Should you pay for a flu jab at your local pharmacy or chemist ?

For the last 2 years I have paid to have a flu jab at a local pharmacy. This is a fairly recent service that some pharmacies have been offering and I welcomed it initially, having had a particularly bad bout of flu several years ago which left me ill on the sofa for a good week and took several weeks to fully recover from.

Having worked previously in the NHS for many years I had been eligible for flu vaccination through my occupational health service or my local GP. When I changed jobs this was no longer part of the package and I went for several years with no flu vaccination. I had asked at my local GP surgery if I could pay to have a flu vaccine, but this was not a service that they were offering.

I was very excited last year when I spotted a pharmacy in a nearby town offering the service so I went along and booked an appointment to have the jab later that day. The young pharmacist was very nervous and had clearly not done many of these (I later found out I was his first paying customer ) He encountered a problem getting the air bubble out of the syringe and after trying several pre-loaded flu vaccine syringes he advised me he would be unable to do the flu vaccination, and that I would have to come back another day when they had more of the pre-loaded syringes in. I returned several weeks later  as I thought by this time he would have gained in expertise, but he was still very nervous, but did thankfully manage to successfully give me the vaccination. He later told me that I was his second successful flu vaccine paying customer as the uptake had been very poor in the area. He had been on a training course to learn injection techniques but I wonder how much practice he had had on live humans (it is very different to injecting an orange or dummy)

This year I saw another local pharmacy was offering the flu vaccination service and decided to give it another go, as last year I did not succumb to flu. I booked an appointment and yesterday I had my vaccination. It was a very different experience but unfortunately not in a good way. The pharmacist rushed the injection and in fact injected me with a fairly large amount of air which alarmed both her and me (although I did not let on to her that I knew what she had done & she worryingly did not admit it to me) She then repeatedly asked me if i was ok and if I felt faint. I felt quite anxious following the experience but thankfully it is now 24 hours later and I am fine-touch wood apart from a large bruise & egg sized swelling on my upper arm ! (not usual after a flu injection)

This experience set me to thinking & concluding the following;

  • I wish that I had not gone to the pharmacy for the injection. I do not feel the staff that I dealt with this year or last year were competent enough at performing the injections unsupervised
  • I wish that GP’s would offer this service to their patients for a fee-the nurses at the local surgery are fully trained & are great at giving injections (they get plenty of practice)
  • I have had many injections over the years and these 2 were by far the worse experiences that I have had, and have put me off going to a pharmacy again for an injection
  • What training does a pharmacist have before they are allowed to administer injections to the public ?
  • Do the pharmacists feel competenet to be doing the vaccines or is it something they are being pressured in to by the company ?

If you do decide to have a flu shot at your local pharmacy it may be worth asking the pharmacist who is going to administer the shot the following:

  • How many vaccines they have given this year ?
  • How much training did they receive on live patients ?
  • How many flu vaccines have they given this autumn 2011 ?
  • Would they have a vaccine in a pharmacy or would they rather go to a practice nurse ?

I welcome your comments

Running on empty ?

I have just broken down on my own drive (actually half way up the shared drive-embaressing but at least I was home) and the reason for this-my petrol tank is empty !

How could this happen I ask myself ? This has never happened before in 23 years of driving. What has been different this week ? How did I forget to fill up ?

I started to think about health & these thoughts prompted me to write a blog post & think further about

  • how often do we run our bodies on empty ?
  • what are the signs that we are running on empty ?
  • how do we fill our bodies tank up when we feel like we are running on empty ?
  • how does it affect our health ?
  • how does it effect our families ?

Fortunately my lack of petrol is fairly easily solved, but that is not always the case with our bodies, health & relationships . How often do we take our health & relationships for granted and forget to fill up our ‘fuel tanks’ ?

I welcome your comments & ideas.

The biochemistry of steroids-what are steroids and what are they used to treat medically ?

From school children to medics nearly everyone has heard of a subgroup of hormones known as steroids. However if asked to define what a steroid is, few would get further than: something that has an effect on the body. So what exactly is a steroid? 

Chemically a steroid is any molecule that has a specific arrangement of cyclic carbons. Namely a steroid contains 3 cyclohexane structures and 1 cyclopentane. These are arranged in a specific order and if you wish to see this order simple google it. However when most of us talk about steroids what we really mean is steroid hormones, i.e. human hormones within the body that are steroids. Steroid hormones are subdivided into three types: Glucocorticoids, Mineralocorticoids, Androgens, Estrogens and Progestogens.

