Jim’s Blog

Ryan’s Corner

Written by Ryan French; August 4, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from one of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

All About Pharmacy Compounding

What is Pharmacy Compounding? Basically, “compounding” means that our pharmacy staff takes ingredients and makes a “compound” out of them, according to a recipe prescribed by a doctor or other healthcare practitioner. We can’t actually duplicate a commercially-available drug, but we can make a preparation of that drug specific to your needs.
What need does a Compounding Pharmacy fill? Not everyone can tolerate commercial preparations of drugs, and not every drug is commercially available in every possible dose or preparation. Compounding allows all patients access to their prescribed drug at their specific dose, in the preparation right for them, without ingredients they are allergic or sensitive to. Without pharmacy compounding, some people simply wouldn’t have access to the appropriate medicinal treatment.
What kind of ingredients can be replaced by Prescription Compounding? The active ingredient in each drug preparation is only one of several other ingredients used to stabilize the formulation—have you ever read the list of inactive ingredients on an over-the-counter drug? For example, most drugs don’t naturally form pills! Drug manufacturers use ingredients called excipients to bind pills together until they can be absorbed by the body—and sometimes brand name drugs use different excipients than generic versions. Some excipients contain gluten, which can trigger reactions in people with celiac disease. While the FDA has strict requirements for food and supplements that may contain gluten, there are currently no such rules in place for drugs. A compounding pharmacy can coordinate with your doctor to make sure that every medication prescribed for you is compounded without ingredients containing gluten, or any other ingredient your body can’t tolerate.
What if I have trouble swallowing pills altogether? A compounding pharmacy can prepare liquid suspensions of drugs for patients who are unable to take pills (and we can even add flavoring to get rid of that “medicine” taste). Your preparation will be provided in an oral syringe (without a needle, of course!) that you simply squirt into your mouth. Depending on the dosage, frequency of administration, and personal preference, we can either provide a bottle with a syringe you draw from yourself, or individual pre-filled single-use syringes. Pharmacy compounding is all about customization!
What other kinds of Prescription Compounding do you do? We can create compounds that have specific pediatric doses that aren’t available commercially. We can compound specific creams and ointments (they really are two different things!) to exactly match a hormone replacement therapy treatment plan—creams for preparations that are quickly absorbed into the skin, and ointments for drugs that need more time to penetrate. The only type of compounding we are not equipped for is preparing medications that are administered by injection or eye drop.
Do you Compound Prescriptions for pets? We also compound veterinarian prescriptions! We can compound your pet’s prescription into dosage forms they may find tastier than just hiding a pill in a piece of cheese. Some common prescriptions can even be made into yummy treats for your four-legged friend!
How do I know my Compounded Prescription is safe? Jim’s Pharmacy adheres to the highest safety and quality standards for prescription compounding. We follow USP800 guidelines and built our own on-site dedicated compounding facility in 2019. We follow a detailed, comprehensive cleaning regimen and have a dedicated “clean room.” Our lead compounder, Linda B., has over 20 years of experience in prescription compounding.
 
For further reading:
https://www.pccarx.com/
https://celiac.org/gluten-free-living/gluten-in-medicine-vitamins-and-supplements/
https://www.fda.gov/drugs/ensuring-safe-use-medicine/medications-and-gluten

Ryan’s Corner

Written by Ryan French; July 20, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from one of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

Communication and Jargon

On the day I’m writing this blog, I just found out that Donald Rumsfeld passed away. No matter what you or I might think of his life and career, the thing I’ll always remember him for is this quote:
“Reports that say that something hasn’t happened are always interesting to me, because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don’t know we don’t know. ”                                                                      –Donald Rumsfeld – February 12, 2002
When reading this quote it’s easy to repeat the “noan” sound until it sounds ridiculous, but he was referring to an important distinction in how we process information and even perceive the world around us. That “known vs unknown” distinction is similar to a concept called the Johari window, which divides information between what we know or don’t know versus what others know or don’t know and forces us to consider the distinction. And this asymmetry in access to information—the existence of unknown unknowns that others know—is a major hurdle in providing excellent customer service in healthcare.
Understanding healthcare jargon can be a major problem for pharmacy customers. To begin with, there are hundreds of anatomical terms for all the different structures and systems in the body. Then, each drug has its own long and complex name (even when you think you’ve got a simple name like Lipitor, you find out everyone at the Pharmacy actually calls it “atorvastatin”). Health care professionals need to use these otherwise-obscure terms with each other so that they can communicate quickly and concisely, and over time that jargon becomes so well-known to the speaker that they can easily forget to explain those terms to customers. Even I use the term “OTC” so frequently with coworkers that I forget to say “over-the-counter medicines” to customers.
I once asked a customer for their insurance card, and they responded with “I have a prescription, isn’t that enough?” Well, a prescription is just a doctor’s order that you should start a particular treatment, whereas your insurance card tells us who is paying for that treatment. In a perfect world, none of us would have to deal with the price of healthcare, but that’s another area where unknown unknowns abound. I deal with deductibles, coinsurance, and pre-authorizations every day, and that can lead to saying those words to customers as if everyone knows what they are. A deductible is the amount of money your insurance plan requires you to pay out of your own pocket for your healthcare before they ever kick in a dime. Coinsurance is the percentage of the charges that you have to pay even after you’ve paid your deductible, to make sure you still have “skin in the game.” Pre-authorization is a process where an insurance company needs more information before they can decide whether to pay for a prescription. Just because your doctor prescribed a treatment plan doesn’t mean they want to pay for it!
When faced with jargon, the best thing you can do is simply ask questions. A simple “pre-authorization, what does that mean?” will cause a healthcare provider like me to stop in my tracks and remember that my known knowns are other people’s unknown unknowns. It’s not that I tried to make things more complicated—by habit I use terms that are familiar to me, occasionally forgetting that they won’t be familiar to others. Sometimes I need a little jolt to remind me to get out of that rut.
As my introduction says, I have a degree in English language and literature, so communication is a passion of mine. The goal of this blog is to communicate, and to truly create understanding between us, I need feedback. Drop a line to ryanf@jimsrx.com and let me know what you think and how I’m doing. Let’s make unknowns known!

