Just one more way our pharmacy is trying to keep the community safe.
It took awhile to figure out how to dispose of sharps, but we are now contracted with Drug and Lab disposal. I have a 30 gallon drum delivered and we have it changed out every 90 days or sooner if we fill it up. If you are diabetic or are using syringes for any other reason and do not know where to dispose of them (please do not put in normal trash) we can be of service. We do need them in self contained sharps containers however.
Just one more way our pharmacy is trying to keep the community safe.
Ah the beauty of the changing seasons of Michigan. After a blistering summer I am ready for the refreshing crispness of the autumn air. Apple cidar doughnuts, football and flu shots. The perfect beginning to the season. The predictability of the start of football season, however, is in stark contrast to the flu season. Flu season can begin as early as October and has been known to peak as late as April. It is important to get the flu shot early due to this unpredictablity. It can take your body 2 weeks to produce the necessary antibodies after vaccination to ensure protection.
We need to get the updated vaccine each year because the viruses change over time and our circulating antibodies are reduced over time. Many people want to wait until November to get the vaccine with the notion that their immunity will not last for the whole season but this is not a problem.
For patients 65 or older there is high dose version of the flu shot which in studies does elicit a stronger immunue response in the form of higher antibodies. The question is does this actually result in more protection vs the standard dose? The answer isn't known yet. The study that will most likely answer this will not be completed until 2014-2015. As of now the CDC is not recommending one over the other. Medicare part B pays for the high dose version so until we know more it may be a good idea to get it.
Many insurances already cover this important preventative measure and next year they are required to offer with no copay. So there should not be too many reasons not to get the vaccine. Unless of course if you are allergic to a component of the vaccine as in an anaphalactic reaction to eggs. Of course we can protect those that cannot get the vaccine by getting it ourselves and not becoming a carrier.
Most common fallacy about the flu shot? "I got the flu from the flu shot". Not a possibility as this vaccination contains a killed virus. There is a possibility of getting the flu soon after the vaccination but that is because of the delay of antibody production. This is merely a coincidence. A very important observation in science is this: correlation does not equal causation. This is not to say some people may not feel lethargic and muscle aches after the vaccincation. But not an actual infection.
So protect yourself, family and community and get your flu shot today!
I want to thank everyone that voted in the Best of Saline to make us the Best Pharmacy in Saline. We thank everyone for their continued support of our pharmacy and look forward to finding new ways to serve the community.
I have been silent in the blogs as of late due to the pharmacy getting busier but I saw a headline today that I thought I should comment on. The CDC states that pertussis bacterial infections aka whopping cough has hit a 50 year high in the US. In Washington state earlier this year the Washington State Secretary of Health declared a pertussis epidemic. Preliminary counts indicate that more than 17,000 cases of pertussis were reported to CDC through July 12, 2012. 10 pertussis-related deaths have been reported during that same time period. The majority of deaths continue to occur among infants younger than 3 months of age. World wide this disease is still very much a common deadly disease estimated by the World Health Organization to cause 50 million cases and 300 000 deaths occur every year. Rates in developing countries are estimated to be as high as 4% in infants.
Pertussis is caused by the bacteria Bordetella pertussis which can cause a highly contagious respiratory disease resulting in violent coughing fits. The difficulty in getting breaths in between coughs gives the distinct whooping sound upon inspiration. This disease is spread primarily through respiratory droplets from person to person. Complications can include apnea (slow or stopped breathing), seizures, pneumonia, cracked ribs from coughing and death.
Pertussis is a vaccine preventable disease. This is given in the same vaccine as tetanus and dipherthia. Children should receive 5 total doses from the age of 2 months to 4 years. Adults are now recommended getting a booster as immunity wanes over time. The seriousness of the disease is considerably less for adults but the idea is to prevent the transmission to infants that are most at risk for serious complications. You might have read about "herd immunity" in reference to vaccine preventable disease. This is the theory that proposes that if we attain high vaccination rates (depending on the disease but usually stated above 94%) this will significantly reduce the spread and resulting epidemics. With this vaccine we are woefully short of that goal. Only 70% of children have received all five vaccinations and adult booster rates are at an abyssmal 8%.
