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Monday, January 26, 2009

Hey, Kool-Aid Man!

Times, they are a changing, and with these changes I am one of the privileged many to test new computer software, phone systems, and new ways to bring the pharmacist back to the patient and away from the pill counting.

Working by myself at night can be very hectic with phones ringing, a line of cars, and a line of people waiting to ask questions or pick up their meds. Add the easy listening "all suicide network" that is piped in and it is a veritable cluster f*ck of sensory overload. Many days it is more than a sane person can take but since I am "nuts" it only gets bad on occasion.

While I was off one week we were uploaded to the new central operating system. It consists of many teams dedicated to specific tasks such as data entry, verification, phones, and filling next day pick up prescriptions for shipments to stores. It works as if I had beaten the cookies out of the Keebler elves and made them my b*tches. As if by unicorn tears and rainbow wishes my prescriptions are entered, checked, printed, and in many cases my robot friend (I call it Twiki) has them filled for me when I get back from the drive-thru or out window and consultation areas.

What it amounts to is that I now have the luxury of actually using my education to help people achieve better therapeutic outcomes. Hallef*ckin'lujah! All these years I worked retail and it was all about how fast you can complete 1,000 tasks at the same time where now I can actually take time out to really help people by answering questions and addressing concerns with their health. Sure it has some drawbacks and needs to be tweaked here and there but we are a test market so these things are to be expected. When all the bugs get worked out it will be a brave new world where patients get real health care without feeling neglected by their pharmacist.

Yep kids, I drank the corporate Kool-Aid and it tasted like magic.

Oh Yeah!

Wednesday, January 21, 2009

Open Letter To The Lady That Keeps Complaining Via E-Mail About Plastic Packaging

Dear Eco Warrior Princess,

I share your concerns with the impact that big business has on the environment. Your complaints about the larger prescription vials we use are confusing. Apparently you were not enlightened at new cost effective procedures that save jobs and keep your prescriptions from being $500 each and every month that involve robotic filling systems that use larger vials but fill 10,000 more prescriptions than a mere mortal could in a single day. Mayhaps you should ask your insurance company about that sort of thing when they switch over to mandatory mail order service for maintenance med refills later this year and inconvenience you with large vials and plastic bags of their own.

Your concerns about all the plastics we use are also unfounded. Instead of telling you where I think you could put that plastic bag you keep e-mailing us about "How am I supposed to dispose of it because it will just end up in a landfill and damage the environment?" I will tell you how you can dispose of said bag and everything else you think we give you that will destroy the environment.

Instead of mounting your pulpit to push for corporate crucifixion perhaps you should take a closer look at EACH plastic item. There is a little symbol that looks like a triangle made from 3 arrows pointing at each other on each product. On the bottom of the vial it is a thin triangle with a number in it that is raised so you can see it. On the lower left corner of every plastic bag we use there is a bright red triangle of arrows with a number in it. These items are ALL recyclable. Do you recognize the symbol or do you just like annoying the hell out of other people to make yourself feel better?

In addition to upgrading machinery, we at McDruggie's are constantly looking for ways to "pinch pennies" by cutting waste in every department and save our natural resources by using less paper and more recyclable materials. In California we have also started installing solar panels on many stores to become energy independent. I hope this eases your stupidity a little bit. If you want to crusade against corporations perhaps you should e-mail McDonald's corporate offices every day because a study of New York City stated that McDonald's food packages were their greatest source of litter.

Ingenuously yours,

Big N Tasty

Sunday, January 18, 2009

Give 'Em A Hand

In movies and on television we see Hollywood magic bring fascinating prosthetics and "super-human" body enhancements to life. In reality we aren't quite there with Wolverine's pliable metal skeleton, which would require a LOT of explaining at airport security, and the 6 Million Dollar Man or Bionic Woman, with a completely revamped body that does wondrous things and has that great "bionic action" dut-dut-dut-dut-dut music with it but one thing we are closer to is the Luke Skywalker hand. You know the one at the end of Empire Strikes Back with the whole "Luke I am your father." sequence where Darth Vader cuts off Luke's hand and later on the medical freighter he has a new robotic hand that is fully functional like a real human hand.

We are very very close. I found a company called Touch Bionics that has indeed come the closest I have seen to the Skywalker hand. Unfortunately is has a lame name, the i-LIMB (damn you Apple for the i- on everything now). Anyway, it has individually motorized fingers that allow a person to grip, open soda cans, and even use a key in a lock. But it gets better...

