00:00:00Pivoting Pharmacy With Nutrogenomics
00:18:09Implementing Nutrigenomics in Pharmacy Practice
אודות פרק זה
As a pharmacist, I’m sure you're all too familiar with the constant revolving door cycle our healthcare system puts our patients in.
But how can we help break the endless cycle plaguing our patients and truly make a change so they can start feeling better for good?
I’m Dr. Tamar Lawful and just like you, I asked myself that same question throughout my career. That’s why I made it my mission to unlock the unending potential we as pharmacists have to transform the way we think about health care through the lens of nutrigenomics. I’m thrilled you’ve decided to join me on this journey, so stay tuned because we’ve got a lot to cover!
BY THE TIME YOU FINISH LISTENING, YOU’LL DISCOVER:
But how can we help break the endless cycle plaguing our patients and truly make a change so they can start feeling better for good?
I’m Dr. Tamar Lawful and just like you, I asked myself that same question throughout my career. That’s why I made it my mission to unlock the unending potential we as pharmacists have to transform the way we think about health care through the lens of nutrigenomics. I’m thrilled you’ve decided to join me on this journey, so stay tuned because we’ve got a lot to cover!
BY THE TIME YOU FINISH LISTENING, YOU’LL DISCOVER:
- How a seemingly successful medication initiative led to a major lightbulb moment.
- Why the way we as pharmacists have been trained to treat common issues may be more of a “band-aid over a bullet wound” approach than an actual solution.
- The key to unlocking your full potential so you can start treating the whole patient, not just their symptoms.
Special Message from Dr. Tamar Lawful: Discover the InHer Glow® Concierge Wellness Experience , a precision health program designed exclusively for high-achieving women ready to lose weight, boost energy, and reduce medications without guesswork. Spots are limited! Apply today at thelyfebalance.com/concierge
✨ Ready to take today’s insights and put them into action?
WANT AN ELEVATED APPROACH TO YOUR HEALTH?
- Concierge Wellness Consult – Discover how your DNA unlocks energy & vitality [Apply Here].
- Preview A Genomic Report – See a sample [Preview Here].
- follow Dr. Lawful on LinkedIn [Follow Here].
FOR PRACTITIONERS & HEALTH PROFESSIONALS
- Refer With Confidence – Explore partnership opportunities [Schedule Here].
FOLLOW TAMAR LAWFUL, DOCTOR OF PHARMACY
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WEBVTT
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As pharmacists, you're all too familiar with the drive-through revolving door cycle of our healthcare system.
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You know the long lines of patients dropping off prescriptions, irritated patients taking up medications, the limited time you have to counsel them, the company metrics and politics, short and shallow consultations All of this only to see the same patients again and again for the same ailment.
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At some point you've probably wondered is what I'm doing actually helping my patients?
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Am I just maintaining their chronic condition or am I helping them get better?
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These are questions I definitely asked myself throughout my career.
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How can we get out of the drive-through and off the revolving door to have a meaningful impact on the health of our patients so that they can feel better, reduce the need for medications and you can start feeling fulfilled in your career because you are making a difference?
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How can we go from being an expert in disease maintenance to a powerful guide for healing and optimal health?
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I'm going to show you how in today's episode.
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Welcome to Pivoting Pharmacy with Nutrigenomics.
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Part of the Pharmacy Podcast Network, a must-have resource for pharmacist entrepreneurs seeking to enhance patient care while enjoying career and life.
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Join us as we pivot into Nutrigenomics, using pharmacy and nutrition for true patient-focused care.
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Explore how to improve chronic conditions rather than just manage them.
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Celebrate entrepreneurial triumphs and receive priceless advice.
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Align your values with a career that profoundly impacts patients.
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Together, we'll raise the script on health and pivot into a brighter future.
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Hello, hello and welcome to the first episode of Pivoting Pharmacy with Nutiogenomics.
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I'm Tamar, your guide in this exciting new journey.
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Brace yourselves as we're about to deep dive into the unending potential we, as pharmacists, have to transform healthcare, and the juicy part.
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It involves studying the fascinating crossroads of what you eat and your genes.
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Now to lay down some of my own journey.
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A few years ago, I found myself steering a transition of care service in a hospital setting.
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One of our unique offerings was a med-to-bed program.
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Picture this At discharge, my patients will leave not only with a 30-day supply of their medications, but also with real, deep insight about their health condition.
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Partnering with my All-Star Pharmacy technician, we'd sort their doctor's appointments and diligently follow up post-discharge.
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We became a constant in the hospitalist team, keeping a watchful eye on our patients and offering crucial therapeutic recommendations.
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You know what's coming right.
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This initiative was a smash hit.
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30-day hospital re-emission rates dropped for those enrolled in the program.
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We didn't just improve health outcomes, we also saved a pretty penny.
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The notable victory was in part due to having a passionate pharmacist like you on the team to make sure that patients receive the right medications, dodging interactions, minimize inside effects and avoiding therapeutic duplications.
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Still, among the high fives and celebratory dances, there was a little worm of worry those patients that still found their way back.
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What was their story?
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The pattern was blatant.
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When they were re-admitted, blood pressure reaching for the moon.
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Tack on another medication, blood glucose going haywire, crank up the insulin dose, the quick fix seemed to revolve around that buzz kill of a question what pill can we give to patch this up?
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This led to prescriptions piling up higher and higher and of course that meant a hardier pill load, side effects going through the roof, routine hospital visits and healthcare cost skyrocketing.
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It dawned on me that the majority of these patients needed more than medication management and a lightning fast consultation.
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As fellow pharmacists, I know each of you share my understanding of these systemic issues plaguing our healthcare, the ones looming over us like big medicine walls blocking our path to better patient outcomes.
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So let's dive into today's hot topic.
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The mother of all issues and impedes the improvement of patient outcomes by pivoting our focus from a medication-driven approach to a holistic approach centered on nutrition and lifestyle, we can be better equipped to provide patients with the support needed to improve their health.
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The issue is that in our day-to-day practice we do not focus on nutrition and lifestyle with our patients.
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But can you blame us?
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As pharmacists, we've been trained and practiced relentlessly in the art of medication management.
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We've got therapeutic indications, drug interactions, kinetics and mechanisms of actions down to a fine art.
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But let's press the pause button.
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Didn't someone along the way also whisper something about coaching our patients on nutrition and lifestyle tweaks?
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But ask yourself this how often are we really shining a light on those aspects?
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And when we do take a breather to deal with nutrition and lifestyle, how deep do we really go with our patients?
