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Bioidentical Hormone Replacement Therapy (BHRT)

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Bioidentical Hormone Replacement Therapy (BHRT)
By Sheila Jiwan

Compounding pharmacists at our Pharmasave stores can create customized BHRT that closely mimics individual patients’ optimum natural hormone levels. With natural, customized BHRT, patients can mitigate the symptoms associated with menopause and other hormonal imbalances, while minimizing side effects and risks associated with synthetic hormones. With bioidentical hormones, doses can be easily adjusted and fine-tuned to control symptoms and provide long-term health benefits.

Hormones perform a vast array of complex functions in the body. When hormone levels are deficient or imbalanced, people can suffer unpleasant symptoms. Hormone replacement therapy (HRT) has many benefits for women (and men) suffering from hormone imbalances and deficiencies.

Western medicine has tended to treat hormone imbalances and deficiencies with doses of synthetic hormones. Although they are similar to the hormones that occur naturally in our bodies, synthetic hormones are chemically and structurally different than human hormones. For these reasons, synthetic hormones can cause undesirable side effects (such as fluid retention, nausea, breast tenderness, blood clots, headaches, leg cramps, irritability, and depression). The body may also take longer to eliminate them.

Bioidentical hormones, on the other hand, are chemically identical to the hormones produced by the body. For this reason, they produce few unwanted side effects when taken in appropriate quantities and ratios. They are also easily eliminated from the body.

For more information on Bioidentical HRT (BHRT), please watch this video and decide if this treatment is of interest to you. Contact one of our pharmacies for an appointment with me to discuss your unique situation; together we’ll determine if BHRT is right for you.

Sheila Jiwan is a Pharmacist and expert in women’s health and wellness. She has helped women of all ages with personalized healthy aging programs that make a significant difference in the lives of her patients and customers.

Is it influenza or a cold?

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Is it influenza or a cold?

Humourous 15 second ad from ImmunizeBC that highlights the difference between a cold and influenza.

The following table from HealthLinkBC can help you determine whether you have influenza or a cold.

Symptoms Cold Influenza (“the flu”)
(a) Fever Rare Usual, sudden onset 39° to 40°, lasts 3 to 4 days
(b) Headache Rare Usual, can be severe
(c) Aches and Pains Sometimes mild Usual, often severe
(d) Fatigue and weakness Sometimes mild Usual, may last 2 to 3 weeks or more
(e) Extreme fatigue Unusual Usual, early onset, can be severe
(f) Runny, stuffy nose Common Sometimes
(g) Sneezing Common Sometimes
(h) Sore throat Common Sometimes
(i) Chest discomfort, coughing Sometimes mild to moderate Usual, can be severe
(j) Complications Can lead to sinus congestion or earache Can lead to pneumonia, respiratory failure, and more complications in
persons with chronic diseases
(k) Prevention Frequent hand-washing Yearly influenza vaccine and frequent hand washing
(l) Treatment No specific treatment is available; symptom relief only Anti-viral drugs by prescription, which can reduce symptoms

Talk to your pharmacist – they’re your #1 resource this cold and flu season!

Not only can community pharmacists provide flu vaccines, they can also offer advice on over-the-counter medications and natural health products if you have a cold.


What is Compounding?

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By Sheila Jiwan, Pharmacist and Certified Metabolic Anti-Aging Medicine Consultant

Simply put, compounding is the art and science of creating personalized medication. We take individual ingredients and mix together the exact strength and dosage required by the patient and prescriber. Unlike manufactured medications, where there are only a few different dosages strengths and forms, compounding allows for endless options.

Compounding’s history

Back in the days of your great grandparents, nearly all prescriptions were compounded. It wasn’t until the 1950’s and 60’s that mass drug manufacturing began to rapidly grow. Pharmacists quickly changed their role from manufacturer to dispenser. Unfortunately pharmacists were no longer trained to compound medication. However, the “one-size-fits-all” nature of many mass-produced medications meant that some patients needs were not being met. Fortunately, compounding has experienced resurgence as modern technology and innovation have allowed more pharmacists to customize medications to meet your specific needs.

