We bring the FAST and laughs to pharmacy.

Thursday, January 31, 2008

Idiot week

Apparently this week was Idiot week and I did not get the memo. What a rotten week and I have one more day to go!

Thank you, Dr. Moron, for leaving a voice message for 3 rx's 5 minutes before I closed on Tues. alerting me to the fact that the patient was on their way and may already be there glaring at me and wondering out loud as to "why" their med. wasn't ready.

Thank you, Mr. Guam dude, for yelling at me about your American citizenship. I don't really care and you can stick whatever citizenship you claim to have up your ass! I am not giving you 200 percocet that I feel you changed the quantity on without first checking with your doctor. Too bad-so sad.

Thank you to all the Plan B buyers! Yeah for the no breeders! It really should be free...

Thanks, dipshit methadone customer, for yelling at me in front of all my regular patients that I f%^$ed up the quantity of your prescription when I clearly explained why you are now getting the methadone 10 mg's instead of the 40 mg's. Need a hearing aid with that? Or a brain?

Thank you, Ms. 35 year old, for proving that a small tablet is bigger than your brain. Are you seriously telling me you cannot swallow that little azithromycin tablet? No problems swallowing the 120 vicodin you get a month, eh?

I already have one a-hole and do not need another so get out of my line to all of you cranky bastards who just want to give me a hard time. Yeah, yeah-some of you are sick and I respect that but don't give me shit just to ruin my night.

The list goes on and on...


Thursday, January 24, 2008


I was inspired by a patient who came in from the emergency room with three MRSA (methicillin resistant staphylococcus aureus) lesions. He showed me the boil on his stomach. He also had a lesion on his arm and the one that sent him to the ER was the one on his testicle that had burst. I didn't even want to see that one. Poor bastard. I hope the oral/topical antibiotic regimen clears that up for you. Devastating...nobody wants to lose a testicle to a bacteria, and I don't even have testicles to sympathize with so here is a shout out from my ovaries...and a little educational journey for the rest of you.

MRSA was "discovered" about two years after the beta-lactam antibiotic methicillin was introduced as a treatment for staphylococcus. This was way back in 1961. So over the next forty or so years, more of these clever little devils passed on the genetic ability to resist ultimate obliteration by beta-lactam antibiotics. The mechanism is a penicillin-binding protein coded for by a mobile genetic element termed the methicillin resistant gene or mecA. This lovely mechanism is easily spread from gene pool to gene pool and offers pathways to block other antibiotics as well.

For all its media hype, it is only found in 25 to 30% of the world population's nasal passages with less than 1% of that being MRSA (thanks US Centers for Disease Control). This just proves that bad press is the ultimate promotional tool, go Britney and K-Fed!

The Kaiser Foundation reported in 2007 that approximately 1.2 million hospitalized patients have MRSA. This includes a mortality rate of 4 to 10%. The risks of contracting MRSA vary and are more prevalent in clinical settings with a rising infection rate in community settings.

There are only two ways to get infected with MRSA: physical contact with an infected person or carrier and physical contact with something contaminated by an infected person or carrier. Physical contact includes but is not limited to sex, touching body parts, and being sneezed or coughed on. Coughing is especially infective if the patient has MRSA pneumonia. In this case the pathogen is aerosolized in lung secretions and totally reminds me of that movie theater scene in the movie Outbreak where the guy sneezes/coughs and there is that slow motion shot of the ebola infected secretia droplets spreading throughout the room...gross... Other types of physical contact can come from door knobs, sheets, floors, sinks, towels, computer keyboards, etc. Contamination is everywhere......

Don't be scared, it really is not that dangerous. You are feeling the anxiety generated by rabid newsies going for ratings. I don't need ratings, I am not paid for this. It is merely a labor of love and something to fill the void left by the writers' strike.

You must have a break in the skin or inhale infective droplets. Breaks in the skin can include piercings, cuts, scrapes, burns, scaling (like psoriasis), surgical wounds, rubbing your eyes, etc. Other patients who need to watch out are immunocompromised patients, such as patients with cancer, transplants, diabetes, pneumonia, pregnant/breast feeding, on oral/injectable steroid therapy, etc. Health care workers are no exception. Hospitals and nursing homes have the highest prevalence of MRSA along with other types of clinical acquired infections and should take proper precautions to prevent spread of infection from patient to patient.

