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Vaccines — which were first developed in 1796 for smallpox and continue to evolve with new research and technology — build on your immune system’s natural function to protect you from serious diseases. Just like white blood cells and the other components of your immune system, vaccines help you develop immunity, but without the initial illness and risk of health complications. Here’s a look at how vaccines work.

The Science Behind Vaccines

Your immune system has a natural way of defending you from the viruses and bacteria that cause illness. As these germs multiply rapidly and infect your body, an army of white blood cells fights back, producing antibodies that attack the invaders.

The first time you are infected by a specific virus or bacteria, your immune system often cannot destroy the germ quickly enough to prevent you from becoming sick. After you’ve recovered, certain immune cells hold onto the memory of the infection. This allows them to mobilize quickly if they encounter the same germ again, preventing illness in the future. Immunity, your body’s resistance to certain types of infection, is the outcome of this process.

To understand how vaccines work, it’s helpful to know how your immune system naturally fights an infection. B-lymphocyte white blood cells produce blood proteins called antibodies, which attack antigens — the part of the invading germ that triggers an immune response. T-lymphocyte white blood cells attack already infected cells in the body. After the infection has ended, a few T-lymphocytes, or memory cells, remain to ensure a fast immune response should the same germ reappear.

Vaccines imitate infections, triggering the process of building immunity to a specific disease without causing illness. Your immune system responds to these imitation infections the same way it would to an actual infection. Detecting antigens from the vaccine, your immune system produces antibodies and T-lymphocyte cells. The imitation infection leaves your body with T-lymphocyte memory cells and B-lymphocytes, which will know how to quickly fight that antigen in the future. This prevents you from becoming sick if you are exposed to the virus or bacteria that cause the disease.

It typically takes several weeks for your body to produce T-lymphocyte and B-lymphocyte cells in response to a vaccine, which is why in most cases you will not immediately develop immunity. This means that you could become infected with a disease and develop symptoms shortly after vaccination, so it’s important to take necessary precautions until you become fully immune to the virus or bacteria. The healthcare professional administering your vaccine will inform you of the anticipated timeline for immunity.

Sometimes the imitation infection created by a vaccine causes mild symptoms such as a fever. These side effects are normal and indicate that your body is building immunity.

While all vaccines arrive at the end result of immunity, there are several paths for getting there. When deciding which type of vaccine to create for a disease, researchers consider a variety of factors, including the immune system’s response to the germ that causes the disease, the population likely to receive the vaccine, and the regions of the world where it will be used. These are the seven types of vaccines commonly used in the U.S.

Live vaccines use a weakened version of the living virus or bacteria that causes a disease. They are most similar to the natural infection and produce long-lasting immunity. The weakened form of the germ does not lead to serious disease, like that caused by the wild form of the germ, for most individuals with strong immune systems. However, live vaccines aren’t safe for those who are immunocompromised, including children undergoing cancer treatment. Examples of live vaccines include the measles, mumps, and rubella (MMR) vaccine and the chickenpox vaccine.

Inactivated vaccines are produced by inactivating, or killing, the germ that causes a disease. Examples include the polio, hepatitis A, and flu vaccines. They don’t provide as strong of immunity as live vaccines, so additional doses, also referred to as booster shots, are often needed for ongoing protection.

Toxoid vaccines target a toxin, a harmful substance produced by a germ, rather than the entire germ itself. They contain a weakened version of the toxin to be targeted called a toxoid, which teaches your immune system how to fight off the natural toxin. Similar to the germs used in live vaccines, toxoids are weakened to a point where they do not cause illness. These vaccines are used to prevent diseases caused by toxin-producing bacteria such as diphtheria and tetanus.

Subunit vaccines use portions of a virus or bacteria called subunits rather than the entire germ. Vaccines for diphtheria, tetanus, and pertussis, or whooping cough, are combined into the DTaP vaccine. The pertussis component is a subunit vaccine.

Conjugate vaccines fight a specific type of bacteria whose antigens are more difficult for a child’s immune system to detect due to their outer coating. The vaccines link the coating to stronger antigens that the immune system can more easily respond to. Like subunit vaccines, these vaccines are more targeted and only use part of the germ. Examples of conjugate vaccines include the haemophilus influenzae type B (Hib) vaccine.

Viral vector vaccines produce immunity to a virus by using a modified version of a different virus to deliver instructions to your immune cells. The modified version of the other virus is referred to as a vector virus. Recent Ebola vaccines have used this technology, and the Johnson & Johnson COVID-19 vaccine is also a viral vector vaccine.

mRNA vaccines help your body produce a protein that triggers an immune response and the development of antibodies. This technology was used to create the Pfizer-BioNTech and Moderna COVID-19 vaccines.

Read ‘What the COVID-19 Vaccine Means for Those With HIV’

All vaccines in the United States require approval by the Food and Drug Administration (FDA) and are held to rigorous safety and effectiveness standards. The vaccine approval process starts with lab tests, which may take years in some cases. The FDA analyzes the results to determine if the vaccine should be tested with people. If the vaccine moves forward, the next step is clinical trials where the vaccine is tested on volunteers.

