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Why Lose weight?

Why do we want to lose weight? Aren’t we all a little more cheerful when we have a little weight? What is the harm in not being super skinny?  Is it just social pressure and social conventions that say we should be a certain size?

A new study suggests that previous studies have under estimated the harmful effects of carrying extra weight. The new study, conducted by researchers from the University of Bristol in the United Kingdom, attempted to find a link between Body Mass Index (BMI) and risk of death.

Other studies have also suggested that even a small amount of weight gain in healthy, young individuals is associated with worsening heart function, posing a greater risk for future heart failure. People who were not obese at baseline and gained weight had a greater negative impact on their cardiac structure and function than people who were obese already.

What are the benefits of losing weight?

1.      Feeling better:

·         Having more energy

·         Sleeping better and waking up feeling rested and in a good mood

·         Having fewer aches and pains

·         Improved ability to move and get around

·         Finding it easier to breathe

·         Improved immune system (ability to fight off illness)

2.      Reduce risk of diseases like diabetes, heart disease, stroke, weight related cancers

·         Asthma

·         Arthritis

·         Deformity of the lower legs (Blount’s disease)

·         Sleep apnoea (a person temporarily stops breathing during sleep)

·         High blood pressure

·         Fatty liver

·         Polycystic ovary syndrome (PCOS) where cysts form in the ovaries

·         Menstrual (period) problems

·         Insulin resistance meaning that the body becomes resistant to insulin, the hormone that controls the amount of sugar in the blood.

·         Type 2 diabetes

The Best way to lose weight is through lifestyle changes (healthy diet) and exercise. The endocrine Society came out with clinical practice guidelines in 2015 for the use of medications in weight loss. Use of approved weight-loss medications is endorsed for people with a body mass index (BMI) of 30 kg/m2 and above or at least 27 kg/m2 with one or more comorbidities.  Yet many of the drugs are not being used because not everyone is convinced of the safety of these medications. The newer drugs to the market are bupropion/naltrexone (Contrave, Orexigen Therapeutics) and liraglutide(Saxenda, Novo Nordisk) for weight loss. These new comers join  controlled-release phentermine and topiramate (Qsymia, Vivus), and lorcaserin (Belviq, Arena Pharmaceuticals) and over the counter orlistat (Alli, GlaxoSmithKline).  Another consideration is that weight loss medications are usually not cover by insurances and can be quite expensive.

Is always best to speak to your Primary Care Doctor before embarking in any diet or exercise changes

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Happy New Year

New year, new you! With the start of a new year we all feel like it is the start of a new you, that is why we make resolutions for the new year. Having had to deal with the illness of a family member and having to make tough decisions like palliative care; it has become increasingly clear to me that we have a finite amount of time and we should make the most out of it. Since we are here for a set amount of time, it should be clear that we should take care of our bodies so that we may have longer healthier life and enjoy more the world out there. As humans we are not perfect, and we can always improve, personally, health wise and improve relationships with family. Like many of you I find myself needing to lose weight and start exercising more. I will start an exercise program and eat healthier.

The first step is setting health goals that are realistic and obtainable, choose one to two goals instead of having too many which will make it hard to keep track of them, and break the larger goals into smaller steps that will be easier to do.  If loosing weight is one of your goals, you want to make sure to do it the right way and stay away from gimmicks. One way to lose weight is adjusting your calorie intake, this new online tool can help you figure out how to adjust your calorie intake.  Small changes can add up and make a big difference, so start small with changes you know you can stick with.

Don’t forget exercise as it is one of the best things you can do to keep you healthy and loose weight. Logging what you eat can help you see how much you are eating and keep track of calories. There are many apps for your smart phone that you can use. There are also apps that can help you exercise such as the 7-minute workout. Writing down goals and letting your friends and family know can help you stay on track. Lastly, don’t for get to schedule time for exercise, if can’t do it daily start with three days per week. What ever your goals, the most important thing is to get started.

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Industry Pharmacist

Industry pharmacists need a pharmacy degree and can be involved in everything from sales, to research, to law, to marketing, to general business. Specialty areas will require extra experience and training. Departments in which you may find Pharmacist in Industry include:

Pharmaceutics: developing new drugs.

