Bonnie Hui-Callahan, PharmD on Importance of Vaccination Options with Linda Kreter
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Welcome to Wise Health for Women Radio with Linda Prater. Women are pressed daily to give more, learn more, and be more, often at the expense of mind, body, or spirit. Each week with intriguing guests and topics, we'll bring you fresh ways to view your limited time, encouraging a shift to new, healthier perspectives. Wise Health for Women Radio, helping women thrive. And now here's your host, Linda Prater.

Good morning and welcome to Wise Health for Women Radio. I'm Linda Crater and we have a very interesting discussion for you today. It's hard enough to be a mom and it's hard to be a working mom outside of the home and

and it's hard to be involved in the medical scene these days. And we're going to be talking to a pharmacist, Bonnie Hue Callahan. And Bonnie, I hope I said that right. If I didn't, when you come on, you can correct me. And we're going to talk about how

important it is to stay current with your health, to be good on self-care, to understand what are required, needed things to do, your annual physical, for example, well women visits, that kind of thing, self-care, and we're going to be getting it from a pharmacist's viewpoint and that of a mother. So Bonnie, welcome to our show. Thank you, Linda. It's so nice to be here. I appreciate the time.

Well, I think it's a really hard thing to work in the medical field, especially after the last five years. My whole family works in the medical field. So I'm afraid it's never been far from our topics of conversation around dinner tables and Thanksgiving, et cetera. But I think it's also important to know about balance.

And as you, you have four children under the age of nine or 10, and you also are a full-time pharmacist and you are very current with everything. Let's start with how do you balance all of that? That's a great question. And I ask myself every day.

I will say, you know, off the bat, I don't know if a true balance will ever exist. But it's a matter of, you know, understanding that we do, especially as women, we just we wear a ton of hats and just acknowledging that and being okay with which hat you're on, you're putting on at that time and just being in the moment and just doing the best you can with that hat on. And so it is a lot though. I

though. I mean, you know, I just this morning, I took all four kids to school and dropped them off and I had to get a quick run in just for my own self-care before starting work, right? So I think a lot of it, too, what I've learned through the years is this idea of intentionality because unintentionality

with it, it's not going to happen. And I will add to that, you know, for behaviors to become or for actions to become true behaviors and routine, we have to do it on average 66 times. So I think this idea of

So intentionality and repetition is really helping me in my daily routine to make sure that I have, you know, what I need, my run every day to give myself that, you know, breath of fresh air before getting into the crazy workday and then getting into the crazy routine afterwards.

So I think building that routine and being intentional with the behaviors in my everyday life is really what has carried me through. I agree with you. And I agree with you also that true balance doesn't really exist. I liken life to a teeter-totter. So sometimes it shifts to the left. Sometimes it shifts to the right.

But it always is in motion. So we are not in stasis. Life doesn't stay static for us. And so we do the best we can. And I agree with that. I also think it's about

Building habits and persistence. So I imagine as you began your, as you said, over 66 times you do things and it becomes a habit and becomes routine, you almost start to miss it or you do miss it if you don't get it in.

Yes. And, you know, I was just thinking about an example where, gosh, it's been maybe eight or nine years ago now. I started, I moved from the retail pharmacy setting to kind of more of a corporate setting. So I was in an office, there was a shower on the first floor and I said, you know what, I'm going to start bringing my running clothes to work and using my lunchtime to run around the block a few times. And so

It felt so weird, right? Because you're in this corporate environment, all dressed up, they're going lunch with their colleagues and stuff. And here I am in my gym, I are running around the block

And I did it even up until I was eight months pregnant with my second and third child. I was at the same company. And, you know, I will say the first 66 times it was weird. And then comes time 67. I swear my body was like, come on, let's go. What are you doing? What are you doing? Right. And the fun part, too, was like people started to see it and they were like, Bonnie, what is Bonnie doing? Oh, my gosh, I want to do that. And so did they join you? Yes, they joined me.

I love it. No, yeah. And they started skipping lunch. Yeah, because they were like, I need to fit it in too. And I said, you know what? Yeah, I have to, you know, two kids, you know, at that time, there's no other way for me to fit this in. And so again, I'm going to take that step and do it when I can and be intentional about it and repeated it enough for it to feel comfortable and normal. And like you said, your body just was like, started to crave it. So it's kind of

It's kind of amazing how that does happen, how our bodies can be trained to essentially start craving self-care. And I will say, I wish, I'm hoping to get to a point where other aspects of self-care I can fold in. You mean like sleep? Yes. That's a good one. That's a great one.