Clinical trials typically begin with a smaller group of 20 to 100 volunteers before including thousands more. The trials gather information about vaccine safety, the typical immune response, and dosing. If any safety concerns emerge during this stage, the FDA must address them before it can authorize the vaccine.

Vaccine manufacturers are required to continuously monitor vaccine safety after approval and test every batch produced to ensure effectiveness, quality, and purity. These test results are reviewed by the FDA, which also conducts an inspection of the factory where the vaccine was produced. If you experience severe side effects after vaccination, contact your healthcare provider so that they can report potential concerns to the Centers for Disease Control and Prevention (CDC)’s vaccine monitoring database.

COVID-19 mRNA vaccines were developed and approved more quickly than a typical vaccine given the urgent nature of the pandemic. This expedited timeline was made possible by significant investment from governments and companies in the vaccine development process and decades of research on mRNA vaccine technology. These vaccines were as thoroughly vetted for quality and safety as any other vaccine.

Many vaccines are received during childhood, like the polio, chickenpox, and MMR vaccines, but there are others you may need as an adult. The CDC recommends the zoster vaccine, which prevents shingles, for adults ages 50 and older and the pneumonia vaccine for those over 65. Other vaccines may be recommended based on additional factors including job or school requirements, travel, and health conditions. Check in with your doctor about which vaccines you need.

The CDC also recommends an annual flu vaccine for everyone 6 months and older. New versions of flu vaccines are developed annually in anticipation of circulating flu virus strains, so health experts recommend getting one every year to prepare for cold and flu season. It’s especially important to be proactive about flu vaccination if you are over the age of 65 or have a chronic condition such as COPD or diabetes.

For detailed vaccine recommendations by age group, reference the CDC’s recommended immunization schedules for children and adolescents and adults.

At Alto, a pharmacist is your partner in health. If you take medication, we will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible. And our team of pharmacists is available to chat whenever questions come up. 

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Inhalers and nebulizers are both effective at delivering medications for respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD). A nebulizer is a device that transforms a liquid medication into a fine mist which is then inhaled into the lungs through a mouthpiece. While nebulizers take longer to deliver medications than inhalers, their accurate dosage delivery is often a good fit for children living with asthma and other lung diseases, and many adults find them helpful as well. Here’s what to know if you’re considering using a nebulizer.

What to Know About Nebulizers

Three types of nebulizers can be used to treat asthma, COPD, and other lung diseases like pulmonary fibrosis.

Jet nebulizers transform liquid medication into an aerosol or fine mist using an air compressor. They are the most common type of nebulizer.

Mesh nebulizers use a fine mesh to create an aerosol from the liquid medication. They are the newest type of nebulizer and emit the smallest particles.

Ultrasonic nebulizers create an aerosol through high-frequency vibrations. They are typically used in hospitals or at doctors’ offices.

There are different models of nebulizers, including portable, battery-run nebulizers that can be taken with you on the go and larger tabletop nebulizers that require an electrical outlet. These devices can deliver a variety of medications, including quick-relief medications that treat acute symptoms of lung diseases as well as longer-term maintenance medications. They may even be used to deliver more than one medication at once.

Your healthcare provider can advise you on the best method of medication delivery for your individual treatment plan. As you explore your options, be mindful of the key differences between nebulizers and inhalers.

Inhalers deliver medication quickly, but they require enough coordination to inhale and spray the medication at the same time. Some individuals, particularly young children, may find it challenging to properly use an inhaler. This can result in not receiving the full dose of medication.

To receive a dose of medication from a nebulizer, all that’s required is to breathe normally. However, nebulizers will take at least five to ten minutes to fully deliver the medication. You may want to ask your doctor which type of device they recommend for treating acute symptoms during an asthma attack or COPD flare-up.

If you and your doctor have decided that a nebulizer is a good fit for your needs, learning about proper use and cleaning of the device is a key part of managing your health. It will also ensure that you are taking your medication as prescribed. Be sure to follow your doctor’s instructions and review the manufacturer’s instructions for your nebulizer before using it for the first time, as there is some variation among these devices.

All nebulizers have a medicine cup, a mask and/or mouthpiece, an air compressor, and plastic tubing to connect the compressor to the medicine cup. Always wash and dry your hands before using your nebulizer and make sure that all the pieces of your nebulizer are clean. Pour the correct dose of your medication into the medicine cup and connect the tubing to the air compressor and medicine cup. Turn on your nebulizer and ensure that it’s properly working. You should see a fine mist coming from the mask or mouthpiece.

Once you see a mist appear, your nebulizer is ready for use. To inhale your medication, secure the mask over your nose and mouth or put the mouthpiece in your mouth. Sit upright and breathe normally. Taking slower breaths can help the medication enter your airways. Continue to breathe normally until the medication is gone from the cup.

Bacteria and other germs can grow inside of a nebulizer that has not been properly cleaned, so it’s important to clean your device after every use and disinfect it once a week.

