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Wednesday, October 24, 2007

Infant Protection

There has been a stirring controversy over parents and/or guardians overdosing infants with cough, cold, and decongestant products. Many have been recalled by manufacturers. I have fielded several questions from concerned parents that these medications are deadly. I assure them when used at the appropriate dose for the child's weight under a doctor's order there have been no problems. The main problems occur when dosing is guessed at or an inappropriate formulation (adult strength or something designed for 6 to 12 year old) has been used.

Things all parents/guardians should know about infants and medication:

1. Their organs are not fully functional or resistant to the effects of chemicals like an adult.

2. Their brains and nerve systems are still developing.

3. A major cause of diarrhea in infants is high sugar fruit juices. Many of these juices also contribute to cavities when children start to get their "baby" teeth by wearing down enamel with natural fruit acids. All things in moderation.

4. Gatorade it NOT formulated for an infant. Pedialyte IS. Too many times a patient tells me they were giving an infant Gatorade but the diarrhea won't stop. Duh, Gatorade is full of sugar and high concentrations of electrolytes. It was designed for fully grown athletes. Give them Pedialyte. If the diarrhea has been going on for more than a day call your pediatrician or go to the ER. Maybe your infant will survive your inherent lack of common sense.

5. Tablet formulations are not meant to be broken into pieces to give to an infant. Liquid formulations developed and dosed for an infant are. I had a woman who wanted to give an infant an Imodium tablet because every time she used the liquid the infant ended up in the hospital because she got diarrhea from the sugar in the liquid. I explained to her that there was no way a 2mg tablet could be broken into a 0.4mg dose. She would be poisoning her child. She reluctantly took the liquid PRESCRIBED BY HER PEDIATRICIAN.

6. Smoking during pregnancy and exposure to smoke, mold, mildew, and vermin after birth increases the frequency and intensity of asthma and allergy attacks, even if a child is on medication treating these conditions. This breaks down to basic cleanliness of the home environment. It is not that hard and there are many cleaning products recommended for use in homes with small children.

7. Child safety packaging does not mean that it is 100% child proof. You still need to put locking mechanisms on cabinets with cleaning products and medications in them. This also applies to pets. Several cases of pet death occur in dogs that ate a bottle of medication that was left sitting on a counter or nightstand. Many of these cabinet "locks" are merely a piece of plastic that latches so that the cabinet cannot be opened more than a couple of inches. They are cheap and can prevent a lot of calls to 911.

Come on people.........this is getting ridiculous. Perhaps a part of every high schooler's education needs to be on home safety and basic pet and child care. Even better, instead of having an occasional assembly to discuss not putting things in your mouth that appear to be candy with young children, it should be part of every curriculum. Start young and educate children to keep themselves out of every day dangers. There are more dangerous things out there than pedophiles and many can be found in your own home.

Sunday, October 21, 2007

Peep Show Protocol

Life in south Florida leads to encounters with shoppers showing way too much skin for a retail setting. Sometimes it is an accident. What should one do in this situation? Let's take a stab at some choices you can make.

Saturday afternoon at McDruggie's a gentleman in short shorts comes in (yeah it really happened Sat Oct 12) and shops like everyone else. A cashier noticed that his periscope had come down and was looking out from the leg of his shorts. Some choices you must now face:

A. Point and laugh hysterically.

B. Nonchalantly inform him to checkity check himself.

C. Try to resist its gravitational pull on your optic nerve.

D. Go to another aisle and laugh hysterically.

E. Point it out to another employee with a big mouth who will inapropriately shout aaaaahhhhhh, aaaaahhhhhhh, aaaaaaaahhhhhhh.

F. All of the above.

I would have chosen F in this situation because I thoroughly approve of toilet humor. Since I was not there option E occurred and then all other employees were told about the incident as a break room joke. Note to self, don't wear a push-up bra with a low cut shirt under the magic white jacket while at work unless it is time for your hot police officer you want to fulfill your dirty bad-cop sexual fantasies to come in for a refill.

Thursday, October 18, 2007

Poop Soup

I had an early morning/late night caller concerned because she had diarrhea and Imodium was not working. She went and gave all the gory details: severe diarrhea, can't sleep cuz she has to poop, crapped her pants several times and didn't realize it, changed clothes 16 times because she soiled her unmentionables, blah blah blah, wearing a thick pad like Depends because there is constant leakage, blah blah blah, has had this since last Wednesday.......What what what??!!??!!

