Is intermittent fasting right for you?

Over the past few years, intermittent fasting has become an increasingly popular way of eating, with many followers crediting it with weight loss and improved overall health.

Erin Peisach, RDN, a registered dietitian nutritionist and wellness education specialist with Sharp Rees-Stealy, answers some common questions about intermittent fasting.

What is intermittent fasting?
Intermittent fasting is an eating strategy that fluctuates between restricted calorie (food) intake and normal calorie intake over designated time spans.

Types of intermittent fasting:
Alternate day fasting — fasting for a full day followed by eating normally the next day
Modified fasting (5:2) — eating 20% of energy needs on 2 fast days per week, followed by typical eating patterns for the other 5 days of the week
Time-restricted feeding — eating normal amounts but during a restricted time window each day
Extended fasting — fasting for 1 day or longer
Religious fasting — fasting for religious or spiritual purposes
Intermittent fasting is not an eating strategy that specifies which foods or food groups to eat, but rather it addresses when and how much to eat.

What are the benefits of intermittent fasting?
Findings appear promising for intermittent fasting to help with metabolic health. This may be because fasting allows the body to repair, replenish and recycle cells involved in metabolism. Think of it as a “metabolic tune-up.”

One predominant theory is that the body uses ketone bodies — chemicals made by the liver — as an alternative fuel source to glucose during fasting. Ketones are created from the breakdown of fats when glucose is in short supply, and act as a potent energy source, providing fuel to high-demand areas such as brain neurons.

Additional benefits of fasting come from its ability to reduce total calorie intake. It is well-established that eating less helps to support longevity and lower the risk of many chronic diseases. The question remains whether these benefits are experienced from the fasting, or if continuous calorie restriction alone (dieting) produces the similar effects.

Is intermittent fasting safe?
Intermittent fasting is appropriate and safe for most adults without preexisting medical conditions who may be looking to experiment with their diet in a safe and reasonable manner.

However, intermittent fasting is not appropriate for everyone, especially people who:
Have chronic health conditions such as diabetes, hypothyroidism or electrolyte imbalances
Are critically ill with conditions such as advanced kidney or liver disease, or an unstable heart or lungs
Live with mental health conditions including eating disorders
Are in developmental life stages such as pregnancy and early childhood
People who are interested in intermittent fasting should discuss the appropriateness of this eating pattern with their health care provider.

Can you exercise while intermittent fasting?
It is OK to engage in physical activity while fasting. However, bodies need to adjust to the new eating pattern. It’s recommended to start with lower-intensity workouts during a fast and eventually build up the intensity over time. Eating windows should begin shortly after a morning workout to help support workout recovery.

“Intermittent fasting is a flexible eating approach that can fit your needs and lifestyle,” says Peisach. “Keep in mind that you don’t need to stick to your intermittent fasting every day,” she says. “Plan your social calendar ahead to account for your fasting days and times each week.”

Can you die of a broken heart?



Anyone who’s suffered a traumatic loss — or experienced intense stress — understands the toll that grief and emotional strain can take. Doctors say both can also be dangerous for your heart, and for some people during the pandemic — especially women — they became life-threatening.

“Broken-heart syndrome,” also known as stress-induced cardiomyopathy, is a real medical condition that can develop after a stressful event — a breakup, serious accident or loved one’s death — or intense emotional stress, such as living through a pandemic. And according to a study published in JAMA Network Open, there was a significant increase in the incidence of stress-induced cardiomyopathy during the COVID-19 pandemic.

While none of the study participants had COVID-19, researchers believe pandemic-related stressors contributed. Living through a pandemic is generally stressful, but added challenges, such as financial worries, increased responsibilities at home, isolation, illness, and loss of loved ones, may have led to the surge in stress-induced heart issues.

How stress affect the body
When the condition strikes, the body releases a surge of stress hormones that stun the left ventricle, which can no longer pump enough blood to the rest of the body. In very rare cases, it can be fatal.

“We don’t fully understand how stress and grief affect the body, but this is a very real syndrome,” says Dr. Hirsch Mehta, a cardiologist affiliated with Sharp Memorial Hospital.

People with broken-heart syndrome often think they’re having a heart attack, Dr. Mehta says. Following a traumatic or emotional event — even a happy one like winning the lottery — they experience chest pain, sweating and shortness of breath. They can also have palpitations, nausea and vomiting.

“Our initial tests will show that some kind of cardiac event is happening, but there are no blocked arteries, as you’d see in a heart attack,” Dr. Mehta says.

A particular issue for women over 55
Japanese researchers first described the condition in 1990. They called it takotsubo cardiomyopathy — takotsubo means “octopus pot” in Japanese — because on X-rays the left ventricle of patients with the syndrome looks like the shape of a Japanese octopus trap.

Broken-heart syndrome can strike anyone, even those in good health with no previous heart problems. However, women age 55 and older are much more likely to experience the condition. Researchers think older women may be more vulnerable because they have lower levels of estrogen in their bodies following menopause.

Patients can be treated with medication and lifestyle changes. For most, their hearts go back to normal within weeks. However, anyone who thinks they may be experiencing a heart attack should seek medical attention immediately, Dr. Mehta says.

5 steps to take if you think you have COVID-19
Dec. 21, 2021
Woman getting tested for COVID-19
With COVID-19 case numbers once again increasing across the country due to the spread of the delta and omicron variants, you might be wondering if you can continue to avoid infection, especially if you have not yet received a COVID-19 vaccine. Even if you are vaccinated, you may have similar fears.

Whether you are vaccinated or not, there is risk of infection. However, for those who are fully vaccinated and have received a vaccine booster dose, the risk of infection is minimal compared to those who are unvaccinated or not fully vaccinated.

COVID-19 vaccines are effective at preventing severe illness and death, and the addition of a booster dose makes them highly effective at reducing the risk of infection. Additionally, people who experience a breakthrough case of COVID-19 after vaccination are likely to have no or very mild symptoms.

For those who are unvaccinated, the risk of infection, severe illness and death is much higher. In fact, the majority of people who have been hospitalized with COVID-19 or who have died due to complications of COVID-19 were unvaccinated.

Exposed, aka in ‘close contact’
Regardless of whether you are vaccinated or not, what should you do if you are exposed to someone with — or experience symptoms that could be — COVID-19? First, it’s important to understand what it means to be exposed to someone who has COVID-19, and what symptoms to watch for — whether you know you've been exposed or not.

According to the Centers for Disease Control and Prevention (CDC), you are considered to have been exposed to — or in close contact with — someone with COVID-19 if you were within 6 feet of the infected person for a total of 15 minutes or more over a 24-hour period.

This 24-hour period starts 2 days before the infected person's illness began, or if they are without symptoms (asymptomatic), 2 days before they tested positive for COVID-19. The period goes until approximately 10 days after their symptoms first appeared or they are released from isolation.

What to do if you are exposed to COVID-19
If you have been exposed to COVID-19 and are unvaccinated, you should isolate yourself and be tested. If your test result is negative, stay home for 10 days after your last contact with the person who has COVID-19, monitor your symptoms, and try to stay away from people you live with, especially people who are at higher risk for getting very sick from COVID-19. If your test result is positive, isolate yourself for 10 days after your first day of symptoms or 10 days after receiving your positive test result if you do not have any symptoms. After isolation, follow strict masking guidelines.

