Hepatitis A Outbreak

San Diego is experiencing a Hepatitis A outbreak.  Here’s what you need to know about the disease.  It can be prevented with a safe and effective vaccine.

What is the source of the outbreak?

Since early 2017, the Public Health Services Division, in the County of San Diego Health and Human Services Agency, has been investigating a local Hepatitis A outbreak. The outbreak investigation is ongoing. It has been challenging because of the long incubation period of the disease (15 to 50 days) and the difficulty experienced to contact many individuals sickened with the illness who are homeless and/or illicit drug users. To date, no common source of food, beverage, or other cause has been identified; as a result, the source of the outbreak remains undetermined.

How many people have been affected?

So far, there have been 312 people affected by the local outbreak.  Unfortunately, 10 people have died and 215 people have been hospitalized.

What is Hepatitis A?

Hepatitis A is a liver infection caused by the Hepatitis A virus, which is highly contagious. It can cause liver disease, lasting a few weeks to a serious illness lasting months. In some cases, people can die.

How Is It Transmitted?

Hepatitis A virus is usually transmitted by:

  • Touching objects or eating food that someone with Hepatitis A infection handled.
  • Having sex with someone who has a Hepatitis A infection.

Take CDC’s Hepatitis Risk Assessment and get a personalized report in 5 minutes.

What Are the Symptoms?

Hepatitis A does not always cause symptoms. Some people get Hepatitis A and have no symptoms of the diseases. Adults are more likely to have symptoms than children.

Symptoms include fever, fatigue, nausea, loss of appetite, yellowing of the eyes (jaundice), stomach pain, vomiting, dark urine, pale stools, and diarrhea.

How Can Hepatitis A Be Prevented?

  • Get two shots of the Hepatitis A vaccine six months apart. The vaccine may be given as a twin vaccine against both Hepatitis A and B.
  • Don’t have sex with someone who has Hepatitis A infection.
  • Use your own towels, toothbrushes, and eating utensils.
  • Don’t share food, drinks, or smokes with other people.

Who Should Get the Hepatitis A Vaccine?

  • Individuals who are homeless.
  • Individuals who work with homeless and/or users of illegal drugs.
  • Travelers to countries with high or medium rates of Hepatitis A virus.
  • Men who have sex with men.
  • Users of injection and non-injection illegal drugs.
  • Individuals with chronic liver disease, such as cirrhosis, hepatitis B, or hepatitis C.
  • Anyone who is concerned about Hepatitis A virus exposure and wants to be immune.
  • Persons with clotting factor disorders.

Note: individuals with chronic liver disease (i.e., cirrhosis and hepatitis C) may not be at increased risk of getting HAV infections but are at increased risk of having poor outcomes if they are infected with HAV.

We have the Hepatitis A vaccine in stock and can provide it for you without a prescription.  Our pharmacist will write the prescription and administer the vaccine in one quick visit.  Book your appointment today!

 

Here’s a video about the local outbreak:

 

Can You Make Quitting Smoking Your New Year’s Resolution?

We hope you had a wonderful time ringing in the new year!  Now it’s time to decide on your new year resolutions.  We have one in particular in mind that we can help you with.  So consider taking on this resolution:  Quit smoking.  Or help a loved one quit cigarettes or other tobacco products.  

We all know smoking is bad for our health and the health of those exposed to secondhand smoke too.  Tobacco use is the leading cause of preventable death in the United States. Californians suffer undue illness and premature death from the use of tobacco products.

Did you know we can help you by prescribing nicotine replacement medications?  Not just the gum, lozenges, and patches.  We can also give you prescription-only nicotine replacement medications like the nasal spray and inhaler.

 You may have tried to quit before, and felt discouraged if you were unable to stay quit. You may wonder what services are available to help you quit, or if you want help to quit.  A new California law allows pharmacists to provide prescription nicotine replacement medications without a doctor’s prescription to help you quit tobacco. This increases access to these medications for you, and makes them more affordable. Counseling and medication options are effective on their own, but are even more effective when combined. When you are ready to quit tobacco, remember to ask your pharmacist for help.

You can book your appointment on our website or give us a call today!

Hope to see you in clinic soon!  

drug-interactions-with-tobacco-smoke

Tobacco smoke interacts with medications and affects the absorption, distribution, metabolism, or elimination of other drugs, potentially causing an altered pharmacologic response. Any smoker is susceptible to the same degree of interaction. Some of the most significant interactions are with the following medications:

  • Caffeine
  • Coumadin (warfarin)
  • Plavix (clopidogrel)
  • Hormonal contraceptives (birth control pills, patch, ring)
  • Clozaril (clozapine)
  • Lopressor or Toprol XL (metoprolol)
  • Zyprexa (olanzapine)
  • Insulin
  • Requip (ropinirole)
  • Chemotherapy: Camptosar (irinotecan) and Tarceva (erlotinib)

If you smoke and take any medications, we can review any potential interactions and make sure your dosages are appropriate and monitor for complications.

