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Healthy Habits

You have decided to become healthier, but big changes make you anxious?

Not sure where to start, do I have to exercise 5 to 7 days right from the start? I’m a big proponent of making small changes, keeping those changes to a small number like 1 to 2 goals at a time. Depending on what areas, you think you need to improve, you can choose from the following list to get started:

Self-Care:

• Practicing stress reduction or deep breathing
• laughing or socializing
• using mindfulness or meditation
• attending a financial wellness seminar

Rest & Recover:

• Stretching
• taking a yoga class
• getting 7-9 hours of sleep
• taking time for yourself
• getting a chair massage (self-massage counts, too!).

Movement:

• Taking the stairs instead of the elevator
• going for a walk
• biking or walking to work
• taking an onsite yoga class
• running a race
• going to the gym

Nutrition:

• Eating a fruit or vegetable

• drinking water

• bringing lunch from home

• sharing a healthy snack with coworkers

Small changes will add up and make a big difference to your health. Changing your habits is a process that involves several stages. Sometimes it takes a while before changes become new habits. Healthier habits may protect you from serious health problems like high blood pressure or diabetes. If you continue these habits for a while, they may become part of your daily routine.

The four stages of changing a health behavior are:

• contemplation
• preparation
• action
• maintenance

If you started to make some changes, it is a good idea to set health goals. Review what worked, what didn’t work, and can you make changes to make sure you can accomplish that goal. Measuring progress is important to make sure your changes are yielding the results you wanted.
Changes are hard but small changes or steps can help overcome the anxiety that comes with big changes. Keeping motivated can also be a barrier, change your routine and reward yourself whenever you reach a goal. Healthy Habits become even more important for patients with chronic disease like hypertension and diabetes.

Patients with chronic disease states like hypertension or diabetes, should consult with your Primary Care Doctor before starting any kind of exercise program. More information can be found online at the American Diabetes Association for patients with diabetes or Pre-diabetes. Certified Diabetes Educators can help patients with diabetes get blood sugars under control, set health goals and develop a diabetes plan. For patients with chronic disease Ambulatory Care Pharmacist and Community Pharmacist are a great resource to help you get your health to goal.

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Can I Eat Eggs?

Eggs are a good source of protein, but they have dietary cholesterol. The cholesterol we eat does not necessarily raise blood cholesterol for most people. Our bodies make all the cholesterol we need, we do not need dietary cholesterol. What has a big impact on cholesterol is the amount of fat you eat.  For patients with cardiovascular disease or cardiovascular risk lowering dietary cholesterol is important.

What is Cholesterol?

Cholesterol is a type of fat in the body. Cholesterol helps form the lining (membrane) of the body’s cells and it plays a role in hormone production. Two subtypes of cholesterol we care a lot about are:

HDL (the “good” cholesterol) and LDL (the “bad” cholesterol).

  • LDL can get trapped in the lining of the artery. Over time, leading to a heart attack or stroke.
  • HDL’s job is to help remove LDL from the body.

Can I eat eggs or not?

Yes, but in the right way. If you regularly have an egg, reduce saturated fat in other areas of your diet.  Eating moderate amounts of eggs will have little impact on blood cholesterol for most people.
However, if you are adding a lot of saturated fat (bad fat), such as preparing eggs with butter, cheese, bacon, sausage, or eating excessive amounts of eggs a day, you are going to run into issues.
Are there other satisfying breakfast or snack choices that won’t impact cholesterol? Absolutely! Oatmeal, low-fat plain yogurt, egg whites, fruit with modest amounts of nuts, avocado and whole wheat toast, or peanut butter on whole wheat toast are excellent choices. But taste preferences, cultural differences, allergies, and time constraints make some of these challenging.

Reasons to Choose Eggs

• Good source of complete protein. If you don’t eat much red meat or high-fat dairy, eggs are a good addition to the diet. At seven grams of protein per whole egg, it’s a more efficient, readily absorbed protein option (more so than beans or lentils).
• Keep you fuller for longer and are satisfying! The fat and protein content of eggs will keep you fuller longer, prevent overeating later compared to options like bagels, toast, cold cereal, pancakes, or waffles.
• Eggs won’t raise blood sugar. This is a big for patients with diabetes, especially those who don’t eat much poultry or fish. While lentils and beans have protein, they are primarily carbohydrate (which raises blood sugar).
• Easy to prepare. They take a few minutes to cook. Hard-boiled eggs make meal and snack time simple.
Overall, yes, eggs can raise your cholesterol but not as much as saturated fat. It’s about your dietary balance in general.
Eggs can be part of your diet if you don’t over due the amount of fats you eat, egg whites are also a healthy alternative. For patients with diabetes one egg per day is OK to eat but should refrain from frying or adding a lot of butter and cheese. For patients with diabetes there is no diabetic diet, we recommend a healthy diet low in starchy carbohydrates. Using the plate method can help make sure you get enough protein in your diet.

