Now Offering Strep Testing, with results in 5 minutes!
Why is it important to test for Strep?
Rapid diagnosis and early antibiotic therapy for Group A Streptococcal infection are the best means of preventing medical complications and reducing the spread of the disease.
Group A Strep is a bacterial infection common in school-age children (with limited cases in infants and older adults) that is generally experienced in the United States during winter and spring.
Streptococcus pyogenes is a gram-positive coccus, which contains the Lancefield group A antigen that can cause serious infections such as pharyngitis, respiratory infection, impetigo, endocarditis, meningitis, puerperal sepsis, and arthritis. Left untreated these infections can lead to serious complications, including rheumatic fever and peritonsillar abscess. Traditional identification procedures for group A streptococcal infection involve the isolation and identification of viable organisms using techniques that require 24 to 48 hours or longer.
Rapid diagnosis and early antibiotic therapy of group A streptococcal infection appear to be the best means of preventing medical complications and reducing the spread of the disease.
What type of testing is offered by Rancho Pharmacy?
Group A Streptococcus rapid antigen testing is a digital immunoassay that quickly efficiently and reliably detects the presence of Group A Strep antigen from throat swabs of patients suspected of having Group A Strep. It is a qualitative test that detects the presence of Strep A antigen in throat swab specimens from symptomatic patients, providing results within 5 minutes.
The test is a simple throat swab sample collection with fast, reliable results in as few as 5 minutes.
The test utilizes antibodies specific for whole cell Lancefield group A Streptococcus to selectively detect Strep A antigen.
What is the sensitivity of the test?
Sensitivity measures the ability of the test to appropriately make a positive identification. The test has a high sensitivity rate of 95.4%, resulting in fewer false negatives.
What is the specificity rate?
Specificity measures the ability of the test to properly identify the absence of the test target. The test has a high specificity rate of 95.7%, resulting in fewer false positives.
What happens if I receive a positive test?
If you receive a positive test you should immediately contact your doctor. If you would like our pharmacy to contact your doctor please let the pharmacist know so that we may coordinate with your provider. Your doctor will decide on how to proceed further and may choose to prescribe an antibiotic. If your doctor prescribes an antibiotic our pharmacy is happy to assist with filling your prescription.
What is the cost of the test?
The test costs $30. At this time, we are unable to accept insurance however we are more than happy to provide you with receipt so you may attempt to seek reimbursement from your insurance.
Now offering 10 minute FLU A + B Testing!
Now offering 10 minute FLU A + B Testing!
Influenza illness classically presents with sudden onset of fever, chills, headache, myalgias, and a non-productive cough. Epidemics of influenza typically occur during winter months with estimated 114,000 hospitalizations and 36,000 deaths per year in the U.S.
Influenza viruses can also cause pandemics, during which rates of illness and death from influenza-related complications can increase dramatically. Patients who present with suspected influenza may benefit from treatment with an antiviral agent especially if given within the first 48 hours of onset of illness. It is important to rapidly distinguish influenza A from influenza B in order to allow physicians a choice in selective antiviral intervention. Moreover, it is important to determine if influenza A or B is causing symptomatic disease in a particular institution (e.g., nursing home) or community, so that appropriate preventative intervention can be taken for susceptible individuals. It is therefore important to not only rapidly determine whether influenza is present, but also which type of influenza virus is present as severity and treatment can be different.
What type of testing is offered by Rancho Pharmacy?
Rancho Pharmacy uses a 10 minute testing kit developed by BD. The system is called BD Veritor System for Rapid Detection of Flu A+B. The test is FDA-Cleared Rapid Influenza Diagnostic Test (Antigen Detection Only).
The BD Veritor System for Rapid Detection of Flu A+B (also referred to as the BD Veritor System and BD Veritor System Flu A+B) is a digital immunoassay (DIA) to qualitatively detect influenza A or B nucleoprotein antigens from respiratory specimens of symptomatic patients with a time to result of 10 minutes. The test is qualitative and not quantitative, meaning it can only indicate if influenza A or B is present in the sample collected, but not how much influenza is present.
