Author: Blessy Joseph

Love Your Heart: All You Need to Know About Hypertension

Posted on | by Blessy Joseph

It’s that time of year to raise awareness of how important it is to focus on heart health. Spread the word, motivating each other to make healthy lifestyle changes and prevent heart disease. Heart disease is the leading cause of death in the United States, so let’s fight this together!

What is hypertension?1

Hypertension is abnormally high blood pressure. Blood pressure is the force or pressure of the blood circulating against the walls of blood vessels, and is measured using two numbers. The top number is called the “systolic” pressure, which measures the force in the arteries each time your heart beats. The bottom number is called the “diastolic” pressure, measuring the pressure in the arteries between heart beats, when the heart is resting. Even though our blood pressure varies throughout the day, based on our activities, such as exercise or stress, it should not consistently remain high. A normal blood pressure level is less than 120/80 mmHg.

Types of Hypertension2,3,4

Essential hypertension

This type of hypertension is the most common, affecting about 95% of people with high blood pressure. A diagnosis of essential hypertension requires a high blood pressure reading on 3 or more doctor visits, without any known cause. People diagnosed with essential hypertension usually experience no symptoms, therefore it is important to keep scheduled check-up appointments and physicals.

Secondary hypertension

Secondary hypertension is caused by another medical condition or by an outside source. The most common cause is a defect in the arteries supplying blood to the kidneys. Other causes include obstructive sleep apnea, adrenal gland disorders, hormone imbalances, high salt diet, alcohol, and over-the-counter medications containing ibuprofen or pseudoephedrine. This type of hypertension can be controlled if the cause is found.  

Resistant hypertension

About 25% of people with hypertension have resistant hypertension. This occurs when a person is taking 3 or more blood pressure medications and still has high blood pressure. Resistant hypertension is most commonly seen in the elderly and obese patients.

Isolated systolic hypertension

This type of hypertension is most common among our 65 and older population. As people age, the elasticity in the arteries decrease, causing a rise in the systolic pressure, the top number. If the systolic pressure rises above 140 and the diastolic pressure remains below 90, this is isolated systolic hypertension. This increases the risk for heart disease.

Hypertensive Emergency

A hypertensive emergency is rare, but is considered a medical emergency that should be treated in a hospital. Hypertensive emergency occurs when your blood pressure rises extremely quickly > 180/120 mmHg. A person can experience organ damage that may be life threatening including brain damage, stroke, injury to the kidneys, and heart attack.

Symptoms of Hypertension1,2

Hypertension is considered the “silent killer” because there are typically no warning signs or symptoms associated with it. Some people with hypertension, however, have reported complaints of headaches, feeling tired or dizzy, and nose bleeds. It is very important to periodically check your blood pressure to help your doctor diagnose any health problems early. Additionally, because you cannot feel blood pressure, it is important to take your medications, as directed by your doctor, to prevent complications of hypertension. 

Diagnosing Hypertension3

Diagnosing hypertension should be based on an average of at least two readings, on two separate occasions. Checking blood pressure levels at home, using an automated monitoring device or blood pressure cuff, is preferred. Sometimes blood pressure readings at a doctor’s office tend to be higher. This is known as “white coat syndrome.” This can lead to inaccurate clinical decisions related to needed treatments. 

Risk Factors for Hypertension1,2,3,5,8

  1. Elevated blood pressure (SBP 120-129 mmHg and DBP <80 mmHg) – Hypertension usually develops over time. A borderline high blood pressure, left untreated, could develop into hypertension or chronic high blood pressure.
  2. Obesity (BMI > 30kg/m2) – Research has shown a direct relationship between obesity and high blood pressure and is responsible for 40 to 78% of hypertension diagnoses. When a person is overweight, the heart has to work harder to pump blood throughout the body. This puts more strain on the arteries, causing blood pressure to increase. 
    1. Smoking – Smoking can damage the heart and blood vessels throughout the body. Smoking produces a gas called carbon monoxide. When this gas is inhaled, it reduces the amount of oxygen that the blood can carry. Additionally, nicotine, found in cigarettes,  narrows blood vessels, increasing blood pressure. 
  3. Alcohol – Drinking too much alcohol can increase blood pressure because alcohol causes the body to release proteins and hormones into the bloodstream that make blood vessels constrict or get narrower. When blood vessels constrict, normal blood flow is prevented, which increases blood pressure.

Know the limits:

  • Women = no more than 1 drink per day     
  • Men = no more than 2 drinks per day
  1. Diet – It is important to eat a well-balanced diet that is not too high in sodium (salt) and not too low in potassium. Foods that are high in sodium (canned or boxed foods and restaurant foods) can increase blood pressure. Not eating enough potassium in meals can also cause high blood pressure. Potassium is an electrolyte that our body needs to function properly, especially our heart. Some healthy foods that contain potassium include sweet potatoes, beets, beans, and bananas.
  2. Heredity – Of course, we cannot change our past, but family history can be a contributor to health conditions. If there has been a family history of high blood pressure, this can increase a person’s risk of having high blood pressure themselves. 

Complications of Hypertension1

If blood pressure remains high, it can damage important organs in the body causing serious health conditions.

  • Heart disease (angina, heart attack, heart failure) – High blood pressure makes the heart pump harder, putting extra force on arteries. This can damage the arteries, which decreases blood flow and oxygen to the heart. 
  • Stroke – High blood pressure can cause the pressure in the arteries to be too high. The arteries that supply blood and oxygen to the brain can burst or become blocked from a clot causing a stroke. When the brain stops getting enough oxygen, brain cells die causing disabilities in basic activities such as speech and movement.
  • Kidney disease – The force of high blood pressure can cause damage to the blood vessels and filters making it difficult for the kidneys to do their job of removing waste and toxins from the body and returning important nutrients and vital substances into the bloodstream. 

Treating Hypertension1

There are countless oral medications used today to help treat high blood pressure. Since every person’s body has different needs, the best first step is talking to a doctor about what will work for you. Blood pressure medications work in different ways. Some relax blood vessels, while others cause your heart to beat with less force. Another type causes your body to get rid of excess fluid (water). When your body holds on to more fluid, the heart has to work harder to push blood through blood vessels, causing high blood pressure. Many individuals may need to take more than one medication to control their blood pressure. Talk to the doctor about how long the medication will take to start working and make sure to take the medication exactly how the doctor prescribes it.

6 Ways to Prevent Hypertension6,7

Healthy living is key! 

  1. Healthy Eating — Eating a variety of foods rich in potassium, fiber, protein, low in sodium (salt), and low in saturated fat can help control hypertension. A healthy diet plan called DASH (Dietary Approaches to Stop Hypertension) has been proven to help people lower their blood pressure. 

Daily and Weekly DASH Eating Plan Goals for a 2,000-Calorie-a-Day Diet

Food GroupDaily Servings
Grains6-8
Meats, poultry, and fish6 or less
Vegetables4-5
Fruit4-5
Low-fat or fat-free dairy products2-3
Fats and oils2-3
Sodium2,300 mg
Food GroupWeekly Servings
Nuts, seeds, dry beans, and peas4-5
Sweets5 or less
  1. Healthy Weight – Keeping a healthy weight will decrease the risk of high blood pressure. To determine whether a certain weight is healthy, doctors usually calculate body mass index (BMI). If you know your height and weight, you can calculate your BMI using this link.
  1. Physical Activity – Staying physically active can help lower blood pressure. Adults should get at least 30 minutes of continuous moderate-intensity exercise 5 days a week, such as brisk walking or bicycling. Children and teenagers should get at least 1 hour of physical activity every day.
  2. Do Not Smoke – Smoking increases blood pressure and increases risk of heart disease and stroke.
  1. Limit Alcohol Use – Drinking alcohol increases blood pressure. As mentioned above, men should have no more than 2 alcoholic drinks per day, and women should have no more than 1 alcoholic drink per day.
  1. Get Plenty of Sleep – Not getting enough rest can increase your blood pressure. Most adults need at least 7 hours of sleep every night. Sleep helps the body recover and function properly.

References:

  1. High blood pressure symptoms, causes, and problems | cdc.gov. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/bloodpressure/about.htm. Updated 2020. Accessed Feb 11, 2021.
  2. Hypertension types – hypertension center – everyday health. EverydayHealth.com Web site. https://www.everydayhealth.com/hypertension/understanding/types-of-hypertension.aspx. Accessed Feb 11, 2021.
  3. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the american college of cardiology/american heart association task force on clinical practice guidelines. Hypertension. 2018;71(6):e13-e115. https://www.ahajournals.org/doi/10.1161/HYP.0000000000000065. Accessed Feb 17, 2021. doi: 10.1161/HYP.0000000000000065.
  4. Resistant hypertension: Diagnosis, evaluation, and treatment. Circulation. 2008;117(25):e510-e526. https://www.ahajournals.org/doi/10.1161/circulationaha.108.189141. Accessed Feb 17, 2021. doi: 10.1161/CIRCULATIONAHA.108.189141.
  5. Facts about moderate drinking | CDC. https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm. Updated 2021. Accessed Feb 21, 2021.
  6. Prevent high blood pressure | cdc.gov. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/bloodpressure/prevent.htm. Updated 2020. Accessed Feb 21, 2021.
  7. DASH Eating Plan | NHLBI, NIH. Nhlbi.nih.gov. https://www.nhlbi.nih.gov/health-topics/dash-eating-plan. Published 2021. Accessed February 22, 2021.
  8. Husain K, Ansari RA, Ferder L. Alcohol-induced hypertension: Mechanism and prevention. World J Cardiol. 2014;6(5):245-252. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038773/. Accessed Feb 24, 2021. doi: 10.4330/wjc.v6.i5.245.