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Let's be brutally honest here.
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The roadblock we're up against is twofold.
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First, our main adversary the gross neglect of nutrition and lifestyle and healthcare management.
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Hot on its heels comes our secondary adversary the stark deficit in reinforcement mechanisms to cheerlead our patients as they navigate the tangled web of nutritional and lifestyle overhauls.
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Think about your own experience.
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How often do you see patients given a prescription along with referrals to a nutritionist, dietitian, health coach or personal trainer?
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More often than not.
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The narrative is dominated by medications, while the support for lifestyle and nutrition modifications is kept on the back burner.
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So where does this lead us?
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Straight to Sky High Hospital re-emission rates.
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My friends, the numbers don't lie.
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The Centers for Medicare and Medicaid Services, cms, reveals that as of 2022, there was a 30-day hospital re-emission rate of 15%.
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Massachusetts seems to take the lead with nearly 16% re-emission rates, and the lower end of the spectrum includes Utah, hawaii and Washington, all hovering around 14%.
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Suffice to say, recurring hospital admissions are a significant bottleneck in healthcare, adding stress to patients and contributing to the strain of the overall healthcare system.
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The catch is, many of these re-emissions are avoidable, often attributed to poor chronic disease management and insufficient follow-up care.
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Now, as I pointed out earlier upon re-emission, patients typically experience one of three things with their medications An upward dose adjustment, an additional medication to their already burdened regimen or a combination of both.
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Discharged patients often find themselves on a larger slate of medications than when they enter the hospital.
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This approach directly leads to polypharmacy.
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Consequently, many patients are now on five or more medications.
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Polypharmacy not only escalates medication costs, but also places patients at risk for medication-related complications, adverse drug events and unpalatable side effects.
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The overemphasis on medications often bypasses the root causes of health issues, trapped in patients in a relentless cycle of prescriptions and side effects.
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Now numerous instances come to my mind.
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Where my gung-ho pharmacy residents or students would come to me wide-eyed, unfolded a case where a patient was on as many as 20 medications before hospital admission.
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Unsurprisingly, a majority of these medications were continued upon admission, along with newer ones added to the list.
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Now, as pharmacists, our job becomes reviewing these for necessity, checking for drug interactions, verifying appropriate dosages and ensuring they're not exacerbating the patient's current condition.
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Additionally, we also have to confirm the accuracy of their preadmission medication list via medication reconciliation and luckily, by following these steps, we can be prescribed and reduce the number of medications a patient needs to take.
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But the heart of the matter remains untouched the neglect of nutrition and lifestyle changes.
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Traditional healthcare models frequently fail to acknowledge the integral part nutrition and lifestyle play in our overall health and wellness.
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Band-aid solutions barely scrape the surface of health issues, leaving golden opportunities for holistic healing and optimal health on the table.
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Why are we missing the mark here?
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As pharmacists, we remember those long college nights studying right Our textbook, and professors taught us to promote nutrition and lifestyle alterations for chronic conditions like diabetes, hyperlipidemia and hypertension, before we even think about medications.
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But let's get real.
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Was our training as filled with nutrition and lifestyle intervention strategies as it was with pharmacology?
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I can hear you shaking your heads.
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Even though lifestyle modification always sounded like a great idea, our toolbox to actually implement it was embarrassingly sparse, and I have a sneaky suspicion physicians might be feeling the same way.
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And what's our attempt at a solution?
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Given our bare bones education on nutrition and lifestyle, our counseling on medications and chronic conditions often culminates in quick pep talks, touching on basic guidelines like reducing salt intake, limiting sugar and carbs and getting, say, 150 minutes of exercise per week.
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But can these snippets of advice really help our patients make profound health transformations?
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Keeping on with this band-aid approach has a pretty hefty price tag.
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In 2019, the CDC reported that a staggering 130 million American adults were living with diabetes or pre-diabetes, with an estimated 1.4 million new cases of diabetes diagnosed that year among adults 18 and older.
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This number continues to increase annually and will undoubtedly persist if we fail to pivot from our current medication centric healthcare model.
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It's high time we dug deeper with a firm resolve to invest in our patients' outcomes in a more holistic and sustainable manner.
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You know as well as I do that our roles as pharmacists goes beyond just swiftly dispensing medications and dishing out basic, cookie cutter health advice.
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We're called to aim higher and push boundaries.
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Our patients are counting on us for more.
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They need that consistent, personalized support that sees them through their journey to improved health.
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It's not about a one-off conversation on diet, exercise and medications.
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It's about ongoing, tailored guidance.
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We have a unique opportunity to reshape our patients' health by meshing our services with personal needs, lifestyle and genetic makeup and beyond.
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By marrying our pharmaceutical knowledge with emerging fields like nutrigenomics, we delve into the heart of personalized medicine, adopting a holistic viewpoint to understand each patient's nutritional patterns and lifestyle.
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This means having profound conversations with our patients, helping them devise personalized dietary plans, assessing their adherence to medications, tracking their physical activities and even lending an ear to their mental health concerns and other life circumstances.
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Yes, this is how we can forge an all-encompassing health plan that doesn't just manage chronic conditions, it improves them and truly encourages patient engagement in their health journey.
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And guess what?
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We already got two powerful tools in our arsenal for this mission Health coaching and nutrigenomics.
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When paired together, they form an unparalleled duo that elevates our personalized patient care to new heights.
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So pivot with me and picture this.
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You're in a typical pharmacy setting.
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It's just another Friday, the phone is ringing off the hook, medication orders are spilling out of printers and sanitized smell of pills are in the air.
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Patients come and go with some variation of advice in hand Eat healthier, exercise more, watch your blood sugar.
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But you know what?
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As healthcare professionals, you and I, we're way too savvy to think it's that simple, aren't we?
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We see that.
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Look in our patient's eyes the overwhelm, the uncertainty and yes, even there.
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They know they should eat healthier, but they're not sure exactly what to eat.
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They know they need to manage their diabetes, but they have trouble grappling with the daily pressures while maintaining their health, with glucose readings becoming more of a bitter foe than a guiding friend.
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You've probably asked yourself what I have often asked myself.
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What if we tore up the repetitive scripts?
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What if we could do more than just manage our patient symptoms?
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What if we could empower them to take control of their own health journey?
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This is where health coaching comes in, stepping up to bridge that knowledge action gap.
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It's not about dishing out one-size-fits-all advice, but rather about tailoring a plan that fits the specific lifestyle challenges and goals of each patient.
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Think of health coaching as a dynamic duo of guidance and support.
