garments.

Now for the white elephant in the room: Vitamin E oil. Known as an antioxidant, the main one in the skin in fact, people including doctors have always used it on anecdotable eveidence that it helps scars-but does it? I read lots of articles on it and nowhere is there solid proof that it works.

If anything it may cause some irriation. If used too early on fresh scars it can actually weaken the scar and cause the scar to widen. Its possible the type and strength of Vitamin E count for something…one study was using 320 IU per gram of cream. Typical Invite E cream in pharmcies is only 100IU per gram (Invite E oil is 25IU per drop).

Not surprisingly scientists decided to use Vitamin E with silicone gel sheets to see what wopuld happen and results blew them away-the combo dramatically improved scar colour, size and appearance.

invite e
Source: http://www.pinsdaddy.com/pure-vitamin-e-oil_6yJEc3SKpc4Ur*0Wu55Ru*QT3cKaAHw5FtCj1eyhdtU/

Now I could go on about the various other remedies out there but not much evidence exists so I’ll just briefly list them here:

  • Onion extract (only slightly better than using Vaseline!)
  • Imiquimod 5% (needs more research, some promise)
  • Vitamin A (aka retinoic acid; reduces scar sizes, can be a teratogen if absorbed into the body, needs more research)

 

More invasive options do exist however…

  • surgical excision (cutting it out) but for keloids, they recur in 45-100% of cases (reserve for resistant scars)
  • Steroid injections (corticosteroids): first line therapy for keloids. Response rate 50-100%, Recurrence of 9-50%. Painful. Side effects: discoloration, dimples, spider veins.
  • Radiotherapy: most effective treatment for keloids but high exposure to radiation. Response rate: 10-94%, Recurrence rate: 50-100%.
  • Laser (carbon dioxide, argon, flashlamp-pumped pulsed-dye): conflicting results. more research needed.
  • Cryotherapy: flattens keloids after two sessions. Side effects: permanent skin discoloration, pain, skin shrinkage. reserved for small scars.

An unusual observation is the use of paper tape to hold together fresh incisions made by a surgeon, used for several weeks, seemed to be “useful”. albeit not as effective as silicone, it could serve the purpose of prepping the skin prior to silicone gel sheets.

So for our friend Iman, I think sticking to silicone gel sheets like Scar FX or Cica-Care is her best bet with the addition of some Vitamin E oil (optional) and a pressure garment.

Sources:

Keloids

Pressure Garments

https://www.regionshospital.com/rh2/specialties-and-doctors/specialties/burn-center/garments/index.html

Burns Scars

http://www.smith-nephew.com/key-products/advanced-wound-management/cicacare/

Scar FX 1" x 22" Self-Adhesive Silicone Sheeting

 

 

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Daily Dose Ep44. How To Treat Thrush (Vaginal & Penile)

https://youtu.be/CFUHhuSgpIo

Busy Bee? Tune into the podcast here

Embarrassing but it happens! If you’re a women over the age of 16 years, you’re likely to get thrush at least once in your lifetime. Men you’re not off the hook either it can happen on the tip of your penis

Now to be clear, thrush is NOT a sexually transmitted disease (STD) and is more a result of a compromised immune system. 

What’s that mean? Well when your not good on the inside, you can start having problems on the outside. E.g. you’re dehydrated, you’ve been sun tanning for hours, you’re physically overworked at the gym or on some project, you’re underslept, you’re running on more than 3 cups of caffeine-containing drink. IMO these are 50% of the time the cause for the thrush.

The other 50% cause is being on antibiotics in the last few days. See antibiotics kill not only the bad bacteria (e.g. causing that skin boil), but also the good bacteria. Yet the good bacteria help maintain a balance of acidity in the vagina. Without good bacteria, yeast aka thrush take advantage and explode in numbers causing serious itching, a white-cheesy discharge. Gosh you think! You were just doing the right thing by going to the doctor for antibiotics but end up with thrush! Yep, happens all the time. That’s why I always feel remiss if I don’t tell my female patients to consider getting a probiotic (good organisms) with their script. A favourite of mine is Saccharomyces boulardii. There’s many brands of it around, ask your local pharmacist for one-it drastically reduces getting thrush (as well as side effects from the antibiotics like diarrhoea). 

Fun fact: “SB is a tropical species of yeast first isolated from lychee and mangosteen fruit in 1923 by French scientist Henri Boulard.” – Wikipedia

So to loop back to my earlier point about your immunity, taking good care of your fundamentals will mean you’re also less likely to get thrush. Stay hydrated on hot days, go gym or stay active couple times a week, eat your veges – they have fibre which nourishes your good bacteria and acts like a detox sponge for your insides, and if you drink coffee/tea drink double the number of cups in water to balance out their diuretic effects. 

