Forever Young – Your Guide to Skin Care


From a fresh haircut, to the perfect lipstick shade, to blemish free skin, everybody wants to look their best. Men and women alike are always making efforts to make their looks as aesthetically pleasing as possible, and they will often go to great (and sometimes expensive) lengths to do so.  So before we break the bank on needless products that may or may not work, let’s delve into some of the best practices and products that will help us put our best faces forward.

First and foremost it’s important to concentrate on the basics of skin care.  For instance, limiting extensive UV ray exposure from the sun can help the skin to age better, decreasing wrinkles and dark spots.  Smoking cessation or abstinence allows the skin to maintain its vibrancy and elasticity.  Additionally a healthy well balanced diet helps to maintain overall health and beauty of the skin.

As a pharmacist who specializes in nutritional supplementation, I often get requests inquiring which vitamins and supplements can be used to treat ongoing skin conditions, as well as which can serve to beautify appearances. Generally, the main things I recommend are probiotics, omega-3, 6, and 9 fatty acids, and Vitamin D3.  Probiotics are beneficial in that they help to increase the ratio of good bacteria to bad bacteria in the gut.  How does balancing the body’s bacterial flora help the skin? Often, when bad bacteria outnumbers the good, it manifests in skin inflammation such as acne, rosacea, psoriasis, and eczema.  Therefore taking the good bacteria in the probiotics can help to limit these conditions.  Likewise the omega fatty acids play a significant role in reducing skin inflammation.  Additionally they function to increase and support the functional integrity of the skin, and can even sometimes reduce UV-ray caused damage to the skin, and signs of skin aging.  Vitamin D3, like probiotics and omegas, plays a role in reducing inflammatory conditions of the skin such as psoriasis and acne, and also has been shown to have some benefit in hair growth.

An additional supplement often taken to improve aesthetic appearance is biotin. Biotin is a form of vitamin B, and deficiencies in the body can sometimes result in brittle or thinning hair and nails.  Biotin helps to strengthen keratin infrastructure, a basic protein that makes up hair, skin, and nails, and supplementing with it, in some cases, helps to reverse these unwanted effects in these structures of the body.

Of course while what we put into our bodies plays a major role in our appearance, what we put onto our bodies also is significant.  Both men and women alike use cosmetic products such as soaps, shampoos, makeup, moisturizers, shaving creams, hair gels, and many more.  However, these products are often riddled with harsh petrochemicals, parabens, dyes, and synthetic fragrances that, while aesthetically pleasing in the short term, can wreak havoc on the skin and hair long term, not to mention their effects on overall health.  So does that mean all skin care products are bad? Not at all. However, as a consumer, you have to really read your labels and look for product lines that avoid these harsh chemicals.  Companies like Caudalíe, Dr. Haushcka, John Masters, and Jack Black center on providing natural cosmetics in all varieties, from shaving creams to shampoos, oftentimes from organically sourced ingredients.  These types of clean sourced cosmetics give you the benefit of short term beauty without the sacrifice of long term detrimental effects on your skin.

Additionally we often use over the counter creams and moisturizers to treat ongoing conditions that deter from our aesthetic appearances.  Two of the most common issue I see in my practice are scars, both new and old, and skin conditions like eczema and psoriasis which are both aesthetically displeasing and also uncomfortable from a physical standpoint.  For scars, we often recommend silicone based gels, like Scar-Care, which can help to reduce the appearance and severity of scars from a variety of causes, be it old surgical scars, acne scars, or scars resulting from injuries and burns to the skin.  For the treatment of eczema and psoriasis, we often use high quality moisturizers to help to combat this.  When moisturizers are not enough, we go to stronger products like Psoria-Care which is a specialized moisturizer that uses natural products such as boswellic acid to replenish the lipid layer of the skin, thus moisturizing and reducing inflammation.

Finally, sometimes some skin conditions are resistant to even the best over the counter treatments.  For those cases, we have some great prescription options at our disposal to help improve the looks of the skin.  For instance, specially compounded skin lightening creams are often used to help lighten dark spots on the skin often caused by aging.  These creams generally contain a combination of two to three ingredients such as steroids and bleaching agents which blend the dark spots into the surrounding skin, giving a more flawless appearance.  Additionally acne can oftentimes be resistant to traditional over the counter treatments.  Many patients will try common prescription products such as antibiotics and benzoyl peroxide, and for those looking for a more natural approach, specially compounded niacinamide provides a nice option in that it is simply a form of vitamin B which may help to reduce the formation of acne.

These types of natural cosmetic products and supplements, as well as compounded medications, can sometimes be difficult for the average consumer to find as they are not typically sold in regular stores.  Stores that specialize in these types of items, such as Pine Pharmacy in Williamsville, are generally great resources.

There are quite literally thousands of options and products to improve your overall appearance.  Make sure you choose high quality products that beautify gently and safely, and have scientific evidence behind them that supports their beneficial effects.  Doing so will allow you to get the most bang for your buck and keep you looking your best.

Oral Health: A Window To Your Overall Health

Very few people enjoy trips to the dentist. How often do you hear someone declare that they can’t wait to go for their regular tooth cleaning?  The grinding, the chipping away with sharp instruments, and the polishing is enough to make most squirm just reading this.  But, while the experience may be unpleasant, it is extremely important to get regular dental checkups and to maintain overall oral health.

                While we often think of oral health issues as being isolated to the mouth and teeth, oral health and total overall health are linked.  Poor oral hygiene can, of course, lead to issues such as tooth decay and gum disease.  However, it can also result in cardiovascular disease, endocarditis, and potentially premature birth.  Conversely, common disease states such as diabetes and osteoporosis can cause oral health issues.  Additionally, some common medications such as antihistamines, diuretics, and decongestants can have a negative impact on oral health factors such as saliva production.  Therefore it is important to maintain good oral hygiene for both healthy and unhealthy individuals.

