West Knoll Pharmacy

As we get older it becomes more important to get the right screening tests so we maintain or even improve our health. Screening for early diseases allows us to treat potentially life threatening conditions or prevent complications of existing medical scenarios. The following are examples of conditions men should routinely screen for depending on age and risk factors. Ask your physician or West Knoll pharmacist when it is appropriate to screen for these: Hypogonadism As men age, they produce less testosterone. Testosterone may affect energy levels, sexual performance, arousal, mood, cardiac health, and other bodily functions. A simple test can determine your blood levels. Ask your West Knoll pharmacist about different hormone replacement therapies that could restore your testosterone to normal levels. Prostate Health Screening tests can detect early disease, and treatments are generally effective if caught early. Several prescription and non-prescription nutraceuticals can improve your prostate function. High Blood Pressure (Hypertension) In general, the risk of developing high blood pressure goes up with age. Lifestyle and body weight play a major role. However, genetics is a primary determinant. Hypertension could be treated with various pharmaceutical modalities. The right choice for treatment depends on many factors. Ask your physician about the right choice for you. Our pharmacists would be glad to discuss potential drug interactions or side effects directly related to men’s health. High Cholesterol Levels Along with genetic predisposition, high cholesterol levels could cause a build-up of “plaque” along the walls of your blood vessels. Such condition could increase your risk of cardiovascular disease which may lead to heart attacks or strokes. A simple “lipid” panel could give you a baseline level of several key factors such as total cholesterol, triglycerides, HDL, LDL, VLDL, CRP, etc. Medications, along with lifestyle changes, could significantly reduce your risk of heart disease. Feel free to call us to discuss your current regimen, or alternative therapies which may be equally therapeutic but more cost effective. Human Immunodeficiency Virus (HIV) HIV is the virus that causes AIDS. Although we do not have a cure for AIDS, we have several excellent treatment models that can keep the virus from causing HIV related illnesses. Many patients have undetectable viral loads, and most of our patients lead active lifestyles. We carry all available FDA approved HIV medications. Our knowledgeable pharmacists can answer all your questions as well as arrange for delivery of your medications anywhere in the United States.

Hormone Replacement Therapy Restoring Hormonal Balance Customized Hormone Replacement Therapy (HRT) is the replacement of deficient hormones with hormones that are chemically identical to those that the body naturally produces, but which have declined due to aging or illness. Customized HRT has improved the quality of life for millions of women who suffer from hormonal imbalance. The ideal process for achieving hormonal balance includes an assessment of hormone levels and complete evaluation of signs and symptoms, followed by replacement of the deficient hormones in the most appropriate dose via the most effective route for each woman, and monitoring to fine tune the therapy. Estrogen is prescribed to relieve menopausal symptoms and treat postmenopausal problems such as vaginal dryness and tissue breakdown, painful intercourse, and various urinary disorders. Estrogens have been shown to decrease the risks of osteoporosis and colorectal cancer. Progesterone is commonly prescribed for perimenopausal women to counteract “estrogen dominance”, minimizes the risk of endometrial cancer in women who are receiving estrogen, and may enhance the beneficial effect of estrogen on lipid and cholesterol profiles. Published research has shown that the risk of breast cancer is increased by long-term use of conjugated equine estrogens, which are the most commonly prescribed form of commercially available estrogen, and the risk is further increased when the synthetic progestin medroxyprogesterone acetate is added.4,5 Conjugated estrogens are derived from pregnant mares’ urine, but most estrogens from horses are NOT naturally produced by humans. Additionally, synthetic medroxyprogesterone acetate does not confer all of the benefits of natural progesterone. That is why we recommend the use of natural estrogen and progesterone. Androgens are a class of hormones that include DHEA and testosterone, which are normally produced in a young healthy woman, and are important for libido as well as integrity of skin, bone, and muscle. When women enter menopause, testosterone and DHEA levels may decline. Experts now recognize the importance of supplementing androgens for women who are deficient. While women have benefited from therapy with estrogens, progesterone, and androgens that are “chemically identical” to the hormones produced naturally by the human body, researchers and health care professionals realize that this is just the “tip of the iceberg” when it comes to achieving hormonal balance. Thyroid and adrenal function, as well as nutritional status, should also be evaluated and treated when indicated. Women Prefer Natural Hormones Mayo Clinic researchers surveyed 176 women taking natural micronized progesterone who had previously taken a synthetic progestin (medroxyprogesterone acetate, or MPA) to see if progesterone improved the women’s overall quality of life, menopausal symptoms, and satisfaction with HRT. After one to six months, the women reported an overall 34% increase in satisfaction on micronized progesterone compared to their previous HRT, reporting these improvements: 50% in hot flashes, 42% in depression, and 47% in anxiety. Micronized progesterone was also more effective in controlling breakthrough bleeding. In other studies, women using micronized progesterone had specific improvements in the areas of cognition, sleep, and menstrual problems.