The Highs and The Lows: Living with Diabetes

Posted on | by Blessy Joseph

Diabetes is a metabolic disease, caused by no or too little insulin production that affects millions of Americans. As food is broken down by the intestines, glucose or sugar is released into the blood. In response, insulin is released from the pancreas to help move glucose into your cells. Extra glucose is stored within the liver, muscles, and fat cells. The more glucose in your blood, the more insulin the pancreas produces. In type 1 diabetes, the pancreas is no longer able to produce insulin, therefore glucose freely floats within the blood. In type 2 diabetes, either the pancreas is unable to produce enough insulin to control glucose levels or the body becomes less sensitive to the insulin produced.1

As of February 2020, 11.3% of North Carolina adults have been diagnosed with diabetes, with approximately 250,000 more individuals undiagnosed.2

Types of Diabetes1,3

Type 1 diabetes mellitus, formerly known as “insulin-dependent diabetes” or “childhood-onset diabetes” is caused by an autoimmune or viral destruction of the pancreatic beta-cells (the cells responsible for making insulin), typically caused by a genetic or environmental factor. This means that the pancreas is unable to produce any insulin. Beta-cell destruction can occur at different rates, affecting both adults and children and accounts for 5 to 10% of diabetes.

Type 2 diabetes mellitus accounts for 90 to 95% of diabetes and is caused by poor insulin production, rather than complete absence of insulin with type 1, or poor insulin response (insulin resistance). The exact reason this occurs is unknown, but being overweight, physically inactive, and making poor diet choices are key factors.

Individuals diagnosed with prediabetes are those that have blood glucose levels higher than normal, but not high enough to be considered “diabetic.” Prediabetes greatly increases your risk for both diabetes and cardiovascular disease and is typically seen in obese people with high cholesterol and high blood pressure.

Gestational diabetes is high blood sugar during pregnancy, in women without a history of diabetes. Uncontrolled gestational diabetes can lead to an extra large baby, a higher chance of C-section, or preeclampsia (high blood pressure during pregnancy). Women are routinely screened between weeks 24 and 28 of pregnancy to rule out diabetes.

Diabetes insipidus is a rare inherited disorder, affecting 1 in every 25,000 individuals, that causes the kidneys to produce large amounts of dilute and odorless urine. Typically the kidneys make 1 to 2 quarts of urine per day. With diabetes insipidus, the kidneys can produce 3 to 20 quarts daily. Diabetes insipidus is similar to diabetes mellitus because both cause polyuria or excessive urination, however patients with diabetes insipidus do not have trouble producing insulin and have normal blood glucose levels.

Diabetes Symptoms4

Each individual diagnosed with diabetes may experience different symptoms, however the three main indicators of high blood glucose are polyuria (frequent urination), polydipsia (excessive thirst), and polyphagia (excessive hunger). Other symptoms may include blurry vision, numbness or tingling in hands or feet, and slugginess or fatigue.

Diabetes Diagnosis5

The A1c or hemoglobin A1c (HbA1c) test measures the amount of sugar attached to  hemoglobin, a protein found in red blood cells that moves oxygen throughout the body. The higher your blood glucose, the more red blood cells become covered in sugar. A1c estimates your average blood glucose over 2 to 3 months and is measured with blood work or using a fingerstick A1c test. A normal A1c is less than 5.7%. Prediabetes is an A1c between 5.7 and 6.4%. Diabetes is diagnosed with an A1c greater than or equal to 6.5%.

The fasting plasma glucose (FPG) test determines the blood glucose level after not eating or drinking (except water) within at least 8 hours of testing, usually done first thing in the morning. Typically, blood glucose levels would be low if you are fasting since glucose comes from food breakdown. If you have diabetes, however, these levels may be high. A normal FPG is less than 100. Prediabetes is a FPG between 100 and 125. Diabetes is diagnosed with a FPG greater than or equal to 126. Testing blood glucose at any time is considered a random plasma glucose, which can also be used to diagnose diabetes.

The oral glucose tolerance test (OGTT) shows how well your body processes sugars by measuring your blood glucose before and 2 hours after drinking a sweet drink. This test is commonly used in pregnant women to help rule out gestational diabetes. A normal OGTT would be a blood glucose of less than 140, prediabetes 140 to 199, and diabetes greater than 200.

Diabetes Risk Factors6

Since type 1 diabetes is caused by an autoimmune reaction, risk factors for type 1 diabetes are not well understood. Known risk factors for type 1 diabetes, include a family history, since there may be a genetic link, and age. Type 1 diabetes can develop at any age, but there is a greater chance during childhood and early adulthood.

Risk factors for type 2 diabetes include a diagnosis of prediabetes, older age (45 years and older), obesity, and a sedentary or non-active lifestyle. Type 2 diabetes may also have a genetic link, increasing the risk for individuals whose parents or siblings have type 2 diabetes. African Americans, Hispanic/Latio Americans, American Indians, and Alaskan natives are typically at a higher risk.

Diabetes Complications7

Overtime, diabetes can cause complications throughout the body including the heart, blood vessels, nerves, eyes, and kidneys. High blood sugar, alongside high cholesterol, can clog blood vessels making it difficult for the heart to pump blood. This causes high blood pressure, which increases your risk of heart attack or stroke. High blood sugar can also damage nerves leading to neuropathies or a tingling, burning, or numbness in hands and feet. Diabetes increases risk for cataracts or glaucoma and if poorly controlled, blindness. Diabetes may also lead to irreversible kidney damage, requiring dialysis or kidney transplant.

Diabetes Treatment8,9

Because in type 1 diabetes the pancreas is unable to make any insulin, the primary treatment for these individuals is insulin.

Treatment of type 2 diabetes is much more complex, with countless oral and injectable treatments, and typically depends on what works best for each individual. Oral medications work by increasing the amount of insulin released by the pancreas, decreasing glucose production, decreasing glucose absorption, increasing elimination of glucose, or improving the body’s response to insulin to lower blood sugar. Injectable medications work by increasing the amount of time you stay feeling full after eating, to help promote weight loss and by increasing insulin production. For patients with poorly controlled type 2 diabetes, insulin may also be used. 

Gestational diabetes can often be controlled by eating healthy foods and exercising regularly, however some women may need insulin to lower their blood sugar.

Hypoglycemia Symptoms and Treatment10

Hypoglycemia or low blood sugar can be caused by certain diabetes medications, including insulin, or skipping a meal, and can cause seizures, unconsciousness, or even death, if left untreated. Blood sugar is considered low if less than 70 mg/dL, however symptoms may appear at higher values in some patients. Symptoms of low blood sugar may include sweating, shaking, hunger, or fatigue. When treating low blood sugar, we use the “15-15 Rule” — 15 grams of carbohydrates and recheck blood sugar after 15 minutes. It is important to consume simple sugars because your body absorbs these quickly and helps raise your blood sugar the fastest. This includes things like half a glass of orange juice or soda or 5 pieces of hard candy. There are also glucose tablets that can be purchased over-the-counter to help treat low blood sugar. You should inform your healthcare provider if you experience low blood sugars often.

Diabetes Prevention11

Lifestyle changes are especially important for preventing or treating type 2 diabetes. Losing 5 to 10% of your body weight can lower your risk of developing diabetes by about 50%. The American Heart Association (AHA) encourages individuals with diabetes to exercise regularly and eat healthy. Adults need at least 150 minutes of moderate-intensity physical activity per week, with both aerobic and strength training exercises. Dietary changes may include portion control and limiting added sugars, fatty meats, saturated fats, sodium, cholesterol, and alcohol. A proper diabetic diet is rich in high-fiber whole grains, like oatmeal or brown rice, non-fried fish at least twice weekly, lean meats like skinless chicken or turkey, and fruits and vegetables. The AHA also promotes smoking cessation. Individuals with diabetes that smoke are three times as likely to die of cardiovascular death versus non-smokers and have a more difficult time controlling their blood sugar.

For more information and support, visit the American Diabetes Association (ADA) and Centers for Disease Control and Prevention (CDC) websites or talk with your doctor or pharmacist today.