What are the BENEFITS of Compounding?

We can help personalize medication for patients who need specific strengths, dosage forms, or ingredients excluded from medications due to allergies or other sensitivities.

  • When your medication is either discontinued or unavailable from the suppliers we can compound the medication for you so you don’t have to be without or switch
  • If you have allergies to the medication due to preservatives, dyes or fillers, we can customize your medication for you to avoid this problem
  • Tailored dosage strengths for patients with very specific needs such as a baby can be achieved through compounding when the strength required is not commercially available
  • If your doctor has prescribed a strength that is not available, we can compound it for you
  • If you have problems taking the medication; for example, if the pill is too large to swallow we can make the medication in an alternative dosage form such as a suspension liquid or cream.
  • Your option of having alternate dosage forms such as lozenges or gummies
  • We can combine several medications to increase compliance (ie. cream for your skin)
  • If a medication does not taste good, we can add flavor to make it more palatable for the patient, this is ideal for children. We can also flavor accordingly for your pets.
  • If you are prescribed one of many possible dosage forms for bioidentical hormone replacement therapy.

How does a compounding pharmacy work?

A compounding pharmacy uses state-of-the-art equipment, chemicals and advanced techniques to compound and ensure quality products. This method allows the compounding pharmacist to work with the patient and the prescriber to customize a medication to meet the patient’s specific needs. Other pharmacies do not have the time, equipment, chemicals, or education to ‘custom-make’ your medications.
Our trained pharmacists use the only sterile “clean room” in Burnaby to custom make your prescribed medications. Each compound is hand made from the highest quality chemicals and quality assured by the Pharmacist.

For more information on our compounding services, please contact us.

Sheila Jiwan is the Pharmacy Manager at Pharmasave-Canada Way Health Centre in the Summitview Medical Centre. She is American Board Certified in anti-aging medicine as a Certified Metabolic Anti-Aging Medicine Consultant. She leads the compounding pharmacy located in Summitview Medical Centre that prepares unique and highly individualized prescriptions.

What are hormones and what do they do?

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By Sheila Jiwan, Pharmacist and Certified Metabolic Anti-Aging Medicine Consultant

Bio-Identical Hormone Therapy

Hormones are natural substances produced in our body and act as messengers. They are produced by our glands, for example, ovaries, testes, thyroid, adrenal glands and the pancreas. The hormones released form the glands; then control essentially all our metabolic functions by acting on many different cells in the body and by giving the cell different commands as to what to do. As we go through our life our hormone levels change and eventually many of our hormone levels decline. It is the purpose of bio-identical hormone therapy to maintain hormones at their optimum level and to keep hormones balanced. Balancing hormones and maintaining them at a youthful level achieves not only a sense of well being but also slows down the development of many degenerative diseases.


Cortisol is a hormone produced by our adrenal glands. It is a hormone that allows our bodies to deal with situations that we perceive as being dangerous. In response to danger we increase our blood sugar, increase our blood pressure and suppress our immune system. Problems arise when we are under chronic stress and our cortisol levels remain chronically elevated. This can result in poor immune system function which makes us prone to infections. Chronically elevated cortisol levels are also associated with osteoporosis, diabetes, insulin resistance and breast cancer. Problems can also result when the adrenal glands become fatigued and cortisol levels remain chronically low. Good nutrition and supplements, proper sleep and stress reduction all have to be used to maintain healthy adrenal function.


DHEA is a hormone produced by our adrenal glands and like testosterone it is an androgen. As we age our DHEA levels decline. DHEA is a precursor to other hormones made by the adrenal glands including testosterone and estrogen. This is especially important in post menopausal women. DHEA plays an important role in immune function and our ability to handle stress. Good nutrition and supplements can be used to naturally improve DHEA levels.


