Perhaps less well known is the fact that smoking causes blindness. Smokers and people who have smoked are three times more likely to develop macular degeneration.

The potentially serious adverse effects of smoking on our eyesight and the possible benefits of diet and exercise are just some of the messages to come from the recent Macular Degeneration Awareness Week.

Macular degeneration (MD) – sometimes known as age-related macular degeneration (AMD) because of its high prevalence in older people – is the leading cause of irreversible blindness in Australia and other Western countries.

It is the name given to a group of diseases of the retina which cause progressive, painless loss of central vision. Thus the ability to see fine detail, drive, read and recognise faces is slowly but surely lost.

Presently there is no cure for AMD; and treatments to delay or stop its progression have met with limited success. As AMD is so common (one in seven people over the age of 50 is affected) there is increasing interest in identifying risk factors which, when modified, may reduce the chance of getting AMD, or stop the condition becoming worse when it does occur.

A family history of macular degeneration gives us a 50% chance of developing the disease. We can’t do too much to change our parents, so a regular and frequent check up by the eye specialist is important for early diagnosis.

On the other hand, something we can address is a commitment to become a non-smoker. Many studies have clearly demonstrated the link between smoking and AMD.

There is ongoing debate about the relationship between AMD and obesity, high blood pressure and high cholesterol levels; but research strongly suggest that diet is significant.

There’s probably still some doubt as to whether eating your crusts makes your hair grow curly. But there’s no doubt the advice we got from our mums and grandmums with respect to vegetables was pretty accurate.

In particular the likelihood is that the pigments beta-carotene, lutein and zeaxanthin found in carrots, pumpkin, corn and some green leafy vegetables are beneficial. Other antioxidants of interest include vitamins A and E and the trace elements zinc and selenium.

Proprietary preparations containing these substances are now available, but the use of anti-oxidants in high doses is not without risk. Beta-carotene has been found to increase the risk of lung cancer in smokers; and vitamin E has been associated with an increased risk of heart failure in people with diabetes or disease affecting circulation. Check with your pharmacist before you choose a specific product.

On the other hand, there is evidence that fish oil (containing so-called omega-3 fatty acids) might provide protection against AMD. So, the Macular Degeneration Foundation advises eating fish two or three times a week, eating dark-green leafy vegetables and fresh fruit, eating a handful of nuts once a week and protecting your eyes from sunlight exposure; and of course, if you’re a smoker, then quit! You can get more good advice from the Foundation at www.mdfoundation.com.au And you can access a copy of their new publication Slips, Trips and Falls, a guide for people with low vision on how to avoid them.

Also, pharmacies around Australia providing the Pharmaceutical Society’s Self Care health information have a fact card titled Vision Impairment. The card gives details about not only AMD but also glaucoma, cataracts, diabetic retinopathy, and refractive error.

To locate the Self Care pharmacy nearest you, log on to the Pharmaceutical Society (PSA) website at www.psa.org.au and click on “self care pharmacy finder”. Or phone PSA on 1 300 369 772

©2010 Pharmaceutical Society of Australia

Sun protection factor (SPF) labelling provides a reasonable indication of the effectiveness of sunscreens. The higher the number, the more time we can spend in the sun before burning – well that’s the theory anyway. The reality is that the protection will depend on a number of factors such as how well the sunscreen is applied and the formulation of the product itself (e.g., degree of water resistance).

Since 1998 the highest SPF label permitted has been 30+ (previously it had been 15+). It is now likely that a new maximum level of 50+ will be approved this year.

It’s a somewhat controversial move, because although it will allow us to more clearly differentiate between different sunscreens, the extra protection provided between 30+ and 50+ is minimal.

Perhaps more important for adequate protection is that sunscreens be applied in sufficient quantity and reapplied every two hours .It’s also important that we choose a sunscreen that has protection from the broad spectrum of ultraviolet (UV) rays. SPF ratings are measured on the burning UVB rays, but other wavelengths of ultraviolet light (e.g., UVA) can be carcinogenic too. Sunscreens are usually made up of a combination of chemical and physical UV filters. The physical filters zinc oxide and titanium dioxide are particularly valuable because of their ability to filter both UVA and UVB light.