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It's your patient's trusty sidekick, helping them navigate their health journey, providing them with the map and the tools, but ultimately allowing them to drive their own wellness vehicle.
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Now, why is this so important?
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Consider the diabetes epidemic.
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We know, and our patients too know, that diet plays a substantial role in its development.
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Yet despite this knowledge, race of diabetes aren't decreasing.
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Instead, they're on the irritating, perpetually upward trend.
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Managing this chronic condition seems like mounting the same, frustrating, endless merry-go-rounds.
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But with health coaching, there's an opportunity to flip the script.
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Health coaching invites patients to become active participants in their healthcare journeys rather than passive recipients.
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It empowers patients to understand their unique triggers, create healthier habits and, most importantly, to sustain these habits in the long run.
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Now, as pharmacists whether dealing with the challenges of patient care or the ups and downs of entrepreneurship integrating health coaching into your practice can be a game changer.
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Not only could it transform how your patients view and manage their health, but it could alter your role as a pharmacist, too.
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You could become not just dispensers of medications, but dispensers of empowerment, guidance and long-lasting change.
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Health coaching isn't just a change in strategy.
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It's a reinvention of our patient care approach.
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It's about finding that balance between treatment, prevention and patient empowerment.
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You're doing fantastic work already, but remember, even a load of changes can foster big transformations.
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Let's dig deeper into health coaching.
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Let's empower patients to live fully and violently, because anyone's health journey can be a challenging one, but with health coaching it doesn't have to be a journey they take alone.
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Now let's pivot again and picture yourself in a cozy, sunlit kitchen catching up with your oldest and dearest friend.
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You're both so engaged in conversation that the warm steam from your cups of tea is gently fogging up your glasses.
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Your friend shares a recent revelation it's amazing how two people can eat the exact same meal, yet one person feels energized when the other feels fluggish and bloated.
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You nod with a knowing smile because you too have witnessed similar scenarios.
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It's in these moments that we realize the power of our individuality when it comes to health and wellness.
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This is where the magic of Nutrigenomics enters the scene.
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Nutrigenomics is all about diving deep into the intricate dance between nutrition and genetics to create a personalized wellness blueprint unique to each individual.
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You see, we all possess the genetic makeup that is beautifully diverse, which means that our bodies react differently to various foods and nutrients.
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What if, as pharmacists, we could become wellness architects, capable of helping patients build a tailor-made foundation of health based on their unique genetic profile?
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Imagine giving each patient the ultimate compass, guiding their every nutritional decision to address the root of their health challenges.
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Sounds amazing, right?
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While the idea of implementing Nutrigenomics in your practice might seem foreign and overwhelming, trust me, it's not as daunting as it seems.
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It could simply start with establishing relationships with genetic testing labs, getting trained in interpreting genetic test results and using that information to create personalized nutrition and lifestyle recommendations.
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Remember, even the tiniest steps forward bring us closer to creating a greater impact.
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Now you might be wondering about the cost associated with Nutrigenomics, and of course, that's a valid concern.
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Providing the service might initially require an upfront investment in training and test kits, but the value it could bring to both your patients and your practice is extraordinary.
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It does not have to break the bank.
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There are scalable options to fit different budgets and levels and involvement.
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Using Nutrigenomics into your practice could revolutionize the way you help your patients achieve their healthiest lives.
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It's an opportunity to not only alleviate symptoms, but to equip patients with unmatched power to prevent and even possibly reverse certain health challenges through personalized nutrition and lifestyle changes.
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Imagine how powerful it would be to have a plan that truly resonates with your unique needs and possibilities.
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That's what you offer patients with Nutrigenomics, coupled with health coaching, personalized programs that emphasize nutrition, exercise, even stress management and sleep, giving your patients a holistic guidance necessary to live a healthy and happy life.
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By providing personalized nutrition and lifestyle guidance based on your patient's genetic profile, you can better manage chronic conditions and prevent complications that lead to hospital re-emissions.
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You can truly deprescribe nip and polypharmacy in the bud and reduce the need for multiple medications and their associated costs.
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This not only benefits patients but also eases the burden on our healthcare system.
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Incorporating Nutrigenomics into our pharmacy practice can shift the focus of healthcare towards a more holistic, patient-centric approach, emphasizing the importance of nutrition and lifestyle and achieving optimal health.
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Now I have a little secret to tell you, because earlier I mentioned getting all this training in Nutrigenomics so you can interpret labs.
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But I have a secret to tell you when a Nutrigenomics report lands on your desktop whether it's in paper form or it's on your screen, your computer screen it's brimming with potential.
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It describes the types of foods patients should consider including in their diet insights on managing stress, effective exercises and potential supplements customized to their genetic profile.
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And with such an invaluable guide, our role shifts from working with generic recommendations to guides of personalized wellness map for the patients standing right in front of us.
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As pharmacists, we get the incredible privilege of serving our patients in their worst, vulnerable moments.
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We are part of the solution for improving patient outcomes.
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We are uniquely positioned to integrate Nutrigenomics into our practice and lead the charge in transforming healthcare.
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And now, with Nutrigenomics in our toolkit, we get to steer that privilege towards making tangible, lasting differences.
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We are at the heart of a shift in paradigm, the unique gatekeepers poised to bring an exciting transformation in healthcare.
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Now listen closely, because I have another secret to tell you.
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Although I am now a certified nutritional genomic specialist, at the beginning of my journey, my introduction to Neutrogenomics was met with a pinch of skepticism.
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I can still remember questioning can this really help my patients in a way that traditional medicine hasn't Spoiler alert?
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The answer was a resounding yes.
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In fact, the meticulousness and precision of the results were astonishing.
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It was like being handed the keys to a secret map of each individual patient's health.
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I'll never forget one particular client who had a history of seizures.
00:23:14.006 --> 00:23:26.407
She sought my help for weight loss and mood stabilization, instead of just handing her a generic diet plan, her Neutrogenomics report allowed us to home in on her brain health.
00:23:26.407 --> 00:23:34.322
We had overwhelming amounts of data pointing to precise dietary recommendations specifically designed for her.
00:23:34.322 --> 00:23:36.402
But it didn't stop at diet.
00:23:36.402 --> 00:23:41.227
Our action plan extended to adaptations around her sleep and stress management.
00:23:41.227 --> 00:23:46.447
This holistic, personalized approach marked the beginning of her transformative journey.
00:23:46.447 --> 00:23:48.282
She didn't just see changes.