Ryan’s Corner

Written by Ryan French; July 1, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from one of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

A Good Night’s Sleep

When I was younger, I hated going to sleep. Sleeping seemed like such a waste of time—I could be reading another book, planning something creative, or playing video games. The thought of spending almost a third of my life just sleeping—horrible! But sleep is more than just “downtime” you can’t spend on your favorite hobbies or advancing your education; it’s one of the three pillars of a healthy lifestyle: nutrition, exercise, and sleep.
Modern life is just not conducive to good sleep. The prevalence of social media and smart phones has led to a culture where we expect instantaneous communication with anyone at any time. If you’re like me, that means scrolling through apps while you lie in bed—a habit that leads to terrible sleep and directly contradicts the healthy sleep recommendations made by the American Academy of Sleep Medicine (AASM): reserving your bed for sleep, make your bedroom a dark, quiet sanctuary for sleep, and giving yourself a 30-60 minute buffer between using electronic devices and sleep. They also recommend scheduling a regular bedtime to help you establish a clear rhythm, making sure you sleep at least 7 hours per night, staying active (including outdoors if possible) during the day, and avoiding alcohol and excessive caffeine close to bedtime.
Even if you follow all the AASM healthy sleep recommendations every day, there are other factors that can keep you from experiencing the healthy sleep you need. Sleep disorders affect over 70 million people, with one of the most prominent and well-known being obstructive sleep apnea. Obstructive sleep apnea occurs when the soft tissues of the throat collapse during sleep, partially or completely blocking the airway. The sleeper’s brain reacts to the interruption in oxygen flow by partially waking the body enough to open the airway again. This process repeats 15 or more times per hour, every hour of sleep. The result is a lack of good, deep sleep, and a person who wakes up feeling unrested (and often irritable). Daytime sleepiness, especially while driving or operating heavy machinery, is a very dangerous side effect of the disease. Sleep apnea has also been linked to high blood pressure, heart disease, diabetes, and even stroke.
The first-line treatment for obstructive sleep apnea is Continuous Positive Air Pressure (CPAP). A CPAP machine blows air through a mask of some kind into your airway while you sleep. This increased air pressure acts like a splint inside your throat to keep it from collapsing. Sleeping with a CPAP machine takes some getting used to—nobody knows that more than me! I’ve used a CPAP for over eight years now, and my sleep drastically improved during the first year. I used to wake up multiple times per night, and my wife couldn’t sleep through the sound of my snoring. And it wasn’t until I started using a CPAP that I realized I wasn’t even dreaming anymore. It took me quite some time to get used to sleeping with the mask on and the air blowing, but now I don’t even take naps on the weekend without it!
If you have trouble sleeping, or if you think you might have a sleep disorder like obstructive sleep apnea, come down to Jim’s Pharmacy on Wednesday July 14th for our first ever Healthy Sleep Day. Appointments are available but not necessary, and we’ll have special sales on sleep-related items throughout the store.
 
You’re going to spend about a third of your life asleep. Why not make that time the best it can be?
For further reading:
https://sleepeducation.org/
https://www.resmed.com/en-us/sleep-apnea/

Ryan’s Corner

Written by Ryan French; June 9, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from one of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

