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Whelehans Health Blog

ASK YOUR PHARMACIST -Treatment of Flat Feet

Posted by Eamonn Brady on

 

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

This is the conclusion to last week’s article.

 

Treatment

No treatment is required if flat feet do not cause problems. Well-fitted shoes, especially extra-broad fitting types of shoes can help. For people suffering from over-pronated feet, a special insole, which prevents feet rolling over too much, can ease the problems. These specialised insoles can be advised on by a chiropodist or a physiotherapist. These insoles are also called orthotics and are available in pharmacies. A more permanent solution is a customized orthotic, whereby an orthotic is specifically designed for your foot. Measurements for this type of insole are taken, by your chartered physiotherapist, from a plaster cast of your foot or by stepping into a foam box. These are then sent on to a lab where the custom insole will be created.

 

If pain occurs, rest, ice and over-the-counter non-steroidal anti-inflammatories, or NSAIDS (eg. ibuprofen) can give temporary relief. Children with an abnormal foot that has not developed properly may require an operation to straighten the foot or to separate bones that have fused. Luckily operations are rarely needed as these are rare causes of flat feet in children. Other actions that can help include wearing footwear with lower heels and wide toes, losing weight if appropriate and doing appropriate exercises that strengthen muscles in the feet which can include walking barefoot, exercises called toe curls (flexing the toes) and heel raises (standing on tiptoes).

 

Heel cord stretching exercises

These stretch and lengthen the achilles tendon and posterior calf muscles. Your physiotherapist is best for advising on appropriate exercises.

 

How to do:

Stand facing a wall with your hands on the wall at about eye level. Put the leg needing stretching about a step behind the other leg. Keeping the back heel on the floor, bend the front knee until you can feel a stretch in the back leg. Hold the stretch for 15 to 30 seconds. Repeat 2 to 4 times. You should aim to do this exercise 3 to 4 times a day.

Health Step Physiotherapy

Health Step Physiotherapy, at Whelehans Pharmacy is operated by Chartered Physiotherapist, Kevin Conneely MISCP. Kevin can advise and offer treatment for flat feet. Kevin offers reduced physiotherapy rates for under-18s, students with valid student ID and for Over 65’s. He offers reduced rates for affiliated sports clubs and other groups. Contact Kevin on 087 4626 093 to advice or call Whelehans at 04493 34591 to book an appointment.

Our Chiropodist James Pedley can also advise on flat feet in adults and children; to book his clinic for adults or children call 04493 34591 and he also has reduced rates for children and over 60’s.

This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans

 

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ASK YOUR PHARMACIST Flat Feet Part1

Posted by Eamonn Brady on

 

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

During childhood, usually between the ages of 3 and 10, we develop a space (arch) on the inner side of our feet where the bottom of the foot is off the ground. People with a low arch or who have no arch are classified as having flat feet, sometimes referred to as having "fallen arches".

Causes

Flat feet can run in families, and both feet are usually affected. Occasionally, flat feet are due to a problem in the way the foot forms in the womb, in this situation, the feet are stiff and flat and the problem is usually noticeable during childhood.

Another form of the problem is when the foot has a tendency to roll inwards too much while standing or walking. This can be due to weak ligaments in the heel joint or at the base of the big toe. "Pronation" or "over-pronated foot" is a term for excessive rolling of the feet. 

While over-pronated feet usually develop in childhood it can sometimes develop in adulthood. Flat feet may develop due to a ruptured tendon (which is rare), tear of the spring ligament (also rare), arthritis, nerve damage due to diabetes, or injury which leads to stiffness and distortion of the joints of the feet. Conditions of the nervous system or muscles including cerebral palsy, spina bifida or muscular dystrophy can cause flat feet as they can cause muscle weakness or lack of movement in the muscles. These conditions lead to feet becoming stiff which gets worse as the condition develops. Other contributing factors include shoes which limit toe movement such as high heels (walking barefoot may have a protective effect). Tight achilles tendon or calf muscles can make you more prone to flat feet. Obesity also can contribute to flat feet.

 

When is treatment needed?

Most flat feet do not cause any problem so no treatment is needed. Reasons to look for treatment include pain (not eased by any type of foot wear). Pain from flat feet can occur in a number of areas including inside the ankle, at arch of the foot, the outer-side of the foot, calf, knee, hip or back. Other reasons for treatment include wearing out shoes quickly, feet appear to be getting flatter, feet tire easily, swelling on the inside bottom of feet, feet are stiff and lack of feeling in the feet or weakness.

 

Health Step Physiotherapy

Health Step Physiotherapy, at Whelehans Pharmacy is operated by Chartered Physiotherapist, Kevin Conneely MISCP. Kevin can advise and offer treatment for flat feet. Kevin offers reduced physiotherapy rates for under-18s, students with valid student ID and for Over 65’s. He offers reduced rates for affiliated sports clubs and other groups. Contact Kevin on 087 4626 093 to advice or call Whelehans at 04493 34591 to book an appointment.