00:23:48.282 --> 00:23:52.386
They were significant shifts paving away to her improved health and quality of life.
00:23:52.386 --> 00:23:57.666
Stories like hers underlined the power and potential of Neutrogenomics.
00:23:59.057 --> 00:24:00.342
Now here's my message to you.
00:24:00.342 --> 00:24:05.186
It's easy to feel overwhelmed in the maze-like structure of today's healthcare system.
00:24:05.186 --> 00:24:12.624
But remember, you didn't enter this field to be stuck in a revolving door of unfilling rote responsibilities.
00:24:12.624 --> 00:24:20.228
You poured your heart and soul into becoming a pharmacist because you wanted to impact lives, to make a difference.
00:24:20.228 --> 00:24:23.464
So who said you must accept the status quo?
00:24:23.464 --> 00:24:27.104
It's time we disrupt the assembly line mentality.
00:24:27.104 --> 00:24:41.667
Imagine stepping out of that monotonous fast food style drive-through and instead invite your patients to sit at the table with you, fostering meaningful conversations and architecting plans tailored for them.
00:24:41.667 --> 00:24:47.847
My friends, this is how you can play a better and more fulfilling role in their health journey.
00:24:47.847 --> 00:25:00.988
This is how you can reduce their reliance on a medicine cabinet full of prescriptions, because, at the end of the day, a happy, healthy patient reflects a successful and satisfied pharmacist.
00:25:02.075 --> 00:25:06.646
Being custodians of patient health is not just about dispensing medications.
00:25:06.646 --> 00:25:13.088
It's equally about dispensing knowledge, understanding, inspiration and hope.
00:25:13.088 --> 00:25:23.918
And trust me, no career satisfaction can parallel the gratification of knowing you have made a significant difference in someone else's life, don't you agree?
00:25:23.918 --> 00:25:32.028
So let's keep exploring Nutrigenomics and step into our role as builders of personalized wellness and health superheroes.
00:25:32.028 --> 00:25:46.629
Let's grasp the potential to empower our patients to take control of their health, all while staying true to ourselves and staying connected to the reason we became pharmacists in the first place to help others.
00:25:46.629 --> 00:26:01.208
Think of it as beginning the next chapter in your pharmacist superhero story, where you embark on new adventures in the world of Nutrigenomics and together we redefine the landscape of patient care.
00:26:01.208 --> 00:26:07.887
Now let's get to work and pivot into Nutrigenomics and raise the script on health.
00:26:07.887 --> 00:26:10.742
That is all I have for you today.
00:26:11.375 --> 00:26:16.087
Thank you for joining me on this first episode of Pivoting Pharmacy with Nutrigenomics.
00:26:16.087 --> 00:26:19.324
The excitement in the air is palpable, isn't it?
00:26:19.324 --> 00:26:28.228
Especially when you consider the revolutionary changes that Nutrigenomics holds for our health care system and for our dear patients' lives.
00:26:28.228 --> 00:26:30.700
Are you loving what you're hearing?
00:26:30.700 --> 00:26:32.841
If yes, I have a favorite ask.
00:26:32.841 --> 00:26:36.459
Picture a fellow pharmacist entrepreneur in your mind.
00:26:36.459 --> 00:26:51.663
Perhaps they're at a crossroads in their business or struggling to incorporate unconventional services like Nutrigenomics, or maybe they've just started opening up and about feeling a bit stuck lately, not knowing which direction is steer their business.
00:26:51.663 --> 00:26:54.061
Would you share this episode with them?
00:26:54.061 --> 00:27:08.088
By doing so, you're not only adding value to their journey and fostering nurturing connections in your community, but also joining in an exciting communal endeavor raising the bar in health care for our patients.
00:27:08.088 --> 00:27:12.505
After all, we're all comrades in this grand mission, aren't we?
00:27:13.535 --> 00:27:20.308
It starts small just by sharing this episode, and if you've appreciated how we spent together on this show, let the world know.
00:27:20.308 --> 00:27:21.398
Leave a review.
00:27:21.398 --> 00:27:23.060
It's as simple as that.
00:27:23.060 --> 00:27:27.866
Open your Apple Podcast app, scroll down and give it a five star rating.
00:27:27.866 --> 00:27:30.703
Maybe share a sentence or two about what you enjoyed.
00:27:30.703 --> 00:27:35.346
That action, as tiny as it might seem, would mean the universe to me.
00:27:35.346 --> 00:27:41.947
Plus, it also lets other kindred souls know that our show is worth a listen in their precious time.
00:27:41.947 --> 00:27:45.224
Together, we can make a difference in the world of health care.
00:27:45.224 --> 00:27:46.519
Are you up for it?
00:27:46.519 --> 00:27:58.885
Coming up next week on the show, we'll dive deeper into the science behind Neutrogenomics and discuss how you can begin implementing it in your practice, because this may be the first time you're hearing about Neutrogenomics.
00:27:58.885 --> 00:28:07.744
If it's not, you're probably wondering why it should matter to you as a pharmacist and how you could possibly start using it with your patients.
00:28:07.744 --> 00:28:10.819
So tune in next week, don't miss it.
00:00:58.701 --> 00:01:03.551
As pharmacists, you're all too familiar with the drive-through revolving door cycle of our healthcare system.
00:01:03.551 --> 00:01:20.490
You know the long lines of patients dropping off prescriptions, irritated patients taking up medications, the limited time you have to counsel them, the company metrics and politics, short and shallow consultations All of this only to see the same patients again and again for the same ailment.
00:01:20.490 --> 00:01:25.792
At some point you've probably wondered is what I'm doing actually helping my patients?
00:01:25.792 --> 00:01:30.450
Am I just maintaining their chronic condition or am I helping them get better?
00:01:30.450 --> 00:01:34.150
These are questions I definitely asked myself throughout my career.
00:01:34.150 --> 00:01:49.513
How can we get out of the drive-through and off the revolving door to have a meaningful impact on the health of our patients so that they can feel better, reduce the need for medications and you can start feeling fulfilled in your career because you are making a difference?
00:01:49.513 --> 00:01:57.173
How can we go from being an expert in disease maintenance to a powerful guide for healing and optimal health?
00:01:57.173 --> 00:01:59.766
I'm going to show you how in today's episode.
00:01:59.766 --> 00:02:03.807
Welcome to Pivoting Pharmacy with Nutrigenomics.
00:02:03.807 --> 00:02:13.473
Part of the Pharmacy Podcast Network, a must-have resource for pharmacist entrepreneurs seeking to enhance patient care while enjoying career and life.