By CaraBeth Harrison, PharmD, PGY1 Resident

References:

  1. American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes. Diabetes Care [Internet]. 2020 [cited 2021 Jan 25]; 43(Suppl. 1): S14-S31. Available from: https://care.diabetesjournals.org/content/43/Supplement_1/S14.full-text.pdf.
  2.  The Burden of Diabetes in North Carolina [Internet]. Arlington (VA): American Diabetes Association. 2020 Feb [cited 2021 Jan 25]. Available from: http://main.diabetes.org/dorg/docs/state-fact-sheets/ADV_2020_State_Fact_sheets_NC.pdf.
  3. Diabetes Insipidus [Internet]. Rochester (MN): Mayo Clinic. 2019 Feb 16 [cited 2021 Jan 25]. Available from: https://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/symptoms-causes/syc-20351269.
  1. Diabetes Symptoms [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. [cited 2021 Jan 25]. Available from: https://www.cdc.gov/diabetes/basics/symptoms.html.
  1. Diagnosis [Internet]. Arlington (VA): American Diabetes Association. [cited 2021 Jan 25]. Available from: https://www.diabetes.org/a1c/diagnosis.
  2. Diabetes Risk Factors [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. 2020 Mar 24 [cited 2021 Jan 25]. Available from: cdc.gov/diabetes/basics/risk-factors.html.
  1. Type 2 Diabetes [Internet]. Rochester (MN): Mayo Clinic. 2021 Jan 20 [cited 2021 Jan 25]. Available from: https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193.
  1. Basina M and Watson S. Everything You Need to Know About Diabetes [Internet]. Healthline; 2018 Oct 4 [updated 2020 Feb 26; cited 2021 Jan 25]. Available from: https://www.healthline.com/health/diabetes.
  2. Gestational [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. 2020 Jul 14 [cited 2021 Jan 25]. Available from: https://www.cdc.gov/pregnancy/diabetes-gestational.html.
  1. Blood Sugar Testing and Control: Hypoglycemia (Low Blood Sugar) [Internet]. Arlington (VA): American Diabetes Association. [cited 2021 Jan 25]. Available from: https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia.
  2.  Living Healthy with Diabetes. Dallas (TX): American Heart Association. 2020 Mar 12 [cited 2021 Jan 25]. Available from: https://www.heart.org/en/health-topics/diabetes/prevention–treatment-of-diabetes/living-healthy-with-diabetes.

COVID-19 Vaccines: What You Need To Know

Posted on | by Blessy Joseph

This year, the pandemic caused by COVID-19, has led to the loss of many loved ones, friends, and acquaintances. We all have been working hard to follow the Centers for Disease Control and Prevention (CDC) guidelines by wearing masks, social distancing, and washing hands to help prevent us from getting sick, and control the pandemic. Lately in the news we have heard about the approval of vaccines against COVID-19, but what does that mean for us? When can we get them? How do we know they are safe? This blog post is meant to help answer some of the questions commonly asked about the vaccine, explain the vaccines that have been approved and their differences, when the vaccines will be distributed, and what to expect when you get the vaccine. 

WHAT ARE MRNA VACCINES?

One common question people have regarding the COVID vaccine is how does it work and how is it different from other vaccines? Traditional vaccines work by using a weakened or inactivated virus. The virus is injected into the body, which recognizes it as foreign and works to get rid of it, without getting us sick. This immune response leads to the formation of antibodies which prevent us from getting the disease in the future. The COVID vaccine is different because it does not contain a weakened or inactivated virus at all. Instead, it sends instructions (messenger RNA or mRNA) to cells on how to make a “spike protein,” which is a harmless protein that is found on the COVID virus. When the vaccine is injected into the arm, the immune cells in the body recognize this protein as foreign, and work to get rid of it, just like traditional vaccines. After our immune system has fought off the protein, we are left with antibodies that could prevent us from getting COVID-19 in the future. One concern that has been brought up about the way this vaccine works is whether or not it can interfere with the cells in our body and interact with our own DNA. This is not true, as it does not enter the nucleus of the cell, where our DNA is stored. The vaccine does not interact with DNA at all. The cells that make the protein also break down and get rid of the mRNA once it has finished doing it’s job.1

THE PFIZER VACCINE VERSUS THE MODERNA VACCINE

The first COVID vaccine that was approved was the one developed by the drug company, Pfizer. This vaccine is a 2 dose series that is given once, and then again 21 days later. It is approved for patients age 16 or older. This vaccine has been shown in studies to be 95% effective after both doses, and results from these studies were published on December 10, 2020. In this study, there were 36,621 participants who were randomized to get either the vaccine or a placebo. Of the patients who received the vaccine, only 8 got COVID-19, while 162 in the placebo group got COVID-19. The most common side effects seen in patients who received that vaccine were pain and irritation at the injection site, tiredness, and headache.2 

The second COVID vaccine that was approved was the one developed by the drug company, Moderna. This vaccine is also a 2 dose series, but is given once, and then again 28 days later. It is approved for patients age 18 or older. This vaccine has been shown in studies to be 94.1% effective after both doses, and results from these studies were published on November 30, 2020. In this study, there were 30,350 participants who were randomized to get either the vaccine or a placebo. Of the patients who received the vaccine, only 6 got COVID-19, while 92 in the placebo group got COVID-19. There were no cases of severe COVID-19 in the group who received the vaccine, while there were 30 severe cases in the placebo group. The most common side effects seen in patients who received the vaccine were pain and irritation at the injection site, tiredness, chills, headache, and muscle pain.3

BENEFITS OF GETTING VACCINATED

Getting vaccinated against COVID-19 is the best and safest thing you can do to prevent the spread of the virus. COVID-19 can have serious, life-threatening complications, and there is no way to know how COVID-19 will affect you. If you get sick, you could spread the disease to friends, family, and others around you. COVID-19 symptoms can last for months. The virus can damage the lungs, heart, and brain, which increases the risk of long-term health problems. Even young, otherwise healthy people can feel unwell for weeks to months after infection. By getting vaccinated, you are preventing yourself from getting the virus, or are making it less severe if you do get it. You also will be protecting those who are at a greater risk of getting COVID-19 and rely upon others to get vaccinated in order to not get sick. This process is called herd immunity. There have been warnings against certain people getting the vaccine, such as children younger than 16 years of age, pregnant people, people who carry Epipens, and people with certain medical conditions. If you fall under one of these categories, you may need to speak with your doctor to see if the vaccine would be beneficial for you. These patients may have been excluded from studies, therefore more evidence is needed to determine the safety of the vaccines in these patients. Overall, we can control the spread of the virus by following the Centers for Disease and Prevention (CDC) guidelines and getting vaccinated.4

TIMELINE OF VACCINE DISTRIBUTION

It is hard to say for sure when the vaccine will be available to everyone, but it likely will not be until Spring 2021. The distribution of the vaccine is determined by each state, with recommendations from the CDC on who should get vaccines first. North Carolina has 4 phases of vaccine distribution, and as of December 28th we are in phase 1A. Phase 1A restricts vaccination to healthcare workers and people in nursing homes. Phase 1B will include other frontline workers such as grocery store employees, teachers, firefighters, and law enforcement. Phase 2 will include people who are older than 65 and those with chronic medical conditions. Phase 3 will include students and workers at universities. Phase 4 will include everyone else in the general population who would like to receive a vaccine.5 Moving into phase 1B and the following phases is dependent on the number of vaccines available, therefore it is unknown, at this time, when that will occur.6 As of now, manufacturing companies are working on creating more vaccines so that we can move on to the next phase. This process is expected to take a few months, so it may not be until March or April before most people can receive the vaccine.

WHAT SHOULD I EXPECT ONCE I GET THE VACCINE?

With the COVID-19 vaccines, some patients experience no symptoms afterwards, while some patients do. The most common symptoms patients experience after getting vaccinated are pain or swelling in the arm where they were injected, chills, mild fever, tiredness, and headache. Although these symptoms feel like the flu, and can even affect your ability to do daily activities, they are typically mild and last for only a couple of days. It is also important to know that you will need two shots in order for these vaccines to work. Even if you have side effects after the first shot, you should still get the second, so you are protected from the virus, unless advised otherwise by your doctor. Vaccines also do not work right away. It takes 1 to 2 weeks for these vaccines to work fully, so you are not completely protected until that time has passed since being vaccinated.7 Since the vaccine studies are still in progress, we do not yet know how long the vaccines will protect you against COVID-19. However, it is still important to get vaccinated as this is currently the best and safest thing to do to prevent you from getting sick. 

WHAT DO I DO WHILE I’M WAITING FOR THE VACCINE TO BE AVAILABLE? 

The best thing you can do while waiting for the vaccine to be available to the public is to continue following CDC guidelines to prevent the spread of infection. This includes washing your hands frequently, wearing masks, maintaining social distance, and avoiding large crowds or gatherings.8 While getting vaccinated is a huge step towards ending the pandemic, it is still very important that everyone follows these guidelines to prevent the spread of the virus. 

