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Our mission at Alto is to fulfill medicine’s true purpose — to improve quality of life — for everyone who needs it.

Services that reduce travel and encourage social distancing are now more essential than ever, not only for vulnerable populations but all of us as members of our communities. Alto’s free same-day doorstep delivery ensures you have safe and reliable access to medications in this time of uncertainty. 

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In this post, we'll share how we identified the problem of failing cypress seeds, what the culprit was, and three ways to make seeding test data more robust.

How to Debug Slow and Failing Cypress Seeds

End-to-end test failing before it even begins? Here’s how we timed, debugged, and sped up our seed data.

At Alto, we use Cypress to test our Rails application end-to-end. As our application grows, so does our end-to-end test suite — along with the seed data it requires. This led us recently to a perplexing problem:  when run in CircleCI, our end-to-end tests would mysteriously time out during the seed step, causing them to fail and block deploys.

Seeds can be painful to debug. They’re typically set up through a single request and, depending on how thorough the tests are, call upon most of the models involved in the application. If a model throws, say, a validation error because of bad seed data, you'll see it in your Cypress logs. If a model hangs, the request often doesn't show up in the logs at all. There's no status code, no error message—all you know is that somewhere, somehow, some process is failing to finish.

In this post, I’ll share how we identified the problem, what the culprit was, and three ways to make seeding test data more robust.

To Identify the Problem, Focus on Your Logs

We started by comparing logs from our failing CircleCI runs with those from local test runs. Turns out, our CircleCI logs in failed runs stopped after a specific log message. 

For example, when our test runs succeeded, the logs looked something like this:

...
LOG: creating model
WARN: foo with id=123 not found
WARN: foo with id=456 not found
WARN: bar with id=789 not found
ERROR: Invalid parameter to function `foobar`
LOG: model created
... rest of logs

But when they failed, they instead looked like this:

. . .
LOG: creating model
WARN: foo with id=123 not found
WARN: foo with id=456 not found
[end of logs]

This let us know where to focus: after the function that looks for foo, but before or during the one that looks for bar. Of course, this only works if you have enough log statements scattered around in the first place. I’d recommend logging the time it takes to create each model in seeds, which has the added benefit of telling you where to start if your seeds are becoming annoyingly slow. 

At the top of our file in db/seeds, we declare the following function to add timings to our CI logs:

@last_time = Time.now
def log_time(label)
    Rails.logger.info("Time [#{label}]: #{(Time.now - @last_time)}")
    @last_time = Time.now
end

We then call the function after each create statement in our seeds:

Product.create!({...params})
log_time(“Product Create”)

This prints logs in the following format:

...log metadata message=Time [Product Create]: 12345
...log metadata message=Time [User Create]: 1102
...log metadata message=Time [Address Create]: 105
...

These logs will help you figure out problematic model create calls, but each model may have a lot going on in its callbacks (before_save, before_commit, after_save, etc). You can follow a similar approach to time those callbacks:

# in the model file
Class Model < ApplicationRecord
	
...

before_save :foo

...

def foo()
   start_time = Time.now
   [ ... things that happen inside the function ]
   Rails.logger.info("Time [foo]: #{(Time.now - start_time)}")
   [ function return statement, if applicable ]
end

It’s important to note that the most time-consuming statements in your seeds often cause the most trouble, but that’s not always the case. If your seeds are hanging due to external API calls, it’s entirely possible for those calls to usually take a short time to complete. If you have hanging tests, I would recommend logging test runs in CircleCI, since you may not be able to find the problem locally. 

Through timing our seeds, we narrowed down our search to five of our most time-intensive models. We were then able to time the individual callbacks within those models. One callback  in particular—containing a call to an external database—raised the most suspicion. It took up most of the time it took to create the model, didn’t return any information needed in our test, and was not mocked or stubbed out. 

Requests to this test database would usually work, however, since we call on it multiple times on every CI run, with concurrent CI runs, these requests would sometimes take a long time to complete, leading to a test timeout. 

In our case, since we were making calls to a hosted database in our tests, we changed our test environment to create and refer to an isolated instance of the database. While this was the best approach for our specific issue, we also explored some other ways of stubbing out API calls and skipping callbacks from your seeds file, which we describe below. Use these approaches with caution, as the more you stub, the less true-to-life your tests will be. 

Ideally, you would have already stubbed out third-party API calls in your code using environment variables. An example approach:	

def do_the_thing()
    if Rails.env.production?
    	[ ...do the thing ]
    else
	[ ...do some fake thing if needed ]
       Rails.logger.info("We theoretically would have done the thing.")
end

However, you can also use Typhoeus to mock third-party api calls in seeds, similar to how you might in a test. Imagine that your Product model makes a call to "https://slack.com/api/foo”. We can then mock that call out as follows:

mock_response = Typhoeus::Response.new({code:’500’, body: {
    “ok”: false,
    “error”: ‘not_authed’
}.to_json})
Typhoeus.stub("https://slack.com/api/foo”).and_return(mock_response)
Product.create!({...params})

Again, I would advise you to stub check for environment variables in your code rather than stub out individual API calls in your seeds and tests. But if for some reason you need to do the latter, it’s possible!

Similarly, you might want to stub out a function you’ve written if it takes a long time to run and doesn’t affect the outcome of your tests. This can’t be stubbed out in the ways we mentioned above since (1) you might need it  for — and hopefully are testing it in  — other tests and (2) it doesn’t have a url. minitest has a tool for this. Imagine you’re trying to stub out some functions from a Photograph model.

require ‘minitest/autorun’

Photograph.stub :fetch_product_photo_url, ‘’ do
   Product.create!({...params})
end

This will return an empty string when Photograph.fetch_product_photo_url is called within the Product model’s callbacks. You can also replace the empty string with anything else you might want the function to return.