First Aid Kits

My favorite season is almost upon us: Summer. Just like Olaf from Disney’s Frozen, I love summer, and the sun, and all things warm. The bees abuzz, kids blowing dandelion fuzz… But summer activities can pose dangers even to those of us who are not made of snow. That’s why spring is the right time to check your First Aid kits and other emergency supplies!
Certain items are at home in every First Aid kit. Obviously we all know we need bandages, but not just little ones for minor cuts. I cut my hand completely open on a camping trip when I was a teenager and luckily someone had packed a 2”x2” gauze pad that was big enough to keep the wound closed—I still have a scar from that! Make sure you have other field dressing supplies like antibacterial wipes and ointment, wound closure strips, tweezers and scissors, hand sanitizer, and disposable gloves. You should also have one triangular bandage (which can be used as an arm sling) and a tourniquet.
But a First Aid kit isn’t just for treating wounds; you also need to be prepared for illness. Always pack a thermometer as well as fever reducers and pain killers, including and especially aspirin which can be used to help treat a suspected heart attack (remember, aspirin is only for adults over age 21). Other medications to keep handy are an anti-diarrhea drug, a laxative, as well as an antihistamine. And make sure you have a week’s worth of your prescription medication if you are planning a trip, even if it’s just a day of hiking. And of course: sunscreen! Even when the sky is overcast, UV light from the sun can still give you a nasty sunburn.
While you can buy pre-made First Aid kits with all these items in them just about anywhere, that is no substitute for building your own. Each of us is different, with our own unique medical history and our own risk factors. When building your First Aid kit, think about each of the people who will be using it: you, your children or parents, a spouse or significant other. Think about where you will be taking it and what you will need it for.
Does someone in your group have diabetes? Consider packing glucose tabs to deal with low blood sugar and extra antibiotic ointment to help prevent cuts on fingers and toes from getting infected. Is someone on blood thinners, like warfarin? Make sure to pack fast-acting coagulant agents like WoundSeal or Celox. Tore your ACL or MCL back in college? Pack a simple knee sleeve just in case it starts acting up again. Wear contacts? Make sure you have extra eyewash and your backup glasses. Have children? Make sure you have children’s versions of every medicine in your kit!
Make sure your Emergency Kit addresses the situations in which you’re most likely to find yourself. If you like going on road trips, make sure you keep a gallon of water and enough food for an emergency meal in your car, as well as a blanket for each passenger. Packing a kit to take hiking with you? Put your medications in separate ziploc baggies with copies of the label or your prescription on each one.
Summer is a time to get out there and enjoy the beauty of nature—safely!
For additional reading:

https://www.ready.gov/

https://emergency.cdc.gov/protect.asp

Ryan’s Corner

Written by Ryan French; May 24, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from one of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

Cardiovascular Carnival

I love roller coasters. There’s something exhilarating about the wind whistling through your hair, the anticipation as the cars inch up the slope and hang on the edge of an impossible drop, the death-defying feeling of holding your hands in the air instead of gripping the only safety rail keeping you in place. Your circulatory system is like a roller coaster—your heart pumps your blood off the edge of a huge drop-off, all the way to your toes. But your body doesn’t have pumps and motors down in your feet to push that blood all the way back up to your heart, does it?
Well, your veins may not have motors to pull those blood cells back up, but they have special valves that keep that blood moving back up with each heartbeat. Blood can only flow one way through these valves when they work properly. Unfortunately, they can break down over time, allowing your blood to flow back down between heartbeats, putting even more stress on the fewer still-functioning valves. The veins can also become distended, such that the valves don’t fully close anymore, leaving bulges in your legs where the blood pools. Malfunctioning valves can also lead to blood clotting in the veins, which further restrict circulation and can be very dangerous. In each of these cases, the roller coaster isn’t making it back to the starting point very quickly.
One way to support your circulatory roller coaster is to wear gradient compression stockings. “Gradient” compression simply means that the stockings don’t have the same compression throughout the full length—they have the strongest compression furthest from the heart, lessening as they get closer. Basically, they compress your leg, leaving less space available at the foot and ankle for all the various fluids in your body to hang out, forcing them to keep moving back up. They squeeze those distended veins back together to support the damaged valves and help them function properly. They don’t allow extra space for blood clots to form. They give the roller coaster a boost at the bottom to keep it moving back up.
Gradient compression can also help the lymphatic system, your “second circulatory system.” Lymphedema refers to swelling caused by excess lymph, especially in the extremities. Lymph is a fluid made up mostly of waste products that can build up after cellular damage (like a sprain or surgery), and it primarily circulates as a result of muscle action when you move, even just to shift your weight. The primary driver of lymphatic movement in the lower extremities is the calf muscle, so when you have to sit or stand still for long periods without moving, your lymphatic system doesn’t circulate as well as it usually would. This can make your feet and legs feel tired and achy. But compression stockings that cover your calf muscle can amplify all the little movements that you make when shifting your weight, helping drive that lymph back where it needs to go.
When gradient compression stockings were first introduced, they only came in a tan color often described as “hospital beige.” However, now you can find compression stockings in several different colors and even fun patterns and tie-dyes. Jim’s Pharmacy carries several different types of compression stockings, from every-day socks to medical grade compression garments. Like all medical treatments, there are a few contraindications (reasons not to use compression stockings), like severe arterial insufficiency, uncontrolled heart failure, or skin conditions like red, sensitive or infected skin, hardening of the skin, or untreated leg ulcers. Consult your physician to determine if compression therapy is right for you, especially if you are bedridden or have impaired sensitivity of the limb or develop sensitivity to the garment material.
Thanks for reading, and thanks for making Jim’s Pharmacy your partner in health!

Ryan’s Corner

Written by Ryan French; April 23, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from one of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

Lift Off!

