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The Legal Drug Dealer Podcast

Getting Pharmacy as a profession Closer to The Patient

January 28, 2020

BioIdenticals ~ Hormonal Replacement

With Sharzad Green and Marilena Grittani, RPh

This episode is quite informative and a bit deep into the pharmacy world for those that are not part of it.
I believe the information that Sharzad had shared with you is going to be useful and an eye-opener for your own health and the health of those you love.

If you get the chance to work with her, DO NOT DOUBT IT! She is sweet, has so much compassion, and is SO KNOWLEDGABLE!!!

Some of the most relevant points she made are:

    • There are times that women think that oh, well, this is how it’s supposed to be or my mom went through it the same way or No; my neighbor didn’t have any symptoms. So maybe I’m just kind of a hypochondriac and thinking that there’s something, you know, wrong, where it’s not.
    • I meet with the patient to talk to them, I go over their past medical history, their family history, risk factors for developing different diseases, their symptoms, their blood work. I talk to them about hormonal and non-hormonal ways to help improve their symptoms. That may include lifestyle modifications, it may include supplements. I do, go over their supplements, make sure that they’re taking the right things that are needed. For example, a postmenopausal woman may be at higher risk for developing bone loss and break their bone osteoporosis, right. So we want to make sure that they’re, because of  taking calcium, magnesium, vitamin D, etc.
    • I appreciate the opportunity that my patients have given me over the past 20 years, I’ve probably done close to 20,000 one-on-one consultations with patients.
    • Women who experience vaginal dryness because their hormone levels have dropped, oftentimes end up having bladder problems, such as a leak, urinary tract infections or needing to pee too frequently. Yeah. So things that are related to the bladder. And oftentimes, once we address the vaginal dryness, their bladder function improves.

"I have a great passion. I'm one of those lucky people who has fallen into the place where I'm supposed to be I have great passion for doing what I do, which is taking care of patients, mainly women, but I also have male patients as well"

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Listen To The Episode Here

If you think that you or someone you know can benefit from the information shared in this episode, please share it with them. And don’t forget that, if you are subscribed to our mailing list, you got the informational sheet that Dr. Sharzad Green prepared for you. On this occasion is about Menopause and BioIdenticals

As an attachment to our weekly email, but if you are not subscribed, make sure you subscribe to it, and you will get immediate access to it, and you will be up-to-date for future episodes.

"I just want everybody to know that we don't always stay young. But that does not mean that we should sacrifice the quality of our lives. So pay attention to your body. Take good care of your body nutrition, exercise. We hear about it all day long, but really take it to heart. Take good care of your body. You only have one!"

Sharzad is professional, knowledgable and have over 20,000 patient consultations… That is what I call experience!

Let me know what you think about this episode or if you have any questions

comments@thelegaldrugdealer.com

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"If you put in a balance, what would be better for you to invest a little bit more money on your health, taking care of it with somebody that would tailor it for you, or you would go with whatever the insurance company that wants to tell you what to do? And then maybe, hopefully not, but maybe have negative consequences. That is your choice. But my mission was this podcast with this information is for you to know the options that are out there for you to learn what experts are that pharmacists are open in this country, in and all over the world actually, to help patient-specific situations where they are experts."

Marilena Grittani, RPh

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Episode Transcripts

Marilena Grittani, RPh  0:09  

Welcome to our podcast.

Dr. Sharzad Green, PharmD  0:11  

Well, thank you. It’s nice to connect with you and your audience.

Marilena Grittani, RPh  0:16  

Thank you for coming with us. I’m very happy about this because they’re going to love what you do and understand what is it that you do and how specific it is because everybody likes personal life stuff. So let’s just start a little bit with you as a pharmacist. Why did you become a pharmacist? Would you tell us

Dr. Sharzad Green, PharmD  0:36  

of course, I’ve always enjoyed interacting with people with actual person being a pharmacist that gave me the ideal setting where I could actually be myself. Do what I love to do, which is health care, and then take care of my patients on one on one. I enjoy that interaction. 

Marilena Grittani, RPh  0:56  

Me too. So that’s what we’re doing this. 

Dr. Sharzad Green, PharmD  1:00  

I went to UVA in Tucson and graduated in 1990 with a Doctor of Pharmacy degree

Marilena Grittani, RPh  1:07  

30 years! So tell us about what type of pharmacy jobs have you done in the past.

Dr. Sharzad Green, PharmD  1:12  

I started with retail pharmacy in a big chain. And I actually enjoyed it again, I I’m the type of person who loves interacting with patients directly. But a couple years into it, I started doing home infusion for patients who were in home care. And that introduced me to long term care, which is nursing home pharmacy, so I did that and that involved a lot of patients care, even though it was not direct, but it was more like pain management and taking care of their antibiotics that were infused like meaning injectable antibiotics essentially. So things that were a little bit more clinical until I met my mentor 20 some years ago and that’s when I fell in love with compounding. Now, for those of you don’t know what compounding is, it’s basically an art where the pharmacist basically takes all the raw materials and mixes it together in a scientific way and makes a final product that’s individualized for you in particular, and not everybody gets the same compound. So I’ve been a compounding pharmacist for the past 20 years, and my focus has been taking care of patients. Again, going back to my patient interactions. I’ve been doing one on one hormone consultations and consultations for Adrenal Fatigue Syndrome is sexual dysfunction for the past 20 years.