What may cause a false positive?
Per the manufacturer FluMist® is made from attenuated live flu virus and although the concentration tested (1%) was non-interfering, it is possible when tested with higher concentrations that an influenza A and/or influenza B false positive may occur.
What happens if I receive a positive test?
Regardless if you receive a positive or negative test it is highly recommended to call your physician to receive an evaluation. The pharmacy will provide you with your results and if asked by the patient or legal guardian may offer to call the physician if a medication may be warranted. Tamiflu is a medication that is indicated for influenza for the treatment of acute, uncomplicated illness due to influenza A and B infection in patients 2 weeks of age or older who have been symptomatic for no more than 48 hours. Tamiflu is indicated for prophylaxis of influenza A and B in patients 1 year and older.
Vitamin B12
Vitamin B12 and the Immune System
Published studies demonstrate that low vitamin B12 levels are linked to a decrease in the immune system. Vitamin B12 plays an important role in white blood cell production, acting as an immunomodulator. A study found that patients deficient in vitamin B12 had a decrease in the absolute number of CD8+ cells and suppressed NK cell activity (both are white blood cells). When patients were treated with B12 (the methylated form), augmentation of CD8+ cells was observed. The authors of the study concluded that vitamin B12 may acts as immunomodulator for cellular immunity, hence it is beneficial to our immune system.
What are B vitamins and what is vitamin B12?
Vitamin B is a water soluble vitamin. There are 8 types of vitamin B and each type has a different role. B vitamins may help with blood cell production, cognitive development, and increased energy.
Vitamin B12 helps keep the body’s nerve and blood cells healthy, and supports DNA production. It is a coenzyme involved in the metabolism of cells and plays a role in DNA synthesis and regulation, as well as fatty acid and amino acid metabolism.
Vitamin B12 may help prevent a type of anemia known as megaloblastic anemia. People with megaloblastic anemia may feel tired and weak. In pregnancy vitamin B12 promotes blood formation and may prevent birth defects. Vitamin B12 may lower homocysteine levels, which is thought to help prevent dementia and heart disease.
How does the body absorb vitamin B12?
There are two steps that are required for the body to absorb vitamin B12 from food. The first step involves hydrochloric acid, found in the stomach, which separates vitamin B12 from protein. The second step involves intrinsic factor, a protein made in the stomach, combining with vitamin B12. Once intrinsic factor combines with vitamin B12 the body can then absorb it. Some people have pernicious anemia, a condition in which they cannot make intrinsic factor. As a result, they have trouble absorbing vitamin B12 from all foods and dietary supplements. With this condition to bypass the gut, vitamin B12 injections are preferred.
What are symptoms or signs of low vitamin B12 levels?
Symptoms include premature graying hair, tingling and numbness in hands and feet, pernicious anemia, fatigue, constipation, weight loss. Deficiency tends to be rare, even in vegetarians, while children and babies are more at risk.
What are good dietary sources of vitamin B12?
Good sources include fish, dairy, meat, tempeh and miso.
What is the best form of vitamin B12?
The best form of Vitamin B12 is sublingual tablets (dissolved under the tongue), oral liquid, or B12 injections.
Vitamin B12 shots are preferred over tablets in the following situations:
1. You have low B12 levels (<200 ng/mL) and are experiencing symptoms (mental slowness, weakness and tingling in your extremities)
2. You have a GI disorder that might affect the absorption of Vitamin B12 (such as celiac disease, IBD, SIBO, bariatric surgery, etc.)
3. You are taking a medication that limits your absorption such as a proton pump inhibitors (PPI’s) or metformin therapy
4. You have the autoimmune disorder called pernicious anemia, which attacks vitamin B12 absorption by not making enough intrinsic factor. As mentioned before intrinsic factor is needed for vitamin B12 absorption
Which populations are at a greater risk for deficiencies?
