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Alto Pharmacy Technician

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It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community ofGreat Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits.

Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy.

Be Part of a Great Place to Work — Join Our Team

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Read the latest Alto blog posts covering healthcare, family health, managing diseases, and other Alto highlights.

Blog | Alto Pharmacy

A consistent lack of sleep can also affect your physical and mental health in the long term. Here's what you can do to improve your sleep hygiene.

How Sleep Affects Heart Health | Alto Pharmacy

If you’ve ever slept less than the CDC-recommended minimum of seven hours per night, you may have experienced short-term effects of sleep deprivation like forgetfulness, irritability, and an inability to focus. A consistent lack of sleep can also affect your physical and mental health in the long term. And just like diet choices and frequency of physical activity, your sleep habits are linked to your risk for heart disease.

Below, we explain more about how sleep affects heart health and what you can do to improve your sleep hygiene.

Sleep allows your body to recharge. As you enter a state of deep sleep, your heart rate slows down and your blood pressure drops. These physical changes give your heart a chance to recover from how hard it works when you’re awake.

When you don’t spend enough time in uninterrupted deep sleep, your heart doesn’t get the opportunity to rest. Research has found that chronic sleep deprivation and sleep disorders can contribute to numerous cardiovascular health issues including high blood pressure, high cholesterol, and a greater risk for a heart attack or stroke.

Cardiovascular health issues related to sleep

Over time, many sleepless nights can lead to higher baseline blood pressure levels during the day. High blood pressure, or hypertension, is among the leading risk factors for heart disease and stroke. If you experience consistent stress or if you have other risk factors for high blood pressure, you may be more likely to develop high blood pressure as a result of sleep deprivation.

Poor sleep may also contribute to these cardiovascular health issues:

Coronary artery disease occurs when cholesterol and other fatty material (collectively referred to as plaque) builds up in your arteries, making it harder for your heart to pump blood to the rest of your body. This accumulation of plaque is also called atherosclerosis.

Some research has found that a lack of sleep may contribute to atherosclerosis. This is partially due to the connection between sleep deprivation and hypertension, as high blood pressure strains your arteries. In addition, poor sleep can trigger chronic inflammation over time, which also contributes to the accumulation of plaque and the hardening of your arteries.

Chronic sleep deprivation may also increase your risk for a heart attack. One research study found that people who slept less than six hours per night had a 20% higher risk of a heart attack in comparison to those who got more sleep.

While your heart slows down when you are in a state of deep sleep, your heart rate and blood pressure can increase if you wake up suddenly. Over time, consistent sleep disruptions can put greater stress on your heart and contribute to your overall heart attack risk.

A stroke is a cardiac event in which blood flow to your brain is interrupted, causing brain cells to die. Because sleep deprivation can drive high blood pressure and plaque accumulation in your arteries — two leading risk factors for strokes — there is also a correlation between a lack of sleep and your risk of having a stroke.

Type 2 diabetes is a condition in which your body’s cells become resistant to insulin, and your pancreas cannot produce enough insulin to regulate levels of blood glucose. It develops gradually due to a mix of genetic, lifestyle, and environmental factors.

Research has linked poor sleep to prediabetes, a health condition defined primarily by blood sugar levels that are higher than normal but below the official range for a type 2 diabetes diagnosis. If left untreated, prediabetes can progress into type 2 diabetes and lead to health complications in the long term, including cardiovascular issues.

If you already have diabetes, a lack of sleep or frequently interrupted sleep may also impact blood sugar management.

There are two primary sleep problems that can impact your long-term cardiovascular health: sleep apnea and insomnia.

Sleep apnea is a disorder in which your airway is blocked during sleep, which causes you to stop breathing for short periods of time. It affects your oxygen levels while sleeping and may increase your risk for high blood pressure, heart attack, and stroke.

Insomnia is when you have trouble going to sleep or staying asleep. Many individuals have experienced insomnia in the short-term, and the CDC estimates that 1 in 10 U.S. adults may experience chronic insomnia.

More than 1 in 3 adults in the U.S. report getting less than the recommended seven hours of sleep per night. The good news is there are steps you can take to improve your sleep hygiene. Start with the following:

Maintain a consistent sleep schedule, going to bed and waking up at the same time every day, including weekends.

Avoid use of electronic devices close to your bedtime.

Get plenty of natural light and stay physically active during the day, but avoid exercising close to bedtime.

Avoid consuming food or beverages close to bedtime, particularly caffeine, alcohol, and high-sugar or high-fat foods.

Keep your bedroom dark and quiet and maintain a comfortable temperature. 