So what preventative steps can we take to maintain oral health?  Well the first should be easy, as all of us learned it from the time we were toddlers.  Brushing at least twice a day helps to remove acid build up on the teeth from the breakdown of food, thus preserving the protective enamel that coats the teeth.  Brush thoroughly, being sure to contact all surfaces of the teeth.  If brushing after each meal isn’t always possible, rinse your mouth with water after eating to help wash away food particles.  And while recent research has called into question the benefits of flossing, it is certainly not harmful to floss at least once a day to provide an even more thorough cleaning.

Much like all other aspects of health, what we ingest plays a large role in oral health.  Tobacco usage has a large negative impact on dental health and should be avoided.  Likewise, high sugar containing beverages like soda and juices should be limited, as sugar can wear on the enamel of the teeth.  Additionally, obtaining the right amount of calcium in the diet is essential as that can help to strengthen the teeth.

Finally, bite the bullet and see your dentist regularly.  Not only are routine checkups great for maintaining hygiene, but they can also spot issues such as cavities early before they become difficult (and expensive!) to treat.  Visit the dentist at least twice per year, and whenever toothaches or jaw pain appears.

While we often think oral health issues are limited to being treated in the dentist’s office, and many are, such as cavities and root canals, as a pharmacist, I often treat patients experiencing some difficult conditions related to the oral cavity.

One of the most common complaints patients present to us with in the community pharmacy is dry mouth.  This can be the result of many different factors such as medication, other disease states, or improper diet.  Obviously staying properly hydrated is a key factor to treatment in this arena, but sometimes, that is not enough.  In those cases, patients can benefit from over the counter products that help to increase mouth lubrication, such as Lubricity™, a topical spray used after each meal.  For patients with extremely difficult to treat dry mouth, medications which enhance salivary production, such as pilocarpine, can be made in special dosage forms like lozenges or lollipops. By sucking on the lozenge or lollipop, the patient gets an increase in saliva production while avoiding side effects in the rest of the body from the drug.

Another condition we see quite often in our practice is patients with oral lesions.  These sores, such as canker sores, can be extremely painful, and interfere greatly with quality of life.  These conditions can result from a variety of factors, be it stress, diet, or other illnesses, and can be stubborn to treat.  Some of the best treatments for these are oral medicated mouth rinses which combine multiple drug classes, such as steroids, antibiotics, antifungals, and anesthetics, into one rinse. These rinses often go by names such as “Rothwell’s” or “Magic Mouthwash”, and are swished around in the mouth regularly throughout the day to coat the sores, and help to both soothe irritation and speed healing.

Finally another condition we sometimes see is “burning mouth syndrome”.  Burning mouth is just what it sounds like in that it often causes a strong tingling or burning sensation throughout the mouth.  This sensation is often felt on a consistent basis and can be quite difficult to deal with.  Many patients experiencing this may benefit from over the counter supplements like lipoic acid which may help to alleviate the nerve sensation.  For those patients with difficult to treat instances of burning mouth, medications such as clonazepam and capsaicin can be made into mouth rinses or lozenges.  By placing these medications in the mouth, the overactive nerves causing the burning are in effect numbed out, and the patient achieves relief.

These types of specialty medications and supplements listed above are generally found at pharmacies which specialize in vitamin supplementation and the art of compounding, such as Pine Pharmacy in Williamsville.

Following proper oral hygiene and having any dental issues addressed in a timely fashion is a great way to keep your mouth clean and healthy, and stop it from affecting other aspects of your health.  Don’t ignore it, or else you will find yourself regularly in the dentist’s chair, and paying a lot of hefty dental bills.  Remember, there is a reason root canals are often used as a metaphor for some of the most unpleasant things in life, so do your best to prevent them!

Women’s Health


Hot flashes, night sweats, mood swings, insomnia…sounds like a nightmare doesn’t it? Unfortunately though, fifty percent of the people reading this article will like experience these symptoms in their lifetimes, and possibly a few more.  Of course, I’m referring to women experiencing the effects of hormonal changes in the body, be it premenstrual, pregnancy related, or menopausal, although for those women currently experiencing them, they might argue that nightmare sums it up much better.

Women’s health is a wide ranging topic.  While many men often complain that women are hard to understand, it is for good reason! A woman’s body is complex, undergoing many changes throughout life.  In fact, even in health conditions that afflict both men and women, women often have different outcomes and risks than men do.

So naturally, the question is what steps can be taken to minimize women’s health risks and what treatment options are available for the common conditions afflicting women? First there are the obvious answers. See your doctor yearly to get regularly scheduled checks such as Pap smears, reduce stress as much as possible, exercise regularly, and maintain a well-balanced healthy diet.

However, rather than rehash what most women already know they should be doing, I’d like to address some of the more common conditions and complaints I get from women as a practicing pharmacist.

By far and away the most troubling condition for women in my practice is menopause and perimenopause, the period immediately preceding menopause when hormone levels initially begin to decline.  The decline, and ultimate discontinuation, of hormone production by the ovaries can lead to a host of symptoms that can wreak havoc on a woman’s quality of life.  In addition to the hot flashes, insomnia, and mood swings, woman can also experience weight gain, decrease or loss of libido, vaginal dryness, and memory loss.

To combat this, there are a few tools at our disposal. First there are over the counter supplements that can help in certain cases.  For instance, rhubarb root extract, sold under the trade name of Estrovera®, is a great option to reduce hot flashes, one of the biggest complaints of menopause.  This non-hormonal herbal extract has been used in Europe for over twenty years, and has shown in clinical studies to have comparable results to low dose hormone therapy.  Other over the counter options that help to manage menopausal symptoms include evening primrose oil and black cohosh.  Additionally, cortisol, our body’s hormone that helps us to manage stress, is often disrupted by the hormonal changes menopause presents, leading to issues such as weight gain, fatigue, and potentially hot flashes. Adaptogenic herbs such as eleuthero, ashwaganda and rhodiola rosea, commonly sold in combinations products like Adrenotone®, are highly effective at helping the body normalize cortisol levels, thus relieving these symptoms.