REFERENCES

  1. Understanding and explaining mRNA COVID-19 vaccines | CDC. https://www.cdc.gov/vaccines/covid-19/hcp/mrna-vaccine-basics.html. Updated 2020. Accessed Dec 28, 2020.
  2. Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine. New England Journal of Medicine. December 2020. https://doi.org/10.1056/NEJMoa2034577. Accessed Dec 28, 2020.
  3. A phase 3, randomized, stratified, observer-blind, placebo-controlled study to evaluate the efficacy, safety, and immunogenicity of mRNA-1273 SARS-CoV-2 vaccine in adults aged 18 years and older. 2020. https://clinicaltrials.gov/ct2/show/NCT04470427. Accessed Dec 28, 2020.
  4. Benefits of getting a COVID-19 vaccine. Centers for Disease Control and Prevention Website. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-benefits.html. Updated 2020. Accessed Dec 28, 2020.
  5. COVID-19 vaccine 101. NC Department of Health and Human Services Website. https://files.nc.gov/covid/documents/COVID19-Vaccine-101-Deck-Final.pdf. Published Dec 17, 2020. Accessed Dec 28, 2020.
  6. Burns M. When can anyone in NC get coronavirus vaccine? state officials say timeline uncertain. WRAL Website. https://www.wral.com/coronavirus/when-can-anyone-in-nc-get-coronavirus-vaccine-state-officials-say-timeline-uncertain/19423317. Updated 2020. Accessed Dec 28, 2020.
  7. What to expect after getting a COVID-19 vaccine. Centers for Disease Control and Prevention Website. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html. Updated 2020. Accessed Dec 28, 2020.
  8. How to protect yourself & others. Centers for Disease Control and Prevention Website. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Updated 2020. Accessed Dec 28, 2020.

INTERESTED IN WHAT CBD COULD DO FOR YOU?

Posted on | by Blessy Joseph

Let me introduce you to Mary. She wanted to try CBD for sleep, she got so much more than better sleep.

First we have to understand a little about what quality Cannabidiol (CBD) is.

You can’t just go by the milligrams (mg) on the label.

Mary had tried CBD before, but not from a pharmacy. She said she was on 1500 mg of CBD, what she didn’t know was CBD labeling is not consistant across all companies. Some companies report the amount of CBD and some report the amount of CBD oil. Whats the difference? CBD is the active cannabinoid that so many people know and love. CBD oil on the other hand can include all kinds of other cannabinoids and the carrier oil. That means there is a big difference between the two. CBD oil might only contain 30% of the reported CBD.

Always verify before you buy.

Mary had heard things about contaminants in CBD and she was worried about lead the most. Each CBD product you buy must have a certificate of analysis to verify that it contains the stated amount of CBD, the expected amount of THC (either <0.3% or none), no pesticides, heavy metals, or other contaminants. That’s why she went to a pharmacy for her CBD products. She wanted the best and she knew her pharmacist never compromised on quality.

What form of CBD to use?

Once again her pharmacist was happy to help. Together they decided on a Full Spectrum Sublingual oil. Whats that? Full Spectrum means that in addition to CBD and other cannabinoids and terpenes, this oil also contains some THC (<0.3%). A broad spectrum oil contains only CBD and other cannabinoids and possibly very small trace amounts of THC. An Isolate contains only CBD.

How much CBD to take?

Now that Mary had her CBD she had to find her dose. CBD supports your natural endocannabinoid system, which means your body will respond to different amounts of CBD than someone else. Mary started taking 10 mg of active CBD, which is where many people start. She took it for a week and decided it was helping her at that dose, but wanted to see if it could be even better. She went up to 20 mg. Now she was sleeping better and getting better quality sleep. She tried going up to 25 mg a week later and discovered she didn’t feel as good as she did on the 20 mg, so she went back to 20 mg. Mary did what she needed to, she listend to her body and adjusted her dose to suit her needs. Keep in mind that CBD effects everyone differently and it is always best to start low and go slow.

What happened to Mary?

Mary went into the pharmacy after about 3 months to pick up another bottle of her CBD. She called her pharmacist over and told him that she had jogged down the stairs last week.

Her pharmacist was confused and said, “That’s great, I’m glad you were able to get some exercise.”

Mary smiled, “You don’t understand, I used to take the stairs one at a time, sideways, while holding the hand rail. This CBD has changed my life and helped with my arthritis that I’ve had for years.”

Her pharmacist smiled, “That’s amazing. I am so glad to hear that CBD has helped you so much. Do you mind if I tell others your story?”

Mary smiled, “Please do, everyone should get the chance at this kind of relief.” Stories like Mary’s are why Josefs pharmacists only recommend the best CBD.

FDA Disclaimer: These products are not for use or to be sold to persons under the age of 18. This product should be used only as directed on the label. It should not be used if you are pregnant, trying to become pregnant, or nursing. Consult with a medical professional before using if you have a serious medical condition or are taking any prescription medication. A medical professional’s advice should be sought before using this or any other supplement or dietary product. These products and statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease.  By using this site and purchasing products, you agree to follow all Terms and Conditions found on this site.

Jonathan Harward Awarded 2020 National Preceptor of the Year Award by NCPA Foundation

Posted on | by Blessy Joseph

Copied verbatim from NCPA.org > Current Link

ALEXANDRIA, Va. (Oct. 20, 2020) – Jonathan Harward, pharmacy manager at Josefs Pharmacy in Raleigh, N.C., was honored as the recipient of the 2020 National Preceptor of the Year Award by the National Community Pharmacists Association Foundation as part of NCPA’s Annual Convention, which was held virtually. Harward, who is originally from Carthage, N.C. and now lives in Holly Springs, has precepted pharmacy students with Josefs Pharmacy since 2015.

Harward attended Campbell University, completing his undergraduate studies and graduating with his Doctor of Pharmacy degree in 2013. He completed a PGY-1 Community Pharmacy Residency with Kerr Drug and Campbell University.

In nominating him for this award, Dr. D. Byron May, professor and chairman of the Department of Pharmacy Practice at the Campbell University College of Pharmacy and Health Sciences, writes that Harward “understands that students have different learning styles and he cares enough to ascertain how each student learns best in order to maximize their learning experience.” May says Harward knows the importance of individualizing students’ experiences and prioritizes involving them in all aspects of his pharmacy practice. Students say Harward was a mentor to them long after their experiential training ended, giving testament to his compassion and dedication to their personal and professional development.

Harward’s commitment to pharmacy professionalism extends beyond precepting future pharmacists, carrying into his work at Josefs Pharmacy, where he is dedicated to his patients and his community. He has worked to develop and implement a medication synchronization program seeking to promote comprehensive medication reviews, immunizations and assessments in patients with HIV, HCV and rheumatoid arthritis. He worked to develop the ScriptAbility program through which visually impaired patients (using special technology) can hear instructions printed on their medication vial. He also holds immunization clinics at nearby businesses and places of worship for those who are uninsured, and shares his knowledge in presentations to various educational sessions throughout the community.

Harward is involved with efforts to transform community-based pharmacies, working with CPESN® USA and Flip the Pharmacy. These initiatives, among other things, aim to improve medication adherence and lower overall cost of care. Harward is currently seeing patients with hypertension through Flip the Pharmacy with plans to expand this coming year.

Harward says, “It is a privilege to be able to mentor and show students the great services that independent pharmacies have to offer our patients, while sharing with them the challenges we face from pharmacy benefit managers who attempt to undermine our work.” He thanks Dr. May in addition to Dr. Katie Trotta, Dr. Taylor McDaniel, and Dr. Tina Thornhill at Campbell University for nominating him for this award. Harward also thanks Finny and Blessy Joseph, the owners of Josefs Pharmacy, for allowing him to have students in the business.

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The NCPA Foundation is a nonprofit 501(c)(3) organization established in 1953 to honor the previous incarnation of NCPA, the National Association of Retail Druggists (NARD) Executive Secretary John W. Dargavel. Contributions to the foundation are tax-deductible as charitable donations to the extent permitted under federal tax law. The NCPA Foundation supports the growth of independent community pharmacy through scholarships to pharmacy students, critical research/programs to improve the success of independent pharmacy and patient care, community service programs, and financial aid to community pharmacy owners for their recovery in the event of disaster or other adverse circumstances. For more information, go to www.ncpafoundation.org.

Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing over 21,000 pharmacies that employ approximately 250,000 individuals nationwide. Community pharmacies are rooted in the communities where they are located and are among America’s most accessible health care providers. To learn more, visit www.ncpa.org.NCPA

CMRs: What is the Comprehensive Medication Review?

Posted on | by Blessy Joseph

A comprehensive medication review (CMR) is an encounter conducted face-to-face or via telephone between a patient and their pharmacist. The pharmacist collects patient-specific information to identify medication-related issues and creates a plan to resolve them, alongside the patient and/or prescriber.1 CMRs allows the patient and pharmacist to work together to improve patients’ knowledge of their medications, empowering patients to take ownership of their health. CMRs, unlike targeted interventions that address one condition or a single medication, are all-inclusive and can be time-consuming. A thoroughly executed CMR can take as long as 45 minutes to 1 hour.2 All medications and relevant medical conditions are evaluated. Action plans are developed, and patients are periodically reassessed. You should receive a CMR at least once a year. If your medications change frequently or you have been admitted to the hospital several times recently, you may benefit from more frequent CMRs. CMRs are a free service offered by your pharmacy. Ask your pharmacist about scheduling a CMR today!