This hand has fingers that can be unscrewed and quickly replaced if there is a defect or it ceases to work. This allows the user to maintain functionality instead of having to wait while the prosthetic is fixed and walk around hand less so people can point and stare. They have also developed a silicone based product with a few other companies called Livingskin that covers the prosthesis and can be colored to match with skin tone, freckles, veins, and finger nails so that the casual observer has no clue that your hand is a prosthetic. Awesome!

Touch Bionics will be the first call I make if I lose a hand. Oh wait, I lied... The first call I make will be 911, the second call will be my parents, and the third call (in the event that my hand cannot be reattached) will be Touch Bionics. Bravo!

www.touchbionics.com It is fascinating and innovative stuff!

Tuesday, January 13, 2009

Full Moon Fun

Scientifically the full moon has absolutely nothing to do with mania, psychosis or the weird sh*t that people do but that does not stop us from holding romantically to the ancient belief that the full moon possesses an arcane embrace with humanity and allows malevolent spirits to make us dance like puppets. It's not that the moon is at fault but I rely on this busted Muppet show in a live-action format and really really look forward to the antics and the phone calls to break up the corpo pharmacy monotony.

Night One, ie Friday

Nothing out of the ordinary, just the usual 10 daily calls from hypochondriac/OCD guy, harrumph. A lack of Viagra/Levitra/Cialis still indicative of a crap economy. I did sell a lot of condoms and Plan B so some people were still having more fun than me.(**jealous**)

Night Two, ie Saturday

A regular calls who is mentally handicapped and has all the capabilities and facilities of a teenager. She takes several medications and has had a problem in the past with popping her benzos like "Sno-caps" then saying she lost them. Tonight was another such incident. She called and said she lost her bottle of pills and needs them or she will end up in the hospital because she feels like she needs more than than the doc gives her. I asked her if the doc had increased her dose and she said no so I looked in the profile and she last got a 30 day supply 12 days ago and there are no refills left so we will have to call the prescriber. She throws a fit and I calmly try to explain we cannot give or sell any tabs without an active prescription because it is a controlled substance. I also explained that with no refills she has 3 options: search her house again, call her prescriber's answering service or go to the emergency room.

She snarks back that she already looked everywhere in her house, doesn't want to bother her doc at 1am (rare to hear that one), and said "We all know how the emergency room works out." She then wants me to sell her just one tablet until she can call the doc Sunday morning. I explain again, no active rx for a controlled substance, no pills, do you need me to go over your options again? She then threatens to sue because "What do you do when people are in pain? That is not what a pharmacy does to people. That is not right and I will go over your head. I've sued "insert corpo-pharmacy name here" and won thousands before. I need to speak to the person above you."

I told her I am the pharmacist on duty and there is nobody above me until the pharmacy manager comes in the next morning. She told me I was rude and hung up on me. So I went about my weekly C-II inventory. The phone rings again and it is her telling me how unethical and rude I am, how can I live with myself being so cruel to people, and how she will go above my head if she has to and blah blah blah. I just let her vent and didn't say a single word. After she said all she wanted to say I was going to speak and she hung up. How rude and hypocritical of her. Oh well, she's retarded so I will take the abuse as if I really deserved it but I am not breaking the law for anybody.

As the evening became early morning I got a call from a pharmacist in North Carolina who was asking me about a doc. I told her that we aren't currently filling any of his prescriptions because he is under investigation for catering to cash for candy patients. She asked me to look in a guy's drug profile. Of course if was multiple Oxycontin and Roxicodone rx's from multiple physicians filled in multiple stores. The day staff had filled an Oxycontin earlier because the patient told them the doctor said it was cheaper there. I laughed because from KY (or TN, I forgot which one) to south FL to NC and back to KY (or TN) would have been at least a 2100 mile road trip. The price couldn't possibly be that much cheaper. Sounds to me like somebody is trying to cover his "about to lose his license" arse.

She also told me about the state-wide controlled substance registry they have. I am totally jealous and want a nationalized one for Christmas this year, please Mr. Clause or Mr. Obama???... So I entertained her with my favorite recommendation I tell ER docs when they call with a drug seeker: a shot of Toradol in the arse, because it hurts like the dickens, it's non-narcotic, the seeker thinks injections are the "good stuff" and it does provide pain relief. All parties satisfied.

Night Three, ie Sunday

The Grand Finale to my weekend is this elderly lady that always has her son in his forties bring her out on errands. He was throwing a fit because she took his pain pill prescription and wouldn't give it to him. She was afraid he was addicted to it because he had been taking it since New Year's and it was from a "walk-in" clinic. He was screaming at her about how she just wants him to be in pain all the time and to control him. He was also screaming about how his knees hurt and she wants him to suffer because he hasn't had a pill in three days and he is in agony.