In the prescription realm, hormone replacement therapy (HRT) is another option to combat the symptoms of menopause. This type of therapy is highly individualized, as each woman’s hormone deficiencies and imbalances are different.  For instance, while one woman may need estrogen, another may have too much estrogen already in their body and need progesterone to balance that excess.  When customized properly to the individual’s needs and symptoms, the results can provide drastic improvements in quality of life.  Additionally, while you may have heard of risks associated with HRT such as breast cancer and cardiovascular events, when the dosages and hormones of HRT are customized to each individual by a physician and pharmacist well trained and experienced in the field of HRT, the risks can be greatly minimized by administering the proper combinations in the proper dosage forms.

A main distinction in hormone replacement therapy is non bio-identical hormones, such as medroxyprogesterone and conjugated equine estrogens, versus bio-identical hormones such as progesterone and estrogens like estriol and estradiol.  The main difference between the two is that a bio-identical hormone’s chemical structure matches exactly to the hormones you already have circulating in your blood.  In other words, giving your body a bio-identical­ hormone is giving it something it expects to have, and has had your entire life.  Conversely, non bio-identical hormones vary in their structure and function from the natural hormones you have in your body, and your body does not have receptors designed to receive those hormones.  In essence, taking a non bio-identical hormone is like fitting a square peg into a round hole.  As you might expect, medical literature and data has demonstrated that using a bio-identical hormone tends to be more effective and have a better safety profile long term as compared to a non bio-identical hormone.

While menopausal issues are significant, there are many other women’s health issues that I see in my practice. For instance, many young women experience trouble with premenstrual syndrome and the symptoms associated with it.  While prescription drugs such as birth control can be effective at controlling those issues, over the counter supplements that contain herbs like chaste tree berry, wild yam root, and passionflower, are great options to support PMS naturally.

Additionally, there are often concerns about what constitutes a good prenatal vitamin. Generally, you want to look for a prenatal vitamin that is comprehensive and provides an adequate amount of folate, preferably as methlyfolate, a readily active and utilized form in the body, as compared to folic acid which must be converted to the active form in the body and is done so poorly in some women who have certain genetic mutations.  Additionally, look for a product that gives you a good amount of DHA, an omega-3 that supports healthy brain development in your baby.  Try to get at least 400 to 500mg of DHA per day while pregnant or nursing.

Finding the right healthcare professional to address your health is essential. Women are complex and sophisticated, and their health is no different. Seek out physicians and pharmacists that specialize in women’s health and have experience in the field.  Compounding pharmacies such as Pine Pharmacy in Williamsville are great resources for both hormone replacement and vitamin supplementation to support a woman’s health from youth through the golden years.


Pediatric Health, Wellness, and Medications!



By James “Bo” Catanese, Pharm.D.

As both a pharmacist and a father, I find that my toughest (and most entertaining) patient is my toddler son. Generally, whenever my wife and I attempt to give him medication or explain to him the importance of healthy habits, a grand inquisition ensues, and no matter what answer is given, another “but why?” quickly follows.  I’m sure any parent reading this knows this story all too well.  However, no matter the difficulty they present as patients, I’m also sure any parent will agree that the health of our children is our number one priority.

Of course, there are plenty of basic tenants that go into keeping our children safe and healthy.  Many of them are the same principles we use as adults.  Diet, exercise, hydration, and adequate amounts of sleep are the foundations to build upon.

When it comes to diet, parents need to find ways to strike a balance for their children.  While it is a rite of passage in childhood to get your fill of cake and ice cream at a birthday party, it’s important that we teach our children that these are treats, and not daily meals! A good rule of thumb is to live by the 80-20 rule, spending 80 percent of the time eating as healthy as possible, and the other 20 percent allowing your child a little leeway.  Most importantly, understand what is and isn’t healthy.  For example, fruit juice might sound healthy with “100% vitamin C!” plastered all over the label, but what they are missing on that label is “packed with loads of sugar!”. There is no substitute for plenty of whole fruits and vegetables, whole grains, and healthy proteins such as lean, unprocessed meats.  And when we explain to our children why these foods are healthy, and that they build strong bones and muscles, it reinforces healthy decisions later in life.

Likewise, staying active is essential to healthy development in children, and most kids should get at least sixty minutes of physical activity per day.  This can range from playing outside, to going for a walk, to taking part in a sport.  Fostering this appreciation of physical activity will not only improve physical health, but also will have the added benefit of limiting idle time spent in front of the television or playing video games, teaching children to be attentive and engaged.  In fact some research has shown that physical activity has improved testing scores in school aged children.

However, while prevention with healthy habits is always the best medicine, as any parent with a child in daycare or school will attest to, inevitably, they will pick up germs and get sick at some point.  Sometimes this can be as simple as a minor 24 hour bug, or it can be as severe as a chronic illness.  It’s important that we as parents are attentive to even the slightest of issues, and address them in a timely manner to prevent them from becoming full blown concerns.

Whenever your child develops symptoms of concern, contact a health professional such as a pediatrician or pharmacist.  These professionals can help you better asses the severity of the situation, and point you in the best direction to address the illness.  Sometimes the advice may be simple TLC and watchful waiting, whereas other times, medications may be necessary.

When medications are necessary, things can get a little tricky.  I can’t count the number of phone calls over the years I have received at the pharmacy from desperate moms and dads attempting to give their children medication, only to have it spit back out on them due to taste or an inability to swallow whole tablets or capsules.  Kids are picky, and sometimes, I don’t blame them! Some medications are not the most pleasant things in the world.

When these issues present themselves, custom compounding of medications is a great option.  Pharmacies that specialize in compounding have the ability to make medications into a variety of kid friendly dosage forms including liquids, chewable gummies, lollipops, medicated pacifiers for infants, or even making the drug into a topical cream to avoid the oral route altogether.  Additionally, the oral dosage forms can be flavored with options such as grape, bubble gum, or strawberry, making the medication more palatable for the child.  Compounding also allows for pediatric appropriate dosages to be given, as the medication can be made to the exact needs of each child based on their age and weight.  That becomes especially important when children need to be given medications which are only manufactured at adult dosages, such as acid reflux medications often given to infants.