After you’ve finished using your nebulizer, wash the mouthpiece or mask and the medicine cup in warm soapy water and let them air dry. For weekly disinfecting, soak these pieces in a vinegar solution for 30 to 60 minutes, or for the amount of time specified by your doctor or in the manufacturer’s instructions. Your doctor may provide you with a disinfectant solution, but if not, you can mix one part white vinegar with three parts hot water. After the pieces are done soaking, let them air dry. Put these pieces in a plastic container or bag and store it in a cool, dry place.

As part of nebulizer maintenance, you should replace the plastic tubing on a regular basis. Ask your healthcare provider how often to replace the tubing.

When deciding whether a nebulizer is a good fit for your needs, be sure to consider your health insurance benefits. Most insurance plans have separate medical and pharmacy benefits in addition to a Durable Medical Equipment (DME) section. Many nebulizers fall under the DME category of your policy. There may be restrictions on the brands, suppliers, or types of nebulizers that are available, and it’s important to check with your specific policy to understand what will be covered and under which sections.

Alto makes it easy to stay on top of your asthma or COPD treatment, with free hand-delivery, automatic savings investigations, and easy medication management tools through our website and app. And our team of pharmacists is always here to answer your questions by phone or chat. 

Inhalers and nebulizers are both effective at delivering medications for respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD).

Whether traveling domestically or abroad, arriving at your destination with the medication you need is rarely as simple as packing it in your suitcase. From TSA compliance to temperature control, there are many factors to consider when traveling with medication — not to mention getting enough of a supply for the whole trip (plus extra, just in case).

Managing Your Medications While Traveling | Alto Pharmacy

Planning is key to managing your prescriptions and staying on top of your health needs while you’re away from home. Follow these tips to prepare for your next trip.

Research your destination’s medication laws

Many medications that are legal in the U.S. aren’t allowed in other countries. And it’s not only prescription medications: even over-the-counter treatment options may not be permitted in some destinations.

To avoid any unwelcome surprises while going through customs — or any missed doses — confirm that your medications are legal in the country you’re visiting. As a starting point, check with that country’s U.S. embassy. Consider that some countries may only allow a 30-day supply for certain medications and/or require you to carry an official prescription or additional information from your doctor with you. If you learn that your medication is not allowed at your destination, contact your healthcare provider to discuss your options.

There are legal considerations to be aware of even if you are traveling within the U.S. For example, you may be able to fill certain prescriptions out of state if you lose your medication or forget to order a refill before your trip, but the laws vary by state and there are often restrictions on controlled substances. Do your research in advance and make sure to prepare for any scenario.

Make sure you have enough of your medication

Unforeseen changes can happen when traveling, so it’s important to have more than enough medication on hand. Aim for an additional week or two’s supply. Allow yourself plenty of time to fill your prescription(s) before your trip. Depending on when you are due for a refill, you may need to request an early refill authorization from your insurance company — sometimes referred to as a vacation override — in order to get your medication in advance. (Alto can help with this!) 

In addition, make sure you’re prepared in the event that you misplace your medication during your trip. Write down the generic names of your medications, which may be more commonly available at pharmacies in other countries.

Lost luggage can be more than an inconvenience if your medication is in your checked bag, so always pack any important medications in your carry-on. This does mean you’ll have to be mindful of security requirements, particularly if carrying liquid medication. The U.S. Transportation Security Administration (TSA)’s current limit on liquids, gels, and creams in a carry-on bag is 3.4 ounces (100 milliliters), but there are exceptions for liquid medications. For the easiest travel experience, inform the TSA officer that you are carrying more than 3.4 ounces of liquid medication before your screening process begins, and be aware that additional screening of your medication may be required.

Keep your medications in their original packaging to avoid any issues when passing through security or customs. You may want to bring an official prescription or other documentation of your medical condition as an additional precaution, especially if you take a controlled substance or are traveling abroad.

Many medications lose their effectiveness if held at extreme temperatures, which is another reason to put your medication in your carry-on, as a plane’s luggage compartment can be very cold. If you take a medication that requires refrigeration like insulin, make sure you have what you need to hold your medication at an appropriate temperature.

Many people with diabetes use insulated medication bags to refrigerate insulin when traveling. Read ‘How to Prepare a Diabetes Emergency Kit’ for more information on the diabetes essentials to bring on a trip.

If you’re traveling far from home, anticipate how time zone changes may impact your medication schedule. Before your trip, ask your doctor how to handle the time zone shift and what to do if you accidentally miss a dose — some medications have more flexible timing of doses than others. 

Getting a last-minute refill before a trip is low stress with a flexible pharmacy partner like Alto. We offer free same-day delivery seven days a week, with the convenience of choosing the best delivery window for your schedule. And we’ll work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible

Managing Your Medications While Traveling

Since certain types of cancer treatments and procedures can temporarily or permanently impact both male and female fertility, it’s important to have a discussion about fertility with your oncologist as soon as possible. Read on to learn more about fertility preservation options and financial resources for those recently diagnosed with cancer.

Fertility Preservation Options After a Cancer Diagnosis

A cancer diagnosis can bring much uncertainty. If you are considering having children in the future, you may be wondering how your options for cancer treatment will affect your reproductive health. Fertility preservation treatments like egg or sperm freezing can bring peace of mind during this potentially overwhelming time, allowing you to leave open the possibility of starting a family after cancer treatment.

