1-818-812-7222 Office Hours: 8:00 AM to 5:00 PM
10 Congress St., Suite #300
Pasadena, CA 91105

Results for : "Vitamin A"

Vitamin D supplements

August 01, 2011 1:12 am

Vitamin D is a fat soluble vitamin.  It plays an important role in bone metabolism and structure. It has also been found to affect the immune regulation, control off- inflammatory reactions, and also be involved in a number of broad cellular functions throughout the body.  Until a few years ago, very little attention was given to vitamin D levels. More recently, we have realized that due to a number of factors, there is a tendency for vitamin D deficiency to be present in the U.S. adult population. This finding is even more pronounced and severe in overweight patients.
The recommended dose for vitamin D supplements is much larger today than it was a few years ago. For example, it is not too uncommon to recommend an average dose of a 50,000 (IU) international unit of vitamin D Dry Water Miscible (Water Soluble) by mouth on a daily basis after the duodenal switch operation. Since vitamin D is a fat soluble vitamin, it is important that the appropriate type be utilized. Dry formulation of vitamin D is needed to ensure adequate absorption. There are a number of manufacturers that produce these. When searching for one “Dry” D3-50 the patient would be looked for. Some larger supplement manufacturer’s carry these products. The links to these manufacturers is located here.

Vitamin D Structure

July 30, 2010 10:41 pm

Walking out into the daylight we sometimes complain about the sun’s rays hit our eyes or burning our skin. Most people overlook the importance of the sun, for they are unaware of its benefits. Vitamin D is a natural resource produced from the ultraviolet light waves from the sun hitting our skin. As a result, this allows normal bone growth and development to take place. In addition, vitamin D can be found in various foods, such as seafood and milk. Also, vitamin D’s main function is to maintain consistent levels of calcium and phosphorus.

What are the major sources of vitamin D?
The major sources are food and exposure to sunlight. Important food sources are:

  1. Fortified foods with major dietary sources of vitamins and minerals. For example, Milk in the United States is reinforced with 10 micrograms (400 IU) of vitamin D per quart.
  2. Fatty fish and fish oils.

Exposure to sunlight is an important source of vitamin D as well. Ultraviolet (UV) rays from sunlight generate vitamin D composition in the skin. There is some evidence that the body can make 10,000 iu to 25,000 iu in a single short sun exposure if the sunlight is adequate and appropriate amount of skin is exposed.

What is Vitamin D’s function? Calcium and phosphorus are two vital minerals which are constantly controlled and conserved by vitamin D in our bodies. Calcium is responsible for managing our body’s bones and keeping them stable. In addition to keeping our bones healthy, phosphorus assists with keeping nerves and muscles working together efficiently. In many countries, such as Alaska where sunlight is scarce, many people develop skeletal deformities, or muscular vulnerability. Without vitamin D, bones can become brittle and soft, also known as rickets.

Lack of Vitamin D Minimal amount or deficiencies are major causes of rickets and osteomalacia. An absence of vitamin D develops when dietary intake is insufficient, little exposure to sunlight, the kidneys not modifying it to its active form, or when the individual isn’t capable of absorbing vitamin D from the gastrointestinal tract. In addition, Americans over the age of 50 may be at risk of deficiency because the ability of skin to manipulate vitamin D into its active form slows as we grow older. As a result of various diseases the reduction of a person’s ability to absorb dietary fat decreases. Also, the kidneys which convert vitamin D to its malleable form decrease in efficiency as well. This is a brief over view of the many functions and uses of this important vitamin. Over the last few years there has been a wealth of information that has been published.

Excess Vitamin D Too much vitamin D can cause nausea, vomiting, poor appetite, constipation, weakness in fatigue, pain in the bones and weight loss. Also, vitamin D stimulates the formation of kidney stones, stiffening of soft tissue, and rise in blood levels of calcium. It is however realize that being that vitamin D is a fat soluble vitamin, it is very hard, if not impossible to get excessive amount of calcium after Duodenal switch operation. In order to avoid this very rare complication, patients on Vitamin D supplements should have their Vitamin D 25-OH levels check regularly.

