Archive for July, 2020

As of July 23, 2020, Governor Dewine has issued a statewide mask order.

This means that all individuals in Ohio must wear facial coverings in public at all times when:

• At an indoor location that is not a residence.
• Outdoors, but unable to maintain six-foot social distance from people who are not household members.
• Waiting for, riding, driving, or operating public transportation, such as a taxi, a car service, or a private car used for ride-sharing.

The order only requires those 10-years-old or older to wear a mask. Additional exclusions include:

• Those with a medical condition or a disability or those communicating with someone with a disability;
• Those who are actively exercising or playing sports;
• Those who are officiants at religious services;
• Those who are actively involved in public safety; or
• Those who are actively eating or drinking.

The Centers for Disease Control and Prevention (CDC) has also stated that wearing cloth masks or face coverings while out in public can help slow the spread of COVID-19 especially because the virus can be spread by people who do not have any symptoms.

An editorial published in the Journal of the American Medical Association (JAMA) mentioned a report from Missouri where two symptomatic hair stylists wore face masks while seeing clients, who also wore masks, before being diagnosed with COVID-19. After public health contact tracing and a two-week follow-up, none of the clients displayed symptoms of COVID-19.

What are the different types of masks?

N95

N95 is a type of respirator that can filter out both large and small particles when the wearer breathes in. N95 masks are designed to block around 95% of very small particles. Additionally, some N95 masks come with valves; however, these are not recommended because the valves only work one way and release unfiltered air when the wearer exhales. N95 masks should generally be reserved for healthcare workers and those working on the frontlines.

Surgical masks

Surgical masks are disposable. They cover the mouth and nose to protect the wearer from droplets, splashes, and sprays that may contain germs. A surgical mask filters out larger particles and protects others from respiratory droplets and saliva.

Cloth masks

Cloth masks are meant to protect others by trapping droplets that can be released when the wearer coughs, sneezes, or speaks. Cloth masks are the recommended mask to wear on a daily basis as N95 and surgical masks are in short supply and should be reserved for those working on the frontlines such as healthcare workers and first responders. Cloth masks work best when everyone wears them as people can spread COVID-19 without showing any symptoms.

Is there a risk of CO2 poisoning with masks?

While wearing face masks for long periods of time can be uncomfortable, they do not cause carbon dioxide (CO2) intoxication or oxygen deprivation. If you feel uncomfortable in your mask, try to limit talking and breathe through your nose rather than your mouth. This will also help reduce humidity in the mask. For some people with chronic lung conditions, masks may make breathing more difficult, but will not cause a buildup of CO2 in the mask.

Tips and Tricks for making masks more comfortable:

Ear savers: Sometimes, wearing masks can cause friction on the ears that can be uncomfortable and painful. Ear savers can help by keeping the loops of the mask off your ears (see photos below of two types of ear savers).

Foggy glasses: To help avoid foggy glasses while wearing a mask, it’s important to make sure the top of the mask fits snugly around the nose so warm air doesn’t escape up to fog glasses.

Additionally, one study from a surgeon suggests washing glasses with soapy water and letting them air dry before wearing your mask to help provide a temporary fix for foggy glasses.

Lastly, wearing masks, in addition to frequent hand washing and social distancing, can help slow the spread of the virus.

References:

Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission—The Time Is Now. JAMA. Published online July 14, 2020. doi:10.1001/jama.2020.13107

Malik SS, Malik SS. A simple method to prevent spectacle lenses misting up on wearing a face mask. Ann R Coll Surg Engl. 2011;93(2):168. doi:10.1308/003588411x12851639107313b

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters

https://governor.ohio.gov/wps/portal/gov/governor/media/news-and-media/covid19-update-07222020#:~:text=Governor%20DeWine%20announced%20that%20beginning,in%20all%2088%20Ohio%20counties.&text=All%20individuals%20in%20Ohio%20must,that%20is%20not%20a%20residence

https://www.cdc.gov/media/releases/2020/p0714-americans-to-wear-masks.html

https://www.eamc.org/news-and-media/why-is-wearing-a-mask-important

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-mask/art-20485449

https://www.lung.org/blog/covid-masks

https://www.healthline.com/health-news/no-face-masks-cant-cause-co2-poisoning

Migraines are commonly misconstrued as “just another headache”; however, migraine sufferers know that migraines are more than just a headache. Oftentimes, migraines are accompanied by a warning symptom known as an aura. An aura can present as tingling on one side of the face, arm, or leg, difficulty speaking, or as visual disturbances such as flashes of light or blind spots. Other symptoms of migraine include throbbing pulsing headache, usually on one side of the head, nausea, vomiting, and sensitivity to light and/or sound.