00:02:13.473 --> 00:02:21.253
Join us as we pivot into Nutrigenomics, using pharmacy and nutrition for true patient-focused care.
00:02:21.253 --> 00:02:26.106
Explore how to improve chronic conditions rather than just manage them.
00:02:26.106 --> 00:02:30.114
Celebrate entrepreneurial triumphs and receive priceless advice.
00:02:30.114 --> 00:02:34.551
Align your values with a career that profoundly impacts patients.
00:02:34.551 --> 00:02:39.867
Together, we'll raise the script on health and pivot into a brighter future.
00:02:39.867 --> 00:02:51.013
Hello, hello and welcome to the first episode of Pivoting Pharmacy with Nutiogenomics.
00:02:51.013 --> 00:02:54.509
I'm Tamar, your guide in this exciting new journey.
00:02:54.509 --> 00:03:04.421
Brace yourselves as we're about to deep dive into the unending potential we, as pharmacists, have to transform healthcare, and the juicy part.
00:03:04.421 --> 00:03:09.692
It involves studying the fascinating crossroads of what you eat and your genes.
00:03:09.692 --> 00:03:12.663
Now to lay down some of my own journey.
00:03:12.804 --> 00:03:17.933
A few years ago, I found myself steering a transition of care service in a hospital setting.
00:03:17.933 --> 00:03:21.769
One of our unique offerings was a med-to-bed program.
00:03:21.769 --> 00:03:32.750
Picture this At discharge, my patients will leave not only with a 30-day supply of their medications, but also with real, deep insight about their health condition.
00:03:32.750 --> 00:03:40.793
Partnering with my All-Star Pharmacy technician, we'd sort their doctor's appointments and diligently follow up post-discharge.
00:03:40.793 --> 00:03:49.954
We became a constant in the hospitalist team, keeping a watchful eye on our patients and offering crucial therapeutic recommendations.
00:03:49.954 --> 00:03:51.745
You know what's coming right.
00:03:51.745 --> 00:03:54.424
This initiative was a smash hit.
00:03:54.424 --> 00:03:58.332
30-day hospital re-emission rates dropped for those enrolled in the program.
00:03:58.332 --> 00:04:03.010
We didn't just improve health outcomes, we also saved a pretty penny.
00:04:03.010 --> 00:04:18.230
The notable victory was in part due to having a passionate pharmacist like you on the team to make sure that patients receive the right medications, dodging interactions, minimize inside effects and avoiding therapeutic duplications.
00:04:19.079 --> 00:04:29.566
Still, among the high fives and celebratory dances, there was a little worm of worry those patients that still found their way back.
00:04:29.566 --> 00:04:31.250
What was their story?
00:04:31.250 --> 00:04:34.064
The pattern was blatant.
00:04:34.064 --> 00:04:38.543
When they were re-admitted, blood pressure reaching for the moon.
00:04:38.543 --> 00:04:54.593
Tack on another medication, blood glucose going haywire, crank up the insulin dose, the quick fix seemed to revolve around that buzz kill of a question what pill can we give to patch this up?
00:04:54.593 --> 00:05:06.050
This led to prescriptions piling up higher and higher and of course that meant a hardier pill load, side effects going through the roof, routine hospital visits and healthcare cost skyrocketing.
00:05:06.050 --> 00:05:13.533
It dawned on me that the majority of these patients needed more than medication management and a lightning fast consultation.
00:05:14.500 --> 00:05:26.252
As fellow pharmacists, I know each of you share my understanding of these systemic issues plaguing our healthcare, the ones looming over us like big medicine walls blocking our path to better patient outcomes.
00:05:26.252 --> 00:05:29.024
So let's dive into today's hot topic.
00:05:29.024 --> 00:05:45.591
The mother of all issues and impedes the improvement of patient outcomes by pivoting our focus from a medication-driven approach to a holistic approach centered on nutrition and lifestyle, we can be better equipped to provide patients with the support needed to improve their health.
00:05:45.591 --> 00:05:52.612
The issue is that in our day-to-day practice we do not focus on nutrition and lifestyle with our patients.
00:05:52.612 --> 00:05:54.283
But can you blame us?
00:05:54.283 --> 00:06:01.213
As pharmacists, we've been trained and practiced relentlessly in the art of medication management.
00:06:01.213 --> 00:06:08.392
We've got therapeutic indications, drug interactions, kinetics and mechanisms of actions down to a fine art.
00:06:09.120 --> 00:06:10.725
But let's press the pause button.
00:06:10.725 --> 00:06:20.274
Didn't someone along the way also whisper something about coaching our patients on nutrition and lifestyle tweaks?
00:06:20.274 --> 00:06:27.343
But ask yourself this how often are we really shining a light on those aspects?
00:06:27.343 --> 00:06:36.618
And when we do take a breather to deal with nutrition and lifestyle, how deep do we really go with our patients?
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Let's be brutally honest here.
00:06:39.367 --> 00:06:42.211
The roadblock we're up against is twofold.
00:06:42.211 --> 00:06:48.661
First, our main adversary the gross neglect of nutrition and lifestyle and healthcare management.
00:06:48.661 --> 00:07:01.600
Hot on its heels comes our secondary adversary the stark deficit in reinforcement mechanisms to cheerlead our patients as they navigate the tangled web of nutritional and lifestyle overhauls.
00:07:01.600 --> 00:07:04.406
Think about your own experience.
00:07:04.406 --> 00:07:12.939
How often do you see patients given a prescription along with referrals to a nutritionist, dietitian, health coach or personal trainer?
00:07:12.939 --> 00:07:14.947
More often than not.
00:07:15.046 --> 00:07:22.117
The narrative is dominated by medications, while the support for lifestyle and nutrition modifications is kept on the back burner.
00:07:22.117 --> 00:07:24.206
So where does this lead us?
00:07:24.206 --> 00:07:27.689
Straight to Sky High Hospital re-emission rates.
00:07:27.689 --> 00:07:30.211
My friends, the numbers don't lie.
00:07:30.211 --> 00:07:40.541
The Centers for Medicare and Medicaid Services, cms, reveals that as of 2022, there was a 30-day hospital re-emission rate of 15%.
00:07:40.541 --> 00:07:51.985
Massachusetts seems to take the lead with nearly 16% re-emission rates, and the lower end of the spectrum includes Utah, hawaii and Washington, all hovering around 14%.
00:07:51.985 --> 00:08:02.985
Suffice to say, recurring hospital admissions are a significant bottleneck in healthcare, adding stress to patients and contributing to the strain of the overall healthcare system.