Difference between D2 and D3 Vitamin D is present in two forms, cholecalciferol (D3) and Ergocalciferol (D2). D2 is manufactured by plants or fungus. D3 is formed by the body as a result of sunlight exposure and to some degree by animal products. Other differences about them is that D3 has a longer shelf life, and D2 can be toxic in most patient at high doses. Most of the beneficial effects of the Vitamin D have been contributed to D3. Further discussion here.

vitamin-d
Chemical structure of Vitamin D2 and Vitamin D3

Study: Vitamin D may boost heart health during weight loss

May 25, 2009 10:27 pm

Supplements of vitamin D may improve cardiovascular health during weight loss, without impacting on how many pounds are shed, suggests a new study.Supplements of vitamin D may improve cardiovascular health during weight loss, without impacting on how many pounds are shed, suggests a new study.

“The results indicate that a vitamin D supplement of 83 micrograms/d does not adversely affect weight loss and is able to significantly improve several cardiovascular disease risk markers in overweight subjects with inadequate vitamin D status participating in a weight-reduction program,” wrote the authors, led by Armin Zittermann from the Clinic for Thorax and Cardiovascular Surgery in Bad Oeynhausen.

With obesity rates still high – not only in developed countries but also, increasingly, in newly wealthy emerging markets, there is considerable attention to ways to trim down waistlines. The results of the new randomised, double-blind, placebo-controlled trial indicate that vitamin D supplements may be useful as a means of boosting heart health during weight loss.

The details on D

Vitamin D refers to two biologically inactive precursors – D3, also known as cholecalciferol, and D2, also known as ergocalciferol. The former, produced in the skin on exposure to UVB radiation (290 to 320 nm), is said to be more bioactive.

While our bodies do manufacture vitamin D on exposure to sunshine,
the levels in some northern countries are so weak during the winter months that our body makes no vitamin D atall, meaning that dietary supplements and fortified foods are seen by many as the best way to boost intakes of vitamin D.

In adults, it is said vitamin D deficiency may precipitate or exacerbate osteopenia, osteoporosis, muscle weakness, fractures, common cancers, autoimmune diseases, infectious diseases and cardiovascular diseases. There is also some evidence that the vitamin may reduce the incidence of several types of cancer and type-1 diabetes.

Study details

Zittermann and his co-workers recruited 200 healthy overweight people with average 25(OH)D levels of 30 nmol/L (12 ng/mL) and randomly assigned them to receive either placebo or vitamin D for one year. All the subjects also participated in a weight-reduction program.

At the end of the study, 25(OH)D levels increased in the D group by 55.5 nmol/L, but by only 11.8 nmol/L in the placebo group. Furthermore, a 26.5 per cent reduction in levels of parathyroid hormone (PTH) were observed in the D group, compared with 18.7 per cent in the placebo group. “High blood concentrations of parathyroid hormone […] are considered new cardiovascular disease risk markers,” explained the authors.

Improvements in triglycerides levels were also observed in the vitamin D group, with a 13.5 per cent decrease noted compared with a 3.0 per cent increase in the placebo group.

Finally, levels of the marker of inflammation TNF-alpha decreased by 10.2% per cent following vitamin D supplementation, compared with 3.2 per cent in the placebo group.

“The beneficial biochemical effects were independent of the loss in body
weight, fat mass, and sex,”
noted the researchers.

On the downside, the researchers noted that participants receiving the vitamin D supplements did experience an average 5.4 per cent increase in their levels of LDLcholesterol.
Source: American Journal of Clinical Nutrition
May 2009, Volume 89, Pages
1321-1327, doi:10.3945/ajcn.
2008.27004
“Vitamin D supplementation enhances the beneficial effects of weight loss on
cardiovascular disease risk markers” Authors: A. Zittermann, S. Frisch, H.K. Berthold, C. Götting, J. Kuhn, K. Kleesiek, P. Stehle, H. Koertke, R. Koerfer
May 25

Vitamin D Found To Stimulate A Protein That Inhibits The Growth Of Breast Cancer Cells

March 06, 2009 9:44 pm

Chistakos, a professor of biochemistry, has published extensively on the multiple roles of vitamin D, including inhibition of the growth of malignant cells found in breast cancer. Her current findings on the vitamin D induced protein that inhibits breast cancer growth are published in a recent issue of The Journal of Biological Chemistry. Previous research had determined that increased serum levels of vitamin D are associated with an improved diagnosis in patients with breast cancer. Prior to the current study, little was known about the factors that determine the effect of calcitrol on inhibiting breast cancer growth, she said. During the study, Christakos and coauthor Puneet Dhawan, Ph.D., examined the protein involved in the raction that can reduce the growth of vitamin D in breast cancer cells. “These results provide an important process in which the active form of vitamin D may work to reduce growth of breast cancer cells,” said Christakos. “These studies provide a basis for the design of new anticancer agents that can target the protein as a candidate for breast cancer treatment.”

