Wintertime brings with it the opportunity for so many fun activities -- from sledding to snowball fights. But one activity few people look forward to is clearing snow and ice from streets and sidewalks.

After the first snowfall, shoveling may become a neighborhood activity that one enjoys with some good natured camaraderie. Storm after storm, however, can leave some people feeling weary of snow removal and anxious to find the quickest means to melting snow. But don't be so quick to turn to chemical de-icers. While very effective at doing their job, there may be some unintended side effects to these products that aren't so pleasant for the environment.

When the snow melts from chemical salts and sands, the runoff can flow into streams, rivers and possibly even local water supplies. Depending on which products are used, the results can range from reduced oxygen levels for marine life to killed vegetation or burnt lawns and shrubbery. Chemical de-icers can also be tracked indoors, where they have the potential to damage carpeting and bring potentially hazardous residue inside the home. For households with pets or young children who crawl and play on the floor, chemicals nearby can be dangerous.

Here's how to handle snow removal and use as minimal an amount of chemical products as possible.
* Shovel often and well. De-icing products only work on a thin layer of snow and ice, so it's wasteful and fruitless to toss salt down onto thick piles of snow.

* Limit access to your home. If you have more than one entry into the home, limit use to only one door during the winter. This reduces the number of entryways that will need to be cleared and the amount of product used to keep them from getting slippery.

* Sand isn't the best alternative to salt. Sand doesn't melt ice or snow, it just provides a little added traction. Sand runoff can cause sediment buildup in waterways. In lieu of sand, invest in special grippers that can be applied to the bottom of your shoes for added traction while walking. Also, some companies sell runners that can be placed on outdoor staircases and walkways for improved traction.

* Consider investing in heated driveways and walkways, particularly if you live in areas hard-hit by snow. These devices are installed within the concrete and heat up the surface to melt the snow.

HEALTH CANADA WARNING - ACTOS

Health Canada is informing diabetic patients taking Actos (the brand name for the prescription drug pioglitazone hydrochloride) of recent changes to the prescribing information for this product.

Health Canada has worked with the manufacturer to strengthen the labelling around heart failure and emphasize proper use. The current Product Monograph for Actos contains the following new or updated information:

r Actos should not be used in patients with any stage of heart failure (Contraindications section)

r Actos is not approved for use with metformin and a sulfonylurea (i.e. the three drugs should not be taken together) (Warnings and Precautions section)

Actos is used to treat type 2 diabetes mellitus (non-insulin dependent diabetes). While previous labelling addressed the risk of heart failure, a safety assessment completed by Health Canada on Actos identified the need for new restrictions to better manage the risk.

People with diabetes are at increased risk of developing heart failure or may have pre-existing heart disease, and are more likely to experience cardiovascular adverse events. Actos may further increase the risk of heart failure and should not be used by diabetics with any history of heart failure. Patients who experience signs of heart failure including unusually rapid weight gain, swelling, weakness, or shortness of breath while taking Actos should immediately report these signs to their health care provider.

Actos, in addition to diet and exercise, can be used to control blood sugar. It can also be used in combination with one of either metformin or a sulfonylurea (other types of drugs used to treat diabetes) but not both, in patients whose blood sugar is not adequately controlled by diet, exercise and one of these drugs alone.

Also, Health Canada would like to remind patients that the use of Actos in combination with insulin is not approved in Canada, as outlined in the Warnings and Precautions section of the Product Monograph.

Any patient who has concerns or questions about using Actos should keep taking the drug and talk to their physician.

Consumers requiring more information about this advisory can contact Health Canada's public inquiries line at (613) 957-2991, or toll free at 1-866-225-0709.To have postage pre-paid, download the postage paid label from the MedEffect™ Canada Web site. The Canada Vigilance Reporting Form and the adverse reaction reporting guidelines may also be obtained via this Web site http://www.hc-sc.gc.ca/dhp-mps/medeff/index-eng.php
 

Six tips to staying healthy when flying this winter

Healthy Travel:
(NC)-There is limited air moisture inside an aircraft and much of it is actually other people's sweat and breath. Add to this the fact that airplane filters do not remove all circulating viruses and that passengers are in very close and confined quarters, and it becomes clear people face vastly increased exposure to germs on flights.
If you are planning a winter getaway to the ski slopes or the southern sun this season, here are a few important health tips to take with you:

1. Travel well rested. Be sure to get lots of sleep a week prior to departure. In an environment with lots of people in close contact, sleep also helps keep your immunity strong to fight airborne germs.

2. Bring medications and treatments. Put your medications in your carry-on luggage just in case your suitcase is lost. Take supplements prior to travel to help prevent a cold or the flu. Certain extracts of North American ginseng root (found in the natural supplement Cold-fX) help boost your immune system to keep you healthy. Some clinical tests show virus-fighting results as high as 89%. If you feel a cold or flu coming on, you can opt for the new 'extra strength' version (with 50% more immune boosting power) as an alternative to antibiotics and other drugs.

3. Keep hydrated. Humidity levels can get as low as 10% and that will exacerbate any ailment from dry skin to headaches to catching a cold. Drink plenty of fluids but be aware that alcohol and caffeine are dehydrating too.

4. Wear comfortable clothes and shoes. Even healthy people can get blood clots in their legs, so on long flights, stretch your calf muscles at your seat from time to time.

5. Pack alcohol-based hand sanitizers. They're more effective than soap and water in killing bacteria and viruses that cause disease and are an excellent alternative while on the road.