Read our previous blog for strategies that can help you avoid stress-related sleep problems..

If you think you may have a sleep disorder, you should also consult with your doctor for a diagnosis and treatment, in addition to taking the actions above.

At Alto, we’re committed to making it as simple as possible to protect your heart health 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

Reach out any time via text or phone at 1-800-874-5881 or in-app messaging.

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.

How Sleep Affects Heart Health & Tips for Better Sleep

Alto Connect is the industry’s first mobile app for clinical teams to track prescriptions and message with the pharmacy on-the-go.

Introducing Alto Connect

Big news from the team here at Alto: today we launched Alto Connect, the industry’s first mobile app for clinical teams to track prescriptions and message with the pharmacy on-the-go! You’ll also see the new Alto Connect brand on our desktop portal, formerly known as AltoMD: new name, same great pharmacy services.

The Alto Connect mobile app is the next evolution of Alto’s custom-built provider communications center, formerly known as AltoMD. Alto was the first pharmacy in the United States to offer a prescriber-focused pharmacy communication platform when the original desktop-based AltoMD product launched in March 2016. Since then, more than 500 doctors offices have integrated Alto Connect into their daily workflows and prescription management. 

Doctors offices who work with Alto Pharmacy can now access Alto Connect across all of their devices, providing greater flexibility and convenience for monitoring prescriptions on busy days spent juggling patient consultations and other business needs. Instead of spending hours on the phone or fighting with the fax machine, Alto Connect provides instant access to prescription information and pharmacy messaging, and Alto Connect users can move seamlessly between the two platforms throughout their workday.

With Alto Connect, clinical staff can view all current prescriptions at Alto Pharmacy, including delivery status, out-of-pocket costs and refills. You'll never have to wonder if a patient picked up their prescription or stayed on track with their refills between visits - our system tells you exactly where every prescription stands for every patient.

Have a question for our pharmacy team? Curious about insurance coverage, delivery times, or other aspects of our service? Our team is here to help! You can send us a general message or ask a question specific to one of your patient's prescriptions. 

Alto Connect's push and email notifications alert you when a prescription needs additional information to move forward — most commonly, a clinical clarification or additional data needed for a prior authorization. We'll only alert you when we're certain we need your team's input, so you can stay focused on your patients.

Using AltoMD on your computer today? Nothing changes other than the name! Ready to try Alto Connect mobile for yourself? Scan the QR code above to download the app - your AltoMD login works on the mobile app. 

Need help setting up an Alto Connect account or want training for your staff? Reach out to providersuccess@alto.com.

When engineering incidents happen, typical deployment pipelines are just too slow—especially if customers’ medications are on the line. Here’s the speedier rollback process we use at Alto Pharmacy to ship fixes in 3 minutes, flat.

How Alto Reduced Time to Resolution for Production Incidents

Production incidents caused by newly-merged code happen to us all. When they do, most engineering organizations discuss the root cause and how to prevent similar incidents in the future. At Alto, we evaluate two additional metrics:

Time to detection: How quickly did we know something was wrong?

Time to resolution: How quickly did we restore service?

Time to resolution is especially critical for us as a pharmacy, where a long-running incident could block a user from getting their medication on time.

Over 30 times a day, an engineer at Alto hits the merge button, deploying a new build to production. Our well-automated CI/CD pipeline, built by our Infrastructure team, handles the 3-step deployment process:

1. Build: install Ruby & JavaScript dependencies

The average runtime for our standard deployment pipeline is 30 minutes—reasonable for a CI/CD pipeline, but too long when shipping a fix for a production incident.

We introduced a “hotfix” workflow as a first pass at an expedited deployment pipeline for incident response. A hotfix is a commit that introduces new code to address the incident by either removing or reverting the buggy code that introduced the issue in the first place or by shipping new code that fixes the initial issue. 

The hotfix deployment pipeline reduces incident time to resolution by triggering a specific CI job that removes the test step from our standard pipeline, reducing the workflow to just the Build and Deploy steps.