Everybody will want to sleep and unwind a little bit. Well, and rest. I think silence and rest. We are so busy. We are so distracted. Information is pummeling us from all sides that I think...

hard to be intentional about being mindfully quiet, breathing. I'm not running anymore, but I take walks at least twice a day because otherwise I'll be sitting at my desk and the hours just go by and it's crazy. And that doesn't really feel good. And then I read something which should make people feel better, I hope, is that

Most people, when they think of exercise, they think, I've got to go to the gym. I've got to put on my clothes. I've got to get in the car. I've got to drive. I've got to do this, that, and the other thing. When...

it's better for you to have daily exercise than it is to three times a week, go hump it out at the gym. Yep. And so it really is interesting. We make things hard on ourselves when we really just should get up and walk. And I, I envy people with dogs at times because my cats will not stand being walked. Not that I would even try, but I do think that gets them out in nature.

which also helps stress points. Don't you agree? Oh, absolutely. Absolutely. I mean, there are days that, you know, I can't run every day and there are days that I miss it. But at the end of the day, I'm like, you know what? I'm going to go walk to my mailbox and my mailbox is, you know, it

in my in my driveway it's up the hill a little bit because we kind of have this shared setup and so it's a good 10 minute walk you know all around and sometimes that's just enough just to get out of the house take a breath of fresh air you know watch the sunset you know and that the 10 minutes can be enough I think a lot of times we think of self-care we think of it's this

spa day, right? Like we got to plan it. We got to like pay for it. We got to all these things. And, and that's great. That's fantastic for those who can do that. But for me, I mean, as a busy mom, it almost sounds intimidating. Like for me to do self-care, I have to do a spa day. And it's like, no, like, no, for me, let's take a step back. What is the purpose of self-care, right? It really is to promote health and mental wellbeing. And so that can look

different for everyone. You know, how at the end of the day, does the behavior that you're doing, does it manage your stress? Does it lower your risk of illness? Does it increase energy? You know, and if it is, then that's great. That's what self-care is. I feel like a lot of times we can put it in a box, but we need to break that box open and allow ourselves to do whatever it takes to promote our health and mental well-being.

And they're so closely connected. Physical health helps our mental health and vice versa. And even just intentional breathing can help you to trigger both the sympathetic and parasympathetic nervous systems to chill, to chill. And once we learn to do that, and it takes some practice, probably way more than 66 times, right?

because I'm constantly reminding myself about that breathing. I think it is very important to know that they're tied together. I mean, we so often get, well, I don't feel like it. I know, but think how you'll feel when you're done. And I think that's what kept a lot of people going during the pandemic when they were alone or isolated. And then it helps people afterward when they maybe let some good habits slip and

And needed to get back on track. But it unfortunately points right back to you. You have got to do it yourself. Or find friends who will do it with you. But the best way to do it is to not ever let yourself really get to a point where it's daunting to even begin doing it.

Yes, yes. Agreed. Absolutely. And, you know, I think as busy moms as well, what we tend to do is we put others first so much. Oh, amen. It's true. Yes, absolutely. And, you know, I just, it's a blessing and a curse, right? I mean, as moms, we're great at being moms because we...

we, you know, we make sure our children are taken care of. We make sure the household is, our husband, you know, all these things. But it's the crisis that so often that means like, where's the time for us, right? Where's the margin for us after everyone else is taken care of? You make a very good point. It's in the margins. Yeah. Yeah.

It's often in the margins instead of front and center. And I also put that for relationships. I think it's really important for spouses or partners to make time for each other, not just the children.

And because you have to build all these relationships, you have to keep your friends. It's really difficult if you become truly socially isolated. And it's very unhealthy. There's an epidemic of loneliness in this country. And so all of these things go together.

So as a member of the allied medical team that helps people, I personally think pharmacists are underutilized. I think, and maybe I'm wrong, and correct me if I am, I believe that we have questions about things, especially now. And so when asked questions, it's important to be able to get moments alone with your pharmacist and say, okay, what are the potential side effects I should be aware of with this new drug? I'm trying this.

I think prior to that, it's always good to ask your physician, is there a non-drug intervention I can try first? Because so many pharmaceuticals, as you know, work on symptomatic relief as opposed to root cause. But people are getting smarter. And I think that that brings more questions. Do you find that people are bringing questions to you more than they used to maybe five years ago?

Yes, absolutely. Absolutely. And I agree that pharmacists are probably one of the most underutilized resources. And, you know, I think traditionally, or I should say the stereotype, right, is that the pharmacist is at the street corner in that pharmacy and they're, you know, giving out your drugs, right? But what...