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Trying to Eat Well but…

Many patients report overeating in the evening time or often given into cravings when trying to change the way they eat. For many, the day hours seem to pass by without a problem either because they don’t feel hungry, or when they eat, they eat healthily. When the sun sets, or they set foot in their house that’s when food has a new power. Many believe there’s something wrong with them or they “don’t have any self-control.” Truth is, that’s rarely the case. Here are the three most common situations: I see in the clinic:

Define “eating well.” Often when people try to improve what they eat, they reduce the types and amount of food they are allowed – especially if they are trying to “make up” for last night. This results in an underfed body and an unsatisfied mind. An underfed body is a hungry body – hormones like ghrelin increase making you feel like a bottomless, insatiable pit.

Ignoring hunger cues / skipped meals. It’s easy to ignore your hunger when you’re busy doing projects or distracted. Hunger catches up with you when your mind is finally winding down at the end of the day. As a result, food has greater power and gets more attention.

Relaxation. We all need a way to release the emotional pressure of life. For many, food is a convenient way to relax. If you pair the need to relax with an underfed body, the desire to eat becomes so great, it feels humanly impossible to resist eating beyond the point of physical need.

Here’s are a few tips so you can try to find your own balance:
• Recognize hunger cues and intensity – eat before you are starving. For most eating every 3-4 hours is a normal rhythm
• Eat balanced meals that leave you satisfied – that includes fruits/vegetables, protein, AND grains (carbs are not the enemy). Don’t forget healthy fats! It is great for satisfaction.
• Rest and stress – just because stress is “normal” in your life, doesn’t mean your mind and body don’t physically react. Our minds and bodies need rest – whether that means a break from the office or getting enough sleep. Without a balance of each, the desire for food and fuel increases.
• Identify stress outlets – Consider additional outlets for relaxation such as socializing, laughing, drawing, yoga, walking, meditation, petting a dog, reading, knitting…that way food isn’t the only option.
Nutrition is a challenging topic. While food helps our physical body, eating is also emotional, social, and cultural. Food isn’t often about willpower or decision-making. Rather it’s about balancing our human needs.

Picture by Deanna Marie Velasquez

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Celebrate Women Pharmacists

March is Women’s History Month. As a Pharmacist, I want to mark this month by recognizing and honoring the many women that have contributed to the success and advancement of the pharmacy profession.

I want to start by giving a great thanks to Dr. Suzanne Rabi Soliman, PharmD. Who worked very hard to make October 12 National Women Pharmacist Day, October is American Pharmacist Month, and she chose the number 12 in honor of Elizabeth Greenleaf. Ms. Greenleaf was the first woman pharmacist in America and had 12 children. As a Pharmacist and mom, Dr. Soliman found Mrs. Greenleaf to be inspiring and therefore chose October 12 as the day to honor Women Pharmacist.

Recently Dr. Soliman wrote an article about being a Pharmacist and a Mom which you can read by clicking the following link: http://www.pharmacytimes.com/news/are-you-a-pharmacist-and-a-mom.
Jean Kennedy Irvine, was born in 1877 in Hawick. Her first post was an assistant pharmacist to the Glasgow Apothecaries Company to which she subsequently became Chief Pharmacist. She was the first woman president of the staff side of Whitley Council for National Insurance administrative, technical and clerical services. She was the first woman elected to the presidency of the insurance Committee Officers Association for England and Wales.

Another pioneer is the first female pharmacist in the United States. After graduating from the Woman’s Medical College of Philadelphia in 1857, Susan Hayhurst served on the College’s staff and ran its pharmaceutical department for many years. In 1883, at the age of 63, Susan Hayhurst became the first woman to graduate from the Philadelphia College of Pharmacy.

Ella Stewart (born in Stringtown, West Virginia). Stewart wished to attend the University of Pittsburgh’s School of Pharmacy but was met with discrimination when she was told admissions were closed. She persisted, however, and although segregated from other students, she graduated with high marks passing her state exam in 1916, to become the first licensed African-American female pharmacist in Pennsylvania and one of the earliest practicing African-American female pharmacists in the country.