Stress can be caused by environmental, physical, psychological or nutritional factors. One of the body’s initial responses to fear or stress is the release of hormones such as epinephrine (adrenaline) and cortisol that initially help us to react or adapt to a stressful situation. Cortisol raises blood sugar and blood pressure, increases the breakdown of protein, interferes with thyroid hormone action and stimulates visceral fat deposition, which can lead to metabolic syndrome. But, chronic stress is maladaptive and ultimately disrupts the body’s signaling system (the Hypothalamic-Pituitary-Adrenal Axis = “HPA Axis”) and the adrenal gland’s normal pattern of cortisol release. This can lead to problems such as: Insulin resistance/diabetes Cardiovascular problems including arrhythmias, CHF, MI, atherosclerosis and hypertension Osteoporosis Dementia/memory loss Immune suppression Impaired thyroid function Decreased kidney function Exacerbation of skin conditions (acne, psoriasis, eczema) Gastrointestinal problems (GERD, Irritable Bowel Syndrome) Mood disorders and depression Increased risk of neurodegenerative diseases Sleep disorders Reproductive disorders Premature aging Over time, the body may no longer be able to produce the needed amounts of cortisol and patients can ultimately end up with low cortisol levels (hypocortisolism). Fatigue, pain and stress associated with HYPOcortisolism may result in Chronic Fatigue Immuno-Deficiency Syndrome (CFS), Fibromyalgia and Post Traumatic Stress Disorder (PTSD), asthma, chronic pain syndromes, and autoimmune diseases. Treatment of Adrenal Dysfunction Stress reduction techniques –Gentle exercise, Tai Chi, yoga, Pilates, meditation Sleep hygiene - Regular sleep-wake cycle, avoid third shift work. The following supplements may be helpful: 5-HTP, Melatonin, Phosphatidylserine, L-Theanine, Calming herbs (Valerian root, Chamomile, Hops, Passion flower) Lifestyle modification - Delegating responsibilities to eliminate stressors, regular meals, avoid caffeine and alcohol Vitamins and minerals - Magnesium Glycinate or Magnesium Citrate, B Vitamins, selenium, zinc, calcium, manganese, Vitamin E with mixed tocopherols, Vitamin C (Ascorbate) Adaptogens – Ashwaganda, Rhodiola, Holy Basil

