Taking Healthcare by Storm: Industry Insights with Nicholas Lombardo

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Nicholas Lombardo, PharmD, clinical pharmacist and owner of The Gear Box Gym.

Nicholas describes how his interests in chemistry and patient care led him from planned retail pharmacy to inpatient clinical work, emphasizing the value of pharmacists on hospital rounds for proactive medication optimization, infectious disease stewardship, and chronic disease management in areas like diabetes and heart failure. He also explains how COVID-era remote education weakened experiential training, outlines why strength training and muscle mass are foundational for longevity and independence, and shares plans to scale The Gear Box Gym while envisioning expanded pharmacist roles in prevention and emerging personalized approaches.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

The views and opinions expressed by the host and guests are their own and do not necessarily reflect the views, positions, or policies of Quality Insights. Publication number QI-031226-GK

Transcript

 Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director at Quality Insights, and we're having a unique conversation today. I am excited to welcome Nicholas Lombardo of pharmacist whose work sits at the powerful intersection of medicine.

Movement and prevention. Nick brings a unique dual perspective to healthcare serving patients in the clinical setting, while also owning and operating the Gearbox Gym, a strength focused gym built around long-term health, resilience and performance. As a pharm d Nick understands firsthand the critical role pharmacists play on hospital rounds in infectious disease management.

In supporting patients with chronic conditions. At the same time, his work outside the hospital reflects a broader vision of health, one that recognizes strength training and physical capacity as foundational to preventing disease, improving quality of life. And keeping people independent as they get older.

So we're gonna be exploring how Nick came to combine these two worlds with the COVID pandemic changed in pharmacy education and practice. It's something we really don't wanna talk about anymore. I maybe don't wanna talk about it anymore, but I think we can learn powerful lessons. Why he believes strength training is essential healthcare and where he sees both the gearbox Jim and the future of pharmacy headed over the next five years.

I'm excited because this is a conversation about redefining what healthcare can look like. So we're gonna be talking about what healthcare can look like inside the hospital, inside the gym, and everywhere in between.

Nick, thank you so much for joining us today. Course, I'm super happy to be here. Thank you for having me. So you, as I said in the intro, you're a pharmacist and you're gym owner, which is super unique, and these two worlds don't always connect. How did your journey into pharmacy begin and what moments shaped the way you practice today?

So my road into pharmacy isn't particularly one that is just anything out of the ordinary per se. When I was younger in high school, I was always super interested in chemistry and I remember thinking about, you know, I had a headache one day, I was taking some ibuprofen. And I'm like sitting there thinking, well, how does this drug know where to go, know what to do?

How does this alleviate my symptoms? And I also had a very high interest in chemistry at the time. From there, I was like, well, I know that I wanna do something in the medical field. Do I want to go through medical school? Do I wanna do pharmacy? I wasn't exactly sure. So I started working at my local pharmacy and just to try to get some experience moving forward through undergrad, and I decided I would kind of go that route.

I wanted to help people and I wanted to try to merge that passion for science and chemistry with. Helping individuals. So that was kind of the path that I went down. Funny enough, I actually was planning to do retail pharmacy until I got through the majority of my didactic schooling in pharmacy. And then on my first clinical, rotation, which is the advanced practice rotation in your final year, I started to realize that I had a much more, passion for.

Doing clinical work, hands-on stuff, inpatient care, and I kind of excelled in that area and I just could never look back to doing retail pharmacy again. Not to say that that's not important because it is. Everybody has their role. Moving into clinical pharmacy and working, um, firsthand with physicians and patients was just kind of the way that I wanted to go, what I was good at and what I enjoyed doing.

Yeah, I met Nick during my time when I was rounding in the hospital and he was present on hospital rounds. So we would walk together with the whole team and seeing patients. So from your experience, why is having a pharmacist present, physically present on hospital rounds so critical to patient safety and clinical decision making?

I think that there's a couple different reasons  and a couple different areas in which this is important. I think the most primary thing is with a lot of drug therapy, and the, and the way that pharmacy typically is, is the orders get entered. They get verified if there's an issue that's called about, but sometimes those.

Issues aren't very present. They're not very obvious. It's not a clear contraindication or duplication or whatever it is that the, the pharmacist is checking. But there are some more nuances with the patient's clinical condition, seeing how they are, what they're actually able to do, what the overall goal is with the care team.