  • Research development: bench scientist to clinical research specialist, conducting and managing clinical trials.
  • Field investigation: develop and administer drug trials.
  • Epidemiology: monitor and manage safety reporting for drug products and new products.
  • Production: work in both early production development and quality control responsibility.
  • Regulatory affairs: work with the U.S. Food and Drug Administration (FDA) on regulation of drug development and promotion.
  • Medical and scientific information: work as a drug information specialist for industry.
  • Education: develop programs to inform professionals on uses and specific drugs.
  • Sales: sell in the field or work with special high profile clients and large institutions.
  • Marketing: work on advertising and/or general marketing of products.
  • Finance: work with business issues and company financials.
  • Legal: work on contract law or malpractice or regulatory law.
  • Lobbyist: work on Capitol Hill or on the state.

Pharmaceutical industry provides more flexibility and opportunity such as travel. Many industry pharmacists find themselves working in both domestic and international divisions, which requires a lot of travel. Industry pharmacists rarely have patient contact. Within the drug information department, some pharmacists do provide answers to patients’ questions (that come in by phone or mail) about products, their use and side effects. Pharmacist can also be responsible for managing clinical trials but they don’t interact with patients.

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October is Pharmacist Month

“Know Your Medicine, Know Your Pharmacist.”

American Pharmacists Month recognizes and celebrates the role pharmacists play in in all aspects of health care – from community and hospital pharmacy, to industry, academia and beyond.

Pharmacist month celebrates the pharmacy profession and helps promote awareness of the many services pharmacists offer beyond the safe distribution of medications through retail or community pharmacies. Pharmacist month recognizes the impact pharmacists have on improving medication use, advancing patient care, and improving patient access to healthcare and public health.  Services provided by pharmacist include immunizations, medication reviews that make sure medications are safe for the patient, that medications are effective, they look for interactions and make sure the patient takes the medications as instructed. Pharmacist participate in care management and they counsel patients on diseases such as diabetes, high blood pressure, and high cholesterol; and smoking cessation counseling.  Pharmacists play a role in public health and emergency preparedness. Whether it is in distribution of vital medications, setting up mobile pharmacies, or providing patient care. Pharmacist also play a vital role in medication research, many aspects of pharmaceutical industry and teaching or academia.

Through the month I like to explore the different rolls Pharmacist play in healthcare.

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What is Self-Management?

Self-management is the key to good diabetes control.

• Self-management is what people with diabetes do to manage their chronic condition and the effects on their health, daily activities, social relationships and emotions.

• Self-management uses education and strategies to increase diabetes management skills and confidence. It can also refer to the organizational structure such as your Primary Care Doctor’s office educational programs for diabetes patients.

• The goal of self-management is to help people achieve good quality of life and improve those aspects of life worsened by diabetes.

Self-Management is the Use of Skills to…

• Deal with your illness (medication, physical activity, doctor visits, changing diet)

• Continue your normal daily activities (chores, employment, social life, etc.)

• Manage the changing emotions brought about by dealing with a chronic condition

(stress, uncertainty about the future, worry, anxiety, resentment, changed goals and expectations, depression, etc.)

Road to self-managing includes the follow wing steps

1.    Set goals

2.    Making an action plan

3.    Feed back

4.    Problem solving if needed

5.    Making a new Action Plan

6.    Acknowledge progress

Always check with your Primary Care physician or endocrinologist to see if there is a diabetes education program, a Certified Diabetes Educator or a diabetes group that can help you manage your diabetes.

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Chronic Disease and the Holidays

Chronic disease — defined as illnesses lasting more than three months, being persistent or recurrent, having a significant health impact, and typically being incurable. So, with holidays like Christmas and Hanukkah at hand, there is always a temptation to abandon healthful living routines.  Eating too much, not getting enough exercise, staying up late, worrying about family members getting along — all these things can make you feel worse.

Patients with diabetes, heart conditions, or epilepsy, for example, must take care of yourself or the disease gets worse. With autoimmune diseases, such as MS, fibromyalgia, or lupus, your symptoms will get worse but not the disease itself.

Holidays bring out all the physical and social concerns around chronic diseases. The demands and expectations around holidays can “out” people whose conditions were hardly noticeable. During the year, they spend so much of their energy working and handling the daily chores of living that they have little time left for socializing. Come the holidays, they’re expected to show up and contribute.

Many chronic illnesses, such as diabetes, depression, arthritis, fibromyalgia, etc., are not noticeable. “People go to work or volunteer or shuttle kids to school. Most of the time, they don’t look sick. When illness flares up, their pain is invisible. Or they have bone-numbing fatigue, so bad that they can’t take a shower and go to the store in the same day. There’s a cultural misperception that says you’re not sick unless you look sick. They need to make their illness visible by talking about it.”