Signs and symptoms of MRSA infection:
*cellulitis-infection of skin or fat and tissue immediately beneath the skin, usually starts as small red bumps
*boils-pus filled infections of hair follicles
*abscesses-collections of pus in and under the skin
*sty-infection of eyelid gland
*carbuncles-infection larger than an abscess, usually with several openings to the skin
*impetigo-a skin infection with pus filled blisters

Any of these accompanied by fever, chills, low blood pressure (feelings of passing out, dizziness, lightheadedness), joint pain, headache, shortness of breath, or all over body rash should seek medical attention immediately. MRSA can spread to internal organs and lead to complications or death if not treated early.

The FDA approved the BD GeneOhm StaphSR assay that can detect MRSA within 2 hours, where cultures require one to two days for positive results. The clinical trials used for approval showed a 100% detection of MRSA and a 98% detection of other common, less infective staph. There is a caution though because it should not be used as the sole diagnosis and does not rule out other infections.

What this all means for you: KEEP IT CLEAN!

Clean your dorm rooms, locker rooms, classrooms, shower and change sheets after sex, don't touch your friend if they have the infection, wash sports equipment frequently, clean wounds and wash hands. Clean everything and you will probably never get a lesion. Just don't go crazy and end up in a plastic bubble. If it looks like a gigantic pimple but hurts worse than any zit you have ever had or you have other symptoms get it checked out.

Thursday, January 10, 2008

My Favorite New Year's Copay So Far

A new year means insurance copays and deductibles skyrocket to the realms only the super-rich can afford. My favorite copay so far was $275 for a 30-count bottle of Truvada.

For those of you who don't know, Truvada is used to treat HIV and AIDS. It is a critical component in a multi-drug cocktail necessary for many patients to keep viral loads at manageable levels.

The patient was shocked. In December the copay was $25. Hmmmm, simple computer error or insurance conspiracy cooked up by religious groups to kill AIDS patients....I wonder....

Nah, that would be too simple. It has to be a "cost saving" measure so the insurance company can stay in business and afford their lobbyists and under-the-table deals with Big Pharma.

It sucks!

I don't care how expensive it is (>$1000/bottle). It is for a life-threatening illness! The other thing that really r-e-a-l-l-y pisses me off is that in other countries (the ones without excruciatingly long patent standards) people are already able to get generic versions of many HIV/AIDS treatments along with a slew of other "still branded in America" drugs.

Thanks for f**king us all America!

Tuesday, January 8, 2008

Medical Intern Nightmare

So it was my first day as a medical intern and I was sent to an abortion clinic. I am nervous as hell and when I get there the doctor in charge is pissed off. He was ranting and raving at how they were overbooked for abortions and his only help is a God damned intern. He needed a real medical assistant.

So the day got out to a bang up start. I ended up being a gopher. Go for this and go for that, hold this, don't do that. It was terrible. The next patient we saw told me not to worry about it because this was not her first nor second abortion. Apparently this was her only form of birth control. So after an excruciatingly terrible first day I went home.

Home consisted of a house occupied by four other medical interns and myself. It was a kind of off campus dorm set up. The problems there involved constant hostility toward one intern because he was a kleptomaniac and kept stealing every one's stuff. It got so bad that I had to hide my iPod in the dirty laundry basket. I hated him and so did everyone else.

So when I got home everyone was all ..."get a shower and change because we are going out for the hated interns birthday." Great. I have a bad day and now I have to celebrate with King Klepto. So we all went out and pretended to have a good time.

The next day at the abortion clinic went no better. Where did all the other medical staff get away to? There was a receptionist, a nurse, the doctor, me, and a whole waiting room full of patients awaiting their abortions. What the f**k? Who did I piss off to get this internship in Hell's waiting room?

So after another grueling day I went shopping. The local store was kind of like a mix between a 7-Eleven and a very small McDruggie's. The owner had a stock room and apartment upstairs. It gets even better.

I am in the cleaning aisle and the store is overrun with zombies. You heard me right, zombies. The day just got really bad. So the other patrons, the store owner, and myself are just throwing random items to slow the zombies down. We all end up going up the stairs to try and get a more defensible position.

Zombies are coming up the stairwell so we start throwing things down the stairs. Sixteen roll packages of paper towels, cleaning supplies, etc. There are no weapons here so we have to improvise.

The zombies are getting ever closer so I launch the largest Bag O' Socks I can find and hit a zombie in the head. He starts laughing, "Bag o' Socks, that's funny intern." He is still laughing so I hit him in the head with a large bottle of Windex. Bag O' socks indeed, Mr. Zombie, Bag O' Socks indeed.