There are several ways that cancer treatments can affect your fertility, including the following:

Surgery to treat cancer of a reproductive organ — such as in the prostate, testes, ovaries, or cervix — may lead to infertility.

Chemotherapy-induced changes in hormone levels can lead to early menopause for women and decrease sperm production in men.

Radiation therapy near the reproductive organs, abdomen, pelvis, or spine may damage eggs or sperm cells depending on the dose and level of radiation.

Hormone therapy used in the treatment of breast cancer and other types of cancer may affect fertility, though these effects are often temporary.

The extent to which these cancer treatments may impact your fertility depends on your personal health history — including your age and baseline fertility — and the duration and dosage of treatment. Your care team can provide a clearer sense of what to expect based on your health and treatment plan.

Many individuals of reproductive age choose to freeze their sperm or eggs for future use before beginning cancer treatment.

Sperm freezing is a fairly simple process in which a person’s sperm is collected, analyzed by a doctor, and, if viable, frozen in vials with cryoprotectant agents and stored for future use.

In the egg freezing process, fertility medications stimulate egg production and maturity. The eggs are retrieved in a minimally invasive procedure and then frozen and stored for future use. There is also the option of freezing embryos, which are eggs that have been fertilized with sperm.

There are several ways that you can use your frozen sperm, eggs, or embryos to have children biologically in the future after cancer treatment. Intrauterine insemination (IUI) is a process that allows you to use your frozen sperm and have it placed into your partner’s or a surrogate’s uterus.

In vitro fertilization (IVF) is a process in which eggs and sperm are fertilized and then placed into the uterus with the potential outcome of a pregnancy. Women who have previously undergone cancer treatment might use this process to have their frozen eggs or embryos implanted into their own uterus. If using eggs rather than embryos, there will be the additional step of fertilizing the eggs with a partner or donor’s sperm. If you had a hysterectomy to remove all or part of your uterus during cancer treatment, you can have your embryos implanted into a gestational carrier’s uterus.

Given the urgency of cancer treatment and the important timing of fertility medications during an egg freezing cycle, you will likely have to make quick decisions about fertility preservation, often within a few days of receiving a diagnosis. Your oncologist may refer you to a fertility specialist called a reproductive endocrinologist who can answer questions about cancer treatment and fertility and help you understand your fertility preservation options. It isn’t uncommon to begin taking fertility medications the same day as your consultation with a reproductive endocrinologist. 

If your oncology team does not know that fertility preservation is a priority for you, do not be afraid to take the initiative in starting the conversation. Be sure to get clarity on how moving forward with the fertility preservation process might impact the timing of your cancer treatment and what your oncologist recommends. Depending on your treatment plan, you may also want to ask about radiation shielding, which can be used during cancer treatment to protect the ovaries or testicles and limit how much radiation they are exposed to.

It’s important to take the financial aspects of fertility preservation treatments into account when planning for the future. While these treatments are significant financial investments, there are resources that can alleviate some of the costs of treatment, including programs designed specifically for those in cancer treatment and survivors.

If Alto is your fertility pharmacy, your fertility medication protocol likely includes medications manufactured by EMD Serono or Ferring Pharmaceuticals. Both companies offer financial assistance for individuals whose fertility has been affected by cancer treatment.

EMD Serono donates fertility medications to eligible cancer survivors diagnosed during their reproductive years through the Livestrong Fertility Discount program. Start the application process on Livestrong’s website to learn if you are eligible.

Ferring Pharmaceuticals provides some fertility medications at no cost for individuals pursuing fertility preservation before cancer treatment. To be eligible, you must be a female U.S. citizen or permanent resident with a cancer diagnosis who has not received chemotherapy within the previous six months. To apply, learn more about Ferring’s Heartbeat program online, or call 1-888-347-3415. (Residents of Arkansas, Massachusetts, or New Jersey can call 1-877-252-0553.)

Read our previous post on financial planning for egg freezing.

A fertility pharmacy partner you can rely on

Since 2016, Alto has supported more than 50,000 fertility journeys. We understand that fertility treatment is a significant investment — physically, emotionally, and financially — and we see ourselves as a partner in your health.

We offer free, same-day delivery seven days a week and temperature controlled packaging to ensure that your fertility medications always arrive in the right condition. And our fertility-trained pharmacists are available until 9 pm PST (12 midnight EST) on weeknights to offer any support you need.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881. You can also request a price quote online.

Overall heart health involves all the components of this complex network. Coronary artery disease — the most common type of heart disease — affects your blood vessels and the flow of blood to your heart. It typically develops over the course of many years, and many of the key risk factors can be managed. Here’s what to know about preventing and treating this type of heart disease.

Coronary Artery Disease, Explained

Your heart is at work every minute of the day, pumping blood to deliver oxygen to vital organs. Each part of the heart plays a role in this important task, along with the rest of your cardiovascular system, including your arteries and blood vessels.

Like any organ in your body, your heart needs oxygen to function. Coronary arteries are the blood vessels that supply your heart with oxygen-rich blood. Coronary artery disease occurs when these blood vessels are hardened or blocked, affecting the flow of blood to the heart itself.