An article in Arthritis Today offers three tips for managing holiday stress:

Daily rest and relaxation. Don’t get stuck in a never-ending to-do list. Do a crossword puzzle or take a walk or a nap. The mental and physical break will rejuvenate you.

Prioritize. Decide how much shopping, cooking, or partying you can do and stick to it. Ask for help.

Volunteer. Take toys to the Marine Toys-for-Tots Foundation, take food to homebound seniors through Meals on Wheels, or provide goods and services for Hurricane victims. It will boost your spirit and remind you what the holidays are about.

The holidays can be hard on everyone but more so to patients with chronic diseases. Family members and in general people need to be more accommodating to those who have chronic illnesses.

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Is Eating Vegan Healthy?

A few years ago, one of my patients asked me if I knew anything about Forks over knives. She reported she saw a cardiologist to get cleared for surgery, he told her he would not clear her but encouraged her to see the documentary Forks over Knives and to follow the diet. The patient was very stressing over the fact she could not get the surgery, she told me that the cardiologist encouraged her to eat a vegan diet. Vegans abstain from eating any animal products while vegetarians do not eat animal meat but still eat eggs, cheese, milk.  The Forks over Knife documentary and book explores the claim that all deteriorating diseases can be control, even reverse by not eating animal based and processed foods.

Most people become vegan to avoid animal cruelty products and wanting to be healthier. But is a vegan diet Healthy? Around 2.5 percent of people in the United States (U.S.) are vegans, according to a 2016 poll. Here are some facts about the vegan diet:

The vegan diet contains only plant-based foods. All protein, vitamins, and minerals must come from non-animal sources, so food choice and preparation are important. Tofu, tempeh, and mushrooms are three of the many alternatives than can provide the nutrients found in meat. A vegan diet can help to protect bone and heart health, and lower the risk of cancer.  Supplements are recommended to replace levels of certain nutrients abundant in meat, such as vitamin B12.

Animal fats have been linked to various cancers, diabetes, rheumatoid arthritis, hypertension, heart disease, and a range of illnesses and conditions. Animal sources are likely to account for 13 of the top 15 sources of cholesterol-raising fats in the U.S.  Not eating meat reduces the overall risk of mortality.

The following are likely to be in short supply on a vegan diet, but alternatives are available.

  • Vitamin B12: Vitamin-B12 fortified plant foods, such as fortified soy, seaweed, cereals, and nutritional yeast can supplement intake.
  • Iron: Dried beans and dark leafy greens may be better sources of iron than meat on a per-calorie basis. Using a cast-iron skillet to prepare a meal is a good way to absorb more iron into the food.
  • Calcium: Eat more tofu, tahini, and green, leafy vegetables.
  • Vitamin D: Regularly consuming more vitamin-D fortified foods and spending time in the sun can boost vitamin D levels.
  • Omega-3 fatty acids such as DHA and ALA: Omega-3 fatty acids, such as fish oil, are vital for cardiovascular health, eye function, and brain function. Though EPA, another type of omega-3, can’t be obtained with a vegan diet, ALA and DHA can be found in ground flaxseed, walnuts, canola oil, soy products, and hemp beverages.
  • Zinc: Whole grains, legumes, and soy products are rich in zinc.

My patient followed the diet and lost around 20 lbs., reported feeling better, got off most of her medications and could get her surgery. The patient was not able to stick with the diet for more than 18 months, and has since started to eat meat again. While eating vegan can be healthy, making sure to get vitamin B12, iron, calcium, vitamin D, omega 3 acids and zinc; is important.

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Emergency Preparedness – Keeping Medications Safe

The Center for Drug Evaluation and Research takes an active role in helping the nation prepare for, respond to, and recover from, emerging health threats and natural and man-made emergencies. They recommend having a plan in place for emergency medication and medical supplies.

Patients are advised to:

  • Keep an up-to-date list of their medications, including dose and indicated use
  • Know how much medication they have on hand
  • Obtain early refills if they anticipate access to their pharmacies will be disrupted
  • Place medication bottles or packages in water-tight containers (such as plastic containers with lids) if there is a possibility of flooding or other water damage
  • Have ice available for medications that need refrigeration

An emergency plan is especially important for those with health concerns, particularly if the power goes out. Taking precautions for storing medications and supplies is key to being prepared.