The low vaccination rate could be a result of several different factors. The awareness of the need of the booster is most likely quite low. Anyone that regularly sees a physician would have been asked about vaccinations status and given the dose if needed. Pharmacists are in a perfect position for education and administering vaccinations outside of a physician's office. Larger employers should also promote immunization clinics for their employees and families.
Another possibility is the perception of the unimportance of vaccines. For some people they may think that since they are healthy and maybe the disease may not be serious as an adult that the vaccine is a waste of time. Again the increased vaccination rate will lower the transmission rate to those that are most susceptible to the disease. There are those that cannot be vaccinated due to age or other disease states and we should be interested in protecting those individuals.
There is also so much misinformation out there about vaccinations. Anyone educated by Google University will be inundated by false statements, conspiracy theories, pseudoscientific claims and "alternative" means of prevention. Without getting properly educated on these matters it is very easy to be swayed by arguments that you see on the interwebs. The fear that vaccinations, particularly the measles, mumps, rubella (MMR) vaccine, cause autism is still very much alive. Though the physician that stirred things up back in the late 90's has been thouroughly discredited and epidemiologic studies find no link, this idea persists. For some reason in this country we seem to care about what celebrities think on issues that they know nothing about. Jenny Mcarthy of Playboy fame weighs in regulary on this issue and further muddies the waters. I don't know about you but I prefer my science from scientists not from famous people that are famous for being famous. It would be like getting my climate change info from Rush Limbaugh which by happenstance is not actually a climatologist at all but tries to play one on the radio.
There is also a perception that some of the vaccines protect against diseases that are no longer an issue. 'Maybe my gradmother was worried about measles, mumps, diptheria, whooping cough but those never happen any more' said the person that is lulled into a false sense of security. These bacteria and viruses never truly go away but with the advent of vaccines have made them such rare occurences that we lose sight of how serious these diseases can be. It wasn't that long ago that parents regularly lost children to these diseases. All of these can come back as we are beginning to see with pertussis if we become lax with proper vaccinations. Ask your physician or pharmacist for more information and many pharmacies are able to administer the booster shot to adult individuals.
Unless you are in the intensive care unit you most likely see the pharmacist more than any other health professional so keep us abreast of how you are doing medically. I appreciate getting to know more about a patient than their medical history like pets, kids, vacations, work, hobbies, etc. But keeping up to date on the medical history is the most basic patient-pharmacist relationship we must foster.
Just began taking a medication for the first time? When it's time for a refill let me know how things are going.
-Did you have trouble remembering to take all of the doses each day? If not we can talk about ways to remember or we can consult with the doctor about an extended release dosage form which may simplify the regimen. Medications that require more than one dose a day are as you would expect are much more difficult to comply with.
-Any side effects after taking the medication? Some adverse effects are self limiting and cease in the first week or two. There are other adverse effects that will persist without intervention. A good example are statin drugs. It is well known that they can cause muscle pain/cramps, some more than others, but I have seen many patients grin and bear the pain without bringing it up until it really begins to affect quality of life. The solution can be as easy as switching to a different statin which is often successful or an alternative cholesterol agent when necessary.
-Were you able to tolerate the dosage form? Whether it be a cream, tablet, capsule or suspension there may be a reason why you aren't able to take the medication regularly. Again let us know because there may be many solutions to the problem including specially compounding the medication for you.
If there are problems with your medication regimen, don't wait for the next doctor's appointment in six months bring it to a pharmacist's attention or call your doctor. Many times this may avoid more serious adverse outcomes and reduce the impact on quality of life.
We are getting ready for our first community health education event on June 5th in which our focus will be on diabetes education. We have invited Courtney Stinson, a registered dietitian, to provide tips on healthy diets, recipes and to answer questions. I will be on hand to check blood pressure, medication counseling and provide instruction on blood glucose machines and injection technique. We are having a sale on the Dr Comfort line of shoes and socks this day as well. Properly fitting shoes can reduce the risk of foot complications due to diabetes such as neuropathy and ulcers which can result in the need for amputation. We will measure you in the store and have them sent to us in a couple days. In addition we will have:
-educational handouts including glucose diary
-Raffle for gift basket ($100 value)
-Coupons for insulin products
-Free One Touch Ultra meters (while supplies last)
-Free one week membership to Powerhouse Gym
Come join us on Tuesday, June 5th from 12pm to 4pm at the pharmacy.
