Month: October 2017

Mail-order pharmacy. Sigh. This phrase instantly makes me annoyed. When I began practicing as a pharmacist, mail order pharmacy was not available. Now 8 years later, patients have the option of having their prescriptions mailed right to their house. Often this is the chosen route because of perceived convenience, but sometimes the insurance plan they have left them no choice. Preventing a patient from coverage at their local pharmacy is just plain wrong.

I do plenty of online shopping and appreciate the ease and rapidness of receiving what I ordered 2 days later. I live rather rural and have to drive a good distance for major shopping opportunities. Medicine is not the same as a cookbook or a new pair of shoes though. I do not need someone to explain my purchase of an object to me.

Medicine affects your entire body. It may have side effects that need to be explained. The directions may be confusing. The medicine may interact with other medications you are on. You may have concerns about the medicine your doctor is starting you on for the first time. As part of my job, I have to call mail order pharmacies on occasion. I wait on hold a long time. I get transferred to many people. Sometimes I get hung up on. It is not easy to talk to a pharmacist. When you do reach a pharmacist, they do not know you. They have never seen your face. Although they may perform their job well, they do not have a personal connection with you.

When you walk into my store, it is likely one of the staff knows your name. They may know your mom, or their kids go to school with your kid. They grew up in the same city as you. When a new prescription is given to you, a pharmacist, in person, explains it to you. You can call with questions and reach your pharmacist quickly. Your pharmacist cares about you and your health.

Mail-order pharmacies also have to deal with the mail. Your prescription may get lost in transit. Your prescription may have run out of refills delaying your delivery. You may run out of your medication and have to go without. I have helped many patients who use mail-order pharmacy with obtaining their medication when it does not arrive on time. This requires some effort on my part. I have to call the doctor, have them send to me a prescription for a short supply of medicine. Then I have to call the insurance and have them place an override allowing me to fill the prescription that the mail-order pharmacy was unable to achieve in a timely manner. I do this because it is important to me to ensure each patient has access to their medicine. Even when the mail-order pharmacy is at fault.

The pharmacist is the most accessible health care professional. We are available to answer any question from concerns about a medication, to recommendations on how to help a baby with colic. We will even try to coax your crying baby to smile while we talk with you. Most of us became a retail pharmacist because we wanted to help the community we serve improve their health. Mail order pharmacy is drawing people away from a valuable service. A retail pharmacist has more to offer than just filling your prescription.

The profession of pharmacy is continually growing and expanding. Your local pharmacy now likely offers many services aside from prescription filling. Many are free or billable to your insurance. Programs such as blood pressure checks, medication therapy appointments, and vaccinations are just a few of the options available at many retail pharmacies now. I love my job and having a personal connection with as many patients as I can. I feel it helps me understand the entire picture of their health and needs as it relates to their medicine. Choose local pharmacies, they will provide you with the best care. Your health is more important than convenience.

Take Care

Tiffany Herring PharmD

 

Probiotics seem to be gaining in popularity over the last few years. When I began practicing as a pharmacist 8 years ago, I hardly ever answered questions from patients related to probiotics. Now it seems daily I will give a recommendation on which probiotic to use, when to take it, and why take one at all.

Lets start with why probiotics are important. Probiotics are the good guys in your gut, the bacteria who aid in the fight against bad bacteria entering the body. The actual definition of probiotic is: Live microorganisms that, when administered in adequate amounts, provide a health benefit to the host. Some names for these good guys are:

• Lactobacillus
• Bifidobacterium
• Bacillus species
• Saccharomyces boulardii.

Your gut is the place where nutrients are absorbed and is the first place where bad bacteria will run into the immune system. It is here that initial security forces are in place, to defend the body against the bad coming in and to heal any of the damages of infection and inflammation caused during battle. My husband is in the army and probiotics remind me of soldiers, fighting and fixing at the same time.

The concept of a large role of the immune system being centered in the gut was new to me. As a pharmacist, I understood the good bacteria are important to protect from having too much bad bacteria. I also knew to counsel patients on taking a probiotic while on an antibiotic to keep the good guys going… but didn’t realize just how important the gut was to health. Reading that 70% of the immune system lives in the gut was surprising to me.

A quick run down of the immune system….

The immune system is made up of 2 parts: the innate immune system and the adaptive immune system. The innate immune system consists of cells with antennae like structures to feel for any bad guys entering your body. These cells live on the surface of the intestine and send messages up the chain of command to the adaptive immune system when an enemy is present. The adaptive immune system cells adapt to the ever-changing battle field and will send into action the immune cells responsible for making the antibodies to kill the enemy. These immune cells ( T cells and B cells ) are located within the intestine lining.

This system functions like a perfect machine when everything is in order, but if the system malfunctions in any way it causes chaos for the entire body. 

When all is well in the gut, there is a balance of bacteria that keeps the immune cells functioning as designed. The good bacteria help the immune cells to learn good from bad, self from enemy. They also help the body produce antibodies to respond to the enemy.

So how does the balance become undone?

We have all heard it is good for children to get dirty (or eat dirt if it is my kid…). There is truth in this statement, when not exposed to germs and bad bacteria, the body has no chance to learn that some are good and will instead attack all that is bacteria. When prevented too much from having germs enter the body, the good guys and the immune system may not achieve a strong working relationship to battle the bad bacteria together. In other words, do not be overly obsessive with hand sanitizer or having a disinfected and dirt free home. 

Antibiotic use will put a patient at risk for unbalance since the good bacteria will get killed in the cross fire of attacking the bad bacteria.

A diet lacking in fermented foods (think sauerkraut, kefir, kombucha, yogurt) and fiber from grains, fruits and vegetables can lead to a lack of good bacteria colony in you gut.

So, how do you know if a probiotic is something your body needs? There are many signs given by the body when the good to bad bacteria balance is not right. When the gut is not happy, you usually can feel it:

Gas

Bloating

Constipation

Diarrhea

Cramping

Indigestion/acid reflux

Probiotics are also taken to prevent issues when taking an antibiotic. When used for this purpose, it is important to remember to take the probiotic either 1 hour before or 2 hours after antibiotic. This allows time for probiotic to colonize before antibiotic swoops in and tries to kill them all again.

While it is possible for a probiotic product to lead to an infection of bacteria in a bad way through your system, the bacteria used are already commonly found in the gut of humans. Patients with very low immune system function may want to use caution if starting a probiotic.

Now, how do you go about choosing the best probiotic? I prefer to recommend products that contain more than 1 type of probiotic. The greater the amount and diversity of good bacteria the more balanced and prepared the gut will be going forward against bad bacteria. I personally rely on probiotics daily because of antibiotic use, and have a few different options in my home to switch up the good bacteria and maintain a balance of colony types in my gut. I also enjoy drinking kombucha tea. (If you have not tried it, it comes in a large variety of flavors. Some will have a vinegar taste to them, but many do not. I have even had orange soda flavored kombucha tea!) 

Your Health Matters

Tiffany Herring PharmD

**THIS AUTHOR AND SITE INTENDS ONLY TO SHARE INFORMATION AND NOT TO DIAGNOSE OR TREAT DISEASE.