Below are five things to know about a comprehensive medication review…

1.   What are the benefits of a comprehensive medication review?

Each patient is unique, with a different set of health concerns, a list of medications, allergies, social barriers, and needs to be met. Medication reviews allow your pharmacist or another healthcare provider to specifically address your “differences” and optimize your care. In 2019, an online article discussed the following 8 benefits of comprehensive medication management3:

●      Medication Assessment – Patients’ medications, both prescription and over-the-counter, are evaluated to determine if appropriate and effective at treating medical conditions and achieving goals of care.

●     Personalized Therapy — Care is customized to meet the needs of each individual patient.

●      Collaborative Care — Healthcare professionals, including pharmacists, providers, and nurses work together to offer optimal patient care.

●     Patient Engagement — Involving patients in discussions and decisions regarding their medical care allows them to take ownership of their health, promoting improved outcomes.

●      Ongoing Regimen Review — Patients are periodically reassessed for changes in medication regimens, control of symptoms, and progress toward goals. This creates an environment for longitudinal care or care over a period of time.

●     Improved Outcomes — Improved medication adherence and greater control of chronic diseases, reduces hospital admissions/ED visits, and enhances patients’ quality of life.

●     Reduced Costs — Patients only pay for medications that are necessary for their health. Improved medication adherence and decreased adverse events reduce hospital admissions, ED visits, and overall healthcare expenses.

●     Increased Satisfaction — Patients receive better care for a fraction of the price, while providers witness better outcomes for their patients.

2.  Am I eligible for a comprehensive medication review?

In 2015, a study funded in part by the National Institute on Aging looked at the increased prescribing of medications in the older adult population. Nearly 40% of these patients were on at least 5 medications.4 The most common medications noted were statins for high cholesterol, anti-hypertensive agents, diabetic medications, and antidepressants.  Polypharmacy or the use of several medications at once has been shown to increase medication nonadherence and increase the risk of drug duplication, drug-drug interactions, and adverse drug reactions. Patients on numerous medications, regardless of age, are prime candidates for medication reviews. Your pharmacist can help determine if you are taking any unnecessary drugs if your symptoms are controlled on your current regimen, and ensure that each medication is being used properly.

“Transitions of care” has become a hot topic in healthcare in recent years and refers to the movement of patients between multiple providers and settings as their conditions and healthcare needs evolve.5 For example, a patient discharged from the hospital into a rehab facility, then eventually back home following a stroke. These transitions are typically complicated by poor communication between care providers, lack of patient education, and failed collaborative care. Medication reviews in these patients allow the pharmacist to help bridge gaps in care. Your pharmacist can take the time to sit down with you and explain the changes that have been made in your medication regimen. They can develop strategies to help you take your medications as directed and clear up any uncertainties.

Medication reviews are a free service offered by your pharmacy. Although the patients mentioned above may benefit the greatest, anyone who would like a medication review is eligible. 

3. Who will be completing my comprehensive medication review?

Pharmacists pride themselves on being the “medication experts” and are excellent sources of information for both prescription and over-the-counter medications. Their education is focused on assessing medication-use for appropriateness, effectiveness, and safety to help prevent and resolve medication-related problems.6 This training, along with the idea that over 90% of Americans live within 5 miles of a community pharmacy,7 make them an obvious player in medication reviews. Your pharmacist may conduct the review, but a successful review does not stop there. A medication review is an umbrella term, which includes interventions carried out by various healthcare professionals such as providers, pharmacists, nurses and/or medical assistants.8 It is a team effort to ensure each patient receives the best care possible. A nurse may collect a list of your medications during an office visit or at hospital admission to provide to the pharmacy. They may review your discharge summary and notate changes in your regimen. A provider may prompt conversations and conduct examinations to determine which medications should be added, adjusted, or removed based on your current health needs. A pharmacist may review prescriptions prior to dispensing them, assessing for correct dosage and indication, and providing patient counseling when warranted. This integrated approach allows the puzzle pieces to come together so that optimal patient care is provided.

4. How to prepare for a comprehensive medication review.

You have been scheduled for a medication review with your pharmacist, either in-person or via telephone… now what? Preparing for a medication review, as a patient, is simple. Collect and bring all of your medications, both prescription and over-the-counter, and any devices, such as inhalers or insulin pens with you.9 It is important to include all vitamins and herbal supplements, as some of these cause significant drug-drug interactions. “Over-the-counter” does not always mean “safe.” Prior to the review, think about how you take each medication. Are they effective or do they make you feel worse? Have you noticed any side effects? If you regularly monitor your blood sugar or blood pressure, what are your recent readings? Are you having difficulty remembering to take your medications? Write all of this down, as well as any questions you may have and prepare to be honest with yourself and your pharmacist.

Your pharmacist has likely prepared for the medication review, as well. They may have already gathered a comprehensive medication list from your providers, confirmed disease states, evaluated fill history, and identified potential medication-related issues.10 This allows the pharmacist to establish a game plan and prioritize the objectives of the review to create an effective and efficient encounter.

5. What to expect following a comprehensive medication review.

Follow-up is a key component of a medication review. Your pharmacist may elect to follow-up within a few days or months, depending on the severity of issues identified during the review. Follow-up allows the pharmacist to monitor progress towards goals, ensure resolution of issues, and identify any new medication-related problems.10

Many pharmacists will create a handout or takeaway for you at the conclusion of your encounter, including an up-t0-date medication list and medication action plan (MAP). The MAP provides an overview of what was discussed and guidance on how to achieve patient-centered goals, including non-pharmacological options or  lifestyle changes.10 

Citations:

1.        Gamble K. MTM Advisory Board Updates Definition of Key Pharmacist Role [Internet]. Cranbury (NJ): Pharmacy Times; 2011 Aug 8 [cited 2020 Aug 24]. Available from: https://www.pharmacytimes.com/news/mtm-advisory-board-updates-definition-of-key-pharmacist-service.

2.       Smart Retailing Rx. How to Conduct Comprehensive Medication Reviews [Internet]. [place unknown: Health Mart ® Pharmacy]; 2017 Dec 1 [cited 2020 Aug 24]. Available from: https://join.healthmart.com/business-and-operations/how-to-conduct-comprehensive-medication-reviews/.

3.       Ross SM. 8 Benefits of Comprehensive Medication Management [Internet]. [place unknown: Cureatr ©]; 2019 May 2 [cited 2020 Aug 24]. Available from: https://blog.cureatr.com/8-benefits-of-comprehensive-medication-management.

4.       Charlesworth CJ, Smit E, Lee DSH, et al. Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1998-2010. J Gerotolog A Biol Sci Med Sci [Internet]. 2015 Mar 1 [cited 2020 Aug 24]; 70(8):989-995. Available from: https://academic.oup.com/biomedgerontology/article/70/8/989/2947682.

5.       Joint Commission (US). Transitions of Care: The need for a more effective approach to continuing patient care [Internet]. [place unknown: Joint Commission]; [cited 2020 Aug 24]. Available from: https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/topics-library/hot_topics_transitions_of_carepdf.pdf?db=web&hash=CEFB254D5EC36E4FFE30ABB20A5550E0.

6.       Kehrer JP, Eberhart G, Wing B, et al. Pharmacy’s role in a modern health continuum. Can Pharm J [Internet]. 2013 Nov [cited 2020 Aug 24]; 146(6):321-24. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819958/.

7.       Twigg G, David T, Taylor J. An Improved Comprehensive Medication Review Process to Assess Healthcare Outcomes in a Rural Independent Community Pharmacy. Pharmacy (Basel) [Internet]. 2019 Jun 17 [cited 2020 Aug 24]; 7(2):66. Available from: https://pubmed.ncbi.nlm.nih.gov/31212922/.

8.      Blenkinsopp A, Bond C, Raynor DK. Medication reviews. Br J Clin Pharmacol [Internet]. 2012 Oct [cited 2020 Aug 24]; 74(4):573-80. Available from: https://pubmed.ncbi.nlm.nih.gov/22607195/.

9.       Sunderland CCG Medicines Optimisation Group. Medication Review [Internet]. Switzerland: PSNC; [cited 2020 Aug 24]. Available from: https://psnc.org.uk/sunderland-lpc/medication-review-leaflet/.10.   Angaran D, Whalen K. Medication Therapy Management: A comprehensive approach [Internet]. New York: McGraw-Hill Education; 2015 [cited 2020 Aug 24]. Available from: https://accesspharmacy.mhmedical.com/content.aspx?bookid=1079&sectionid=61423929.

Author: CaraBeth Harrison

Everything You Need To Know About Ranitidine (Zantac) Recall

Posted on | by Blessy Joseph

Introduction about Zantac Recall

If you or someone you know takes the medication ranitidine for occasional heartburn or gastroesophageal reflux disease (GERD), you may be aware that the Food and Drug Administration (FDA) has recalled and removed the medication from the market due to concerns of a cancer-causing impurity. However, you may be wondering what that means and what you need to do. We hope this article helps you understand why the recall and what you need to do.