Estrogen is a term given to a family of hormones. We actually make three different types of estrogen in our body; Estriol, Estradiol and Estrone. Bio-Identical hormone therapy can include any one or all of the estrogens. Maintaining optimum balance of estrogen protects against heart disease, osteoporosis and dementia. Symptoms of Estrogen deficiency include hot flushing, night sweats, mood swings, depression, memory loss, vaginal dryness, decreased libido, skin dryness and fine facial wrinkles.


Insulin is a hormone produced by the pancreas. Insulin is secreted from our pancreas in response to increase in our blood sugar. Insulin then allows our cells to process blood sugar and use it or store it for energy. Excess weight and obesity causes our cells to become insulin resistant; the cells need more and more insulin to process the same amount of sugar. When we do not have adequate insulin our blood sugar stays high and diabetes can develop. Elevated levels of sugar in our blood cause premature aging in many of our organs, leading to kidney damage and cardio vascular disease. Weight management, physical activity, diet and nutritional supplements should all be used to maintain a healthy insulin and glucose balance throughout our entire life.


Progesterone is a hormone that balances estrogen in our bodies; it thus protects us from developing uterine and breast cancer. Progesterone also prevents osteoporosis, helps to treat fibrocystic breast disease and endometriosis. It is progesterone that frequently is lacking, even in the peri-menopausal years, and causes many unwanted symptoms such as anxiety, irregular periods, breast swelling and tenderness, fluid retention and weight gain.


Testosterone is primarily a male hormone but it has many important functions in both men and women. It maintains muscle mass and protects against osteoporosis. In both men and women low testosterone can result in loss of sex drive, decrease in energy level, depression, loss of muscle strength and hot flushing. In men symptoms also include increased abdominal fat, development of fatty breasts and problems with erections.


Thyroid hormone controls almost all aspects of our metabolism. Hypothyroidism, or under production of thyroid hormone, is a common condition as we age. Thyroid hormone acts as a thermostat in our body, when too low, all processes and metabolism slows down; when too high, the processes speed up. Common problems associated with suboptimal thyroid function include: feeling cold, even when others are warm, cold hands and feet, fatigue, especially in the morning; weight gain, dry skin, constipation, hair loss and high cholesterol. Sometimes standard tests do not reveal subtle deficiencies. It is important to accurately asses thyroid function, replace thyroid hormone and optimize its levels by using natural thyroid replacement and by using supplements that support thyroid gland function.

Bio-Identical Hormones

Bio-Identical hormones are identical and have the exact same molecular structure as those produced by our body. Bio-Identical hormones are made from natural plant compounds that are similar in structure to human hormones. Estrogens and progesterone are made from compounds derived from yam and soy. Unfortunately, most commonly prescribed hormones and hormones used in large studies have been synthetic. The synthetic hormones are structurally different from human hormones and therefore have unwanted effects on our bodies. Some of the synthetic hormones, for example, were derived from pregnant horses’ urine and the product then contained horse estrogens which are unnatural and harmful to humans. When considering the risks and benefits of hormone therapy it is crucial to keep in mind that bio-identical and synthetic hormones are not the same and at times have completely the opposite effects on the human body. When bio-identical hormones are prescribed correctly they can treat many symptoms and prevent diseases associated with aging. Bio-identical hormone preparations or creams are made at special pharmacies called compounding pharmacies. Compounding Pharmacies make each preparation on a case-by-case basis for each patient to meet their specific needs.

Sheila Jiwan is the Pharmacy manager at Pharmasave Health Centre in the Summitview Medical Centre. She is American Board Certified in anti-aging medicine as a Certified Metabolic Anti-Aging Medicine Consultant. Sheila speaks to groups about healthy aging and the positive effects of Bio-Identical Hormone Replacement Therapy (BHRT). She leads the compounding pharmacy located in Summitview Medical Centre that prepares unique and highly individualized bio-identical hormone prescriptions.

Women’s Health

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Women’s Health
By Sheila Jiwan

Are you always fatigued, feeling tired but “wired” or constantly stressed and burnt out?