Last but not least, it’s possible to skip entire callbacks and validation. I wouldn’t recommend skipping all of them, as that can cause models in your tests to stray very far from how your models actually work, but you may find it useful to skip specific callbacks.

While all the methods that I’ve suggested above are possible and can be useful, remember that stubbing and skipping from your seeds may just be band-aids for issues you have elsewhere. In our case, we could have stubbed out a model function or created an isolated database for testing. While both methods would have been functionally the same, doing the latter allows us to have to worry less about that database in the future—if, for example, we write more functions that depend on it, or update the mocked functions to do more than they currently do. Keeping tests in line with how the product works also keeps it more in line with the actual user experience: if it’s taking a long time to create a model in your seeds, it probably takes a long time for your users, too. 

Since adding timing logs and creating an isolated database to our end-to-end tests, we have a regular source of truth for the efficiency of our models, are able to develop more smoothly with fewer spontaneous test failures, and have more confidence in our ability to quickly pinpoint and resolve seed timeouts in the future. 

Here’s what you need to know about potential changes to your coverage when your plan updates on January 1st. 

What You Need to Know About Your Insurance in the New Year

With a new year comes new insurance benefits, copay costs, and deductible resets. Here’s what you need to know about potential changes to your coverage when your plan updates on January 1st. 

It is common for insurance companies to adjust their rates and offerings each year and then allow people to select new plans or renew their current coverage. The process enables insurers to update their plans based on inflation, the introduction of new medications, and other market changes. It also provides each of us an opportunity to assess and adapt our health insurance needs every year. 

If you had health insurance this past year, you likely went through an “open enrollment” period in the fall. During that time, you learned how your plan was changing and which key benefits would continue. You then had the opportunity to renew your current plan for another year or switch to a new option altogether. 

Why are insurance renewals important right now?

Most health insurance plans operate on a calendar year, meaning any changes take effect on January 1st. We recommend reviewing any recent changes to your plan to avoid unwelcome surprises later in the year. 

Which insurance updates might impact me the most?

As you review your yearly changes, you’ll want to make special note of the following, as these updates could affect your budget: 

Your premium is the cost of your health insurance plan each month. It’s common for your premium to change slightly from year to year, so be sure to double-check if yours is going up.

Your deductible is the amount you have to pay for healthcare services before your insurance starts to help cover the costs. For example, if your deductible is $2,500, you will need to pay that amount for covered services on your own before your copay kicks in. Your deductible resets at the beginning of the year, which could mean a significant uptick in your healthcare expenses until you spend enough to cover your deductible. Make sure to budget accordingly. 

Your copays and coinsurance—the amount you’ll owe for healthcare services after you’ve exceeded your deductible—may also change. Different types of health services can have different copays, so look closely at the ones you think you’ll use most often. 

A formulary is a list of generic and brand-name medications that are covered by your insurance company. The list includes tiers that indicate which medication versions are preferred by your insurer and therefore offered at a lower out-of-pocket cost for you. 

If you have current prescriptions, you’ll want to make sure that your plan still covers your specific medications. You may also want to find out if there is a cheaper version of your medication available that you can discuss with your healthcare provider. If you fill your prescription with Alto, we’d be happy to investigate the options for you and let you know if there are alternatives that could lower your costs. 

For more on decoding common insurance terms, we recommend this helpful glossary from JDRF. 

What can I do if I find out my medications are more expensive?

Combing through insurance updates can be confusing, especially if you discover that you have to pay more for your medications this year. If copay changes and deductible resets affect your out-of-pocket expenses, we’ll search for any available savings, so you’ll know you’re getting the lowest price. 

If your insurance company requires a written request from your doctor to keep you on the same medication because of formulary tier changes, we’ll work with your doctor to proactively file the paperwork. Plus, we’ll keep you informed the whole way. 

Read more about prior authorizations and how we can help here. 

Yes! Your updated health insurance plan may come with new benefits that can save you money and enhance your health. Look for bonus perks like free annual exams and preventative care; discounts on fitness and nutrition programs, gym memberships, chiropractic care, and massage; savings on health products; and reduced vision care rates. Often, people forget to use these benefits, which can mean money left on the table.

As you make your health plan for the coming year, don’t forget the benefits of choosing a better pharmacy. With a simple switch to Alto, you’ll get insurance support, price investigations, and your medications hand-delivered for free. Plus, you can call or text our pharmacists any time for quick advice. If 2020 saw you waiting in line or on hold to access pharmacy support, let this be the year that the care you need comes directly to you.

Ready to switch to a better pharmacy? Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text, or the app.

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.

At Alto, we believe that staying on top of your health should be as simple as possible. Here’s how we’re applying this philosophy to feeling our best this winter and creating healthy habits that we can cultivate all year long. 

Alto’s Guide to Wellness in the New Year

It’s easy to feel jaded about setting health goals for the new year. We often enter January with optimism and big intentions, only to find our new habits slipping within days or weeks. But let’s not give up on our health goals altogether. The sense of renewal at the start of the year can be a powerful motivator—provided we don’t saddle ourselves with unreasonable expectations and an “all-or-nothing” attitude. 