She called her daughter to come get her because she was afraid to get in the car with him because he might take her purse to find the prescrption. So he went and sat on the hood of the car. Now mind you, this guy easily weighs 400 pounds. He probably does have severe knee pain just from the force of gravity on his fat. At his age and weight it happens. So I fill her rx and the daughter shows up with her husband and they all go have a nice long chat.

They come back and have all reached a mutual resolution. We will fill the prescription and his mom will give him one pill tonight for his pain and she will hold onto the rest to prevent any "abuse" until she can take him to her orthopedist in the morning. The prescription was not from a "walk-in" clinic doc and it was only for 30 pills so I think she was just a little on the paranoid side but she said he had addiction problems in the past. I just thought he sounded like a spoiled 5 year old myself but in the spirit of pain management addiction does not necessarily mean you should withdraw treatment so their agreed upon resolution sounded like a winner to me.

Another weekend survived and another month to look forward to a fresh episode of "Full Moon Theater." It is not as entertaining as Nip/Tuck but what else is a girl to do? The policeman that looks like Dr. Troy doesn't work the night shift anymore....

Wednesday, January 7, 2009

Legacy Of The Nude Dude

In reference to the "Springeresque" lifestyle of meth addicts, last night a nude dude was strolling around Fort Lauderdale. For serious, a nude dude with not a care in the world but where his next rock came from was strolling around the streets of Fort Lauderdale and came to my McDruggie's parking lot.

When the manager called Fort Lauderdale's finest there had already been several calls about the offensiveness of this Au naturale phenomenon. So nude dude disappears for a while then I get a call from the manager, "You've gotta come out front and see this! The nude guy now is running around in underwear and socks."

By the time I got up there he had disappeared across the street and a couple of PD were using search lights to locate him. He got away but as we talked about it I couldn't stop laughing. This can only be topped by an episode of C.O.P.S. Our episode would be called "No Shirt, No Shoes, No Service" or maybe for the regulars who come in "No Pajamas, Por Favor."

Kids, crazy sh*t like this happens every night in Fort Lauderdale. It is a wicked awesome circus of "stars." Send in the clooooooowwwwnnnnssss.........

Sunday, January 4, 2009

It's All About Choices

Addiction is a tricky thing. Many people loosely use dependence and addiction interchangeably but they really are not. Even in the standard diagnostic texts only chemicals are included in things that can be addictive.

For example, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) states that their definition of "substance" includes drugs of abuse, alcohol, medications, or toxins. By this definition someone nonchalantly saying they are "addicted to shoes" would not qualify. Flippant remarks such as this cloud the public perception of addiction and make it seem okay.

We live in a society that praises addiction as entertainment. You will see on any given day several shows with teens drinking or having "pill parties" where they collect meds from their relatives and their "dealers", toss them all together in a bowl then take a few to see how f*cked up they can get.

There are even shows like Celebrity Rehab and Intervention that try to show the bad parts of addiction but only come off as schlocky "Jerry Springeresque" entertainment. I don't think these shows even get a message through to the people they are trying to help because most of them end up right back where they started a few months down the road.

Hell, even big money high profile celebrities have photos splattered over every magazine known to man each time they go on a bender and another stint in rehab. This is how they get attention and we glorify it. We then glorify their "return to fabulosity" with another tabloid spread.

The DSM-IV criteria are aimed at substance abuse where "The relationship with the drug becomes primary--it is like a consuming love affair--it becomes the most important relationship for the individual and all decisions made are based on the maintenance of this relationship. The definition has psychological and physiological characteristics. Psychological because the individual has an obsessive preoccupation with the drug and physiological because of the neuro-chemical action taking place in the brain."

Substance Abuse (one or more)
*Failure to fulfill major obligations
*Use when physically hazardous
*Recurrent legal problems
*Recurrent social or interpersonal problems

Substance Dependence (three or more)
*Large amounts over a long period
*Unsuccessful efforts to cut down
*Time spent in obtaining the substance replaces social, occupational or recreational activities
*Continued use despite adverse consequences

How can parents deal with this? Well, there is no right answer. For most cases of drug addiction the abuser is just hooked on a lesser "legal" addictive substance and put through a counseling program. I have never met a "reformed" drug addict that didn't go right back to their favorite substance of abuse at some point in time and I have met several. I also know casual or "recreational" users who have no problem with addiction. Finding a "safe" addiction to replace the "harmful" addiction is half the battle. Maybe something like sculpting, writing, or macrame?