This condition is often caused by atherosclerosis — the accumulation of substances like cholesterol and blood-clotting material in your arteries. (These substances are collectively referred to as plaque). A variety of factors can increase your risk for atherosclerosis — and therefore your risk for heart disease — including high LDL cholesterol, high blood pressure, diabetes, obesity, physical inactivity, and smoking. Additional key risk factors for heart disease include age and family history. 

There are several known symptoms of coronary artery disease, including chest pain or tightness (also called angina) and shortness of breath. Depending on where your blood vessels have narrowed, you may also experience pain, numbness, or weakness in your arms or legs. Women are more likely than men to experience additional symptoms such as nausea, back and jaw pain, and shortness of breath without accompanying chest pain.

Symptoms of coronary artery disease present differently from one person to another. It is best to discuss your risk of heart disease with your doctor if you have concerns rather than waiting for symptoms to appear. It’s especially important to be proactive if you have a family history of heart disease.

In the long term, coronary artery disease can increase your risk for other heart health issues, including heart attack and heart failure, which occurs when your heart cannot pump all of the blood that your body needs. These serious health risks are preventable — by identifying coronary artery disease at an early stage and following the treatment plan your doctor recommends, you can manage the condition and lower your risk for related complications.

Too often, people learn that they have coronary artery disease only after experiencing a more serious complication like a heart attack, stroke, or heart failure. Consulting with your doctor about your risk for heart disease and staying up to date with blood pressure, cholesterol, and blood glucose screenings is key to detecting heart health problems early on. Here are some of the numbers your doctor will track to identify your risk for heart disease, along with your individual and family health history.

The National Institutes of Health defines normal blood pressure for most adults as below 120 mm Hg systolic and 80 mm Hg diastolic. (Systolic pressure, the first number in your blood pressure reading, is typically the reading that’s most important when monitoring blood pressure.) If your blood pressure falls in this range, typical screening frequency is at least once per year. If your blood pressure is in a higher range, ask your doctor about recommended screening frequency.

Your cholesterol levels can also help your healthcare provider identify your risk for heart health issues. If your total cholesterol is under 200 mg/dL, you can have your cholesterol checked every 4-6 years. If you are at higher risk for heart disease and stroke, consult your doctor about recommended screening frequency.

In the long term, high blood sugar can damage your blood vessels, and diabetes is a risk factor for coronary artery disease. It’s important to monitor your blood glucose levels as part of your broader heart disease prevention efforts, especially once you enter your 50s and 60s. Your doctor can advise you on recommended screening frequency.

Remember that it’s never too early or too late to prioritize heart-healthy living. Read our previous blog, ‘How to Prevent Heart Disease at Any Age’ to learn about important heart disease prevention actions for your age group.

If you have coronary artery disease, your doctor may recommend lifestyle changes and/or medications to manage your heart disease risk factors. Quitting smoking, planning a heart-healthy diet, and exercising more frequently are often a first step in managing coronary artery disease.

The specific medications used to treat coronary artery disease vary by individual. Your doctor may prescribe one or more of the following types of medications depending on your health history:

Cholesterol-lowering medications like statins, fibrates, and niacin

Blood pressure medications like beta blockers, calcium channel blockers, and ACE inhibitors

Anticoagulants and antiplatelets to reduce your risk of blood clots

Heart-healthy living is a lifelong practice, and heart disease prevention or treatment is an ongoing commitment to your health. At Alto, we make it as simple as possible to manage your risk for heart health issues like coronary artery disease and stay on top of cholesterol-lowering or blood pressure management medications. 

We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

When inflammation persists, it no longer serves a helpful purpose. This type of inflammation, also referred to as chronic inflammation, occurs when your body consistently acts like it’s under attack, releasing white blood cells indefinitely. In the long term, an elevated white blood cell count can affect other organs such as your heart, lungs, and kidneys. Research has also found a connection between chronic inflammation and other chronic diseases including heart disease, diabetes, cancer, Alzheimer’s disease and Crohn’s disease.

Inflammation, Explained

Acute inflammation is the body’s natural way of fighting infections and injuries as part of the healing process. When you have an injury, blood flow increases as your body instinctively releases white blood cells, proteins, and other inflammatory chemicals to protect the wounded area. This leads to redness, swelling, and pain at the site of injury. The body reacts similarly when you have a virus or cold, but in these instances, the blood cells and inflammatory chemicals are released throughout the whole body rather than to one spot. This type of inflammation is good for you, as it allows your body to heal.

But when inflammation persists, it no longer serves a helpful purpose. This type of inflammation, also referred to as chronic inflammation, occurs when your body consistently acts like it’s under attack, releasing white blood cells indefinitely. In the long term, an elevated white blood cell count can affect other organs such as your heart, lungs, and kidneys. Research has also found a connection between chronic inflammation and other chronic diseases including heart disease, diabetes, cancer, Alzheimer’s disease and Crohn’s disease.

Read on for more information about the causes and symptoms of chronic inflammation and how to prevent or treat it.