If you are fully vaccinated — meaning 2 weeks have passed since your second dose of either the Pfizer or Moderna vaccine or single dose of the Johnson & Johnson vaccine — you should get tested 5 to 7 days after your exposure, even if you don't have symptoms. Wear a mask when around others for 14 days following exposure — in California, all people must wear a mask in public indoor locations — and monitor yourself for any symptoms. The same guidance applies if you are fully vaccinated and have received a booster shot.

Feeling COVID-19 symptoms
Even if you haven’t knowingly experienced an exposure to COVID-19, you might still have picked it up when you were around others in public or with a loved one who is unaware they’re infected. While people — vaccinated or unvaccinated — are able to transmit the virus by the third day after exposure, they may not begin to experience symptoms until day 10 or later.

If you experience any of the following common COVID-19 symptoms, you might be among the millions who have been infected in the U.S.:

Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Talk with your doctor about getting tested or go to a nearby COVID-19 testing site. Home self-test kits are considered to be as accurate as antigen rapid tests and can be purchased at some pharmacies. They are easy to use and provide results in approximately 15 minutes. However, PCR tests — provided at most COVID-19 testing sites — are considered the most accurate test to determine an active infection.

5 steps to take if you have COVID-19
If you have received a positive COVID-19 test result or have been exposed to COVID-19 and are experiencing symptoms, the CDC says to take these five steps:

Keep in contact with your doctor. Most people with COVID-19 have mild symptoms. Your doctor can help you decide if you can care for yourself at home or need additional treatment. Always call before you go in person to get care for COVID-19, so that your health care provider can be prepared to protect staff and other patients from potential infection.

Stay home. Stop the spread by isolating yourself and avoiding public areas (unless you’re seeking medical care) for 10 days after first experiencing symptoms or receiving a positive COVID-19 test. Isolate yourself as much as possible from the people and pets in your home and use a separate bathroom, if possible. Wear a face mask if you must be in the same room with others — even pets — and when leaving your home for COVID-19 testing and care.

Take care of yourself. If you are experiencing mild symptoms, you can most likely find relief with the use of over-the-counter pain relievers and fever reducers, along with lots of rest and hydration. Monitor your symptoms and call your doctor if symptoms worsen. Call 911 or go to the nearest emergency room if you are having trouble breathing or persistent pain or pressure in your chest, are unable to stay awake, have bluish face or lips, or are experiencing confusion.

Talk to your own close contacts. It’s important that you reach out to anyone you may have exposed to COVID-19. Think back to all the places you’ve gone and people you’ve seen starting 2 days before your symptoms began or you tested positive. You might receive a call from public health contact tracers in your area; it is important that you cooperate with their efforts.

Keep things clean. Wash your hands often with soap and water for at least 20 seconds or clean them using hand sanitizer with at least 60% alcohol. Make sure to wash dishes, glasses, cups, utensils, towels and bedding after use, and avoid sharing them with others in your household. Use effective household cleaners and disinfectants on all surfaces and regularly touched areas, such as TV remotes and handrails.
The best way to avoid getting COVID-19 is to follow the recommendations of public health agencies: Get vaccinated and receive a booster shot when eligible, wear a mask in indoor public locations, avoid crowds, stay away from people who are sick, and wash your hands often.

When hitting your head can be serious
Feb. 9, 2022
When hitting your head can be serious
It happens to all of us — standing up too quickly below an open cabinet or falling off a bike or scooter — but some accidental head injuries can be more serious than others.

An estimated 3 million people in the United States are diagnosed with a concussion every year. With so many people being affected, it’s important to know how even a minor injury to your head can affect your daily life.

What is a mild traumatic brain injury?
A mild traumatic brain injury, also called a concussion, occurs when the head is moved quickly and abruptly, either due to a sudden force (like a blow to the head) or deceleration (an abrupt stop of movement from whiplash or a fall). There may be brief loss of consciousness — less than 20 minutes — or a period of confusion.

What happens to your brain?
“When a brain injury occurs, the soft tissue of the brain collides against the hard surface of the skull,” says Dr. Jerome Stenehjem, a physical medicine doctor affiliated with Sharp Memorial Hospital. “Nerve fibers may be stretched or torn, which can affect brain function, even in mild cases.”

Some symptoms occur immediately, but others — especially in more mild injuries — may become noticeable as you return to your daily routine.

Common symptoms of mild traumatic brain injury include:
Nausea
Headache
Fatigue
Poor or double vision
Changes in smell or appetite
Poor hearing or ringing in the ears
Forgetfulness
Thinking more slowly
Distractibility or poor concentration
Irritability or moodiness
Sensitivity to light or noise
Most people experience some of these symptoms occasionally. However, if multiple symptoms occur after a head trauma and seem to get worse, then seek medical attention. Thankfully, most people notice an improvement in their symptoms within days or weeks and return to feeling normal within one to three months; however, for some, recovery takes longer.

If you experience a mild brain injury, consider these suggestions until your symptoms have resolved:

DO
Rest and pace yourself
Return to your daily routine gradually
Do one thing at a time
Schedule important work earlier in the day, away from distractions and interruptions
Use caution in assuming responsibilities at home, school or work without supervision
Avoid strenuous exercise
Avoid alcoholic beverages
Take only the medicine prescribed by your doctor
DO NOT
Participate in contact sports or other activities where another head trauma may occur
Make major business or life decisions
Drive a car if you are unsure of your ability to drive
Push yourself beyond what you can do comfortably and safely
Follow up on lingering symptoms
"If your symptoms last for many months or cause problems in work, school, family or social responsibilities, you should notify your doctor," says Dr. Stenehjem. "Your doctor may recommend you see a health professional who specializes in evaluation and treatment of mild traumatic brain injury."

Can you get COVID more than once?
Feb. 2, 2022
Woman wearing mask feeling ill
When attempting to explain the basic difference between the two recent variants of the coronavirus that causes COVID-19, you could say that delta is more dangerous, but omicron is everywhere. However, that doesn’t tell the whole story.

Early reports indicate that omicron may cause less severe illness. However, because it is far more contagious than previous variants, it has led to a surge in cases, an increase in hospitalizations, and a higher risk for COVID-19 reinfection — when someone is infected, recovers and then later becomes infected again.

Ask anyone who has had COVID-19 and they’ll tell you that once is bad enough — even severe or life-threatening for some. Getting it two or three times is certainly not appealing. But a repeat infection is possible, especially if you’ve not yet received a COVID-19 vaccine and booster.