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Flu Myths and Tips

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You’re probably aware that we’ve officially entered both the holiday season and flu season. This year, we’d like to help you focus on the spirit of giving…except when it comes to giving the flu!

There’s still time to get a flu shot. Flu season lasts through Spring each year. In fact, in June of this year there was a late-season flu-related death here in San Diego County. Regardless of age or health condition, anyone can catch the flu, and get very sick. Even if it’s a mild case, he or she can still spread it to other people, like family, friends and co-workers. People with flu are contagious even before they develop symptoms. Everyone 6 months of age and older should get this important protection.

Our clinic has been full of the holiday spirit as families, couples, children, and adults of all ages have been coming in for their flu shots.  For those of you who have already come in for your flu shot, kudos!  For those of you who haven’t had the time or might be hesitant to get the flu shot, please take a few minutes out of your schedule to squeeze this important preventive health visit in.  We can provide flu vaccines to anyone who is 4 years of age or older.  If you have health insurance, the cost may be covered.  For example, Medicare covers this vaccine.  If you don’t have insurance, we have the lowest prices  (only $25 for the regular flu shot that covers 4 virus strains and $54 for the high dose flu shot if you are over age 65).

You can book your appointment on our website or give us a call today!

Hope to see you in clinic soon!  Happy Holidays!

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In addition to protecting yourself with the flu shot, there are some other things you can do to help avoid getting sick with the flu, colds and other respiratory diseases (and avoid spreading illness to others):

  • Cover your coughs and sneezes. Use a tissue or your arm.
  • Wash your hands often, with plenty of soap and warm water.      
  • Stay away from sick people whenever possible.
  • Stay home when you’re sick.
  • Get enough rest, exercise regularly and eat a healthy diet.

These tips are helpful in protecting your health all year, not just during flu season.

flu-shot-mythsMYTH #1: The flu shot gives you the flu.

The flu shot doesn’t give you the flu, because it can’t. The flu shot contains killed virus. That killed virus can’t infect you and give you the flu. You may have received a flu shot in the past and then become sick after that. But it wasn’t caused by the flu shot. It could be that you were already infected with the flu before you got the shot.  Or it could be that you had become infected with another strain of the flu that wasn’t in the vaccine. Or you may have had a respiratory infection or a cold, and experienced flu-like symptoms. But that doesn’t mean you had the flu.

MYTH #2: I don’t need the flu shot because I never get sick.

Even if you have never been sick, that doesn’t mean you will never get sick. If your loved ones have never been in a car accident, does that mean they shouldn’t have to wear a seat belt? Of course your answer is NO, so why take chances with the flu? The virus doesn’t care how healthy you’ve been. You can still catch the flu and become very ill. You can miss work, school and other important activities in your life. And you can make others sick, too—including people who have health conditions like heart disease or cancer that make them especially vulnerable to flu and its complications like pneumonia. The flu can even be fatal. (For stories about real people whose lives were touched by vaccine preventable diseases like influenza, visit http://www.shotbyshot.org.)

MYTH #3: The flu isn’t a big deal.

We wish that was true! Last year in San Diego County alone, there were nearly 7,000 cases of flu that resulted in 120 hospitalizations in the intensive care unit (ICU) and 68 deaths.

Let’s Talk About Plan B (and other forms of emergency contraception)

 

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Practicing safe sex is very important for many reasons. One reason we will focus on today is preventing unplanned pregnancies even after having unprotected sex. This is where emergency contraception (“EC”) enters the scene — it helps prevent pregnancy after the deed is done. Some people still call it the “morning after pill” but you have a bit more time than that to get your hands on it. Plan B is usually the first to come to mind we think of EC — but there are other options  and we will be discussing those as well!

When should you use emergency contraception?

If you had unprotected sex, EC can be used to prevent pregnancy. EC is most effective if taken right after unprotected sex occurs but can actually be used up to 5 days after (Side Note: as days go by, the effectiveness goes byebye).

Are there any side effects?

