We all know we can feel under the weather when the nights draw in and the days get colder. Coughs and colds spread quickly, vulnerable people can get serious flu, patients are more likely to come into the pharmacy to get hold of digestion aids and hangover cures, and many people with mental health problems can find this time of the year particularly difficult.
Despite this, it is entirely possible to help your customers (and yourself!) enjoy the festivities this Christmas season, but you need to be prepared and realistic about how the festivities will unfold.
“Christmas is a nightmare!” says clinical psychologist Linda Blair. Citing unrealistic hopes that family will all get along, exhaustion from a full social calendar and overcrowded living conditions at this time of year, she says it is no wonder many of us find the Christmas season a very difficult time. “The reason that Christmas is so difficult is we have too high expectations,” Linda explains.
In addition to this, Linda says that winter is often hard for people who are sensitive to the changes in light levels that occur at this time of year (known as seasonal affective disorder or SAD), though people who don’t have this condition can also be affected by tiredness and stress in the winter.
“We really have abandoned the way we used to live since we got electric lighting and since we did that our melatonin – the neurochemical which allows us to relax and drift off to sleep – doesn’t get a chance to rise up [in the evening] and help us sleep,” Linda explains.
Back-lit screens, as well as electric lighting, Linda continues, mean that “melatonin is always pushed down and we start to live on artificial time and our circadian clock gets thrown off and once again that makes us feel exhausted as we aren’t resting as much.”
Sleep is the key to just about every stress in the winter, Linda adds, saying people should give themselves “permission to treat yourself to more rest” in the winter.
If people do find themselves experiencing low mood and tiredness during the winter months then they may have SAD. There are lamps designed specifically for people with SAD and Linda advises dimming lights in the evening, as well as making sure they get outside for at least 20 minutes a day. “Wake with the sunrise, and if you can’t do that as you have to get up earlier, wake with a light alarm, as those things will go a long way to alleviating your symptoms,” she says.
For many people it wouldn’t be Christmas without the alcohol flowing freely and with super-cheap alcohol piled up in the supermarkets it’s all too easy for people to drink too much. Fizz for breakfast anyone?
Yet be warned, all this alcohol can affect sleep patterns and people should be careful of drinking too much in the evening for this very reason. “Though alcohol lets you get off to sleep easier initially, it then depresses you and then of course it dehydrates you so you get up because you are thirsty, and then you have got to go to the loo. That can really throw off your sleep,” Linda explains.
Of course, disturbed sleep is just one of the many negative side effects of overconsumption of alcohol. The hangovers that are caused by it bring people into the pharmacy throughout December, and often into January too.
If people have drunk to excess then they should be advised to rest, rehydrate and take some painkillers if they think they need them. Hangover cures such as hair of the dog – drinking more alcohol – should be avoided as it simply delays the hangover.
If you want to help customers avoid getting a hangover in the first place, advise them on current alcohol consumption guidelines (14 units a week for men and women) and guide them towards a drink tracker to help them keep an eye on how much they are drinking, such as the NHS One You Drinks Tracker app, available at: nhs.uk/Tools/Pages/drinks-tracker.aspx.
The knock on impact of alcohol consumption during the festive period can be significant, says pharmacist Gordon Heeley who says he sees a spike in people coming to obtain the morning after pill at his LloydsPharmacy in Nottingham around the New Year. “You should make sure people are aware how to treat [customers] sensitively when you get these enquiries,” he advises.
It’s not just alcohol that people overindulge in over Christmas. With the supermarket aisles piled high with festive food from mid-October or even earlier, eating healthily and not overindulging can be a struggle.
About two weeks before Christmas more people start to come into Gordon’s pharmacy asking about indigestion remedies. “We often find in the fortnight before Christmas, that people are thinking about indigestion remedies and asking what is best for when they have overindulged at Christmas,” he says. “We recommend things like proton pump inhibitors or other gastro products.”
Indigestion can be caused by alcohol, which irritates the stomach lining, as well as fatty foods and eating to excess. While it is unrealistic to suggest people don’t overindulge at Christmas, it is important to understand just how overeating can affect the body, says Ayela Spiro, nutritional science manager at The British Nutrition Foundation.