When incorporated into sunscreens in their coarse powder form zinc oxide and titanium dioxide give the skin a white colour; so they are now generally used in microfined, so-called nanoparticle form. Despite some concerns expressed about the use of nanoparticles in industry, there is currently no evidence to suggest that use of nanoparticles in sunscreens causes damage to skin cells.

Remember the adverse effects of sunlight on the skin are cumulative. The damage on and beneath the skin is building up, even without burning.

Research undertaken by the Cancer Council and the Australian Department of Health and Aging shows that it’s not just the day, or even several days, at the beach that causes the most sun damage to our skin. The many days spent involved with everyday activities, without adequate protection from the sun, might be even more dangerous. And with most states in Australia now “saving daylight”, there is the possibility we will have more usable leisure time in the sunshine.

If you’re 55 years old or more, you were probably in your 30s when the need for skin protection became well recognised; and most of the damage to your skin had already taken place.

Of course, it’s not too late to look after your skin now; but you also need to check your skin regularly for any new spots or a change in appearance of those existing spots.

If you must have a tan, a fake tan is the best option. There are a number of products your pharmacist can recommend which offer a much safer alternative to the sun-induced variety. But, remember, the colour from a fake tan does not provide protection against UV radiation. And fake tan products that contain a sunscreen only provide protection for a few hours after application – not for the duration of the tan.

You can get more advice and a Sense in the Sun Fact Card on how to stay sun smart this summer, from pharmacies providing the Pharmaceutical Society’s Self Care health information. Phone 1300 360 772 for the location of your nearest Self Care pharmacy or check out the Pharmaceutical Society website at www.psa.org.au and click on Self Care Pharmacy Finder.

©2010 Pharmaceutical Society of Australia

Apples are a good source of fibre and vitamins – especially vitamin C, but some other vitamins and minerals as well. In the fibre department, apples contain both soluble fibre – such as pectin which helps prevent the build-up of cholesterol in the lining of the blood vessels – and insoluble fibre, which provides bulk in the intestinal tract. This bulk enables a quick passage of food through the digestive system – just what the doctor ordered.

Creative commons licensed image

Probably the best known Australian apple is the “Granny Smith”. In 1838, Thomas and Maria (Granny) Smith migrated from Sussex, England to Ryde in NSW. It was some 30 years later that the famous green skinned apple was developed – apparently from the remains of some French crab-apples grown in Tasmania.

However, it’s the red apple which has greater significance this month. The red apple is the symbol of the Bowel Cancer and Digestive Research Institute; and Red Apple Day on June 10 aims to increase awareness of bowel cancer and other gastro-intestinal problems.

Other than skin cancer, bowel cancer is the commonest of all cancers affecting both men and women. There are 10,000 new cases of bowel cancer diagnosed every year; and there are twice as many deaths from bowel cancer in Australia as from motor vehicle accidents. One Australian dies from bowel cancer – also known as colorectal cancer (CRC) – every two hours.

Perhaps because these statistics are so frightening, there’s a reluctance for us to seek medical attention or even acknowledge the possibility of CRC. Nevertheless, bowel cancer is both treatable and curable.

In the early stages, bowel cancer often has no symptoms; but blood in the bowel motions, persistent changes in bowel habits (diarrhoea or constipation) frequent “wind” pains and loss of weight for no known reason, should all be investigated by your doctor. If a close relative has had bowel cancer, your own risk increases significantly, and a regular check-up is necessary.

If you turn 50, 55 or 65 before the end of 2010, you’re eligible to receive a free bowel cancer screening test as part of the Australian Government’s National Bowel Cancer Screening program. The test should arrive in the mail around the time of your birthday. Otherwise you can purchase a Rotary Bowelscan from participating pharmacies or log on to the website (www.bowelcanceraustralia.org). These simple to use tests identify so-called faecal occult blood – blood in the stool which may be an early sign of bowel cancer.

Bowel cancers usually begin as small growths called polyps. Most polyps cause no problems. However, over time, some polyps may become cancerous and their growth is then uncontrolled. It’s important therefore, to remove polyps as soon as they are detected. This procedure is carried out by means of a colonoscope – a long flexible tube which allows the operator (a specialist gastroenterologist) to visually assess the health of the rectum and the colon, and cut out any suspicious bowel tissue for further examination.