There are many things that can trigger a migraine. Some triggers include changes in weather, physical exertion, stress, strong smells such as perfumes and colognes, and changes in sleep. Additionally, certain food and drinks like aged cheeses, salty and processed foods, caffeine, and alcohol can trigger a migraine. As a result, it may be beneficial to keep a log or a diary of foods and environmental factors to help track what triggers your migraines as each person has a different experience.

While there are prescription medications available to help reduce the duration and severity of migraines, there are also natural supplements that may help treat and prevent migraines. These include magnesium, riboflavin, and coenzyme 10.

Magnesium

Magnesium is a mineral that is naturally found in the body and plays a role in regulating muscle and nerve function, stabilizing blood pressure, promoting heart health, and building bones, DNA, and protein. Magnesium deficiency is common amongst migraine sufferers and is not often detected through blood work. Magnesium deficiencies can present as muscle twitching, leg or foot cramps, fatigue, cold extremities/cold intolerance, and insomnia. Some studies have shown that high doses of magnesium can decrease attack frequency and reduce pain by blocking pain transmitting chemicals in the brain. Magnesium is available as an oral tablet and a common side effect of this supplement is diarrhea.

Coenzyme Q10

Coenzyme Q10, or CoQ10, is an antioxidant that the body makes naturally and is important for growth and development and is beneficial for effective functioning of the mitochondria. The exact mechanism is not known, but studies have shown that CoQ10 can help reduce frequency of migraine attacks. Additionally, the clinical trial observed that the maximum effect of CoQ10 was seen after taking daily doses consistently for at least three months. CoQ10 was well tolerated in the studies, but some side effects seen were diarrhea and nausea.

Riboflavin

Riboflavin, also known as Vitamin B2, is a vitamin that is naturally found in the body and helps with energy production. Vitamin B2 is found in many foods such as eggs, lean meat, green vegetables, and enriched breads and cereals. Studies have shown that at high doses, riboflavin was effective for migraine prevention compared to placebo. However, like CoQ10, the maximum effects of riboflavin were seen after three months of taking the supplement daily. Riboflavin is also well tolerated, but some notable side effects are diarrhea and yellow-orange urine.

Before choosing and starting a supplement, it is important to consult with your doctor to determine if these supplements are appropriate for you.

References:

https://americanmigrainefoundation.org/resource-library/magnesium/

https://americanmigrainefoundation.org/resource-library/nutraceuticals/

https://www.withcove.com/learn/coq10-migraine-prevention

Gaul C, Diener H, Danesch U. Improvement of migraine symptoms with a proprietary supplement containing riboflavin, magnesium and Q10: a randomized, placebo-controlled, double-blind, multicenter trial. J Headache Pain. 2015;16(1). doi:10.1186/s10194-015-0516-6

D’Onofrio F, Raimo S, Spitaleri D, Casucci G, Bussone G. Usefulness of nutraceuticals in migraine prophylaxis. Neurological Sciences. 2017;38(S1):117-120. doi:10.1007/s10072-017-2901-1

Mauskop A. Nonmedication, alternative, and complementary treatments for migraine. Continuum (Minneap Minn). 2012;18(4):796-806. doi:10.1212/01.CON.0000418643.24408.40

Sándor PS, Di Clemente L, Coppola G, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology. 2005;64(4):713-715. doi:10.1212/01.WNL.0000151975.03598.ED

Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology. 1998;50(2):466-470. doi:10.1212/wnl.50.2.466

What is CGM? How is it different from BGM?

Continuous glucose monitoring (CGM) automatically tracks blood sugar levels throughout the day and night. A small sensor is placed under the skin which tests the sugar levels in the interstitial fluid. Through CGM, you can see changes and trends in your blood sugar over time which can help get a better handle on your diabetes.

On the other hand, blood glucose monitoring (BGM) tests sugar levels in the blood through fingersticks and measures your glucose levels at a single moment in time.

FreeStyle Libre System Overview

The FreeStyle Libre System is a continuous blood glucose monitoring device for people with Type I and Type II diabetes. A small sensor is placed on the back of the arm and can be scanned with a reader or app on your phone to see real time glucose levels and trends in your glucose levels.

FreeStyle Libre Sensor 

The FreeStyle Libre Sensor is a small device about the size of two stacked quarters. The filament on the sensor is less than 0.4 mm thick and goes into the interstitial fluid, a thin layer of fluid below the skin.

How do I put the sensor on?

1. Choose an area on the back of the upper arm that is free of any moles, scars, or recent insulin injections.
2. Peel the lid off completely from the sensor pack. Unscrew the cap of the sensor applicator and set aside.
3. Line up the dark mark on the sensor applicator with the dark mark on the sensor pack. On a hard surface, press down firmly on the sensor applicator until it comes to a stop.
4. Place the sensor applicator over the chosen site on the arm and press down firmly until the sensor is securely in place.
5. Recap the sensor applicator and discard sensor pack and applicator as appropriate.