Women should go for the broccoli when the relish tray comes around during holiday celebrations this season.

While it has been known for some time that eating cruciferous vegetables, such as broccoli, cauliflower, and cabbage, can help prevent breast cancer, the mechanism by which the active substances in these vegetables inhibit cell proliferation was unknown — until now.

Scientists in the UC Santa Barbara laboratories of Leslie Wilson, professor of biochemistry and pharmacology, and Mary Ann Jordan, adjunct professor in the Department of Molecular, Cellular, and Developmental Biology, have shown how the healing power of these vegetables works at the cellular level. Their research is published in this month’s journal Carcinogenesis. “Breast cancer, the second leading cause of cancer deaths in women, can be protected against by eating cruciferous vegetables such as cabbage and near relatives of cabbage such as broccoli and cauliflower,” said first author Olga Azarenko, who is a graduate student at UCSB. “These vegetables contain compounds called isothiocyanates which we believe to be responsible for the cancer-preventive and anti-carcinogenic activities in these vegetables. Broccoli and broccoli sprouts have the highest amount of the isothiocyanates. “Our paper focuses on the anti-cancer activity of one of these compounds, called sulforaphane, or SFN,” Azarenko added. “It has already been shown to reduce the incidence and rate of chemically induced mammary tumors in animals. It inhibits the growth of cultured human breast cancer cells, leading to cell death.” Azarenko made the surprising discovery that SFN inhibits the proliferation of human tumor cells by a mechanism similar to the way that the
anticancer drugs taxol and vincristine inhibit cell division during mitosis.
Mitosis is the process in which the duplicated DNA in the form of chromosomes is accurately distributed to the two daughter cells when a cell divides.

Hundreds of tiny tube-like structures, called microtubules, make up the machinery that cells use to separate the chromosomes. SFN, like the more powerful anticancer agents, interferes with microtubule functioning during mitosis in a similar manner to the more powerful anticancer drugs. However SFN is much weaker than these other plant-based drugs, and thus much less toxic. “SFN may be an effective cancer preventive agent because it inhibits the proliferation and kills precancerous cells,” said Wilson. It is also possible that it could be used as an addition to taxol and other similar drugs to increase effective killing of tumor cells without increased toxicity.

Vitamin D to treat heart failure

July 03, 2008 9:40 pm


 

Strong bones, a healthy immune system, protection against some types of cancer: Recent studies suggest there’s yet another item for the expanding list of Vitamin D benefits. Vitamin D, “the sunshine vitamin,” keeps the heart, the body’s long-distance runner, fit for life’s demands.

University of Michigan pharmacologist Robert U. Simpson, Ph.D., thinks it’s apt to call vitamin D “the heart tranquilizer.” In studies in rats, Simpson and his team report the first concrete evidence that treatment with activated vitamin D can protect against heart failure. Their results appear in the July issue of the Journal of Cardiovascular Pharmacology. In the study, treatments with activated vitamin D prevented heart muscle cells from growing bigger – the condition, called hypertrophy, in which the heart becomes enlarged and overworked in people with heart failure. The treatments prevented heart muscle cells from the over-stimulation and increased contractions associated with the
progression of heart failure.

About 5.3 million Americans have heart failure, a progressive, disabling condition in which the heart becomes enlarged as it is forced to work harder and harder, making it a challenge even to perform normal daily activities. Many people with heart disease or poorly controlled high blood pressure go on to experience a form of heart failure called congestive heart failure, in which the heart’s inability to pump blood around the body causes weakness and fluid build-up in lungs and limbs. Many people with heart failure, who tend to be older, have been found to be deficient in vitamin D.

“Heart failure will progress despite the best medications,” says Simpson, a professor of pharmacology at the U-M Medical School. “We think vitamin D retards that progression and protects the heart.”