And I feel that being present on rounds, being with the physicians. Allows you to be a bit more proactive rather than being reactive. So as you're discussing the goals of care, what's going on with the patient, maybe, you know, the nurse just said something, you're able to make a informed decision, to kind of provide the best care for the patient possible.

Instead of waiting, maybe that person gets a medication that isn't the best for them. They get a dose and then a day or two later we look back and it says, Hey, maybe we could have done something to augment or make this. Therapy better, but I feel that being present is able to. It puts us in a unique position where we're able to prevent those errors or  maybe just suboptimal medication choices from actually reaching the patient.

And then I also think that the way that a lot of medicine is going and a lot of the way that clinical pharmacists are being utilized, we need to be able to function at a level very similar to physicians within our realm, within the realm of pharmacology. So I think that there's a lot of respect to be gained.

 Just by, you know, working with you guys as physicians and you're able to start to develop rapport with us, develop trust in some of our recommendations, and the same thing goes in the other direction. I think it's just a unique location to be in where everybody can kind of work together. And I do think that laying eyes on the patient and seeing the patient and doing all those things is extremely important in making the proper decisions, both from a physical care aspect, but also choices.

A hundred percent. I think it's so valuable. And you know what, how I see, think right now, infectious disease issues are huge  in the hospital setting. Especially, I mean, I'm primarily based in the nursing home setting, but in, and obviously they're. Very pressing infectious disease issue there too. But what do you see as the most pressing issue in infectious disease in the hospital setting, and how can pharmacists help address it in real time?

I think the most pressing issue in the hospital setting is very similar to that outside, and I think it's this, this ever growing. A microbial resistance that comes with whether it's inappropriate broad spectrum therapy or appropriate broad spectrum therapy that just lasts too long and it's, it's super easy to, you know, get a sick patient, start them on Vancomycin and Zosyn, whatever broad spectrum coverage we feel is adequate for the scenario.

And then just continue to leave them on that day after day. Now, I'm not advocating for early discontinuation in a scenario that would be deleterious to the patient, but sometimes, you know, we get M-R-S-A-P-C-R results and culture results, and we are able to make informed decisions to narrow therapy to allow the patient to heal and get the care that they need, but also pull back on the risks that incur between c diff kidney injuries.

And then, like I said, antimicrobial resistance. So. I think that with, um, whether it's a dedicated infectious disease pharmacist or most inpatient medicine pharmacists are pretty well versed in antibiotics and, serve a very important stewardship role. I think that helps to pull back on that primary issue there of just whether it's inappropriate prescribing to begin with.

and when I say that, I mean maybe a suboptimal choice or helping to narrow therapy, optimize dosing based on PKPD, organ function, what have you, and also prevent double coverage of like prolonged empiric therapy. So I. I think all those things together not only reduces the risk of, hey, these drugs aren't going to work anymore in the future, and start developing these super bugs, but also reducing any, uh, adverse effects.

And kind of plague our patients from just kinda riding these things out too long because it gets really easy, especially when you've got some sick people to just continue, continue, continue. Because, you know, it started working and they started showing a response. The white count's coming down, their fever's gone, but we're killing every single bug under the sun.

I mean, antibiotics are not without harm.  Yeah. Huge. And, and not only in the hospital, I mean the nursing home, I feel like they're also like, it's a huge overuse problem. Most definitely. And UTIs to be a very common one. Yeah. So  I wanna talk a little bit about chronic disease. You know, with the big  Maha push currently, and I, I really do think pharmacists are underutilized in chronic disease care.

So, where do you think pharmacists can have the biggest impact in managing chronic long-term conditions? I think there's a, a select hand few of conditions that lend themselves to be managed by. Very, very well, and a lot of healthcare systems are actually utilizing this and moving pharmacists into mid-level positions for things such as heart failure, diabetes, a lot of these cardiometabolic conditions that are particularly difficult to treat.

They're nuanced a bit, but they're. Straightforward enough where we're able to really utilize that evidence-based medicine to kind of guide treatment there. And that's kind of the bread and butter for a lot of these clinics. And what it does is it puts us in a unique position where we're able to focus on the pharmacology, make sure that we're able to titrate dosing to wherever it needs to be, and get really nerdy with all the drug information and allow you guys as physicians to kind of take on the more.

Acute issues when they arise and kind of pull some of that, I don't want to call it paperwork or just busy work 'cause it's not, it's care, but it is very time consuming and allow you to kind of focus on things that need more of your attention. So I feel like that's a very interesting location. And then as things progress as we start to.

