Archive for February, 2017

You may have seen the commercials on TV for the pneumonia vaccine Prevnar. It is the newer of the two pneumonia vaccines and is currently heavily advertised. You may have wondered if it is something you need, especially if you have already received the other pneumonia vaccine, Pneumovax. This blog is meant to clear up confusion that often surrounds the pneumonia vaccines.

Let’s start with the basics of what pneumonia is. Pneumonia is an infection of the lungs that can be caused by viruses, bacteria, or fungi with the most common cause being the bacteria Streptococcal pneumoniae. (The vaccines protect against this kind of pneumonia).

People with pneumonia can experience symptoms such as shortness of breath, painful breaths, coughing up mucus, or fever. Symptom severity can vary across different patients.

Prevention of pneumonia is important, because, every year, an estimated 900,000 Americans get pneumonia, 400,000 are hospitalized, and 5-7% die from the infection. The young and the old are more susceptible and tend to get sicker when they get pneumonia.

As mentioned earlier, there are two different pneumonia vaccines, Prevnar and Pneumovax.

Prevnar is the newer pneumonia vaccine and contains thirteen pneumonia strains. Pneumovax has been around longer and contains twenty-three strains. Both vaccines are recommended by the Centers for Disease Control and Prevention (CDC).

See the bullet points below for important pneumonia vaccine information, but don’t get bogged down by all the facts. Your doctor will help you determine when it is appropriate for you to get doses of the pneumonia vaccines.

• Both pneumonia vaccines are inactivated, meaning the bacteria is dead and the vaccine will not give you pneumonia. After receiving the vaccine, you may experience side effects such as injection site pain, redness, or a low grade fever which should go away in a day or two.
• Unlike the flu vaccine, the pneumonia vaccine is NOT one that you should get every year. Many people just need one dose of Prevnar and one dose of Pneumovax in their adult life.
• Most people over the age of 65 should receive both vaccines. If you haven’t had either of the pneumonia vaccines, it is recommended to get Prevnar first, then Pneumovax ONE YEAR LATER.
• If you are younger than 65, but have a chronic heart condition (NOT including high blood pressure), COPD, asthma, diabetes or smoke cigarettes, one dose of Pneumovax is recommended. If you don’t have a spleen, you should get two doses before age 65. With any of these conditions, you should still get another Pneumovax dose after age 65.
• If you are younger than 65 but have cochlear implants, HIV, or other conditions of weakened immune systems, one dose of Prevnar is recommended. There is not a need to get another Prevnar dose after age 65.
• It is important to make sure that Prevnar and Pneumovax doses are given at least one year apart from each other and that, if you get more than one dose of Pneumovax, the doses are no closer than five years apart.
• The manufacturer labels state that you can get the Prevnar and Pneumovax vaccines as young as 50-years-old, but the recommendation from the CDC is still age 65 for people without the conditions discussed above.

References:
Pneumococcal Disease: Fast Facts. Centers for Disease Control and Prevention. https://www.cdc.gov/pneumococcal/about/facts.html. Last updated 10 Jun 2015. Accessed 20 Feb 2017.
Adult Immunization Schedules. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html. Last updated 6 Feb 2017. Accessed 20 Feb 2017.

Pretend you are in an auditorium attending a guest speaker lecture. The room is dimly lit with the stage bright with spot lights. The speaker comes out and addresses the audience with an opening question: “Show of hands, how many people here would like to suffer?”

After hearing this question, do you raise your hand?

I venture to say that, in this metaphorical situation, no one in the audience would raise their hand.

It’s almost a universal belief that no one wants to suffer. And yet, we live in a world where all we see and hear are stories about the suffering of others. It’s almost like there isn’t a single place that isn’t plagued by suffering.

One place we tend to forget that has daily suffering is any healthcare setting. Day in and day out, people enter and leave hospitals and clinics suffering. We make it our effort to relieve the symptoms of others with the hopes of curing medical problems. But medical advances can only do so much. What’s that leave us with?

Enter, Palliative Care.

Palliative Care is a specialized form of medicine for individuals who have a serious medical illness. The symptoms and stresses of the illness are the target of Palliative Care. The ultimate goal: improve the quality of life of both the patient AND the family. This goal can be achieved with a Palliative Care team working with the patient and family.

Who makes up a Palliative Care team?

A multidisciplinary team (meaning many different healthcare providers across all kinds of specialties) includes physicians, nurses, therapists, pharmacists, chaplains, and anyone else who wants to alleviate suffering. If you are lucky, your Palliative Care team will be an “interdisciplinary” team, meaning everyone works together at the same time to figure out how best to help their patients.

