Compounding Talk with Bill Kalman

Essential Wellness Pharmacy

When Jeff and Stacy Robins retired last summer, they left the pharmacy they founded seven years prior in capable hands. Since taking over as the new owners of Essential Wellness Pharmacy, Bill and Monica Kalman have continued their dedication to assisting clients on their path to health and wellness. iBi recently sat down with Bill Kalman to discuss the differences between traditional and compounding pharmacies, the process of compounding, bio-identical hormones and other trends in the industry. 

Tell us a little about Essential Wellness Pharmacy, as well as your own backgrounds. How did you become interested in purchasing the business?
Essential Wellness Pharmacy was started in 2009 by Jeff and Stacy Robins. Jeff had been a compounding pharmacist for about 20 years—he worked at two local compounding pharmacies before opening Essential Wellness. When he started, he felt there was a better way to practice pharmacy. He realized that “healthcare” was not really related to getting people healthy… it was “disease care,” and the goal is to prevent people from dying.

He found a movement for an integrated approach to healthcare, emphasizing the functioning of the systems of the body and how they affect disease and aging. The idea behind integrated or functional medicine is the body or systems in the body have changed to bring on these conditions (“diseases”), and how it can be corrected or prevented. I became interested in integrated medicine through many discussions with Jeff, and began to change the way I approached healthcare and the best way to care for my patients.

My father is a retired pharmacist who opened an independent pharmacy in Orion, Illinois when I was in third grade. I saw the interactions he had with his patients, and quickly realized pharmacy was the career I wanted. I graduated from the University of Iowa College of Pharmacy in 1990, and I have been in the Peoria area ever since—first with Super-X, which became Revco, then CVS. I left CVS to work for Hometown Pharmacy in Creve Coeur and Chillicothe, and then I returned to CVS before starting at Essential Wellness about four years ago.

Monica went to the St. Louis College of Pharmacy and graduated in 1999. After graduation, she began working at CVS in Peoria, where we met. After working there about 10 years, she left to go to Green Tree Pharmacy, a long-term care and assisted living pharmacy.

We became interested in purchasing the pharmacy after I had been working there for about a year. Ever since my dad had his pharmacy, I have dreamed of owning my own pharmacy. When Jeff and Stacy decided to retire, they approached Monica and me, and we had several discussions before they asked if we were interested in purchasing the pharmacy. Their goal was to be sure the pharmacy would continue to grow and help the people of the Peoria area.

Describe the transition to new ownership. Have you made any significant changes since taking over?
For most of my career, I have been a pharmacist-in-charge at the pharmacies to which I have been assigned, with responsibilities for various personnel and business operations. This helped me with some of the responsibilities of ownership, but not all. As the pharmacist-in-charge for Essential Wellness, Jeff assigned me additional jobs and included me in some operational tasks, which gave me additional training needed for ownership. After the sale, Jeff has continued to help at the pharmacy on occasion. Jeff and Stacy have continued to serve as mentors and advisors for Monica and me as we transition into our new roles as owners. Our intention is to continue the great care and service they started. We do not have any plans to make changes in the service we provide to our patients. Our goal is to improve the health and wellness of central Illinois, one patient at a time.

Tell us more about your key products and services. How is Essential Wellness different from traditional pharmacies?
Essential Wellness is a full-service pharmacy. We can fill regular prescriptions, but our specialty is compounded medications—our compounding services make us one of the top compounding pharmacies in the Peoria area and the country. Our specialties are bio-identical hormone replacement for both women and men, topical pain creams and gels, custom-compounded thyroid replacement, veterinary medications, allergen-free medications and more. We work with patients and their doctors on the best treatment option for them.

One service we provide which sets us apart from a traditional pharmacy is health and wellness consultations. During a consultation, one of our pharmacists will meet one-on-one with you to discuss your health and wellness concerns, as well as your current health symptoms and lifestyle. Based on that information, our recommendations may include dietary and lifestyle changes, changes to current medications, or the need for compounded medications, vitamins or supplements. More people are becoming interested in achieving their health and wellness goals as naturally as possible. We have a very knowledgeable staff available every day to help patients achieve those health goals.

We believe most health conditions can be prevented or treated naturally with changes in lifestyle, exercise and diet, while supporting the changes of the body with supplements and compounded medications. We carry pharmaceutical-grade vitamins and supplements, many of which are available only through healthcare professionals. We carry products from Pure Encapsulations, Metagenics, Ortho Molecular, Douglas Labs and Xymogen; we have chosen these companies because they independently test their products to assure potency and purity.

What is drug compounding, and what are its benefits?
Compounding is the art of custom-making a drug product based on the specific needs of a patient. This may entail compounding a drug which is not commercially available or into a dosage form not available, compounding to avoid specific allergies, or combining medications into a single dose which is unavailable commercially.

Many patients are sensitive to the effects of medications. In these cases, we are able to compound dosage changes in smaller increments than what is commercially available, or in dosage forms which avoid those effects. Other patients may have difficulty taking medications by mouth, such as many hospice patients. We may be able to compound a topical dosage form for these patients.