“The increased volume of food causes our abdomen to distend so it can feel physically uncomfortable. The pressure can also increase the acid from our stomach moving to our oesophagus with the characteristic burning pain of heartburn,” Ayela explains. “More acid and enzymes will be produced to digest the foods we have. Such increased digestive needs are energy expensive and contribute to the feeling of tiredness we experience.”
Despite the negative impact overeating can have on the body, pharmacy staff should take care that customers are not tempted to ‘detox’ in the New Year. Ayela says: “Feeling guilty after overeating can promote a period of over-restrictive eating, but this can trigger further overeating. Just try and get back on the right track of healthy, balanced eating and hydration, and physical activity.”
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The longer-term consequences of overindulging in alcohol and food, can include the lowering of the immune system. Add to this the fact that many people find that when they finally relax after the stress of the build-up to Christmas they get ill, you can see a lot of opportunistic infections in the winter months.
Stomach complaints such as norovirus, are included in this. Norovirus is highly contagious and prevention depends largely on hygiene measures, such as handwashing.
Boots’ pharmacist Angela Chalmers says pharmacy staff can advise people to wash their hands regularly and to make sure they do it properly. “When you wash your hands you should be soaping and cleaning them for as long as it takes you to sing Happy Birthday twice,” she explains. “Make sure you use enough soap to cover all hand surfaces. For a quick on-the-go fix, keep anti-viral hand gel in your handbag then wash hands thoroughly as soon as you can.”
Vulnerable patients, or those with vulnerable people at home, such as the elderly or children, should also make sure they minimise exposure to people with norovirus. They shouldn’t go to visit someone with the condition until at least two days after their symptoms have passed, and if they come down with norovirus themselves they should be advised to clean bathrooms, taps and door handles with disinfectant and wash towels and sheets on a hot wash.
The big risk with stomach bugs is dehydration so customers should be advised to keep properly hydrated, use rehydration sachets if necessary and eat only bland foods when they do get their appetite back.
A depressed immune system also leaves us particularly vulnerable to upper respiratory tract infections such as coughs, colds and sore throats in the winter. Rhinovirus, which causes many of these infections, is more prevalent in the winter as the virus replicates more rapidly at lower temperatures. Put these two factors together and you see very high incidences of cough, colds and sore throats across the winter period.
Pharmacy staff play an important role in treating these conditions by recommending OTC medicines and offering self care advice. A Community Pharmacy Management of Minor Illnesses report recently showed 30 per cent of people who come into pharmacy directly are seeking help for upper respiratory tract infections such as coughs and colds.
“This means it is really important that [pharmacy staff] are kept up to date with treatment guidelines and know when to refer their patients to the GP,” says Lindsey Tier, senior marketing manager for Ultra Chloraseptic.
One example is in the management of sore throats. These are very often viral in origin and therefore should not be treated with antibiotics or prescription medication, she explains. Over-the-counter medication such as sprays and lozenges should be considered alongside other pain relief options. “Rather than let it continue and let it have a debilitating effect, treat it as soon as you start to suffer,” Lindsey advises.
Though pharmacies delivered over one million flu vaccinations since 1 September – more than the total number delivered through pharmacy last year, which stood at 950,765 – the flu season is only just beginning.
While pharmacies will have helped a wide range of customers receive their flu vaccine already, there are undoubtedly still some people who may need it and so it’s important to maintain vigilance with identifying people who may be eligible.
The main flu season runs until March, says Gordon, who points out that pregnant women who have only recently become pregnant and missed the original target period for vaccines should be identified.
“We have to talk about how to stop getting the colds or flu in the first place,” Gordon adds, highlighting the link between healthy living and cold prevention. “This ties in very nicely with the healthy living champions we all have now, and making sure [customers] are getting their five portions of fruit and veg a day, and getting exercise,” he says.
Taking the opportunity to speak to customers about improving their general health to avoid common winter ailments is a great way to give them the confidence to come back to the pharmacy, especially if they want to make additional health improvements in the New Year.
Gordon says he offers people advice on smoking cessation in the run up to Christmas as many people plan on quitting in the New Year. “People ask a lot about e-cigarettes and we will let them know about a traditional patch or gum as well,” he says.
Letting customers know they can come to the pharmacy for healthy living advice could pave the way to them making some real, healthy changes to their lives come the New Year.
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Despite the negative impact overeating can have on the body, pharmacy staff should take care that customers are not tempted to ‘detox’ in the New Year