Another unique benefit of compounding pharmacy in pediatrics is the ability to exclude potential allergens from medications.  Food allergies are becoming increasingly recognized, and unfortunately, many times manufactured medications contain allergens such as gluten, casein, corn, soy, and dyes.  Compounding pharmacists in many cases have access to pure powdered sources of the drugs, and can therefore prepare medications to be compliant with each child’s allergy profile, thus getting your child better without causing other issues.

It is important to note that while many pharmacies have compounding capabilities, when seeking one out, look for one that has achieved accreditation, such as Pine Pharmacy in Williamsville.  This accreditation gives you peace of mind that the pharmacy is meeting proper quality control standards when preparing medications for your little ones.

Pediatric health is a lifelong journey for both child and parent.  As I can personally attest to, it isn’t always a perfect one and mistakes will be made along the way.  However, you will always be your child’s best advocate, so be sure to put their health at the forefront in everything that you do.


James “Bo” Catanese, Pharm.D. is a pharmacist at Pine Pharmacy



Preserve and Maintain Your Vision!

There is nothing like seeing things with your own two eyes. We use our eyes every day, every moment that we are awake, yet we often don’t think about them.  Given our significant reliance upon them, though, it’s important that we give proper attention to protecting and preserving their health.

The eyes are the second most complex organ in the body, behind only the brain.  In fact, they have over two million working parts.  And while the eyes are excellent at maintaining themselves, working efficiently to filter out dust and dirt and heal scratches, they can’t do it alone.  So what can we be doing to make sure our eyes stay healthy and functioning properly?

Obviously, it goes without saying that having a regular eye exam is a great start to maintaining your healthy vision.  Not only are eye care physicians able to assess the functioning of your vision, but they are able to get a close up look of the eye during these routine exams to search for early indications of disease development which don’t often present any overtly detectable warning signs.

Of course, like with any other topic of health, the correct course always includes a healthy, well balanced diet. Your eyes rely on vital vitamins and nutrients to function properly, and our diets are the best sources of these.  Ensuring you eat plenty of green leafy vegetables, citrusy fruits, fatty fish such as salmon, and nonmeat protein sources like eggs and nuts will give you a great foundation of those nutrients.  Additionally, eating healthy and staying active maintains a proper body weight, helping to protect against diabetes, which can wreak havoc on the eyes.

Included in this healthy diet approach is the avoidance of smoking. Smoke can have detrimental effects on the entire body, and the eyes are no exception, as it can lead to issues such as cataracts and macular degeneration, both of which can lead to blindness.

Protecting your eyes from harmful external factors is an important step as well. Wearing proper safety wear when playing sports or working on projects at home or work is a start.  But more commonly, the external factor that can do the most damage is the sun and its ultraviolet rays.  These rays can lead to macular degeneration and cataracts.  Therefore, wearing sunglasses is not just a fashion statement, but a way to preserve your eye health.  Pay close attention when buying sunglasses and ensure your pair blocks 99% to 100% of both UV-A and UV-B radiation.

Given our reliance today on computers, tablets, and phones, screen time has become a significant contributing factor to eye strain. When looking at screens, we often tend to blink less than we would otherwise, which is why we often experience eye strain, headaches, or trouble focusing after spending extended periods working on our electronics.  To combat this, the obvious remedy is to make an effort to blink more often.  Additionally, you can take advantage of the 20-20-20 rule.  It states that when working at a screen, every twenty minutes, look away at something roughly twenty feet from you for twenty seconds.  This will give your eyes a chance to rest and reduce fatigue.

In the medication and supplement realm, there are many beneficial products that can help to improve current issues you might be having, as well as to prevent issues from occurring in the first place. From a medication standpoint, over the counter, there are a variety of topical products that can help with dry eye, allergic inflammation and more.  From a prescription standpoint, your doctor can prescribe even stronger options to handle these conditions as well as others such as infections, dilation issues, and glaucoma.

On the supplement side of things, taking a supplement that combines eye healthy vitamins and nutrients is a great option for both prevention and maintenance of eye related conditions, especially for those who may not have the perfectly balanced diet. An example of such a product would include vitamins, minerals, and antioxidants that have a synergistic effect, protecting the eyes in multiple ways.  For example, carotenoids such as Vitamin A, lutein, and zeaxanthin protect the macula and retina of the eyes, guarding against macular degeneration.  Minerals like zinc and selenium also protect the macula and in addition, can both prevent and retard the progression of cataracts by increasing the body’s production of antioxidants that protect the lenses of the eye.  Additional antioxidants like glutathione and alpha lipoic acid further enhance this protection.  Vitamins like A, C, and E, can strengthen the retinas, combat dry eye, and protect the macula.

Keeping with the supplement theme, omega-3 fatty acids also play an integral role in the health of the eye. Omega-3’s have evidence to support their use in the prevention of age-related macular degeneration, the treatment of dry eye, and they may help to improve the condition of glaucoma patients.  Additionally, omega-3’s play a role in converting the light transmitted to our retinas into nerve signals which eventually results in our sight.  For the most part, many of us are deficient in omega-3’s given the western diet doesn’t emphasize the consumption of fatty fish such as salmon at least twice weekly.  Consuming a quality, highly concentrated omega-3 supplement that contains the active omega-3’s EPA and DHA in sufficient quantities is a great way to fill the gaps within your diet.

It’s important when purchasing supplements for eye health, or any other condition, to consult with your pharmacist, or physician, to ensure you are buying a quality product with the right ingredients. Seek out a store that specializes in these types of products so you can ensure their quality.  Pharmacies such a Pine Pharmacy in Williamsville are a great resource in this realm.

Taking the steps listed above can be a great start to preserving and maintaining your vision. We rely on our eyes for nearly every aspect of our lives, so be sure to take care of yours.