The side effects of Plan B are similar to other hormonal birth control and generally not an issue for most people. In case you do have any side effects, these are normal:

  • Nausea and vomiting
  • Headache
  • Fatigue or dizziness
  • Tender breasts
  • Abdominal pain or cramps

These side effects only last a couple days. Also, your menstrual cycle may become affected (light, heavy, early, or late). Do not worry if this occurs. However, if you have severe abdominal pain or do not get your next period, please visit your primary care physician or gynecologist.

Is Plan B FDA-approved?

Yes! It’s a very safe medication that has no contraindications or safety concerns.

Are there options other than Plan B?

Yes! Let’s dive right into this subject!

There are a few options available to you.  The first is the popular Plan B One-Step pill or one of its many generic forms (Take Action, Aftera, React, MyWay, etc).

The second is the Ella pill, which is less famous because it requires a prescription but works a bit better than Plan B.  You can only pick one of these two pills. Taking both is a recipe for failure since they basically cancel each other out, so please don’t try it.

Your third and most effective option is the copper IUD. If you’re interested in this one, check with your local clinics to see if you can get it quickly enough. It’s a good idea to take one of the pill options while you figure out the IUD.

How do EC pills work?

Little known fact, it can take up to 6 days for the sperm and egg to meet after having unprotected sex. This form of birth control causes the woman’s ovary to delay releasing the egg. Hence, there will be no egg for the sperm to meet! Sorry guys.

Now that we’ve discussed these options, you’re probably wondering how you can get a hold of them…

No matter how old you are or your gender, anyone can buy Plan B or one of its generic versions over-the-counter — that means no prescription needed — at your local pharmacy. However, everyone needs a prescription for Ella. A prescription for Plan B will probably help get your insurance to pay for it though.

You can meet with Dr. Sally at The Pharmacists Clinic and get a prescription for EC or other methods of birth control. Tip: Go in and get it before you need it. That way you can just grab it out of your medicine cabinet if the situation presents itself.

Remember, these are back up and there are more effective methods of birth control that can be used before you jump in between the sheets.


bianca-tranquil-round

About the Author:

Bianca S. Faridian is a third-year pharmacy student at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.

Hormonal Therapy & Endo Workshop

Later this month, I’ll be speaking to women with endometriosis about hormonal birth control and other treatment options. I’m sure they will have great questions and experiences that will inspire future blog posts.  Let me know if you’re interested in attending this free lecture at the Mission Valley public library in San Diego, California.

Bloomin' Uterus

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August 31, 2016, from 6:00pm-7:00pm (you can arrive as early as 5:45pm)

Mission Valley Library; Seminar Room A; 2123 Fenton Pkwy, San Diego, CA 92108

Join us to discuss Endometriosis treatment options with clinical pharmacist, Dr. Sally Rafie. Our focus will be on hormonal therapy, such as hormonal birth control and other hormone regulators. We will review effectiveness, side effects, and common concerns.

The talk will be interactive and casual, so please send in your questions in advance (to drrafie@pharmacistsclinic.com) or bring them with you!

Speaker:

rafie
Dr. Sally Rafie, PharmD, BCPS
The Pharmacists Clinic
www.pharmacistsclinic.com
www.instagram.com/pharmclinic
www.facebook.com/pharmacistsclinic

IMPORTANT: seating is severely limited. As of this moment, there are only 9 seats available.  If you RSVP and need to cancel, please let me know so I may review the waiting list. You will receive a confirming message from me that you are on the seating list, as well as my telephone number…

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5 Tips To Remember Your Birth Control

Remembering to do something as important as taking your birth control everyday and on time can be quite difficult — Especially with our hectic schedules! Here are some tips and tricks to help remind you:

1. Put it next to something you use every day.

Do you brush your teeth at about the same time everyday? Do you wear contacts? Do you take other medicines? Try pairing one of these daily routines with taking your birth control.img_4904

2. Use your phone.

In this day and age, our generation is attached to their phones. Why not have a special alert or alarm to remind you to take your birth control? Maybe even choose the crying baby ringtone?

  • Alerts. Advice from prior experience: Have two alerts. Due to busy schedules, sometimes it slips your mind even if you saw your alarm go off. Better safe than sorry!
  • Apps. Some of us love our apps! Everheard of WomanLog or MyPill? Or even Google calendar? There are lots of apps you can try.
  • Messages. Sign up for free text message reminders to take your pill from Bedsider. These messages will put a smile on your face and help you remember to take your pill.phone-alert

3. Not interested in technology?

  • Use sticky notes! Add one to your bathroom mirror or maybe even on your coffeemaker? Add it anywhere you know you’re bound to see it everyday.
  • If you have a to-do list that you love checking off, add another bullet point for your birth control. It’s a task you must complete each day!