00:08:02.985 --> 00:08:12.439
The catch is, many of these re-emissions are avoidable, often attributed to poor chronic disease management and insufficient follow-up care.
00:08:13.326 --> 00:08:25.985
Now, as I pointed out earlier upon re-emission, patients typically experience one of three things with their medications An upward dose adjustment, an additional medication to their already burdened regimen or a combination of both.
00:08:25.985 --> 00:08:33.439
Discharged patients often find themselves on a larger slate of medications than when they enter the hospital.
00:08:33.439 --> 00:08:36.811
This approach directly leads to polypharmacy.
00:08:36.811 --> 00:08:40.677
Consequently, many patients are now on five or more medications.
00:08:40.677 --> 00:08:53.620
Polypharmacy not only escalates medication costs, but also places patients at risk for medication-related complications, adverse drug events and unpalatable side effects.
00:08:54.346 --> 00:09:03.759
The overemphasis on medications often bypasses the root causes of health issues, trapped in patients in a relentless cycle of prescriptions and side effects.
00:09:03.759 --> 00:09:07.149
Now numerous instances come to my mind.
00:09:07.149 --> 00:09:18.985
Where my gung-ho pharmacy residents or students would come to me wide-eyed, unfolded a case where a patient was on as many as 20 medications before hospital admission.
00:09:18.985 --> 00:09:28.940
Unsurprisingly, a majority of these medications were continued upon admission, along with newer ones added to the list.
00:09:28.940 --> 00:09:42.945
Now, as pharmacists, our job becomes reviewing these for necessity, checking for drug interactions, verifying appropriate dosages and ensuring they're not exacerbating the patient's current condition.
00:09:42.945 --> 00:09:57.879
Additionally, we also have to confirm the accuracy of their preadmission medication list via medication reconciliation and luckily, by following these steps, we can be prescribed and reduce the number of medications a patient needs to take.
00:09:58.321 --> 00:10:03.985
But the heart of the matter remains untouched the neglect of nutrition and lifestyle changes.
00:10:03.985 --> 00:10:11.977
Traditional healthcare models frequently fail to acknowledge the integral part nutrition and lifestyle play in our overall health and wellness.
00:10:11.977 --> 00:10:20.591
Band-aid solutions barely scrape the surface of health issues, leaving golden opportunities for holistic healing and optimal health on the table.
00:10:20.591 --> 00:10:22.871
Why are we missing the mark here?
00:10:22.871 --> 00:10:40.746
As pharmacists, we remember those long college nights studying right Our textbook, and professors taught us to promote nutrition and lifestyle alterations for chronic conditions like diabetes, hyperlipidemia and hypertension, before we even think about medications.
00:10:40.746 --> 00:10:41.879
But let's get real.
00:10:41.879 --> 00:10:48.264
Was our training as filled with nutrition and lifestyle intervention strategies as it was with pharmacology?
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I can hear you shaking your heads.
00:10:51.235 --> 00:11:04.784
Even though lifestyle modification always sounded like a great idea, our toolbox to actually implement it was embarrassingly sparse, and I have a sneaky suspicion physicians might be feeling the same way.
00:11:04.784 --> 00:11:07.461
And what's our attempt at a solution?
00:11:07.461 --> 00:11:25.062
Given our bare bones education on nutrition and lifestyle, our counseling on medications and chronic conditions often culminates in quick pep talks, touching on basic guidelines like reducing salt intake, limiting sugar and carbs and getting, say, 150 minutes of exercise per week.
00:11:25.062 --> 00:11:31.817
But can these snippets of advice really help our patients make profound health transformations?
00:11:31.817 --> 00:11:35.703
Keeping on with this band-aid approach has a pretty hefty price tag.
00:11:35.703 --> 00:11:51.879
In 2019, the CDC reported that a staggering 130 million American adults were living with diabetes or pre-diabetes, with an estimated 1.4 million new cases of diabetes diagnosed that year among adults 18 and older.
00:11:51.879 --> 00:12:02.801
This number continues to increase annually and will undoubtedly persist if we fail to pivot from our current medication centric healthcare model.
00:12:03.715 --> 00:12:10.783
It's high time we dug deeper with a firm resolve to invest in our patients' outcomes in a more holistic and sustainable manner.
00:12:10.783 --> 00:12:19.705
You know as well as I do that our roles as pharmacists goes beyond just swiftly dispensing medications and dishing out basic, cookie cutter health advice.
00:12:19.705 --> 00:12:22.842
We're called to aim higher and push boundaries.
00:12:22.842 --> 00:12:25.802
Our patients are counting on us for more.
00:12:25.802 --> 00:12:32.399
They need that consistent, personalized support that sees them through their journey to improved health.
00:12:32.399 --> 00:12:36.945
It's not about a one-off conversation on diet, exercise and medications.
00:12:36.945 --> 00:12:40.062
It's about ongoing, tailored guidance.
00:12:40.855 --> 00:12:48.884
We have a unique opportunity to reshape our patients' health by meshing our services with personal needs, lifestyle and genetic makeup and beyond.
00:12:48.884 --> 00:13:02.059
By marrying our pharmaceutical knowledge with emerging fields like nutrigenomics, we delve into the heart of personalized medicine, adopting a holistic viewpoint to understand each patient's nutritional patterns and lifestyle.
00:13:02.059 --> 00:13:18.803
This means having profound conversations with our patients, helping them devise personalized dietary plans, assessing their adherence to medications, tracking their physical activities and even lending an ear to their mental health concerns and other life circumstances.
00:13:18.803 --> 00:13:30.081
Yes, this is how we can forge an all-encompassing health plan that doesn't just manage chronic conditions, it improves them and truly encourages patient engagement in their health journey.
00:13:30.081 --> 00:13:30.878
And guess what?
00:13:30.878 --> 00:13:38.641
We already got two powerful tools in our arsenal for this mission Health coaching and nutrigenomics.
00:13:38.641 --> 00:13:45.802
When paired together, they form an unparalleled duo that elevates our personalized patient care to new heights.
00:13:46.715 --> 00:13:48.621
So pivot with me and picture this.
00:13:48.621 --> 00:13:50.922
You're in a typical pharmacy setting.
00:13:50.922 --> 00:14:00.817
It's just another Friday, the phone is ringing off the hook, medication orders are spilling out of printers and sanitized smell of pills are in the air.
00:14:00.817 --> 00:14:08.864
Patients come and go with some variation of advice in hand Eat healthier, exercise more, watch your blood sugar.