They're a little bit more than that, but go ahead. Exactly, exactly. I mean, it's our scope of practice has really transformed to not only being that person who, you know, gets the prescription and gets you your drugs, but it's more the holistic care. Preventative health is a large portion of our training in pharmacy school, you know, and we want to, as much as everyone else wants to, really push the idea, not push the idea, but, you know, the

There's, you know, it's not just the drug. Let's get to the root cause. Is it exercise, right? We are involved with chronic condition management. You can get your blood glucose tested or screened for at your community pharmacy, right? So we are equipped to talk about diabetes, diabetes prevention, you know, hypertension. And all of those are so tightly associated with lifestyle modifications and health.

And that is one of the services I think that pharmacists provide that is untapped. That, you know, we're so busy as consumers going to the pharmacy to get that drug, and rightfully so, you're sick. You know, you don't really want to be there. But know that, you know, pharmacists are there. They are...

the most accessible healthcare provider. You can call them, you can also just walk up to them. So yes, absolutely. And I will mention as well, we administer vaccines and that as a busy mom, that's helpful as well for me to bring my kids to the local pharmacy versus schedule appointments. We also do, we review your full medication regimen and make sure, hey, are there ways to save you money?

Are there drug interactions? How can we optimize your drug regimen, right? So a lot of different services outside of the getting your meds that we provide. And so, yeah, so definitely more than just kind of your typical role as a pharmacist.

Actually, very intrigued by what you just said about optimizing your drug regimen, because with so many specialists these days and multiple electronic health records, unless you keep everything in the same exact spot all the time, many people do, but not everyone. I work a lot with veterans, and this is a huge problem in the VA because there are drug interactions that

They're on so many meds, they can't keep them straight. And I, of course, I'm not a clinician, so I do not give them clinical information. But there are many apps that will talk about drug interactions, but those can get them confused. So you're a perfect person to say, OK, I looked and sometimes a little knowledge is dangerous. Or Dr. Google gave six million five hundred and forty three, you know,

other reasons for side effects. And if you read a package insert on anything, you're not going to take it. But there's a time and a place for pharmaceuticals. And so I'm just curious, do you find that there are drug interactions that we're not aware because this doctor retired and this one took over? There are a lot of really normal reasons why that could happen. Yes.

But it's really dangerous when it does. Yeah. Yeah. I mean, if you think about, you know, pretty typical journey for a consumer when they access the health care system, right? Oh, I feel sick. I go to and it's a weekend. My doctor's not been. I go to the urgent care. Oh, OK. Describe me something. I start taking it for a day or two. I don't feel that great. Now I'm going to go to the ER because I'm worse. Right. And then you go to the ER, they give you something and then they like they say, well, follow up.

with your primary in a week or two just to make sure you're stable. Now you're at the third healthcare provider. So just in a matter of the week and a half that I just described, how many different medications now are you prescribed and do you have in your medicine cabinet, right? How many of them do you, you know, how often do we then take a look back and say, well, should I stop taking this? Do I keep taking this? Do I need more of it, right? Because

Because some of them are long-term medications. Maybe you're a PCP prescribed that you should be on, but the urgent care doc just gave a few days of it. So there's a lot of buildup that can happen. And one of the things that pharmacists can do is take a look at your full regimen because they do have access, especially if you fill up the same pharmacy, which we recommend. A lot of people do, right. It's great.

All there, right? So no matter which prescriber, we have your full record, or at least most of it. We also ask, what OT over-the-counter medications are you taking? Because that doesn't go through our dispensing system. No, and people are very unaware that OTC meds, they're like, oh, I can get it myself, so it's all completely safe. Well...

Not necessarily. A lot of them used to be pharmaceutical grade, you know, prescription only, and now are not. And so it's the old, well, if it was prescribed, it would be

three times a day. And well, it won't matter then if I double the dose because it's over the counter. It can't hurt me. But what if you took it with three glasses of wine? Yes. There's interactions between drug and drug, drug and alcohol, drug and food. And then on the flip side, some drugs don't work if you don't take it with food. Some people are

to take everything with food, but then there's some that, you know, you shouldn't, right? So, or if you take it with yogurt or calcium products, it's going to bind to it and not make it work. And that's where a lot of the vitamins come into play, right? They can bind to the medications and not make it as effective as it should be. Or it could decrease the effect of, let's say, birth control, right? And we can see some of the effects

So a lot of those drug interactions are things definitely that when you do get a drug at the pharmacy, that is something that pharmacists make sure to screen for, make sure to counsel the members on or your patients on just so that there is awareness there. You know, and you mentioned supplements. I think that people are taking many more supplements than they used to. Specifically, I'll mention D3 and K2 supplements.