Implementing a hotfix pipeline on top of our standard pipeline in CircleCI was relatively simple—in our `.circleci/config.yml`, any part of our CI workflow that should be skipped in case of a hotfix runs a job called “early_exit_if_hotfix” that will skip the current step if the last commit message of the code being built includes the keyword “[hotfix]”.

early_exit_if_hotfix:
    steps:
      - run:
          name: Early exit if hotfix
          command: |
            git_commit_message=$(git log --format=%B -n 1)
            if [[ $git_commit_message =~ "Merge pull request #" ]]; then
              echo "This is a merge commit. Checking if this is a hotfix deploy"
              git_commit_sha=$(git log --format=%H -n 1)
              git_commit_message=$(git log --format=%B $git_commit_sha^-)
            fi
            if [[ $git_commit_message =~ "[hotfix]" ]]; then
              echo "exiting early for hotfix deploy"
              circleci-agent step halt
            fi
            echo "not a hotfix deploy, continuing"

run_ruby_tests:
  steps:
early_exit_if_hotfix
run_tests

The hotfix workflow reduces time to ship a resolution, once we identify the fix, from 30 minutes to ~18 minutes. It’s faster than our standard pipeline but still requires considerable hands-on work from the engineer performing the hotfix.

To further speed up deployment and reduce manual work, we introduced a workflow that simply rolls back to a previously-built healthy deployment image. In this workflow, the entire pipeline is reduced to just the Deploy step.

To invoke a rollback, an engineer commits a message with the keyword “[rollback]”, followed by the SHA of the commit to rollback to. Similar to the hotfix approach, any build step that should be skipped during a rollback checks the commit message for the “[rollback]” keyword before running:

early_exit_if_rollback:
    steps:
      - run:
          name: Early exit if rollback
          command: |
            git_commit_message=$(git log --format=%B -n 1)
            if [[ $git_commit_message =~ "Merge pull request #" ]]; then
              echo "This is a merge commit. Checking for rollback sha..."
              git_commit_sha=$(git log --format=%H -n 1)
              git_commit_message=$(git log --format=%B $git_commit_sha^-)
            fi
            if [[ $git_commit_message =~ "[rollback]" ]]; then
              echo "exiting early for rollback deploy"
              circleci-agent step halt
            fi
            echo "not a rollback deploy, continuing"

run_ruby_tests:
  steps:
early_exit_if_hotfix
early_exit_if_rollback
run_tests

The rollback workflow looks for a build matching the specified SHA and posts a confirmation message for the engineer, then deploys that build to production. The rollback approach dropped our time to resolution even further, from 30 minutes to ~3 minutes.

There are three edge cases that we’ve also baked into our rollback workflow: potentially stale images, database migrations, and blocking new merges and deployments.

Our script has a special block warning the engineer if a target image is older than an hour. The older the image, the riskier the rollback, as the delta between the image and the latest commit on main is larger.

time_rollback=$(git show -s --format=%ct ${rollback_revision})
time_now=$(date '+%s')
if [ $(($time_now - $time_rollback)) -gt 3600 ]; then
    message="${message}\n\n:warning:The rollback commit is more than an hour old."
    message="${message}\nThe [hotfix workflow](https://www.notion.so/alto/Deploying-a-Hotfix-Rolling-Forward-bb8e9cea05b44c67a64e23ae652653b6) might be a better candidate for this deployment."
fi

We also want to warn engineers if any database migrations have occurred between the current image and the target by checking the diff of the db/migrate directory. Rolling back application code without applying changes to the database can result in the database and application code becoming out of sync, resulting in further problems. Our script will warn engineers if a migration has been detected between the current and target image and provide instructions on how to rollback migrations if required.

Because a rollback deploys an image that’s older than our latest build, we also need to block continuous deployment until we’ve restored the main branch to a safe state — typically by deploying a hotfix as soon as we can identify an appropriate fix. We accomplish this using a Github issue with a specific tag that, when open, triggers a job causing any active CI job to fail. After the incident is resolved, the incident manager closes the issue, which will retrigger the blocked jobs and resume the normal build and deploy workflow.

The expedited rollback process has reduced our overall time to ship a resolution for incidents down to a speedy 3 minutes—a valuable improvement for our internal operations users, as well as for our customers and healthcare providers who rely on Alto’s service to get prescriptions filled. Branching these incident response workflows off of our existing standard deploy pipeline keeps the maintenance cost low for our infrastructure team, and robust automation reduces the risk of manual error for our product engineers when they need to invoke these workflows.

The Engineering Team is hiring! Learn more about open positions here.

If you are considering freezing your eggs, it’s important to take the financial aspects of treatment into account. Here are our top financial planning tips and resources to support your egg freezing journey.

A Financial Planning Guide for Egg Freezing

Egg freezing — a fertility preservation treatment that allows you to freeze unfertilized eggs and store them for later use — has allowed millions of individuals to leave open the possibility of having children in the future and experience more flexibility in their family-planning timelines.

If you are considering freezing your eggs, it’s important to take the financial aspects of treatment into account. While it’s true that egg freezing is a significant investment of time and resources, there are many options for managing or lowering the costs of treatment so that you can move forward with the process. Here are our top financial planning tips and resources to support your egg freezing journey.