Move into a more like preventative based medicine. I feel that's where a lot of society is hopefully going to not wait till something occurs, maybe let's prevent it from occurring. We can kind of be put in these unique positions to not only look at drug therapy, but also maybe nutrition and exercise, and I'm sure we'll talk about this very soon, but kind of help to manage these conditions and prevent them before they're even showing up.

Yeah, absolutely. And then you don't need all these interventions. Right. I just wanna cover one last thing around like the pharmacy side of things. Mm-hmm. And I said in the intro, I was gonna talk about the COVID pandemic because I still think we really haven't learned. All, all what we should probably  have learned and, you know, should continue to learn.

So how did the, COVID pandemic change pharmacy education and training, and what lasting effects, positive or negative are you still seeing today? So it's kind of a double-edged sword.  I feel I'm sure a lot of people feel this way, but I tend to lean on the more negative side, unfortunately for the way that this all impacted things in education.

On the positive side, I do feel that we did pivot and utilize technology and telemedicine and all these types of things to help continue care. And there are some scenarios where that's more than adequate, but I feel, yeah. In the vast majority of cases, I'm very old school in the sense that I believe you need to, you know, see patients and be at the bedside, physically be in somebody's presence because there's something that you get from being present that you can't get through a screen.

It's hard to describe, but I feel that most clinicians and physicians, would, uh, basically agree with me, but with regards to training, I felt that we got people out of the lecture halls and in some scenarios that's fine. There are some lectures and stuff that really just, you can kind of teach yourself.

But I think the biggest thing was the experiential learning for me was, uh, not being able to have students in the same scenarios that you typically would, at least for an extended period of time. And I feel that this isn't the case for everybody because there's obviously outliers, but I feel that  the knowledge base that I was used to having students have when they came on rotation with me just wasn't there anymore.

And I feel that it's because the, um. The accountability was kind of gone in a way, and moving to remote testing and just, you know, remote lectures where nobody was required to be present. You didn't have to have your screen on. I just think it kind of let people put things by the wayside, unfortunately, which isn't a good thing.

But, um, I don't know. Would you concur with med students and all that kind of stuff, or? Yeah, I'll just say, I mean, I've done a, a bunch of podcasts with some individuals who are working with high school athletes. Mm-hmm. So I think something happened  and I don't know really, and yeah, I will say, I think I also lean negative.

I think that. Something was lost in that kind of getting people out of the classroom, getting people, like everybody was at home and they were learning through a screen, you know, med student, students, pharmacy students, high school students. So, yeah  I would agree. And, and maybe, maybe the, the, the good part is.

I've heard that there's a movement to like, going back to old school, like really? Mm-hmm. Getting back into book learning and writing. Yeah. Like physical pen and paper, you know? Mm-hmm. Maybe that's better. I mean, there's something about just those analog, uh, ways of doing things that I feel just, you know, has a much higher rate of return and people will memorize things and learn things better.

When you're in person, you're writing things down. More than just like, you know, convincing yourself that you're learning something because you read it and typed it. It's, I, maybe I'm just super old school. That's how I've always, I've always, um, helped to retain information, but I do feel that the caliber and the knowledge base is just not there.

And usually they're able to get up to speed quickly. And I don't mean to be a negative Nancy, but it's just, yeah, it's different.  Yeah, I totally agree. Yeah, most definitely. So now I wanna shift and talk about your gym, which I have seen, and I, it's really a unique gym and, um, like I said, you're in a unique position because  of what you do, so.

Mm-hmm. What inspired you to open the gearbox gym and how did your background in healthcare influence the culture and mission you wanted to create there? Yeah, so it was a few different things.  I've always had a passion for weightlifting and training, uh, ever since I, you know, got into college. I think that's really when that all started to, um, really resonate with me.

So it just over time that passion grew and grew and I became much more in depth with it. And it teaches you a lot about yourself voluntarily putting yourself through some excruciating. Periods is, is just, uh, something that's unique and I feel that it kind of, translates to a lot of different things, whether it's work, schooling, having that discipline to go and train hard definitely carries over into other aspects of life.

And one unique thing about this form of training and if bodybuilding, if you will. And I don't mean being, becoming a Mr. Olympia or doing whatever, everybody can kind of do it to their own intensity, but it makes you realize the importance of recovery and food and nutrition and, you know, appropriate supplementation.