4. This one is for all the fur-mommies out there!

Cats and dogs are persistent when it’s time to feed them. They’re always right on the dot. So, what did I do? I placed my birth control right next to the cat food. Whenever they alert me to feed them, it’s an instant reminder to take my pill as well. It’s perfect because they don’t stop meowing until fed! This can work with other furbabies too.

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5. Put it in your wallet.

Work and school are busy, but you always have a lunch break. Need to pay for lunch? What do you do? You open up your wallet! It’ll be the first thing you see. I’ve even seen women use their pill pouches as wallets and store some cash or credit cards. Want something a little more unique? Try one of these hand-painted pill wallets.

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Anything to Add?  We know many of you have your own ways of remembering to take your pill on time everyday, so please share in the comments! Reading about what works for you might help another reader!


Bianca

About the Author:

Bianca S. Faridian is a third-year pharmacy student at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.

Clinic Open House & Walk-In Flu Shots

Did you know? 

All adults should get a flu vaccine every year by the end of October.

Vaccination is especially important for people at high risk of developing flu-related complications and their close contacts:

  • 65 years of age and older,
  • pregnant/planning to become pregnant, or have
  • cancer,
  • diabetes,
  • asthma/COPD, or
  • heart disease.

We are having a special event this Saturday, September 17th.  The clinic will be available for touring and you can meet the pharmacists and staff that make the clinic and pharmacy run smoothly to serve our patients.  Drop by for your annual flu shot, free blood pressure and blood glucose screenings, or just to say hello.


Let us know you’re coming!

If you’re new to the pharmacy, please bring your health insurance card so we can process payments through your insurance and minimize your out of pocket costs.

Located inside Point Loma Shelter Island Drug in San Diego, California.

Local Pharmacy Promotes Naloxone to Save Lives on Overdose Awareness Day

Today is Overdose Awareness Day. This annual awareness day aims to reduce the stigma of drug-related overdose, prevent overdose-related death, and remember loved ones injured or lost to overdose.

Opioid-related overdoses and overdose fatalities are a growing epidemic in the United States and in San Diego. Opioids, including prescription opioid pain relievers and heroin, killed more than 28,000 people in the U.S. in 2014 alone. Home naloxone decreases overdose-related fatalities. Naloxone is an antidote to opioids and when given, reverses the effects of opioid overdose immediately. California and some other states have expanded access to home naloxone through pharmacist prescribing and dispensing.

Naloxone on Overdose Awareness DayThe Pharmacists Clinic is committed to saving lives by offering naloxone to patients. We offer overdose education and home naloxone kits to all patients who have a personal opioid overdose risk or a loved one at risk. Some of the risk factors for overdose are: history of overdose, history of opioid misuse or abuse, chronic prescription opioid use with complex medical problems, or taking long-acting opioids. Patients can choose to get naloxone to use at home as an injection, nasal spray, or auto-injection device. Our clinical pharmacist, Dr. Sally Rafie, will review the signs of an overdose, how to respond, and how to administer naloxone in case of emergency with each patient.

According to Dr. Rafie, “many patients underestimate their risk of opioid overdose or that of their loved ones. My goal is for my patients to have this available just in case. There’s no judgment or consequence to keeping this life-saving medicine on hand in case of emergency.” Anyone can book a quick appointment and walk out of the pharmacy equipped with a naloxone kit.

If you take opioids, here are some tips to help ensure you and your loved ones are safe:

  • Do not mix opioids with alcohol, other pain medications, anxiety medications, sleep medications, or street drugs. Mixing opioids with other substances is a leading cause of opioid injury and death. Talk to your doctor and pharmacist about other meds you are taking, and let them know if you have any changes in your meds.
  • Keep out of reach from children, other people, and pets. This medication can hurt people if taken by accident.
  • Get rid of any opioid medications that you no longer need.  The safest way to get rid of unused meds is by taking them to a drop off location. If you are unable to take them to one of these places, you should flush them down the toilet or the sink to prevent others from taking them accidentally.
  • Talk to your doctor about carrying naloxone (Narcan) with you in case of emergency. You will need someone else to give you naloxone, so tell your friends or family members where you keep it and how to use it. In an overdose, naloxone can reverse opioid side effects and save your life.
  • Take only as prescribed. Taking more than your doctor told you can lead to injury and in some cases, death. If you feel that your medication is not meeting your pain needs, talk to your doctor to discuss other options that may work better for you.
  • Do not drive or use heavy machinery after you have taken opioids until your doctor says that it is safe. Opioids can cause confusion and sleepiness, which can affect how well you do these activities.
  • Talk to your doctor if you have been taking opioids for a long time and you think that you no longer need them. Your body can get used to the medication. Your doctor may help you prevent withdrawal symptoms such as anxiety, sweats, trouble sleeping, loss of appetite, nausea, and fatigue.