Before you can determine how to pay for egg freezing, it’s important to have a sense of the total cost. Keep in mind that egg freezing expenses are ongoing. In the short term, you are accounting for fertility medications and the egg freezing cycle (or cycles). These costs vary from one individual to another, as your reproductive health — including the number of eggs in your ovarian reserve — will inform your individual medication protocol and the number of cycles needed to retrieve your target number of eggs.

Long-term egg freezing expenses include the cost of storing your eggs and in vitro fertilization (IVF) — the process of thawing your eggs, fertilizing them with sperm, and having them placed into your uterus through a non-surgical procedure — if you decide to use them in the future. The length of time that you store your eggs will impact the overall cost. 

You may not be able to accurately predict all of these variables in advance, but identifying your longer-term reproductive goals and mapping out a vision can help you prepare as much as possible for the total investment. Setting up a consultation with a fertility clinic can be a good first step toward getting the information you need about your reproductive health to plan accordingly. The cost of a consultation typically ranges from $250-500, and clinics typically list these fees on their website or can provide specific information over the phone.

Savings and support from family and friends

Depending on your individual circumstances, you may have money in a savings account that you can use for part of your egg freezing expenses. If you have questions about getting started with a savings account, a financial planner or a budgeting tool like NerdWallet, Mint or Savology can help you determine how much money you may need to seek through grants, loans, and other resources.

You may also have family or friends who are able to contribute. If you are comfortable sharing your egg freezing experience with others, consider using fundraising websites like GoFundMe to reach out to your extended network for donations.

Health insurance coverage and workplace benefits

Some health insurance plans offer partial or full coverage of egg freezing-related costs including medications and IVF. Note that most insurance plans have separate medical and pharmacy benefits. In most cases, professional services provided by your doctor or clinic will fall under medical benefits. Fertility medications will likely fall under pharmacy benefits, though in some cases they may fall under your medical benefits.

If you have a health savings account (HSA) or a flexible spending account (FSA) — two types of pre-tax accounts you can use for healthcare expenses — consider planning ahead to use these accounts to reduce the total cost of your fertility treatments and your taxable income.

In addition, some employers offer egg freezing coverage as part of their employee benefits, separate from your health insurance plan. Do not be discouraged if you learn that your employer doesn’t currently cover egg freezing: employers who offer fertility coverage often do so in response to an employee’s request. RESOLVE: The National Infertility Association, a nonprofit that supports individuals and couples affected by infertility, has resources to help you start a conversation with your employer about fertility coverage benefits.

Your total egg freezing expenses also depend on your choice of fertility clinic. Most clinics can share the total out of pocket costs for egg freezing if you do not have any insurance coverage. As you explore your options, call various clinics to ask about costs with a list of questions prepared in advance. Here are examples of questions to ask:

Based on my specific treatment plan, what is the typical all-inclusive cost?

What is included in the treatment cost and what is not?

Can you provide a detailed list of procedures and costs?

What is the typical cost of fertility medications for my treatment plan?

You may also want to ask if they will store eggs for up to a year as part of the cost of an IVF cycle, which is a common practice at many clinics.

In addition, some fertility clinics offer no- or low-interest payment plans. During your search, ask various clinics about any available financial assistance.

Many individuals and couples fund a portion of their egg freezing expenses through a personal loan. There are companies that provide loans for fertility treatments, with flexible monthly payment options, including Lending Club and CapExMD. Some lenders focus exclusively on fertility, including Origin Finance, and can lend enough to cover the entire cost of the treatment, with plans starting around $250/ month. (Great news: the Origin application fee is waived for Alto customers!)

Regardless of which lender you choose, verify the interest rate and any other fees. Many of these companies have budgeting tools on their websites so that you can get a sense of what your monthly payments will be before you decide to take out a loan.

In addition, many companies and organizations offer grants that help cover a portion of fertility treatment costs. Some are based on income level and demonstrated financial need while others are designed to support specific groups including members of the LGBTQ+ community and people of color.

Fertility for Colored Girls (FFCG) offers grants for Black women and couples.

Men Having Babies, which supports gay men and couples in starting their families through surrogacy, offers income-based cash grants through the Gay Parenting Assistance Program. (If you are starting a family as a gay man, your path to parenthood will likely include an egg donor and IVF but not necessarily egg freezing.) In addition, Family Equality has a list of family-building grants that help LGBTQ+ families afford fertility treatment.

You can also search for additional grant opportunities through RESOLVE.