I want to make this point of order. PALLIATIVE CARE DOES NOT ALWAYS MEAN DYING.

There is a misconception that if Palliative Care is consulted then it means death is around the corner. In reality, if Palliative Care is called to the case then you can expect an increase in your quality of life. That mentality is shared with Hospice.

Hospice is the care associated with a health condition that limits life to six months or less. Palliative Care sprouted from Hospice and shares similarities in philosophies of care, but they are distinctly different.

With these misconceptions comes a miscommunication of what Palliative Care stands for and can do for patients. Compiling lists from various authors, here’s what those who are in Palliative Care and who have experienced its healing want you to know:

• Palliative Care is appropriate at any stage of an illness: As I stated before, it’s assumed that Palliative Care is meant for end-of-life care. I’ve personally seen Palliative Care give a woman back her ability to breathe. If that hadn’t happened, she would surely have died. But Palliative Care got her back on her feet and out the door. Palliative Care doesn’t always mean dying.
• Palliative Care isn’t only for cancer, but is beneficial for ANY chronic illness: It’s easy to think that Palliative Care is for cancer patients. If I asked people “which illness causes the most suffering?” most would probably think of cancer. But remember, that every health condition can cause suffering. That means Palliative Care can help with anything as long as a symptom exists that is decreasing a patient’s quality of life. Starting early with Palliative Care can give someone’s life back when there’s still life to be lived.
• Palliative Care manages total pain: Pain is thought to be this obnoxious feeling that causes discomfort. Pain is more than that. Pain is physical, but it is also social, psychological, and spiritual. The summation of all of these make up a patient’s total pain. Palliative Care treats all of them together and wants to get rid of total pain.
• Palliative Care can treat many symptoms that can be impacting a patient: You name it, Palliative Care attempts to alleviate it. Typical symptoms might be nausea, fatigue, shortness of breath, and pain. But anything that can be affecting the quality of life of the patient or their family is what Palliative Care wants to treat.
• Palliative Care also focuses on treating emotional symptoms too: Suffering is not only physically exhausting, but emotionally exhausting, too. Those emotional stresses can add to the overall suffering. It doesn’t matter if the emotions are related to the illness, the course of the illness, or are related to spiritual questions that need answered. Palliative Care wants to deal with those problems along with the physical symptoms being experienced.
• Early involvement with Palliative Care gives life: I’ve said this multiples times throughout this posting, but it is worth repeating: Palliative Care doesn’t always mean dying. That’s because its goal is to give a quality of life back to patients and their families. This is supported with research. A study on patients with non-small cell lung cancer who were treated by a Palliative Care team lived almost three months longer than patients who didn’t have Palliative Care on board. The goal of Palliative Care is to alleviate suffering. Without suffering, patients can go back to living their life as best as they can.

Pretend you are back in the auditorium with the guest speaker. The speaker asks a second question: “If I had the answer to make your suffering go away, would you let me help you?”

If you answer “yes” then this is the chance to let Palliative Care make a difference for you or your loved ones. No one should have to suffer from their illnesses.

To watch a video on Palliative Care, click on the link below:

https://www.youtube.com/embed/lDHhg76tMHc

References

1. What Is Palliative Care? Get Palliative Care. 2017. Available at: https://getpalliativecare.org/whatis/. Accessed February 12, 2017.
2. Top 10 Things to Know About Palliative Care – The Silver Pen. The Silver Pen. 2017. Available at: http://www.thesilverpen.com/breast-cancer-information-facts/top-10-things-to-know-about-palliative-care/. Accessed February 12, 2017.
3. Strand J, Kamdar M, Carey E. Top 10 Things Palliative Care Clinicians Wished Everyone Knew About Palliative Care. Mayo Clinic Proceedings. 2013;88(8):859-865. doi:10.1016/j.mayocp.2013.05.020.

Some medications are available over-the-counter (OTC) to buy and for all individuals to take. These same medications can cause great harm in some individuals with certain illnesses. They can also cause harm to anyone if taken in too large of a dose or too often. We are here to help you make sure the medications you have in your cabinet are not going to cause you any harm.

Times that over-the-counter medication use are appropriate include, but are not limited to:

• Mild to moderate pain which you have had before.
• After speaking with a physician about a diagnosed issue.
• Symptoms that have not been ongoing for more than seven days.

Speak with the pharmacist if you have any concerns about which product would be best for you.