She has had a scene from the "Exorcist" spraying out her pooper for a week and is JUST NOW concerned.....I am baffled. If I have a touch of the squirts for more than a day and cannot pinpoint what I ate and/or drank (usually it is drank) that would have been a major causative factor I am calling a doctor or squirting my way through the ER, undies and pride be damned. Man...a whole week...need some Tucks pads for the burning, honey? I am still baffled.

I explained to her several times that it is of GREAT importance that she goes to a doctor as soon as possible. I can think of several not so pleasant causes of severe diarrhea like cancer, infectious organisms, parasites, etc. Don't forget dehydration and all of its lovely little complications (my favorites being organ failure and dementia). She wants to wait til she flies back home on Saturday (3 more days from this conversation...). I had to bite my tongue not to remind her that the carry-on flight limit for all containers of liquid is 3 ounces...maybe it was dementia setting in on her part or maybe the situation just turned into an episode of South Park that I found really really funny...either way a medical visit was muy necesito!

She still balked at the idea because she had no insurance. I hooked her up with a clinic she could visit at 8am that specialized in helping people with no insurance. She asked me if it was a dirty clinic. A "dirty" clinic? No, this isn't where all the crack heads and homeless go for services, if that is what you mean by "dirty." This clinic mainly assists foreign travelers who might not be able to afford medical care while on vacation or recently relocated and have no insurance yet. You are a traveler with no insurance.(...duh...) They can help you.

She still was not satisfied and did not like further suggestions like Metamucil capsules to help soak up some of her internal seepage. It is called a "bulk forming" laxative for a reason. It soaks up liquid to form a solid mass and may afford you a little bit of relief, especially if you really really plan to get on a plane in 3 days instead of see a doctor until you get home. She hung up on me. One unsatisfied customer.

Don't ask the questions if you know you are going to ignore the answers. Oh yeah, and if you ever ignore my suggestion in favor of "little know-it-all that knows nothing medical" that walks in off the street, you deserve every bit of the bad outcome(s) that will happen. You can't sue the pharmacy for something the pharmacist didn't recommend, especially if they advise you not to take the suggestion from that person and your dumb ass does it anyway. Poop soup for you!

Monday, October 15, 2007

A Cure for Radiation Sickness?

Cancer hurts! It not only hurts because cells have gone all mutation happy on you and cause inflammatory responses, cell death, nutritional deficits, etc. but also because the treatments themselves are cell killers too.

The list of side effects for many chemotherapy agents reads like a large volume of Encyclopedia Britannica (do they still publish those?). This list contains things far scarier than the dust bunnies under your bed and far more painful than being pistol whipped at retail on the 3rd shift (I am waiting for that one to happen but I am sure it is not as painful as chemo and radiation...).

Funding for many types of medical research is hard to get. Charities can only do so much and the government is currently more worried about funding a war and getting their annual pay raise. It is disgusting to see what selfish little piggies run this country. Our health care system sucks and all government efforts have gone belly up like an overfed goldfish. I am not even going to start on the Medicare Part D debacle...but instead I want to talk about radiation.

Radiation along with chemo kills cancer dead. Radiation also makes your hair fall out, your bones brittle, and a million other not so fun things. It makes you feel like a scene out of a Monty Python sketch where little parts of you keep falling off but your still alive and wilting like a funeral bouquet. Since almost every person will get cancer before they die unless something else kills them first (diabetic complications, coronary artery disease, accidents, murder, etc.) we need something to combat the ills of radiation.

Oooh, the threat of a "dirty" bomb (ie home made radiation deployer) to our troops and countrymen occurs and poof, funding for radiation sickness suddenly appears. That was a big f***ing rabbit you pulled out of your hat Uncle Sam. Thanks for finally getting around to it. Sam has spent $6 million so far and plans to commit another $82 million over the next three years (this is from "Surviving Side Effects" in Scientific American, October 2007).

Progress is being made and there are several shining stars on the rise for future treatment. It is a sad state of humanity when fear equals funding for valuable research that should have been started and maybe completed twenty years ago. Let's see what the feds think will get them elected next time around since they are all looking bad on the "going green" but still flying in a private jet to appearances thing and they still hate homosexuals getting "married".

Monday, October 8, 2007

Late Night Priapism

I had a gentleman caller concerned about a Viagra induced priapism (extremely long -lasting painful erection). What started out with an "embarassed" query became phone sex all too quickly. I am a medical professional not a hooker. I believe you dialed the wrong number to get your rocks off. I may be a pervert in my personal life but I am not while wearing the magic white jacket of a professional pill pusher.