Finally, treatments for thrush are all behind the counter so ask your friendly pharmacist for help on these. 

xoxo Smiling Pharmacist

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The Friday Tune Up Ep.2

The Friday Tune Up Podcast Cover Image (Smaller JPEG)

Friday, August 21st 2020

My current health hack –

While not quite a health hack in the strictest terms, I’m quite enjoying another new app right now called DuoLingo. Available on Google Play or App Store I’m trying to learn Chinese-Mandarin again for like the 99th time but this app have stick-a-bility. It reminds me each day to give it a go and I do the fun gamified lessons for about 10 mins and call it a night. I like that it’s there on my iPhone within armsreach so no messing around with pen or notepads or chunky dictionaries. To me it’s all about the habit and if it’s a good habit, then it’ll have knock-on effects on other aspects of my life too like health, wealth, relationships and happiness.

New dish of the week –

Tonight I swung by my fiancee’s grandma for Banh Canh, a thick cut rice noodle in a thick chicken broth, chicken pieces, garnished with fried garlic bits and shallots. Comfort food at it’s best. To top it all off, the noodles were freshly handmade a few hours earlier. Considering the cold front that’s hitting much of NSW this weekend, I was super grateful!

What I’m watching on Netflix –

Drive to Survive a documentary about Formula 1 racing. As a kid growing up I was fascinated by fast cars, reading NRMA’s Roadside magazine each quarter. Although not a rev-head in the traditional sense, I came to like Formula 1 for all the high tech it involved. Netflix now lets you in behind the scenes as it follows predominantly two underdog teams: Red-Bull Racing and HASS USA during the 2019 season. The visuals are stunning, the sound is legit, and the struggle in real for these underdogs. I’m personally cheering on our Aussie boy: Daniel Riccardo 

Quote of the week –

“Faster is the scariest word in the world” Gary Vaynerchuck

On having patience to execute the daily menial tasks, so that you can achieve later live on your terms. Gary is like a virtual mentor to me. Bit of context: he was born in Belarus (former Soviet Union), his parents immigrated to America, he helped in his Dad’s liquor store for all of his 20s and now at 43yo he is a leader in the marketting space. More importantly, his legacy is to show impressionable young men (think myself) that success = happiness. To not be misled by all the glamour of entrepreneur land ie jets, bling, girls, champagne. I’ve been pondering a lot this last week about my definition of success. I used to want to become a millionaire but I dont think I have the ambition to get me there. Doing what I love ie. helping others with their health challenges and seeing that AHA moment makes me joyful. What’s yours?

What I’m reading –

The Greatest Salesman In the World, by Og Mandino. A tiny book written in parable form which brought me to tears right at chapter two. It’s about a young sheep herder boy who is working for a wealthy merchant in modern day Damascas whom suddenly is overcome with ambition to become rich to marry the girl of his dreams. I love the simplicity of the tale and the moral of the story at the end of each chapter is worth it’s weight in gold. Currently I’m reading it exactly as prescribed ie. each chapter three times a day for 30days before moving onto the next chapter. It sounds cheesy but it’s a habit thing like I mentioned earlier.  Results thus far? Better reading habits, meal prep habits, gym habits. For most that’s a gamechanger.

Hope you enjoyed that one! xoxo Vien 

PS. Remember to rug up guys, it’s a windy one in Sydney this weekend!

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The Friday Tune Up Ep.1

 

Cover Image

Welcome to the blog version of our new podcast titled The Friday Tune Up (click for audio)

We talk: health hacks, books, films, food, and favourite quote of the week!

In bite-sized form, here we go!

My current health hack –

The Fitbod app Available from App Store

Ever gone to the gym wondering what today’s workout should be? Wonder no more! Using smart algorithms, this app will track which muscles are sore from your last exercise and target fresh muscles for your next session. It’ll even give you count-down timers for break time so you don’t slack off too long on social media. My work outs before the app were approx 1hr or more, nowdays I can smash out a full workout in 46 miuntes.

New restaurant I dined at –

So earlier this week my fiance and I had the pleasure of taking our good customer-turn-friend, George, to Mr Wong’s in Sydney. A very fancy (but not fine dining) experience at an historical NAB bank building that burned down long ago and retrofitted with georgous decor, a vintage vibe with old wooden beams and low lit light making you feel like you’re in a gangster’s Chinese restaurant straight out of a James Bond film! Peking Duck Pancakes are a must try; everything else you can save your money for your local diner lol.

What I’m watching on Netflix –

Dr Sleep, the film adaptation of Stephen King’s novel. I gotta say I was never a fan of thriller until meeting my fiance. I realise most of them have pyschotic wives chasing their cheating husbands with knives in hand (Girl On Train, Gone Girl). But King keeps you guessing at every twist of the plot and I’ve come to enjoy his storytelling. Long film but will have you on the edge of your seat!