Orthopedic Health and Wellness

Maybe you’ve been there, or maybe you were just there this morning. You wake up, and go to get out of bed, only to feel aches and pains in your back, your knees, or, even worse, your entire body feels like you were hit by a truck.  Unfortunately, joint and muscle issues tend to catch up to most of us at one point or another.  While these aches and pains may not be life threatening, of all of the health conditions that can affect the human body, orthopedic problems tend to interfere the most with our quality of life.

Orthopedic conditions, which afflict the bones, joints, and muscles of the body, are among the most common causes of long-term pain and physical disability.  These conditions can range widely and include arthritis, fibromyalgia, back pain, knee pain and ligament issues, osteoporosis, and many more.  Generally, these issues are a result of autoimmune irregularities, years of wear and tear on the body, or unhealthy habits.

So what can we do to try to prevent ourselves from feeling older than we really are when we get out of bed?  Many preventative steps are helpful in maintaining and improving orthopedic health, the most important of which are diet and exercise.  Staying active helps bones and joints to maintain their health.  Exercises that focus on strengthening and flexibility, such as brisk walking, light jogging, and light weight or resistance band training, are great for the muscles and joints.  Be careful though, especially if you currently have orthopedic issues, to avoid high impact exercises that will only serve to further damage the bones and joints.

Likewise, a healthy, well-balanced diet provides your bones and muscles with essential nutrients for proper growth and maintenance.  Especially important are consuming proper amounts of calcium and vitamin D, which are integral to bone health.  Vitamin D can be obtained from sun exposure, while calcium is generally obtained through foods like milk, cheese, spinach, and broccoli.  A properly balanced diet also has the added benefit of promoting a healthy weight, thus preventing over exertion on the bones and joints in the body.

Beyond diet and exercise, other preventative steps can include maintaining a healthy posture, both during the day and while sleeping, and wearing proper footwear that provides comfort and support.  Finally, don’t ignore issues.  When injuries occur, don’t just push your way through.  Ice, elevate, and rest the area, and if the swelling or pain intensifies over time, have the injury looked at before further damage is done.

While preventative measures are great, and staying committed to them even after diagnosis of orthopedic issues is important, if you’re really struggling, it might be time to get more intensive in your approach.  Having an orthopedic specialist diagnose the issues you are having is essential to receiving proper treatment geared towards your given diagnosis.  Depending on your condition there are many conventional steps that can be taken, from physical therapy, to orthopedic aids and supports.

From a medication standpoint, pain relievers are often a mainstay of orthopedic treatment.  Drugs such as non-steroidal anti-inflammatories, muscle relaxers, or those geared towards reducing nerve pain are often prescribed to reduce the pain and inflammation associated with orthopedic conditions.  One common downfall to these medications is the side effects they often come with, from gastrointestinal issues, to sedation and grogginess.  When this becomes an issue, or potential drug interactions are a concern, some orthopedic physicians will have custom mixed “pain creams” made up by specialty compounding pharmacies.  These creams combine the types of drugs used to treat orthopedic conditions into one topically applied dosage form.  The creams, applied directly to the area of pain, provide a multi-faceted approach, combining drugs that attack the pain in multiple mechanisms, while limiting the systemic absorption in the body seen with oral medications. This limited absorption renders side effects and drug interactions nearly non-existent.

For those patients looking for a more natural approach, there are many great options in the supplement realm to support orthopedic health.  When it comes to pain relief of the joints, products that contain mixtures of anti-inflammatory herbals such as curcumin (derived from turmeric) and boswellia, along with minerals that support the joints such as zinc and selenium can be highly effective.  Further, adding in supplements that can support the production of cartilage, the joint’s natural cushion, such as glucosamine, MSM, and collagen, along with hyaluronic acid, which can aid in joint lubrication, can also be highly effective.  Because these supplements all work synergistically in tandem, it is best to find them in an all-in-one supplement such as Designs for Health’s® Arthrosoothe™.

Another great option for anti-inflammation is a high quality fish oil.  Omega-3‘s, found in fish oil, can be highly anti-inflammatory to the joints.  When buying a fish oil, it is essential to read the label carefully, as many can be misleading, labeling total fish oil concentration, or total omega-3 concentration, including inactive omega-3 ALA in its potency. Ensure that the concentrations of the active omega-3’s, EPH and DHA are sufficient in the product you buy.  You should aim to get at least 1000mg of EPA per day, as this is the anti-inflammatory omega-3.

Finally, when combatting issues with the bone, as mentioned earlier, calcium and vitamin D are essential.  While it is great to get calcium from the diet and vitamin D from sun exposure, it is not always easy.  When deficiencies are a concern, supplementation is another option.  For vitamin D, be sure to take the active form, D3.  Depending on your level of deficiency, take in the range of 2,000IU-10,000IU per day.  In regards to calcium, purchase carefully, as not all calciums are created equally.  There are many different forms of calcium such as carbonate and citrate, and unfortunately, some are poorly absorbed.  Choose a highly absorbable form of calcium such as malate, as your body will better utilize the supplement you are taking.  If osteoporosis or osteopenia is a concern, consider a more intensive product such as MCHC, a more specialized and intensive form of calcium that provides further nutrients for bone repair and rebuilding.

These types of supplements, along with the specialty “pain cream” mixtures mentioned above, can generally be found at specialty pharmacies such as Pine Pharmacy in Williamsville.

You only get one body in life, so take care of it well, and care for your orthopedic issues, that way you can wake up in the morning feeling rejuvenated, instead of resigned to aches and pains.

June is Men’s Health Month

By James “Bo” Catanese, Pharm.D.

Men can be stubborn, or at least that’s what my wife tells me (everyday).  As a gender, we don’t always listen to good advice when we should, or admit when we are wrong, and the topic of our health is no exception.  But, the fact of the matter is, it’s time to start listening, as men’s health is an area that is sorely lacking.

Current estimates are that nearly fifteen percent of adult men in the United States are in fair or poor health.  Couple this with the facts that nearly thirty-five percent are considered obese, and that only about half get an adequate level of exercise, and it is easy to see why men’s health needs to be concentrated on more closely.  So what can we do to improve our state of affairs?