Causes and symptoms of chronic inflammation

Several known factors can trigger chronic inflammation:

Lifestyle factors including obesity, diet, smoking, alcohol use, stress, and sleep disorders

Autoimmune diseases like type 1 diabetes or lupus, in which the body mistakenly attacks itself

Long-term exposure to pollution, industrial chemicals, or other toxins

Some individuals with this type of inflammation experience fatigue, fever, and joint and muscle pain. However, while there are clear physical signs of acute inflammation, chronic inflammation does not always have visible symptoms.

Your doctor can help determine if you have chronic inflammation. They will likely ask about your symptoms and perform a physical exam as a first step. They may then order additional tests to detect inflammation. These tests look for various indications of inflammation in your body, but they cannot formally diagnose inflammation or any other health condition. Rather, they provide a more comprehensive picture of your health so that your doctor can recommend the best next steps.

Potential tests your doctor may recommend during this process include a C-reactive protein (CRP) test and/or an erythrocyte sedimentation rate (ESR) test. A CRP test identifies your blood levels of CRP, a protein produced in your liver. Chronic and acute inflammation have both been linked to high levels of CRP.

An ESR test examines how quickly your red blood cells sink to the bottom of a test tube, with higher rates of settlement pointing toward more inflammation. Doctors often recommend this test when there is a possibility of high inflammation.

Sometimes these tests may help your doctor diagnose an inflammation-linked condition, such as rheumatoid arthritis or type 2 diabetes.

Chronic inflammation and other health conditions

There is a connection between chronic inflammation and many other health conditions. Inflammation can occur directly as the result of rheumatoid arthritis, which is both an autoimmune condition and an inflammatory disease. If you have rheumatoid arthritis, your immune system attacks your joints — often in your hands, writs, and knees — which leads to inflammation. There is also a direct link between inflammation and other inflammatory diseases, like ulcerative colitis and Crohn’s disease.

Inflammation has also been linked to heart disease and diabetes, but research into this connection is ongoing. While inflammation is more common in individuals with these health conditions, there is not yet definitive evidence that inflammation by itself directly increases your risk for these conditions.

Inflammation in the walls of your blood vessels has been linked to atherosclerosis, the accumulation of fats, cholesterol, and other substances in your arteries. In the long term, atherosclerosis increases your risk for a heart attack or stroke.

Since obesity, smoking, and physical activity are all risk factors for inflammation, heart disease, and diabetes, the overlap of these risk factors likely plays a role in the connection between the conditions. The good news is that a single healthy choice can lower your risk for all three diseases at once.

Your healthcare provider will recommend treatment based on the type of inflammation you have, however not all cases of chronic inflammation require medication.

Two types of medications are commonly used to lower both acute and chronic inflammation: nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil®), aspirin (Bayer®) or naproxen (Aleve®) and oral steroids including prednisone (Deltasone®, Prednicot®), methylprednisolone (Medrol®), and dexamethasone (Decadron®, Dexasone®). Steroid injections can reduce inflammation in a specific joint or muscle and are often used to treat rheumatoid arthritis.

If you have an inflammatory disease, your doctor may recommend medications specifically used to treat that disease. Medication classes commonly used to treat inflammatory diseases include:

Disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate (Rheumatrex®), sulfasalazine (Azulfidine®), and leflunomide (Arava®). These medications can slow the progression of rheumatoid arthritis.

Statins, a type of medication commonly used to treat high cholesterol. They have anti-inflammatory effects and can lower CRP levels.

You can also fight inflammation simply by what you eat. An anti-inflammatory diet includes antioxidant-rich foods like the following: 

Cherries, blueberries, oranges, and other fruits

There are also some foods that have been linked to higher levels of inflammation. If you have chronic inflammation, your doctor may suggest limiting your intake of the foods below as part of your treatment plan:

White bread, pasta, pastries, and other refined carbohydrates

Soda, fruit juices with added sugar, energy drinks, and other beverages high in sugar

Red meat and processed meat like hot dogs and sausage

At Alto, we’re committed to making it as simple as possible to prioritize your health and well-being and stay on top of your medications.  We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Working from home offers many benefits. The lack of commute to and from the office can mean more quality time with family, mid-day workouts, or a load of laundry over lunch. And with fewer distractions, the environment of a home office is a productivity boost for certain work styles.

How to Say Healthy While Working From Home

At the same time, some individuals may find it more difficult to concentrate outside of a physical office, and remote work can also impact your mental health. In a recent public opinion poll conducted by the American Psychiatric Association (APA), nearly two-thirds of the respondents reported feeling isolated or lonely at least sometimes as a result of working from home, while 17% said that they experience isolation and loneliness all the time. And a majority of the respondents who partially work from home said that they find it difficult to step away from work at the end of the day.

With remote work on the rise — the number of U.S. adults who work from home increased from 22% to 42% between 2019 and 2020 — it is important to prioritize your mental and physical well-being and create boundaries between work and social life. Here are steps you can take to stay sane and healthy while working from home.

A physical office space naturally incorporates structure into your day. Simply sitting down at your desk and seeing colleagues allows you to mentally shift into work mode. This is important for not only productivity, but also for work-life balance — just as you are able to jump right into your to-do list once you enter the office, the clear boundary between work and home means you’re less likely to revisit that list once the day is over. Plus, watching a coworker take a break may be a much needed reminder that it’s time to grab lunch or get some fresh air.