All these little things that in a society today where there's a McDonald's in every single corner, all of the food is processed. It really makes you realize what you're putting in your body, how you feel when you do certain things. It's one of those things that you never really have. A day off.

Like if you're playing a sport, you go to practice for two hours and come home. But when you're, when you're doing this and this turns into a lifestyle, it's, it's 24 7, you're eating lunch, you're hydrating, you're doing whatever, it never really shuts off and it turns into the gym being the easy part. So that became  something that I.

Aim to know and love and have you, as you see your body transform and just everyday life gets easier, you get stronger, you get less fatigued, your injury risk goes down. It's overall just a very rewarding sensation. And um, as I became more and more passionate about it, I was like, wow, I would really love to like design my own gym or have a say in the way that a gym operates.

And I've would go around all the time to all the different local gyms and gyms when I would travel and I just turned into a little. Snob about equipment and like I'm remotely OCD. So I, I think that being able to design all of these things would really be really interesting to me.  And then as I got into healthcare and started seeing patients and stuff, I would spend every single day just like seeing people at their worst, like all of these disease states that we talk about and we talk about prevention.

You see the worst of it inpatient, especially with diabetes and heart failure and, and just seeing that day in and day out makes you realize the importance of prevention. And unfortunately, like I don't have a, I think the statistic is anecdotal for sure, but I feel like 90 to 95% of patients that we see, it's unfortunately self-induced disease.

It is a lifetime of bad decisions, whether they were intentional or they didn't have the education or the motivation to. Kind of change things. It just, it put them in that position, and that really just made me understand the importance of staying healthy, becoming healthy. I. It just kind of merged well with the gym and then I was fortunately in a position where I was able to kind of, you know, take a risk and open up a little private training facility, and I just felt that the ability to help others and build a network and build a culture of people that want better themselves, that will help each other would be very unique and rewarding.

So I just kind of pulled the trigger and luckily it worked out and things are going great. Yeah. And, and I'm just gonna say like, it's a, I said I've seen it and the primary focus of the gym, I mean, there are, there are some, cardio equipment, but I think the primary focus of the gym is in strength training.

So you're a huge advocate for strength training? Yes. Why do you believe it's so essential? Because like the, the traditional thinking is right, like walking and like getting mm-hmm.  Cardiovascular  exercise. But why do you think strength training is so essential? Not just for fitness, but for long-term health and disease prevention?

Yeah, for all of that stuff, I feel the data is pretty clear and more and more of it starts to come out. And I believe you lectured on this, maybe a year or two ago when you, we were still working together, but there's very clear evidence that correlates muscle mass with, uh. For example, reducing the risk of fracture and just longevity.

So your muscles, uh, it's not just for picking things up, it's not just for looking strong, but it's a very, very metabolically active part of our body with you. Think about glucose. Usability and the way that it's metabolized and the risk of injury and the risk of fracture as we age. Your muscle mass is directly correlated with your likelihood to survive as you age.

So if there's one thing that you can kind of hold onto as we get older and older, it is your amount of lean tissue and as balance starts to shift into having an excessive amount of adipose tissue. We start to see outcomes and quality of life and everything just kind of reduce. So it's not just aesthetics, it's not just being able to pick up heavy things.

I think that there's a direct correlation with your ability to carry out everyday tasks, protect yourself, both physically, but also against time. That's just something that we are all, unfortunately going to lose the battle with at some point. I would try to make that as long of a. Also, that's kind of the, the reason why I advocate that so much.

I have a couple trainers at the gym and we have plenty of elderly clients and just the anecdotal stories of where they were and where they are now and how they. Feel with their energy and their body composition and just being able to continue on doing basically everyday things that we totally neglect to think about now.

But when you're older and you're trying to go get groceries or do whatever, it's just, I can't imagine these small things becoming so difficult, and I see it every day where people can't take care of themselves. So I feel that retaining this tissue as long as possible is very beneficial to your wellbeing.

There is plenty of evidence that actually supports my claim. I'm not just making this up. If you're interested, certainly read into that, but I think that. Super, super important. Cardiovascular fitness is obviously important too. I'm not saying don't, don't do any cardio, but you should 100% be implementing strength training into whatever fitness program you're doing.