I read a lot of Medicare rules and regulations as part of my job. I think the funniest thing Medicare has ever printed is found in the local coverage document for Seat Lift Mechanisms, the kind of lift motors that are built into Power Recliners (more popularly known as Lift Chairs). The document says: “Excluded from coverage is the type of lift which operates by spring release mechanism with a sudden, catapult-like motion and jolts the beneficiary from a seated to a standing position.” That’s right, Medicare is not going to pay for your own personal catapult!
Unfortunately, Medicare rarely ever pays for any kind of Lift Chair. My least favorite quote also comes from the Lift Chair coverage document, where Medicare notes that, to qualify for coverage, a patient has to be completely incapable of standing up from a regular armchair, but also capable of ambulating (walking, basically)—and it specifically says that “almost all” who are capable of ambulating can stand up from an armchair. So basically, Medicare wants us to know that almost no patient qualifies for coverage of a Lift Chair. Not cool, Medicare!
Luckily, Jim’s Pharmacy knows that even if you don’t “qualify” for a Lift Chair, that doesn’t mean you don’t need one! We want to make it easy to get you the equipment you need to be healthy, independent, and safe at home. We deliver and set up every Lift Chair we sell, at no additional charge, so you aren’t left with a box on your porch. We can help you select the best chair for your needs, and show you how to use it. Our service techs are fully trained on how to maintain and repair each piece of equipment we sell. When you buy a Lift Chair from Jim’s Pharmacy, you don’t just get a product—you get the best service possible!
At Jim’s Pharmacy, we stock Lift Chairs from Golden Technologies, who puts them together in Old Forge, Pennsylvania. Golden Technologies builds their chair frames out of hardwood, not pressed board covered with black felt so you can’t see it. They stand behind their chairs with a lifetime warranty on the frame and a five year warranty on the motors. I know I don’t have any furniture at home with a lifetime warranty!
Lift Chairs used to just come with one motor, built into a scissor mechanism that smoothly moves the chair from reclined, to upright, to lifted up and forward to help with standing up. Today’s Lift Chairs from Golden Technologies can have as many as five motors, each individually contributing to properly positioning a patient for maximum comfort. In addition to the main lift motor that controls recline and lift, one motor controls the foot rest, one controls a lumbar pillow, one a head rest, and one rotates the entire chair back to move your center of gravity from under your hips to behind your back.
There’s only one thing left that you need to know: Between now and June 30th, all Lift Chairs at Jim’s Pharmacy are 20% off, just in time for Mother’s Day and Father’s Day!
Thanks for reading, and thanks for making Jim’s Pharmacy your partner in health!

Ryan’s Corner

Written by Ryan French; March 31, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from one of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

DIY Walker Maintenance

I know I’m dating myself here, but have you ever vacuumed up a telephone cord? I remember as a pre-teen, vacuuming the family room, I rolled over the telephone cord by mistake and it got sucked up into the brush roller. It made a terrible shriek and I could smell the belt burning up. Mom had to flip the vacuum cleaner over to show me how the cord got wrapped up and help me get it out, and that was the first time I saw how much hair gets wrapped up around that roller (especially when your mom has beautiful long hair).
The same thing can happen to your walker wheels (although you’re less likely to roll over a telephone cord these days). Walker wheels roll smoothly because they have very small ball bearings seated in grease between the wheel and axle bolt. When hair gets wrapped up in the wheel and around that bolt, it can wick that grease out of there, which dries up the ball bearings and makes the wheel jerk and stick instead of rolling freely and smoothly, and eventually stopping it completely.
You can test how well your wheels are working by flipping your walker upside down (or just on its side) and giving the wheels a spin. If they won’t spin freely, or they slow down right away or in jerks, or if they rumble excessively, it’s time to do some preventative maintenance on them. You can follow these directions, using simple household tools to remove the wheels, clean them, and put them back on. You’ll need pliers, a proper size wrench from a set, a hex key or Allen wrench set, and possibly some tweezers and a pair of gloves.
And of course, here we have to put a disclaimer that you should only try this if you are capable of operating the required tools and understanding and following these directions. You should also make sure you have a backup walker or are capable of going without it for a few days if something goes wrong or you need to bring it in for repair. Also, these instructions work on most walkers but not all of them. If anything about your walker looks different from what I’m describing here, feel free to bring it in and ask us to show you how to maintain it properly.
Start by using your pliers to pry the plastic cover off of the bolt in the center of each wheel (it’s easy to lose these, so don’t worry if it’s already missing). Insert your hex key into the screw head and use your wrench to hold the bolt on the other side while you unscrew it (lefty loosey!). Once you have the nut off, hold onto the wheel while you slide the bolt out of the center. If the ball bearings fall out of the wheel loose and scatter across the floor—don’t bother trying to put them back in, you need a new wheel! Unwrap any hair from around the bolt, then take a look at the center of the wheel—it may have hair gummed up around the casing that holds the ball bearings. You can probably pull that out with your fingers (hope you’re wearing gloves for this), but you may need tweezers for this part. Then put it all back together just the way you found it. If you have trouble getting the bolt back through the wheel, you can stick a screwdriver through from the other side to help line up everything correctly. Screw the nut back on without over tightening it to the point where the wheel won’t spin freely.
Repeating this cleaning process regularly will keep your walker wheels in great condition and working for a good long time. At some point, though, even the most well-maintained device breaks down and needs to be replaced. That’s why we carry replacement parts for all of the walkers we sell, so you can get your prized possession fixed and back into service as quickly as possible. And when it’s finally time to upgrade to a newer model, we will be glad help you there, too!
Thanks for reading, and thanks for making Jim’s Pharmacy your Partner in Health!