In addition to applying the loans or grants mentioned above toward your fertility medication expenses, some fertility medication manufacturers offer patient assistance programs in partnership with fertility clinics to further alleviate these expenses.

If Alto is your fertility pharmacy, your fertility medication protocol likely includes medications manufactured by EMD Serono or Ferring Pharmaceuticals. EMD has several programs that lower the cost of fertility treatment, including the Compassionate Care program, which offers income-based assistance for fertility medications that aren’t covered by insurance, and special opportunities for military veterans and cancer survivors.

Ferring Pharmaceuticals also offers financial assistance programs to offset the cost of fertility medications, including the Heart Tomorrow program for individuals who elect to freeze their eggs, and special opportunities for military veterans and cancer patients.

Read our previous blog to learn more about EMD Serono's financial assistance programs and how to apply.

Your choice of fertility pharmacy matters

There’s one more factor that can significantly impact the cost of your fertility medications: your choice of fertility pharmacy partner.

Alto is committed to your financial well-being alongside your physical health. To help you save as much as possible on your fertility medications, we’ll automatically search for and apply any savings, as well as connect you with any outside programs that require you to apply directly.

We know that managing the costs of egg freezing is just one part of your fertility journey, and we’re here to make the process as easy as possible. We offer free same-day delivery of your medications, with discreet packaging, and fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists.

If you’re interested in learning more about how Alto can support your fertility treatment, you can request a price quote online. 

We’re excited to welcome Ramiah Martin to Alto as Vice President, Operations & Supply Chain. Here’s more on what drew him to Alto and the opportunities he’s most excited about, in his own words. 

Meet Ramiah Martin, VP, Operations & Supply Chain

We’re excited to welcome Ramiah Martin to Alto as Vice President, Operations & Supply Chain. Prior to joining Alto, Ramiah was Senior Director of Operations at Amazon, where he developed the strategic vision for the company’s operations and led a cross-functional team in implementing new processes and technologies to streamline use of resources.

His dedication to continually improving the customer experience is matched by a passion for healthcare change, and we could not be more thrilled to have Ramiah on the team. Here’s more on what drew him to Alto and the opportunities he’s most excited about, in his own words. 

Welcome to Alto! What inspired you to join the team?

When I first learned about Alto, its mission and values stood out to me first and foremost. I immediately felt a strong connection with the company’s mission of improving the quality of people’s lives through medicine and its commitment to putting customers first.

I was compelled by the opportunity to truly make a positive impact and help transform an industry that is both in need of improvement and slow to evolve. Through my previous experiences in operations management at Amazon and UPS, I know that streamlined processes can have a massive impact on a company’s results. At Alto, all of those efforts to innovate and maximize efficiency are in the service of driving broader change within pharmacy and healthcare.

I also appreciated that Alto is intentional about investing in talent representative of the communities we serve. As we continue to grow, and our customer base diversifies, it’s critical to have that diversity represented in the people building our new model for pharmacy care.

What is the focus of your role and what opportunities are you excited about?

As Vice President of Operations & Supply Chain, I’m focused on creating a scalable and sustainable organization, ensuring that as we grow, we continue to deliver an exceptional experience for our customers.

We have a great opportunity to ensure that individuals who have been historically underserved by medicine receive the standard of care that they deserve. I believe in the product — we make it as simple as possible to manage your health and learn more about medication and pricing, and our customers’ medication adherence rates are far above industry standards. I know there’s a lot more we can accomplish, and it’s a privilege to lead a team that’s united by a bold vision for healthcare.

I love movies, except for horror (Michael Jackson's “Thriller” video and Children of the Corn scarred me). I will go to the movies by myself as long as I have my Cherry Coke. It’s my way of shutting off my brain for an hour or two and relaxing.

You can find more information about Ramiah or connect with him directly on LinkedIn. If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers.

From vigilant hand-washing to getting enough vitamin C and D, here are a few ways to give yourself an immunity boost in advance of cold and flu season.

How to Prepare for Cold and Flu Season

The leaves are turning and the days are getting shorter, which means it’s time to start preparing for cold and flu season. The flu — shorthand for influenza — is a respiratory illness caused by viruses that affect your nose, throat, and lungs. In the U.S. and the rest of the Northern Hemisphere, flu cases typically ramp up toward the end of October and peak between December and February.

One reason the flu spreads more easily during the winter months is that cold air protects the virus as it travels through the air in the form of tiny droplets. The other main reason is that people socialize indoors more frequently, where it’s easier for the flu to spread when someone affected by the virus coughs or sneezes.