Omicron presents increased risk
According to a recent U.K. study, the risk of COVID-19 reinfection is now 16 times greater than when delta was causing most COVID-19 cases. Also, the study revealed a few other significant findings related to omicron:

People who received a COVID-19 vaccine were less likely to be reinfected than those who were not vaccinated.
People who were unvaccinated were twice as likely to be reinfected than people who had their second vaccine within the last 3 months.
People who previously had COVID-19 were less likely to be reinfected than people not previously infected; however, their risk of reinfection with the omicron variant was greater than their risk of reinfection with delta.
“Essentially, the stakes are higher when it comes to omicron,” says Dr. Abisola Olulade, a family medicine doctor with Sharp Rees-Stealy Medical Group. “You’re risking a variety of things that can cause problems and may be debilitating for a lot of people, including long-term COVID.”

People who are unvaccinated at greater risk
The County of San Diego continues to report that the majority of people hospitalized for COVID-19-related complications are unvaccinated. In fact, the hospitalization rate in the county is 2 times higher for those not fully vaccinated. And the death rate for those who are not fully vaccinated is 7 times higher than fully vaccinated San Diegans.

“All of this definitively tells us that the best way to get protected is by vaccination,” says Dr. Olulade. “Vaccination is always going to be the safest way to get protected from this virus.”

The Centers for Disease Control and Prevention (CDC) recommends that everyone age 5 and older receive a COVID-19 vaccine. Those age 12 and older are also eligible and encouraged to receive a vaccine booster.

Experts also advise everyone to continue to follow other preventive measures:

Wear a well-fitting face mask in public locations
Stay 6 feet apart from people not in your household
Avoid crowds, people who are sick and poorly ventilated indoor spaces
Wash hands often with soap and water or use hand sanitizer with at least 60% alcohol
People should also get tested for COVID-19 if they have symptoms, have been in close contact with someone who has COVID-19, or are directed to be tested by their doctor, school, workplace or public health department.

Testing is available through several community and health care partners. At-home tests are also available online or in stores. Follow CDC quarantine and isolation guidelines while waiting for — and after receiving — test results.

Can omicron cause long COVID-19?
Jan. 25, 2022
Woman sick in bed
By mid-January, close to 99% of all new COVID-19 cases in the U.S. were due to the omicron variant. Since then, case numbers have continued to soar and hospitals across the country now find themselves overwhelmed by people with COVID-19 seeking care.

Early reports have indicated that the omicron variant is different than other variants of the coronavirus. It was labeled a variant of concern by the World Health Organization (WHO) because of the number of mutations within it — 22 more than the delta variant. And while omicron spreads like no other previous variant, it is believed that it may lead to milder illness.

However, questions about the symptoms of COVID-19 caused by omicron remain: Are the symptoms different, or just milder? Can the symptoms last after the infection and even be long-term — known as long-haul COVID-19 or long COVID?

According to Dr. Kaveh Bahmanpour, a board-certified family medicine and geriatric medicine doctor affiliated with Sharp Community Medical Group, some of the answers to these questions about omicron have been revealed and some are still unknown.

“It has become apparent that omicron generally leads to milder symptoms for the most part,” Dr. Bahmanpour says. “And symptoms usually last 5 to 10 days, which is shorter than previous variants, which could last up to 14 days.”

The Centers for Disease Control and Prevention (CDC) does not differentiate between the symptoms caused by each variant. Common symptoms of COVID-19 — regardless of which variant may have caused the infection — include the following, with the symptoms in bold being the most reported now:

Cough
Congestion or runny nose
Fatigue
Headache
Sore throat
Muscle or body aches
Shortness of breath or difficulty breathing
New loss of taste or smell
Fever or chills
Nausea or vomiting
Diarrhea
The possibility of long COVID
While omicron may cause less severe symptoms, this may not mean a decreased risk of long-term sickness. In fact, the CDC advises that long COVID — a range of symptoms that can last weeks or months after a person is first infected, or can appear weeks after infection — can happen to anyone who has had COVID-19, even if their illness was mild or they didn’t have any symptoms (asymptomatic).

Experts estimate up to 30% of people who have experienced COVID-19 are likely to have persistent symptoms. These symptoms can include those commonly experienced with COVID-19, along with:

Brain fog
Chest or stomach pain
Lightheadedness
Fast-beating or pounding heart (heart palpitations)
Sleep problems
Change in smell or taste
Sensation of pins and needles
Rash
Mood changes
Also, a small number of children with COVID-19 — or who had COVID-19 — experience multisystem inflammatory syndrome (MIS-C). MIS-C is a rare, life-threatening condition that can cause dangerous inflammation in the eyes, skin, blood vessels and heart.

“The possibility of long-term symptoms was something that we found out later in the course of the disease,” Dr. Bahmanpour says. “As we collect more data about each variant, we will be able to predict more. For now, while omicron seems to cause milder symptoms, the possibility of long-term effects is something yet to be determined.”

Decrease your risk
Hospitals across San Diego County are experiencing a surge of patients with severe COVID-19 due to the increased contagiousness of omicron, indicating that not all omicron-related cases are mild. In California alone, the average daily number of patients hospitalized with COVID-19 in the first two weeks of the year was over 11,000.

What’s more, unvaccinated people in the state were found to be eight times more likely to be hospitalized with COVID-19 than fully vaccinated people. This is why vaccination — and receiving a booster shot when eligible — remains vital to stop the spread of COVID-19 and reduce the risk of severe illness, hospitalization and death.

If you experience a coronavirus infection, regardless of your vaccination status, Dr. Bahmanpour advises following the CDC guidance to isolate for no less than 5 days from when symptoms started or testing positive. Isolation can end only if you are fever-free for 24 hours without the use of fever-reducing medication and any other symptoms are improving. You should then wear a face mask around others — in your home and in public — for 5 more days.

“Most of the symptoms should improve after 10 days,” he says. “However, if you are still feeling fatigue and headache or persistent cough, you should be seen by a doctor. Additionally, if you experience shortness of breath anytime during the course of the disease, you need to seek immediate care.”

What’s new in the treatment of diabetes?

Diabetes is an American epidemic. The Centers for Disease Control and Prevention (CDC) reports that just over 1 in 10 Americans — approximately 34.2 million — has diabetes, and it is estimated that 88 million adults in the U.S. have prediabetes. Many aren’t even aware of their condition.

Dr. Darius Schneider, a board-certified endocrinologist affiliated with Sharp Community Medical Group, explains that diabetes is a lifelong condition, and is caused when a person’s blood glucose levels become too high. There are three main types of diabetes:

Type 1 diabetes occurs when the body’s immune system attacks and destroys the cells that produce insulin.

Type 2 diabetes occurs when the body’s cells do not react to insulin — known as insulin resistance — often in the context of obesity, but not always.

Gestational diabetes sometimes occurs during pregnancy, when women develop very high levels of blood glucose, and the body is unable to produce enough insulin to metabolize it.
Other rare types of diabetes include maturity-onset diabetes of the young (MODY), which develops in adolescents, but acts more like adult Type 2 diabetes; latent autoimmune diabetes in adults (LADA), a slow-progressing form of autoimmune diabetes; and pancreatic diabetes.

According to Dr. Schneider, what all types of diabetes have in common is the high level of blood glucose. This results in a subsequent “spillage of glucose into the urine,” he says.

In fact, diabetes means “sweet urine,” stemming from a widespread diagnostic method known as “urine tasting,” which was used in ancient Greece and Egypt. Proof, Dr. Schneider says, that diabetes has been around for a very long time and remains a serious health concern.