Marilena Grittani, RPh  2:45  

Okay, so it’s been 30 years of quite a different jobs that have a lot to do with pharmacy but they’re absolutely different. Just to clarify a little bit for those that are not familiar with it when Sharzad mentioned  long term. She was basically talking about those hospitals where they don’t have you in the hospital that you had surgery or you were admitted after ER, they transfer you to places that take care of you for a longer time up to three months. And then some of those hospitals don’t have a pharmacy so they hire pharmacist outside of their facility to make all the drugs that the patient will need mainly in their veins because they are not able to eat so it includes food sent the body that they need that they don’t have in their facility. a pharmacist who makes it that is what is long term.

Dr. Sharzad Green, PharmD  3:36  

That’s where when I actually met my mentor, okay, oh, he was a compound there. So after that, the rest is history.

Marilena Grittani, RPh  3:44  

The rest is history. So about compound and specifically Dr. Angela Soliz that was here in a previous episode (episode #6), I’m going to be the one to talk specifically and more in depth about compounding, which I love because it’s like cooking and I love to

Dr. Sharzad Green, PharmD  3:58  

it is it’s an art and It is so much fun.

Marilena Grittani, RPh  4:02  

I’m getting chills talking about it. That’s how much I love it. So yeah. What is it that motivates you to help your patients?

Dr. Sharzad Green, PharmD  4:10  

So going back 20 some years ago, I have to started by telling you about my mom who had been taking regular commercially available hormones. She took it for a few years, she asked me if it was safe, she asked her doctor if it was safe. And we both told her Yes; because she had a predisposition to developing heart disease because her her dad died of heart disease and she had a heart condition. So based on studies, we thought that that was the best option for her because hormones can protect you against heart disease.

Marilena Grittani, RPh  4:48  

So we’re talking about what type of hormones and and what type of commercially available hormones.

Dr. Sharzad Green, PharmD  4:53  

She specifically took Prempro, which is Premarin and provera. So Premarin is a hormone that comes from pregnant mares urine, pregnant horses urine provera is a synthetic progesterone. So they combined it, they gave it to her. After a few years, she was diagnosed with breast cancer. And about the same time I met my mentor, and I it was kind of like thing that I didn’t even expect something that I didn’t think that would happen. But when you’re in that situation, then you stop and think about, well, what else was possible was available could have been done for my mom. And that’s what brought me to the to the field of bio identical hormones.

Marilena Grittani, RPh  5:40  

So, let’s just verify your mom started taking this hormones because she was going through menopause. Right? And she needed to replace those hormones that she didn’t make any more because of her age. And then the symptoms were flashes then couldn’t sleep and and the husband complaining that she can he can sleep because she Can’t sleep. So that’s why people start on this type of hormones. estrogen and progesterone are the most common drugs. So just to clarify, that’s what your mom started using them, right? 

Dr. Sharzad Green, PharmD  6:11  

Correct. Correct. 

Marilena Grittani, RPh  6:13  

Okay. So you started giving us a little bit of information. But what is it that you specifically do right now, I want every one of our listeners to hear about what you do, because it’s so cool. So go ahead, tell us. 

Dr. Sharzad Green, PharmD  6:25  

First of all, I have a great passion. I’m one of those lucky people who has fallen into the place where I’m supposed to be I have great passion for doing what I do, which is taking care of patients, mainly women, but I also have male patients as well. So essentially, the way it works is patients contact me You can contact me through email. And tell me about kind of briefly what’s going on. Give me your contact information. I’d like to talk to you for just a five to 10 minute brief conversation, to see what I can do for you. Oftentimes These women are suffering from hormonal imbalance whether it’s after giving birth to a baby or perimenopause, which is you know, right before menopause, or menopause or post menopause, the average age of menopause is 51. So anyone between the ages of 40-60 or even more can benefit from my services. But basically they contact me I talked to them, they discuss the goals, and I guide them and their doctor or the nurse practitioner or physician assistant as to what labs need to be drawn, what levels need to be checked as far as hormones like your estrogen, progesterone, testosterone, whatever it is. And then once I have all that information, then I can do a full consultation for these patients and help them get back on track. So these recommendations after I do the consultation may include some compounded hormones again, They’re individualized. They’re custom made based on your own body’s needs. And my recommendation based on your labs based on your risk factors, based on your symptoms, and all that. So I take all of that into consideration and start you on a regimen. And then after that patients we report to me, we do follow up phone calls or meetings, essentially, and make sure that you’re doing well. I always like to take a look at everything that they’ve had within the past three years or so we do need current labs. Now, one thing that I wanted to tell you is that it doesn’t have to be a lab draw a typical blood draw that you go to actual lab. There are other ways that we could handle that such as saliva test or a kind of like a finger stick to check their blood sugar. There are kits that are available and I could put you in touch with the company or provide the kids to you so we could have it done that way to

Marilena Grittani, RPh  8:58  

Hold on. Did you say that you can test my hormones in my saliva? Is that what you said?