The good news is that there are simple steps you can take to strengthen your immunity. From vigilant hand-washing to getting enough vitamin C and D, here are a few ways to give yourself an immunity boost in advance of cold and flu season.

The number one thing you can do to protect your health and that of your loved ones is to get an annual flu shot, which will prompt your immune system to create antibodies that will defend you against the flu. Medical experts recommend getting the vaccine each and every year. every year.

Keep in mind it can take up to two weeks for the antibodies to provide sufficient protection. Given that flu season often peaks around December, the best time to get vaccinated is during September and October, and ideally no later than the end of October.

The flu can cause more serious health problems for people over the age of 65 and individuals living with chronic conditions such as COPD or diabetes, so it’s even more important to be proactive about flu vaccination if you fall into one of these groups.

Good personal hygiene can lower your risk of getting the cold or flu and spreading it to others. Practice simple preventative measures like frequently washing your hands, disinfecting frequently touched surfaces, and keeping a healthy distance from anyone who isn’t feeling well.

And yes, there is a “right way” to wash your hands when it comes to cold and flu prevention. The CDC recommends following the simple steps below to stay healthy and avoid spreading germs.

1. Wet your hands with warm or cold running water and apply soap.

2. Lather your hands, including the backs of your hands, between your fingers, and beneath your nails. 

3. Scrub your hands for at least 20 seconds. (Singing “Happy Birthday” twice is one option for timing yourself.)

Get a good night’s sleep and regular exercise

Your body is better prepared to defend against infectious diseases when it’s well-rested. Research has found that sleep can strengthen your T cells’ ability to help you fight infection. (T cells are a specific type of white blood cell and an important part of your immune system.)

To strengthen your immunity, aim for 7 to 9 hours every night. If you’re having difficulty falling asleep or sleeping through the night, there are some steps you can take to improve the quality of your sleep. Try to follow a consistent schedule: go to bed at the same time each night and wake up at the same time each morning, even on the weekends. And avoid consuming heavy meals or caffeine or using electronic devices close to your bedtime.

Staying physically active can also help you sleep better. In fact, exercise may boost your immunity in other ways, too, such as increasing your circulation, which helps white blood cells and antibodies travel to parts of your body where they’re needed. 

Studies have found that U.S. adults tend to exercise less during winter and fall than they do during spring and summer, so be sure that your calendar can still accommodate your fitness routine during the colder months. Whether you explore virtual workout classes or bundle up to brave the cold, aim for about 150 minutes of exercise a week or 30 minutes per day.

Your dietary choices can strengthen your immune system, not only during cold and flu season but all year round. 

Probiotics are tiny organisms that can help you maintain a healthy balance of bacteria in your digestive system, which will also support your immune system. Fermented foods like kimchi, sauerkraut, and kefir all contain live probiotics, as does greek yogurt. In addition, legumes like chickpeas and lentils contain prebiotics, a type of fiber consumed by probiotics which also contributes to a healthy digestive system.

Oranges, tomatoes, and spinach each offer up plenty of Vitamin C, a powerful nutrient with many health benefits, including the ability to boost immunity and fight inflammation.

You’re automatically exposed to Vitamin D — another crucial immunity-related nutrient — on hot, sunny days, but during winter, it’s extra important to add it to your diet. Sources of Vitamin D include egg yolks, mushrooms, canned tuna, and salmon, which also contains other immunity-boosting nutrients like zinc and omega-3 fatty acids. There is evidence that taking Vitamin D daily can significantly lower your risk of getting sick with the cold or flu, and you may also consider taking Vitamin D supplements.

Lastly, if you’re feeling under the weather, be sure to drink 6-8 cups of water a day, as you can become dehydrated more easily when sick.

When you’re chronically stressed, your body releases a hormone called cortisol very frequently. Cortisol helps the body fight inflammation and infection, but its continual release can lessen its effectiveness as part of your immune system. 

Some degree of stress is inevitable, but there are healthy ways to keep it under control, like practicing meditation, exercising, and staying connected to family and friends. If stressors at work or at home feel difficult to manage, your primary care provider can help you find mental health resources. 

In addition, check out free mental health apps like What’s Up?, which helps you manage stress and negative thoughts through a therapy approach called cognitive behavioral therapy (CBT), and Insight Timer, which has a diverse library of free guided meditations.

We’re here to help you navigate this year’s cold and flu season

We hope that the immunity-boosting tips above will help you enjoy a healthy fall and winter. If you do develop flu symptoms, remember to keep others safe by staying home and reporting your symptoms to a doctor as soon as possible (ideally within 48 hours to reduce the severity and duration of your illness). And with a strong immune system, you’re likely to be on the mend in no time at all.