The U-M researchers wanted to show whether a form of vitamin D could have beneficial effects on hearts that have developed or are at risk of developing
heart failure. They used a breed of laboratory rats predisposed to develop human-like heart failure. The researchers measured the effects of activated Vitamin D (1,25 dihydroxyvitamin D3, a form called calcitriol) in rats given a normal diet or a high-salt diet, compared to control group rats given either of the same two diets, but no vitamin D treatment. The rats on the high-salt diet were likely to develop heart failure within months.

The rats on the high-salt diet, comparable to the fast food that many humans feast on, quickly revealed the difference vitamin D could make. “From these animals, we have obtained exciting and very important results,” Simpson says.

After 13 weeks, the researchers found that the heart failure-prone rats on the high-salt diet that were given the calcitriol treatment had significantly lower levels of several key indicators of heart failure than the untreated high-salt diet rats in the study. The treated rats had lower heart weight. Also, the left ventricles of the treated rats’ hearts were smaller and their hearts worked less for each beat while blood pressure was maintained, indicating that their heart function did not deteriorate as it did in the untreated rats. Decreased heart weight, meaning that enlargement was not occurring, also showed up in the treated rats fed a normal diet, compared to their untreated counterparts. Simpson and his colleagues have explored vitamin D’s effects on heart muscle and the cardiovascular system for more than 20 years. In 1987, when Simpson showed the link between vitamin D and heart health, the idea seemed far-fetched and research funding was scarce. Now, a number of studies worldwide attest to the vitamin D-heart health link.

The new heart insights add to the growing awareness that widespread vitamin D deficiency—thought to affect one-third to one-half of U.S. adults middle-aged and older—may be putting people at greater risk of many common diseases. Pharmaceutical companies are developing anti-cancer drugs using vitamin D analogs, which are synthetic compounds that produce vitamin D’s effects. There’s also increasing interest in using vitamin D or its analogs to treat autoimmune disorders.

In more than a dozen types of tissues and cells in the body, activated vitamin acts as a powerful hormone, regulating expression of essential genes and rapidly activating already expressed enzymes and proteins. In the heart, Simpson’s team has revealed precisely how activated vitamin D connects with specific vitamin D receptors and produces its calming, protective effects. Those results appeared in the February issue of Endocrinology. Sunlight causes the skin to make activated vitamin D.

People also get vitamin D from certain foods and vitamin D supplements. Taking vitamin D supplements and for many people, getting sun exposure in safe ways, are certainly good options for people who want to keep their hearts healthy. But people with heart failure or at risk of heart failure will likely need a drug made of a compound or analog of vitamin D that will more powerfully produce vitamin D’s effects in the heart if they are to see improvement in their symptoms, Simpson says.

Vitamin D analogs already are on the market for some conditions. One present drawback of these compounds is that they tend to increase blood calcium to undesirable levels. Simpson’s lab is conducting studies of a specific analog which may be less toxic, so efforts to develop a vitamin Dbased drug to treat heart failure are moving a step closer to initial trials in people.

heart-muscle-cells-in-rats

left: Heart muscle cells in untreated rats bred to develop heart failure show signs of disease: Cells are irregular in size and shape and show fibrotic lesions (areas in purple). Right: Heart muscle cells remain healthy in rats treated with calcitriol, the hormone that Vitamin D becomes in the body. (Credit: Image courtesy of University of Michigan Health System)

Exercise for Your Bone Health
Vital at every age for healthy bones, exercise is important for treating and preventing osteoporosis. Not only does exercise improve your bone health, it also increases muscle strength, coordination, and balance, and leads to better overall health.

Why Exercise?
Like muscle, bone is living tissue that responds to exercise by becoming stronger. Young women and men who exercise regularly generally achieve greater peak bone mass (maximum bone density and strength) than those who do not. For most people, bone mass peaks during the third decade of life. After that time, we can begin to lose bone. Women and men older than age 20 can help prevent bone loss with regular exercise. Exercising allows us to maintain muscle strength, coordination, and balance, which in turn help to prevent falls and related fractures. This is especially important for older adults and people who have been diagnosed with osteoporosis.

The Best Bone Building Exercise
The best exercise for your bones is the weight-bearing kind, which forces you to work against gravity. Some examples of weight-bearing exercises include lifting weights, walking, hiking, jogging, climbing stairs, tennis, and dancing. Examples of exercises that are not weight-bearing include swimming and bicycling. While these activities help build and maintain strong muscles and have excellent cardiovascular benefits, they are not the best way to exercise your bones.