“We see an increase in both main types of diabetes, Type 1 and Type 2,” Dr. Schneider says. “The increase in the numbers of people living with Type 2 is likely linked to the obesity epidemic. For Type 1 diabetes, there is no exact answer as to why we are seeing an increase. Though one hypothesis involves viral infections.”

The additional risks of diabetes
Continuously high blood glucose levels have a toxic effect on cells and tissues, especially on the cells that make up small blood vessels found in the brain, eyes, kidneys, nerves and heart. This can lead to a functional impairment of those vessels, known as microvascular disease, putting those living with diabetes at risk for a variety of additional health concerns, including.

Infections
Stroke
Diabetic kidney disease
Diabetic eye disease
Diabetic neuropathy — a type of nerve damage that can cause pain and numbness
“Small blood vessel injury leads to impaired blood flow to the tissues,” Dr. Schneider says. “And high glucose levels lead to immune cell dysfunction, making for impaired wound healing.”

According to Dr. Schneider, this is an area of intense and exciting exploration. He participated in research that discovered that certain sugar end products — or advanced glycation end products (AGEs) — that accumulate in people with diabetes serve as anchors for bacteria to enter the tissue, thus explaining why people with diabetes are prone to more frequent and more severe infections.

Effective diabetes monitoring is key
To effectively monitor and treat diabetes — both crucial due to the severity of illness it can cause — the finger-stick test remains the gold standard in blood glucose monitoring, Dr. Schneider says. However, continuous glucose monitors (CGM) are gaining in popularity.

A CGM is a small, skin-attached device that is automatically checking glucose levels every few minutes and transmitting the values to a receiver. It is made up of a sensor — a small needle-like device that is inserted through the skin and senses how much glucose is in the fluid under the skin — and a transmitter, which sends results to a receiver or mobile phone.

CGM data can also be transmitted directly to an insulin pump, where it is used for insulin dosing. When this happens automatically, it is called a closed-loop system.

“People with diabetes using this fascinating technology sometimes call themselves ‘loopers,’” Dr. Schneider says. “CGMs have been repeatedly proven to improve diabetes control tremendously. They are truly game changers for so many people living with the disease.”

Finding solutions to daily challenges related to diabetes
However, experts have learned to acknowledge the immense burdens people with the disease endure. According to Dr. Schneider, they now invest more time trying to help their patients tackle their daily challenges.

Some of these challenges include:

The discipline required to manage diabetes — “What people without diabetes take for granted is a constant effort for people living with diabetes,” Dr. Schneider says.
Access to care and drug prices — “U.S. prices for insulin, which is necessary for the bare survival for those living with disease, have skyrocketed and have seen a 200% to 300% increase in the past years,” he says.
The lack of access to healthy food — “In the U.S., healthy food choices can be very expensive and are oftentimes out of reach,” Dr. Schneider says.
Therefore, research on the disease, as well as new and improved treatments, is ongoing. According to Dr. Schneider, new treatment options for Type 1 diabetes include extremely fast-acting insulins, slow-acting insulins and fully automated insulin pumps that can communicate with CGMs to create an “artificial pancreas.”

“We’ve also seen extremely exciting studies for the treatment of Type 1 diabetes with transplantation of stem cell-derived insulin-producing cells, as well as major breakthroughs in approaches to prevent Type 1 diabetes,” he says. “There is a better understanding about the impact of diet and exercise, and about ways to successfully implement behavioral changes.”

While Dr. Schneider is concerned about increasing sedentary lifestyle and weight issues, which have a general negative impact on health, he also sees a positive shift among some people.

“We see a trend of people becoming more health-conscious and wanting to feel empowered — to take on the challenge of living with diabetes,” Dr. Schneider says. “I have never seen so many people in my practice who come in because they want to do whatever it takes to reverse diabetes.”

Dr. Schneider says that it is important to acknowledge and honor these efforts. “Successful stories do exist in the challenging environment of diabetes,” he says.

Do you really need an annual physical?

Many of us have been raised to believe that annual physicals — also referred to as wellness exams — are required to maintain good health. Physicals are typically a benefit covered by insurance plans, seemingly putting them in the same category of preventive care as annual eye exams or biannual teeth cleanings. But is an annual physical really necessary? The answer might surprise you.

Scheduling a physical with your doctor should depend on your individual needs, not the calendar, according to Dr. Matthew Messoline, a family medicine doctor with Sharp Rees-Stealy Medical Group. If you are generally in good health, you may not need an annual physical.

“It’s best to talk with your doctor to determine how often he or she would want to see you based on your individual health needs and goals,” Dr. Messoline says. “Of course, if you have a particular health issue that you feel needs attention, such as if you’re sick or have symptoms that should be evaluated, you should talk with your doctor to discuss your concern and schedule a regular appointment.”

Adults over age 65 and individuals with chronic health conditions, such as diabetes or high blood pressure, should also consult with their primary care physician, as their annual physical requirements may be different and they may need to come in twice a year.

How effective are annual physicals for healthy people?
Dr. Messoline explains that several studies on the effectiveness of annual physicals in healthy people have not demonstrated better health outcomes or reduced mortality rates in this group.

“Research has not proven that a scheduled yearly visit to the doctor can make a healthy person healthier,” he says. “In fact, annual physicals can increase the likelihood of unnecessary tests and screenings on healthy people with no risk factors. There is also an increased chance of false-positive results that can cause anxiety and unnecessary follow-up tests and treatments.”

When annual physicals incur an unwanted charge
An annual physical is a routine review of your general well-being. Sometimes patients assume they can use this time to discuss health concerns with their doctor.

Maybe you want to talk about that twinge in your lower back or stubborn sinus congestion you’ve been experiencing. After all, it seems like a convenient time because you’re at the doctor, right?

Bringing up other health issues is not part of any preventive or wellness exam, so patients could be charged for a problem-focused visit when performed with a preventive exam, like an annual physical. Later, patients are often shocked and unhappy when they receive a bill for what they thought was a free preventive service.

Scheduling a regular appointment with your doctor
Anytime you’d like to discuss a health concern with your doctor, you’re encouraged to make a regular appointment. During these regular appointments — whether they are in person or virtual — your doctor will also review any needed preventive care services.

For example, during a visit to discuss your lower back discomfort, your doctor may also notice it’s time to get your cholesterol checked or schedule a mammogram screening. Important elements of a wellness exam are incorporated into an appointment every time, with the care team working to ensure your health needs are met, regardless of the reason for your visit.

And for patients who don’t need to come in for a visit because they are healthy, Sharp Rees-Stealy reaches out to remind patients of necessary vaccines and screenings, based on published recommendations put forth by the U.S. Preventive Services Task Force.