First and foremost are the two things we all hear every time we head to our doctor’s office, diet and exercise.  While it might sound redundant to list them here, there’s a reason those two items get drilled into our heads.  Eating a well-balanced diet is the key to any healthy approach.  We are what we eat, and while enjoying chicken wings and a cold beer is a rite of passage for any Western New Yorker, it’s important to remember that this should not be a daily meal.  Getting plenty of fruits and vegetables, limiting fried foods and saturated fats, avoiding refined carbohydrates, and eating lean meats is just a start to improving parameters such as blood pressure, weight, and cholesterol.  When eating the perfectly balanced diet isn’t always possible, including a high quality multivitamin can help fill in the blanks.

Likewise, adequate exercise is vital to improving heart healthy parameters and can help to lower the risk of heart attack and stroke.  While it can seem daunting, regular exercise does not mean that we need to become Olympic marathon runners or champion weight lifters, although all the kudos to you if you do.  Walking, jogging, swimming, or biking are just a few of the many options that are easy to perform for anyone.  Thirty minutes of moderate level intensity exercise five times per week, or twenty-five minutes of vigorous level intensity three times per week, is more than adequate in providing cardiac health benefits.  Mixing in muscle strengthening at least twice per week can lead to additional health benefits as well.

While these steps are great at prevention, many of us have, or will develop underlying health conditions, sometimes even in spite of our best efforts.  Unfortunately, men often bury their heads in the sand and ignore these issues when they present themselves, which most of the time, only makes things worse.  It’s important to treat conditions as they present themselves, to both improve our health and to prevent further headaches down the road.

Probably the most common health conditions in men revolve around the heart.  Blood pressure and cholesterol are parameters which are often elevated, especially when lifestyle choices such as diet and exercise are less than adequate.  As mentioned, improving those can go a long way, but when they don’t, further action is necessary.  Naturally, there are many medication options to treat these conditions and drugs like “statins” have become commonplace in the medication regimen of millions of Americans to improve heart health.

What sometimes isn’t as well understood is that there are many great nutritional options as well, for those who would like to reserve medication as a last resort. For instance, supplements such as omega-3’s, omega-7’s, red yeast rice, and niacin can all function to improve cholesterol and triglyceride profiles, and supplements like arginine may help to relax blood vessels, thus potentially lowering blood pressure.  Improving these parameters is vital to decreasing the likelihood of heart attack and stroke.

In addition to heart concerns, another men’s health topic has seen increased interest recently. Many are familiar with the symptoms declining testosterone levels can bring such as fatigue, cognitive decline, decreased strength, and declining libido.  Testosterone replacement therapy has grown significantly as a result of this.  This is often a great way to treat diagnosed declining levels.  Unfortunately, many of the commercially available testosterone replacement prescription products come with a significant price tag.  When price becomes an issue, many men will turn to specialty compounding pharmacies whom are able to customize dosages at a fraction of the cost of the commercially available counterparts.  And for those men who would like to avoid hormone replacement, there are many nutritional options as well that may improve the symptoms associated with low testosterone.  These products often include supplements such as tribulus, chrysin, diindolylmethane, and others that promote healthy testosterone metabolism and function.

Even more specific to men’s health, enlargement of the prostate can lead to changes in urinary frequency and urgency, as well as declining ease of urination. Often, these issues will be treated with prescription medications to control the prostate growth, thus easing the flow of urine.  Additionally, nutritional supplementation with items such as saw palmetto and nettle complexes may help to improve minor symptoms with a more natural approach.

Finally, we’ve all at one point or another seen the commercials promoting erectile dysfunction medication. While it can be embarrassing for men, this condition is far more common than we think, and given the significant toll it can have on social and mental health, it should not be ignored given the many effective treatment options for it.  Of course there are the pills that we see in the commercials, and these work effectively and easily for many men.  However, these pills are often very expensive and sometimes not covered by insurance.  When price is an issue, there are generic options available which are just as effective and can be had for a fraction of the cost.  For those who may not respond to these, doctors will sometimes prescribe injectable mixtures, commonly referred to as “tri-mix”, which are custom mixed and often work with great success.  Both the generic tablets and custom injections can be found at specialty compounding pharmacies such as Pine Pharmacy.

Of course there are many more issues and conditions in men’s health, but the bottom line to take away is that from both a preventative and treatment standpoint, men can stand to improve their overall health. Don’t be too stubborn guys, start working your way to a healthier you.  After all, the worst words you can hear your spouse say are “I told you so”.

James “Bo” Catanese, Pharm.D. is a pharmacist at Pine Pharmacy

Taking Care of Your Skin



Skin is the largest and fastest growing organ in the human body and, since it is the most visible portion of our bodies, we all strive to make ours as presentable as possible. Unfortunately though, while we concentrate greatly on the attractiveness of our skin, we can sometimes forget to concentrate on improving the health of our skin, and that the two are not always one in the same.  Given the summer months are just around the corner, it’s a great time to look at just what we can do to make our skin as healthy as possible.

To understand the importance of skin health, it’s important to remember that skin is not merely an aesthetic feature.  Human skin plays a number of vital functions in the body such as temperature regulation, protection of internal organs, temperature and pressure sensation, and even Vitamin D production.  The importance of it is exemplified by the sheer volume of it, as it accounts for roughly 15% of our body weight.

When it comes to maintaining and caring for your skin, there are many intensive and specialized treatments that target different areas and conditions of the skin with a great deal of effectiveness.  However, for those who do not have the time or resources, there are also many simple and easy practices we can use to prevent skin conditions as well as delay the natural aging process.

First and foremost is protecting your skin from sun exposure.  While many think a good tan looks great, long term UV ray exposure can cause wrinkles, dark spots, and increase the risk of skin cancer. Wearing a sunscreen with an SPF of at least 30, reapplying the sunscreen after swimming, staying away from the tanning booths, and covering the skin at peak sunlight hours can help to protect and preserve the vitality of your skin.