I am not paid by the minute to talk dirty to you. I did find it hysterically funny when you asked if you came in and showed it to me if I could do anything for you. I would have laughed at you because I had already told you there was nothing I would be able to do for it, perhaps you should try some form of sexual activity or the emergency room. I had to hang up on you when you asked if I like to suck dick. I am not going there at work. The last time I saw anything near the penis in the pharmacy was a guy that pulled his pants down to show me what appeared to be syphillitic lesions. I told that guy to get an antibiotic from his doctor a.s.a.p. because there was no over the counter cream to treat his lesions and his problem would get worse without treatment (ew).

This caller has a history. The last few times he called it was because his "girlfriend" was using Nuvaring. He wanted to know why it made her horny because she wanted sex all the time. Quite frankly, I think you aren't getting any lovin' and that is why you are calling me at 3AM looking for a stimulating voice to wank off to. Well sir, you can fire away all you want with those knuckle children of yours, but please don't bother the pharmacist unless you have a legitimate concern that requires immediate medical attention.

Sunday, October 7, 2007

Three Minutes or Your Order is Free

If that were the case, all businesses except some fast food joints and a handful of wiener carts would have to close. Oh, and my bank would still be open. I never wait for service there. Consumer expectations for service are pissing me off.

When you bring in an insurance card, make sure it says "prescription" somewhere on it. I don't need the one that says MD, Mental Health, Emergency, etc. I need the one that says "prescription." No, your car insurance is not going to let me electronically bill for that prescription from your accident and neither will the card that says "dental" because it just covers your "dental" visit, procedures, etc., not the prescription written as a result of it.

If you have Medicaid and you have a third party payor for "prescriptions" it would be great if you had that card or at the least, the payor name, ID number, and group number. I can work with that.

If you have Medicare Part D I would love to see the "prescription" card for that. There are so many plans currently available it has become impossible to use my extrasensory perception to pick your brain and figure out what paperwork you filled out and what the card says. I am not the Great Kruskan. I am just a lowly paper processor and pill pusher for "the man."

I also will not call the insurance company to ask why a drug is not covered. I can tell you right now it was left off the formulary for budgetary reasons. They can't afford to pay for everything. I am nice enough to call your doctor to find a suitable substitute to treat your ills, eventhough you feel the need to take out your anger and disappointment on me.

I will not call to get ID numbers. Your body, your insurance, your problem. They sent you a nice little paper or plastic card to carry with you. I have approximately 1000 other things to do and patients to take care of in my immediate surroundings, not hold your hand while you pee. You are an adult. I will not babysit you. If you cannot possibly handle that one tiny detail in your life I hope you do not have children to supervise and raise. If you do, I weep for them and hope that they never get into an accident and need you to have the proper insurance cards handy.

If you just came from the emergency room, I promise to fill your prescriptions with all the other folks who came from the emergency room before you. I cannot do this in 3 minutes as they are also sick, tired, grumpy, and waiting. There is no reason to poke at the sleeping infant and make it cry. I will not push your prescription out any faster. You are just a douche bag and a terrible parent for doing that. Ten to fifteen minutes means ten to fifteen minutes. That baby was sleeping just fine til you thought it would get you out faster if it was crying. Child and family services should do it a favor and find it a more responsible and loving home.

All because a medication comes in a box does not mean I can "slap a label on it" and get you out of here fast. There are lots of boxes in the pharmacy. Many of them look similar. I can put a label on any box and send you on your merry way so you don't have to wait ten minutes but it could be wrong and kill you. It's the lady or the tiger. I am forcing you to pick the lady because I am not risking your life or my livelihood on the tiger. Tigers look cute and cuddly and I like to see them humanely kept at the zoo but their claws will rip through human flesh like a machete through hot butter. It's not pretty, ask Sigfried....

The optimal way to get a prescription for a maintenance medication (the stuff you take every day, week, month, etc.) is drop off at the drive-thru on your way to work and pick it up either on your way home or the next morning on your way back to work. This gives us time to resolve any issues such as "drug not covered", clarification of handwriting, verifying high dosages or interactions with your physician, etc.

There are some things that do not resolve as easily as that. Out of stocks do happen occassionally. This is especially true for injectables, meds that are not routinely prescribed, and meds that need special authorization from insurance or regulatory requirements before they can be ordered (because they are terribly expensive, highly regulated, and go out of date pretty quickly... You wouldn't keep something like that in your refrigerator unless you were going to use it and neither should we.).

The main reason we give you a time for completion of your prescription is safety. You should thank us for that. Being a deathdealer is only suitable for gaming or prison executioners not pharmacists. We don't want to kill you. We may not like some of you but we really really really don't want to kill you. So the next time you are "inconvenienced" and yell at me, just remember I made you wait because I C.A.R.E!