There are several ways to give yourself structure while working from home. First, mimic the experience of going to work. It may be tempting to stay in pajamas and check emails from bed, but many remote employees find it easier to concentrate — and to leave work behind at the end of the day — by creating a morning routine and using a designated workspace that’s not in your bedroom.

In addition, having a clear plan for the day can boost both productivity and mental health, as you will have carved out time for high-priority tasks and breaks. For some individuals, planning the day the night before makes it easier to jump into work the next morning, so consider incorporating this into your end of day routine if you find it helpful. There are a variety of ways to lay out what needs accomplishing, from organizing your day entirely on a calendar to using a task management tool. Increasing focus and productivity while working from home is all about finding the system that’s right for you.

It’s just as important to consider your personal preferences and work habits when planning breaks. The frequency of your breaks should correlate to how long you can maintain a state of deep focus. Taking breaks every 75 to 90 minutes may be realistic for some individuals, but others may find shorter bursts of work more helpful. The pomodoro method has become a common approach to time management. You will focus on a single task for 25 minutes then take a five minute break, repeating the pattern three more times before taking a 15 minute break.

Whichever system you choose for breaks, remember to use some of that time for physical activity. Exercise affects both your physical and mental health and may help reduce some of the stress and isolation that often comes with remote work.

Having a designated workspace can help you create boundaries between work and social life. Working from home can contribute to burnout, and using your bedroom as the office can often lead to a workday that stretches well past eight hours. If you can, make a workspace in another room. If you don’t have space to use as a designated home office, try the kitchen table or living room.

In addition to supporting your mental health, working in a space that’s set aside for work can help minimize distractions and maximize productivity, particularly if you live with family members or roommates. Young children or anyone who’s never worked from home themselves may not know to avoid interrupting you during your workday. You can set boundaries by informing everyone at home of your working hours and communicating your expectations.

The design of your workspace can also impact your emotional well-being and physiological health. Exposure to sunlight is linked to higher levels of serotonin, a hormone believed to regulate your mood and lower anxiety. If possible, use a workspace that gets a lot of natural light, and use part of your break time to soak up some sun. Add some greenery to your home office too — research has found that having plants nearby as you work can increase productivity.

Maintaining good posture while you work can prevent tightness in your neck or back pain. If working while seated, keep your feet flat on the ground beneath your knees. Avoid working from a chair that’s too tall and prevents your feet from reaching the ground. If you can, use an ergonomic office chair or a standing desk, which offers many health benefits. If using an office chair, remember that each person’s physiological needs are different, so take time searching for the right fit.

The repetitive motion of typing in a seated position has been linked to carpal tunnel syndrome — numbness and tingling in your hand, wrist, and/or arm caused by pressure on your median nerve. A hunched posture can put strain on your wrists and hands, so using an ergonomic chair or standing desk is already a step toward preventing carpal tunnel syndrome. Be mindful of your arm and wrist position as well. Work with your elbows bent by your side and keep your forearms stretched out in front of you parallel to the floor. Using an external computer monitor or keyboard can make it easier to maintain this position.

Working in silence by yourself can lead to greater concentration and productivity in some cases, but too much isolation and loneliness affects your mental health. An office environment allows for natural socialization and conversation throughout the day, and recreating this experience at home requires a bit more intention.

If you work on a team, use workplace messaging tools to maintain connections with coworkers. Take the initiative in setting up virtual or in-person events like happy hours. And if you’re located in the same area as your colleagues, schedule a coworking session in a local coffee shop. Remote work is also a great opportunity to expand your professional network by joining a coworking space.

It’s important to maintain other social connections, too. Schedule after-work plans with friends and family, and don’t forget to pause notifications and sign off for the day.

Let Alto support your health and wellness

Practicing good self-care while working from home involves prioritizing your physical health. Alto is here to support you with exceptional pharmacy care at every step of the way. We make it simple to stay on top of your medications with free, same-day delivery and medication management tools like reminders and auto refills in our mobile app.

How to Stay Healthy While Working From Home

Last year, we set out to tackle this technical debt by splitting the User model into separate concerns and refactoring the entire system into this new paradigm.

Tackling Technical Debt and Improving Security: How Alto Untangled an Overloaded User Model

At Alto, we have three types of users: customers, healthcare providers (nurses, doctors, etc), and operations users who run the pharmacy. For each type of user, we maintain a separate application (though they share a monolithic backend for now): our customer app; our Alto Connect app for providers; and our internal pharmacy management tool called Wunderbar, which powers the pharmacy experience from prescription intake to fulfillment.

Early on, we made the pragmatic choice to represent both customers and operations users with a single User model, distinguishing them with a “roles” attribute. This required repetitive checks that, over time, slowed down our engineering teams, presented substantial privacy risk, and posed difficult scaling challenges as we evolved our monolith into different microservices. 