People higher risk for deficiencies include the following:
1. Vegetarians and vegans (do not eat meat)
2. People aged 60 or over (more prone to chronic gastritis caused by H. Pylori)
3. People who regular use proton pump inhibitor’s (PPI’s) to help prevent stomach acid and people on diabetes drugs like metformin
4. People with Crohn’s disease, ulcerative colitis celiac or IBS
5. Women with a history of infertility and miscarriage
Are there any medications that may put someone at risk for vitamin B12 deficiencies?
There are certain medications that may increase the risk of vitamin B12 deficiency. These medications include stomach acid reducing medications, such as H2 blockers (examples include Zantac, Pepcid) and proton pump inhibitors (examples include Prilosec and Nexium). In addition, the following medications may reduce vitamin B12 absorption: colchicine commonly used for gout, metformin commonly used for diabetes, and AZT commonly used for AIDS. In addition, birth control may cause vitamin B12 deficiency (including also a deficiency in vitamin B2, magnesium, selenium and zinc).
What are the different types of vitamin B12? Which one is the best form to supplement with?
Vitamin B12 is cobalamin as it is the only vitamin that contains small amounts of cobalt. Cobalamin cannot be obtained from plants (as plants do not need vitamin B12) or sunlight and is produced in the gut of animals.
The different forms of cobalamin include: methylcobalamin, adenosylcobalamin, hydroxocobalamin and cyanocobalamin.
Methylcobalamin is the natural form that exists in the body and is readily absorbed. This is an active form of vitamin B12 and works with several enzymes to synthesize amino acids, produce red blood cells, repair DNA and assist with other important physiologic processes. There are claims that this form of vitamin B12 helps maintain normal circadian rhythms to assist with sleep and supports the body with methylation processes. It also assists with recycling homocysteine, which is linked to cardiovascular disease.
Adenosylcobalamin is another natural and active form of vitamin B12. It is required for cell energy and metabolism. The body is able to interconvert between adenosylcobalamin and methylcobalamin.
Hydroxycobalamin is a synthetic type of vitamin B12. This form is either engineered in the laboratory from bacteria or it is produced by bacteria in the digestive tract from food. It is a precursor to the active forms of vitamin B12. This means the body converts this form to the active forms: adenosylcobalamin and methylcobalamin. It is a precursor to the active forms of vitamin B12.
Cyanocobalamin is a man-made form that contains a cyanide molecule. Cyanide provides this form of vitamin B12 stability. Although cyanide is commonly associated with poison the amount is inconsequential to cause harm. The FDA has approved its use and it has been demonstrated not to cause toxicity. The body easily converts cyanocobalamin to the active forms. The body does this by the liver detoxing the cyanide molecule and modifying the vitamin to methylcobalamin by attaching a methyl group.
References:
1. Tamura J, Kubota K, Murakami H, Sawamura M, Matsushima T, Tamura T, et al. Immunomodulation by vitamin B12: augmentation of CD8+ T lymphocytes and natural killer (NK) cell activity in vitamin B12-deficient patients by methyl-B12 treatment. Clin Exp Immunol. 1999;116(1):28–32.
2. Mikkelsen K., Apostolopoulos V. (2019) Vitamin B12, Folic Acid, and the Immune System. In: Mahmoudi M., Rezaei N. (eds) Nutrition and Immunity. Springer, Cham
Elderberry (Sambucus Nigra)
Sambucus nigra, Elderberry
Elderberry, also known as Sambucus nigra, is great for colds and may help invoke sweating and diuresis. It helps induce sweat and relieves joint and muscle pain during fevers. There are small studies to support antiviral properties, immune modulation and antioxidant properties.
Studies involving patients with influenza have shown a reduction in symptoms when taking Elderberry. The studies reported Elderberry shortens the duration of flu symptoms such as fever, fatigue, headache, sore throat, cough and body aches. These studies concluded that further larger studies are needed to confirm the results.