Quote of the week –

“If you can meet with Triumph and Disaster
And treat those two impostors just the same.”― Rudyard Kipling from his full poem

What I learned here was a man whose luck in life was up and down, from loss of his daughter due to pneumonia, to winning the Nobel Prize in Literature, to the loss of his son in WW1…Life is tough, keeping an even keel helps. I’m forced to remind myself of this when I have difficult customers (embarassingly).

What I’m reading –

Currently reading Tour de France 7x winner, Lance Armstrong’s biography: It’s Not about the Bike: My Journey Back to Life Good Reads

Here’s a man who obviously went through a lot: growing up as a loser kid, proving himself on a bicycle, topping his sport, and getting taken down by scandal at the end of his career. But I’m getting ahead of myself. I’m halfway through the book and it’s detailing his battle against testicular cancer. Cancer of the balls-enough to decimate the manliest of men. Most people die. He’s survived it out of sheer force of his will to live, determination to seek the best doctors, getting second and third opinions when others casts doubt on his chances. For that alone it’s worth a read.

Hope you enjoyed the very first episode! xoxo Smiling Pharmacist Vien

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Daily Dose Ep16: Best Vacuum for my Allergic Kid

 

I’m a little too excited for our new Dyson vacuum lol..

Ever wondered what household products are suitable for your child who might be sensitive to allergies like dust mites, mould, smoke, perfume etc…?

The National Asthma Council of Australia has a useful website called Sensitive Choice (https://www.sensitivechoice.com/products-services/) which is a non-profit that gives stamps of approval for products ranging from house paint to roof insulation to you guessed it, vacuum cleaners.

When choosing a vacuum cleaner, go for one with the Blue Butterfly stamp of approval. They will have high level HEPA filters meaning? the air coming out is cleaner than the air that went in! Other vacuums won’t fully trap all the dust and dirt – yikes!

Some even have carbon filters to absorb gases like the “new-paint” smell (avoid moving into a freshly painted room for at least a day, the longer the better), or the smell of house-hold bleach (another good reason to strictly keep them out of reach of children)

During spring season its bad enough to have pollen counts rising outdoors, but indoors, you can do your bit with the right choices of household products =)

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Daily Dose Ep9: Iron Deficiency and Alternatives to Ferro-Liquid

Alternatives to Ferro-Liquid (currently out of stock, July 2019)

Parents, are your kids deficient in Iron but you struggle to find an alternative to Ferro Liquid?

I did some research today into the main causes of iron deficiency, and share with you the currently available products (Maltofer, BioCeuticals Liquid Iron, and SpaTone) as well as a comparison of their pros and cons.

How Do I Take Iron?

Something I forgot to add in the video is when you can take iron with food and when NOT to. Some forms of iron bind to food and therefore won’t be absorbed as well.

Ferro-Liquid and SpaTone: best empty stomach (but do eat about 15 minutes afterward else iron itself may upset your tummy)

Maltofer: best with food

BioCeuticals Liquid Iron: with juice or water

What To Expect

  • Your poop is going to look black-this is completely normal
  • Black teeth: remember to brush after taking a dose!
  • Constipation and Nausea may occur (More common with Ferro-Liquid)

Side by Side Comparison

Brand Form of Iron Concentration of elemental iron Suitable from
Ferro-Liquid Ferrous sulphate 6mg/mL 2 years
BioCeuticals Liquid Iron* Ferric pyrophosphate 1mg/mL 2 years
SpaTone sachets Ferrous iron 1mg/mL 2 years
Maltofer Syrup Iron Polymaltose 10mg/mL 12 years

*Requires GP or Naturopath or Pharmacist advice before buying

From the table its clear that Maltofer is the most potent yet on the box it doesnt allow for dosing in kids under 12yo which is strange.

The alternatives are then the BioCeuticals or the SpaTone sachets.

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💰💰 Don’t Get Ripped Off at the Chemist 💊💊

 

Save money this cold and flu season!

4 Tips to Save at the Chemist:

1) don’t be suckered for the add-on sales which are airy fairy like vitamin C or echinacea (on their own they suck)

2) Go generics for basics like antibiotics: it’s the same chemical ingredients and u can save over $5. If you need a lozenge, simple eucalyptus drops only cost $2.50-skip more $$$ ones

3) early birds: recognize a cold coming? That scratchy throat? Take a solid product like Armaforce containing andrographis WITH vitamin C, echinacea, zinc, olive leaf within 24hrs of that sore throat..can nip it in the bud and rapidly get better (In my experience overnight-yes! Overnight!)

4) Pain relief in pharmacy these days are limited to non-codeine products (codeine now needs a script). As such our strongest options are basically paracetamol combos with ibuprofen. Sound familiar? Cos it’s Panadol and Nurofen! Just take two pills of each and skip the fancy packaged options like Maxigesic and Nuromol

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Home Deliveries to the Inner West Sydney from $15 Phone: (02) 8068 7131

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Follow Vien on Facebook and Instagram: @smilingpharmacist

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