May is hypertension awareness month and an
appropriate time to address medication adherence with this condition.
Hypertension is the term for what is commonly known as high-blood pressure.
Consistent high-blood pressure over time can put considerable stress on the
cardiovascular system and put one at much higher risk for stroke and heart
attack. As many as 70% of strokes in the US can be attributed at least in part
to hypertension making this the single most controllable risk factor in stroke.
Hypertension is often referred to as the 'silent killer'. The condition gets
this moniker because most people can walk around seemingly quite healthy until a
heart attack or stroke fells them. This is also perhaps one of the prime
reasons that medication adherence is quite low overall in patients being treated
If a patient goes to the ER and is given a prescription for an antibiotic this is filled 90% of the time. For hypertension
and diabetes prescriptions this falls to about 75% or lower. At least 1 out 4
prescriptions for hypertension are never even filled once. Is it that they do
not think this is a serious condition? I think most people know at least a
little about the dangers of hypertension but since this is a long term problem
it can be hard to focus on it or feel a sense of urgency to treat. It is hard
to think long term and we tend to look at short term issues and consider them a
higher priority. Just plain forgetting to refill the medication is probably a
factor. Long term medication adherence is very poor as well. After 6 months
50% stop taking their medication regularly. That's a pretty off putting number.
As a pharmacist, anecdotally, it's probably not far from what I see on a
Here are a few tips in managing your
-Get a pill reminder system. These come in many
shapes and sizes for your needs, and prefill a week at a time. As you are
setting out the last week call the pharmacy for a refill.
-Utilize available technology. There are
medication reminder apps for Apple or Droid systems that can remind you on a
daily basis when to take your dose. Also many pharmacies have a auto refill
program that will keep up with the routine refills for you.
-Monitor your own blood pressure. An automatic
blood pressure cuff is very important to have and use daily. Omron is
considered a very reliable machine but many exist. You can bring the machine in
with you and have the doctor check the accuracy against their own. Keeping a
daily log of blood pressure will assist your physician in treating you. If they
only have the one blood pressure reading that was taken at the office, the
physician will only see a snap shot of what's going on.
-Regular exercise is a great way to reduce blood
pressure even if it is just going out for walks.
-Do not get discouraged if it takes multiple
medications to get your blood pressure under control. There are several
different classes of hypertension medication working differently but together to
reduce your blood pressure.
-If adverse effects are preventing you from
filling your meds tell your doctor or pharmacist. Again there are many
medications out there that may be a better fit for you.
In a closing note, the medications that are
prescribed do not just treat a number (your blood pressure) but have been
proven to reduce the risk of stroke and heart attack. If you don't take your
medicine it can't help you to reduce this risk. Any questions or concerns have
a conversation with your doctor or phamacist.
On Saturday April 28th I mentioned the DEA working with local authorities for prescription disposal. Saline police department WILL be participating in this event as well as Pittsfield Township. They will be taking solid dosage forms only, no liquid formulations please. Contact Saline Police Dept for further questions at 429-7911
On Saturday, April 28th from 10am to 2pm the DEA is having a Drug Take Back Day throughout Michigan. This is an opportunity to dispose of unwanted prescription medications particularly controlled substances. This is a free service and no questions asked. You can dispose of non-controlled medications at any time at Jensen's Community Pharmacy as we are partnered with Washtenaw county. There isn't a pick up in Saline but Ann Arbor has a couple of locations. The Pittsfield Township Dept of Public Safety and the Washtenaw County Sheriff's Main Lobby are the two closest to us. For more information please refer to the DEA website: www.deadiversion.usdoj.gov/drug_disposal/takeback
I think this is an important event to keep prescription medications from being used inappropriately and keep our community healthy. The last time the DEA did a take-back was Oct 29th of last year and nationwide collected 188.5 tons of unwanted and expired medications. So take a look in your cupboards and medicine cabinets over the next couple of weeks and use the opportunity to get rid of it.