Veterinary medicine has a great need for compounded medications. With the many different sizes of pets, dosages may need to be adjusted to get the best treatment for an animal with the least side effects. Some animals may not take the medication in the form available. We are able to compound into flavored suspensions or chews, which the animal may take easier. Some veterinary medications can be given topically to avoid the difficulty of oral dosing.

Tell us more about the process of compounding and the equipment involved.
Compounding a medication starts with the specific need of the patient and the desired treatment from the doctor or prescribing practitioner. After a formula is found or developed for that prescription, the medication is compounded from bulk powders of active and inactive ingredients and put into the desired dosage form. If a capsule is needed, special plates hold the capsules and separate the two halves. The powder is then packed into the capsules using a spatula and a press, which compacts them evenly. If a suspension is needed, the base the ingredients are put into is determined by their solubility. The ingredients are then mixed to as fine a particle size as possible, then either dissolved or “wet” with a liquid ingredient before being added to the base liquid. Once the ingredients are “wet” and mixed with the base, the mixture is blended with an ointment mixer, then run through an ointment mill to assure proper mixing and the breakdown of the particles into the smallest possible size. Once completed, the compound is packaged for dispensing and inspected by a compounding team technician and a pharmacist to assure accurate preparation and compounding.

How is the regulatory environment different for compounding pharmacies versus traditional pharmacies?
All pharmacies must follow the pharmacy laws of whichever state they are located in, as well as all federal laws. Pharmacies that compound must adhere to proper compounding standards set forth by the United States Pharmacopeia. The USP sets standards for the proper techniques and procedures for different types of compounds, as well as production of the raw ingredients used in compounding. In addition, FDA regulations may apply. Some of these are regarding substances banned from use in human compounding, or special regulations regarding the handling of hazardous substances.

What are some misconceptions people have about the use of natural supplements over traditional prescription drugs?
We are known as the pharmacy that doesn’t like drugs. There are times when traditional prescription medicine is needed to treat a condition; there are also many times when vitamins and supplements can naturally help a condition. Many people have a desire to try natural supplementation and lifestyle change to correct a condition.

One common misconception is that natural supplements do not have side effects or interact with other medications or substances. This may not be the case. Unfortunately, most natural substances have never been tested against traditional prescription medicines for interactions. Traditional prescription medicine must follow strict FDA procedures for testing prior to release to determine the effectiveness against the condition intended, as well as potency, safety, side effects, drug interactions, bioavailability and elimination.

Most natural substances have never been scientifically tested to determine their effectiveness, safety, bioavailability or elimination. That does not mean they do not work or you shouldn’t try them. Most natural substances used are based on years, decades or centuries of use for certain conditions throughout the world. Many traditional medicines are based on natural substances because they cannot be patented by a drug manufacturer—one manufacturer cannot obtain exclusive rights to all forms of a natural substance. They can, however, determine which component may elicit the desired effects and produce a substance similar to that.

What are bio-identical hormones, and how can they improve one’s health?
Probably our biggest category of compounding and supplementation is bio-identical hormone replacement. The term bio-identical hormone is not common medical terminology, and is often misunderstood by both the medical community and the general public. Bio-identical simply refers to hormones that are biologically identical to what is produced by the human body, so the body knows how to use them and how to remove them through detoxification.

For example, many products used for progesterone deficiency do not contain actual progesterone; they contain progesterone-like compounds known as progestins. Since they are not identical with natural human hormones, the body has a more difficult time detoxing them and the side effects can be greater. Bio-identical hormone replacement is as natural a way as possible to supplement hormone deficiencies.

As we age, hormone levels decrease naturally and the incidence of “disease” increases. Integrated and functional medicine is focused on keeping the patient as healthy as possible and decreasing the signs of aging that may be associated with the decline in hormones and other body functions. There remains a lot of caution around hormone replacement based on beliefs that it may lead to other conditions. The idea behind raising hormone levels is to have patients near the levels when they had the best health, generally between the ages of 25 and 35. This is the time in our lives when hormones are usually as high as they will ever be and the incidence of disease and cancer are the lowest. It comes down to what changes occur before the majority of aging and disease takes place—and avoiding those changes.

What are some current trends you are seeing in the industry?
More and more people are seeking natural ways to heal and remain as healthy as possible. More information and research comes out every year about how changes in lifestyle, diet and exercise outperform many common medications. Some conditions may never be cured by natural supplementation, but how many conditions may be preventable with natural supplements is hard to know.

There have been several news stories over the past few years which point to things like stress and inflammation as two of the leading causes of almost every disease. Inflammation has been linked to such conditions as diabetes, cardiovascular disease, dementia and Alzheimer’s disease. People may not realize they have inflammation because they don’t feel any pain associated with it, but unresolved inflammation can be damaging to the body. Inflammation can occur from the foods eaten in a standard American diet. Stress, anxiety, depression and conditions related to inflammation are areas we are seeing an increase of patients requesting consultations. iBi

Essential Wellness Pharmacy is located at 4625 N. University Street in Peoria. For more information, visit essentialwellnesspharmacy.com or call (309) 681-8850.

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