In addition, in vitro studies (not humans) have proven Elderberry to be effective against numerous strains of influenza. It is thought that the constituents help neutralize the activity of the hemagglutin. Hemagglutin is found on the surface of the virus and by neutralizing the activity of hemagglutin the virus becomes inactive and is unable to infect cells.
Elderberry can be used during active flu (optimally combined with Oregano Oil or Echinacea Goldenseal), or used as a preventative to avoid getting sick during the flu season.
Elderberry has a high concentration of anthocyanins. These are purple pigments (also what gives Elderberry its color) serve as antioxidants and enhance immune function (by immune modulation) stimulating the innate immune system and boosting the production of cytokines. Cytokines are proteins that regulate the immune response. Elderberry is also rich in flavonoids, quercetin (thought to be a natural antihistamine) and vitamin A and C. It can be taken daily to help strengthen a person’s immune system. Stronger immune systems have a better chance of fighting infections.
Elderberry may also offer cardiovascular protection. This is thought to be due to its oxidative properties and reducing the oxidation of LDL cholesterol. LDL is bad cholesterol and is a risk factor for cardiovascular disease. By helping to reduce LDL it may benefit people with high cholesterol. In addition, it has the ability to potentially improve endothelial cells to help with vascular function. Studies have been very small and larger studies are needed to warrant the effect on LDL and the cardiovascular system.
At Rancho Pharmacy we carry Elderberry, both for adults and kids! Stop by today to get your bottle of Elderberry!
References:
1. V. Barak, T. Halperin, I. Kalickman. The effect of Sambucol, a black elderberry-based natural product, on the production of human cytokines: I. Inflammatory cytokines. European Cytokine Network. 2001;12(2):290-6 https://www.ncbi.nlm.nih.gov/pubmed/11399518Accessed on March 23, 2020
2. http://www.altmedrev.com/archive/publications/10/1/51.pdf. Accessed on March 23, 2020
3. Zakay-Rones Z, Varsano N, Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 1995;1(4):361–369. doi:10 Access on March 23, 2020
Vitamin D
Vitamin D AND the Immune System
COVID-19 is increasingly on people’s minds and many are focusing on how to keep their immune systems strong. There is a link between vitamin D and strong immune systems. Vitamin D can regulate the innate and adaptive immune responses. When vitamin D is deficient there is a link to autoimmune disease and an increased susceptibility to infection. Cod liver oil, which has a high content of vitamin D, is often used in tuberculosis treatment. A report that included almost 19,000 patients from the years of 1988 to 1994, showed patients reporting low levels of vitamin D (<30 ng/ml) also self-reported recent upper respiratory infections. Although recent studies have not shown consistent results, most likely due to methodological concerns, there is one well-designed study in school aged children that demonstrated that vitamin D administration decreased the flu (influenza) by 42%.
What is vitamin D and what role does it play?
Vitamin D is a fat soluble vitamin that helps support healthy bones through calcium absorption, promoting bone mineralization, and providing immune and cardiovascular support. It also plays a role in muscle function and the brain function and emotional health.
Which vitamin D supplement is best? How much vitamin D?
There are two major types of vitamin D, vitamin D3 and vitamin D2. Humans produce vitamin D3, also known as cholecalciferol, in their skin when exposed to sunlight. The only other source of vitamin D3 is found in animals. Vitamin D2 is sourced from plant foods and is known as ergocalciferol.
Calcidol, also known as 25-hydroxyvitamin D3, is a pre-hormone made directly from cholecalciferol (vitamin D3). This occurs in the liver by the enzyme 25-hydroxylase CYP27A1. This pre-hormone is not active; however, it is the major form of vitamin D that circulates in the bloodstream. Vitamin D blood tests typically measure the concentration of this pre-hormone. The activated form is known as calcitriol (1,25-dihydroxyvitamin D3). The enzyme 1-alpha-hydroxlation CYP27B1, converts the pre-hormone (calcidiol) in the kidneys to the active form, calcitriol. This is the most potent steroid hormone in the body. (Yes Vitamin D is a hormone, and technically calling it a vitamin is a misnomer).