Ryan’s Corner

Written by Ryan French; March 17, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from one of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

A Blood Pressure Primer

Basically, blood pressure is the amount of force that your blood exerts against your artery walls, from highest to lowest, during the cycle of heart activity from beat to beat. But what do those numbers mean? How are they measured? Humanity has many different methods for measuring pressure, whether atmospheric air pressure (millibars), water pressure (pounds per square inch, or PSI), or CPAP/ventilator pressure (centimeters of water column). Blood pressure, like many other types of pressure measurement in medicine, is measured in millimeters of mercury—mmHG (HG being the chemical abbreviation for mercury on the Periodic Table).
Mercury’s peculiar property as the only liquid-at-room-temperature metal make it very useful, especially in temperature and pressure gauges. However, it’s rarely used in medical devices anymore, having been replaced with more expensive but less toxic liquids. The mmHG metric itself has endured, probably because no one wants to measure their blood pressure in pascals (“Looks like 16,000 over 11,000”) or PSI (“It’s about 2.32 over 1.55”). Millimeters of mercury is also the unit used for the pressure exerted by compression garments (which could be anywhere from 8 mmHG up to 50 mmHG) and tourniquets (I’ve seen medical records describing a tourniquet as 300 mmHG).
Now let’s talk about systolic and diastolic, the two numbers you get for blood pressure, with systolic on top and diastolic on bottom. The systole (from Greek sustellein “to contract”) is the pump action phase of the heart, so systolic pressure is usually the maximum blood pressure in your large arteries during a heartbeat. The diastolic (with Greek prefix dia- “apart”) pressure is the minimum blood pressure in your large arteries, during the time your heart is relaxing between beats. If I needed to remember this for a test, I would say your blood pressure “dies down” when your heart isn’t beating—thus “die”-astolic is lower and on the bottom.
When taken by a medical professional, blood pressure measurement uses auscultation (from the Latin auscultare “to listen”, which sounds similar to the Latin word audire “to hear” where we get our word audio)—literally listening to the artery filling with blood. That’s why a nurse taking your blood pressure at the doctor’s office puts you in a quiet room and uses a stethoscope (from the Greek stethos “breast” + skopein “look at”—the stethoscope was originally developed to listen to the heart) in addition to the blood pressure cuff, or sphygmomanometer (from the Greek sphugmus “pulse” + manos “thin” + metre “measurement”—literally “measuring the thinness of your pulse”). You can tell I went to college for language by how excited I am to share all this Latin and Greek etymology!
Most automatic or digital blood pressure monitors use oscillometry (from Latin oscillo “to swing”), using a pressure sensor and electronics to calculate minute changes in pressure inside the cuff itself and convert them to a reading in millimeters of mercury. For these monitors to work, you need to put the cuff on correctly, following the instructions so that the sensor is directly over your artery.
There are a few other caveats to using an automatic blood pressure monitor correctly. Your blood pressure is always changing, from one heart beat to the next, as well as throughout the day with your circadian rhythm. To get a meaningful series of readings, you should test at the same time every day, after sitting quietly and calmly for about 10 to 15 minutes. The sensor in the cuff should always be at the same level as your heart, so that means holding up your wrist if using a wrist monitor. Make sure not to compress any part of your body—don’t cross your feet or sit on your leg. The cuff should be put on snug but not tight—but it needs to pump up tight enough to actually cut off your circulation through the artery. Some monitors require you to pump up the cuff yourself, while others do it for you. Then the monitor slowly releases that pressure on your arm, picking up the telltale signs of your blood flowing through the artery with each heartbeat (the systolic pressure) and when your blood flows through the artery between heartbeats (the diastolic pressure).
Now that you know everything about blood pressure (or at least enough to pass a pop quiz), you just need to know one more thing: Jim’s Pharmacy carries blood pressure monitors (manual and automatic) and stethoscopes, as well as supplies for them, so you can stock up today!
Thanks for reading, and thanks for making Jim’s Pharmacy your Partner in Health!