Exercise Tips
If you have health problems – such as heart trouble, high blood pressure, diabetes, or obesity – or if you are over age 40, check with your doctor before you begin a regular exercise program. According to the Surgeon General, the optimal goal is at least 30 minutes of physical activity on most days, preferably daily. Listen to your body. When starting an exercise routine, you may have some muscle soreness and discomfort at the beginning, but this should not be painful or last more than 48 hours. If it does, you may be working too hard and need to ease up. STOP exercising if you have any chest pain or discomfort, and see your doctor before your next exercise session.

If you have osteoporosis, ask your doctor which activities are safe for you. If you have low bone mass, experts recommend that you protect your spine by avoiding exercises or activities that flex, bend, or twist it. Furthermore, you should avoid high-impact exercise in order to lower the risk of breaking a bone. You also might want to consult with an exercise specialist to learn the proper progression of activity, how to stretch and strengthen muscles safely, and how to correct poor posture habits. An exercise specialist should have a degree in exercise physiology, physical education, physical therapy, or a similar specialty. Be sure to ask if he or she is familiar with the special needs of people with osteoporosis.

A Complete Osteoporosis Program
Remember, exercise is only one part of an osteoporosis prevention or treatment program. Like a diet rich in calcium and vitamin D, exercise helps strengthen bones at any age. But proper exercise and diet may not be enough to stop bone loss caused by medical conditions, menopause, or lifestyle choices such as tobacco use and excessive alcohol consumption. It is important to speak with your doctor about your bone health. Discuss when you might be a candidate for a bone mineral density test. If you are diagnosed with low bone mass, ask what medications might help keep your
bones strong.

2018 Back on Track

January 28, 2018 11:38 am

Join our 2018 Back on Track challenge and let’s get back on track for 2018! The holidays were wonderful but if you find yourself with a few extra souvenirs don’t feel alone. The average American gains between 1-8 pounds during the holiday season and I am no exception. Let’s get back on track 2018 together.

Time to clear out the kitchen! Disposing of temptations and high trigger foods is the first step to getting back on track. Throw it all away and don’t allow them back in. If foods are difficult to acquired then they are less likely to be consumed.

Stock up on high protein and whole, unprocessed foods that are low carbohydrate and nutrient dense. When quality foods are easily available we are more likely to stay on track with the types of foods we should be eating. Simple sugars/carbohydrates are the biggest culprit of holiday weight gain. We need to go back to the basics of hydration, high protein, low carbohydrate/sugar, vitamin/mineral supplements and exercise. Simple sugars and carbohydrates are easy for our bodies to use and absorb. Cutting them out can jump start your weight loss. Each individual needs to identify the daily carbohydrate intake that works for them. Some people stay under 50 grams of carbohydrates daily and some can tolerate more daily grams. You may also need to look at your protein and fat intake. All excess nutrients absorbed have the potential to turn into fat mass and inhibit weight loss. Metabolism video.

Hydration is an important ways to start getting back on track. Water is essential to life functions. The brain is 85% water, blood is 80% and muscle is about 70% water. Hydration aids in digestion, eliminating waste, byproducts and toxins. It also can decrease the feeling of hunger. Lack of hydration can increase fatigue which can lead to craving high carbohydrate foods to increase energy.

Protein’s importance in almost every bodily function and muscle mass can not be ignored. High quality complete Protein sustains muscle mass during weight loss, aids immunity, antioxidant function, and enhances leptin and insulin function. Filling up on protein first will help with carbohydrate carvings and give a sustained satisfied feeling. A prior blog post gives additional information on the importance of protein and the effects of protein malnutrition. WLS makes daily protein intake important but especially after Duodenal Switch, protein is a necessity of daily life.

Vitamins, minerals and supplements will ensure the body has the nutrients it needs to function adequately and can keep cravings at bay. Deficiencies in vitamins and minerals can cause cravings for foods. Vitamin and minerals are essential to muscle function, red blood cell production, bone health, and numerous other physiologic functions. We may all slack off on our supplements occasionally but now is the time to get back into the habit of daily vitamins and mineral supplements. A daily vitamin, mineral, and supplement routine is a lifetime commitment after Duodenal Switch or any WLS. Here is a list of commonly used supplements. If you haven’t kept up with your minimum yearly laboratory studies, now is the time to be seen and have your labs done.