At Alto, we believe that staying on top of your health should be as simple as possible. That’s why we built a pharmacy that delivers medications and expert advice directly to you. Here’s how we’re applying this philosophy to feeling our best this winter and creating healthy habits that we can cultivate all year long. 

According to U.S. News & World Report, 80% of New Year's resolutions fail by mid-February. It’s not that we’re incapable of making meaningful changes. It’s that the way we’re accustomed to making resolutions doesn’t set us up for success. 

If you haven’t been exercising at all during quarantine, setting a goal to work out for an hour every day may not be practical. Instead, behavioral scientist, Susan Weinschenk Ph.D., outlines three critical steps for building new habits that stick: start with a small and specific action, tie it to an existing habit, and make it easy to accomplish during the first week. 

Rather than saying you’ll “exercise more” or become a hardcore workout enthusiast overnight, resolve to enjoy your morning coffee while walking, then increase your daily walk by ten minutes the next week. When you anchor your intention to an existing action, you give your brain a natural cue to put it into practice. And since the key to solidifying your new habit is repetition, starting with an easy action will create self-trust and allow you to expand on your goal over time. 

During the darker winter months, you may find your mood dropping along with the temperature. According to the Mayo Clinic, these seasonal bouts of melancholy are likely related to reduced exposure to sunlight, which can upset your circadian rhythm and cause serotonin (the “happy hormone”) levels to dip. 

To combat the effects of winter depression, try to keep your home as bright as possible by keeping curtains and blinds open and sitting closer to well-lit windows when you can. Be sure to spend some time outside every day, even if the weather is cold or the sky is grey. The morning is an especially potent time to get outside and walk around. 

Though it is tempting to go into full hibernation mode, excess sleep can make the issue worse. Try to stick to your usual sleep schedule and get some form of physical activity every day. If you find that your appetite and sleep patterns are adversely affected, or your symptoms interfere with your daily responsibilities, reach out to your doctor or a mental health professional. There are treatments available that can help make the seasonal shift much more manageable. 

Despite your best intentions, your health goals can become sidelined by the season’s viral villains: the common cold and flu. Neither is curable, so a solid prevention strategy is your best bet for staying well. Getting your annual flu shot and following COVID-19 precautions such as wearing a mask and social distancing will undoubtedly help, but your last line of defense is your immune system. 

Experts at the Cleveland Clinic recommend incorporating immune-boosting foods into your winter menu to help your body dispatch any seasonal invaders. Fill your grocery cart with a wide range of colorful fruits and vegetables to ensure you consume a full arsenal of antioxidants. Be sure to stock up on raw garlic, which contains antiviral compounds, along with vitamin-C-rich foods like citrus fruits, peppers, broccoli, and kiwis.

According to the Mayo Clinic, people who don’t get enough sleep are more likely to succumb to sickness after being exposed to a virus. Aim for seven to eight hours of sleep per night to support healthy infection-fighting antibodies and cells. We’ve compiled these tips for getting the nightly rest you need when sleep is elusive.

Unfortunately, no matter how many antioxidant-rich foods you eat, it’s not always possible to avoid coming down with a cold or flu. If you can’t stomach one more raw garlic clove and you’re simply feeling miserable, over-the-counter (OTC) medications can help ease your symptoms and reduce the amount of time you feel knocked off your feet. 

Here are the medications our pharmacists recommend to help you feel better fast.

Not sure why you’re feeling so sick? Read “Cold, Flu, or COVID-19? Your Seasonal Symptom Guide” for clues. If you think you may have symptoms of COVID-19, it’s important to avoid contact with others and call your medical provider right away. 

When you’re sick, your nose can alternately feel like a leaky faucet and a blocked pipe. If you have nasal or sinus congestion, a decongestant, such as pseudoephedrine, can help. For a runny nose or postnasal drip, an antihistamine may do the trick. 

Just keep in mind that antihistamines may make you drowsy, while decongestants may keep you awake. Decongestants come in both oral and spray or drop form. If you’re considering a nasal spray or drops, don’t use them for more than three days in a row, or you may end up even stuffier than you were before (due to a condition called rebound congestion). 

If you’re taking other medications, talk to your doctor or pharmacist before starting a decongestant or antihistamine. Adverse interactions are possible with some medications, such as those that treat heart disease. If you’re an Alto customer, simply reach out by phone, text, or in-app chat, and one of our pharmacists can help determine which medicine may be right for you.

A raw, scratchy throat is often the first painful signal that a cold or flu is coming on. However, it could also be a sign of something more serious, such as a streptococcus bacterial infection (strep throat). Talk with your doctor if the pain in your throat is persistent, severe, or if you have trouble swallowing. For milder soreness, over-the-counter pain medications such as ibuprofen or acetaminophen may help.

Medicated lozenges and gargles that contain oral anesthetics/analgesics such as phenol and benzocaine are also available. These products can provide temporary pain relief for your throat. Just don’t use them for more than a few days in a row. You want to remain aware of whether the pain is progressing and may need a doctor’s attention.  

Coughing from time to time is your body’s way of clearing out your lungs. But constant coughing can be a nuisance at best and pretty painful at worst. 

If your cough is wet, you’ll need an expectorant, which will help to loosen mucus in your chest and throat. Guaifenesin is the active ingredient in OTC cough syrups designed to clear congestion from your airways. 

For a dry cough that just won’t quit, look for a cough suppressant, also known as an antitussive. Cough suppressants help to relieve your cough by blocking the cough reflex. A common antitussive ingredient you’ll see on the shelf is dextromethorphan. 