The bottom line is that addicts won't successfully rehabilitate unless they really want to. They chose that substance and the lifestyle or lack thereof associated with it. Parents should not blame themselves. Unless you specifically were seen abusing a substance by your child, gave your child the substance, or physically or psychologically tortured (and I mean secret illegal we don't talk about it military style torture) then you have NO blame in the addiction. A lot of it starts as a psychological need to escape or a need to fit in with peers or "look dangerous" or "popular" and ends up being a physiological need for brain chemical stimulation so it is hard to fight and prevent.

At the end of the day it's all about choices. I don't feel sorry for anyone. We all make choices every day that lead us to where we are. Life is what you make of it. Some people are ambitious and do what they need to do to get what they want and some people choose to be f*cked up all the time. Some people choose to eat donuts, pizza, and ice cream when they know their diabetes and weight are out of control then cry about it later. Some people choose to play video games all hours of the day and barely maintain a job in order to do such. These all qualify as addictions and should be treated as such. I am all for a new expansion of "addiction" and "dependence" to include things that go beyond "obsession" and "compulsion." So choose wisely, Grasshopper, and you will turn out okay.

Thursday, January 1, 2009

Future Predictions

Madame Tasty has peered into her crystal ball and will let you in on a few of the mystic secrets that have appeared.....

Soon all brand name drugs will require prior authorization coverage on all insurances. The resulting phone and fax volumes required to send requests and file forms will short out all telecommunications systems resulting in a resurgence of HAM radio, Morse code, and "snail" mail being the only source of communication for the ensuing 20 years it takes to rebuild the telecommunication infrastructure. Blogs will be on a "snail" mail subscription service which will suck. On the up-side, the postal service and telecommunications repair will supply jobs to all the autoworkers who will be unemployed shortly.

Co-pays will triple while provider reimbursement halves. This will result in 90% of prescriptions going through mail order services to cut costs and drastically change retail pharmacy as we know it. Again, more jobs for the postal service.

The price of insulin will skyrocket when e. coli form a union and demand employee benefits for insulin production. This will result in many diabetics ending up on welfare to afford their life-saving medications.

The ghost of Elvis Presley will haunt all responsible for taking his song "Viva Las Vegas" and tainting it for advertising with "Viva Viagra." For shame!

Wal-Mart's $4 drug prices will be the final nail in the coffin of "Mom and Pop" pharmacies everywhere. It will be a sad day for pharmacy with such price perversion subverting everything "free enterprise" and "family owned and operated" business stands for.

The once mighty Rite-Aid will fall in the woods and be devoured by hungry bears named CVS and WAG. It will be a grizzly splatter-kill of a mess that will become a made for Lifetime after school special called "When Business Attacks"...for shame!

By 2012 the intermingling of HIV genotypes from orgy parties, random bar tricks, IV needle sharing, and prostitution will mutate to resist all current drug regimens....plague anyone?

Due to the ever rising popularity and overuse of hand sanitizers and antibacterial cleansers in all environments MRSA will shoot up onto the list of top 10 causes of death in humans.

Someone else besides me will read the ingredients on a package of cotto salami and realize it is the turkey hearts that make it so damn delicious.

By 2012 all bacteria will be resistant to azithromycin due to patients insisting on taking it every time they get a sniffle or stuffy nose and the prescribers who cave in to the patients' whims and give z-paks with refills. Why don't people ever learn that allergies and viruses cannot be cured with antibiotics and a Nettie pot????

A food manufacturer will develop "Snacks" and "Meals" under the guidance of a secret consultant (you will know who if you have read the Gaiman/Pratchett novel Good Omens) so that anorexia and malnutrition will be the wave of the future.

"Pac-Man Fever" will be cured with a classic arcade and a pocket full of quarters.

Retail torture will continue as Hall and Oates songs will still be in heavy rotation on the muzak permanently. AAAAAAAAAGGGGGHHHHHH!!!!!

Patients will mistakenly listen to people in the aisles instead of health care professionals when choosing an OTC treatment resulting in many deaths and hospital visits. Oh wait, that happens now so that one is already true. Damn, I am good!

My corporate paymasters will use many of my previous posts as a reason to force me into leaving the company quietly under threat of a major libel suit. With secret identity compromised I will admit defeat and move on to a career change that will lead me to a dream job at Gamestop where I will spend my days recommending games to the "hard core" and playing all day long. I will become the pot smoking slacker princess I always knew I could be.