Elizabeth Marshall was born in 1786, the second USA woman to be Pharmacist. In 1805 she took over the drugstore owned by her grandfather and restore the struggling business to a successful business.
Mary Munson Runge born in 1928, graduated from Xavier University of Louisiana in 1948. She practiced pharmacy for 21 years, she was the first woman and African American to serve as president of the American Pharmacist Association (APhA) in 1979.

This is only a small group of the many women who have been part of pharmacy through the years. Mary Euler, PharmD, FAPhA, Professor and Associate Dean for Student Services at the West Virginia University School of Pharmacy noted that in the early 1900s, many pharmacy programs opened with all men; a woman in the program would have been a rarity. During World War II, a temporary increase of women in the profession occurred as men were not as available. In the 30 years that Dr. Euler has been in pharmacy academia, she has seen a gradual shift from 60% men/40% women to now about 40% men/60% women.

The success of women pharmacists today can in many ways be credited to the women in our past. These women were instrumental in not only increasing female pharmacist representation but also advancing the profession.

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Gestational Diabetes

Gestational diabetes refers to diabetes diagnosed during pregnancy. Pregnancy hormones can interfere with the way insulin works in the mother’s body which can lead to elevated blood sugar levels during pregnancy. Women are typically screened for gestational diabetes at 24-28 weeks of pregnancy, however, women who have risk factors may be screened earlier.

Risk factors for developing gestational diabetes include having a family history of diabetes, being overweight, or over 25 years old. Women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

Blood sugar control during pregnancy is critical as elevated maternal sugar levels can lead to pregnancy complications and increase risks to the health of the baby. Gestational diabetes is likely to recur during subsequent pregnancies.

The Center for Disease Control estimates that up to 9.2% of pregnant women will develop gestational diabetes.

To learn more go to http://www.diabetes.org/diabetes-basics/gestational/

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Basic Diabetes Information Patients Should Know

Newly diagnosed or just looking to refresh previous information; this page will provide you with a list of topics that you should be familiar with. Diabetes can be confusing and overwhelming with all the new things you have to learn and understand but the more you know, the more you can help yourself.

What is Diabetes?

Find out about diabetes: the terminology, symptoms, diagnosis and goals of treatment. Learn how the body keeps the blood sugar in balance.

• What is blood sugar

  • What is insulin

• Symptoms

• Diagnosis

• Goals:  A1C, Fasting Blood sugars, Postprandial blood sugars

• More about the body and blood sugar

Types of Diabetes

There are many types of diabetes. Learn more about your type of diabetes or look at the classification table to see a comprehensive list.

• Type 1

• Type 2

• Gestational

• Other

• Classification table

Causes of Diabetes

Read more about how different types of diabetes develop: what are the risk factors, what is the process that leads to diabetes.

• Type 1 diabetes

• Type 2 diabetes

Complications of diabetes

  • Cardiovascular (heart attacks and strokes)
  • Eyes (retinopathy)
  • Kidneys
  • nerves (diabetic neuropathy)

Treatment for type 1 diabetes

Insulin given by injection is the central treatment for type 1 diabetes. There are fast-acting and long acting insulin formulations. It is important to understand when to use these different formulations and the concepts behind choosing the right insulin dose. There is one other injected medication for type 1 diabetes, Symlin, that may be given in addition to insulin

• Insulin

• What is insulin

• Types

• Injecting

• Dosing

• Storage

• Other non-insulin medication

• What are the different types of other medications

Treatment for type 2 diabetes

The treatment for type 2 diabetes may be a simple as lifestyle changes (diet, exercise and weight management) with one or two pills to many different pills and/or insulin or other injected medications. Your medical team will help you decide the best choices for you

• Pills:  Metformin, glyburide, glipizide, glimepiride Etc

• Other medications

 Insulin

• What is insulin

• Types

• Injecting

• Dosing

• Storage

Find out if the treatment is working

Blood sugar monitoring lets you know if the treatment plan is working and you are achieving the goals of therapy. And keeping a logbook helps everyone review and assess the results

• Blood sugar targets: A1C, Fasting blood sugars, after meal blood sugars

• Blood sugar monitoring

• Ketones

• Logbooks

Changing the diet

Eating a healthy and balanced diet is another important part of living with diabetes. The first think you need to understand is which foods have sugar and starch (carbohydrates).

• Basic nutrition

• What is a carbohydrate?

• Quick carbohydrate counting

When the blood sugar is uncontrolled

When your blood sugar is too high or too low, you need to understand the symptoms and what to do. Some situations require urgent medical attention.

• Low blood sugars

• High blood sugars

When your blood sugar is not controlled…

Read about common reasons for your blood sugar to be out of balance.