“If only I had the energy I used to!” sounds familiar to you, perhaps you ought to consider knowing more about a condition you may be suffering from called adrenal fatigue, adrenal exhaustion, or adrenal burnout.

I am continuing to see an increase in women suffering from constant stress that leads to high cortisol levels, adrenal imbalance and complete exhaustion. It occurs when the adrenal glands are putting out the wrong levels of stress hormones — either too low or too high — in relation to the amount that is needed. This mismatch often results in troubling symptoms. In addition to fatigue, women with adrenal imbalance may experience weakness, moodiness or depression, hair loss, weight gain and dozens of other symptoms — some very serious.

If you’re like many women in today’s world, you probably can’t imagine how it’s possible for you to reduce stress and the negative effects it has on your body.

That’s why every woman with any of these symptoms should undergo a series of tests that evaluate markers of stress, including cortisol and DHEA levels. The clinical results — in over thousands of cases — are remarkably consistent: only 20–25% have cortisol levels consistent with healthy adrenal function, while 75–80% suffer impaired function in various patterns ranging from mild to more serious.

How chronic stress leads to high cortisol, adrenal imbalance and severe symptoms

With stress, your adrenals rally your body into a “fight or flight” survival response by increasing adrenaline and cortisol production. No matter what the cause of the stress, your body sees it as an emergency.

In its normal function, cortisol helps us meet these challenges by converting fats and proteins into energy, keeping us alert, balancing electrolytes, calibrating heart beat and pressure, and counteracting inflammation. In the short run, that’s great — even protective and restorative. However, problems can develop as today’s relentlessly busy lifestyle forces your adrenal glands to be on constant “high alert” resulting in sustained high levels of cortisol.

Sustained high cortisol levels are dangerous because they:

• Slow down healing and normal cell regeneration.
• Co-opt parent molecules needed to make other vital hormones
• Impair digestion, metabolism and mental function
• Interfere with healthy endocrine function
• Weaken your immune system

When your adrenals are required to constantly respond to stress, they eventually have to struggle to produce cortisol, as well as other key hormones such as DHEA and the sex hormones estrogen, progesterone and testosterone. This difficulty in producing hormones becomes especially critical as a woman enters peri-menopause and menopause and needs the full support of her adrenals to prevent extreme sex hormone fluctuations.

The damaging effects of high cortisol

Adrenal imbalance in women tends to peak between the ages of 35 and 55. Most women can recognize themselves in one of these descriptions:
• You’re always active and feel “wired.” Your system is constantly fueled by adrenaline and cortisol to create what feels like a continual state of hyper-energy. Yet you often feel drained.
• You can’t get up in the morning — but you can’t sleep at night. Your natural 24 hour cycle of energy and relaxation is off-balance. If you’re able to fall asleep, you may wake up in the middle of the night fully alert.
• You have no energy — period. You feel exhausted all the time. Even getting out of bed often feels like a challenge. You may also experience intense cravings and unexplained weight gain.

Adrenal imbalance may also be a factor in many other serious conditions, including fibromyalgia, hypothyroidism, chronic fatigue syndrome, depression, arthritis, and more.

Normalize cortisol levels to restore adrenal balance

Women with mild to moderate adrenal imbalance can have several options that can help them feel significantly better while keeping symptoms from becoming more severe. The key is taking the right steps to normalize cortisol levels and restore healthy adrenal function. You can take immediate action by asking these simple questions:

Are you eating in tune with your natural cortisol curve?

• At mealtime it is important to rebalance your adrenal glands. The goal is to achieve more stable energy levels throughout the day, which you can accomplish by eating three balanced meals with two snacks.
• What you eat makes a difference as well. Try to reduce refined carbohydrates — such as sugar, flour, potatoes, and white rice — which cause stressful ups and downs in your blood sugar that can lead to adrenal imbalance. This may be difficult, however do the best you can. At the beginning, the goal is progress, rather than perfection!

Can nutritional supplements support my adrenal glands?