If you’re still unsure of when to make a regular appointment, Dr. Messoline suggests scheduling a visit with your doctor:

When you are already sick
When you have a symptom that could indicate illness
To manage an ongoing or chronic condition
To check on effects of a new medication
For prenatal care
For lifestyle issues such as family planning, STD prevention and healthy eating — especially important for young adults
For other reasons based on your individual health needs
If you haven’t had health care for a long time
“Patients can be assured we’re taking into account their total health when we see them,” says Dr. Messoline. “We are proud to offer outstanding preventive medicine at every visit,” says Dr. Messoline. “We really want patients to seek help when they need it, not just wait for a special annual visit to the doctor

Men’s health 101: routine maintenance
Dec. 7, 2021
Man fixing his car
Many men make the time to maintain their cars and keep current on their fantasy football lineups. But when it comes to taking care of their own health, they tend to put it off — or worse, avoid it altogether. This can lead to more serious health issues if not addressed.

Three notable threats to men’s overall health and wellness are mental health, prostate cancer and testicular cancer. The good news is that many of these threats can be prevented by improving awareness and education, making a few lifestyle changes, and building a “health maintenance plan.”

Understanding mental health and suicide prevention
Often ignored, mental health is a key component to men’s overall wellness. Nearly 1 in 10 men in the U.S. reported experiencing some form of depression or anxiety, but less than half of those men sought treatment, according to the National Center for Health Statistics (NCHS).

Though men are evolving, there is still a preconceived notion that “being a man” means being silent and strong, which doesn’t serve them well. Trying to go it alone when feeling down can increase the risk of depression going unrecognized and untreated.

Untreated or prolonged depression is a major risk factor for suicide, and according to published studies, depression plays a contributing role to the major difference in suicide rates for men and women. In the U.S. in 2020, men died by suicide 3.63 times as often as women, although women were 1.4 times more likely to attempt suicide.

“It’s difficult at times for men to feel free and honest about their emotions and their behavioral health,” says Dr. Hans Crumpler, a board-certified family medicine physician affiliated with Sharp Grossmont Hospital. “We have degrees of stigma that have followed behavioral health for centuries now, and it's unfortunate because everybody experiences an imbalance at some point in their lives, some more severe than others.”

Although both men and women can develop some type of mental illness, the warning signs displayed can vary greatly. Outside of noticeable changes in energy level, aggression and even thoughts of suicide, some men may have physical symptoms, such as digestive disturbances or headaches.

Men typically respond differently to life’s unexpected challenges. Meeting these challenges head on and taking control is an effective way to reduce the risk of serious mental health events. Making the decision to reach out and initiate a conversation with a friend, loved one or trusted acquaintance, and establishing better social connections, will also lead to improving their quality of life.

“There are certain resources that are going to be more individualized for each person if they feel comfortable reaching into that part of their psyche and talking about emotional health,” adds Dr. Crumpler. “Society has at least accepted it and is giving more avenues for men to be able to express themselves.”

Although small, the prostate plays a large role in men’s health
The prostate gland produces seminal fluid that nourishes and transports sperm, as well as serves as a passageway for urine. Although it’s only about the size of a walnut, it plays a major part in men’s health.

The risk of developing prostate cancer increases with age. It’s the second leading cause of cancer-related death in men in the U.S., and about 1 in 8 men will be diagnosed with it during their lifetime.

Slow growing, prostate cancer may never cause any noticeable symptoms, and monitoring is recommended, as detection can be difficult. On many occasions, a doctor may be the first person to notice it during a routine checkup. It’s important to get an annual evaluation, as the survival rate of prostate cancer is greatly improved with early detection and personalized treatment.

A digital rectal examination may be used to identify an issue. The doctor examines the prostate by inserting a gloved, lubricated finger into the rectum to feel for any bumps or hard areas on the prostate that might be cancer.

According to the United States Preventive Services Task Force, men age 55 to 69 should also consult with their doctor about the prostate-specific antigen (PSA) blood test. This test measures the blood level of PSA — a protein made by cells in the prostate gland.

If the PSA level is too high, further testing with a specialist may be needed to look for the presence of prostate cancer. Although it is not a perfect test — it can provide some false results — it may be useful as part of the screening process, along with a man’s family history and previous symptoms.

A healthy lifestyle is also key to reducing the risk of prostate cancer. Consuming fresh vegetables and fruits, staying hydrated, not overindulging in alcohol and caffeine, and avoiding smoking and tobacco products are all added benefits to overall health, particularly for the prostate.

“Let food be your medication so medication does not become your food,” Dr. Crumpler says.

Testicular cancer: not just an older person’s disease
Another major threat to men’s health is testicular cancer. In 2021, an estimated 9,470 men in the U.S. will be diagnosed with testicular cancer — one of the most diagnosed cancers in young adult men, with the average age of diagnosis at 33. In 2020, there were an estimated 3,100 new cases among men age 30 to 39, and 3,000 new cases among men age 20 to 29.

“Discussing this topic starts with my male teenage patients to help them get comfortable with their bodies,” explains Dr. Crumpler. “I like to educate them on how to examine their testicles and what they’re feeling for. If there’s something abnormal within the body of the testicle, they should bring this up with their primary doctor.”

The odds of survival for men with testicular cancer are better when it’s diagnosed in the early stages. When the cancer remains local and does not spread beyond the testicles, there is a 99% 5-year survival rate, which means that 99% of patients will live at least 5 years beyond diagnosis. Even patients that have a prognosis of cancer that is regionalized, or spreads to nearby tissues, have a favorable 96% survival rate.

“Detection starts with communication from infancy on up, then it boils down to familiarity and education,” explains Dr. Crumpler. “It's important that we all take some degree of measuring and monitoring of our own body’s responses and signals to see what it's telling us.”

Taking action to maintain overall health
The feeling of invincibility often causes men to stand in their own way to better health. Although some steps are self-evident, such as making healthier lifestyle choices, the ability to recognize that this is a lifelong commitment is even more important to reaching the ultimate goal — improving overall health and extending life expectancy.

“You don't wait until the check engine light comes on in your car before you decide to change the oil,” states Dr. Crumpler. “You hopefully treat it before smoke blows out of the tailpipe. For the human body, it's just as important — in fact, even more so — because it is more complex and more precious than any vehicle.”

Dr. Crumpler tells his male patients that it's OK to be selfish about paying attention to your body. It's objective information that the body generates.

Why holiday movies improve your mood
Dec. 9, 2021
People at home watching movies
By Serene Carruthers, a licensed marriage and family therapist and manager of Sharp McDonald Center.

Sunday mornings in winter, there’s a good chance you’ll find me on the couch watching “Christmas in the Smokies,” “The Spirit of Christmas” or “A Timeless Christmas” — all modern, made-for-TV holiday movies. Growing up in a small town, where main street parades and holiday craft fairs were my reality, there is something special and comforting about these holiday movies.

As a working mom, they provide an escape from the hustle and bustle of meetings, to-do lists and raising five kiddos. As a licensed marriage and family therapist, I understand how they provide a mental break at a time when many of us need it the most.

The plots are predictable, the endings are happy — and we often see characters that we respect and aspire to be, making decisions that are selfless. Holiday movies also highlight the tenets of the recovery model — an approach to mental wellness that incorporates five core elements that help us improve and grow.

5 core elements of the recovery model

Hope
We feel a sense of hope when we watch someone find love, peace and joy, especially when it takes less than an hour for that journey to be completed. These movies serve as a reminder that even in the worst of times, there is always hope.