Osteoporosis -The Silent Disease Osteoporosis is a painful, crippling disease characterized by low bone density, but it is both preventable and treatable. Osteoporosis occurs when not enough new bone is formed or too much bone is lost, or both, and therefore bone is brittle, weak and more likely to fracture. Osteoporosis is often called "the silent disease" because it can progress painlessly until a strain or fall causes a bone to fracture, and many times people don't know they have the problem until the first fracture occurs. Bone is not a hard and lifeless structure; it is complex, living tissue. Bones provide structural support for muscles, protect vital organs, and store calcium which is essential for bone density and strength. Signs and symptoms of osteoporosis include: Pain in the back, ribs and abdomen. Loss of height is normal as people age, but is increased by osteoporosis. Fractures of the hip, spine and wrist, as well as ribs, humerus, and pelvis. Humped back, known as "Dowager's Hump." Of the individuals who fracture a hip, one-half will be permanently disabled, and almost 20% will require long-term nursing care. One in five individuals with hip fractures die within one year, usually from complications such as pneumonia or blood clots in the lung related to either the fracture or subsequent surgery. Osteoporosis affects approximately 25 million Americans and 250 million people worldwide, predominately women. Osteoporosis can strike at any age. Significant risk has been reported in people of all ethnic backgrounds. However, whites and Asians are more susceptible. Menopause is a known risk factor for osteoporosis. Osteoporosis is most common in older women, occurring in about 25% of those over 60 years of age. Women who have either had their ovaries surgically removed before age 45 or undergone early menopause, without receiving hormone replacement therapy, are also more likely to develop osteoporosis. Other female risk factors are small body frame and excessively strenuous exercise that stops menstrual periods. Additional risk factors for osteoporosis include: Family history of osteoporosis Smoking Excessive use of alcohol Low body weight (less than 127 lbs) Sedentary lifestyle Low dietary intake of calcium Use of corticosteroids, anticonvulsants, certain cancer treatments and aluminum-containing antacids Certain hormonal disorders such as hyperthyroidism, hyperparathyroidism and Cushing’s Disease Other diseases such as chronic liver and intestinal disorders Prevention Although there is no cure for osteoporosis, these steps may slow or stop its progression. Eat a balanced diet - Nutritious food is important in maintaining an appropriate weight, also a factor in preventing osteoporosis. Avoid caffeine and carbonated beverages which can cause calcium to be eliminated from the body. Exercise - Daily weight-bearing exercise helps to reduce bone mineral loss. Stop smoking and limit alcohol. Have bone density baseline testing in your 30’s and then every one to three years. Take quality nutritional supplements. Testing & Diagnosis: Early Detection is Key Specialized bone density tests can measure bone mineral density (BMD) in various sites of the body. Bone density testing is painless, noninvasive and safe. Test results can help you and your doctor decide the best course of action for your bone health. A bone density test can: Detect osteoporosis before a fracture occurs Predict your chances of fracture in the future Determine your rate of bone loss and/or monitor the effects of treatmen Treatment Customized Hormone Replacement Therapy (HRT) - Replacement of declining hormones slows the loss of bone and increases bone density, which helps to decrease the risk of fractures. Estrogen can prevent bone loss, and many practitioners report increased bone density following progesterone administration. Testosterone therapy may also be utilized to improve bone health. Thyroid hormone is required for normal bone remodeling to take place. If thyroid hormone is deficient, old bone that is not as strong and is abnormally thick tends to accumulate. However,excessive thyroid hormone may cause osteoporosis. Calcium supplements, and other vitamins and minerals (including magnesium, manganese, folic acid, boron, zinc, strontium, copper, silicon, and vitamins A, B6, C, D, and K) are important to bone formation and maintenance.

Skin Care and Cosmeceuticals for Anti-aging Cosmeceuticals After a proper analysis reveals areas of dry, oily, or aging skin, we can provide the appropriate correction for each skin type in a cosmetic base containing the exfoliants, emollients, and micronutrients necessary for cellular repair. Antioxidants such as Alpha Lipoic Acid (ALA) and Ascorbyl Palmitate (Vitamin C Ester) are vital to the energy production of skin cells and the formation of collagen. Alpha Lipoic Acid promotes optimum efficiency for the production of energy and removal of intracellular waste products, essential for cellular healing and elimination of wrinkles and facial scars. Ascorbyl Palmitate also inhibits the body’s production of inflammatory arachidonic acid, which plays a role in the development of psoriasis and the micro-scarring that leads to the formation of wrinkles. Molecular biologist Olga Marko, Ph.D., found that Ascorbyl Palmitate stimulates the growth of fibroblasts which help to produce collagen and elastin in human skin. Studies have shown that antioxidants can be delivered percutaneously to directly supplement the skin’s antioxidant reservoir. Oral supplementation has not been successful in raising levels of antioxidants in the skin. Retinol assists in the rejuvenation process that leads to a more youthful appearance and provides the same benefits to the skin as retinoic acid, but in a more gradual, gentle manner. Retinol works with Alpha Lipoic Acid to provide maximum benefits, effectively and gently. Alpha and beta hydroxyl acids may be used to exfoliate the skin, increase cell turnover, and reduce fine wrinkles and mottled pigmentation. Amino acids such as DMAE (2-dimethylaminoethanol; deanol) tone and add firmness to the skin, prevent age spots and aid in healing the micro-scarring which causes wrinkles. The benefits of DMAE include a potential anti-inflammatory effect with possible improvement in underlying facial muscle tone. In a randomized clinical study, 3% DMAE facial gel applied daily for 16 weeks was shown to be safe and efficacious in the mitigation of forehead lines and periorbital fine wrinkles, and in improving lip shape and fullness and the overall appearance of aging skin. These effects did not regress during a 2-week cessation of application. Long-term application of DMAE gel for up to 1 year was associated with a good safety profile. Am J Clin Dermatol. 2005;6(1):39-47 Cosmetically appealing preparations Compounding pharmacists continue to develop new bases to improve both the aesthetic and therapeutic aspects of compounded medications. For example, anhydrous gels deliver medications which facilitate rapid absorption of the active ingredient into the skin and prolonged retention of the drug in the stratum corneum and epidermis, with minimal systemic transport of active drug. These cosmetically appealing gels are very stable and well accepted by patients. Chemical peels Chemical peelings with kojic acid, glycolic acid, and trichloroacetic acid (TCA), alone or in combination, are available for the treatment of hyperpigmentations. Research has concluded that dermatologists should have a choice of formulations to satisfy individual patient needs. Sunscreens We can compound sunscreen formulations with low-allergenicity UVB protectors in combination with chemicals such as oxybenzone that extend protection to UVA wavelengths. For broad-spectrum coverage that blocks or reflects UVA and UVB, physical sunscreens containing titanium dioxide or zinc oxide may be preferable. When vitamin C or a combination of vitamin C and E is formulated with a commercial UVA sunscreen (oxybenzone), an greater than additive protection is noted against the phototoxic damage. Skin Discoloration Increases or decreases in skin pigmentation can be due to many conditions (such as acne, pregnancy, cirrhosis, chronic renal failure, celiac disease) or use of medication. Most types of skin discoloration are harmless from a medical viewpoint, but they may be cosmetically unacceptable. The goal of therapy in hyperpigmentation disorders is to lighten the skin so it blends into the surrounding normal skin. Most preparations that are used to lighten the skin contain the drug hydroquinone. Other commonly used medications include azelaic acid, glycolic acid, hydrocortisone, kojic acid, and tretinoin. Our compounding pharmacy can prepare customized dermatologics to meet each person’s specific needs. It may take three to six months of therapy before improvements in pigmentation are noticed. These preparations may increase sensitivity to the sun, so ask our pharmacist about an effective sunscreen.