There are people who are very low and deficient in magnesium. There's all sorts of things that you can use that will help you to feel more healthy. But do you know what you're taking, when you're taking it, how to take it? And something so simple as if you're going to take D3 and you've been told you're low, your levels are low, are you taking it with fats? Because it's a fat-soluble vitamin.

And I know many who do not know those particulars. And so I think it's interesting because I'm pleased to hear that you do have supplements on the drug regimen thing. I didn't think you did. Oh, yeah. No, that's definitely part of it as well. We do our best to ask them, you know, our patients, you know, what are you taking for the counter? Because, you know, it doesn't put on our record. Sometimes it does if they're prescribed and, you know, some plans will pay for it. But, you know, many times...

they don't. And I think you said, you know, a lot of people assume that they're all safe, but in fact, they're actually, because they're over the counter, they're not FDA regulated. They go through a different, you know, entity. So, you know, we got to make sure that there's, the pharmacist can do that due diligence to help make sure that it's safe. It's really important. And I think what's also interesting is my background was clinical trial work and a

pharmaceuticals for many, many years. And the one thing that is not emphasized enough is generics are the same compound, but they may not be the same drug delivery system. So one might work for you, but the generic does not for whatever reason or vice versa. And there's a huge cost differential between those two. Once it goes off patent and goes generic, it's much less expensive. But

what is it? Same, but not equivalent. Is that the right phrase? Therapeutic equivalence, you know, that is a, you know, usually when it's, um,

a generic that's exactly equivalent. There's kind of a naming convention to it that shows that it is exactly the same. And what's different though, to your point, is that there are excipients, which is kind of the non-active ingredients that are in perhaps, you know, the generic, but not in the brand or vice versa. And so there may be possibilities

possibility of allergies or whatnot that maybe that's why someone can't tolerate one over the other. But I would say generally speaking, I mean, yeah, I recommend the generic unless you, for whatever reason, can't tolerate it or it's not effective. Unless it's, of course, not considered generically or therapeutic. Equivalent. Right. It's so interesting because

If I hadn't had this background, I wouldn't know some of these things. But that's why I'm glad we have you on today, because you're far more qualified to put this out there as opposed to my stories about when we studied these trials. And it was very interesting. So in terms of vaccinations, kind of a really...

hot topic these days, both good and bad. And yet it started a conversation and that's a good thing because when we learn more about things, we learn what the purpose was, what the trials were about, if you're interested in finding out this information. So there's a new hepatitis B

vaccine for adults. And the CDC is recommending that all adults are vaccinated against hep B. Why is this important? And what's the prevalence of hep B in the adult population?

Yeah, so yes, as you mentioned, so just last year, CDC updated its adult vaccination recommendation. And so now they recommend that all adults ages 19 to 59 be vaccinated against hepatitis B. And so with the addition of hep B vaccine, there's now 6%.

vaccines that the CDC recommends for all adults. So that's Tdap, shingles, pneumonia, flu, COVID, and now hepatitis B. And so, you know, in the past 10 years, the rates of acute hepatitis B in the U.S. has steadily increased, especially amongst adults 40 and over. And so by making the hepatitis

recommendation or vaccine recommendation more universal, this should really help increase vaccine coverage and decrease the number of cases overall. Currently, there's around 2.5 million people in the U.S. with chronic hep B. And so if that's left unmanaged, one in four of those individuals would die from liver failure or liver cancer.

And so, and it's actually a hundred times more infectious than HIV, believe it or not. And since most people with Hep B are unaware that they have the infection, the virus can- - Silent, right? - Yes, exactly, exactly. And since there's no cure for Hep B right now, it's the best way to, is really prevention through vaccination. - Now I'm gonna ask the $64 million question.

The COVID vaccines do not stop transmission or the disease itself. And so they changed the definition of vaccine for that. For the ones that you just named, other than COVID, they do stop transmission. Is that correct?

Yeah. So what it does is, you know, generally speaking, the vaccine works by causing your body to make its own protection. Right. Or antibodies. It's an immunization reaction. Right. And so and it does this.

by basically when you're injecting the vaccine into your body, the active ingredient in all vaccines is called an antigen. And that could be either like a weakened or a killed bacteria or virus or the outer shell bits of it, right? And so just enough for your body to create that immune response. And I call that fighters for my kids to really understand what that means. Okay.

And in doing so, it allows your body, if that same virus or, you know, bacteria does come into your body, you know, down the line after you get vaccinated, your body will have either have all the necessary or the amount of immune response to not even give you any symptoms of the sickness. So you don't get sick at all. Or it reduces the severity of the sickness. Right.