Dr. Sharzad Green, PharmD  9:02  

Yes, yes, that’s the easiest way. It’s very interesting because saliva really is one of the most accurate ways to check your hormone levels. It is. It can be Yeah, it can tell exactly what it’s available to your body. So it is one of the easiest ways but you have to remember some doctors kind of resist saliva testing. So for that reason, the companies also provide blood spot testing where you prick your finger and they will analyze your the drops of blood. Or we could go with the regular life. You do want specific labs and most doctors actually don’t necessarily order those labs for us. It’s very interesting because providers think that okay, well, you know what, you’re in menopause. Big deal, you’re having hot flashes, we’ll deal with it and they are worried about the consequences of hormone therapy because there are So much controversy around usage of hormones and possibly causing breast cancer or other diseases that they’re worried they’re scared. They don’t want to go where they don’t know what’s going on and what’s going to happen. And that’s why I do all the assessment prior to even starting the patient on hormones prior to even sending you for blood draw. We want to know if you’re even a good candidate, and that’s something that I am very careful with because I don’t want anybody to get cancer.

Marilena Grittani, RPh  10:30  

That’s for sure. Talk a little bit about that in detail, because part of the mission of this podcast is to educate our audience, each one of the beautiful listeners, that we have about what is it the pharmacies do and what are we experts on and what is our job. The same way that you have somebody in the store there’s somebody that registers or somebody that is showing you the shoes, somebody that is in the back, putting the shoes away; everybody has their specific job and that is what they’re good at. If you ask somebody about what size of this brand they have in the back, and the lady works at the register, she had no idea. She might know something about that she heard, but she would be irresponsible and would most likely not say, Oh, we have size 9, 10 and 10 and a half, because she doesn’t really know. Now when we translate that information to pharmacy and doctors, doctors and practitioners in general (we’re talking about nurse practitioners and physician assistants); they’re very good at diagnosing or their symptoms or their signs, but they are not that good with specifics that had to do with drugs, because they did not go to school to learn drugs or medication. And then, they have somebody else that he’s the expert that is going to take care of the management of the drug; how is written, how a patient responded to it, what possible complications or negative effects they can have and most importantly, if is working. So that’s where the pharmacist comes into place. And then that’s what we do now, when we, as you were saying when a physician, or a practitioner in this case is afraid of the consequences of using hormones is because that particular person is not good at the follow up, and that’s why they’re afraid of it. Now, if that person orders and refers the patient to somebody like you, that is an expert on the management of this specific hormones; then that person will be more confident on going that route. But, the person is going to say, you know what I can give it to you, but I don’t know what to do with it afterwards; is very complicated and really uncomfortable for a practitioner to say those words. That’s why they said I just don’t trust that I prefer to go another way. Yeah, you’re telling me but you’re not telling me so you can go with a physician that has that mentality and then supplement the monitoring of what they ordered with somebody that you like you because at the end of the day, you do not prescribe. 

Dr. Sharzad Green, PharmD 

Pharmacists, at least in Arizona, we’re not allowed to prescribe. There are some pharmacists and who can prescribe very, very limited number of things in other states, but in general, you’re right pharmacists do not prescribe.

Marilena Grittani, RPh  13:13  

So whenever the doctor diagnosis that the patient has these imbalances, and then they said, You know what, I want somebody or the patient requests, hey, I want to make it customized. I wanted to make a like a very fitted dress that is gonna fit me perfectly. I want you to help me I want you to refer me to somebody that is an expert, then the doctor should refer the patient or the patient can make the decision to go directly to somebody like you. Right? 

It’s a it’s a triangle relationship between the patient, the doctor or prescriber and the pharmacist. So the three of us work together. It’s something that I emphasize on because I think it’s really important. It’s group effort. We’re not trying to say that you don’t need your practitioner that you need your dog Nurse Practitioner or your physician assistant is just that everybody, has their job. The person that handles the drugs is that’s what they do the prescriber of the one that order tests like CT scans or or x rays, that is the doctor the one the diagnosis, and then everybody has their place it’s a team effort to get the best out of the situation where the where you are and give you the best options and monitor. Which means making sure that everything fits correctly. So we were talking about earlier about how making this, what do you call it bio, bio identical hormones.