Though fevers aren’t fun, they’re actually an encouraging sign that your immune system is mobilizing to fight off an infection. According to the Mayo Clinic, except for very young or old individuals, generally healthy people don’t need to take medication to lower their temperature if it’s under 102 degrees Fahrenheit. However, if you’re feeling uncomfortable, a pain-and-fever reducer like acetaminophen or ibuprofen can help with your fever and also soothe muscle aches. 

For When It All Hits You Like a Ton of Bricks

Of course, coming down with a cold or flu is often so unbearable because it brings on a slew of uncomfortable symptoms all at once. Rather than keeping a pile of medications on hand, you can seek out one of the many multi-ingredient “cold and flu” medicines.  

These all-in-one options seem to have endless variations. In reality, they all contain different combinations of the four ingredients we’ve covered: decongestants, pain and fever reducers, cough suppressants, and expectorants. Once you know which basic components to look for, you will notice that there is really no difference between brand name and generic versions of these medicines—except that the generic version is often much cheaper. 

Just keep in mind that combination cold and flu medications often have more ingredients than you need to treat your symptoms, putting you at greater risk of side effects and overdosing. Make a note of the active ingredients in every OTC medication you take and never double up on medications containing the same ones. If only one symptom is truly bothering you, it’s best to stick to medicine that only relieves that specific discomfort. 

When in doubt, talk to your pharmacist. The team at Alto is on call to discuss which medications will be most effective and safe. We’re available from 9 am - 9 pm PT Monday - Friday, and 10 am - 6 pm PT on weekends; download the mobile app for secure messaging, or call or text 1-800-874-5881.

Remember—keep wearing your mask and social distancing to prevent the spread of COVID-19. It will also help keep you safe from catching a cold and flu. Get plenty of sunshine, prioritize sleep, and spice up your meals with immune-boosting foods. With these precautions in place, we hope you’ll be enjoying a healthy winter season ahead. 

Whether you’re pregnant, trying to conceive, or thinking about adding to your family, experts recommend starting to take a prenatal vitamin right away. Here’s what you should know if you’re ready to take a prenatal vitamin for the first time.

What to Look for in a Prenatal Vitamin

Whether you have recently found out that you are pregnant or are just starting to consider the possibility, prenatal self-care can feel a lot more complicated. Everything you do now has implications for two (or more!). 

The good news? A simple prenatal vitamin can help put your mind at ease. It’s one of the easiest and most effective ways to ensure you get the key vitamins and minerals needed to nourish your baby through a healthy pregnancy. 

Whether you’re pregnant, trying to conceive, or thinking about adding to your family, experts recommend starting to take a prenatal vitamin right away. By beginning early, you’ll help seed your body with the nutrients it needs for the earliest stages of fetal development. Here’s what you should know if you’re ready to take a prenatal vitamin for the first time.

With a wide range of over-the-counter prenatal supplements to choose from, we recommend consulting with your healthcare provider about the ideal choice for you. In some cases, your doctor might even prescribe a prenatal vitamin based on your unique nutritional needs. If you’re starting to do your research, here are the key nutrients your doctor will likely recommend supplementing. 

As you tour the ingredient label on any prenatal supplement, folic acid should be your first stop. This B vitamin helps the body make new cells and prevents congenital disabilities that affect a baby’s brain and spinal cord. 

Folic acid’s role in fetal development is crucial, so the CDC recommends all women of reproductive age take at least 400 micrograms per day. Birth defects of the brain and spine, known as neural tube defects, usually occur during the earliest weeks of pregnancy, often before many women know that they are pregnant.  

You will find that most over-the-counter prenatal supplements contain between 400 and 800 micrograms of folic acid. Sometimes, your provider may want you to take a little more, however any product with 1,000 micrograms of folic acid or more requires a prescription. 

You may also see this vitamin listed as “folate,” a general term for vitamin B9. Folic acid is a synthetic version of folate that is more stable when exposed to heat and easily absorbed by the body. 

Iron is a mineral that helps your body make blood cells that supply oxygen to your growing baby. It also helps prevent anemia, which occurs when your blood has too few healthy red blood cells. Your body needs more iron than usual during pregnancy because your total blood volume increases. The Mayo Clinic recommends supplementing with 27 milligrams of iron a day. 

Developing babies need calcium for bone growth. If you’re not getting enough, your own bone density could suffer. The general guideline is to take 1,000 milligrams per day while pregnant or nursing, which is the equivalent of three to four servings of dairy. Calcium can also be found in greens like spinach and broccoli. If you’re concerned that you’re not getting enough calcium in your diet, be sure to look for this mineral in your prenatal supplement. 

Vitamin D helps with calcium absorption and bone growth. The Mayo Clinic recommends that you get 600IUs of Vitamin D per day. 

Omega-3 fatty acids include docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). These essential fats support heart and neurological health. DHA, in particular, is known to support fetal brain development. 

While dietary sources like fatty fish are the best source of omega-3’s, this can present an issue if you want to limit fish consumption while pregnant. Some fish contain high levels of mercury, which can impair brain development in babies. For that reason, researchers at the Women's and Children's Health Research Institute advise that you take the recommended 200 milligrams of DHA a day in supplement form. 

The Mayo Clinic also suggests looking for a prenatal vitamin that includes vitamins C, A, and E; B vitamins; zinc; and iodine. Penn Medicine created this helpful chart to find the recommended daily allowance while you’re pregnant or lactating, but it’s important to consult with your doctor about your needs. 