As I was driving across the state to Easter dinner with my family, I was surprised to see how many bugs were plastered to my
windshield. With the unseasonably warm weather we can see an early start to
mosquito season. In the southern states they are already beginning mosquito
control measures in preparation for a particularly nasty year. We should also
be prepared for a nasty year and protect ourselves and loved ones from mosquito
transmitted infection most notably West Nile virus. Some people infected will
show no symptoms, others can develop mild flu-like symptoms. The more severe
cases can result in swelling of the brain (encephalitis) and meningitis
(swelling around the brain and spinal cord) both of which can have deadly
results. Because this is a virus, our armament of antibiotics will not have any treatment value and currently
we have no antivirals to treat West Nile so only supportive measures are used.
When we can't treat an illness effectively, prevention is going to be the most
important measure. There were 33 reported cases in Michigan in 2011 which
resulted in 2 deaths. There were no reported cases in Washtenaw county
but were several in the surrounding counties.
A couple questions that come up each season are “ What is the most effective repellent?” and “which repellent is safe for
The gold standard for repellent is DEET (N,N-diethyl-m-toluamide). This chemical can be found in many products and in
various concentrations. The higher the concentration the longer the product
will be effective though the effect will plateau near 50%. Based on a 2002
study 4.75% DEET would be effective for 1 & ½ hours and 20% would afford 4
hours of protection. This will help you select an appropriate product. If you
only plan to be outdoors for a couple hours 10% and lower would be a good
choice. For extended outdoor activity perhaps a 25% product. This chemical has
been used for over 50 years with very few adverse events reported even in
children. The American Academy of Pediatrics (AAP) recommends that DEET can be
used in children over 2 months old and that 30% seems to be as safe as 10% in
Picaridin (KBR 3023) is another chemical that has
demonstrated high degree of efficacy as a repellent. This chemical is similar
in concentrations to time of protection to that of DEET. This is sometimes
preferred by some because it is less greasy and less of an odor. The AAP does
not have an official opinion on the chemical at this time but there doesn't seem
to be any realistic danger to using these products in children.
Oil of Lemon of Eucalyptus is a good alternative
to the above as it has similar protective effects to DEET in low concentrations.
I would expect around 1 & ½ hours of protection so you may want to stick to
DEET for extended outdoor activities. Again AAP does not have an opinion on
this product however the labeling suggests not for use under 3 years old.
Permethrin is a good choice to spray on clothes
for additional protection but do not apply directly to skin.
Of course many other choices exist but how
effective are they? Many other products out there on the internet make claims
which are not supported by any peer-reviewed journal articles and are not
regulated by the EPA. I have seen various bracelets infused with citronella for
sale. The good news is the bracelet most likely will not be bitten by a
mosquito but I can't say the same thing about the people wearing them.
Citronella candles do not seem to be any more effective than regular candles
unless you are completely enveloped in the smoke. Citronella oil may be
effective but for very short periods of time probably around 20 to 30 minutes.
Other essential oils do not seem to be efficacious in most studies. Also don't
waste your money on sonic mosquito deterrents as this is just wishful thinking.
Eating cloves of garlic is sometimes recommended
but is not going to repel mosquitoes.
-Wear long sleeves and pants when possible to
minimize potential mosquito targets and use permethrin on clothing for
additional protection particularly on thin fabrics.
-Avoid combination sunscreen/repellent products
as you usually have to apply sunscreen more often. First apply sunscreen to
allow binding to skin then apply repellent if necessary.
-Young infants can be protected using proper
clothing and mosquito nets.
-Apply repellents to face by spraying on hands
and rubbing on. Seems sensible but I am sure someone out there has sprayed
repellent directly in their eyes.
-When returning indoors, you will want to wash
off the repellent with soap and water
of the early mosquitoes so I can enjoy a nice Mojito in peace this summer but I
will be prepared for the mosquito apocalypse in any case.