Many individuals have chronic pain that may or may not be diagnosed, but can be treated. We want to make sure patients do not use too many pain medications together for their pains as this can be harmful. Bringing up these pains to the doctor when going in for a visit is always a good idea. The doctor can prescribe a medication or, at least, recommend something over-the-counter. In addition to pain medications, non-pharmaceutical ways to relieve pain, such as stretches and light exercise, should always be practiced.

Today we will go over the most common over-the-counter pain medications and some things to watch out for when taking each of these.

• Acetaminophen (Tylenol)– Keep daily use under 4000 mg. Make sure your other medications do not have hidden acetaminophen in them, as well, since large amounts can harm your liver. Individuals who have been diagnosed with liver issues or who heavily drink alcohol should not take this medication.

• Ibuprofen (Advil)– Maximum over-the-counter daily dose is 1200 mg (6 tablets). If pain is not resolved by this dose, see your doctor to approve a prescription for the higher doses. Too high of a dose of ibuprofen can lead to stomach pain and ulcers. You can tell if you have an ulcer by the occurrence of black or tarry stools associated with stomach pain. Ulcers can lead to more serious issues, so speak with your doctor if you experience these symptoms.

• Naproxen (Aleve)– Maximum dose is 660 mg (3 tablets). Naproxen is very similar to ibuprofen, but is advertised as better because it only needs to be taken once or twice daily as compared to ibuprofen which needs to be taken four to six times daily. Taking higher than the maximum dose can also lead to stomach pain and ulcers if the dose is too high for too long.

• Aspirin– Maximum daily dose is 4000 mg. As pharmacists, we try to stay away from aspirin as it can cause increased bleeding risk, kidney injury, and stomach issues/heartburn if used in excess. Other medications have shown better results with fewer side effects.

You may be saying to yourself, what about joint pain that is not taken care of by these medicines we have spoken about? Sometimes topical pain relievers such as creams, ointments, gels, or sprays are used to help with these kinds of pain.

Here are some tips when using topical pain relievers:

• Do not use these on areas or joints which you use a brace on or wrap with warm compresses, as this will cause increased absorption and can cause blistering.
• Wash your hands before and after applying medication.
• Take warming patches off before sleep.

So you have not had pain for a while at this point and have expired pain medications from your previous issue.

What should you do with these medications?

When prescriptions have expired or are no longer needed many people are unsure what to do with them. Here is how to handle that.

• Local hospitals/some pharmacies will hold drug take back days to make sure drugs are off the streets.
• Some firehouses or police stations will have drug drop off boxes where you can take your unused medications.
• If you have no other way to get rid of medications, you can crush them up and put them in an undesirable medium such as coffee grounds or kitty litter.

Finally, whom should you call if you feel you have overdosed on these pain medications?

• Call your pharmacy or doctor if you have taken an extra dose of your medication by accident.
• Call poison control (800-222-1222) if you have taken more than one extra dose of your medication by accident and are not feeling right.

References:

• Pain Management Over-The-Counter. Medicinenet.com Accessed January 9, 2017.
• Lexicomp.com Accessed January 9, 2017.
• Lexicomp.com Accessed January 9, 2017.
• Lexicomp.com Accessed January 9, 2017.
• Lexicomp.com Accessed January 9, 2017.
• How to Dispose of Unused Medicines. fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm. Accessed January 9, 2017.

We want to wish everyone a very, very Happy Valentine’s Day. It’s not too late to stop in the pharmacy and get a gift and a card if you have waited until the last minute! We have lots of nice things for your sweetie.

We also wanted to wish our parents, Bob and Roberta Timmons, a very Happy Anniversary on Valentine’s Day.

Don’t you love how Joe and Greg jumped in and “photobombed” this picture with Mom and Dad? Joe looks pretty happy. Not sure what Mom and Dad are thinking! Greg just looks surprised (a common look for him!).

Did you know that February is American Heart Month? American Heart Month was first created in 1964 by Lyndon B. Johnson. At the time of American Heart Month’s creation, heart disease was the cause of 50% of US deaths.

Heart disease and stroke remain the leading causes of death, with more than 17 million deaths each year. In fact, the American Heart Association created National Wear Red Day, which happened on Friday, February 3, as part of their Go Red for Women initiative. It is meant to spread the word that heart disease is the leading killer of women, too, not just men.

There are many factors that can go in to whether or not someone will develop heart disease. These factors include (but are not limited to) diet, activity level and genetics. The aim of this blog is to give you some tips for how to keep your heart healthy. The American Heart Association’s website is a great resource and you can always check there for additional tips and tricks on how to improve your heart health.