What is ranitidine?

Many people take over the counter (OTC) Ranitidine or commonly known as Zantac to prevent and relieve occasional heartburn. It is also available as a prescription for the treatment and prevention of ulcers as well as the treatment of gastroesophageal reflux disease (GERD).

Ranitidine was available in three strengths; 75mg, 150mg and 300mg. People who have been taking this medication, generally take it once or twice daily. The OTC labeling of this medication indicates a short course of treatment of no more than 14 days for relief or prevention of heartburn. If one requires further relief, one could see their primary care physician for evaluation to determine the root cause of their heartburn.

Ranitidine is classified as a histamine-2 (H2) blocker which works by reducing gastric acid in the stomach. Histamine is a chemical that naturally occurs in one’s body and encourages the stomach to produce acid when one eats to help digest the food. By taking a H2 blocker, one can reduce the amount of histamine produced in turn reducing the amount of acid produced.

Why did the FDA recall ranitidine and then remove it from the market?

In September of 2019, the FDA announced that preliminary tests of ranitidine contained low levels of a probable human carcinogen or a substance that is known to cause cancer. The substance found in these batches of ranitidine was N-nitrosodimethylamine (NDMA).  However, at that time, the FDA did not recommend discontinuation but did recommend talking with your doctor about alternatives.

Beginning in October of 2019 through February of 2020, some manufacturers of ranitidine implemented voluntary recalls of their product. It was not until April of 2020 that the FDA requested all ranitidine products be removed from the market. The FDA determined that there were only a few cases unacceptable levels of NDMA found in some samples tested. However, they noticed that the levels of NDMA increase overtime when it is stored at higher than room temperatures. Since there was no way of knowing how old the product was and how it was stored, the FDA decided to remove the product from the market due to a concern for safety. As a result of this request, ranitidine products are no longer available to purchase OTC or prescription.

What is NDMA and what does it cause?

NDMA is an environmental contaminant that is found in water and foods. The substance is unintentionally produced in or released from industrial sources through chemical reactions. NDMA is classified as a carcinogen based on animal studies that showed prolonged exposure to NDMA resulted in tumors. Low levels of NDMA can be ingested from our diets and are not expected to lead to an increased risk of cancer. However, prolonged exposure to higher levels of NDMA could increase the risk for cancers.

What should you do if you take ranitidine?

Since the FDA has formally removed ranitidine from the market, if you, a family member or a friend have been taking this medication the FDA recommends that you discontinue and discuss with your primary healthcare provider about options for further treatment. There are other alternative medications available for the treatment of occasional heartburn in the H2 blocker class as well as other classes. There is no evidence that the other H2 blockers or other heartburn medications have been affected by NDMA impurities.

References:

  • Commissioner, Office of the. FDA Requests Removal of All Ranitidine Products (Zantac) from the Market. 1 Apr. 2020, www.fda.gov/news-events/press-announcements/fda-requests-removal-all-ranitidine-products-zantac-market.
  • Commissioner, Office of the. “Zantac (Ranitidine): Safety Information – NDMA Found in Samples of Som.” U.S. Food and Drug Administration, FDA, 13 Sept. 2019, www.fda.gov/safety/medical-product-safety-information/zantac-ranitidine-safety-information-ndma-found-samples-some-ranitidine-medicines.

Phase Two of North Carolina’s reopening

Posted on | by Blessy Joseph

To our valued Patient,

I hope you and your family are staying safe and healthy as we navigate the COVID-19 pandemic.  This time of isolation has offered time for the team at Josefs Pharmacy to reflect and realize how fortunate we are to be able to serve you.  Our mission has always been to be caring neighbors. During this time we seek to make a meaningful contribution to the health and safety of our community, while maintaining the health and well-being of our wonderful Josefs Pharmacy team.

I want to take a moment to update you on our plans for reopening our Josefs Pharmacy locations to the public.  During Phase 1, we continued to offer drive thru pickup or curbside service for prescription and over-the-counter purchases, in addition to our free home delivery service as usual.

Our staff wear masks and either wear gloves or sanitize their hands after each patient interaction.  We have adjusted our hours to allow our staff to sanitize all contact surfaces in the pharmacy for both our staff and your protection.  One of our pharmacists has made over 75 masks that we have been able to offer for sale to our patients for protection while in public.

Our goal is to reopen to the public so that we can provide great personal service and care to you and your family.  We will only do so when we feel conditions are safe both for you and our staff.  We anticipate that we will open gradually, initially by limiting the number of patients in our pharmacy at one time, and progressively loosening restrictions as our state government allows.

During this time we will continue to implement the following:

  • Require all Josefs team members to monitor their temperature daily, and remain out of work if they experience any respiratory or flu-like symptoms.
  • Require all Josefs team members to wear personal protective equipment to ensure the safety of our staff and patients.
  • Install barriers at our “Drop Off” and “Pick Up” stations to protect patients and staff when we begin to allow the public back into our pharmacies.
  • Limit our hours of operation so that we can sanitize contact areas in our pharmacies daily.
  • Offer curbside or drive thru pickup, as well as free home delivery.
  • Offer communication via texting through our Josefs Rx Local App.

We encourage you to give us a call, text, or visit www.josefspharmacy.com for any questions or concerns you may have during this time.  Thank you again for the opportunity to be your primary source of healthcare products and services.

Stay safe,

Finny Joseph

Owner and CEO

Josefs Pharmacy

How to Purposefully Meal Prep

Posted on | by Blessy Joseph

Ahh yes, meal prep. The often touted #hashtag of fitness enthusiasts all over Instagram. At first, this might seem like a simple concept. You make food at the beginning of the week; you eat it throughout the week. Yes, at a macro level (oh, the irony) this is what is happening. But a GOOD meal prep takes understanding, consistency, and an ability to eat leftovers and not feel like you are missing out on the finer things in life (for many this is an acquired skill). But seriously, a properly executed meal prep will set you up for nutritional success every day of the week, and that is exactly what we are looking for!

            In order to see the results you are looking for, whether it be losing body fat, gaining muscle, training for sport, etc., consistency is key, and your nutrition HAS to be consistently leading you towards your goals. If it isn’t, you are wasting your efforts over the long term, it will take you longer to reach your goals, and the process will become frustrating. Consistently following whatever nutritional protocol you have aligned yourself with is what will allow you to reap the benefits of said nutritional plan.

            What better way in this busy world to stay consistent than to have all your meals made, put away, and ready to be eaten whenever you decide – especially when you know those meals are helping you get to where you want to be with your health/fitness?

Enter: meal prep.

Nutritionally, your meals should do the following, in general priority of importance:

  • Provide sustenance for you to survive
  • Not cause GI/health issues
  • Help you reach your health/fitness goals in a sustainable manner
  • Make you satiated until the next time you eat
  • Be accessible when you are ready to eat
  • Taste good

            Notice taste good is at the bottom of the list. Now, what you need to understand is that your food CAN and SHOULD taste good. However, if you are looking to achieve any sort of fitness goal, you need to shift your thinking about eating away from it being a short-term comfort or a social activity, and towards it being a means to an end.

Your food is what is getting you to where you want to be. Once you have achieved your goals, or are a healthy, fit individual, you can have the luxury of eating out with friends more frequently or being a bit less strict with what you eat in general. However, if you are just getting started with a nutritional protocol, or are on the path towards a fitness goal that will take time, whatever it may be, I have news for you: you have to have discipline, and often times it is not going to be easy. When people tell you it is, they are lying. Reaching your goals can be hard, and that is what makes it worth it in the end.

            However, don’t get that confused with people thinking your nutrition should be a punishment, or that the harder you are on yourself the more results you will see. This is not the case. The name of the game is sustainability. Your nutrition protocol should be set up to get you in the best shape of your life in a sustainable manner, while not sacrificing any of your mental well being (which oftentimes is an unfortunate byproduct of many fad diets).

            And this is exactly why people meal prep. It is an easy way to make sure they have access to healthy food that will help them reach their fitness goals. Step one is to consider what your nutrition plan is, and what food you need to have access to at specific times throughout the day when you plan on eating. Then, you have to plan if you will have time to make your meal when you will eat it, or prep it before hand. So, for most people, breakfast can be made in the AM (or prepped if you are strapped for time) lunch should be prepped, and dinner is up in the air depending on your schedule.

    Personally, I LOVE the egg meal I make in the morning. I sauté onions, peppers, spinach, tomatoes, mushrooms, a small portion of meat, and sometimes nuts, then add my eggs/egg whites. I get up earlier than I have to each day so I can make and eat this meal fresh. It is my favorite start to my day, it doesn’t interfere with the start of my morning, it is a meal that is helping me reach my fitness goals, and I enjoy it enough to eat consistently seven days a week. Knowing this, I only have to prep lunch and dinner. Before I do this, I consider the following (and encourage you to do the same!):

Will these meals provide with me with the micronutrients and macronutrients I need to maintain proper bodily function and lead me to my health/fitness goals (vitamins, minerals, proteins, carbs, fats, etc.)? Will they help me achieve all the checkpoints on the priority list above?