Apart from the existence of polyps, bowel cancer appears to be more common in people whose diet is high in fat, and low in fibre, fruit and vegetables. Smoking and alcohol consumption may also add to the risk. So just crunching an apple a day won’t mean we have no need for a regular check-up; but along with other fruit and vegetables the apple may reduce our bowel cancer risk. We also need to limit our alcohol intake to no more than two drinks a day and we should definitely not smoke. It seems regular physical activity also reduces the risk.

Pharmacies providing the Pharmaceutical Society’s Self Care material can give you more information about bowel cancer. For the location of your nearest Self Care Pharmacy check out the PSA website at www.psa.org.au or phone 1300 369 772 and ask the pharmacy for the fact cards titled Fibre and Bowel Health and Fat and Cholesterol. They contain some great hints on how to keep your bowel and also the rest of your body healthy and functioning well.

©2009 Pharmaceutical Society of Australia

Australia has the world’s highest rate of skin cancer with about 400,000 people being diagnosed with the condition each year; of this number there are around 1600 deaths. So there is the potential for many lives to be saved.

Professor Ian Frazer, former Australian of the Year, has led the research team in developing the vaccine for skin cancer. And as with the jab now given to millions of young girls each year to prevent cervical cancer (the vaccine for which was also developed by Professor Frazer), children between the ages of 10 and 12 would be offered the skin cancer vaccine.

However, as promising as this sounds, it is certainly no cure for skin cancer. Firstly, the vaccine is likely to be effective against only one of the skin cancers, namely so-called squamous cell carcinoma.

Squamous cell is the second most common skin cancer. Less common, but more deadly are melanomas; and it’s yet to be determined as to whether the vaccine will offer any protection against melanomas.

Secondly, it is likely to be many years before the vaccine has been proven suitable and safe and generally available for human use.

Meanwhile, protecting the skin from UV radiation (that is sunlight) is the best course of action. And remember, the adverse effects of sunlight on the skin are cumulative. The damage on and beneath the skin is building up, even without burning.

Research undertaken by the Cancer Council and the Australian Department of Health and Aging shows that it’s not just the day, or even several days, at the beach that causes the most sun damage to our skin. The many days spent involved with everyday activities, without adequate protection from the sun, might be even more dangerous. And with most states in Australia now “saving daylight”, there is the possibility we will have more usable leisure time in the sunshine.

Results of the survey indicated that Australians were much more likely to get sunburnt at home than anywhere else. So even “accidental tanning” is a risky business.

Perhaps that’s not so surprising. The survey showed that while around 8% of Australians regularly went to the beach at the weekend, nearly 30% spent time gardening or working around the house.

If you’re 55 years old or more, you were probably in your 30s when the need for skin protection became well recognised; and most of the damage to your skin had already taken place.

Of course, it’s not too late to look after your skin now; but you also need to check your skin regularly for any new spots or a change in appearance of those existing spots.

If you must have a tan, a fake tan is the best option. There are a number of products your pharmacist can recommend which offer a much safer alternative to the sun-induced variety. But, remember, the colour from a fake tan does not provide protection against UV radiation. And fake tan products that contain a sunscreen only provide protection for a few hours after application – not for the duration of the tan.

You can get more advice and a Sense in the Sun Fact Card on how to stay sun smart this summer, from pharmacies providing the Pharmaceutical Society’s Self Care health information. Phone 1300 369 772 for the location of your nearest Self Care pharmacy.

Except in medical circles, cancer is probably not a common topic of conversation. However, it makes plenty of sense to know the warning signs and symptoms, where to get help and what treatment options are available. There are many forms of cancer, but what they have in common is that when diagnosed early enough, they can nearly always be cured.

It’s an interesting coincidence that Bowel Cancer Awareness Week and International Men’s Health Week are occurring at the same time. Certainly men are affected by bowel cancer more than women. Nevertheless, other than skin cancer, bowel cancer is the commonest of all cancers affecting both men and women.

There are 10,000 new cases of bowel cancer diagnosed every year; and there are twice as many deaths from bowel cancer in Australia as from motor vehicle accidents. One Australian dies from bowel cancer – also known as colorectal cancer (CRC) – every two hours.

Perhaps because these statistics are so frightening, there’s a reluctance for us to seek medical attention or even acknowledge the possibility of CRC. Nevertheless, bowel cancer is both treatable and curable.