I woke up laughing. I should really turn that one in to a novel. Horror from the brain that hates me to humor the medical community and others who would get a laugh out of it. Oh yeah, and since I published it here first it qualifies as intellectual property and I can sue you if you try to write and publish it before I do.


Tuesday, January 1, 2008


Some stories you hear all the time so you think of them as pharmacy "Urban Legends." The call I got New Year's Eve was definitely one of them.

Caller: Are you the pharmacist?

Me: Yes, how can I help you?

Caller: I am visiting from out of town and I was brushing my teeth but it didn't taste right. I took the brush out and realized it was my yeast cream. I took the wrong tube out of my bag. Do I need an antidote?

Brain: (laughing hysterically) Could this be a prank call? Am I being punk'd? Where's Ashton?

Me: No mam, you can just brush with toothpaste and that will wash out any other cream that you had in your mouth. Beyond the weird taste it should not hurt you.

Caller: Oh thank you! I thought I might need to go to the hospital or something. Bye!

I still haven't decided if that was a prank or just another stupid human trick...

Big Medicine on the Discovery Health Channel

Preparing to "ring in the new year" properly on the overnight shift at McDruggie's I needed some thought provoking programming to ponder. My muse was Big Medicine. It is a father and son doctor team that perform lap band surgeries to help the "super" obese lose weight and return to a normal size. Since this was a marathon I had a lot to think about.

I myself am not thin but nowhere near the mind blowing weights these people come in at. Of a 700lb man I probably weigh as much as one of his thighs plus an ass cheek. I am using mental pictures of these barely mobile land mammals to fuel my workout and dietary changes. I think to myself, "Self, do you want to end up like those pitiful people? They are totally out of control and have no regard to their personal health so they turn to surgeons for the miracle cure. Can they even fit into a car?"

I do not want to end up like that. I also do not want to employ Omar the tent maker to sew me a dress or a pair of pantaloons from his finest roll of canvas.

The most thought provoking man was 550lbs. He said he liked to "..eat steaks til the slaughterhouse runs out..." He also stated that his cholesterol had been normal and that he never had high blood pressure or diabetes. Well cowboy, you probably were knee deep in the bad cholesterol and high blood pressure after you passed the 300lb mark. The main symptoms of diabetes are often ignored or unnoticed. He believed that everything just went wrong at once after he hit 550lbs.....

Reality check! When was his last doctor appointment? You don't balloon up to 550 in a week or two, this kind of outward expansion takes years. If he had been to a primary care physician, he/she would have pointed out the obvious: obesity=diabetes, high cholesterol, high blood pressure, and risk of blood clots, stroke, and coronary events. High blood pressure is called the "silent killer" because without regular monitoring you may not even know it is high.

I had my reality check for the new year. My blood pressure is in the 135/85 range. It is not dangerous in the short term but I am going to lose 30lbs over the next 3 months to lower it. I would rather nip it in the bud (or expanded butt as may be the case) and drop the weight to treat it without medication. I will be damned if I end up on 3 blood pressure pills and a cholesterol combo to take care of myself. Screw that! I am not giving Big Pharma my hard earned money so they can back some political douche bag's election campaign and keep us from getting a socialized medical system....

No, I am not some crazy anti-government liberal. I am not some earthy all organic hippie. I have not seen that movie "Sicko" by Michael Moore. I am a well educated person that believes the only things we should be putting in our bodies are food, vitamin/mineral supplements, and the occasional alcoholic beverage or two. Okay, busted, I like to drink a lot...

***When I say food I mean anything that has been prepared fresh not cooked or processed then pumped full of preservatives and packaged for secondary or God forbid tertiary consumption (ew).***

But I digress. What I am taking a really long time to say is that each chemical compound we put in the body to perform one specific task (like lower blood pressure) can have many many other effects that were unintended or even dangerous (like kidney failure). That printout you get with your medication has a long list of "common" side effects. It even has a list of potentially dangerous side effects that you should call your doctor immediately if you experience them. What you do not get in the printout is the even longer list of "rare" side effects, many of them a potential trip to the ER. If you are on any medication, you better hope you are never in that less than 1% of the test population that had severe "rare" side effects. It does happen. How many drugs have been pulled off the market within the first five years of release? Think about it....

Everything in moderation and at least 30 minutes of brisk walking at least 3 days a week may be enough to keep you from becoming the next featured patient on Big Medicine. It may seem like a lot to change but it really is not and if you need somehing to ponder before going to your tediously boring job watch Discovery Health Channel. They have a lot of great shows but sometimes even I get a little squeamish at the surgery programs. Nothing makes me squeal with revulsion like watching a facelift....