• High-quality vitamins, minerals, and essential fatty acids help support a healthy metabolism and hormonal balance, which contribute to adrenal health. I recommend Platinum Naturals Super Easy Multi 45+ with 30 vitamins and minerals as an easy-to-take formulation that builds a strong nutritional foundation.
• Specific amino acids and herbal supplements, such as GABA and Siberian ginseng, are effective at reducing the negative side effects of stress, producing calming effects and encourage sleep. Rhodiola rosea and cordyceps play an integral part in improving oxygen absorption, increasing your energy, physical recovery and endurance. Rhodiola has also been associated with improved moods and is recommended for conditions such as Seasonal Affective Disorder (SAD). I recommend Platinum Naturals Stressentials which has a unique formula that targets the underlying symptoms of stress to provide you with quick relief.

Which lifestyle changes are best to restore adrenal balance?

• You may not always reduce stress; however you can take steps to reduce its effects on your life. Take time to understand where your stress is coming from, and then think about how you’ll make changes that are right for you and your lifestyle. It’s helpful to make a list of stressors that interfere with your wellbeing, especially those that are ongoing or self-imposed.
• Get more rest. Your body needs down time to heal!

At Pharmasave Canada Way located in the Summitview Medical Centre we can show you how to get back to feeling as energetic and vibrant as you ever have. Call me for a personal consultation at 604.453.0136 and together we’ll come up with a plan unique to your needs.

Sheila Jiwan is a Pharmacist and expert in women’s health and wellness. She has helped women of all ages with personalized healthy aging programs that make a significant difference in the lives of her patients and customers.

Hormones and Harmony – The key to balanced health

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Hormones and Harmony – The key to balanced health
By Sheila Jiwan, Certified BHRT Specialist

Your hormones should exist in harmony with each other. When levels of each hormone are in the right proportions, body systems are stable. When balance is lost, hormone deficiencies and excesses can cause chronic symptoms or disorders, and potentially raise risks for disease.

As men and women age past 40, hormonal changes occur that can inhibit physical, sexual, and cognitive function. This loss of well–being, sometimes manifesting as anxiety and/or depression; are common psychological complications of hormone imbalance. Until recently, these changes were attributed to just simply “growing old”.

Most men and women accept the fact that their bodies enter into a long degeneration process commonly associated with the “natural” aging process. However, now advanced protocols in male and female hormone profile testing allow certified clinicians to reset the aging clock and improve the outlook on overall healthy aging and longevity.

There are a whole host of symptoms that may signify an imbalance; Fatigue, Headaches, Weight Gain, Irritability, Infertility, Mood swings, Loss of libido (sex drive), Depression, and Hot flashes are among a few. The symptoms of hormonal shifts occurring in our bodies can be very strong and can even make you feel out of control at times.

If you have tried to figure out what is happening or perhaps treated your symptoms in ways that don’t seem to work; testing your hormones may be the first alternative step to feeling better.

Saliva and blood spot testing reliably identify hormone imbalances and assist certified clinician’s in identifying the right Bio-identical Hormone Replacement Therapy (BHRT) needed to restore balance.

BHRT is the use of supplemental doses of hormones that have a chemical structure identical to the hormones that the human body naturally produces which makes them biologically identical. Because bio-identical hormones are identical to those produced by the human body they offer important therapeutic advantages as well as relief from the symptoms of hormonal imbalance.

To learn more about hormones and how they work in our body click here.

Are you wondering what hormones are and what they do? See my previous blog post. Or check out what Oprah says in this article on The Basics of BHRT from her website.

Is Bio-identical Hormone Replacement Therapy right for you? Download, print and complete this Symptoms Checklist (PDF) and take it to your specialized BHRT healthcare provider to determine your symptoms of hormone imbalance and to help you choose the appropriate hormone test profile.

For more information on Bio-identical Hormone Replacement Therapy contact Sheila Jiwan, Certified BHRT Specialist, at Pharmasave/Summitview Medical Centre and book an appointment for a no charge 15 minute consultation. She can be reached at 604.453.0136.