Many mild cases of the cold or flu can often be treated with rest and extra self-care, but if your doctor prescribes an antiviral medication, we’ll hand-deliver it to your door for free. Reach out any time via text or phone at 1-800-874-5881, or in-app messaging.

Evidence suggests that gut health may also belong on the list of heart disease risk factors. Here’s what to know about the link between heart health and gut health, including steps you can take to maintain a balanced gut microbiome.

What to Know About the Heart and Gut Health Connection

Different factors can increase your chance of developing heart disease, like age, family history, high cholesterol, and high blood pressure, among others. And now, evidence suggests that gut health may also belong on the list of heart disease risk factors.

There are trillions of bacteria, fungi, and other small, microscopic organisms called microbes housed in your digestive system. They are collectively referred to as the gut microbiome. In recent years, researchers have found that the gut microbiome affects more than your digestive health alone. Heart disease is one of several health conditions that may be at least partially fueled by an unhealthy balance of gut bacteria.

The good news? This is a heart disease risk factor you definitely have control over. Here’s what to know about the link between heart health and gut health, including steps you can take to maintain a balanced gut microbiome.

Metabolites and your cardiovascular system

During the digestive process, microbes produce substances called metabolites. One of these substances in particular, trimethylamine (TMA), is linked to your risk for cardiovascular disease and other chronic health conditions like diabetes.

TMA forms when the bacteria and other organisms within the gut microbiome consume choline, a nutrient contained in red meat, fish, poultry, and eggs. The liver then converts TMA into a substance called trimethylamine N-oxide (TMAO). 

The medical community has identified a connection between high levels of TMAO in your blood and deposits of cholesterol, blood-clotting material, and other substances in your arteries. These substances are collectively referred to as plaque, and its accumulation in your arteries is referred to as atherosclerosis, a leading cause of cardiovascular disease, heart attacks, and strokes.

A 2017 analysis of several studies on the connection between TMAO blood levels and cardiovascular health found a correlation between elevated TMAO levels and serious cardiovascular issues. In the studies, researchers looked at people from different categories of health conditions in multiple countries, like individuals with and without diabetes, and individuals with and without chronic heart failure. 

Each group included individuals with various TMAO levels. The results showed that people with the highest levels of TMAO were 62% more likely to experience serious cardiovascular issues like heart attacks and strokes. The link appeared to be independent of other key risk factors for heart disease like diabetes and obesity.

In addition to the findings about TMAO, researchers have also identified a link between gut health and inflammation (redness, warmth, and swelling around tissues and joints). Inflammation is part of the body’s natural response to an injury, but when it persists after the healing process and becomes chronic inflammation, it can lead to an ongoing high white blood cell count.  

Over time, this elevated level of white blood cells can affect other organs including your heart, lungs, and kidneys, which may influence your risk for heart disease and other chronic conditions like diabetes.

The majority of the body’s inflammatory cells are stored in tissues in your gut, and researchers have found that an inflamed gut can trigger inflammation elsewhere in your body. Certain gut bacteria produce substances that enter your bloodstream and create inflammation in every part of the body that they travel through. This inflammation in the walls of your blood vessels can eventually lead to atherosclerosis.

Researchers are still learning about the gut microbiome’s influence on your risk for various health conditions. One thing they do know for sure is that a healthy gut microbiome is an important component of your overall health, and there are simple steps you can take to maintain a balanced digestive system.

A balanced diet is a great starting point for better gut health. Start by limiting foods that are processed or high in sugar or fat — particularly cookies, sugary drinks, salty snacks, and frozen foods — as these can lead to increased inflammation. Opt for fiber-rich foods like beans, peas, bananas, and asparagus; fermented foods like kimchi, yogurt, miso, and kefir; and collagen-rich or collagen-boosting foods like salmon, mushrooms, and egg whites.

Staying physically active and avoiding unhealthy habits like smoking and heavy alcohol consumption can also improve your gut health. Looking for a fitness routine that fits your schedule and health needs? Aim for about 150 minutes a week or 30 minutes per day. Explore different activities until you find the one that’s right for you — whether virtually or in person.

Over the long term, stress can lead to many physical and mental health problems, including digestive issues. Staying physically active reduces stress, so you’re already tackling this risk factor simply by working out regularly.

Beyond exercise, check out Insight Timer, an app that offers free guided meditations or Moodfit, a free mood-tracking app. And since there’s an established link between stress and high blood pressure, heart disease, and stroke, these small actions can benefit several aspects of your health at once!