Okay, so making bio identical hormones, similar close to what the patient needs is like, like getting a dress made by a seamstress, not the one that you buy at the store that is either to wide at the hips or too narrow in the in the waist; but it’s something that is actually made to the figure. That you you get it the way that you want it to fit. So when the doctor said, you need hormones, they come to you and then you just take the measurements like the symptoms with do which is like the lab laboratory tests, blood tests, or saliva now, okay, and then you review other areas of the patient’s history. And then you give your recommendation.

Dr. Sharzad Green, PharmD  15:21  

Well, going back to the bio identical hormones, I just wanted to explain to your audience that BioIdentical means that a formulas are exactly the same molecules that your own body produce. So they’re not similar and they’re not different. They’re not horses urine, they are actually female human estrogen, progesterone, testosterone. They’re exactly this.

Marilena Grittani, RPh  15:44  

That’s very good, and important that you said it, because other people, myself included, have mentioned BioSimilar, right that is not the same as BioIdentical, which is what you do. 

Dr. Sharzad Green, PharmD  

That’s true BioIdentical basically is exactly identical to what a woman’s body or a man’s body produces.

Marilena Grittani, RPh 

Basically you review the labs, you got all the results in the blood or saliva and you ask a bunch of questions and you spend quite a bit of time getting the history of the patient which doctors never have time for that your pharmacist does. Anyway, once you get that, what’s the next step?

Dr. Sharzad Green, PharmD  16:20  

The next step is basically I meet with the patient talk to them, I go over their past medical history, their family history, risk factors for developing different disease, their symptoms, their blood work. I talked to them about hormonal and non hormonal ways to help improve their symptoms that may include lifestyle modifications, it may include supplements, I do, go over their supplements, make sure that they’re taking the right things that are needed. For example, a postmenopausal woman may be at higher risk for developing bone loss and break your bone osteoporosis, right. So we want to make sure that they’re taking the calcium, magnesium, vitamin D, etc. So once I do that, then I’ll make a final recommendation to the prescriber and let them know what I’m exactly recommending and wait to hear from them. Once the prescriber approves these prescriptions, then a compounding pharmacy makes those again individualized, compounded medications and their dispense they’re given to the patient and the patient starts on hormone therapy.

Marilena Grittani, RPh  17:34  

So basically, it is custom made for the patient. Okay, so that is like going back to the seamstress example, when you get the dress that she had pins all over it, and is cut the way that it’s supposed to be to put it on you. And then she’s like, Oh, hold on this too tight here, too loose here. You need it. or You want it shorter, because you want to show it a little bit of legs. So is that tailoring part of the process of what you do with the hormone therapy for this patient on BioIdenticals.

Dr. Sharzad Green, PharmD  18:06  

Yes. And that’s why it’s important to actually have a thorough evaluation of the patient, I cannot just give everybody the same thing. It all depends on what we’re dealing with what symptoms, what risk factors, somebody who’s had a family history of osteoporosis does not necessarily get the same thing as somebody who’s having trouble mainly with sleep issues. So everybody’s different. And you have to evaluate that.

Marilena Grittani, RPh  18:35  

When the patient comes back to you, you follow up with them, right when you ask questions, and they tell you things that are relevant, and stuff that they don’t even think about is relevant to the drug. So or the hormone in this case, you’re absolutely

Dr. Sharzad Green, PharmD  18:50  

Right, because there are times that women think that oh, well, this is how it’s supposed to be or my mom went through it the same way or No; my neighbor didn’t have any symptoms. So maybe I’m just kind of a hypochondriac and thinking that there’s something, you know, wrong, where where it’s not. So it’s very interesting because when I talked to the patients I explained, for example, this is something very common that happens. Women who experienced vaginal dryness because their hormone levels have dropped, oftentimes end up having bladder problems, such as leak, Urinary tract infections. Yeah. So things that are related to the bladder, they constantly have to go to the bathroom. And oftentimes, once we address the vaginal dryness, it may help the bladder function. So very interesting because sometimes people don’t connect these two together. And I don’t expect people to do so because they’re not trained in that area. But once we we do take care of one issue on Oftentimes, a lot of other issues can be addressed and hopefully improve. So yes, during the follow up, phone call or meeting, I usually ask them specifically about improvements in certain areas also about side effects because everybody’s different and some people are more sensitive than others. So something that may be right for your sister may not be right for you, and those that’s good for her may be too much for you or too little for you. So it’s really important to do that follow up and make sure that you are on the right track. And then a few months later, and maybe check your levels, your hormone levels to either a blood test or saliva test and see where things are before we proceed.

Marilena Grittani, RPh  20:45  

And there is a possibility that you have to adjust them, right just like a seamstress, you know, you have to be open to that. For example, if you make a dress and it’s it fits perfect. But then a couple months later, the person has lost 10 pounds due to whatever reason. 

Dr. Sharzad Green, PharmD 

All right, so anyway, it doesn’t fit anymore. So you bring that to my attention, then and say, You know what, this is what happened to me then I have to adjust that for you to make you feel your best. 