The Mayo Clinic cautions against taking extra doses of your prenatal vitamin or doubling up on multivitamins as this could be harmful to your baby. You should always take your prenatal vitamins as directed by your doctor. If you forget to take a dose, don't worry, there is no need to double up. Just take your next dose at your regularly scheduled time.

A quality prenatal vitamin combined with a healthy, balanced diet is the best way to ensure your body and growing baby get all the nutrients they need. Talk with your healthcare provider to develop a plan to eat well and supplement your nutrition before and during pregnancy. 

Prenatal vitamins pack a powerful punch, which can make them tough to stomach for some people. The iron in prenatal vitamins can cause constipation, so it helps to drink plenty of fluids, get physical activity daily (if your healthcare provider gives you the okay), and eat more fiber. If constipation becomes a problem, talk with your doctor. Trying another form of iron or a stool softener can help with constipation. 

Some people become nauseous when taking vitamins. If you’re already feeling queasy during your pregnancy, this can present a significant hurdle. Try taking your prenatal vitamin with a meal and experiment with different times of the day. Some people cut their pill in half and take one piece in the morning and the other at night. You might also consider trying a different vitamin brand as each will vary in size, shape, and smell. A gummy, chewable, or liquid option might provide a more palatable option as well. 

If you just can’t seem to stomach your daily pill, don’t give up on your prenatal completely. Your healthcare provider can help you find a solution that won’t sacrifice your nutritional needs. 

The Mayo Clinic recommends that you do not use additional nutritional or herbal supplements during pregnancy. The FDA does not review dietary supplements for safety and effectiveness, and some ingredients could be harmful during pregnancy. 

The Mayo Clinic notes that one possible exception is ginger, which has been shown to help with nausea and is safe for pregnancy. 

If you are considering taking any supplements, always talk with your healthcare provider first. And remember that supplementation—your prenatal vitamin included—should not replace a well-balanced diet full of healthy vegetables and fruits. 

Think of your prenatal vitamin like any medication—more isn’t necessarily better. Stick with the recommended daily dose unless your doctor advises a more significant boost or suggests additional supplements. 

If your doctor recommends a prescription prenatal, you can have the prescription sent straight to Alto, and we’ll hand-deliver it to your home for free. Plus, our pharmacists will only be a phone call, text message, or in-app chat away if questions come up. You’ve likely got plenty on your mind right now, so allow us to handle all the details of your medication needs. 

Blood pressure is one critical way the heart maintains its happy, healthy medium. In this article we'll explore how to manage high blood pressure and what you can do to maintain healthy blood pressure.

The Lowdown on Healthy Blood Pressure

Blood is constantly flowing through every part of your body, propelled by the beating of your heart. Though this hardworking muscle is only about the size of your fist, it contracts sixty to eighty times per minute, sending oxygen-rich blood to the farthest reaches of your body and back. 

Like any finely-tuned machine, the heart requires balance to remain in optimal condition. If it doesn’t pump hard enough, its vital job doesn’t get done. But if it starts working too hard, it runs the risk of tiring and eventually giving out. Blood pressure is one critical way the heart maintains its happy, healthy medium.

Blood pressure is the force of the blood as it moves through the body. It’s important because we need blood to deliver the oxygen and nutrients that nourish our tissues along with antibodies and white blood cells for immunity. Blood pressure also helps us remove the waste products of our metabolism, like carbon dioxide and toxins from the liver and kidneys. 

The heart creates blood pressure with every contraction, but there are other forces at work as well. Blood keeps moving through the network of blood vessels in our bodies because of differences in pressure in our continuously narrowing arteries, veins, and capillaries. It’s similar to what occurs with multi-function showerheads. The amount of water flowing through your pipes remains the same, but a more narrow flow exerts more pressure while a widened spray feels more gentle.  

The initial, most substantial pressure comes from the heart, and the arteries’ structure helps maintain it as the blood continues to flow. 

A blood pressure reading measures two forces. Systolic pressure is the force that occurs as blood flows out of the heart and into the arteries. Diastolic pressure is the force created when the heart fills with blood as it rests between beats. 

These forces are measured using a sphygmomanometer, or what many of us know as the inflatable arm cuff that healthcare providers use during checkups. 

The cuff is inflated enough to stop the pulse, and a reading is taken. When the pulse returns, the cuff is allowed to deflate slowly, and another reading is taken. The numbers are expressed in terms of the pressure it takes to move mercury around a tube against gravity, a unit called millimeters of mercury (mm Hg). Your healthcare provider will give your reading as two figures—systolic pressure first and the diastolic pressure second—such as “140 over 80 mm Hg.” 

The National Institutes of Health advises that normal blood pressure for most adults is below 120 mm Hg systolic and 80 mm Hg diastolic. While both readings provide important information, “high blood pressure” typically refers to systolic pressure, the first number in your blood pressure reading. 

High blood pressure, also known as hypertension, is a condition that occurs when the force of the blood flowing through a person’s arteries is consistently above 130 over 80. The added pressure forces the heart to work harder and can stretch or injure the blood vessels. It also speeds the build-up of harmful plaque that can block blood flow, increasing blood pressure even further.

Over time, high blood pressure can lead to life-threatening issues like heart disease, heart attack, and stroke. It can also damage major organs such as your heart, brain, kidneys, and eyes. According to the CDC, high blood pressure usually has no early warning signs or symptoms. Getting your blood pressure checked regularly by your healthcare provider is the only way to determine whether your blood pressure is too high. 