Our Chiropodist James Pedley can also advise on flat feet in adults and children; to book his clinic for adults or children call 04493 34591 and he also has reduced rates for children and over 60’s.

To be continued….next week I discuss treatment

 

This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans

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Schizophrenia Part 3

Posted by Eamonn Brady on

ASK YOUR PHARMACIST

 

Long acting anti-psychotic injections (For Schizophrenia)

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

                                                 

I previously discussed long-acting antipsychotic injections Westmeath Examiner due to a query from a person who is prescribed them for schizophrenia. First-generation antipsychotic (FGA) long-acting injections were introduced in the 1960s. The first of the second-generation antipsychotic long acting injections (LAI) (risperidone LAI) became available in 2002 and since then Xeplion® (paliperidone) injection has come on the market. For the purpose of this article I refer to long-acting injection versions of antipsychotics as LAIs. This article discusses second-generation antipsychotic LAIs in a little more detail than I did in my previous Examiner article on LAIs.

 

Why used?

According to studies, approximately 40–60% of patients with schizophrenia do not take their medication regularly and in many cases refuse to take it at all. Long-acting injections are often prescribed when a patient is not taking their oral medication as prescribed. Many decide to use them as they offer the convenience of not taking a tablet every day and in some cases where a tablet did not work. LAIs require the attendance to a clinic for regular injection every 1–6 weeks.  This ensures the medication is given regularly and allows regular review of treatment. LAIs do not guarantee the patient will not relapse but they greatly reduce the risk.

 

Comparing Long-acting injectable antipsychotics (LAIs) to oral antipsychotics

A 2011 study published in the New England Journal of Medicines found that, in high-risk patients with schizophrenia and schizoaffective disorder, long-acting injectable risperidone did not provide great improvements to key outcomes such as psychiatric symptoms, quality of life or functioning when compared with oral antipsychotics (tablet versions). However, other studies have shown that LAIs give very favourable results when compared to oral antipsychotics and that they reduce hospitalisations by up to 34% when compared to oral antipsychotics and reduce relapses by between 10 and 30% when compared to oral antipsychotics.

 

Second-generation long-acting antipsychotic injections

Risperidone was the first of the second generation LAIs to be licensed in the UK and Ireland. The drug will not reach a therapeutic level for a few weeks after injection; therefore it is essential that the patient receive supplementary antipsychotic medication (tablet form) during the initial period of treatment following the first injection. It is administered into the gluteus (buttocks) or deltoid (upper arm) muscle every two weeks.

 

Xeplion® (paliperidone) injection is the newest LAI; it only needs to be administered once monthly. Paliperidone is effective in relieving both positive symptoms (hallucinations, disturbances of thought, hostility) and negative symptoms (lack of emotion and social withdrawal) of schizophrenia, whereas older antipsychotics are usually less effective against the negative symptoms Paliperidone also relieves 'affective symptoms' that are associated with schizophrenia, such as depression, guilt feelings or anxiety.

 

For more information, call into Whelehans for a free copy of Eamonn’s comprehensive article on injections used for schizophrenia; he also discusses the older first-generation antipsychotic LAIs (commonly called ‘depot’ injections) such as Zuclopenthixol (Clopixol®) such as Flupenthixol (Depixol®). The information is also available at www.whelehans.ie. We also have a comprehensive article on schizophrenia.

 

This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans

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Schizophrenia Part 2

Posted by Eamonn Brady on

Medication used to treat

This is a continuation of last week’s article in which I discussed causes and symptoms of schizophrenia. Last week I described how antipsychotic drugs are the main class of medication used to treat schizophrenia and are broadly divided into two categories; older typical or newer atypical antipsychotics.

 

Choice of Drug

No one drug can be considered significantly better than the others, however one may be better for one individual than another. For example, some are more sedating than others so may be suitable for patients who are agitated or cannot sleep. If one does not work so well, a different one is tried until a good response occurs. A good response to antipsychotic medication occurs in about 70% of cases. For patients with only one episode of schizophrenia and remain symptom free for two years with treatment, the medication may then be discontinued slowly; closely monitored for relapse when medication is being discontinued.

 

Side effects of medication

Side effects of older schizophrenia drugs

Anticholinergic side effects are more common with the older typical anti-psychotics and include dry mouth, blurred vision, flushing and constipation. These tend to be worse at the start of treatment and often ease off. Drowsiness is also common but may be reduced by reducing the dose. Extrapyramidal side effects (movement disorders) can occur with typical antipsychotics. Chlorpromazine has a tendency to cause skin photosensitivity when exposed to sunlight. Sunscreen must be used if going out in strong sun while taking chlorpromazine.