00:14:08.864 --> 00:14:10.639
But you know what?
00:14:10.639 --> 00:14:17.558
As healthcare professionals, you and I, we're way too savvy to think it's that simple, aren't we?
00:14:17.558 --> 00:14:19.256
We see that.
00:14:19.256 --> 00:14:23.677
Look in our patient's eyes the overwhelm, the uncertainty and yes, even there.
00:14:23.677 --> 00:14:29.306
They know they should eat healthier, but they're not sure exactly what to eat.
00:14:29.306 --> 00:14:43.884
They know they need to manage their diabetes, but they have trouble grappling with the daily pressures while maintaining their health, with glucose readings becoming more of a bitter foe than a guiding friend.
00:14:44.754 --> 00:14:48.625
You've probably asked yourself what I have often asked myself.
00:14:48.625 --> 00:14:52.244
What if we tore up the repetitive scripts?
00:14:52.244 --> 00:14:56.546
What if we could do more than just manage our patient symptoms?
00:14:56.546 --> 00:15:02.167
What if we could empower them to take control of their own health journey?
00:15:02.167 --> 00:15:07.681
This is where health coaching comes in, stepping up to bridge that knowledge action gap.
00:15:07.681 --> 00:15:18.120
It's not about dishing out one-size-fits-all advice, but rather about tailoring a plan that fits the specific lifestyle challenges and goals of each patient.
00:15:18.120 --> 00:15:23.044
Think of health coaching as a dynamic duo of guidance and support.
00:15:23.044 --> 00:15:34.797
It's your patient's trusty sidekick, helping them navigate their health journey, providing them with the map and the tools, but ultimately allowing them to drive their own wellness vehicle.
00:15:35.934 --> 00:15:37.501
Now, why is this so important?
00:15:37.501 --> 00:15:40.413
Consider the diabetes epidemic.
00:15:40.413 --> 00:15:47.072
We know, and our patients too know, that diet plays a substantial role in its development.
00:15:47.072 --> 00:15:51.812
Yet despite this knowledge, race of diabetes aren't decreasing.
00:15:51.812 --> 00:15:56.011
Instead, they're on the irritating, perpetually upward trend.
00:15:56.011 --> 00:16:01.995
Managing this chronic condition seems like mounting the same, frustrating, endless merry-go-rounds.
00:16:01.995 --> 00:16:05.952
But with health coaching, there's an opportunity to flip the script.
00:16:05.952 --> 00:16:13.712
Health coaching invites patients to become active participants in their healthcare journeys rather than passive recipients.
00:16:13.712 --> 00:16:22.871
It empowers patients to understand their unique triggers, create healthier habits and, most importantly, to sustain these habits in the long run.
00:16:23.927 --> 00:16:34.472
Now, as pharmacists whether dealing with the challenges of patient care or the ups and downs of entrepreneurship integrating health coaching into your practice can be a game changer.
00:16:34.472 --> 00:16:42.414
Not only could it transform how your patients view and manage their health, but it could alter your role as a pharmacist, too.
00:16:42.414 --> 00:16:51.693
You could become not just dispensers of medications, but dispensers of empowerment, guidance and long-lasting change.
00:16:51.693 --> 00:16:55.254
Health coaching isn't just a change in strategy.
00:16:55.254 --> 00:16:58.575
It's a reinvention of our patient care approach.
00:16:58.575 --> 00:17:03.913
It's about finding that balance between treatment, prevention and patient empowerment.
00:17:03.913 --> 00:17:11.034
You're doing fantastic work already, but remember, even a load of changes can foster big transformations.
00:17:11.034 --> 00:17:13.153
Let's dig deeper into health coaching.
00:17:13.153 --> 00:17:22.332
Let's empower patients to live fully and violently, because anyone's health journey can be a challenging one, but with health coaching it doesn't have to be a journey they take alone.
00:17:23.145 --> 00:17:30.913
Now let's pivot again and picture yourself in a cozy, sunlit kitchen catching up with your oldest and dearest friend.
00:17:30.913 --> 00:17:39.074
You're both so engaged in conversation that the warm steam from your cups of tea is gently fogging up your glasses.
00:17:39.074 --> 00:17:50.611
Your friend shares a recent revelation it's amazing how two people can eat the exact same meal, yet one person feels energized when the other feels fluggish and bloated.
00:17:50.611 --> 00:17:55.632
You nod with a knowing smile because you too have witnessed similar scenarios.
00:17:55.632 --> 00:18:02.951
It's in these moments that we realize the power of our individuality when it comes to health and wellness.
00:18:02.951 --> 00:18:08.592
This is where the magic of Nutrigenomics enters the scene.
00:18:09.587 --> 00:18:20.893
Nutrigenomics is all about diving deep into the intricate dance between nutrition and genetics to create a personalized wellness blueprint unique to each individual.
00:18:20.893 --> 00:18:30.613
You see, we all possess the genetic makeup that is beautifully diverse, which means that our bodies react differently to various foods and nutrients.
00:18:30.613 --> 00:18:44.252
What if, as pharmacists, we could become wellness architects, capable of helping patients build a tailor-made foundation of health based on their unique genetic profile?
00:18:44.252 --> 00:18:53.652
Imagine giving each patient the ultimate compass, guiding their every nutritional decision to address the root of their health challenges.
00:18:53.652 --> 00:18:55.391
Sounds amazing, right?
00:18:55.906 --> 00:19:05.153
While the idea of implementing Nutrigenomics in your practice might seem foreign and overwhelming, trust me, it's not as daunting as it seems.
00:19:05.153 --> 00:19:18.951
It could simply start with establishing relationships with genetic testing labs, getting trained in interpreting genetic test results and using that information to create personalized nutrition and lifestyle recommendations.
00:19:18.951 --> 00:19:25.328
Remember, even the tiniest steps forward bring us closer to creating a greater impact.
00:19:25.328 --> 00:19:31.079
Now you might be wondering about the cost associated with Nutrigenomics, and of course, that's a valid concern.
00:19:31.079 --> 00:19:41.726
Providing the service might initially require an upfront investment in training and test kits, but the value it could bring to both your patients and your practice is extraordinary.
00:19:41.726 --> 00:19:44.021
It does not have to break the bank.
00:19:44.021 --> 00:19:48.124
There are scalable options to fit different budgets and levels and involvement.
00:19:49.295 --> 00:19:54.601
Using Nutrigenomics into your practice could revolutionize the way you help your patients achieve their healthiest lives.