It’s critical to detect high blood pressure early because it can be treated, usually through heart-healthy lifestyle changes with or without prescription blood pressure medications. Your healthcare provider can determine the right treatment plan for you. 

The American Heart Association encourages everyone to know their blood pressure numbers and adopt a more heart-healthy lifestyle. Impactful changes include eating a well-balanced diet that limits salt, staying physically active, taking steps to manage stress, reducing alcohol, and eliminating smoking. 

Even if you don’t have high blood pressure, eating less salt is one of the best choices you can make for your heart. Though sodium is essential for life, consuming too much salt pulls water into the bloodstream, increasing the volume of your blood. More blood flowing through your blood vessels exerts greater pressure on your heart. 	

The American Heart Association recommends that everyone limit their sodium intake to 1,500 mg/day. The biggest sodium culprits in the average American diet often don’t emerge from the salt shaker on the table. Processed or prepackaged foods like soups, cold cuts, bread, and frozen meals are major sources of excess salt because they often contain sodium-based preservatives and additives to enrich their flavor. It’s not always easy to determine by looking at their labels, however, there are several sodium-containing compounds to watch out for in the ingredient list, such as sodium benzoate, sodium tripolyphosphate, and monosodium glutamate (MSG). 

Start to make a habit of looking at labels while you grocery shop and choosing low-sodium options when possible. The American Heart Association created this sodium fact sheet to help you make heart-healthy choices. 

If your doctor determines that your blood pressure is too high, you’re certainly not alone. According to the CDC, nearly half of American adults have hypertension. If blood pressure medications become part of your treatment plan, we’d be happy to connect you with one of our pharmacists, who are specialists in heart medications. Plus, our free hand-delivery means you’ll never have to plan an extra trip to the pharmacy. With a few healthy lifestyle changes and the support of your doctor and pharmacy, your life doesn’t have to miss a beat. 

Your thyroid makes the hormones that regulate your metabolism. In this article we'll share tips for supporting your thyroid health as well as what to do when your thyroid is out of balance.

All About the Thyroid

The thyroid is a small butterfly-shaped gland located at the base of your throat. It’s part of the endocrine system—a series of glands that produce and regulate hormones. Hormones are chemical messengers that “tell” certain cells and organs what to do, influencing nearly all of the body’s functions. 

Your thyroid makes the hormones that regulate your metabolism: thyroxine (T4) and triiodothyronine (T3). Metabolism is the process by which your body converts food into energy,  facilitating vital functions such as blood circulation, breathing, and cell repair. Without the thyroid, the body could not break down protein, fats, and carbohydrates for fuel. 

The thyroid gland does not simply act on its own. It receives signals from the pituitary gland, the body’s “master gland,” which is located at the base of the brain and regulates vital body functions. The pea-sized pituitary gland sends its instructions through a hormone called thyroid-stimulating hormone (TSH). TSH levels rise and fall in the blood, telling the thyroid the exact amount of each hormone to secrete. Hormone levels within the body are a delicate balancing act, and several disorders can arise if the thyroid overproduces (hyperthyroidism) or underproduces (hypothyroidism) T4 and T3. 

With hyperthyroidism, the thyroid gland makes too many hormones, accelerating the body's metabolism, which can cause unintentional weight loss and a rapid or irregular heartbeat. According to the Mayo Clinic, other symptoms may include increased appetite, nervousness or anxiety, sweating, fatigue, and difficulty sleeping. Without treatment, hyperthyroidism can lead to serious complications, including heart conditions like congenital heart failure, eye problems, and osteoporosis. 

Hypothyroidism occurs when the thyroid isn’t making enough hormones, and symptoms may not be noticeable at first. Common symptoms of hypothyroidism may include increased sensitivity to cold, fatigue, constipation, weight gain, and dry skin. If left unchecked, the condition can eventually lead to obesity, joint pain, infertility, and heart disease.

Both conditions can be treated, often through the use of synthetic hormones or anti-thyroid medications. If you’re concerned about thyroid health, your healthcare provider can administer a blood test to check your thyroid hormone levels and recommend the appropriate treatment. 

Eating a nutritious, well-rounded diet is essential for thyroid health. Many vitamins and minerals support the thyroid, and iodine is chief among them. This trace mineral is an essential building block of thyroid hormones, but our bodies don’t produce it. Therefore, we need to consume iodine in foods such as iodized salt, seafood, seaweeds, egg yolks, dairy products, and lima beans.

It’s important not to go overboard, however. Consuming iodine in excess can negatively affect hormone levels in some individuals. Iodine deficiency is rare in the United States, so if you’re eating a varied diet, you’re likely within the range of the recommended 150 micrograms per day. 

Selenium is another critical mineral for thyroid function that can be found in brazil nuts, fish, meat, poultry, and fortified cereals and grains. Just like with iodine, selenium deficiency in the U.S. is rare, and it can be detrimental to go too far over the recommended 200 micrograms per day. 

Both the Mayo Clinic and Harvard Health recommend eating a variety of healthy foods rather than focusing too heavily on specific foods or supplements for thyroid health. If you have any concerns about your intake of essential nutrients, talk with your doctor about taking a multivitamin with minerals.

A Word of Caution about Thyroid Supplements

Your endocrine system maintains a very precise balance of hormone levels. For that reason, it’s not a good idea to experiment with your hormone health on your own. According to Cleveland Clinic endocrinologist Christian Nasr, MD, taking over-the-counter iodine supplements could result in getting more than the recommended daily value, which may leave you worse off than before. “The effect of iodine supplements can vary by person, causing the thyroid to produce either too much or too little hormone,” he cautioned.