Marilena Grittani, RPh

I did not go to a pharmacist like you. I did not have a BioIdentical specialist like you. Actually honestly, I didn’t even know that was such a thing. So thank you for teaching us that. When you go to a seamstress that tries the dress that she thinks that that’s what it is, but they have some wiggle room to make it more tight if that’s what you want, or more or more. The reason why I went to see the doctor is because I had a lot of fatigue. I felt that I didn’t have the energy to go anywhere. I didn’t want to go to work. I was sad and I didn’t want to do anything and; in my mind was going to that Stupid place that we all females go that is like, “well, I’m getting old, I’m useless. So whatever this is what life is.” And no, it’s not that is not what it is I was barely 44. So at that age, you are way more productive and you still have a lot of energy and you just have a dysfunction on your hormones and that could be repaired, not only repair but substituted by something, something very close to what you do; which is the BioIdentical, 

So please don’t let yourself go find somebody good like Sharzad and tell them hey, girl, this is what’s happening. Fix me. And she would do that right? 

Dr. Sharzad Green

Sure. Sure.

Marilena Grittani, RPh  23:00  

Thank you for being a pharmacist that dedicated your professional life to fix this kind of issues and patients that absolutely need it and I hope and I wish and I ask our listeners to share this information with people to my needed because a pill does not fix everything. At least not to everybody.

Dr. Sharzad Green, PharmD  23:02  

That’s right. That’s right. And I appreciate the opportunity that my patients have given me over the past 20 years, I’ve probably done close to 20,001 on one consultations with patients.

Is been fantastic, because from every one of them, I tend tend to learn one more thing, and I appreciate it so much that I have the opportunity to work with you.

Marilena Grittani, RPh  23:30  

Excellent! So let’s just do a rapid fire questions and I just want quick answers. 

So what’s the benefit that you will bring to a patient that they would not get if they go from a doctor directly to the pharmacy, 

Dr. Sharzad Green, PharmD 23:45  

Individualized medicine, improved quality of life

Marilena Grittani, RPh  23:47  

So how do you help the doctors then?

Dr. Sharzad Green, PharmD I give them the opportunity to send patients to me because the doctors number one may not have the time to spend with these patients. Number two, they may not have you expertise, even though they are experts in many different areas, this may not be their expertise.

Marilena Grittani, RPh  24:06  

Because everybody’s an expert in their area, and she’s an expert on hormones. So if you have hormone issues, you go to a hormone specialist. That is not the doctor, or the endocrinologist that diagnosis and prescribed.  It is the person that monitors that understands exactly based on the power and strength of this drugs or hormone replacement, what you need and then monitors and make sure you’re right. So this is a joint venture between what is it that you call it a triangle…

Dr. Sharzad Green, PharmD  24:38  

A triangle relationship between the patient, the prescriber and myself or whoever the pharmacist is this does this.

Marilena Grittani, RPh  24:47  

Okay, hold on. You said myself? So, can we go to you? but you hold on ,you are in Arizona!. How about, if I live in Florida? what do I do?

Dr. Sharzad Green, PharmD  24:58  

Will fortunately There’s many different ways. In fact, I do this for patients across the country and I even have a couple of patients out of the US. So fortunately, because of zoom and other ways that we could do video conferencing and meeting, it’s made it so easy that it’s as if we’re sitting in the same room.

Marilena Grittani, RPh  25:24  

So if I am in Florida, or somewhere in the north, that they’re going away from the cold (which I don’t blame them because in Arizona here, beautiful today’s beautiful By the way), it doesn’t matter geographically where they are

Dr. Sharzad Green, PharmD  25:37  

Not at all, not at all. I in fact, I encourage you to work with your doctor. So I usually try to introduce myself to your doctor. I’m open to teaching them about the basics of what I do and ask her any questions once you help them. Have to purchase the medication from you or how did they do it? I don’t sell any pain medications. They get it from a compounding pharmacy of their choosing.

Marilena Grittani, RPh  26:11  

Yes, it is important to note the law is very specific in every state and you are not to sell drugs from (any type of drugs including compounding) from one state to the other, unless you’re licensed to do so. Alright, so let’s say that you are a snowbirds or a winter travelers, you know this for a fact. So if you have pharmacy that you normally go to they cannot ship it to Florida because that is not or Texas or Arizona. They cannot ship it here because that would be against the law, which means that they cannot serve patients that live in another geographical area. It has to be within their state. So but you can do directly in the state where they live, whether it’s Florida, whatever state they lived, you can just get the doctor can get in touch with their pharmacies and then they can get their medications.

Dr. Sharzad Green, PharmD  27:10  

I can help my patients locate a compounding pharmacy near where they live.

Marilena Grittani, RPh  27:15  

Would you work directly with the pharmacy to clarify any issues and any complications that the patient might have?