Much like all other aspects of our health, what we put into our bodies also greatly affects the overall health and appearance of our skin.  A balanced diet low in refined carbohydrates and high in healthy fats as well as fruits and vegetables can provide the skin with vital nutrients needed to maintain overall health and vibrancy.  Nutritional supplementation can also be beneficial, as supplements such as omega-3’s, probiotics, and vitamin D3 can not only improve skin health, but also may help to alleviate symptoms associated with some common conditions such as psoriasis and eczema.  In addition, smoking can deplete the skin of oxygen and nutrients as well as destroy collagen and elastin which give the skin its elasticity and strength.

And of course how we treat the skin itself is important.  Performing regular skin checks for irregular growths can be vital in detecting potential concerns.  Avoiding harsh soaps and detergents, shaving carefully with clean sharp razors and proper lubricants, and limiting excessive bathing times to avoid removing healthy oils can help to improve skin health. Regular use of moisturizers and cleansers can also lead to significant benefits, but it’s important to note that not all cleansers and moisturizers are equal, and those made by quality companies such as Caudalie, Hauschka, and Jack Black, are designed to be effective yet gentle on the skin.

Despite our best efforts, various skin conditions may pop up from time to time and require treatment.  Acne, eczema, psoriasis, rosacea, melasma, and even the common wart can present unwanted changes in the skin’s appearance.  When these occur, there are many tools at our disposal to treat these types of conditions and improve the look and feel of our skin.

Because of the scope and depth of treatment options for each of these conditions, it is impossible to describe them each in detail.  In general though, there are many effective manufactured prescription products to treat each of these conditions.  Acne is often treated with topical or oral antibiotic therapy, or with agents such as benzoyl peroxide or tretinoin.  Eczema and psoriasis are often treated with a variety of topical corticosteroids which help to reduce the flare up of inflammation on the skin.  Melasma is often treated with skin lightening creams that contain several ingredients such as corticosteroids and bleaching agents.  And the common wart is often treated with over the counter products such as salicylic acid, which help to “burn” the wart off the skin.

While these prescription options often work well, sometimes conditions of the skin can be stubborn and may not respond to traditional therapies.  In these instances, specialty compounding pharmacies, such as Pine Pharmacy in Williamsville, are often enlisted to prepare specialty combinations of various ingredients that help to improve outcomes.  Compounded medications can help in these types of situations in a variety of manners.  First, various ingredients can be combined into single dosage forms which potentially provides a better effect, such as stronger topical treatments for warts than what is typically available over the counter.  Additionally, non-traditional medications that are not readily available commercially can be specially compounded.  For example, in the treatment of acne, for those patients who like to take a more natural approach, compounded topical vitamin treatment with niacinamide, a form of vitamin B, may provide a better option than more traditional medications.  Compounded medications can also be mixed in specialized bases that are specifically designed to have internal properties that improve certain conditions, thus potentially increasing the success of the overall therapy.

Perhaps one of the biggest benefits to compounded medications comes at the cash register.  The cost of skin care medications can be a point of concern for many patients, and understandably so.  Unfortunately, recent trends in the medication market have seen prescription costs skyrocket, and dermatological products are often some of the biggest culprits, especially if the medication is not covered by insurance, or a patient has a high deductible to meet.  In many instances, compounded medications are covered by insurance, and when they are not, they present patients with options that are a fraction of the cost of their commercially available alternatives.  For just one example, traditional commercially available skin lightening options can cost upwards of $200, whereas compounded options may cost $75 to $100.

Given your skin’s vital role in maintaining your health and appearance, the importance of maintaining its health cannot be understated.  Take extra time this summer to improve your skin health practices, and to look into treating any current issues.  Keep in mind, beautiful skin isn’t always healthy, but healthy skin is always beautiful.

April is Autism Awareness Month

Over 3.5 million Americans live with autism spectrum disorder. However, within the general public, there is only a limited recognition of the disorder.  The specifics of autism, including the impact that it can have on individuals, as well as their families and caregivers, is often not well understood, except by those who deal with it on a daily basis.

Autism is a complex disorder of brain development.  Each person affected by autism will experience differing types and severities of symptoms, and therefore, to reflect the varying degree it can affect an individual, the disorder is referred to as a spectrum. The overarching theme of the spectrum generally involves impaired communication skills, as well as a difficulty interacting socially.  While for some individuals this can result in complete lack of language, in others it may only involve difficulty making eye contact or holding a conversation.  Still, others may have motor coordination delays, difficulty reasoning and planning, repetitive behaviors, or physical health disturbances such as sleep and gastrointestinal issues.

Symptoms of autism generally present early in childhood, around the ages of two to three.  Lack of, or delay in language development, trouble developing peer relationships, and repetitive mannerisms are only a few of the early warning signs.  Some red flags may be spotted even earlier at the infant stage, such as lack of smiling or joyful expressions, and absence of gestures such as pointing or waving as the child approaches twelve months of age.

Not long ago, the cause of autism was a mystery.  Even today, science has yet to grasp a complete understanding of the disorder’s roots despite ongoing research. The most recent research suggests the disorder results from a combination of genetic mutations and differing environmental factors.  For instance, if a developing child already has a genetic mutation, environmental factors such as advanced parental age or complications during childbirth may possibly increase the child’s risk of developing the disorder.  More recent research has begun to examine the body’s own immune system and how it may play a role in brain development and maintenance.

Given that it is thought autism is largely a result of genetic mutations, it is not possible to prevent autism, per say.  However, steps can be taken to limit exposure to the environmental factors that are thought to possibly increase the risk of the disorder’s development. For instance, women who are pregnant or plan to become pregnant would be wise to avoid toxins such as air pollution, pesticides, some cosmetics, and others.  Additionally, some research shows proper prenatal diet, as well as adequate folic acid intake of at least 600mcg to 800mcg per day during pregnancy may lower the risk of autism development.