 

For further reading:

https://www.cdc.gov/bloodpressure/about.htm

https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings

https://en.wikipedia.org/wiki/Blood_pressure_measurement

Definitions and etymologies from Oxford Languages and Oxford English Dictionary

Ryan’s Corner

Written by Ryan French; March 2, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from one of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

Swiss Cheese vs Coronavirus

Mitch Hedberg once said, “Swiss cheese is a rip-off…it’s the only cheese I can bite into and miss.” Everybody knows that one thing about Swiss cheese: it has holes in it. When you look at a slice of Swiss cheese, you can see right through it. But is the same true when you look at a whole block? No, because the “holes” (which cheese aficionados call “eyes”) are really just bubbles of carbon dioxide trapped inside the cheese during the cheese-making process. They only turn into holes when you slice the cheese thin enough.
So what does all that have to do with Coronavirus? Well, a lot of the precautions we as a society are using to protect us from SARS-CoV-2 (the coronavirus that causes COVID-19 disease) are admittedly full of holes when you look at them individually. Masks, social distancing, even the vaccines we’ve developed—none of these is a fool-proof solution to stop the pandemic. But enough of them stacked on top of each other are like slices of Swiss cheese—stack them high enough, and the holes stop overlapping and you can’t see through them anymore. I first saw this theory in a New York Times article citing virologist Ian Mackay and psychologist James T. Reason.
Masks literally have holes in them (albeit nearly microscopic holes), which leads to the two main arguments used to disparage mask mandates, even though they actually contradict each other: masks don’t block viruses, and masks do block carbon dioxide and oxygen. Carbon dioxide and oxygen are very simple molecules (two oxygen atoms with and without a carbon atom, respectively), while a virus is composed of several different types of very complex molecules (proteins and lipids and DNA, oh my!). As a result, one SARS-CoV-2 virus is about 1,000 times bigger than a molecule of carbon dioxide. Even so, a three-layer cloth mask or a paper surgical mask isn’t built to block molecules or even viruses; they block the nasal droplets that we all expel whenever we cough, sneeze, laugh, or even just talk. Our best research tells us that SARS-CoV-2 spreads by hitching a ride on these nasal droplets, not floating around by itself. And the right kind of mask is very good at catching nasal droplets, which are usually about 50 (or more) times the size of an individual virus. You have probably experienced this if you wear a mask for 8 hours at a time, like I do on a typical workday—it can start to feel slightly damp from the water vapor in all those nasal droplets it stopped (ugh, gross). And the really tiny nasal droplets that the mask doesn’t stop tend to at least slow down as they bounce around in the weave of the mask, so that they fall to the ground within six feet of you.

That’s where social distancing comes in. Standing six feet apart, without any other precautions, isn’t a great protection against an airborne virus like SARS-CoV-2. Researchers in South Korea identified a particular case where a COVID-19 positive patient infected someone over 20 feet away at a restaurant, in only five minutes of exposure time. The restaurant’s ceiling-mounted air conditioning system allowed the virus to travel much farther than it usually would, but consider that a sneeze can propel nasal droplets up to 25 feet or more, so that kind of a distance isn’t too unusual. This approach to controlling a pandemic is also full of holes—by itself, social distancing only does so much.
The next piece of cheese protecting us (what a fun sentence to write!) is the development of vaccines against COVID-19. So far, two mRNA vaccines are available in the US to protect against COVID-19. Both vaccines contain messenger RNA, which is like half of a DNA strand that tells your body’s cells to build a harmless protein found in SARS-CoV-2. The mRNA is then destroyed by your cell, while your immune system finds that unfamiliar protein and plans out how to kill it. Your immune system then keeps that plan around (in the form of T-cells) in case it encounters that protein again—like on a real coronavirus. A successful round of vaccination confers around 94% resistance to COVID-19, so it’s not perfect, and scientists don’t have a definitive answer for how long those T-cells will continue to protect you. So again, there are a few holes here.
Each line of defense, by itself, has holes. A mask doesn’t stop every single SARS-CoV-2 virus from getting out. Standing six feet away isn’t enough to keep you out of danger. A vaccine isn’t foolproof and might not last forever. But then add in hand washing, not touching your face, staying home when you’re sick, limiting your time indoors, and only socializing with a small group. Each layer lowers your chance of catching COVID-19 a little bit, and enough of them stacked on top of each other can, hopefully, prevent it altogether. And now, for some reason, I’m hungry for a ham and Swiss sandwich!
Thanks for reading, and thanks for making Jim’s Pharmacy your Partner in Health!
For further reading:
https://www.nytimes.com/2020/12/05/health/coronavirus-swiss-cheese-infection-mackay.html
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html
https://www.latimes.com/world-nation/story/2020-12-09/five-minutes-from-20-feet-away-south-korean-study-shows-perils-of-indoor-dining-for-covid-19

Ryan’s Corner

Written by Ryan French; February 9, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from one of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