Dr. Sharzad Green, PharmD  27:21  

Yes, yes, I do. That’s part of what I do because most compounding pharmacies do not have the extensive service that I provide. They all may have some knowledge of hormones, and of course, they do a fantastic job of compounding things. If you have somebody in the kitchen following your recipe. They don’t need to know how that recipe came about. But you do need the brains for making that recipe to tell you exactly what to put in it and that’s me. So I come up with the recipe, and then they can actually make it for you in their lap.

Marilena Grittani, RPh  27:56  

Any changes that are required like me, that I’m peaky When I start using my cream, it was too much and I had to spread it all over my legs and my arms.I just needed more concentrated so you can work directly to the pharmacy to say this is how we’re going to change the formula and the patient can use a lower amount. 

Dr. Sharzad Green, PharmD 

Absolutely. 

Marilena Grittani, RPh Okay, this is the question of the 50,000 penny. Is this covered by the insurance, like Medicare or other insurances? 

Dr. Sharzad Green, PharmD 

My consultation is not, I do not bill insurance for my consultation. Now, as far as prescriptions are concerned, if you go to a pharmacy where they accept insurance, they may be able to build insurance for you. That does not mean that your prescriptions will be covered because a lot of insurance companies do not cover compounded hormones or they put it at a higher level where your copay is higher than the cost if you were to, you know, pay out of pocket for it. But that’s up to that pharmacy, but for my consultation services, I don’t bill insurance in this case. 

Marilena Grittani, RPh 

It is none sense my opinion. I’m not saying that this is Sharzad’s opinion, but it’s personally Marilena’s opinion. I don’t understand why insurance companies don’t cover this, because she is making sure that you don’t have complications. That it is not causing a problem. She’s making sure you’re getting exactly the drug and, and the little concentrations that you need specifically for you. So it would prevent other consequences. So if I was an insurance company, I would say this is the route that I want you to go because this will guarantee me that you’re not going to end up in the hospital, and then I have to pay for a heart attack or cancer for any other from taking a pill. That is what normally they would pay for it. So even though it sounds to be cheaper, paying for a pill at the long run is not and to be honest, as a patient, I would prefer to pay a little bit more if I’m capable to do so. But protect my health and that long run, rather than just say, well that’s what the insurance pay and they run my life. I’m going to take the pill. And then if I don’t know that I have propensity to develop cancer or any cardiac or heart problems, or if I’m adopted, and I don’t know what my family had before…

Dr. Sharzad Green, PharmD Right, right. 

Marilena Grittani, RPh 

And I don’t want to take that risk. If you put in a balance, what would be better for you to invest a little bit more money on your health, taking care of it with somebody that would tailor it for you, or you would go with whatever the insurance company that wants to tell you what to do? And then maybe, hopefully not, but maybe have negative consequences. That is your choice. But my mission was this podcast with this information is for you to know the options that are out there for you to learn what experts are that pharmacists are open in this country, in and all over the world actually, to help patient specific situations where they are experts. We’re not saying that every pharmacist knows everything. That is not what we’re saying. Because like, I was an oncology pharmacist, And that’s what I did. And if you ask ed me about BioIdenticals, I will be like… Call Sharzad!

Dr. Sharzad Green, PharmD  31:08  

Right. And I would contact you or refer patients to you. If I had oncology patients. You’re absolutely right. It is so vast the knowledge is one person’s ability to know it all. It’s just like positions. There’s a doctor for your foot. There’s a doctor for your eyes, you know, a doctor for your ear, nose and throat. So it’s the same thing with pharmacists.

Marilena Grittani, RPh  31:31  

Yeah, and when you go to the primary care physician or primary care practitioner, they said well, do you have something in your heart go see the cardiologist. Because this is the same thing and they should be more responsible saying this is beyond my capability. Go see an expert, and that’s what it should be. But it doesn’t necessarily happen because, well maybe they don’t want you to look weak in front of you. Maybe they are not comfortable saying something like that because they will put themselves in the lower level of expertise; which is normal, because you know what, you know, and that’s it. Or it, they would prefer to have the patient for themselves and they don’t want them to pay anybody else. But, but that’s a choice that you make. If you’re practitioners like that, and you’re happy with that, fine!. But how many times have we heard “Oh, but my doctor said that I was okay, how come I have this?” Well, because that doctor didn’t know about that Hello! You need to go to the expert. So just keep that in mind.

Dr. Sharzad Green, PharmD  32:24  

Just another thing that I was going to add is that, part of what I do may not even include prescription hormones. So it all depends on the particular patient, or it may involve some over the counter product. I’m not a hormone pusher per se!. I always evaluate my patients. And one of the main things that I think my patients appreciate about me is that I’m very honest, and I tell you if you need something, but I will also tell you if you don’t need and what else can be done to help your symptoms is this really Your hormones are not? Or do we need to refer you out to somebody who is an expert in that particular area because even though you may think it’s related to hormones, it may not be

Marilena Grittani, RPh  33:11  

And then give them alternatives and the patient is the one to decide exactly, you will recommend something. And then second place this or third place this, but the patient go wherever they want to go, whether it’s a cost, or if it’s just their preferences. That’s awesome!.

