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Archive for the ‘Plain City Health’ Category

Vitamin D Deficiency. By Our January Student Pharmacist, Brayson Ramirez.

During the winter months here in Ohio it can be hard to get enough sunlight. The days are short and the weather is usually too terrible to wear shorts or a t-shirt. According to The New England Journal of Medicine, adequate sun exposure is considered direct sunlight to the arms and legs for five to thirty minutes between 10 am and 3 pm twice a week. The weather can be unpredictable, but I know I don’t go outside anywhere close to that much during the winter, even with only my face exposed.

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There are three significant factors that contribute to Vitamin D absorption, or lack thereof:

  • The first factor is skin tone; the darker the skin the harder it is to absorb the UVB rays needed to make Vitamin D.
  • The second factor is weight; the heavier a person is, the less likely they are to produce an adequate amount of Vitamin D.
  • Lastly, age is a contributing factor. Once a person reaches 50 years old, the body doesn’t produce Vitamin D at the same rate.

Rickets, osteoporosis, a weakened immune system, and general fatigue can be caused by a lack of Vitamin D. Each one of these complications is particularly harmful to older adults. Unfortunately, women are prone to bone density issues, such as osteoporosis, so they greatly benefit from maintaining a good level of Vitamin D.

The Centers for Disease Control and Prevention (CDC) reports that at any given time 10% of the population is Vitamin D deficient. In the study where they determined this number, the people they tested were from the northern areas during the summer and the southern areas during the winter. With that selection process in mind, the number of Ohioans during the winter who are Vitamin D deficient is most likely much greater than 10%.

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Taking Vitamin D without an official Vitamin D deficiency diagnosis is okay and recommended by many doctors, but you must make sure to not over do it. If you wanted to take Vitamin D if you know you are not getting enough sunlight, the recommended dosing for an adult is 800 to 1000 units once a day. Doctors commonly prescribe more, but they can run blood tests to have a better idea of how much Vitamin D their patients need.

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When you go to the pharmacy to get your Vitamin D supplement you will most likely come across many choices with many strengths. There will also probably be a Vitamin D2 (ergocalciferol) and a Vitamin D3 (cholecalciferol). Both types are very similar in structure and are safe to use. They are not quite equivalent though. Vitamin D2 originates from plants while Vitamin D3 is what animals, including humans, produce from the sun. Both types are eventually converted by the liver to the same chemical that is used in the body, but some studies show Vitamin D3 produces more of that useable chemical per dose and helps to maintain a higher level in the body. If you are currently using D2 and it is working well for you then there would be no reason at all to change it. When it comes to which one to use, I would pick D3, but if I went to the store and there was a significant cost difference or no D3 options I would go ahead and use D2.

Hopefully, this information can help you understand Vitamin D and why many people are trying to replace it through supplementation.

Continuous Glucose Monitors, a Pharmacy Perspective. By Our January Student Pharmacist, Brayson Ramirez.

Checking blood sugar with finger sticks throughout the day may not be the worst part of diabetes, but it is possibly the most well-known. Finger sticks always have discomfort associated with them and nobody likes to poke themselves to draw blood, no matter how small the sample. The ability to test blood sugar without having a finger stick sounds like a dream solution to a problem affecting such a large number of people. Continuous glucose monitors, or CGMs for short, are trying to offer this option.

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Recently a new product has come to the market and has been gaining popularity in this area, but why? Continuous glucose monitors have been around for a while, but lancets and test strips have not gone away. I wanted to take this chance to look at the continuous glucose monitors from a pharmacy perspective.

There are a couple of very important variables with CGMs that are commonly not considered or well-advertised. The first is the warm-up period of the monitor system. During this time, the sensors are not guaranteed to produce accurate data, so it would not be recommended to use those readings for insulin administration or glucose record keeping.

The second variable is the calibration of the sensors as recommended by the manufacturer. In order to have the most accurate readings, calibration is required. To calibrate a sensor, a traditional finger stick reading is required. In some cases, the calibration finger sticks may be even more poking and prodding than a traditional blood glucose testing schedule.

I went through some of the more popular CGMs and made a quick summary chart of their warm-up and calibration requirements along with their life span. The products listed do not include insulin pumps that can integrate with sensors to get glucose readings.

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As you can see from the chart, the Freestyle Libre system is the only one that does not require the user to calibrate, so it is the most likely to reduce finger sticks. All of the systems require a warm-up period. Again, the Freestyle Libre does show a bit of an improvement in this area. It has a one hour warm-up time, but it has a sensor life of 14 days, so that warm-up time will be coming around less frequently.