 

Side effects of newer schizophrenia drugs

Reduced risk of movement disorders is the main reason atypical antipsychotic drugs frequently are first choice for treatment. Atypical antipsychotics have their own risks; particularly the risk of weight gain and this increases risk of developing diabetes and heart problems (due to raised cholesterol). Longer term blood sugars and cholesterol levels should be monitored regularly. Weight gain appears to be a particular problem with clozapine and olanzapine. Other medication sometimes used to treat schizophrenia include the likes of antidepressants and mood stabilisers (ask in store for longer version of this article which has more detail on these)

 

What is the outlook (prognosis)?

In most cases there are recurring episodes of symptoms (relapses). Most people live relatively independently with varying amounts of support. Frequency and duration of each relapse can vary. Some people recover completely between relapses. Some people improve between relapses but never quite fully recover. Treatment often prevents relapses, or limits their number and severity.

 

Outlook is thought to be better if:

  • Treatment is started soon after symptoms begin.
  • Symptoms develop quickly over several weeks rather than slowly over several months
  • The main symptoms are positive symptoms rather than negative symptoms.
  • The condition develops in a relatively older person (aged over 25).
  • Medication is taken as advised.
  • There is good family and social support which reduces anxiety and stress.
  • Abuse of illegal drugs or alcohol does not occur.

 

Newer drugs and better psychological treatments (discussed in more detail in my longer article) mean that prognosis is now better than it was in the past.

Whelehans Pharmacy, 38 Pearse Street, Mullingar. Tel 04493 34591. Eamonn’s full comprehensive article is available in Whelehans on request. Ask staff for a free copy.

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Schizophrenia

Posted by Eamonn Brady on

Overview

For my detailed article on schizophrenia ask Whelehans staff for a free copy or log on to www.whelehans.ie.

 

Symptoms

Symptoms include hallucinations (seeing and hearing things), delusions (false ideas), disordered thoughts, and problems with mood, behaviour and motivation. It can cause a loss of touch with reality thus becoming unable to tell what is real and what is not. The cause is not clear. Symptoms can recur or persist long-term, but some people have just one episode of symptoms lasting a few weeks.

 

Positive and negative symptoms

The symptoms are classed as either positive or negative. Positive symptoms are abnormal mental functions while negative symptoms are a loss of normal mental functions.

 

Negative symptoms include loss of motivation (loss of interest in social activities and mixing with people, loss of concentration and inability to complete activities you previously had no problem completing), loss of a sense of pleasure, slow movements, lack of facial expression and low or flat mood. The person may neglect appearance and look unkempt. Negative symptoms of schizophrenia are similar to depression symptoms and can be misdiagnosed as depression

 

Positive symptoms are psychotic behaviours not seen in healthy people; they cause loss of touch with reality and include delusion, hallucinations, disordered thoughts and movement disorders

 

Incidence and prevalence

Schizophrenia occurs in about 1 in 100 people; this rate is the same for all ethnic groups. It occurs equally in men and women. It most often first develops between the ages of 15 to 25 in men and 25 to 35 in women. First diagnosis of schizophrenia is rare after the age of 45. The cause is not clear. It tends to run in families; 70% of the risk of schizophrenia is thought to be hereditary.

 

Treatment

People living schizophrenia often do not realise they have a mental illness and may not think they need help because they believe their delusions or hallucinations are real. Antipsychotic drugs are broadly divided into two categories; older typical or newer atypical antipsychotics.

 

Older typical antipsychotics

Sometimes called first generation antipsychotics; first appeared in the 1950’s. Examples include chlorpromazine (Largactil®), trifluoperazine (Stelazine®), haloperidol (Serenace®), flupentixol (Depixol® Injection, Fluanxol® tablets), zuclopenthixol (Clopixol® Injection), and sulpiride (Dolmatil®). 30% of patients have a relapse during treatment with first-generation antipsychotic drugs compared with 80% without treatment.

 

Newer or atypical antipsychotics

Also known as second generation antipsychotics; first prescribed in the 1990’s. Examples are amisulpride (Solian®), aripiprazole (Abilify®), clozapine (Clozaril®), olanzapine (Zyprexa®), quetiapine (Seroquel®) and risperidone (Risperdal®). Atypical antipsychotics are often used first-line for newly diagnosed schizophrenia. This is because they demonstrate good balance between chance of success and the risk of side-effects.

 

Depot injections of an antipsychotic drug

Non-compliance can be a problem with schizophrenia. An American study showed that 74% of patients with schizophrenia discontinued medication within 18 months without consulting with their doctor leading to relapses. Non-compliance is similar for atypical and typical antipsychotics; therefore depot injections can be a solution where compliance is a problem. A depot injection is a long acting injection which is administered by a doctor or nurse and only needs to be administered typically every few weeks.

 

To be continued….next week I discuss treatment in more detail

 

Whelehans Pharmacy, 38 Pearse Street, Mullingar. Tel 04493 34591. Eamonn’s full comprehensive article is available in Whelehans on request. Ask staff for a free copy.

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