For more information:

Launch of New Pharmacist Run Clinic Inside a Community Pharmacy

IMG_1633Point Loma recently welcomed The Pharmacists Clinic and the addition of clinical health services in the local, family-owned pharmacy, Point Loma Shelter Island Drug. We are the first pharmacy in San Diego to provide consultations with clinical pharmacists, prescriptions issued by clinical pharmacists, and lab testing. Patients are able to conveniently schedule a same-day, evening, or weekend appointment online. This means no more taking the day off work or spending hours in a waiting room. All clinic visits take place in a private room in the pharmacy where nobody can hear or see the conversation.

The Pharmacists Clinic is now offering important preventative health services, including consultations and prescriptions for birth control, lab tests, naloxone opioid rescue, and nicotine replacement therapy. We can order and interpret over 2000 lab tests such as cholesterol, thyroid, and blood glucose for very affordable and transparent prices. Women can meet with our clinical pharmacist, Dr. Sally Rafie, for a personalized birth control consultation and leave with a prescription for birth control pills, patch, ring, or shot. We also offer prescriptions for nicotine replacement therapy to help our patients quit smoking and naloxone opioid rescue in case of an emergency opioid overdose situation. Services will soon be expanded to include all vaccines and travel meds.

Dr. Sally Rafie, a board-certified pharmacotherapy specialist and licensed pharmacist, founded the Pharmacists Clinic. Dr. Rafie specializes in women’s health and preventive health. She completed her Doctor of Pharmacy degree from UC San Francisco and residency training at UC San Diego. “People want to take care of their bodies and control their health. We’re here to help make that easier.” – Dr. Sally Rafie

Dr. Rafie is able to offer these services because of a recent law in California that expands the scope of pharmacist practice to increase access to vital public health services and medications. “We’re not here to replace your physicians, but rather offer an additional, convenient point of care and medication expertise. If you have a primary care physician, we will be sure to keep them in the loop.” – Dr. Sally Rafie

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The Pharmacists Clinic and Point Loma Shelter Island Drug have a unique collaboration to offer these clinical services to the Point Loma community! Point Loma Shelter Island Drug is a beloved, family-owned pharmacy established in 1924 and owned by Michael Saad, with a second location called Point Loma Cabrillo Drug.

Male Birth Control With a Flip of A Switch

The future of contraception may allow men to control their fertility with just a flip of an on-off switch! This switch, called the Bimek SLV, was developed by German researchers. This might just be the most innovative uses of technology when it comes to birth control for men.

How exactly does it work?

It’s a small device about the size of a gummy bear that attaches to each of the two spermatic ducts and functions to regulate the release of sperm cells. In its closed state, the device obstructs the release of sperm during ejaculation. It diverts only the flow of the sperm cells, not the ejaculatory fluid. So men can expect to ejaculate normally. Sperm actually makes up only about 5% of the ejaculatory fluid. The rest is made of other substances such as proteins, enzymes, and water.

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Conversely, the valve can be easily switched open and allow the release of sperm, immediately restoring fertility. The sperm cells that are blocked are ejected out of the spermatic duct through several outlets on the device. Outside of the ducts, special cells known as phagocytes break down sperm. The Bimek SLV is proposed as a life-long, hormone-free method for men to control their fertility.

What would the experience of getting this entail?

First off, a medical examination would be required to make sure that he is a good candidate for the device. An incision is made on the testicles and the devices inserted. The procedure to implant the switch is similar to undergoing a vasectomy. Therefore, the risk of complications or adverse effects after insertion is very low. The procedure itself takes only 30 minutes and is done under local anesthesia. And although it only takes only 1 day to recover, it does take 3 to 6 months before the device becomes completely functional and is able to divert sperm from the ejaculatory fluid.

How much does it cost?

Estimated costs for the surgery and the two Bimek SLV valves is about €5000 Euros or about $5,400 US dollars. Pricey, indeed!

It may be years before this device even lands in the US marketplace because it still needs to undergo clinical trials to make sure it’s safe and effective. If everything runs according to schedule, the device is projected to receive European market approval in 2018.

For more information, see the Bimek SLV website.  Or watch this video:


KevinVuPharmDCandidate

About the Author: Kevin Vu is a recent graduate from the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences.