• Cortisol has many functions which include:
  • Blood pressure regulation.
  • Immune system regulation.
  • Helping to balance the effect of insulin by raising blood sugar level.
  • Helping the body to respond to stress.
• Aldosterone helps to maintain the balance of salt and water in the blood and helps to control blood pressure.

Cells in the inner part of the adrenal glands (adrenal medulla) make the hormones adrenaline (epinephrine) and noradrenaline (norepinephrine), which have various actions throughout the body. There are a variety of reasons why the adrenal glands might not work as they should. Adrenal gland disorders, which cause your glands to make too much or too little hormone, may be caused by genetic mutations, tumors, infections, pituitary gland disorders, and certain medications.

The adrenal glands are an essential part of your body’s responses to any kind of physical, emotional or psychological stress.

Examples of physical stress:

• Severe or recurrent infection or illness
• Severe injury
• Surgery
• Nutritional deficiencies
• Insufficient sleep

Examples of emotional or psychological stress:

• Difficult relationships
• Death of family member
• Problems at work

Adrenal fatigue, although not a proven medical condition and not recognized by any Endocrinology society, is believed by some healthcare providers to be caused by chronic exposure to stressful situations. Chronic stress may disrupt the adrenal gland’s normal pattern of cortisol release which can lead to problems such as:

• Insulin resistance/diabetes
• Cardiovascular problems including arrhythmias, CHF, MI, atherosclerosis and hypertension
• Osteoporosis
• Dementia/memory loss
• Immune suppression
• Impaired thyroid function
• Decreased kidney function
• Exacerbation of skin conditions (acne, psoriasis, eczema)
• Gastrointestinal problems (GERD, Irritable Bowel Syndrome)
• Mood disorders and depression
• Increased risk of neurodegenerative diseases
• Sleep disorders
• Reproductive disorders
• Premature aging

Depending on the adrenal gland disorder with which you are suffering, you may require lifestyle advice to reduce stress and improve diet, exercise, sleep and relaxation. In addition, nutraceuticals, supplements and medications may be required to stop the excess or insufficient production of hormones. Your compounding pharmacist, working with your healthcare provider, can help you achieve optimal hormone balance.

Many medications that are traditionally used to manage symptoms of chronic pain can cause undesirable side effects. Opioid-related medications such as codeine, hydrocodone or oxycodone can be very intolerable in the gastrointestinal system. Treating pain topically is an alternative option to avoid these undesirable side effects. Many pharmacies are able to compound topical preparations that contain various medications to help control symptoms of pain. Because these formulations are applied topically, just enough of the medication is absorbed through the skin to help relieve symptoms at the site of the pain.

Your compounding pharmacist can prepare personalized compounding that includes individualized pain management treatment, hormone replacement therapy, and proper supplementation. Many dealing with fibromyalgia do not respond well to traditional treatment with the pain medications available on the market. Your compounding pharmacist can prepare customized treatments to provide pain relief. Your compounding pharmacy can help you explore treatment options geared to address the cause of fibromyalgia.

If hormone imbalance is the cause of the condition, your compounding pharmacist can prepare custom hormone treatment to address your specific imbalance.

If you have a nutritional deficiency, it may worsen your condition. With that being said, your compounding pharmacist can prepare vitamins, minerals, and specific supplements unique to you and your needs.

By working closely with your compounding pharmacists, your practitioner can prescribe medications for the following gastrointestinal conditions:

• Anal fissures
• Burning Mouth Syndrome (BMS)
• Canker sores
• Indigestion
• Inflammatory Bowel Disease/ Crohn’s Disease
• Leaky Gut Syndrome (LGS)
• Nausea
• Opioid-induced constipation (OIC)
• Ulcer Wounds
• Ulcerative Colitis

Opioids, widely used in the treatment of acute and chronic pain, are sometimes limited by their numerous adverse effects, the most common being opioid-induced constipation (OIC), an often debilitating side effect of therapy. Bulk-forming laxatives (eg, psyllium, methylcellulose), which are considered safe in most cases of constipation, can be harmful to patients with OIC. These agents are not likely to relieve symptoms of OIC and may even be detrimental, as they are associated with abdominal pain and increase the risk for intestinal obstruction, and are generally not recommended. Compounding pharmacists are often called upon to prepare medications to either prevent or reverse OIC.

Indigestion, characterized by upper abdominal fullness and/or pain, heartburn, nausea, and belching, is frequently caused by gastroesophageal reflux disease (GERD) or gastritis. When antacids alone or other treatments fail, a “G.I. cocktail”, a general term for a mixture of liquid antacid, viscous lidocaine, and an anticholinergic drug, may provide relief for indigestion.

Whether you are suffering from opioid-induced constipation or indigestion, or another gastrointestinal condition, your compounding pharmacist may be able to prepare medications unique to you and your needs and get you feeling better in no time.

There are several effective products that exist on the commercial market to help with symptom management. If you have low testosterone and if the current available treatment options are not a good fit for you, your compounding pharmacies can work with your medical provider to create a testosterone formulation for you. These medications may be for oral or topical use. With proper monitoring and dosage adjustments, compounded testosterone formulations can help control symptoms associated with low-T in a safe manner.

Serious side effects have been reported with testosterone including the following:

• Blood clots in the legs or lungs. Contact your healthcare provider if you notice pain or swelling in the legs, redness of the legs, difficulty breathing, or chest pain.
• Possible increased risk of heart attack. Seek immediate medical attention if you experience symptoms of a heart attack. Symptoms include:
  • chest pain
  • feeling of pressure in the chest
  • shortness of breath
  • discomfort in the neck, back, shoulder, or arms
  • nausea/vomiting
  • dizziness or lightheadedness
  • sweating
• Possible increased risk of stroke. Seek immediate medical attention if you experience symptoms of a stroke. Symptoms include:
  • sudden numbness or weakness on one side of the body (can be in the face, arm or leg)
  • sudden confusion
  • difficulty speaking
  • sudden change in vision
  • sudden trouble walking (may experience loss of balance or coordination).
• Possible increased risk of prostate cancer. Your healthcare provider will check for prostate cancer before and during treatment with testosterone.
• Edema with or without heart failure. Contact your healthcare provider if you notice swelling of your ankles, feet, or body.

This is not a complete list of testosterone serious side effects. Ask your doctor or pharmacist for more information.

Compounding requires a relationship between the patient, physician, and pharmacist. Together, they will work to provide an alternative treatment option when and if the current available treatment options are not the best fit for you.

The primary hormone of importance in females is estrogen, which exists in three different forms in the body: estrone (E1), estradiol (E2), estriol (E3). Other important hormones include progesterone (P4), testosterone, and dehydroepiandrosterone (DHEA). These substances may help restore natural balance in the body and may help alleviate chronic symptoms arising from imbalance.

There are several effective products that exist on the commercial market to help with symptom management. Compounding allows for a more personal and tailored dose for you. In addition, compounding offers a variety of dosage forms that will best fit you. By working with your medical provider, compounding pharmacies can create various formulations that may include any combination E1, E2, P4, E3, DHEA, and/or testosterone to help manage your symptoms with the lowest possible dose to alleviate symptoms for the shortest period of time.

Complete medical histories will be taken and evaluated to create a product that will help you manage any issues you might be experiencing. The amount of these hormones will be limited to mimic how they naturally exist in your body to ensure safety. Formulation examples include topical and vaginal creams, oral capsules, and orally dissolving or sublingual tablets. With sufficient monitoring, formulations can be adjusted to help relieve your most bothersome symptoms.

Compounding is a relationship between the patient, physician, and pharmacist. Together, they will work to provide an alternative treatment option when and if the current available treatment options are not the best fit for you.

Osteoporosis affects men and women of all races, but white and Asian women — especially older women who are past menopause (when estrogen levels fall) — have the highest risk of developing this condition. Women who have either undergone early menopause or have had their ovaries surgically removed before age 45, are also more likely to develop osteoporosis. Other risk factors for women are small body frame and having periods that stop for six months to a year or more before the onset of menopause due to over-exercising or over-dieting.

Other risk factors include:

• getting older
• being small and thin
• having a family history of osteoporosis
• taking certain medicines such as glucocorticoids and some anticonvulsants
• having osteopenia (low bone density)
• consuming a diet low in calcium and vitamin D
• smoking cigarettes
• having an inactive or sedentary lifestyle
• consuming excessive amounts of alcohol

Osteoporosis is often called a silent disease because bone loss occurs without symptoms and people may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a hip to fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis (severely stooped posture).

Osteoporosis is diagnosed with a bone density test. Bone mineral density (BMD) can be measured by a machine that uses low levels of X-rays to determine the proportion of mineral in your bones. During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only a few bones are checked, usually in the hip, wrist and spine.

BMD tests can:

• detect low bone density before a fracture occurs
• confirm a diagnosis of osteoporosis if you already have one or more fractures
• predict your chances of fracturing in the future
• determine your rate of bone loss, and monitor the effects of treatment if the test is conducted at intervals of a year or more

Patients who need an alternative treatment to medications readily available on the market can benefit from customized hormone replacement therapy.

Estrogen, especially when started soon after menopause, can help maintain bone density and decrease the risk of fractures. Testosterone therapy may also be utilized to slow bone loss. Calcium and vitamin D, as well as other minerals, are important for bone health. Your body needs adequate supplies of vitamin D in order to take up (absorb) the calcium that you eat or drink in your diet.

Ask your compounding pharmacist and other health care professionals for more information about customizing your hormone replacement therapy and nutritional supplementation with compounded vitamins and minerals to optimize your bone health.

Compounding is an option for helping children get the medications they need in a suitable form. Many medications that may not be available in liquid forms can be compounded into solutions, suspensions, and syrups. In addition, gummy bears, freezer pops, lollipops, topical creams are examples of formulations that may be more child-friendly. Many of the oral alternatives can be flavored to help with medication administration in children.

Compounded formulations provide innovative solutions to challenging medical situations involving the treatment of foot and leg issues.

• Topical, transdermal therapy can decrease systemic exposure and significantly reduce the risk of undesirable side effects of certain medications such as drowsiness, gastrointestinal upset or bleeding.
• Compatible medications can be combined into a single formulation for ease of administration.
• Some compounded formulations solve nail removal problems. For example, urea plasters, a non-surgical treatment for nail removal, are less costly, essentially painless, and reduce the risk of infection or hemorrhage.

The following list is just a few of the conditions for which your pharmacist, working closely with your podiatrist, can prepare customized formulations to meet your unique needs:

• Warts
• Nail Fungus
• Heel Spurs
• Plantar Fasciitis
• Poor Circulation
• Wound Care
• Toenail Removal
• Dry Skin
• Inflammation/Arthritis
• Swelling
• Blisters
• Calluses
• Diabetic Neuropathy
• Neuropathic Sprains
• Neuritis
• Muscle Spasm
• Athete’s Foot
• Sprains
• Tendonitis
• Iontophoresis/Phonophoresis

Many issues may arise whether it is stretch marks, not producing enough breast milk, and/or sore and cracked nipples during breastfeeding. Compounded medications can help many issues that may arise during pregnancy as well as post-delivery. Compounded medications can ease your transition after your delivery and you can start feeling like yourself in no time. Compounded medications can also provide customized medications to meet you and your baby’s needs yet are safe for your baby.

Compounding for proctology is the preparation of customized medication for conditions related to the anus and rectum. Conditions that involve the anus or rectum typically will cause one discomfort and pain. In addition, many available topical and systemic treatments may simply be inadequate in treating the condition. Fortunately, your pharmacist can prepare customized medications to manage your condition, and in turn, help to manage your discomfort and pain.

Hemorrhoids

Hemorrhoids (also called piles) are swollen, engorged veins within the lining of the anal canal or lower rectum. They are either inside the anus or under the skin around the anus. Internal hemorrhoids normally don’t cause much discomfort. External hemorrhoids, on the other hand, are typically painful. Both types of hemorrhoids can bleed when they are irritated.

Traditionally, hemorrhoids are associated with aging, pregnancy, chronic constipation or diarrhea, straining during bowel movements, and prolonged sitting on the toilet. These conditions interfere with blood flow to and from the area, causing it to pool and enlarge the vessels.

While bleeding, anal itching and pain are common symptoms, some people with hemorrhoids have none of these symptoms and only learn of their hemorrhoids during routine physical examinations or colonoscopy screenings. Symptoms, when they do occur, usually go away within a few days.

Simple, self-help and over-the-counter measures can ease pain and promote healing. Increased fluid and fiber intake, either by eating plenty of fruits and vegetables, or with fiber supplementation, draws water into stools, making them softer and easier to pass.

Over-the-counter topical therapies such as pads infused with witch hazel (Tucks), as well as soothing creams that contain lidocaine, hydrocortisone, or other ingredients like phenylephrine (Preparation H) are available to help you find relief. Compounded prescription preparations are sometimes necessary for more severe or thrombosed hemorrhoids.

Anal Fissures

An anal fissure is a tear in the anus. Passing hard stools, constipation, and chronic diarrhea can cause stretching and tearing of the anus. Other factors include pregnancy, childbirth and complications of Crohn’s disease, ulcerative colitis or a sexually transmitted infection such as anal herpes infection.

Anal fissures cause sharp, stinging pain that can be severe and tends to worsen when you pass a bowel movement and for an hour or so after. The pain is often accompanied by bleeding during bowel movements. In most people, this skin damage will heal quickly without any problems. However, fissures sometimes become chronic because after the first tear, bowel movements reinjure the area. Some people seem to have a higher than normal pressure in the anal canal from muscle spasms of the internal anal sphincter (the muscle around the anus). Increased anal canal tone and sphincter spasm is believed to decrease blood flow to the anal region and slow the healing process. For this reason, the most effective medications for anal fissures work by increasing blood flow to the region and relaxing muscles to reduce spasms.

Compounded topical treatments such as nitroglycerin, nifedipine, and diltiazem can be prepared by your compounding pharmacist. These medications work by dilating the blood vessels around the anus, and/or by causing relaxation of the internal anal sphincter. Blood is able to flow to the area more easily to promote faster healing.

Your compounding pharmacist can prepare medications in a variety of formulations to treat and manage conditions like hemorrhoids, anal fissures, idiopathic proctodynia (pain syndrome affecting the perianal region), and/or inflammatory bowel disease such as Crohn’s disease.

In addition, your compounding pharmacist can prepare medications to manage pain post hemorrhoidectomy, which is a surgery to remove internal or external hemorrhoids. If you are receiving radiation therapy for pelvic malignancy, you may experience radiation proctitis, which is a known complication. If this is the case, your compounding pharmacist can formulate a customized treatment for you.

In the following instances, a compounded medication therapy may be indispensable:

• Preservative-Free medications are required.
• Certain dyes, sugars, alcohols, or lactose must be avoided.
• Combination products or other special formulations are desired but are not commercially available.
• Normally commercially available product is backordered or discontinued.
• Alternative dosage form or strength outside of what is commercially available is necessary.
• Allergy or side effect to a commercially available product.
• Commercially available treatments have failed.

Your compounding pharmacist can prepare a variety of medications that can help you lose weight. Your pharmacist will work closely with your doctor to determine the best option for you. Common weight loss treatments include:

• Oral appetite suppressants, which can be prepared in a variety of combinations.
  • Customized phentermine capsules and lollipops are commonly prescribed alone or in combination for appetite suppression.
• Specific vitamin injections that help regulate appetite while assisting with the metabolism of fats and carbohydrates into energy.
• Injections that help release fat deposits in the body.
• Human chorionic gonadotropin (HCG) preparations More recently Human chorionic gonadotropin (HCG) has gained popularity. Initially approved by the FDA for the treatment of female infertility and hormone treatment in men, many physicians believe it can be used for weight loss. HCG should be used in conjunction with a diet and exercise plan and should only be taken under the direction of a physician. You can only get HCG with a prescription from a physician. Don’t be fooled by fake HCG supplements sold online. Many websites state they sell HCG, doing so without a prescription is illegal.

There are a variety of compounds that can be prepared as either creams, gels, or ointments that include special combinations of ingredients that can promote healing, remove dead tissue, relieve pain, and increase blood flow to the affected area. In some cases, a medicated wrap or bandage may be a great option for wounds healing on active parts of the body like the legs or arms.