The challenges of relying on a single User model for different types of users

The notion of a User is core to our concept of identity from which authentication and authorization proceeds. From a security perspective, it’s difficult to build an extensible and clean authentication and authorization system when you’re overloading one model for two very different populations of users. From a privacy perspective, this muddied customer records (which are subject to more restrictions because they’re healthcare records) with workforce records, hamstringing many analytics efforts.

Authentication: Alto employees who were also Alto customers were required to use their work emails for their customer accounts. Not only was this restriction frustrating for Alto employees, but it also posed a security risk: employees should only be able to access Wunderbar via corporate SSO, not their personal account passwords. 

Authorization: Engineering new authorization capabilities required intricate knowledge of the idiosyncrasies of our user structure. This both slowed down development and created tremendous risk that any mistake could easily escalate user permissions.

Privacy: Because they existed in the same table, both customer records and Alto operations user records were classified as Protected Health Information, or PHI, which severely limited what we were able to do with them.

Attribution: Our robust audit logs were significantly less useful when a user ID in the transaction log might refer to either an ops user or a customer.

State management: Some updates pertaining to admin identity lived on the customer model, some lived on the employee model, and others lived in other various models.

Architecture: Tight coupling would have prevented us from decoupling our monolithic system into smaller services.

Our backend is primarily a monorepo Rails application that shares a tremendous amount of functionality between our customer, provider, and ops user-specific domains. Generally we use JWTs to secure customer and ops user sessions. These JWTs are issued only once valid credentials have been present.

Ops users are required to log in via Okta SSO, enforcing both valid username/password as well as a two-factor authentication (2FA) prompt. We use Devise and Omniauth to wire up the OIDC flow with our upstream identity provider, and we use CanCan to expand a set of roles per-user into a set of capabilities that restrict what resources they can access/modify.

Ops users primarily work in our internal pharmacy management app. However, the state of these users was shared between several different tables: Users, which otherwise refer to customers, and Employees, which share some ops user-specific state tied to Users.

Large change sets of code being deployed at once are harder to code review, harder to unwind if something goes wrong, and are more likely to be more disruptive. For this project, we knew that such a large architectural change had to be broken up into many more-digestible pieces if we were to be successful. The plan:

1. Create a new dedicated model for our ops users

# == Schema Information
#
# Table name: wunderbar_users
#
#  id                        :bigint(8)        not null, primary key
#  user_id                   :bigint(8)        indexed
#  email                     :string           not null, indexed
#  first_name                :string           not null
#  last_name                 :string           not null
#  token_last_invalidated_at :datetime
#  roles_mask                :integer          default(0), not null
#  title                     :string           not null
#  team                      :string           not null, indexed
#  is_active                 :boolean          default(TRUE), not null
#  slack_user_id             :string
#  pod                       :string

This was the easy part: create the database structure for a properly isolated admin user type, which we called a WunderbarUser.

We now had our admin user state split between Employees and Users, with a new table that engineers and analysts wanted to use that was not yet populated, and we had to make progress while allowing new hires and new customers alike to onboard to our platform.

2. Synchronize state between the old tables and new table

Next, we created a WunderbarUser for any User who was, or ever had been, a Wunderbar user. This required some historical digging —we had a lot of people who were onboarded, and even some offboarded, before we even had the intermediate Employee record!

Two major choices at this stage really helped the project succeed. First, we ensured that the WunderbarUser records all had IDs matching the corresponding User records. This is because a lot of our legacy audit records (that we’re required to preserve and keep useful as a Covered Entity under HIPAA) referenced an `admin_user_id` column populated with the ID of the User. If we just created all new entries for WunderbarUsers, these old logs would require at least one level of indirection (e.g. querying back to User) to make useful.

     # Create with the same ID as the user that we're creating this from.
     wunderbar_user_attributes = {
       id: user.id,
       user_id: user.id,
       email: user.email,
       roles_mask: user.roles_mask,
       date_of_birth: user.date_of_birth,
       token_last_invalidated_at: user.token_last_invalidated_at,
       first_name: user.first_name,
       last_name: user.last_name,
       preferred_first_name: user.preferred_first_name,
       is_active: false,
     }

Second, we created a new WunderbarUser any time we created a new Employee record (e.g. when we onboarded a new employee) and synchronized any changes between Users, Employees, and WunderbarUsers tables. As a side note: we knew we’d have to protect this syncing logic to ensure that we only copied each change once — otherwise, our callbacks would fire forever!

3. Migrate functionality slowly to use the new ops user model

We migrated logic to reference WunderbarUsers where previously we’d referenced Users and/or Employees. Authentication, authorization, audit logs, and pharmacist licenses were all updated here — albeit painstakingly!

We then migrated all of the foreign keys our various Postgres database tables held to either the Users or Employees tables to instead reference the WunderbarUsers. This ended up being around a hundred foreign keys, but a constraint-only migration that fortunately didn’t involve any data changes.

In short: our goal was to do this change slowly and steadily enough that nobody would notice until, one day, we could announce to the team, “Hey, we did a big security-pertinent project, and now you can change your customer email to be anything.”

Authentication: While we use the same JWT format for each, our customer and operations user authentication systems are now totally separated.

Authorization: With separate user types, we have separate capabilities and domain-specific authorization checks for each area, enforced in code.

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