February is American Heart Health Month

I love Superman. Comic books, movies, cartoons… the first Christmas present I remember getting from my brother was a Super-Friends Superman action figure (I got him Batman). The story of Superman has reached the status of an American myth since his introduction just over 80 years ago. Everyone knows that the last survivor of the doomed planet Krypton was sent here to be raised by a childless couple in Kansas on a farm, then grew up to be a journalist at the Daily Planet where his glasses and a quick change of clothes in a phone booth conceal his true identity as Superman!
One of the most poignant scenes in the original 1978 Superman motion picture sees Superman’s adopted father, Jonathan Kent, suffer a heart attack and die. Superman, with all his superpowers, can’t do anything to stop it. Heart disease has consistently been the leading cause of death in the US for years (although some recent statistics indicate COVID-19 could temporarily supplant it for that title). As recently as 2018, it killed 655,381 people in the U.S. Jonathan Kent’s story is one familiar to hundreds of thousands of families.
But there are ways that you can prevent heart disease, even if you don’t have superpowers. Most heart disease can probably be prevented, by managing and reducing risk factors. Some of the biggest risk factors are ones that Jim’s Pharmacy can help you with: smoking, high cholesterol, and high blood pressure.
Smoking cigarettes is well known to cause lung disease, but it negatively affects your heart health as well. The Centers for Disease Control notes that smoking harms every organ and system in the body, and quitting is the most important thing you can do for your health. Talk to your primary care provider about developing a personalized plan to help you quit, and come to Jim’s Pharmacy to talk to one of our pharmacists about putting it into action. We carry nicotine gum and patches to replace cigarettes, as well as prescription Chantix. Chantix (according to their website) is believed to work by blocking nicotine from bonding to receptors in your brain, making smoking a bland activity and helping you break the addiction. Once you break the habit of smoking, weaning yourself off the other nicotine products or Chantix is supposed to be easier.
High cholesterol (especially LDL, the “bad” cholesterol) can be caused by excess weight or obesity, but you can reduce your cholesterol even if you have trouble controlling your weight (like me!). Talk to your doctor about adding heart-friendly supplements like Omega-3 fatty acids and Co-enzyme Q10 to your daily regimen. Jim’s Pharmacy carries all of these individually, as well as one Mason Vitamin’s supplement that combines CoQ10, Vitamin E, and Fish Oil, all in one softgel.
High blood pressure, or hypertension, makes your heart work harder with each beat. Risk factors that lead to high blood pressure include smoking and alcohol use, excess body weight, and excess salt in the diet. Like many other health conditions, the first step in managing high blood pressure is monitoring it. Jim’s Pharmacy carries Omron brand automatic blood pressure monitors, one of the top physician recommended brands, in broth wrist and upper arm measurement. While measuring closer to the heart is considered more accurate, wrist monitors can be more convenient and easier to use on a regular basis. We also carry a variety of stethoscopes and blood pressure cuffs (sphygmomanometers, for you auscultation buffs), and during the month of February they are all 25% off!
February is American Heart Month – time to give your heart some super-strength. Thanks for reading, and thanks for making Jim’s Pharmacy your Partner in Health!
For further reading, check out these websites:
https://en.wikipedia.org/wiki/Cardiovascular_disease
https://www.cdc.gov/heartdisease/
https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-month

Ryan’s Corner

Written by Ryan French; January 19, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from one of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

“How do I get a Covid Vaccine?”

This is probably the number one question I’m hearing lately. Maybe you heard that Olympic Medical Center got their first shipment of vaccines in December, or you saw a Facebook picture of a Jim’s Pharmacy employee getting the vaccine. Most of us want to get the vaccine as soon as we possibly can, and we’ve all been following the news stories, hearing buzzwords like subzero temperatures, mRNA, or phased rollout. What does it all mean?
As you may know, the FDA has approved (for emergency use) two different COVID-19 vaccines, one from Pfizer-BioNTech and one from Moderna. Both vaccinations require two doses, given 21 and 28 days apart, respectively. Both vaccinations have been found to be at least 94% effective at preventing COVID-19 infection starting as soon as 7 days after the second dose. No major adverse events or serious safety concerns have been found during clinical trials on thousands of people. People have asked “Which vaccine should I get?” and I think the answer is “Whichever is closer to your arm!”
But when will that happen? Washington State has a plan to roll out COVID-19 vaccination in phases, so that the people at highest risk of serious complications and death from COVID-19 are first in line. You can see the descriptions of each phase and the projected timeline here. Right now, here in Clallam County, we are still in Phase 1, Tier B1 as I write this. Clallam County is rolling out the vaccine to people in Tier B1 using scheduled appointments at outdoor public vaccination clinics, and they are quickly filling up, as you can read about here.
Pharmacists at Jim’s Pharmacy volunteered their time to be part of the Phase 1 Tier A vaccine rollout, and so far they have administered the Pfizer-BioNTech vaccine to residents and staff at one of the local Long Term Care facilities. You may have seen a few of our employees posting pictures of themselves getting the vaccine as well on social media—this is because we had some extra doses left over, and we decided to use them before they could expire. As an essential pharmacy and home medical equipment supplier, our staff qualify under the Phase 1 Tier A requirements.
I received the Pfizer-BioNTech vaccine myself! The only side effect I noticed was soreness in my arm at the injection site for a day or two after each shot. I experienced the same side effect with the pneumonia vaccine I got late last year, and the tetanus shot I’ve received every 10 years since I can remember. I was lucky—many of my coworkers reported headaches or general feelings of illness for a few days after the shot, especially the second one. These side effects are caused by your immune system kicking into gear when it detects the vaccine in your system, as it’s training hard to fight the real thing.
So am I immune now? Well, not exactly. Even after the second dose, I’m not 100% guaranteed immune to the COVID-19 disease, and if I’m exposed to the virus that causes it, SARS-CoV-2, there’s a chance I could still spread it to others. With that in mind, I still plan on wearing a mask whenever I’m indoors or around other people and maintaining a social distance of 6 feet away from anyone I don’t live with. Those precautions will probably stay in effect for several more months, at least until we see the statewide infection rate drop a lot lower than it is now.
Jim’s Pharmacy is working with the local Department of Health and the State of Washington to get set up as a vaccine distributor as soon as we move into the later phases. We have ordered the equipment necessary to store, prepare, and administer the vaccines to our patients. As soon as we can start scheduling vaccination clinics, we’ll put that information up here on our website as well as on Facebook, Instagram, and in our email newsletter. You can also check the Washington State Coronaviris Information website, and local news sources. Stay tuned!
Thanks for reading, and thanks for making Jim’s Pharmacy your Partner in Health!