The demands of living with the disorder, and the burden of caring for someone afflicted by it, can be a major source of stress.  For individuals with milder forms of autism, the stigma of living with the disorder, and the lack of social competency associated with it, can be difficult.  For those on the spectrum with more significant disabilities, the lack of being able to live independently can weigh greatly on a family.  Parents must try to manage behavioral complications, plan for the future, and cope with a large financial burden, while siblings may feel a lack of attention or embarrassment.

No single treatment protocol is applicable to all individuals on the spectrum.  Because the disorder presents so uniquely in each individual, the treatment of that individual should be just as unique.  Treatment interventions can involve behavioral therapy, conventional medication to control behavior and underlying medical conditions associated with autism, or a combination of both.  Additionally, outside the arm of conventional medication, there exist some complementary and alternative treatments, often termed integrative medicine, that have begun to show promise in the field of autism.

One such alternative therapy approach targets methylation, the body’s process of altering proteins and genes, which thus leads to changing their behavior and expression. Essentially, methylation is required to build and repair all of the cells in our bodies.  Individuals on the spectrum often have faulty methylation pathways, thus leading to abnormal gene expression, as well as decreased production of powerful antioxidants like glutathione, which help to detoxify the body and prevent cellular damage.  Treatments with methylcobalamin, a form of vitamin B-12, and folinic acid are often given to improve this methylation process, as well as glutathione metabolism.  Additionally, glutathione itself may be given as well.  Treating methylation pathways and glutathione metabolism has shown promise in improving communication, language, and social skills, as well as cognition and responsiveness.

Oxytocin is another tool used in integrative medicine to potentially improve social bonding.  This hormone has been linked to social ties such as parent-child bonding.  Some research has shown that when administered as a nasal spray, oxytocin can potentially improve social, emotional, and behavioral problems.

Also in the alternative realm, research has begun to examine the roles certain proteins play in autism, such as gluten (found in wheat and other grains) casein (found in dairy products) and soy (derived from the soybean). It has been postulated that these proteins can lead to increased inflammation in the gastrointestinal tract, which may stimulate autoimmune responses and exacerbate the symptoms of the spectrum.  An elimination diet is sometimes initiated to completely eliminate the intake of these proteins from both foods and medications, with the hope this inflammatory response is reduced.

Finally, many supplements can be used to support the management of the spectrum. Omega-3 fatty acids can be used to support the development and function of the brain, possibly improving cognition and reasoning.  Melatonin may be used to help regulate sleep cycles, and probiotics may help to resolve gastrointestinal issues that are often present in individuals on the spectrum.

Alternative therapies such as methylcobalamin, glutathione, and oxytocin are not available through traditional pharmacies and instead must be custom compounded by speciality pharmacies such as Pine Pharmacy in Williamsville. Likewise, these pharmacies are also able to prepare medications to exclude gluten casein and soy, thereby easing adherence to elimination diets.  Generally, they will also specialize in supplements geared towards the spectrum disorder as well.

Clearly, autism spectrum is a unique disorder and modern medicine still has yet to fully grasp all of the intricacies of the disorder. However, the recognition of the disorder is expanding, and there is hope that advances continue to be made in the management of it.

Facing High Drug Costs? Use Pine as a Resource!

You might have experienced it recently. You go to the pharmacy to pick up your prescription that once cost you ten dollars and it now costs you hundreds. This alarming scenario is unfortunately becoming a common trend in the medication marketplace. For reasons that are not always immediately clear to the consumer, generic drugs that are relatively inexpensive for manufacturers to make spike dramatically in price over very short time periods, leading patients to pay an arm and a leg at the cash register. This can be especially problematic for patients without insurance, or with high deductibles. Why is this happening, and more importantly what can you do to limit the impact on your wallet?

The why is not always an easy question to answer.  Each instance is different.  While one drug may spike in price due to a shortage of raw ingredients, another may rise because of increased FDA regulatory requirements. However, more often than not, the rise in price is simply due to consolidation of generic drug manufacturers.  As manufacturers merge, the competition in the marketplace dwindles. Unfortunately, as a result of this, many manufacturers know they are the only “players in the game” when it comes to supplying certain drugs, and therefore raise prices knowing the demand will still be there. Given that the United States is one of the only developed nations to not have regulatory oversight over drug pricing, there is nothing to prevent this price gouging from running rampant.

While drugs such as EpiPen have received widespread media coverage for their price increases, and rightfully so, there are countless others. Steroid creams for eczema, antibiotic creams for acne and rosacea, antidepressants, oral antibiotics, steroid suppositories, gallstone medications, pain relievers, and hundreds of others for many other indications have all seen their prices skyrocket.

Even if you haven’t noticed this yet, you may soon. These price increases are driving healthcare costs through the roof, causing insurers to implement higher deductibles on their plans.  These high dollar deductibles introduce a certain amount of money a patient must pay before the insurance kicks in their coverage, thus often putting the patient in a difficult situation of choosing to pay for their $300 medication, or put food on the table.

So how can this be combatted? Unfortunately, from the consumer standpoint, not much can be done. Ideally, regulatory pressure will force manufacturers to rethink their pricing strategies. Until that time though, you are left to fight for yourself and search for alternative medication options.

However, affordable manufactured alternatives are not always readily available. One avenue to explore when facing high prescription costs is custom compounding.  Compounding pharmacies like Pine Pharmacy are able to access raw ingredients and custom prepare medications to your doctor’s specifications. While a compounding pharmacy cannot mimic a manufactured medication, many times, there are very comparable alternatives that can be prepared at a fraction of the cost of the commercially available options.

A prime example is a drug such as vancomycin which is an antibiotic often used orally to treat clostridium difficile infections. Manufactured oral capsules can cost nearly $1000, but when compounded as a liquid, it can be made for as little as $100.

Unfortunately, rising drug costs do not look to be going away anytime soon. As a patient, it is important to stay educated on your options, and regularly research your alternatives. If you are facing high drug prices, use Pine Pharmacy as a resource. As your partner in health and wellness, we are happy to examine your options for you and will do our best to try and find you and your family a more affordable option.