• Problem solve high and low blood sugars in type 1 diabetes

• Problem solve high and low blood sugars in type 2 diabetes

Practical part of having diabetes

Every day tips for how to live safely with diabetes.

• Medical Alert

• What to carry with you

• When to check ketones

• Assembling your Medical Team

• Prescriptions

• Sick Days

• Traveling

• Driving and Diabetes

• Avoid common mistakes (when you are taking insulin)

Diabetes FAQs

Everyone who has just been diagnosed with diabetes has some questions.

• Type 1 diabetes

• Type 2 diabetes

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The Changing Role of Community Pharmacist

A recent article published in Forbes gives a possible future version of the shifting and expanding the role of Community Pharmacists. For over a decade now, Pharmacists have been trying to get provider status and recognition from the health care system and insurances for the evolving role of pharmacotherapy.

Most people still see Pharmacist as the traditional person who fills their prescriptions but in this new article in Forbes, the author envisions a larger role for the dispensing pharmacist. It states “pharmacists are in an excellent position to not only play a more primary role in treating illness, but also in preventive care. The information, or “Live Data,” that pharmacists gather while having routine human-to-human interactions” will make for better patient care.

The article also states, “Imagine a future health care system where you see your local pharmacist more than your primary care physician.” This already exists in more rural settings where access to health care close to home may not exist.
It is a very exciting time in the evolution of health care and the possibilities around the expandable role of the pharmacist.

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Diabetes Plate Method

The Diabetes Plate Method is a simple way to plan meals. Using the plate method “formula” encourages you to eat more healthy food and fewer unhealthy foods.

The Diabetes Plate Method helps you control portion sizes of starchy, carbohydrate-containing foods that have the most impact on blood glucose levels. It focuses on eating more non-starchy vegetables, which are low in carbohydrate and calories and high in vitamins, minerals, and fiber.

You can use the plate method for your specific health and nutrition goals including weight loss or maintenance, blood glucose management, and simple good nutrition. The plate method is also a useful tool for people with prediabetes and for those who simply want a healthy approach to eating.

Start by filling half your plate with non-starchy vegetables. Then fill one-quarter of your plate with whole grain or starchy foods and the remaining quarter with lean protein foods. The Diabetes Plate Method includes fruit and low-fat dairy on the side but is optional if you are trying to lose weight.

Healthful fats, which can be used in any section of the plate for food preparation or as condiments, are also key ingredients. The best part about the Diabetes Plate Method? It doesn’t require a lot of math and you can use it almost anywhere.

To create your own plate:

http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/#seven

The following healthy plate reflects the healthy fats that were omitted, thank you for the comments:

Healthy Eating Plate

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COMMON MEDICATION ERRORS AT HOME

Health care providers assume that patients will take medications as directed at home. A recent study found that the rate of out-of-hospital serious medication errors reported to U.S. poison control centers doubled between 2000 and 2012. These at-home medication errors often lead to one-third of these error cases in being hospitalized, (Nichole Hodges, Ph.D., lead author of the study and research scientist at Nationwide Children’s Hospital in Columbus, Ohio (J Clin Toxicol.).

Cardiovascular medications errors are the highest with 21% of serious adverse events, these events were associated with more serious medical complications. Additionally, cardiovascular and analgesic medications combined to account for 66% of all the deaths that occurred during the study period. The most commonly occurring errors involved patients taking or giving the wrong medication or incorrect dosage, and inadvertently taking or giving a medication twice.

The pharmacist can help ensure that patients understand how prescribed medications should be taken at home, especially for individuals who cannot read or write. Can patients or caregivers repeat back the correct dose and do they know when it should be taken or administered? How do they organize and store medications at home? Do they have a system in place for ensuring they take the right medication at the right time?

Pharmacist are easily accessible and can help the patient ensure correct medication Use

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Diabetes Action Plan

First Step:

To make any meaningful changes to your health, fitness, and diabetes you need to set goals and have positive motivation to accomplish those goals.

Goals can change the more you learn about healthy nutrition and exercise. Changing your goals means that you have a clearer idea about what you want and what’s possible. To start set small short-term goals that will help you get to long term goals. For example, set a 1-week goal, a 4-week goal, and a 6-month goal, once you set your goals to share them with family and friends, this will help you keep you on track to get to the goal.

Turn to positive motivation to reach your goals. Whenever you don’t feel like exercising, testing your blood sugar, or eating healthy food, try to remember how you feel on the days where your diabetes management is spot on, and imagine that being every day. Positive motivation can help you get to your short and long-term goals. Imagine how great you will feel when you reach your diabetes management and fitness goals, and let that be your motivation!

See the next steps: exercise and diet diabetes action plan.