The pharmacist’s role in managing Parkinson’s disease

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By Magdalena Kowalska-Villoroel

For many British Columbians, Parkinson’s disease gained recognition when actor Michael J. Fox revealed in 1998 that he had been diagnosed with the disease. But in reality, it is the second most common progressive degenerative neurological disorder after Alzheimer’s.

There are approximately 11,000 people in our province living with Parkinson’s. The average age of diagnosis is 60, but as many as 20 per cent of people with Parkinson’s are diagnosed under the age of 50.

Parkinson’s disease results from the death of brain cells that produce the neurotransmitter dopamine. The causes of cell death are unclear and there is no known cure.

Parkinson’s can be treated in a variety of ways including rehabilitation, stress management and, in select cases, surgery. However, the most common form of treatment is medication, meaning that community pharmacists often play a significant role in caring for patients with the disease.

From my experience, some of the most commonly used medications for Parkinson’s patients are Sinemet – both regular and controlled release – and Azilect, a MAO-B inhibitor. Other commonly seen medications include; COMT inhibitors, Amantadine, and Anticholinergic medications.

Parkinson’s patients are often on other medications that do not directly treat the disease itself, but help with other symptoms, such as laxatives for constipation.

Parkinson’s patients often have constipation, and for a number of reasons. It may be due to improper functioning of part of the nervous system responsible for regulating smooth muscle activity, a side effect of medications used to treat the disease, such as Cogentin, or other common causes like stress, lack of exercise or a diet low in fibre.

Therefore, it’s essential that all causes are determined and addressed since there are multiple interactions between Parkinson’s medications and both prescription and non-prescription drugs.

The addition of any medication to the patient’s current therapy should be carefully assessed. Some of the interactions between Parkinson’s medications and other prescription medications include Levodopa with MAO Inhibitors, or Eldepryl (selegiline) with multiple antidepressants (e.g. Citalopram, Sertraline, Fluoxetine, Venlafaxine).

Patients should also be advised to seek advice every time they purchase OTC medications, including mineral-containing multivitamins. Some common interactions include Levodopa with iron supplements; Azilect (rasagiline) with DM and decongestants; Azilect (rasagiline) with St.John’s Wort; or Eldepryl (selegiline) with DM.

The timing of administration is extremely important as well. Parkinson’s medications given late (even within a half hour) can lead to severe loss of function and patient anxiety.

An issue that comes up with Parkinson’s patients is compliance. They are very often on multiple medications with complex regimens and their therapies are usually not limited to Parkinson’s disease medications alone.

Pharmacists can help with this by blister packing medications or recommending a medication reminder with a sound alarm.

We also provide other recommendations to Parkinson’s patients; such as diet restrictions while on certain medications: Levodopa competes with certain amino acids for absorption, so the absorption of levodopa may be impaired in some patients on high protein diets. Azilect interacts with tyramine-rich foods so they should be avoided or minimized, for example processed meats and fish, aged cheese spreads or poultry skin.

The role of the pharmacist in management of the disease can help patients by checking for interactions and counseling on drug use, providing education regarding diet adjustments while on certain medications or dealing with constipation, advice on the use of OTC medications, and providing emotional support to patients as well as their family members and caregivers who may be in the pharmacy more often than the patients themselves.

There’s always something new that patients can learn from a detailed medication review, even if it’s just diet adjustments or a warning regarding OTC medication use.

We ask a lot of open-ended questions and don’t expect the patient to know what issues to bring up. Every patient is treated as a family member and we appreciate the trust that the public has in us as first-line health care professionals.

Magdalena Kowalska-Villoroel, is a pharmacist and pharmacy manager at Pharmasave in Newport Village, Port Moody. She is very involved with clinical pharmacy services overall, including vaccinations, adapting prescriptions, and conducting medication reviews. Magdalena has also given presentations to Parkinson’s support groups on medications and treatment options. She works closely with Summitview Medical Centre and is available for patient consultations.