Tips:

• Avoid trans fats
  • Trans fats are added to processed foods to enhance flavor and texture. However, it has been shown that they raise LDL (bad cholesterol) and lower HDL (good cholesterol). You can avoid trans fats by limiting your intake of processed foods and by checking nutrition labels. Trans fats may be listed underneath the ‘Total Fat” category on the label or they may be listed as “partially hydrogenated oils” in the ingredients list.
• Quit smoking and avoid secondhand smoke
  • Most people know that smoking is linked to lung cancer, but did you know that it is also linked to heart disease? Smoking increases blood pressure, decreases exercise tolerance, decreases good cholesterol, and increases the tendency for blood to clot. Quitting is one of the best things you can do for your health!
• Get to and/or maintain a healthy weight
  • Being overweight or obese has a negative impact on health, heart health included. Your doctor is likely already monitoring your weight and possibly your body mass index (BMI) as well. A BMI of 18-24.9 is considered “normal,” 25-29.9 is considered “overweight” and >30 is considered “obese.” If you need to lose weight, talk to a doctor or nutritionist about the best way to go about losing weight.
• Keep blood pressure controlled
  • Prolonged, elevated blood pressure can damage blood vessels and increase the risk of heart disease by making the heart work harder than it normally should. If you have high blood pressure, there are things you can do to help keep it controlled such as maintaining a low sodium diet, participating in aerobic exercise, and taking your prescription blood pressure medications as prescribed.
• Keep cholesterol controlled
  • Elevated cholesterol can build-up in major blood vessels and cause plaques that increase the risk of heart attack. In order to prevent this, it is important to eat a well-balanced diet that is low in saturated fats along with regular exercise. If your doctor prescribes a cholesterol-lowering medication, it is also important to take it as prescribed.
• Have good oral hygiene
  • While good oral hygiene is certainly good for dental health, did you know that it can also impact your heart health? It has been shown that the bacteria found in gum disease has been linked to increased inflammation in the body. Inflammation in major blood vessels is an important risk factor for heart attack and stroke.
• Remain active
  • Shoot for a goal of 150 minutes of moderate activity per week. Ideally, this would be spread out as 30 minutes 5 times weekly. If you are already meeting this level of activity, good for you! The more time you put in, the more benefit you will see. You can also try more vigorous activity if your doctor thinks that is safe for you.
  • Examples of moderate activity include: brisk walking, gardening, bicycling slower than 10 mph
  • Examples of vigorous activity include: race walking or running, bicycling faster than 10 mph, swimming laps, hiking uphill or with a heavy backpack
• Limit alcohol
  • Alcohol, in excess, can increase triglycerides, blood pressure, and the risk for obesity. Limit alcohol intake to 1-2 drinks daily for men and one daily for women.
• Get a proper amount of sleep
  • Sleep is beneficial to the body for many reasons, including heart health. A study of 3,000 adults over age 45 showed that people who slept <6 hours were at twice as high of risk of stroke/heart attack than people who slept 6-8 hours

References:

• Getting Heart Healthy One Simple Step at a Time. Healthy Living. American Heart Association. http://www.heart.org/HEARTORG/HealthyLiving/Getting-Heart-Healthy-One-Simple-Step-at-a-Time_UCM_447728_Article.jsp#.WJqOCrvruW8. Updated June 24, 2015. Accessed Feb 3, 2017.
• Gillinov AM. 5 Things to Do Daily to Keep Your Heart Healthy. Health Essentials. Cleveland Clinic. https://health.clevelandclinic.org/2016/01/5-things-to-do-daily-to-keep-your-heart-healthy/. Published Jan 19, 2016. Accessed Feb 3, 2017.
• These five habits can save your heart — here’s how. Healthbeat. Harvard Health Publications. http://www.health.harvard.edu/healthbeat/these-five-habits-can-save-your-heart-heres-how. Accessed Feb 3, 2017.
• Moderate to Vigorous – What is your level of intensity? Healthy Living. American Heart Association. http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/Moderate-to-Vigorous—What-is-your-level-of-intensity_UCM_463775_Article.jsp#.WJqSbLvruW8. Updated May 18, 2015. Accessed Feb 6, 2017.
• February is American Heart Month. American Heart Association. http://newsroom.heart.org/events/february-is-american-heart-month-5712350. Published Feb 1, 2017. Accessed Feb 3, 2017.
• Going red to save women’s lives. American Heart Association News. American Heart Association. http://news.heart.org/going-red-to-save-womens-lives/. Published Feb 3, 2017. Accessed Feb 7, 2017.