The Health Tune Up

Sydney, enjoy your eased lockdowns during COVID this December 2020.   

However be aware that viral gastro is in the wild and appearing as nausea, vomiting, and or diarrhoea. Tummy is usually upset too.   I still see it this 3rd week in Sydney hence this update. 

I highly recommend everyone maintain common sense hygiene measures: social distancing, wearing a mask at the supermarket, sanitise hands after touching stuff in public and on public transport.   

Reason being that the virus is spread by touching objects, surfaces, and close contact with others. Others can spread it through the act of coughing, sneezing, leaving a trail of germs on utensils and table surfaces.  

Who wants to be sick during Christmas!   xoxo Vien

In Australia and New Zealand we have the Food Standards dictating what’s allowed in your baby’s formula powder. 

Fortunately most brands have to hit minimums for protein, carbs, and fats. 

Unfortunately the optional extras are exactly that, optional! I have to also add a disclaimer: breast milk is KING. Formula comes nowhere close. 

Breast milk is like the elixir of life: one moment it’s got lots of sugar to quench your baby’s thirst (the first portion of milk), the next it's filled with nutritious fats (hind milk) which nourishes your baby’s growth. It doesn’t end there, the human oligosaccharides (HMOs) are immune boosting prebiotics and scientists have not quite mastered how to replicate this. However synthetic versions aren’t too bad either and include: non-digestible carbohydrates (NDCs) such as galacto-oligosaccharides (GOS) and fructo-oligosaccharides (FOS). It gets even better! Even if mother isn’t quite up on her nutrition game, her breast milk composition always manages to come together just right. A miracle of the human body! 

Enough about breast. Lets talk formula. 

Colic babies, no one really knows why this occurs but if your baby is crying for no apparent reason, it could be something internal. Research on gut bacteria (the microbiome) reveals that if mum was given antibiotics during labour, then her ability to transfer good bacteria to the baby via milk is compromised. It leads to breast milk that is too high in HMO’s which remain undigested and upsets baby’s tummy. Probiotic supplementation has been found to improve this situation and it can be given either to mum and/or to baby. Having said that, which formula should you use? Find ones that say Colic on the front! They’re usually partially hydrolysed meaning the proteins are smaller and more easily digested by baby. 

Constipation babies, this is a subjective matter because some babies poo daily and others every other day. Generally if a baby hasn’t pooped in three days, we can consider using gentle laxatives like glycerol suppositories. Now in terms of formula, choose those that state Constipation on the front. I haven’t looked closely into what the exact ingredients are that make these suitable but I’d say there’d be more fibre. 

Reflux babies, now I’ve had the opportunity to work in a compounding pharmacy where I see the most extreme cases ie. projectile reflux, silent reflux, regurgitation. These babies have had to be prescribed a proton pump inhibitor (PPI) like Losec. Again noone really knows why babies do this but it seems to start around month 3 and ease off by month 10-12. Baby formula marketed for colic will generally be thickened with starches so that the stomach contents are less likely to backflow. 

Finally allergy babies are those with intolerance to cow’s milk protein and/or lactose (a sugar or carbohydrate). It’s a big difference between the two so be careful selecting the right formula. Most lactose free formula are still based off cow’s milk therefore containing cow milk protein. DANGER! Life-threatening anaphylaxis can occur requiring adrenaline. Ensure your child has an ASCIA Action Plan. Allergy to cow milk protein also means likely allergy to other animal milk too e.g. goat, sheep, horse. Partially hydrolysed formula are NOT suitable e.g. NAN Supreme, formerly known as NAN HA. Your pediatrician may proceed in a stepwise manner as follows: Soy-based formula. Only for 6months+. Extensively hydrolysed formula (EHF) which has most of the cow protein broken down - not suitable if the baby is anaphylactic to cow milk protein Rice-based. Not suitable if food protein induced enterocolitis syndrome (FPIES) Amino-acid-based formula, 1 in 10 babies will need this. Available on prescription. Most tolerable. A great resource for allergy babies is: https://www.allergy.org.au/patients/food-allergy/cows-milk-dairy-allergy

Are you a new mum with painful, sore, nipples that feel like a needle is stabbing? If so you may be suffering from the all too common mastitis. An inflammation of the breast nipple and tissue.

It's definitely not fun to experience and can even bring on serious illness if the infection spreads or you have a severe form of it so see your doctor stat! (one mother literally today, Oct 16th, was in hospital for days on an IV drip for this. Then came in for additional antibiotics. It's a tough condition to beat)

It's estimated 30% of women by week 6 postpartum will experience a sub-acute or acute form of mastitis. This % increases with mothers who've been on antibiotics for GBS+ (Group B Strep Infection) or C-section "Caesar" mothers.

Now don't feel bad about yourself if you're going through this, it's not a reflection on you or of you. Many others have been through this and pulled through. I'm hoping to bring some value to your time today by sharing what I learned. Mastitis happens when there is a stasis (lack of movement) of milk, a blocked duct, or an overgrowth of bacteria, or unfortunately sometimes your baby isn't latching on quite well to suckle out enough milk (Professional help available at Tresilian and Karitane for mothers in Sydney, Australia)

Finally if you're on the fence about the benefits of probiotics and whether that course of antibiotics given during your labor or C-section is to be balanced by probiotics, I give you permission to start! The benefits of the small investment in some probiotic capsules far outweigh the negatives of delaying and include: incomplete maturation of your baby's immune system, increased colic in your baby, increase risk for atopic conditions in your baby: eczema, hay fever, asthma) and on and on.