Connection
Most of us can relate to the loss or longing that is portrayed in these stories. We are human and we are wired for connection. Seeing the power of connection in these stories provides comfort to us, especially during the holiday season — and a pandemic.

Empowerment
We are the author of our own story, and sometimes we forget that. It is nice to have the reminder that at any moment, we can make a different choice, which will produce a different outcome. In these stories, the “fairy-tale factor” allows us to live vicariously through the characters and find our “happily ever after.”

Self-responsibility
When we see the main character take a risk and accept the past, we see them grow. In these stories, there are simple solutions available that change the trajectory of the main character’s life for the better. Though this may differ from our more complex situation, there is comfort in seeing it all work out.

A meaningful life
The key to living a meaningful life is living according to our values. These movies help remind us of what matters most and encourage us to find our purpose.
During this holiday season, I wish you a chance to slow down and assess what matters most to you. The holiday season can be a stressful one. So, like the beloved characters in your favorite holiday movie, put time and energy into the things that help you find connection and a meaningful life.

9 truths about eating disorders
Feb. 24, 2022
Young woman struggling emotionally
Eating disorders — such as anorexia, bulimia and binge eating disorder — are serious mental illnesses that affect people of every age, gender, race and socioeconomic group. It is estimated that just under 30 million people in the U.S. have had an eating disorder at some point in their lifetime.

While eating disorders are a serious illness and can be fatal, they are often misunderstood as a personal choice or “phase” one goes through. This can lead to barriers to better understanding and knowledge, as well as access to affordable evidence-based treatment.

“Eating disorders are nobody’s fault,” says Dr. Linda Santangelo, lead clinical psychologist with the Eating Disorders Program at Sharp Mesa Vista Hospital. “There are numerous contributing factors that lead to their development. Symptoms may vary from person to person, which is why it is important to talk to someone who specializes in treating eating disorders. Understanding the illness is the first step in getting better.”

To help remove the stigma and challenge the mistruths surrounding eating disorders, the Academy for Eating Disorders developed Nine Truths About Eating Disorders. Recognizing these basic facts can help people better understand disordered eating and help those in need find quality care.

Many people with eating disorders look healthy yet may be extremely ill.
Unlike images often depicted in the media of young, emaciated women, people with eating disorders come in all shapes and sizes. In fact, the majority of people are not underweight.

Families are not to blame, and can be the patients’ and providers’ best allies in treatment.
While parents, especially mothers, are often blamed for a child’s eating disorder, parents do not cause the disorders. In fact, recent research supports that eating disorders have a strong biological root.

An eating disorder diagnosis is a health crisis that disrupts personal and family functioning.
Eating disorders can affect all organs in the body, especially the heart, and result in serious physical illness, even death. They are also often accompanied by isolation, mood swings, deception, and intense rigidity surrounding eating and exercise, all of which can greatly affect one’s relationships and quality of life.

Eating disorders are not choices, but rather serious biologically influenced illnesses.
The National Eating Disorders Association (NEDA) reports that having a relative with an eating disorder increases a person’s risk of developing an eating disorder. Anxiety, depression and addiction can also run in families, and have been found to increase the chances a person will develop an eating disorder.

Eating disorders affect people of all genders, ages, races, ethnicities, body shapes, weights, sexual orientations and socioeconomic statuses.
Eating disorders do not only affect young women. They affect many groups of people:

• Men represent 25% of people with anorexia nervosa.
• Approximately 13% of women over 50 engage in disordered eating.
• Women who identify as lesbian, bisexual, or mostly heterosexual were about twice as likely to report binge eating at least once per month in the last year.
• Gay men are seven times more likely to report binge eating and 12 times more likely to report purging than heterosexual men.
• Approximately 16% of transgender college students have an eating disorder.

Eating disorders carry an increased risk for both suicide and medical complications.
Studies have revealed that approximately 20% of deaths of people with anorexia was from suicide. Additionally, a study found approximately one-third of deaths of individuals with anorexia was due to cardiovascular issues.

Genes and environment play important roles in the development of eating disorders.
A growing consensus of evidence suggests that a range of biological, psychological and sociocultural factors come together in the development of an eating disorder. Once the disorder has taken hold, it can become a self-sustaining process.

Genes alone do not predict who will develop eating disorders.
Environmental factors can include society’s thin-ideal norms as well as physical illnesses and other life stressors.

Full recovery from an eating disorder is possible.
Early detection and intervention are important. Eating disorders can be treated through a combination of psychological therapy, nutritional counseling, medical care and psychiatric monitoring. NEDA recommends that the symptoms and medical consequences of the eating disorder be addressed along with psychological, biological, interpersonal and cultural forces that contribute to or maintain the eating disorder.
“Specialized treatment is key to recovery,” says Dr. Santangelo. “Individualized care — which includes group, family and individual therapy — along with medical and nutritional support are all key components in providing a safe space for those who suffer to begin to reclaim their lives, free from their eating disorder.”

If you or a loved one is concerned about disordered thoughts or behaviors related to food and exercise, Dr. Santangelo encourages you to talk with your doctor. Treatments for eating disorders are available and can be highly effective.

Not All Customers Are Jerks
British Columbia, Canada, Employees, Pharmacy | Working | March 1, 2022
I’m picking up the prescription that I ordered online. The tech calls a consult over her shoulder to a pharmacist. It seems odd to me as I’ve been taking the same medication for five years and gave no indication that I had questions.

The pharmacist puts down what he is doing and comes over, looking at me expectantly, but I shrug and look at the tech who is typing into a computer, looking from the keyboard to the screen but nowhere else for the rest of my visit.

He leans over and whispers. In fact, the whole conversation between them is whispered.

Pharmacist: “What does she need?”

Tech: “The number.”

The pharmacist looks between me and the little sheet he’s holding, and I glance at the upside-down sheet, seeing $0, as my insurance covers the cost. I shrug again, as perplexed as he is.

Pharmacist: “I’m not seeing—”

Tech: “The amount.”

Pharmacist: “It’s free; it’s covered. I don’t see the problem.”

Tech: “The amount she wants.”

The pharmacist looks back down.

Pharmacist: “Oh. I see here.” *To me* “You ordered sixty tablets but your doctor only allows thirty at a time.”

Me: “Oh, not a problem. I didn’t know there was a maximum. I’ll take whatever I’m allowed.”

There are odd looks all around and the pharmacist goes back to whispering.

Pharmacist: “Why did you call me over?”

Tech: “I thought she’d be mad.”

The pharmacist and I shared a look as he went back to what he was doing. The tech never looked away from her computer, so I grabbed the few boxes and walked away. I get that I’m a middle-aged woman, but jeez, we’re not all unreasonable!

Probably Would’ve Been Faster To Go Home
Bad Behavior, California, Impossible Demands, Pharmacy, Public Restroom, USA | Right | February 24, 2022
I have been working as a pharmacy tech for two years and have gotten my fair share of crude comments and angry customers. I am working a quiet shift at an independent pharmacy located in a plaza. I like to play a game with myself when it’s quiet to see whether the person driving into the lot is coming into our pharmacy or one of the fast food or retail stores next to us. I’ve gotten pretty good at it!