You would be foolish not to. Yeah, I did lecture. I, I love the topic of sarcopenia and you know, mild kinds that I think most people roll their eyes. Mykines are those hormone, those substances that are secreted by the muscle when you have a contraction.  I mean, it is, I feel like strength training is a magical kind of thing.

Mm-hmm. But yeah, I mean, most definitely, and I think we'll see more evidence as we move forward into the future. And as you look five years into the future, I mean, I love to kind of think about five year plans, 10 year plans. So as you look into the next five years, where do you see the gearbox gym going?

And then the second part of this question is more broadly, where do you see the role of pharmacists evolving in the US healthcare system? So the gearbox itself the location that we have here and local will always be a, you know, it'll pretty much always be my baby. It'll always be a nice little private training facility, but my vision is to hopefully be able to scale this and duplicate it.

To allow us to kind of bring this culture and community and network that we've built that's very, very unique and start to bring it to other parts of the states. I have a couple locations where I have friends and good connections that I feel would really be able to kind of carry the torch, if you will.

Hopefully we could pop those things up in other locations. It's just a matter of figuring out the logistics of scaling it. And, uh, I just think it's something that's very unique. It's hard to describe, but I feel that many, many people could benefit from it and then it would really be a great thing for them to become part of.

And then with pharmacy and everything in itself, I think that the role of clinical pharmacists is hopefully going to grow. Just becoming more and more embedded in working with physicians, both in the inpatient setting and the outpatient setting. I would like to see a larger role of pharmacists in the personalized and like functional medicine setting.

Because I, I feel that's where a lot of things are going. You everybody hears a lot of talk about these different peptides and the science that's very new and it's hard for us, as, you know, standard typically trained. Pharmacists, physicians were always about, you know, having FDA approved medications and all these other things and, and I think that's all well and good.

But there are some really, really groundbreaking things that, um, there's studying going on. I think that as these continue to be investigated and can be used safely, I think they're gonna be a really game changer. So I feel that a pharmacist's role in that setting is gonna be the way of the future.

It's very new now. It's like the wild west of medicine and there's a lot of, uh, there's a lot of really good stuff and there's a lot of sketchier things that aren't really substantiated by evidence and it's more, more or less anecdotal claims, but I think that space is gonna be really big.

It's obviously blown up in the whole med spire area, and that's not what I'm talking about. I'm talking about like legitimate. Research in those different peptides and ways that we're able to kind of use our own biochemistry, what already exists and turn it into a, a fashion that, um, fits us even more aids with healing.

I just think that's really cool and I think that's where a lot of this stuff is gonna go. So if we could some somehow implement clinical pharmacy into that realm to work with physicians to help prevent these issues and Reduce our reliance on just chronic medications. I think that'll be huge.

Yeah, I, I agree. And I do think there's a lot of stuff that's, I guess my teenagers would say is sus Yeah. Kind of fringe medicine a little bit, but a lot of stuff, yeah. It's woo wooo or whatever. But yeah, it's, I think it's super exciting to see, um, you know, where it'll go in the future,  you know, I think now it's kind of based on.

Aging prevention and all that kind of thing, but you know, where is it gonna go with  chronic disease Yeah. Prevention. So yeah. Super exciting stuff. So I know your gym is. Is private, it can people go to a website and find out about it? Or is it kind of word of mouth or they just, is it like an urban legend or something?

It's a little bit of both. So that's part of it that I, I'm a very, uh, private individual in a way, and I like ambiguity. There is a website, if you wanted to check it out, you can go to www.thegearboxgym.com. You're not gonna find a lot of information on there. It's one of those if, you know, you know, things, but I think that's what's made it special is.

Never once. Was there any type of marketing? Nothing like that. 100% organic growth. Word of mouth. We do have a, an Instagram that I manage. It's the gearbox gym on Instagram. I also do a lot of photography. So another aspect of this gym was to kind of serve as my own little studio. I like to do athletic photography, portraiture   fitness photography if you will.

So, uh, that's all on there.  You can kind of check out a little bit of what it's like, but yeah, there's no, there's no marketing, there's no address that's available per se. If you ever wanted to check it out, you know, you could reach out to me on, uh, one of those pages. But yeah, it's a very, very, uh, organic growth model.

Awesome. Yeah, I encourage everybody to, to reach out to Nick through those channels. Nick Lombardo, thank you so much for being with us. I really hope I see the gearbox gym like going across the country as a, hopefully it has a national foothold. Someday be awesome.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.