Okay, so let’s say that my friend, because it’s not me… that my friend is having libido issues, and she knows that she’s going through that menopause thing, the change of life. So, she might want to talk to somebody like you, what do I tell my friend to do to contact you? It’s not me! Is a friend… I’m asking for a friend.

Dr. Sharzad Green, PharmD  33:47  

The best way to contact me is email. You can email me at Dr.SgreenRX@Outlook.com.

Marilena Grittani, RPh  33:57  

So I’m gonna put this in the notes here. Just have to go there and copy and email her directly. So all this information will be there. And then after the email you get in touch you can call you can do video, you can do look this beautiful background that you have right here for me. Thank you for that !Perfect. Okay, that’s awesome. And if you have issues contacting Sharzad, contact me directly at comments@thelegaldrugdealer.com and I’ll be happy to guide you or send it to her and then she will go directly.

Anything else that you want to add about bioidenticals before we go to the fun part of this?

Dr. Sharzad Green, PharmD  34:34  

I just want everybody to know that we don’t always stay young. But that does not mean that we should sacrifice the quality of our lives. So pay attention to your body. Take good care of your body nutrition, exercise. We hear about it all day long, but really take it to heart. Take good care of your body. You only have one!

Marilena Grittani, RPh  34:56  

You can’t buy another one at the store. I feel like I’m 22 still but, I am almost 50!. So there you go. So what matters, it’s not just what you feel like you are is what you actually are. Okay? 

So I want to change the tone of our conversation. Now I want you to be a pharmacist, not the BioIdentical or the hormone specialist that you are, I want you to go back to the pharmacist, what I call the legal drug dealer to your own. 

So, why don’t you tell me something that you think that most patients don’t know about what we do as pharmacists,

Dr. Sharzad Green, PharmD  35:30  

I know for a fact that standing on the other side of the counter as a patient, viewing inside the pharmacy, their jobs look really easy, and it’s as if they’re not really stressed, but you have to remember on the other side of the counter, there’s a lot more going on. In addition to interacting with the patients at the counter. They have to interact with the prescribers they have to interact with the staff. They have to catch drug interactions, they have to catch duplicate prescribing habits that sometimes happen. So there’s a lot more and on top of that they have to deal with insurance companies. Absolutely. Oh, yeah. is so difficult. So please, please be patient with your local pharmacist. It’s not easy to be in their shoes. And they have to stand up on their feet for like eight hours or 12 hours at a time.

Marilena Grittani, RPh  36:27  

Yes. And I did it for 14 hours too. So yes, ma’am. Amen to that. 

Okay. Next question. Tell me what is the most disrespectful thing that a patient has ever said to you?

Dr. Sharzad Green, PharmD  36:41  

Well, this was not a patient, but in particular, a person came. Our printer was down at the pharmacy and a patient came to the counter and there was an older gentleman fixing the printer. And this woman, the patient insisted on talking to the man, even though I was the pharmacist in charge, but the because I was a woman that insisted on talking to the man, finally, one of our technicians, told the patient, “if you want to talk to someone about medications, you need to talk to Sharzad, because she’s the pharmacist, the gentleman who’s here is here to fix the printer”. So oftentimes, I think specifically as female pharmacist, and if you’re younger, this happened to me when I was younger, it takes a while for patients to actually trust you and that is hard. But for those young pharmacists out there, I always tell them, it takes time to earn respect, and it will it will happen 

Marilena Grittani, RPh  37:49  

Side note: Right now the statistics are that 55% of the pharmacies that are practicing today are female. The interesting part is that today the percentage of people that are in pharmacy school to graduate as pharmacists in the next three years, add up to 74% female so it is a profession that is going towards females. More than male and we on this we’re girls and we own this better respect is because guess who we are the drug experts, they’ll come to us and we will help you and respect. Okay!

Next question, what is the funniest lie that you have heard from a patient trying to get a control medication earlier? Like they “need” their Norco four days before the date that they are supposed to get it.

Tell me what them to the funny one.

Dr. Sharzad Green, PharmD  38:28  

It was actually a young mom and she claimed that her kids poured the bottle over each other’s head, the bottle of the narcotic syrup. It was like a cough syrup and poured it over each other’s heads and that’s how she lost that. But we caught up on that because before that a couple of days before that she had claimed that her bottle was sitting right next to the toilet and somehow got knocked over and everything poured into the toilet. So we had an idea that she was not exactly truthful.

Marilena Grittani 39:04  

Now, as I said before, we have heard it all!

So when you think about this idea that “Oh, they will believe me, because they’ve never heard this before” most likely we have, because that’s what we do every day. So be honest, tell us the truth. And don’t try to trick us because we will not let you, one. And two, there is so many tools that we have now, that we must follow by law that tells us the exact drug you have gotten, how many days you have, which prescriber you went to what pharmacist you go to. So sorry, it’s all out there.

Dr. Sharzad Green, PharmD  39:42  

A national database. 