Proactively managing COPD with medication and lifestyle changes can help prevent periods of intensified symptoms, referred to as exacerbations or flare-ups. Here’s more on how to recognize, treat, and prevent COPD flare-ups.

How to Manage and Prevent a COPD Flare-Up

Proactively managing chronic obstructive pulmonary disease (COPD) with medication and lifestyle changes can help slow the progression of the chronic lung disease and prevent periods of intensified COPD symptoms, commonly referred to as exacerbations or flare-ups. 

However, these flare-ups may occur even when closely following your doctor’s individualized treatment plan, especially during the more advanced stages of COPD, so it’s important to have a plan in place to quickly address symptoms. Here’s more on how to recognize, treat, and prevent COPD flare-ups.

Recognizing the symptoms of a COPD flare-up

During a COPD flare-up, symptoms like shortness of breath and wheezing quickly intensify and lung function significantly changes. (Lung function refers to how well your lungs work, specifically how much air they can hold and how easy it is for them to empty air.)

Individual experiences of a COPD flare-up may vary, but many people often notice greater amounts of mucus clogging the bronchial tubes in their lungs and sudden tightening of muscles around their airways. Here are key signs and symptoms to be aware of.

More frequent or more intense coughing, wheezing, or shortness of breath

Changes in the color, thickness, or amount of mucus

Using more oxygen than usual, if your treatment plan includes supplemental oxygen

If you experience any of the symptoms above, the best step is to call your doctor right away. Each COPD flare-up can affect your long-term lung function, so it’s important to address symptoms as quickly as possible.

To effectively manage a COPD flare-up, you’ll want to create a COPD action plan with your doctor. Then, if you experience the signs of a flare-up, you’ll have a specific outline of the actions and medications that can help restore your breathing. Here are some of the medications your doctor may include in your individualized COPD treatment plan.

Short-acting medications like bronchodilators relax your airway muscles and open your lungs to quickly reduce discomfort. Albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) is commonly used to treat COPD exacerbations. This medication is typically taken through an inhaler, but can also be taken as a liquid solution for nebulizer use. (A nebulizer is a device that turns a liquid medication into a mist that you can inhale through a face mask. It allows the medication to travel quickly to your lungs.)

Although not common, potential side effects of bronchodilators include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches. Your doctor can explain more about the risks and benefits of using a bronchodilator to treat COPD exacerbations when building your treatment plan.

Your doctor may also recommend oral corticosteroids, which are fast-acting medications that reduce swelling in your lungs and open your airways so that more air can move in and out of your lungs. They are primarily prescribed for short-term use, typically five to seven days.

Oral corticosteroids commonly used to treat COPD exacerbations include:

Prednisone (Prednisone Intensol®, Rayos®)

Some people experience mild side effects from short-term corticosteroid use, including swollen hands and feet, elevated blood pressure, increased appetite, and shifts in mood.

Many people with more advanced COPD use supplemental oxygen to increase their tolerance for physical activities, while others use it only to relieve shortness of breath during an exacerbation.

If your flare-up is more mild, you may take oxygen at home. When writing your prescription for oxygen therapy, your doctor will explain how and when to use the oxygen. It is important to follow all of your doctor’s instructions, including the flow rate setting (how much oxygen you’ll need per minute). The American Lung Association has resources for anyone starting oxygen therapy.

If your COPD has progressed to a later stage, some flare-ups may require treatment in a hospital setting. This allows healthcare professionals to more closely observe your symptoms and monitor vital signs like your pulse, temperature, and blood pressure. Consult with your doctor about specific symptoms to look out for that may indicate a need for more intensive treatment or monitoring.

How to lower your risk of COPD exacerbations

There are many steps you can take to lower your risk of a COPD exacerbation and reduce the frequency of COPD-related hospitalizations.

First, it’s important to closely follow your doctor’s recommendations, including taking any maintenance medications exactly as prescribed. (We designed our app to make it as simple as possible to do so, with medication management tools like reminders and auto refills that help you stay on track.)

In addition, try to limit your exposure to leading triggers of COPD exacerbations, including cigarette smoke (this includes secondhand smoke), indoor and outdoor air pollution, cold air, and household dust.

To keep the air inside your home as clean as possible, avoid perfumes and cleaning and hygiene products with strong odors. Use air purifiers and vacuum cleaners with a high-efficiency particulate air (HEPA) filter.

Lastly, the flu and pneumonia can worsen COPD symptoms and potentially lead to a flare-up, so it’s important to get your yearly flu shot and ask your doctor or pharmacist if you are eligible for the pneumonia vaccine.

We’re here to support your COPD treatment

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