Exercise can increase weight loss, overall well being, mental well being, mood, alertness, improve digestion, improve sleep, and increases energy levels. Exercise does not have to be a daunting task. Simply adding 15-30 minutes of activity can give added benefits. Yoga, walking, dancing, lifting weights, hiking, and sports activities can be included or added to more traditional forms of exercise. There are many free online videos for all types of exercise available. This year we are teamed up with The Kinesis Centre to offer a 4 week training program that can be accessed from anywhere. A 4 week training program will be included in our 2018 Back On Track Grand prize.

Finding a new hobby can keep both your hands and mind busy, curbing the unconscious eating of foods that are high in sugar and carbohydrates. Adult coloring books, drawing, painting, knitting, crocheting, sewing, dance lessons, gardening, learning to play an instrument and many others are great ways to use your time and expand your quality of life and brain function. New hobbies can also help establish new coping skills. Our previous post on Coping Skills After Bariatric Surgery can be found here. There are a whole host of online videos for “how to” on new hobbies.

back on track 2018 keshishian
2018 Keshishian BOT
File-Jan-28-11-31-20-AM-300x225

Teaming up with others can also help increase weight loss and compliance. Support from friends, family and other groups will assist you. There is a whole gamut of support group online and in person. If you have fallen out of the habit of attending our support group or webinars get back to them. You can find our schedule and announcements regarding webinars here. Our Central Valley Bariatric Facebook page also gives daily inspirational messages, protein recipes and articles and any new information or research available. There is also our Duodenal Switch Facebook Group. Anything that increases accountability is a benefit and motivates us to stay on track.

Experiment with new recipes and flavors that are bariatric friendly and within your dietary needs. There are so many options for quick and easy meals that are whole foods, high protein, and low carbohydrate. We have several recipes on our page for all stages following weight loss surgery and Duodenal Switch. However, there are endless option on the internet in Paleo, low carb, and high protein type recipes.

In the spirit of new starts and getting back on track 2018, we are having a giveaway with the basics to get back into the swing of things. This year we are looking for before and after weight loss surgical journeys for our Grand Prize. Share your weight loss journey! Don’t be shy, your journey can inspire others and/or motivate yourself. To enter the Back on Track 2018 Giveaway, please submit your weight loss surgical journey with before and after pictures to contact@dssurgery.com or you can also post your before and after pictures on our Facebook page. You will also need to sign a release for the use of your story on our website. We will draw 2 names from those that enter by announcing it on our FaceBook page or by e-mail on February 14, 2018. You must submit your mailing information to contact@dssurgery.com in order to claim the prize. You must be a verifiable patient of Dr. Ara Keshishian.

We are also doing 3 prizes of a 4 week training with the Kinesis Centre if you share an achievement picture on our FaceBook page . This achievement picture can be a milestone in your journey, something you’ve haven’t done before, a non-scale victory, a goal that you reached, anything that you are proud of achieving. Let’s do this 2018 Back on Track challenge!

Please remember that medications, health status, age, bowel motility, genetics, and diet all play a role in weight and weight maintenance. Please have a physician review your health history and medications.

*NOTE: Giveaway items may or may not be identical to the pictured items.
We are not affiliated with any of the products nor do we endorse any one type of product. There is no cash value to the prizes.

Compounding Pharmacies

January 22, 2018 2:38 pm

New FDA regulations for compounding pharmacies has spurred changes in our pricing and ability to provide injectable Vitamin A and Vitamin D.  The compounding pharmacies are no longer compounding injectable Vitamin A and there is a nationwide shortage of the national brand of injectable Vitamin A.  We have a tentative date of February 2018 when we may be able to obtain injectable Vitamin A. We won’t be able to quote pricing on Vitamin A injections until we are able to orders.

We are able to obtain and supply our patients with injectable Vitamin D but with a price increase.

The following is the letter we received from our compounding pharmacy.

“The healthcare industry has continuously undergone changes in regulations and legislation. The compounding industry is no exception and has faced rigorous regulatory requirements this past year such as new testing specifications and compliance standards.

We are set on facing these demanding challenges by meeting and exceeding these new regulatory requirements. We want to assure you we will continue to provide the best products on the market for you and your patients. Quality and safety remain a top priority. We understand that our pharmacy plays a vital role in providing care to your patients. The increase in pricing is a reflection of the additional cost in producing and testing the product based on regulatory specifications.”