Hormone Testing Saliva Testing Convenient home collection, accurate, and inexpensive, Saliva Testing provides a true picture of the bioavailable levels of steroid hormones. Capillary Blood Spot Testing Capillary Blood Spot Testing offers easy alternative to venous blood draws in the laboratory or doctor’s office. Combination Saliva and Capillary Blood Spot Combines both Saliva and Capillary Blood Spot test materials in an all-in-one test kit for easy home collection of the major hormone groups— reproductive, adrenal, and thyroid – on the same day at the optimal time. Female Fertility Profiles I and II If there is no physical reason for infertility such as tubal damage, many of the different causes of female infertility can be related to hormonal issues. These include ovarian insufficiency, luteal phase deficiency, polycystic ovarian syndrome, thyroid deficiency, and stress. This simple test can identify potentially correctable hormone imbalances and move couples further towards their goals of achieving pregnancy. CardioMetabolic Risk Profile in Blood Spot (now includes total and LDL cholesterol). Cardiometabolic risk includes disorders related to obesity and insulin resistance, which can lead to Type 2 diabetes and/or heart disease. Vitamin D Testing in Blood Spot (25-OH, Total) Copyright © 2009, ZRT Laboratory, LLC. Used with permission. Saliva testing is a convenient, inexpensive, and above all, accurate means of testing steroid hormones. Scientific studies have shown a strong correlation between steroid hormone levels in saliva and the amount of hormone in the blood that is active or “bioavailable.” It is this fraction of total hormone that is free to enter the target tissues in the brain, uterus, skin, and breasts. Saliva testing can be done anywhere anytime. Testing that relies on blood draws (which need to be done in an office or lab) makes it harder to obtain samples at specific times (such as in the early morning) or multiple times during the day. In addition, hormones in saliva are exceptionally stable and can be stored at room temperature for up to a week without affecting the accuracy of the result. This offers maximum flexibility in sample collection and shipment. Hormones tested in the saliva profiles include: Estradiol Progesterone Testosterone DHEA Cortisol Copyright © 2009, ZRT Laboratory, LLC. Used with permission. Blood Spot testing is the future of blood testing. The process requires only whole capillary blood from a nearly painless finger prick and several tests can be run from a single sample. Blood spot testing provides results on a par with those from serum tests but without the cost and inconvenience of conventional blood drawing. In addition, collection times can be optimized for fasting baseline hormone levels and assessment of HRT dosing and diurnal hormone testing. Tests offered in the Blood Spot Profiles include: Thyroxine (T4), free Triiodothyronine (T3), free Thyroid Stimulating Hormone (TSH) Thyroid Peroxidase Antibodies (TPO) Testosterone, total Sex Hormone Binding Globulin (SHBG) Prostate Specific Antigen (PSA) Insulin-like Growth Factor (IGF-1) Estradiol (E2) Progesterone (Pg) Copyright © 2009, ZRT Laboratory, LLC. Used with permission. The Comprehensive Hormone Profile Putting saliva and blood spot test materials together in one combination kit makes it convenient to collect hormones of the three major glandular systems--reproductive, thyroid, and adrenal--on the same day at the optimal time. Tests include: In saliva: Estradiol (E2), Progesterone (Pg), Testosterone (T), DHEA, and the four diurnal Cortisols.