Most studies show that vitamin D3 (cholecalciferol) is more effective than vitamin D2 (ergocalciferol) at raising blood levels of calcifedol. The recommended daily dose is 2,000 IU of vitamin D3 per day. Always check with your provider before supplementing.
What about when we age, what happens to our vitamin D?
Studies have found as people age; they lose the amount of vitamin D they are able to produce from the sun. This may be a result of the loss of enzymes needed to synthesize the vitamin. Research has found that low levels of vitamin D may be linked to poor cognitive performances in seniors. In addition, if a person receives an adequate amount of vitamin D it may significantly lower levels of inflammation and physiologic stress, factors that may slow down aging.
What do my lab levels mean and what is normal?
Typically blood tests measure the levels of the inactive pre-hormone, Calcidol (25-hydroxyvitamin D3). Although this hormone is not active it is the most reliable measurement of an individual’s vitamin D level. Lab level numbers will vary from lab to lab and providers may differ in what they believe is normal or low. However, most experts recommend having a level between 20 ng/ml to 40 ng/ml, and many will also push for levels between 30 ng/ml to 40 ng/ml. In general levels below 10 ng/ml are considered deficient. If you have your lab levels drawn for vitamin D you will want to work closely with your provider to determine if your levels are low.
References:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406/. Accessed on March 20, 2020
- Urashima M, et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010; 91(5):1255–60. [PubMed: 20219962] Accessed on March 20, 2020
Oil of Oregano
Oil of oregano is a plant that belongs to the mint family. Two major extracts contained in oil of oregano are carvacrol and thymol. Carvacrol is a phenol antioxidant and thymol is a plant (also thought to be an antioxidant) that may have properties to help against toxins and fungal infections. Antioxidants help reduce oxidation and free radicals that can cause damage to cells.
The correlation of SIBO and Oil of Oregano
A small study involved a group of patients with a condition called small intestinal bacterial overgrowth (SIBO) were offered an herbal product or antibiotics. Oil of oregano was one of the several herbals involved in the study. The researchers concluded that the herbals utilized were as effective as antibiotics. However, these results were only positive for a handful of patients (17 patients within the study) and therefore much larger studies are needed before concluding that oil of oregano is effective for SIBO.
Benefits of Oil of Oregano
Oil of oregano is thought to help ease gastrointestinal illnesses, as well as respiratory illnesses. Benefits for bacterial infections have been demonstrated in mouse studies, however they have not been replicated in humans. One published study in mice concluded that oil of oregano was beneficial in prevention or treatment of staphylococcus aureus. Another study in mice demonstrated that oil of oregano was effective in destroying bacteria in dysentery (inflammation of the intestines accompanied by bloody diarrhea). Again, these studies were not done in humans and more studies are needed.
Oil of Oregano should be avoided among the following:
- People with allergic reaction to plants in the Lamiacea family. This includes basil, mint, rosemary, sage, savory, marjoram, oregano, hyssop, thyme, perilla
- Avoid in pregnancy as there is concern of miscarriage
- Bleeding disorders as it may increase the risk of bleeding. Discontinue use two weeks before scheduled surgery due to concerns over bleeding risk
- Caution with diabetes as blood sugar levels may be increased
Mild side effects may include stomach upset and irritation of the intestinal tract.
Medications may interact with Oil of Oregano including: Antidiabetic drugs (may decrease blood sugar), other herbs that may lower blood sugar (alpha lipoic acid, chromium, psyllium), anticoagulants (avoid with garlic, ginger and gingko).
When taken with copper, iron, or zinc it may decrease it’s absorption.
If you are interested in learning more about Oil of Oregano stop by and talk to our pharmacist. Always talk to your pharmacist and provider prior to supplementing.
References:
- https://www.ncbi.nlm.nih.gov/pubmed/15587409. Accessed on March 24, 2020
- https://doi.org/10.1080/15376520590968833. Accessed on March 24, 2020
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/. Accessed on March 24, 2020