While taking inventory, I spot a little gray Honda zipping through the parking lot and coming to a screeching stop in by far the furthest parking spot you can from the plaza, despite the availability of closer locations.

A small, middle-aged woman emerges from her vehicle with a look of determination on her face. Instinctually, I abandon the inventory work in the front of the store and step behind the counter to brace for the storm to come. As she gets closer, I can sense the looming rage emanating from her presence. She flings the door open.

Lady: “Where is your restroom? I really need to go.”

Me: “Hi, ma’am. I’m sorry, but unfortunately, we don’t have a restroom that you can use. You can try the [Sandwich Shop] next door. I’m sure they have one there.”

Our humble store is small, very small. There is very little room for storage, so space is a rare commodity. We have a storage room for the prescription files, but since we only have one washroom for employees, we use a small part of our washroom to store large bins with old prescriptions that are a few years old. Needless to say, anyone coming into our washroom that does not work there is a HIPAA violation waiting to happen.

Instead of explaining all of that, we just say we don’t have a washroom in our store. Luckily, there is a public washroom in the plaza that requires a key to get into for this exact situation. Unfortunately, during renovations in the past year, our store’s copy of the key was misplaced somewhere and cannot be located by the store owner. Most people, upon hearing that we don’t have any washroom facilities to accommodate their brewing situation, leave and look for a place elsewhere. But this is not going to fly with the Honda-driving dame.

Lady: “What am I supposed to do?! All the shops here have closed their washrooms because of [the health crisis].”

Me: “There is a gas station across the street that could let you go in.”

The lady ignores my suggestion and calls our bluff about the washroom situation.

Lady: “Well, guess what? I’m going to go right here!”

She proceeds to unbutton her pants in front of me and the poor relief pharmacist. The lady tucks her thumbs into her waistband and gets ready to pull her pants down. She pauses, cocks her head up at me, and stares me down.

In shock and contemplating whether she is serious about letting us witness her bowel movements, I stare back in silence.

Lady: “You’re really not going to let me use your washroom.”

She pauses, still staring at me. I stare back. She grunts.

Lady: “Ugh! Fine, then! I’ll do it right in front of your store!”

The lady picked up her purse and started walking out of the store, opening our door so hard the handle smacked on the glass of the nearby store. She got outside, turned around, and cupped her hands in front of her face to look at me through the glass.

Like an accident on the road, all I could do was look on at her, expressionless, waiting to see what she was about to do next. She threateningly tugged at her pants again to indicate to me that “she was really going to do it!” I looked past her to see a family with young children standing outside on the sidewalk. Noticing that I was no longer looking at her, she clued in and realized that she was about to flash not only the disapproving public but young, impressionable children.

She rebuttoned her trousers again and stormed off past my field of view and away from the eyes of children. About twenty minutes went by before I saw her sputtering silver vehicle zipping away out of the lot after what I can only presume to be the deed being done.

We Hope Your Car Has A Radio
Arizona, Employees, Ignoring & Inattentive, Lazy/Unhelpful, Pharmacy, Tucson, USA | Working | February 16, 2022
This morning, I leave for work ten minutes early so I can swing through the drive-thru of the pharmacy on the way and pick up my allergy medicine. The medicine I’m picking up does not require a prescription, but my doctor actually did a prescription anyway so that my insurance would pay for it. I got a text message last night that my prescription was ready.

I pull into the empty drive-thru and pull up to the window, and no one comes to help me. I press the call button, a voice says that they will be with me shortly, and no one comes to help me.

I wait five minutes and press the call button again, and no one comes to help me, or even answers this time.

I wait another five minutes, give up, and try to phone the store, and an employee finally comes to help me. I give her my name, birth date, and address so she can confirm my identity, and she scans my prescription, staples a receipt to it without telling me how much it is or asking whether I want to use the card on file, and sets it on the counter inside the window where I have no way of reaching it.

Employee: “The pharmacist will come give this to you.”

And she vanished before I could say anything.

I waited another seven minutes for the pharmacist to hand me the prescription that was already paid for, and, remember, did not actually require a prescription to purchase. I could see about half of the inside pharmacy counter from the drive-thru window, as well as most of the pharmacy waiting area, and there was exactly one other pharmacy customer.

Eventually, the pharmacist came to give me my medication, did not do anything that actually merits waiting for a pharmacist, and offered no explanation for the wait other than that he was on the phone with a doctor, which doesn’t explain why I had to wait for him in the first place.

As I had wasted an additional fifteen minutes on what should have been a two-minute stop, I was barely on time to work and had to rush to get myself clocked in and start working.

It’s All In The Timing
Bosses & Owners, France, Instant Karma, Jerk, Non-Dialogue, Pharmacy | Working | February 14, 2022
A high school friend is working at a big local pharmacy. He has no medical degree, so he does all the other tasks: stocking the shelves, filling the printers, cleaning, etc. He likes to tell the story of how he got the job.

It started as a summer job, and then they gave him a short-term contract, which was renewed twice. The law says that after the third contract you have to consider making it a full-time position. The head pharmacist was all for keeping him, but the owner thought it was a waste of money and said so with some nasty slurs about uneducated people.

So, the head pharmacist talked to my friend, and they arranged the schedule for him to stop working right as the pharmacy opened their brand new orthopedics aisle. With no one to do the basic tasks and the extra load of work for the opening, it was a nightmare. The owner had to step in more than once to keep the pharmacy running.

It took some more negotiations before my friend got his long-term contract, but the owner was way more open to the idea of a non-medical worker helping out. At least the health crisis didn’t hurt them too badly.

Thanks For The Double Dose Of Guilt
Employees, Jerk, Medication, Pharmacy, Sweden | Healthy | February 13, 2022
I take a very expensive medicine. Luckily, since I live in Sweden, I don’t even pay for one month’s full use myself until I start getting it for free. The trick with this medicine is that it needs to be refrigerated, so I cannot order it home and I always need to plan my shopping when getting it since I cannot have it in my bag for too long.

I have just gotten new instructions from my doctor saying I can take out for two months instead of one, since she doesn’t think I should need to go to the pharmacy too often in the health crisis. Unluckily, the power goes that night, and I don’t know for how long, so I call medical services to find out what I should do with the medicine. Since there is a risk that it will be ruined, they tell me to take it back to the pharmacy to get new ones. Since I need a dose for that day, I go to do so, and I have to put other plans aside for the day in order to fix this.

Me: “Hi. I’m so sorry, but the power went and they said to exchange this in case it has gone bad.”

The pharmacist takes the medication and looks at it, then me, then to her computer, and then me again.

Pharmacist: “Do you know how expensive this is?”

Me: “Yes. As I said, the power went off, so the medicine might have been compromised.”

Pharmacist: “This is for two months!”

Me: “Yes, I know. I took it out yesterday — worst luck!”

She frowns and looks at her computer for a while.

Pharmacist: “Well, we don’t have any here, but you can find it at [Other Pharmacy].”