The word bowel comes from the Latin word for sausage and it describes that long tube that runs from the stomach to the anus. It’s in the large part of the bowel, known as the colon and the rectum, where bowel cancers occur.

In the early stages, bowel cancer often has no symptoms; but blood in the bowel motions, persistent changes in bowel habits (diarrhoea or constipation) frequent “wind” pains and loss of weight for no known reason, should all be investigated by your doctor. If a close relative has had bowel cancer, your own risk increases significantly, and a regular check-up is necessary.

Bowel cancers usually begin as small growths called polyps. Most polyps cause no problems. However, over time, some polyps may become cancerous and their growth is then uncontrolled. It’s important therefore, to remove polyps as soon as they are detected. This procedure is carried out by means of a colonoscope – a long flexible tube which allows the operator (a specialist gastroenterologist) to visually assess the health of the rectum and the colon, and cut out any suspicious bowel tissue for further examination.

Even if a bowel polyp grows and becomes a cancer, all is not lost. In its early stages most bowel cancer can be cured by surgery – and most surgery does not involve a bag or colostomy.

Apart from the existence of polyps, bowel cancer appears to be more common in people whose diet is high in fat, and low in fibre, fruit and vegetables. Smoking and alcohol consumption may also add to the risk.

So while just crunching one red apple a day may not keep the doctor away, we certainly need to eat more fruit and vegetables. We also need to limit our alcohol intake to no more than two drinks a day and we should definitely not smoke. It seems regular physical activity also reduces the risk.

Pharmacies providing the Pharmaceutical Society’s Self Care material can give you more information about bowel cancer. Phone 1300 369 772 and ask for the fact cards titled Fibre and Bowel Health and Fat and Cholesterol. They contain some great hints on how to keep your bowel, and also the rest of your body healthy and functioning well.

©2008 Pharmaceutical Society of Australia

There’s nothing new about palliative care. In fact it’s the major effect of many of our prescriptions and non-prescription products and the concept of palliative care has been around for centuries. Medicines which provide a cure are comparatively new arrivals on our pharmacy shelves.

Perhaps it’s because we’re now living much longer these days and, therefore, there is a greater focus on palliative care – the process of providing quality of life – especially towards the end of life.

The need for pain relief as a part of palliative care would seem quite obvious, but for many reasons pain relief is neglected or not provided in an effective way.

It was about ten years ago that an article in “New Scientist” magazine drew attention to the need for a reassessment of pain relief in palliative care.

The author stated that “the magic solution that would allow the vast majority of terminally ill people to die in relative comfort is not expensive or dangerous. It is one of the oldest medicines known: morphine. But because morphine is a narcotic and associated with heroin, it has gained a reputation among the medical profession and the public as a dangerous drug.”

A decade on, most doctors and pharmacists certainly have a better understanding of the benefits of the opioid pain relievers such as morphine. However, there are still misconceptions in the minds of many patients, their families and carers.

In recent years we have seen the development of a number of variations on the old morphine mixtures – preparations which are easier to take, more palatable and less likely to cause uncomfortable side effects. There are long-acting and sustained release tablets and capsules, as well as patches and lozenges in doses which can be individually tailor-made.

Of course, opioid analgesics aren’t the only option – nor even the most appropriate one on many occasions. Simple pain relievers like paracetamol or the non-steroidal anti-inflamatories can be very effective when taken in the right dose. And medicines such as antidepressants, antiepileptics, antispasmodics and steroids – medicines not normally associated with pain relief by patients and their families – are often the drugs of choice.

People who are terminally ill will be under the care of their doctor; and the pharmacist can also provide good advice about the role of various medicines – the way they work, the appropriate dose, whether they are given routinely or just as required and also the potential for side effects and how to treat them.

There might also be the need for regular laxatives or occasional antinauseants and possibly something for dry mouth caused by the side effects of some of the medicines.

Pain is experienced by more than 50% of people with advanced cancer; but it is also often a problem with other chronic conditions. There is no valid reason why effective pain relief should not be available for all these patients.

The World Health Organisation (WHO) has a so-called Analgesic Ladder to help explain how pain relievers are best given. Your pharmacist can guide you through the steps. Ask also for the series of “pain reliever” fact cards available from pharmacies around Australia providing the Self Care health information. Phone 1 300 369 772 for the nearest location or check out the website www.psa.org.au/psc

©2008 Pharmaceutical Society of Australia