If not, what needs to change?

If I can’t change anything, what can I supplement to make sure I am staying healthy? (For me, the answer is vitamin D and fish oil. I encourage everyone to have blood work done to check for any deficiencies.)

Will these meals keep fresh throughout the time I plan on eating them?

For me, this is 6 days, and I home cook all meals on Sundays because I have the time and I love spending the day with my little family.
If not, then you should consider doing two meal preps throughout the week: One on Sunday, and one on Wednesday/Thursday depending on your preference in food and your time available. Nobody wants to eat 6-day-old fish.

Will I get sick of eating these meals throughout the week?

I’m a creature of habit, so the answer for me is no.
If the answer is yes, consider the following:

Meal prep for Sunday-Wednesday, and Wednesday-Saturday to spice things up
Cook more than one option of each food source when you meal prep
Cook a base item, like chicken, and then add various seasonings or toppings throughout the week. You could have chicken and veggies with salsa, with hummus, with hot sauce, and with curry all using the same meal prepped chicken.

Will I have access to a refrigerator at work/during my travels to keep these meals fresh throughout the week?

If not, then get a lunch box (like you had in third grade before it was cool to take paper bags), get an ice pack or three, and bring this with you wherever you go. When I finish my morning training sessions, I go home, write programs and articles, and then pack my cooler for the afternoon/evening I spend at the gym.

            Boom boom boom and boom. Once you have all of these questions answered, it’s time to start your actual meal prep. Knowing exactly what you need is step one, and step two is making it! For most people, you will want to base your meals around protein and vegetables, and you can add in starch from there if it’s necessary depending on your goals. So, for lunch and dinner, your best bet is to do the following:

Pick at least two proteins that keep well (chicken, beef, turkey, and all their variations are a good bet)
Pick at least two vegetables that you enjoy eating with your proteins (broccoli, cauliflower, asparagus, and spinach are some of my favorites)
Cook them. It’s very easy to bake chicken, oven-roast vegetables, and cook ground turkey/beef on the stove all under an hour.
Put them in your tupper ware containers, portioned out by meal. And you are set! You have your protein and veggies for lunch, and you have a different protein and veggies for dinner. Need a starch? Chef up some rice and you are ready to rock!

            Just like that, you are part of the #fitfam that meal preps. You are ready to CRUSH your week of eating, training, and getting to whatever fitness goal you are chasing! As always, don’t focus so much on the little things, like:

“What spices should I use?”
“Should I put my meals in one big container or little ones at the beginning of the week?”
“How many preps should I do in a week? 1? 2? 3?”

            The answer to most of the questions is as follows: Pick your foods, prep them, and see how it goes. Don’t like pre-portioning your meals and you would rather keep them in one big container and portion them as you go? Remember that for the next week. Find yourself enjoying chicken every week? Keep making it. The answer is to see what works for you, and keep doing that. As always, don’t worry about being perfect, worry about getting started, and from there, perfect your meal prep as you go!


Yours in health,

-Max Gordon, CSCS, FNS, Nutrition Coach, Fitness Instructor & Coach

Josefs Pharmacy Offers Free Flu Shots

Posted on | by Blessy Joseph

Major media reported this week the flu season is already “moderately severe” and may get worse. Josefs Pharmacy is hosting a Free Flu Shot event at each of our stores for 1 day only. 100 free flu shots are available at each store. Pre-registration is required. Ages 14 and up only.

Event Dates

Monday January 22, 2018, 10:00am-5:00pm: Josefs Pharmacy, 2100 New Bern Ave, Raleigh, NC, 919.212.2555

Tuesday January 23, 2018, 10:00am-5:00pm: Main Street Pharmacy, 213 West Main Street, Durham, NC, 919.688.1368

Wednesday January 24, 2018, 10:00am-5:00pm: Josefs Pharmacy, 3421 North Roxboro St, Durham, NC, 919.680.1540

Register here: https://flushotsjosefs.youcanbook.me

To prevent lines and long waits, flu shots are only available with advance registration. The
registration link is at Josefspharmacy.com. Walk-ups will not be accepted.  If the booking link is down, please call the desired pharmacy location to register.

Back to School: A Handy Health & Safety Checklist

Posted on | by Blessy Joseph

It’s just about that time again: Time to switch from swimsuits to school clothes and from beach bags to backpacks. That’s the easy part. What about preparing your child to have the healthiest and safest school year possible? Here’s a handy checklist to help.

  1. Schedule medical, eye, and dental checkups. Before school starts, check with the pediatrician to see if your child needs any immunizations. Vision and hearing tests are also a good idea, although schools perform hearing tests during certain grades.1 If your child is playing sports, ask the pediatrician whether a special checkup is needed. With certain sports, concussions can be a serious problem. Talk to the doctor about ways to protect your child.2                                                                                                                                                                                                                                                                                                                                             
  2. Organize your child’s medical history records. Provide copies to your child’s school or daycare providers. I can help you pull some of this together, but the list should include your child’s:
  • Prescription medications
  • Medical problems such as asthma or allergies
  • Previous surgeries
  • Emergency contacts2
  1. Communicate about transportation. Some kids get dropped up and picked up by parents. Others carpool. Still others walk, bike, or take the bus. And, of course, teens may have their own wheels. Regardless, it’s important that your kids be—and feel—safe getting to and from school.
  • If you or another adult picks up your child, agree on a time and place for pickups. Explain what to do if the driver is running late.
  • If your child walks or bikes, do a dry run and explain any potential traffic hazards.
  • If your child or teen takes the bus, find a safe route and agree on a visible pick-up and drop-off spot. Ideally, this is a place where other kids are around and adults can clearly see them.
  • If your teen drives to school, be crystal clear about safe driving—including ditching that teen temptation: texting while driving.

Create an emergency plan in case anything goes awry. In fact, make sure your child knows what to do in an emergency—whether at home or at school or anywhere in between.2

  1. Remember that there’s more to school than hitting the books. For example, good nutrition and exercise are essential for brain health. Here are a few other reminders:
  • Be consistent about bedtime and wake-up times. Growing kids need at least 8 hours of sleep—and teens need even more.1
  • Make homework a habit by having clear routines. But don’t overlook free time and friend time.
  • Explain ways to prevent infection such as by regularly washing hands and by not sharing hats or other clothing. That’s one way lice get around!
  • Keep lines of communication open. Listen for signs of bullying or other concerns. Many parents find that car rides are a great time to have nonthreatening conversations with their kids. Contact the school if a problem like bullying does arise.3,4

Now about those school supplies…. Come by the store to stock up. And while you’re here, we can talk over your health and safety plans for the school year.

Nothing herein constitutes medical advice, diagnosis or treatment, or is a substitute for professional advice.  You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition.

 

Sources

1. WebMD: Back-to-School Health Checklist. Available at: https://www.webmd.com/parenting/features/back-to-school-health-checklist Accessed 7/3/16.

2. EmergencyCareForYou: Homework for Parents—Your Child’s Back-To-School Health Checklist. Available at: https://www.emergencycareforyou.org/Health-Tips/Child-Emergencies/Homework-for-Parents-%E2%80%94-Your-Child-s-Back-To-School-Health-Checklist/ Accessed 7/3/16.

3. National Association Of School Nurses: Back to School Family Checklist. Available at: https://www.nasn.org/portals/0/resources/BacktoSchoolChecklistFamily_2015.pdf Accessed 7/3/16.

4. CDC: Back to School Health & Safety Checklist. Available at: https://www.cdc.gov/media/dpk/2013/docs/back-to-school/Back-to-School-Checklist.pdf Accessed 7/3/16.

Fun in the Sun—or Defeat in the Heat?

Posted on | by Blessy Joseph

Did you know that the number of hot days—and warm nights—is increasing? In the U.S., record high temperatures now outnumber record lows at least two to one.1 What can you do to protect yourself in a heat wave—or simply in the hot summer sun?

Know signs of trouble. Heat cramps are an early sign that your body is suffering from the heat—they’re more likely with heavy exercise or work. Along with muscle cramps, you may sweat heavily and feel very thirsty or fatigued.2

Heat exhaustion can happen when you lose lots of fluids from heavy sweating.3 These are a few other signs and symptoms of heat exhaustion:

  • Headache
  • Dizziness or feeling weak or confused
  • Nausea or vomiting
  • Fast heartbeat
  • Cool, moist skin
  • Dark-colored urine, a sign of dehydration2,4

If not treated, heat exhaustion can develop into heatstroke, which can be deadly because the body loses the ability to cool itself. Call 9-1-1 if someone shows signs of shock, becomes very confused, has a seizure, has a fever over 102 degrees F, breathes rapidly or has a rapid pulse, or loses consciousness. 2,3

Nip problems in the bud. If you have symptoms of heat exhaustion, get out of the heat as quickly as you can. Rest in a cool, shady place with your feet raised. Drink plenty of fluids, but avoid alcohol or caffeine. Apply cool compresses or take a cool shower or bath. Contact a doctor if you don’t feel better within 30 minutes.4

Beat the heat. In a heat wave, take these steps:

  • Avoid taxing activities if you can.
  • Stay indoors during the hottest hours of the day. The sun’s ultraviolet (UV) rays are strongest between 10 am and 4 pm.5
  • If you don’t have air conditioning, go to a library, mall, or other public place to cool down for a few hours.
  • Wear lightweight, loose-fitting clothing. Avoid dark colors, which trap the heat.
  • Use a hat or umbrella outdoors.
  • Allow your car to cool off before you get in.
  • Drink water and eat small meals often. Drink less alcohol and fewer caffeinated drinks.
  • Don’t take salt tablets unless your doctor tells you to.2,3,4

Protect those at increased risk. Help protect those who are most vulnerable in the heat. That includes children, older adults, and people who are obese, ill, exercising vigorously, or not used to the heat or high humidity.2 For example, make sure young ones drink plenty of water. And you might check in on your elderly neighbor once in a while.