Restoring Vitality with Natural Hormone Replacement for Men Numerous changes are associated with an age-related decline in the hormone testosterone. Some men may go through a rather sudden change in testosterone levels that might correlate with the hormonal changes that women experience at menopause. However, most men have a slower and more subtle hormonal decline experiencing symptoms over a period of time. Symptoms of testosterone deficiency are often denied by the patient or attributed to other problems. Andropause may consist of a variety of signs and symptoms, including: weakness, reduced muscle mass fatigue disturbed sleep, insomnia reduced libido erectile dysfunction osteoporosis heart disease, atherosclerosis irritability low sperm counts depression, anxiety memory impairment reduced cognitive function Natural Testosterone Replacement is Central to the Treatment of Andropause. When hormones are replaced or restored back to physiologic levels considered normal for younger males, men may experience a dramatic reversal of many of these changes. On the average, a man’s testosterone levels begin to decline at a rate of 1% per year after age 40. It is estimated that 20% of men aged 60-80 years have levels below the lower limit of normal. The diagnosis of low testosterone levels (medically termed “hypogonadism”) is based on the presence of signs or symptoms and must be confirmed by laboratory testing, which should include Total testosterone, Bioavailable testosterone (Free plus Albumin Bound), Estradiol, Cholesterol, Prostate Specific Antigen (PSA), Complete Blood Count (CBC), Hemoglobin, and Hematocrit. Screening for potential risks of androgen therapy should be performed prior to the initiation of treatment. Evaluation should include a history of or potential for sleep apnea, arrhythmias, significant symptoms of benign prostatic hypertrophy (BPH) or personal or family history of prostate carcinoma, and a physical exam. Proper monitoring of laboratory values and clinical response are essential when prescribing testosterone replacement therapy. Natural testosterone must not be confused with synthetic derivatives or “anabolic steroids,” which when used by athletes and body builders have caused disastrous effects. For example, administration of synthetic non-aromatizable androgens, like stanozolol or methyltestosterone, causes profound decreases in HDL-C (“good cholesterol”) and significant increases in LDL-C (“bad cholesterol”), and has been associated with serious heart disease. Yet, hormone replacement with testosterone, an aromatizable androgen, results in lower total cholesterol and lower LDL cholesterol levels. Healthy Lifestyle A healthy lifestyle has been shown to be associated with higher hormone levels, and higher hormone levels seem to induce a more active, healthier lifestyle. When hormone levels decline, people become less active and gain weight. As people gain weight, hormones are stored in fat and become unavailable to meet the body’s demands. Lack of exercise, excessive alcohol use, and many diseases can reduce bioavailable hormone levels. For optimal results, it is essential that hormone replacement therapy be combined with adequate exercise, proper nutrition, and appropriate use of natural supplements.

Infectious diseases are communicable diseases, or transmissible diseases resulting from an infection by a virus, bacteria, fungus, parasite, or protozoa. We carry a full line of antivirals, antibiotics, and other pharmaceuticals to treat many infectious diseases. Where commercially available products are not available, or not suitable for certain patients, we offer an option to compound some preparations. Please feel free to call us to discuss your particular medication requirements.

West Knoll Pharmacy carries a full line of FDA approved medications for organ transplant patients. We are able to compound many preparations for our pediatric patients with different flavor options. Our system is capable of detecting potential drug interactions, thereby reducing potential harm to the patient. In addition, our program is designed to enhance medication compliance by alerting our staff when refills are due. Most often one of our trained professionals will personally call the patient and remind them that medications are refillable. Consultations are provided at NO charge to both patients and health care practitioners. Please call us with any questions.