6. Don't assume you're safe after you've landed. Researchers have found live cold viruses on hard surfaces in hotel rooms up to 24 hours after cold sufferers checked out. Boost your immune system to protect yourself.
 

RISK OF ADVERSE DRUG REACTION INCREASES WITH AGE, STUDY SAYS

As many as 4 percent of older adults in the United States combine over-the-counter medications with prescription drugs in ways that put them at risk for potentially dangerous interactions, a new survey finds.
A recent report estimated that adults over 65 account for more than 175,000 emergency department visits for adverse drug reactions each year, and commonly prescribed medications accounted for 33 percent of these drug reactions.
"The vast majority of older adults are using at least one medication and more adults are using more medications, particularly prescription medications, compared to a decade ago," said survey author Dima M. Qato, from the University of Chicago.
In addition, almost 30 percent of seniors are taking at least five prescription medications and many combine prescription and nonprescription drugs. Among commonly used medications, drug-to-drug interactions extend beyond prescription drugs, with nearly half involving the use of over-the-counter medications or dietary supplements.
"And despite limited availability of drug safety information for nonprescription medications, particularly dietary supplements, they are frequently used in older adults," Qato added.
Patients need to know that while medications are often beneficial, there are often risks associated with their use, Qato said.
"If they need to self-medicate with over-the-counter drugs or dietary supplements, they should consult with their physician or pharmacist. This is particularly important in older people because as people get older, they are more vulnerable to the negative effects of medications, including drug-to-drug interactions," Qato said.
The report is published in the Dec. 24/31 issue of the Journal of the American Medical Association.
For the study, Qato's team used survey data collected on more than 3,000 adults aged 57 to 85. The researchers looked for all medications, both over-the-counter and prescription, used between June 2005 and March 2006.
The researchers found that 91 percent of U.S. adults, about 50.5 million, used at least one medication regularly. Prescription medicines were used by 81 percent of adults, or 44.9 million older Americans. Most medications were used by those 75 to 85 years old.
In addition, almost 50 percent of older adults used at least one over-the-counter medication or dietary supplement. More women than men used prescription medications and dietary supplements. However, the use of over-the-counter medications was the same for men and women, the researchers found.
More than 50 percent of those surveyed used five or more prescription drugs, over-the-counter medications or dietary supplements. Among those taking prescription medications, 29 percent used more than five drugs and drug use increased with age among both men and women, Qato's group reports.
In addition, the researchers found that 68 percent of older adults used prescription drugs plus over-the-counter medications or dietary supplements. Among those combining drugs, 4 percent were in danger of having an adverse drug reaction.
Moreover, the rate of adverse drug interactions increased with age, particularly among women. Over 50 percent of these interactions involved the use of over-the-counter medications, the researchers found.
The most common adverse interactions occurred with blood thinners such as warfarin and antiplatelet drugs such as aspirin, Qato's group found.
"Physicians and pharmacists need to ask older patients about all the medications they use -- prescription and nonprescription -- and patients need to be prepared to share this information," Qato said. "This is especially important in patients who see multiple providers and patients that fill at multiple pharmacies."
Dr. Laurie Jacobs, chief of geriatric medicine at Montefiore Medical Center in New York City, believes that the potential for adverse drug reactions by mixing drugs is great and patients need to coordinate their medication use with one doctor to guard against harmful reactions.
"No one is looking over the number of medicines they are on to look for potential interactions," Jacobs said. "Someone other than the patient should go over the whole list."
Jacobs noted that the increase in the number of people taking drugs is a good thing. "There has been an intensification of therapy for disease," she reasoned.
However, there has also been a growth in the number of medications and an increased effort in marketing them, which makes people seek out doctors who will prescribe them, Jacobs said. In addition, there has also been an increase in the use of supplements, she noted.
"Often patients have difficulty evaluating the appropriateness of supplements with their own medical problems," Jacobs said. "They are not seeking the advice of their physician on supplement use," she said.

Common adverse drug reactions include:

- Lisinopril (Prinivil) plus potassium can elevate blood-potassium levels and disrupt heart rhythm.
- Warfarin (Coumadin) plus simvastatin (Zocor) can increase bleeding risk.
- Warfarin (Coumadin) plus aspirin can increase bleeding risk.
- Atorvastatin (Lipitor) plus niacin can cause muscle weakness, muscle breakdown
- Simvastatin (Zocor) and niacin can cause muscle weakness and muscle breakdown.
- Ginkgo plus aspirin can increase bleeding risk.

Older Drugs Better at Fighting Depression in Parkinson's Patients
 

Antidepressants that treat multiple brain receptors may be better at treating depression in people with Parkinson's disease than medications that block only the serotonin receptor, a new study says. The report, published in the Dec. 17 online issue of Neurology, found that Parkinson's patients on the tricyclic nortriptyline were almost five times more likely to have their symptoms of depression improve than were those on paroxetine CR. Tricyclics affect the norepinephrine and serotonin receptors in the brain, whereas paroxetine CR is only a selective serotonin reuptake inhibitor (SSRI).
Up to half of all people with Parkinson's experience bouts of depression.
"The study suggests that we may need to use medications that affect both serotonin and norepinephrine, not just serotonin, in the brain to be successful in treating depression related to Parkinson's disease," study author Dr. Matthew Menza, a professor of psychiatry and neurology at the Robert Wood Johnson Medical School in Piscataway, N.J., said in an American Academy of Neurology news release. Tricyclics are part of an older class of antidepressants, first used in the 1950s. They carry a higher risk of overdose and death because of the toxic effects they have on the heart and brain.
Newer medications that target both serotonin and norepinephrine should be tested, Menza said.