So, yeah, so that's really how, you know, generally speaking with vaccines and kind of how it works to protect our bodies. That's kind of the biology behind it. That's how I've explained it to my kids to allow them to understand every year. This is how we go about, you know, this is the reason why we do it. And this is how it protects our bodies. Okay.

I find it interesting that drugs are often titrated dosage levels based on body weight and that kind of thing, but that vaccines are not. Can you speak to that? Yeah, I mean, I think...

really the, yeah, there's a, there's a difference in dosage, um, between, you know, kids vaccine and adult vaccines, but yes, but it is not, you know, you could have a 350 pound man or a hundred pound woman and they get the same vax. Yup. Yup. Yup. That's exactly it. And, you know, to up until this point, at least, um, they've, you know, uh,

that same, you know, the larger man, the smaller woman, you know, they've been able to kind of develop that, you know, immune response enough. Now, now for adult, what they have done is that for, you know, elderly, they've, you know, they have, you know,

a, you know, quote unquote, stronger version of the flu vaccine that's, you know, available. So there is that part. Who knows down the line, maybe they will go to, you know, weight based dosing or whatnot for vaccines. But at this- Well, body mass makes a difference.

And it is kind of interesting because drug dosage, you try and give the least amount of the dose to affect the change you're looking for. This almost seems like a sledgehammer versus a tap hammer for particular people. But I guess if you look at the general population in America, it's larger than normal. Regrettably so. Right.

Yeah, I mean, thankfully, you know, we've the main side effects that we see, you know, whether it's the hepatitis B vaccine or, you know, other vaccines, it's generally similar. And that's, you know, high.

soreness of the arm, headache, maybe some tiredness. And thankfully, the immune response hasn't been too great to kind of affect anything more than that. And that goes, same with whether it's haplosap B, which is one form of the hepatitis B vaccine, that's two doses in one month, or other hepatitis B vaccines, which are three doses over six months. The side effects are

tend to be the same. So that is good news, I think. It is. I think it's such a shame, though, that there is a distrust in medical experts these days. That's why people like you being able to speak very specifically to exact medical

anecdotes and stories and people that you know is very, very important because I think with anything gets centralized and we're suddenly talking about billions of people, you run into generalities that don't fit anymore. So I think it's important that we

are aware of what's out there. We do have a lot of skepticism in the United States today about experts and being led our merry way. And I think that unfortunately that takes the pendulum and swings it in the other direction too far.

And so I think that coming back to self-care, part of that is awareness of what makes you feel good. Are you eating nutritionally? Are you into holistic health? Do you get sunshine? Do you walk barefoot in the grass for grounding? Do you consider cold therapy? I mean, I do all these things. And I surprise myself. I challenged myself with the walking into the river in December. And I

kept it up. And so you really feel invigorated when you challenge your body to different things. But self-care, that's certainly not a spa day. It can be, but not all the time. Right, right. But I guess what I'm saying is we have so many ways to take care of ourselves that it's super important. So did I miss anything in terms of your...

exceptional role in the whole medical scheme of things, being able to explain things that people may not get the time to explain with others. As we know in the doctor's office, they're very busy putting everything in the electronic health records and

And you don't often get that. So if you go to your annual physical with a list of questions, you'll get them answered. But if you don't and you think of something afterward, that's not easy. But that's where you come in. Exactly. Exactly. I echo that to have your list of questions going into your doctor's visits. I do the same thing. But certainly if you don't get that answered, please do talk with your pharmacist. And I will say, you know, I think vaccines.

vaccinations is something that is so often overlooked, especially for busy moms. So talk to your pharmacist about getting caught up, especially with this new recommendation with hepatitis B vaccine. Hepatitis B, like I mentioned, is two doses in one month, so a great option for busy moms. But at the end of the day, talk to your pharmacist to find out more about hepatitis B vaccine at www.hepbcatchup.com. That's

That's where you can find out where your nearest pharmacy has hepatitis B vaccine available. And I would like them to know where to find out more information about you. And that would be at pharmacistmomsgroup.com.

Yes, please do check that out. Pharmacist Moms, we are the largest online community of women pharmacists and we provide support both professionally and personally. And you're also on LinkedIn and other places. But thank you for the wisdom today and appreciate all that you have shared today because our health is our wealth and we certainly learned that. So thank you, Bonnie. Thank you, Linda, for your time. Thanks for having me. A pleasure.

Thank you for tuning in today. You can find more shows at wisehealthforwomenradio.com.