Drugs can be affected by extreme temperatures after a natural disaster such as a tornado, hurricane, or winter storm or after a man-made event that results in power loss. Drugs also can be damaged by contact with contaminated water if flooding occurs or water pipes break.

Pharmacists can help their patients inspect their medications for damage.

In situations where lifesaving drugs have been exposed to water and replacements are not readily available, the drugs may be used if the container is contaminated but the contents appear unaffected.  However, when replacement drugs become available, the drugs that may have become contaminated should be immediately discarded.

Some medications require clean water and refrigeration which may be unavailable during an emergency.  Drugs that must be reconstituted, only bottled water should be used when clean tap water is unavailable. Liquids other than water should not be used to reconstitute these products.

If electrical power has been off for a long time, refrigerated drugs should be discarded. However, if the drug is absolutely necessary to sustain life (insulin, for example), it may be used until a new supply is available.

FDA offers more specific information for disasters such as tornadoes, hurricanes, and winter storms online. Information regarding insulin storage and switching between products in an emergency is also available. Pharmacists and patients can also contact resources like the Red Cross, poison control, and health departments for guidance.

To help prepare check out: www.ready.gov and www.emergency.cdc.gov/preparedness.

It is very important to be prepared for emergency situations.

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Medication Mistakes

In medicine, doctors, nurse practitioners, nurses, physician assistants and pharmacist are expected to be perfect but as we know human beings are not perfect. The institute of medicine estimates that over a million deaths can be attributed to medication errors in the United States.

The shame and guilt that come with making a mistake is all consuming. The shame that makes you doubt if you are good enough to be in your chosen profession. These feelings linger for months and months, the feeling of being alone as colleagues stay away. The systems promulgate the hiding and shame of making a mistake. Even though now all health professionals are encouraged to report errors, once you are identified as having made a mistake; no one was to be associated with you. Limited communication is encouraged with the patient and communication is discouraged between colleagues.

Better communication between health professionals about medical and medication errors can help prevent similar mistakes by making others aware of what type of mistakes can be done. It can help put systems in place to prevent errors and to improve existing systems.

System wide fixes can be put in place to minimize errors including medication errors. Patients can also take steps to minimize errors by getting educated about medications, procedures and by asking a lot of questions about what procedures need to be done, what medications need to be given, side effects and possible drug interactions.

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Even a little bit of movement matters

The take-home message from a mountain of data is that less sitting and more exercise is the goal, and even a little bit of improvement helps. For those who have a desk job, taking short movement breaks throughout the day is protective.

Scientific evidence strongly suggests that the more time a person spends sitting, the higher their risk of death from any cause. Multiple large studies and high-quality data analyses show that regardless of age or health issues, the hours we spend in our office chairs, cars, or on the sofa watching television can literally kill us.

A well-conducted study published in July 2016 in The Lancet looked at a massive amount of data from 16 large studies and including over a million subjects. What they found was that 60 to 75 minutes of moderate physical activity (The CDC has published a table describing many activities ) like walking to work, walking the dog, riding a stationary bike, line dancing, golf or softball, doubles tennis, or coaching sports eliminates the risk of death related to sitting, even from sitting for more than eight hours per day.

Can’t get in an hour of these types of activities per day? Just 25 minutes of moderate activity is somewhat protective, even for people who sit for eight or more hours per day. Other studies have suggested that exercise can be broken up and spread out throughout the day and still be beneficial. One study found that even hourly breaks of light activity decreased measurable damage to our arteries.

Time spent sitting was analyzed separately from time spent sitting and watching television. TV time is associated with even greater risk of death, and exercise was not as protective. Even more than an hour per day of moderate activity did not eliminate the risks associated with five or more hours per day of zoning in front of the tube. Why the extra negative effect of TV watching? The authors hypothesize that people are more likely to get up and walk around at work than they are while watching TV. In addition, people tend to watch TV in the evening after eating dinner, which may have negative effects on our blood sugars and fat metabolism. Or, perhaps people are prompted to snack on unhealthy foods during those commercials breaks. Watching large number of hours of television? Consider an exercise bike or a treadmill, place it in front of the screen.

Whether it’s sitting in an office chair or watching TV, those who get less than five minutes of moderate activity per day fare the worst, and the longer they sit, the higher their risk of death from any cause – be it heart disease or cancer.

For more information see: exercise recommendations for patients with diabetes.