Ryan’s Corner

Written by Ryan French; January 12, 2021
As the Home Health Director, Ryan French has managed the Home Medical Equipment Segment of Jim’s Pharmacy since January, 2014. Ryan graduated from Central Washington University with a Bachelor of Arts degree in English Language & Literature in 2003 before spending 10 years working in the hospitality industry here in Port Angeles. In 2016, Ryan received a nationwide award from of the primary business management software companies in the Home Medical Equipment industry, and he has been interviewed and quoted several times in the industry publication HMENews. Ryan focuses on staying up to date on Medicare and other insurance company policies as well as health industry trends, and shares that with you here at Ryan’s Corner.

In these unprecedented times…

With everything going on in the world…
Now especially…
Over the last 10 months, we’ve all read articles that start with these lines, or seen them used in commercials. Advertisers use them to forge a link to the reader, to show that they aren’t running the usual set of commercials like these are usual times. These words create a connection, remind you that we’re all jointly experiencing these events, and humanize the message by not directly using words like “pandemic” or “lockdown.” That’s why corporations use them in their advertising.
I’ve been thinking about those words and phrases a lot lately. I’ve seen them in ads and I’ve seen them lampooned by comedians. I’ve started this blog by pointing out that advertisers are using them, sometimes cynically, to create a personal connection inside a mass market advertisement without frightening words turning people away. I could start off this first post of our new blog with them: Now especially, in these unprecedented times, with everything going on in the world…
But I don’t need buzzwords because we’re not here to forge fake connections. At Jim’s Pharmacy, we are your friends and neighbors. We are living through the same pandemic, laboring under the same restrictions, wearing some of the same masks. We’ve talked about starting up a blog like this for a long time, so we can communicate directly with our patients and customers about health issues, upcoming events, sales, and other news. Now seems like the right time, because there’s a lot of information we want to share.
First on that list is that we now offer 15-minute COVID-19 testing. This is the CareStart COVID-19 Rapid Diagnostic Test for the Detection of SARS-CoV-2 Antigen (that’s what it says on the package insert). We are offering this test for $99.00 (not covered by insurance) from 10am to 5pm on weekdays. Let’s go step-by-step through the process:
  1. Please do not actually come into the store, especially if you have any symptoms or have been exposed to someone with a confirmed positive test! Get in the Drive-Through lane 2 (the far west lane) and ask for the Covid Test when you get up to the speaker. Pharmacy staff will give you some paperwork to fill out. Head to a parking spot or some other place where you can fill it out.
  2. Once everything is filled out, get back in line at the Drive-Through to turn it in, along with your $99 payment.
  3. You will pull around back into the parking lot and park in one of the designated Covid Test parking spots with the yellow signs.
  4. One of our specially-trained pharmacists or nurses will come out to your car and administer the nasal swab test to the back of your nasal cavity (they won’t actually tickle your brain) and bring the sample into the store to be tested.
  5. You will remain in your car, listening to the radio or reading a book or whatever you need to do to make fifteen minutes go by.
  6. The pharmacist will bring your printed test result to your car and thank you for choosing Jim’s Pharmacy!
As with any medical procedure, this test comes with some small-print. A negative result does not rule out current or future infection with COVID-19 and should not be the sole basis for treatment or infection control decisions. Likewise, a positive result does not rule out co-infection with bacteria or other viruses, nor confirm that SARS-CoV-2 (the virus that causes the COVID-19 disease) is the definite cause of disease symptoms. False-positive results are possible if the sample contains excess blood or mucus. We are required to report positive test results to the Department of Health. This is the rapid antigen test, not the PCR test or an antibody test. You can find more information at the FDA website here and the actual product insert for the test here.
With all that said, this Covid Test is a great way to see if that cold you’ve had for a few days is something to really worry about before you schedule a doctor appointment. We’re working on adding more tests to our lineup as well, from strep to flu, and you can check this blog every week or two to find out where we’re at in that process. And as soon as we have information on Covid Vaccines, we’ll post it here. You can also follow us on Facebook and Instagram to get even more up-to-date information.
Thanks for reading, and thanks for making Jim’s Pharmacy your Partner in Health!

Store Hours: Mon-Fri 8:30am - 7:00pm • Saturday 9:00am - 5:00pm • Sunday 12:00pm - 4:00pm

Jim’s Pharmacy

424 East Second Street
Port Angeles, WA 98362

(360) 452-4200

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