Here is a quick link to a video by FreeStyle US: How to Apply the Sensor

Once the sensor is in place, it has a one hour warm up time before any glucose readings can be obtained and the sensor is worn for 14 days then replaced with a new sensor.

The sensor is water resistant up to one meter of water for 30 minutes and can be worn while showering and exercising.

The sensor should be removed prior to MRI, CT scans, X-rays, and diathermy treatments. Additionally, it should be removed for airport security if you are going through the full body scanner. To remove the sensor, gently pull up the edge of the adhesive of the sensor and peel off in one swift motion. It is important to note that the same sensor should not be replaced on skin if it falls off or has to be removed before the 14 days are up. If the sensor falls off early, patients may call the Abbott Diabetes Care line at 1-855-632-8658 for further assistance.

FreeStyle Libre Reader and LibreLink App

The FreeStyle Libre Reader is a small, chargeable device that is used to scan the FreeStyle Libre Sensor to retrieve glucose levels and trends over time. The reader is held close to the sensor and a small sound or vibration will alert you that data has been collected. One sensor at a time can be paired to a reader and the reader will tell you how many days are remaining on the sensor. It will display an alert when three days are remaining, and when eight hours are remaining. The Reader also contains a port for test strips to check blood sugar levels when a check blood sugar symbol is displayed. The port on the Reader is compatible with the FreeStyle Precision Neo test strips.

What does the reader tell me?

• Visual alerts and trend arrows → alerts when glucose levels are getting high, and shows current glucose reading
• Daily patterns graph
• Time in target chart
• Average glucose graph
• Low glucose events graph

Data is stored on the reader for up to 90 days and reports are available to 7, 14, 30 and 90 days.

FreeStyle LibreLink App

The FreeStyle LibreLink App is an app that allows you to use your smartphone to scan your FreeStyle Libre Sensor similar to the Reader. When you open the app, you hold your phone close to your sensor to get a reading. A small tone or vibration will alert you that the data has been transmitted which you can then view in the app. In the app, you can view your current glucose reading, see how your levels are changing, see glucose history from the last eight hours, and add notes to track food, insulin doses and exercise. The FreeStyle LibreLink App is available to download on the Apple App Store and on Google Play.

References:

https://www.freestylelibre.us/system-overview/freestyle-14-day.html

https://www.freestylelibre.us/support/faq.html

https://www.freestylelibre.us/system-overview/continous-glucose-monitor-app.html

This month, we are joined in the pharmacy by Prutha Patel, a fourth-year pharmacy student from The Ohio State University’s College of Pharmacy.

Prutha will graduate in May 2021 and will then take the test to become a registered pharmacist. Prutha will be with us throughout July, so please stop by and meet her while she is in the store.

Here is what Prutha tells us about herself:

Hello! My name is Prutha Patel and I am a fourth-year pharmacy student at The Ohio State University College of Pharmacy. I will be on rotation at Plain City Druggist for the month of July.

I am originally from a town called Canton in southeast Michigan; however, growing up my family moved around a lot due to my dad’s job. We lived in Hiroshima, Japan for a couple of years and Dusseldorf, Germany for one year. As a result, I have developed a great appreciation for different cultures and a strong passion for travelling.

I have always been interested in science and I knew I wanted to do something in the healthcare field. It was my dad who first suggested I look into pharmacy as a future career as I was applying for colleges. I applied to The Ohio State University and received my bachelor’s degree in pharmaceutical sciences.

While I was an undergraduate student I started working at Kroger pharmacy as a pharmacy technician and became a pharmacy intern when I started pharmacy school. While working in the pharmacy, I quickly realized that I really enjoyed working directly with patients and was able to make a positive impact on their health as I counseled them on medications, made recommendations for over-the counter products, and helped administer vaccines.

As I finish up my final year of pharmacy school, I hope to gain more experience in different areas of pharmacy practice and ultimately hope to practice in a setting that allows me to make connections with my patients while helping them lead healthier lives.

Outside of pharmacy school, I enjoy reading, baking, binge watching shows on Netflix and Hulu, and traveling with my family and friends. I also enjoy listening to podcasts when I am driving. My favorite podcasts are “Binge Mode: Harry Potter” and various murder mysteries. Recently, I have been playing various card games such as Monopoly Deal, Uno Flip, and Spot It. These games have kept me entertained throughout the pandemic!

I am excited to be at Plain City Druggist this month and I look forward to making connections with patients while learning more about independent pharmacy practice!