Generally our body synthesizes mineralocorticoids and glucocorticoids in the suprarenal (Adrenal) glands, which sit atop the kidney. Whilst Androgens, Estrogens and Progestogens are synthesized in the Gonads/Genitals. All five are synthesized from the sterol: Cholesterol. A Sterol is a steroid with a hydroxyl (-OH) functional group attached to the steroid structure. This gives the sterol a amphiphillic structure, i.e. it is both hydrophobic and hydrophillic, which is extremely important for cholesterols use in the cell membranes of cells.

So steroid hormones have a specific chemical structure and are synthesized from cholesterol. But what do thay actually do? Well the answer to this questions is predictably different for each steroid. However the subgroups of steroid hormones divide steroids into categories based on the repercussions they induce within the body. So:

Glucocorticoids – Glucocorticoids are a branch of steroids produced in the adrenal cortex and which bind to the Glucocorticoid receptors, which are present in nearly all vertebrate cells. Glucocorticoids have two major functions within the body; firstly as their name suggests they play a role in the regulation of glucose metabolism. Indeed Cortisol, which is the primary (main) glucocorticoid stimulates several processes, which serve to increase and maintain the glucose levels within the body. The first process by which it achieves this is gluconeogenesis, which occurs in the liver and generates glucose from non-carbohydrate molecules, such as glycerol, lactate and amino acids. The second main process is the inhibition of glucose uptake by muscle and adipose tissue (N.B. Adipose tissue = fat tissue) and thus the catabolism of fatty acids within muscle tissue instead of glucose.

Glucocorticoids also have anti-inflamatory properties and hence are used in medicine to treat allergies, asthma, autoimmune diseases and sepsis. A particularly potent anti-inflamatory is Prednisone, the active metabolite of which is prednisolone. Glucocorticoids achieve their antiinflamatory nature through two methods – firstly they up-regulate the expression and consequent production of anti-inflamatory proteins. This is achieved when the glucocorticoid binds to the glucocorticoid receptor and thus triggers the expression of antiinflamatory proteins in the nucleus a process known as transactivation  Secondly they down-regulate the expression of pro-inflamatory proteins, by preventing the translocation of transcription factors from the cytosol/cytoplasm to the nucleus, a process known as transregression.

Mineralocorticoids – Mineralocorticoids are the second division of steroid hormones generated within the adrenal cortex, leading to the mineralocorticoids and the glucocorticoids collectively being refered to as corticosteroids. However their functions are very different – Mineralocorticoids regulate water and salt content of the blood plasma. The primary mineralocorticoid is Aldosterone, which plays a key role in the Renin-Angiotensin-Aldosterone-System, which is a system that modulates the water content of the blood. I could write a whole article on the RAAS, but that is not the focus of this blog – so back to the specific role of Aldosterone. Aldosterone production is triggered through the RAAS and it results in the kidneys reabsorping more sodium ions within the distal convulated tubule of the nephrons. This reabsorption of sodium leads to water more water moving via osmosis back into the capillaries. Aldosterone also leads to a greater excretion of H+ cations (protons) and potassium ions out of the medulla of the kidneys and into the urea collecting ducts. In short mineralocorticoids control the amount of water and mineral retention in the kidneys and hence the water and mineral content of the blood.

Androgens – These are the Steroid hormones which promote the development and maintenance male characteristics in humans, this includes the development of the male sex organs and also the secondary sex characteristics. The primary androgen is testosterone and is produced in the testes. The production of testosterone as discussed in an earlier blog is mediated by LH from the Pituitary. The original main bulk of anabolic steroids were androgens and androgens are also important precursors to estrogens. 

Estrogens – Estrogens are the female sex steroid hormones. There are three types E1 – Estrone, which is present in post menopausal woman. E2 – Estradiol, present in unpregnant woman and produced by the developing follicles during the menstrual cycle. E3 – Estriol, present in pregnant woman. Estradiol is crucial for the building up of the endometrium, in preparation for embryo implantation.

Progestogens – Progestogens are a group of carbons with a 21-carbon skeleton, known as a pregnane skeleton. The two major Progestogens are Progesterone, which mains pregnancy and Pregnenolone, which acts as a precursor in the production of all other Steroid hormones.