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Hey Sydneysiders its Smiling Pharmacist here to warn everyone to keep up their hand sanitizers and hygiene cos there's viral gastro making the rounds  

Symptoms are diarrhoea, nausea, vomiting, low appetite.  

Spread easily by coughing, sneezing, sharing utensils. So keep up the mask wearing!   

Treatment involves maintaining hydration with oral rehydration salts e.g. Hydralyte/Gastrolyte/Pedialyte. But my all time favourite product is the probiotic combination by MedLab called ORSbiotic. It combines Saccharomyces boulardii beneficial yeast to flush out the bad guys  

Finally I forgot to mention but when you use anti-diarrhoeals e.g. Gastro-Stop/Imodium, you actually do your body a disservice as it stops the outflow of waste, holding it in (increasing chance for cramps) and delaying recovery. Of course there's a time and place for it e.g. commuting to work, before bed, travelling overseas (is there actually anyone at the moment with COVID?)  Stay Safe! #heroeswearmasks

Sun's out, bums out! With warmer weather in Sydney we're seeing people head outdoors and also seeing more injuries!

Grazes, cuts, scabs the lot! Here's how to:

1) prevent fugly scars in the 1st place, and

2) minimize scars that recently formed

Topics covered 📖

-types of scars: keloid, hypertrophic, pitted..

-stages of wound healing

-debunk pop items that DON'T work

-reveal products for pre-scar and post-scar treatment

Background information ℹ️

I heavily emphasise pre-scar treatments as it makes a for a speedier recovery. Lots of my customers still think letting a scab form after an injury is a good thing-It’s not. The dead skin takes longer to slough off.

Rather we opt for a warm, moist environment using hydrogel technology to allow the new skin cells to multiply and migrate to the repair site faster. Combine this runny hydrogel within a pre-formed sheet is even better as it forms a better seal.

Scar Treatment ℹ️

Once the wound is fully healed and no longer bleeding and no signs of infection (pus) then we proceed with the silicone technology to modulate the scars. Scars can be raised, misshapen, discoloured red, and itchy. Silicone can improve all this but the form it comes in is critical.

Most of my customers ask for silicone “gel” but I tell them silicone (pre-fabricated) “sheets” are far superior for similar reasons to the above: better seal and pressure over the wound. Like diamonds 💎, only the best results are produced under pressure!

Wear the sheet on 24/7, 365 (x2). Scars take up to two years to go away and we can jump on this window to maximize cosmetic improvements.

Conditions ℹ️

If you're unsure if this product is for you, speak to your friendly neighborhood pharmacist or GP. Scars from acne require a different treatment.

Any general questions hit me up below ⬇️

Specific medical questions I might answer but typically better reserved for your GP's eyes

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

The Four-Day-Rule-Of-Thumb: this is a diagnostic tool I used to help uncover the root cause of people's hives (a form of allergy).

Often times a customer will come in with a skin rash all over their body and ask for an antihistamine. Of course I give them what they want but when I notice they're not in a hurry I'll ask to give them my 2cents.

Recognising that hives is a whole body reaction oftentimes to stress-overwhelm, and NOT to the last meal they had, I'll usually proceed with a four day survey of what they have been up to: any recent illness? recent overseas travel? (unlikely during COVID-19), recent diarrhoea? recent sports carnival or school camp? recent excursion? What I'm looking for a signals of stress in all its forms:

-stressed immune system (illness)

-poor sleep (jet lag)

-dehyration (diarrhoea, excess caffeine, not enough water)

-physical exhaution (sports, gym, outings in the sun

Note I might query what their dietary choices are like, but often I find this a little intrusive and people get self-conscious so I might even skip it and glean from the aforementioned questions how their immunity status is looking.

What I'll often see is a pattern of of compounding stresses, day after day, and so by the fourth or fifth day, it's just too much, the immunity is at critical threshold, any further stress will set off the whole body into hives. Any guess for what that last thing is? Yep, its usually their last meal.

Hang on you say, "How come you said earlier that the meal isn't the culprit and now I say it is?" Let me explain: the meal is the final straw that broke the camel's back. On it's own any other time of the month it's not a trigger. But with multiple stresses e.g. A (jet lag) + B (dehyration) + C (exhaustion) + D (last meal) = hives!

So stepping back, simply understand that the body can only take so much in a four day period before it'll stress out. Often times I see hives on a Sunday or Monday because of the weekend's activities.

I hope that helps!

If you have any general questions, leave em below.

Leave specific questions to your doctor =)

xoxo Smiling Pharmacist

hey guys I just wanted to quickly rush Ep44 out before the others as I'm getting so many requests for Panadol suppositories..

The update: they're Out Of Stock till Nov 2020 (have been since start of year)

In this podcast I share tips for parents on how to manage with aforementioned product

Enjoy