Marilena Grittani, RPh 

And it’s by law, that we have to use it. So there you go. 

Okay, to close this episode, that it’s been a delight and very informative and fun. And I love having to use your set to be outside this thing. Thank you, thank you. 

What is something that you want to remind our listeners about us pharmacists?

Dr. Sharzad Green, PharmD

That we are humans, that we feel how you feel behind that white coat, that we’re wearing or behind that counter that we’re standing, be seeing us do what we’re doing. We’re actually humans, and we do care, we might have experienced some of what you’re experiencing. So don’t assume that we don’t know what you’re going through. There’s more care to what we do than counting and pouring, licking and sticking.

Marilena Grittani, RPh  40:34  

Thank you for that! 

Well, thank you so much. Sharzad green for coming. Dr. Sharzad. Green pharmacist specialized in hormonal replacement, with specifically BioIdentical, it was a pleasure talking to you. 

This was a fun episode!

Now, I have to make a disclaimer. And I hope you give me a little leeway here. This was my very first episode. That I recorded. Yes is episode number seven!. But it was the very first one that I recorded. And actually, I Re-recorded it because the first one was even worse. I was not the best host. I interrupted her. I talk over her, I talked too much. I am so sorry. I was so simply excited and wanting to communicate to you everything that was in my head that I could not control myself. So, my deepest apologies for that. And kudos to Sharzad for putting up with me for that long! Poor thing. She wanted to talk so many times, and I didn’t let her sorry Sharzad Green, you are a saint. 

Anyways, besides that, I wanted to clarify why Sharzad does not bill insurances. And this is something that is very close to my heart because I think it’s very unfair. So they way it is, is that in order to bill insurances  or to bill to Medicare or Medicare, you must be, what the law calls a “provider”, which is a clinical service that is defined by law as an individual that can go ahead and perform a service to a patient in this case, and then based on the legality and the registration that this person has with this entities, they will be able to bill. 

Well, guess what pharmacist by law are not providers, but physical therapists are!, nutritionists are!, but we’re not. That is absolutely unfair in my book, because we have so much clinical information to give to patients. We are so key in keeping patients out of the hospital and helping patients to improve their quality of life and the benefits of drugs. That doesn’t make any sense that we are not providers. 

And this is not something that happens only in Arizona where I live. This is almost everywhere, almost everywhere, with a few exceptions like Tennessee. Tennessee, I’m very proud of your state for supporting your pharmacist and supporting your community and, at the end of the day because you are supporting your patients, the ones that need our services. 

So, yeah, that’s why she said that. She does not bill insurances, because she’s lazy, or because she thinks she’s special, or because she doesn’t want to do it, or she just wants to cash. That is not the reason. It is because she is not allowed by law to bill insurances. 

So if you have the chance to talk to any legislators or any representatives or any senators, just talk about this! Ask them why they won’t support this. It does not make any sense, at least to me, and yes, I’m biased, but come on, after allI have said to you, about it you should be more knowledgeable about this. 

And if you happen to be a legislator, Senator, please get to this. It’s not only that is fair, but also we have a ton of pharmacists that are unemployed, because there is not enough jobs!. So, if you allow us to be providers, they would have their own practices, and they will have their own patients and they will stimulate the economy of the country. One. Two, they will benefit a ton of patients that are out there needing our services. And three, that would be another way for the future of pharmacy as a profession and the new graduates that are coming out of school in the coming years. 

So please give us a hand. You are responsible for our profession’s future. So give us a hand be fair. 

I don’t care. Seriously, I don’t, if you are voting against a Democrat or a Republican that is sponsoring this bill, that shouldn’t be why you support it. Not this bill. I know politics are “dirty” and that’s the way that it works. 

But pick another law. Don’t damage a whole profession, a bunch of people that are unemployed, or the patients that are needing these services. Be kind. Listen to Ellen DeGeneres. Be kind!

Okay, enough with that rant I’m sorry!

So that’s it for this episode. Thank you so much for listening. And please don’t forget to subscribe to the podcast. Give us a review. And if you have a question, send them to me at comment at the legal drug dealer calm and I will respond to you directly or I will include it in my solo episodes where I would answer all your questions. 

Also, visit thelegaldrugdealer.com look around, to see what I have there for you. Lots of stuff by the way! 

Follow us on Instagram and join our private Facebook group community and subscribe to our mailing list so you will not miss a detail. 

I will talk to you next week, about pre diabetes with Dr. Theresa Morrow. She is very passionate about this. She has a personal reason to be passionate about it. And she is so down-to-earth! She has so many good details that you want to hear about that you should not miss it. 

I am done, for today!

But before I go, and just in case no one has told you today, I wanted to take a second to remind you, of how awesome you are. And how lucky are those that have you in their lives. Thank you for being the awesome you that you are. 

Have a wonderful rest of your day. 

This is Marilena Grittani ~ The Legal Drug Dealer

Bye for now!

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