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When it comes to accuracy with continuous glucose monitors and traditional blood glucose meters, it is very important to understand how each works. Blood glucose meters are basically taking a snapshot of your current glucose level. CGMs measure glucose levels with interstitial glucose that is basically leaking out of your blood vessels, as seen in the above image. Since the interstitial glucose is not a direct measurement of blood glucose, the values are more like delayed blood glucose levels. With this delay, CGMs are not the best in a situation where glucose is rapidly changing, such as a severe high or low glucose reading that you are trying to recover from. In those cases, finger stick glucose readings are going to be more accurate and potentially avoid an even more serious situation.

Continuous glucose monitors have been shown to produce better outcomes overall for diabetic patients due to their more constant monitoring, but it is still necessary to keep a supply of traditional testing supplies for emergencies or sensor malfunctions.

The DASH Diet. By Our January Student Pharmacist, Brayson Ramirez.

At this point, we are a little bit more than a week into 2019. Many people have made New Year’s resolutions and a large chunk of them most likely want to lose some unwanted weight. Weight loss is not a bad idea, but a lot of people do not know how to do it in a healthy way. Some believe eating less is the way to lose weight, but that can be unhealthy and even dangerous.

The best way to lose weight is through diet and exercise, but also keeping in mind what is reasonable and what one is individually capable of doing. Some progress is better than no progress. Some diet changes may show change, but some may just lead to a happier, healthier life.

I recommend focusing on the happier, healthier life and the rest will come with time.

The first place to start a dietary change would be with the DASH diet. This diet has been proven through multiple scientific studies to help lower or prevent high blood pressure and can also help with weight loss and diabetes. The focus of this diet is on foods that have always been considered healthy, such as fruits, vegetables, fish, poultry, and nuts. The DASH diet also tries to keep sodium, sweets, added sugars, and fats in moderation. By adjusting the serving sizes of each group, more nutrients can be ingested while limiting the harmful saturated fats, trans fats, and cholesterol.

Blood Pressure Monitor

To figure out your diet, all you do is check your daily calorie needs for your age and level of activity. Age, is of course self-explanatory, but activity level can be tricky. The DASH diet divides activity level into sedentary, moderately active, and active. Sedentary is only completing your activities to get through the day. Moderately active is walking 1-3 miles a day at a low speed. Active is considered walking more than 3 miles per day and some light physical activity. Females have lower calorie needs on average, as seen in this chart provided by the National Heart, Lung, and Blood Institute (NHLBI).

Chart 1 Calorie Needs

Making this change in diet too quickly can lead to some diarrhea and other uncomfortable problems due to the increase in fiber. Slowly adding a serving or two of vegetables, grains, or fruits each week to transition to the DASH diet can help limit digestive issues and make the change as comfortable as possible.

The hardest part to follow in the DASH diet is knowing the servings needed of each group and what counts as a serving. This is where the diet gets tricky. The NHLBI has a great chart that breaks everything down as shown here.

Chart 2 Food Groups

My advice on this concept is to check out the food groups listed and just try to stay around the top. Maybe try a couple of the meal ideas pre-made on the site or create your own with the recommended food groups. See if there are any meals you enjoy; if you do, start introducing one or two of them every week.

Hopefully, you could get to the point of an all DASH diet approved meal plan, but if you are at least choosing the healthier of two options then that is some important progress. Remember, some progress is better than none and if you are living a happier, healthier life that is most important.


For all my reference material and more information on the DASH diet. And for various resources to use in any dietary adjustments please visit https://www.nhlbi.nih.gov/files/docs/public/heart/dash_brief.pdf


What’s for Lunch? A Back-To-School Lunch Guide By Our September Student Pharmacist, Rebecca Miller.


Feeding our kids healthy and nutritious meals is important because, according to the American Academy of Pediatrics, kids who eat nutritious meals do better in school.

Everyone knows that eating healthy is better for kids, but just how bad is it for a child to eat unhealthy food? A poor diet increases a child’s risk of obesity, cancer, poor cognitive development, and poor school performance (CDC). A single can of soda each day increases a child’s risk of obesity by 60%.

Most parents know that feeding their kids unhealthy food is not good for them. They know that their kids need to eat healthy to be healthy. But they don’t know what is considered healthy or how to make a healthy lunch that will work for school and which their child will eat.