Consumer Reports also issued a warning about thyroid supplements, reporting that many have been found to contain thyroid hormones derived from animal glands—and there’s often no indication on the labels. When researchers randomly tested ten “thyroid support” supplements, they found that nine contained “clinically relevant” levels of thyroid hormones, in some cases at levels that rivaled prescription thyroid medications. Researchers concluded that these supplements posed a “potential danger to public health.” 

Keep in mind that dietary supplements are not reviewed for safety or effectiveness by the FDA, so it’s best to talk with your healthcare provider before beginning a new over-the-counter supplement. Taking “thyroid support” supplements could alter your hormone levels in unpredictable ways and have undesirable health consequences. If you’re at all concerned about your thyroid health, consult your doctor so you can have your hormone levels tested and begin a prescribed treatment plan. 

A healthy thyroid contributes to feeling energized and ready to live life to the fullest. If your doctor determines that your hormone levels are out of balance, taking medication can restore your vitality. Once you develop a treatment plan, we’d be happy to take over the details of managing your medications. We’ll drop them off at your doorstep for free, and your prescription information will always be at your fingertips through our desktop and mobile apps. Plus, our pharmacists will only be a phone call, text message, or in-app chat away if you have questions about side effects or which foods to avoid eating around dosage time. 

Want to learn more about a better pharmacy experience with Alto? Our care team and endocrinology specialists are available to answer your questions from 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends; reach out via phone, text, or the app.

From enjoying a holiday staycation to finally tackling a long-awaited project, here are ten ways we can make the most of being stuck home for the holidays.

The Unexpected Benefit of Being Stuck Home for the Holidays

Our holiday cheer has taken a hit this year. We’ve found ourselves stringing up lights on the heels of a country-wide surge in COVID-19 infections. The CDC has advised that the safest way to celebrate the holidays is with members of our own households. We’d already reckoned with the loss of office holiday parties and made peace with socially-distanced Santa, but the idea of confining our holiday festivities to our own four walls has taken some time to sink in. 

We won’t pretend it will be easy to wish loved ones “Happy Holidays” from afar. Yet, if the true spirit of the season is rooted in togetherness, what better way to honor it than protecting those we love and our community at large? 

After all, there might be benefits to skipping this year’s daylong road trip to mom’s house and no longer feeling obligated to attend an endless list of holiday soirees. When have we ever ended a year with so much extra time? From enjoying a holiday staycation to finally tackling a long-awaited project, here are ten ways we can make the most of being stuck home for the holidays.

Take a day to give your home space an upgrade. Moving around the furniture can be surprisingly impactful, but won’t send you running to the store or blowing your budget.

Use this time to learn a new skill or delve into a topic that intrigues you. For best results, choose a class that you can complete over the course of several days. You might try Harvard and MIT founded edX, which lists free courses from top-ranked universities. To flex your creative muscles and learn a new craft, try Skillshare, which offers a Premium membership but also thousands of free classes. 

If you’re craving a couch marathon, but feel like you’ve watched the entire TV lineup over the past several months, consider revisiting an old favorite and looking for details you’ve never noticed before. 

Remind yourself that this current reality is temporary and one day we’ll be free to travel again. Plan the first trip you’d like to take, giving yourself time to really explore your ideal location in-depth. 

Not your ideal holiday activity? Well, consider this: if you’re anything like the majority of us, the backs of your cabinets could hold items you haven’t seen in years. You’re almost certain to uncover a few surprises. 

If you’ve ever thought longingly about a weekend of yoga and meditation, creative writing and painting, or connecting with nature, this may finally be your moment. Simply choose a time frame, plan a gentle agenda, and prep your meals ahead of time. Don’t forget to let loved ones know that you’re trying to unplug, so you can keep calls and texts to a minimum.

Why not devote some time to your favorite housemate this holiday season? The challenge of working out the trick is a great bonding experience, provided you use plenty of patience and positive reinforcement. For some great tips, check out this article on Dogster. 

Whether you go for classic (Monopoly), wholesome (Candyland), quick-thinking (Taboo), or hilarious (What Do You Meme?), a night of games with your family, partner, or roommates is sure to entertain. If you live alone or want to include more people in the fun, set up a virtual game night. Many popular games have online versions you can use. 

Have you dreamed of visiting the Smithsonian or wandering the halls of the Louvre? Many of the most famous museums in the world now offer online tours that will make you feel like you’re in the room.

Whether you choose to spend your time being productive or relaxed, on a set schedule or simply winging it, there’s one activity we don’t recommend: going to the pharmacy. If you have new prescriptions or refills to pick up, there’s no need to drive to the pharmacy and wait in line. Instead, leave your prescriptions to us and cue up the next module in your online course or episode of TV. We’ll hand-deliver your medications right to your door, then stay on call to answer your questions and provide support. It’s the gift of time—all year long.

We’re wishing everyone a safe and happy holiday season. 

When the pandemic hit, we were thankful to already be in the position to make a meaningful difference for Alto’s working parents. Our Working Parents & Allies Employee Resource Group (ERG) was formed at the beginning of 2020. 

Supporting Working Parents at Alto

With the COVID-19 pandemic forcing the shutdown of schools, offices, and daycare programs this year, working parents have been expected to accomplish Herculean feats of focus. Many parents spend their waking hours with one eye on their computer screens and the other on their children, all while coordinating remote learning, nap times, and video conferences. 