Me: “All right, should I just leave this here and go there, then?”

Pharmacist: “No, you need to bring this with you, or you can’t take out new medication again. Also, next time, perhaps you should only take out for one month; that way you won’t ruin as much of it.”

I did as she said and went a few blocks over to another pharmacy, only to have almost exactly the same conversation. I did get to make the exchange this time. I was so embarrassed and felt guilty about the whole thing, yet it was not even my fault, so thinking back, I wonder why they needed to keep rubbing it in?

You Can Always Trust The Internet
Bigotry, Health & Body, Pharmacy, Stupid | Right | February 7, 2022
I work at a pharmacy. A customer is trying to fill a prescription.

Customer: “Make sure my medication doesn’t come from China! They make microchips there, and I don’t want any of the microchip-contaminated medicine.”

Me: “I’m not sure I understand what you’re talking about, sir.”

Customer: “I learned about it on YouTube!”

Who Traumatized This Poor Tech?!
Bad Behavior, Employees, Insurance, Money, Pennsylvania, Pharmacy, Pittsburgh, USA | Healthy | January 26, 2022
Due to a variety of circumstances, our health insurance benefits come from my husband’s former (lousy) employer. They have switched to a new plan that is horrible. I signed us up for a plan from the marketplace but we are forced to keep the current plan for a month. I need to pick up a refill on my husband’s medication and it’s less than a week before Christmas.

Me: “I’m here to pick up a prescription for [Husband].”

Tech: “Sure. Can I get a date of birth?”

She enters the date of birth and freezes, staring at the computer. Finally, she starts to speak.

Tech: “Um, yeah, so, uh, we, we got his inhaler. It, um, it came in today.”

Me: “Okay?”

Tech: “So, it’s um, the insurance…”

Me: “I assume it’s more expensive under this plan.”

Tech: “Uh, yeah. It’s $405.00.”

Me: “Holy s***. Okay.”

Tech: “So, do you want it?”

Me: “It’s not that I want it. It’s that he needs it, so… yeah.”

Tech: “It’s $405.00.”

Me: “Yes.”

Tech: “Hang on. I’m trying to figure this out.”

Me: “This is horrible insurance. It just started at the beginning of this month and we have new insurance starting next month. I know that’s why. It doesn’t matter about the details.”

Tech: “HANG ON! I’M TRYING TO FIGURE THIS OUT!”

I stand there, stunned.

Tech: “They are saying you haven’t reached your deductible yet. Your deductible is—”

Me: *Interrupting* “I know. This plan started this month. We have a new plan for next year. We will never reach the deductible.”

Tech: *Almost yelling* “I know it’s almost Christmas. I can’t help it!”

Me: “Unless you are actually an insurance company executive in disguise, it’s not your fault. Are you ready for my card?”

Tech: “MA’AM! IT’S $405.00!”

The pharmacist, who had been helping another customer, comes over.

Pharmacist: “It’s fine, [Tech]. She’s not upset. She’s not yelling. Just ring her up.”

Tech: “IT’S NOT MY FAULT!”

Pharmacist: “I know. But she’s not mad at you. Just move and I’ll finish up.”

Just then, the store manager and a security guard come RUNNING toward us.

Manager: “Did they get away?”

Pharmacist: “Who? What’s going on?” *Pauses* “OH, MY GOD! [TECH]! Did you hit the panic button?!”

Tech: “Yes, she was upset.”

Pharmacist: “She was shocked at the price but she was not a problem.”

Manager: “What’s going on?”

Pharmacist: “This lady was picking up a refill. Last month it was $45. The new insurance price was $405.00”

Manager: “HOLY S***!”

Pharmacist: “That’s what the customer said, but she was much quieter about it. She wasn’t yelling or upset. She was just very surprised. I’m going to have a talk with [Tech]. There’s no issue here. You guys can leave.”

He manages to finish things up and I pay. All the while, the manager and security guard stand there, staring at me.

Pharmacist: “Ma’am, I’m really sorry about all this. You did nothing wrong.”

Me: “Look, don’t be too hard on her. I’m going to assume that most people scream at her for things like this. I was expecting the price to have gone up — maybe not by 800% but up. I’m sorry if she thought I was yelling.”

Pharmacist: “You were fine. I think she just needs to take her break now.”

I sincerely hope she calmed down during her break.

13 Reasons Why I Hate Working Here
Coupon, Impossible Demands, Minnesota, Non-Dialogue, Pharmacy, USA | Right | January 24, 2022
During my high school sophomore year, I worked at a large chain pharmacy store through a couple of the major holidays and the dreaded 13¢ coupon days.

I hated the 13¢ coupon days. The store is right next door to an assisted living building for folks over fifty-five that are still well enough to live on their own but sometimes need help. These folks lived for the 13¢ coupon days. They came in droves and snatched up as much as they could for every 13¢ coupon that was in the weekly flyer.

The 13¢ coupons were usually for smaller, knickknack-type things, something you normally wouldn’t want to spend money on, but these people gobbled up the items. We had pencils, large erasers, travel items — such as hand lotion — that kind of thing. Within the first day, we would easily be out of a lot of these items, and the old people would just rant and scream at us for not having more and then demand rain checks to be made.

The manager would have to explain to them that the coupons do not get rain checks and that all items on the coupons are first-come, first-serve. So many angry, blue-haired old ladies. It sucked.

If The Employees Are Terrible, What Does That Make Me?
I Don't Work Here, Jerk, Pharmacy, Reddit, Retail | Right | CREDIT: Cow_Toolz | January 21, 2022
Earlier this year, I was in a pharmacy that was having a sale on makeup, with all the sale items together on one table. I had an armful of products and was searching through the rest for particular colours, moving things around, putting some things back when I found something I liked better, etc.

A woman who was part of a middle-aged couple came into my aisle and stood a few displays away behind me, complaining to her partner about the pharmacy and how she couldn’t find something.

I was focused on what I was doing so I wasn’t really listening to their conversation; my brain just registered some kind of sarcastic white noise that was getting increasingly louder and more passive-aggressive.

Her partner was quietly trying to hush her as she continued to exaggeratedly sigh and moan to him.

Woman: “This pharmacy’s employees are terrible. Gah, I need helllp!”

From the time she’d walked into the aisle, she had just stood there and never attempted to go find an employee or whatever it was she was after.

Finally, she very loudly and exasperatedly bellowed:

Woman: “Does she even work here?!”

I was startled by the outburst and turned around to look at her, finding her looking shocked and turning red because that was the exact moment when she realised that, no, I didn’t work there and wasn’t some employee ignoring her, and also the moment when I realised that the whole two minutes or so of sighing and nasty comments were actually aimed at me.

Flustered, she grabbed her partner’s arm and marched past me without making eye contact, still complaining about the pharmacy and its “terrible service,” though now in the erratic tone of someone trying to convince themselves they hadn’t just done something embarrassing.

I was dressed in all black (not anything like the employee uniform, but not out of the realm of possibility that I could work there) and I can understand how she might have thought I was restocking or sorting the sale table, but what a way to go about it instead of just asking, “Excuse me, do you work here?”