What is a healthy lunch?

School-aged kids need somewhere between 1,200 and 3,000 calories per day. The exact number depends on a variety of factors which include age, gender, and activity level, among others. Every child is so different, though, that it is much less important to make sure that they are not getting too many calories and much more important that the food they have access to has the right kinds of calories.

A simple rule of thumb is to eat, per total meal, ¼ fresh or frozen fruit, ¼ fresh or frozen vegetables, ¼ whole-grains, ¼ protein, and have a serving of dairy (in addition or as the protein). The fruits and vegetables ensure that the child is getting plenty of vitamins, minerals, and quick energy. The protein and whole grains ensure that the child will have long-lasting energy to carry them through the school day and keep their minds sharp.

OK, but that is too expensive and takes too much work for our family…

Luckily, your child doesn’t need a complicated meal every day for lunch. A lunch box filled with grapes (fruit), carrots (vegetable), whole grain crackers (grain), and yogurt (protein and dairy) gives your child everything they need for a healthy lunch. Add a re-fillable bottle of water to keep them hydrated and they are ready to go. Below you can follow a chart which gives several ideas to help you mix and match items from each category to create healthy lunches that are quick to assemble, won’t be boring, and don’t break the bank.


One way to make packing a healthy lunch easier on hectic mornings is… pack the night before. If there are any ingredients which could get soggy (like bread with mustard), just pack them separately and have your child assemble them when they are ready to eat.

fruits and veggies

How do I get my child on board?

A great way to reduce the frequency of the inevitable battle of food that your child doesn’t want is to give them a list of options from each category (either a list of what you have in the house or a list of what you are willing to buy the next time you go to the grocery) and allow them to choose which options they prefer. This allows you to be sure that they are getting a healthy meal and allows them to have some control and choice in their lunches. Packing lunches the night before also allows the kids to participate, giving them a sense of involvement.

For additional resources on healthy meal options see www.choosemyplate.gov


What is “Walking Pneumonia”? By Our September Student Pharmacist, MiKayla Matheny.

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Most people know someone who’s had pneumonia but not everyone really knows what it is.

Pneumonia is a lung infection that is often caused by bacteria but can be due to viruses or other germs. Pneumonia happens when an infection causes the air sacs in the lungs to fill up with mucus. This can cause a fever, chest pain (that is usually worse with deep breaths), a fast heartbeat, shaking or chills, and coughing that brings up mucus.

When a pneumonia is really bad, it needs urgent medical attention and treatment to help prevent further problems. Sometimes, however, pneumonia can be pretty mild and may be hard to recognize. This type of mild pneumonia is sometimes called a “walking pneumonia” because a person who has it may not feel very sick and can still walk around, go to work, and do most of their normal activities. A person with walking pneumonia may have headaches, body aches, a persistent cough, and generally feel tired or run-down. These symptoms are not always bad enough to make a person think they are sick or they may be mistaken for the symptoms of a common cold.

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Walking pneumonia may not sound so bad compared to what people tend to think of with a serious, full-blown pneumonia, but it is still very important to treat it. Here’s why:

Walking pneumonia is usually caused by a different, more unusual type of bacteria than most other pneumonias. This type of bacteria (doctors call it Mycoplasma) grows more slowly than other pneumonia-causing germs but can be harder to get rid of. This means that walking pneumonia tends to get worse slowly, but usually does continue to get worse without treatment. The bacteria that typically cause walking pneumonia can be resistant to some common antibiotics, so it is very important to get treatment early. Treating walking pneumonia, or any type of pneumonia for that matter, as early as possible helps the person recover much more quickly and reduces the risk of having other more serious problems. If you have symptoms that could be pneumonia, it is important to see a doctor.

Even with very mild symptoms, walking pneumonias can still be contagious and spread to other people. An infection which might just be uncomfortable or inconvenient for a young, otherwise healthy person can be devastating if it gets passed to someone with a weaker immune system. Young children, older people (>65 years), and people with chronic medical conditions like asthma, COPD, uncontrolled diabetes or kidney problems are much more at risk of having serious problems if they catch pneumonia.

To help prevent the spread of pneumonias and many other infections (like the flu) always cover your coughs and sneezes and wash your hands frequently. Stay home when you are sick and wear a face mask if you need to go out in public. It is also very important to get your flu shot every year and as well as pneumonia shot if you need one.

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