Those who continue to work outside the home must navigate the unpredictable availability of childcare services. Anything from new shutdown orders to a caretaker forced to quarantine can mean a lapse in care. A recent study found that 33% of working parents had no access to childcare at all, a percentage twice as large as in pre-pandemic times. 

At Alto, we serve thousands of working parents, including many who are juggling caring for their children and aging parents. Just as we support them by delivering a better pharmacy experience, we also want to support the hundreds of heroic parents working at Alto and caring for our customers every day. 

ERGs are meant to empower community groups within an organization by directly linking decision makers and implementing policies that support the group’s specific needs. The groups often center around a shared identity or experience and focus on building community, providing support, and contributing to its members’ personal and professional well-being. By creating an open forum for employees to come together, discuss challenges and opportunities, and foster a sense of belonging, ERGs help both individuals and organizations thrive. 

“Now more than ever it’s important to uplift and advocate for parents,” shares co-lead and mother Lidia Valdez. “The parenting landscape has shifted dramatically in 2020 but with the continued sense of community at Alto we can lean on one another for advice and support.” 

For more on how Alto fosters an inclusive culture and company, we invite you to read Diversity at Alto. 

The Mission of Alto’s Parent & Allies ERG

Alto’s Working Parents & Allies ERG came into being just before the pandemic began placing unprecedented demands on parents. It aims to provide an inclusive space for parents and allies to discuss how they’re feeling, speak openly about the challenges they’re facing, and request what they need from Alto. The ERG also helps parents remain informed and up-to-date on the policies and programs that are in place to support them. 

While the ERG’s first initiatives have centered upon providing pandemic-related support—from child care services to remote learning opportunities—these initiatives will continue to grow and evolve along with the needs of working parents at Alto. 

It was quickly apparent that Alto’s working parents—like parents everywhere—were overwhelmed with trying to manage the sudden shift to full-time, in-home childcare and schooling. The ERG responded by launching forums co-hosted by parents and the ERG leadership committee. These support groups were designed to create a safe space for parents and allies to share how they felt amidst a return to virtual learning in the Fall. Following the discussions, we launched a pilot program to offer immediate, tangible support. 

We began by inviting parents to opt into a program facilitating childcare services through UrbanSitter—a site that connects parents with trusted caretakers from their local communities. Interested parents received a stipend to cover membership fees and in-home or remote care costs. Whether parents needed support during a video conference or last-minute care after finding out their child’s daycare was closed, UrbanSitter could provide some relief.

We also rolled out a program with Outschool—a marketplace of live, online classes for students ages three to eighteen. Participating parents could access five hours of classes per week for free, allowing their children to explore interests ranging from math and music to filmmaking, coding, painting, and writing. With over 50,000 classes available, Outschool helps parents focus by keeping their kids engaged with fun, enriching activities. In the words of one Alto parent, “I really enjoyed Outschool for my kids. It’s such a good help; they are engaged and learning new things. Both my children and I love it!”

In addition, parents that needed hardware support for at-home distance learning were provided laptops at no cost. 

After a few months, we asked parents to provide feedback on the pilot program. We found that 71% of parents participated in the program, and 47% felt that the resources had made a positive impact on their lives or increased their ability to be productive and engaged at work. We’ll use this feedback to continue initiatives that have made a difference in the lives of Alto’s working parents while introducing new programs that can provide further support. 

The ERG leadership team also identified opportunities that would spark joy and support parents outside of the Alto community. “Working remotely can often feel isolating so we wanted to create instances for parents and their children to be recognized,” notes co-lead and parent Sandy Obeji. “In addition, we knew it would be important to extend this acknowledgement beyond parents at Alto.“

In October, we hosted a Halloween costume contest aimed at encouraging fun and creativity. Alto parents were invited to share photos of their kids in costumes, and prizes were awarded for the most unique, scariest, and funniest getups. Both adults and kids participated in choosing the winners, arguably providing more fun than a night of trick-or-treating. 

We also coordinated a Holiday Giveback Program to raise money for supplies and gifts for children and families in need during the holiday season. Alto employees were able to donate items to seven organizations—one for each Alto pharmacy location—virtually with the help of You Give Goods. In the end, we exceeded our fundraising goal and Alto matched the total donation to help make the holidays a little brighter for families across the country. 

Initiatives like these are just the beginning, and the Working Parents & Allies ERG has been collecting feedback that will guide our planning for 2021. In addition to extending access to several of the resources mentioned above, we are also exploring workshops for parents centered around current issues and events. 

There are plenty of reasons to believe that parents are superheroes, but that doesn’t mean we can expect them to perform superhuman tasks. Alto’s Working Parents & Allies ERG was created to help parents find much-needed balance and support during a tremendously difficult time. We look forward to seeing the group grow, aiding ongoing and future initiatives, and continuing to foster a culture where everyone feels included, valued, and supported. 

Interested in learning more about the Working Parents & Allies ERG? Reach out to parents@alto.com. 

Following prevention guidelines like mask-wearing, social distancing, and handwashing is still the surest way to stay safe. In addition, here are seven strategies to follow during the COVID-19 pandemic if you have asthma.

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What to Look for in a Prenatal Vitamin

The Lowdown on Healthy Blood Pressure

All About the Thyroid

The Unexpected Benefit of Being Stuck Home for the Holidays

Supporting Working Parents at Alto

Seven Strategies for People with Asthma During COVID-19

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Staying Healthy During a Challenging Holiday Season

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