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It's an opportunity to not only alleviate symptoms, but to equip patients with unmatched power to prevent and even possibly reverse certain health challenges through personalized nutrition and lifestyle changes.
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Imagine how powerful it would be to have a plan that truly resonates with your unique needs and possibilities.
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That's what you offer patients with Nutrigenomics, coupled with health coaching, personalized programs that emphasize nutrition, exercise, even stress management and sleep, giving your patients a holistic guidance necessary to live a healthy and happy life.
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By providing personalized nutrition and lifestyle guidance based on your patient's genetic profile, you can better manage chronic conditions and prevent complications that lead to hospital re-emissions.
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You can truly deprescribe nip and polypharmacy in the bud and reduce the need for multiple medications and their associated costs.
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This not only benefits patients but also eases the burden on our healthcare system.
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Incorporating Nutrigenomics into our pharmacy practice can shift the focus of healthcare towards a more holistic, patient-centric approach, emphasizing the importance of nutrition and lifestyle and achieving optimal health.
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Now I have a little secret to tell you, because earlier I mentioned getting all this training in Nutrigenomics so you can interpret labs.
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But I have a secret to tell you when a Nutrigenomics report lands on your desktop whether it's in paper form or it's on your screen, your computer screen it's brimming with potential.
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It describes the types of foods patients should consider including in their diet insights on managing stress, effective exercises and potential supplements customized to their genetic profile.
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And with such an invaluable guide, our role shifts from working with generic recommendations to guides of personalized wellness map for the patients standing right in front of us.
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As pharmacists, we get the incredible privilege of serving our patients in their worst, vulnerable moments.
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We are part of the solution for improving patient outcomes.
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We are uniquely positioned to integrate Nutrigenomics into our practice and lead the charge in transforming healthcare.
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And now, with Nutrigenomics in our toolkit, we get to steer that privilege towards making tangible, lasting differences.
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We are at the heart of a shift in paradigm, the unique gatekeepers poised to bring an exciting transformation in healthcare.
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Now listen closely, because I have another secret to tell you.
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Although I am now a certified nutritional genomic specialist, at the beginning of my journey, my introduction to Neutrogenomics was met with a pinch of skepticism.
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I can still remember questioning can this really help my patients in a way that traditional medicine hasn't Spoiler alert?
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The answer was a resounding yes.
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In fact, the meticulousness and precision of the results were astonishing.
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It was like being handed the keys to a secret map of each individual patient's health.
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I'll never forget one particular client who had a history of seizures.
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She sought my help for weight loss and mood stabilization, instead of just handing her a generic diet plan, her Neutrogenomics report allowed us to home in on her brain health.
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We had overwhelming amounts of data pointing to precise dietary recommendations specifically designed for her.
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But it didn't stop at diet.
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Our action plan extended to adaptations around her sleep and stress management.
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This holistic, personalized approach marked the beginning of her transformative journey.
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She didn't just see changes.
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They were significant shifts paving away to her improved health and quality of life.
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Stories like hers underlined the power and potential of Neutrogenomics.
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Now here's my message to you.
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It's easy to feel overwhelmed in the maze-like structure of today's healthcare system.
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But remember, you didn't enter this field to be stuck in a revolving door of unfilling rote responsibilities.
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You poured your heart and soul into becoming a pharmacist because you wanted to impact lives, to make a difference.
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So who said you must accept the status quo?
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It's time we disrupt the assembly line mentality.
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Imagine stepping out of that monotonous fast food style drive-through and instead invite your patients to sit at the table with you, fostering meaningful conversations and architecting plans tailored for them.
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My friends, this is how you can play a better and more fulfilling role in their health journey.
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This is how you can reduce their reliance on a medicine cabinet full of prescriptions, because, at the end of the day, a happy, healthy patient reflects a successful and satisfied pharmacist.
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Being custodians of patient health is not just about dispensing medications.
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It's equally about dispensing knowledge, understanding, inspiration and hope.
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And trust me, no career satisfaction can parallel the gratification of knowing you have made a significant difference in someone else's life, don't you agree?
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So let's keep exploring Nutrigenomics and step into our role as builders of personalized wellness and health superheroes.
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Let's grasp the potential to empower our patients to take control of their health, all while staying true to ourselves and staying connected to the reason we became pharmacists in the first place to help others.
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Think of it as beginning the next chapter in your pharmacist superhero story, where you embark on new adventures in the world of Nutrigenomics and together we redefine the landscape of patient care.
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Now let's get to work and pivot into Nutrigenomics and raise the script on health.
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That is all I have for you today.
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Thank you for joining me on this first episode of Pivoting Pharmacy with Nutrigenomics.
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The excitement in the air is palpable, isn't it?
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Especially when you consider the revolutionary changes that Nutrigenomics holds for our health care system and for our dear patients' lives.
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Are you loving what you're hearing?
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If yes, I have a favorite ask.
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Picture a fellow pharmacist entrepreneur in your mind.
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Perhaps they're at a crossroads in their business or struggling to incorporate unconventional services like Nutrigenomics, or maybe they've just started opening up and about feeling a bit stuck lately, not knowing which direction is steer their business.
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Would you share this episode with them?
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By doing so, you're not only adding value to their journey and fostering nurturing connections in your community, but also joining in an exciting communal endeavor raising the bar in health care for our patients.
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After all, we're all comrades in this grand mission, aren't we?
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It starts small just by sharing this episode, and if you've appreciated how we spent together on this show, let the world know.
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Leave a review.
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It's as simple as that.
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Open your Apple Podcast app, scroll down and give it a five star rating.
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Maybe share a sentence or two about what you enjoyed.
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That action, as tiny as it might seem, would mean the universe to me.
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Plus, it also lets other kindred souls know that our show is worth a listen in their precious time.
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Together, we can make a difference in the world of health care.
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Are you up for it?
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Coming up next week on the show, we'll dive deeper into the science behind Neutrogenomics and discuss how you can begin implementing it in your practice, because this may be the first time you're hearing about Neutrogenomics.
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If it's not, you're probably wondering why it should matter to you as a pharmacist and how you could possibly start using it with your patients.
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So tune in next week, don't miss it.
חיפוש פרקים ישנים
חפש פרקים קודמים של Raise the Script with Nutrigenomics.
הצהרה: הפודקאסט והגרפיקה המוטבעים בדף זה הם מ-Dr. Tamar Lawful, PharmD, APh, CNGS, שהוא רכושו של בעליו ואינו קשור או מאושר על ידי Listen Notes, Inc.