It’s important to know that certain medicines can also increase your risk of heatstroke. This includes allergy, blood pressure, and seizure drugs as well as medicines used for mental health conditions. Let’s talk this over to make sure you stay safe and know the signs of problems. And, if you have a chronic condition, it’s a great idea to ask
your doctor about other ways to lower your risk of heatstroke. 4

Nothing herein constitutes medical advice, diagnosis or treatment, or is a substitute for professional advice.  You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition.

Sources:

  1. Climate Communication: Heat Waves. Available at: https://www.climatecommunication.org/new/features/extreme-weather/heat-waves/ Accessed 5-23-16.
  2. MedlinePlus: Heat emergencies. Available at: https://www.nlm.nih.gov/medlineplus/ency/article/000056.htm Accessed 5-23-16.
  3. Healthy Roads Media: Heat Waves. Available at: https://healthreach.nlm.nih.gov/documents/EngHeatWaves.pdf Accessed 5-23-16.
  4. Familydoctor.org: Heat exhaustion and Heatstroke. Available at: https://familydoctor.org/familydoctor/en/prevention-wellness/staying-healthy/first-aid/heat-exhaustion-an-heatstroke.printerview.all.html Accessed 5-23-16.
  5. FDA: Sun Protection. Available at:  https://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/Tanning/ucm116445.htm Accessed 5-23-16.

 

9 Screening Tests for Men

Posted on | by Blessy Joseph

Are you one of those guys who can’t remember the last time you stepped foot in a doctor’s office? Sure, maybe you’ve gotten in for something urgent, but what about scheduling an annual exam or screening tests? Maybe you simply forget, think you already have healthy habits, or insist that you “feel just fine.” Sorry, guys…. Not quite good enough.

Regular checkups and screening tests aren’t something you can afford to ignore. Baseline tests can help your doctor know how your health is changing over time. Plus, silent killers such as high blood pressure or high cholesterol can wreak havoc—and you wouldn’t have a clue without being tested.

Here’s a simple screening cheat sheet to make your life easier.

Abdominal aortic aneurysm. If you have ever smoked, get this ultrasound test one time between ages 65 and 75. This test will show whether or not your largest artery (abdominal aorta) is bulging. If it is, it may burst, putting you at risk for bleeding—and even death.

Blood pressure. Starting at age 18:

  • Get tested at least every 2 years if your blood pressure is lower than 120/80.
  • Get tested once a year if your blood pressure is between 120/80 and 139/89.
  • Discuss treatment with your doctor if your blood pressure is 140/90 or higher.

Cholesterol. From age 20 to 34, get a regular cholesterol test if you are at increased risk for heart disease. At age 35, get a regular cholesterol test. Ask your doctor how often you need to do this.

Colorectal cancer. Get screened for colorectal cancer from age 50 to 75. This screening may include one or more tests, such as fecal occult blood testing, sigmoidoscopy, or colonoscopy. Ask your doctor which test is best for you and how often you need it.

Depression. Ask your doctor about being screened for depression if over the past weeks:

  • You have felt sad or hopeless
  • You have lost interest or pleasure in doing the things you normally enjoy

Diabetes. Starting at age 18, get screened if your blood pressure is higher than 135/80 or if you take high blood pressure medicine.

Hepatitis C virus (HCV). Get screened once if you:

  • Were born between 1945 and 1965.
  • Have ever injected drugs.
  • Received a blood transfusion before 1992.

Lung cancer. Ask your doctor whether or not to be screened if you:

  • Are between 55 and 80.
  • Have a 30 pack-year smoking history. (This is the number of packs smoked per day times the number of years you smoked.)
  • Smoke now or quit within the past 15 years.

Overweight and obesity. This is a test you can do yourself. Find your body mass index (BMI) by entering your weight and height into an online BMI calculator.

Discuss with your doctor whether you are at increased risk for any other diseases. If so, you may need other tests.

Be honest with your health care provider and me. Be sure to let us know what worries you—whether it’s your weight, alcohol use, or challenges with anxiety. Think of us as your partners in health. We can do a much better job of helping you if we fully understand your health challenges and concerns.

Nothing herein constitutes medical advice, diagnosis or treatment, or is a substitute for professional advice.  You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition.

 

Sources:

  1. AHRQ: Men: Stay Healthy at Any Age. Available at: https://www.ahrq.gov/patients-consumers/patient-involvement/healthy-men/healthy-men.html Accessed 5-4-16.
  2. OWH: Screening tests for men. Available at: https://www.womenshealth.gov/screening-tests-and-vaccines/screening-tests-for-men/ Accessed 5-4-16.

 

 

Heart Health: The Facts of Woman’s Heart Attack

Posted on | by Blessy Joseph

Did you know that the symptoms of a woman’s heart disease are different and atypical than a man’s?  For example, chest pain may not be a described symptom for women experiencing a heart attack.  Examples of most common symptoms experienced by women include:

  • Pain, heaviness, discomfort, or pressure in the chest/abdominal area – Pain that extends to the jaw, neck, shoulder, inner arm, and upper back.
  • Shortness of breath
  • Nausea or vomiting
  • Sweating
  • Unusual, extreme fatigue
  • Dizziness or lightheadedness

For more information, visit https://www.aclsmedicaltraining.com/a-womans-heart-attack-why-and-how-it-is-different-than-a-mans-heart-attack/

New U.S. Dietary Guidelines

Posted on | by Blessy Joseph

Based on the most recent science, the 2015-2020 Dietary Guidelines for Americans were released at the beginning of 2016. Before you say, “here we go again,” let’s take a closer look. The guidelines may sound familiar, but there are some differences from years past.1

Overall guidelines. For the most part, these guidelines don’t advise you about how much to eat of different foods, such as vegetables or meat. Instead, they focus on helping you fit healthy eating into their own unique lifestyle. To that end, they provide three examples of healthy eating plans: a healthy American diet, a Mediterranean-style diet, and a vegetarian diet.

What these three types of diets share is an emphasis on more plant-based foods, healthy fats, and whole grains. The guidelines also suggest making meals and snacks from scratch. That helps avoid the common pitfalls of processed foods, such as high levels of salt and sugar.

Overall, a healthy eating pattern includes:

  • Any vegetable, but preferably a wide variety
  • Fruits, especially whole ones
  • Grains—with at least half being whole grains
  • Fat-free or low-fat dairy
  • A variety of protein sources, including seafood, lean meat, poultry, eggs, beans, peas, nuts, seeds, and soy products
  • Oils1

Specific guidelines. The last set of guidelines came out in 2010. They simply advised people to reduce their intake of added sugars, without giving numbers. The newest guidelines, however, are more specific. They suggest you limit added sugars to fewer than 10 percent of your daily calories. Right now, added sugars account for more than 13 percent of Americans’ daily calories. 1

Soft drinks, fruit drinks, sweetened coffee or tea, flavored waters, and alcoholic beverages account for nearly 50 percent of all added sugars we consume. A recent study revealed that people who drink sugary drinks daily tend to put on more deep belly fat over time.2 That’s the kind of fat that surrounds vital organs and is linked to type 2 diabetes and heart disease. Other sources of added sugars are snacks and sweets, as well foods like bread and prepared meals.

                        The new guidelines also suggest that you limit saturated fats to no more than 10 percent of your daily calories. That’s a goal that fewer than a third of Americans meet. Sadly, these fats can increase levels of bad cholesterol, and your risk of stroke and heart disease.4 About a third of saturated fat comes from prepared foods containing cheese or meat—foods like burgers, tacos, and pizza—as well as dairy products, snacks, and sweets.1

Finally, the guidelines advise eating fewer than 2,300 milligrams per day of salt—a little less than a teaspoon. That’s a guideline that nearly all Americans are failing to meet. But it’s not something to ignore. That’s because too much salt can increase blood pressure, which also increases risks of heart disease and stroke.3

Don’t know where to begin? Stop by and we’ll have a chat. I can offer you a tip or two!

Nothing herein constitutes medical advice, diagnosis or treatment, or is a substitute for professional advice.  You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition.

 

Sources: