Yay Coupons!

You all know those annoying little printouts/shiny papers/cards with a bin number and a happy "this is gonna save you some money on your copay/this is gonna get you a freebie" message that usually have an issue during claim transmission. For the purpose of this blog they will all be referred to as "coupons". The best part is the patient who does not read the fine print and has no idea what the "deal" entails beyond hand me the coupon and get something cheap/free back and getting snotty when something goes wrong or the "deal" is expired.

Things patients need to know about these coupons:

1. You have to have a prescription for the item in the coupon.

2. They all expire at some point in time. The date is printed really tiny but it is on there.

3. They all have some kind of limit. Some are one time use per patient for life, some are two per person per year, some are free for the first fill and a copay reduction for a few fills after, etc.

4. They are not immediate or fast to process. We have to run the prescription then run the coupon based upon its terms. It may take a couple more minutes than you wanted for your prescription to be completed, discount and all.

5. Giving me the "stink eye", cursing, screaming, making the baby cry, threatening to call your lawyer, etc. will not make this process any faster or make the coupon work after the terms expire or are used up.

For example:

You pull up to my drive thru window at 2am to pick up your Relpax that is ready on the shelf and hand me a computer printed coupon. I process the coupon and it gives me the message "plan limits exceeded. one use per coupon." I relay the message that you need a new coupon and you smart off to me. "So I can't get my medicine?" So I replied that you could but it would be at your insurance copay of $35 dollars.

I can see you giving me the "stink face" and rolling your eyes from the passenger side of the car and just smile when you say "So I have to go back home and print out another coupon then come back?" Yes you stupid cunt! I don't have a magic coupon generator or an internet access to the outside world beyond our company website, a handful of specialty authorization websites, and the ever frustrating PAID prescriptions website. You have to expend the exorbitant amount of energy and effort it takes to drive to your house that is a handful of blocks away, log onto your internet service provider, go to the manufacturer's website, answer the super short questionnaire, print out the new coupon, and drive your ungrateful ass back so I can give you the prescription for $15 dollars after the coupon copay discount. Now go home and stop acting like I kicked your puppy or punched your baby in the face, print out the f*cking coupon, and come back here to my "I want to put my size 9 snow boots up your ass" smiling face to get your stupid f*cking discount!

I say "Good day and happy coupon printing!"

A Ghost of Christmas Past

Last Christmas I was in south Florida and we were in the hype, fear, and reality of an H1N1 flu pandemic. I was compounding Tamiflu suspension in 16 ounce batches each and every day. Roche was killing with the sales numbers as Tamiflu was going so fast we couldn't keep it in stock. Every child that had a sniffle or cough with a fever got Tamiflu suspension just in case it was the sinister and potentially fatal H1N1.

Today I stare at the gallon jugs of cherry syrup patiently waiting for their turn to be useful and the boxes of Tamiflu capsules seldom prescribed. They have been rendered unnecessary for the time being by vaccinations. This isn't a bad thing, although I hope Roche is still making Tamiflu for the next viral pandemic, but it proves the value of vaccinations.

As Novartis, Medimmune, and Sanofi-Pasteur reap the financial reward of flu vaccination I hope people realize the value of vaccination programs in general. We can prevent horrible fatal diseases and not as horrible hospitalizing diseases with vaccinations. As the world becomes more densely packed with people and people live with their farm animals, diseases will make the crossover from infecting animals to infecting people. Add in a huge amount of world travelers to act as carriers and we see it more and more often with many fatalities.

It is through science and technology that we are able to isolate, study, and prevent if not eradicate pathogens so that more people survive pandemics. For those people who refuse to vaccinate their children out of fear and misinformation, I hope your children are never infected with a vaccine preventable disease so they do not have to suffer irreparable physical/mental damage or death due to your stupidity.

Vaccines do not cause autism. The amount of thymersol used as preservative in a very few vaccines would not even kill a parakeet, lab mouse, or a goldfish. Stop beating that stupid dead horse and get with the program! You have probably used more thymersol in over the counter eye drops than you ever got from a vaccine and statistics show that rates of autism have multiplied greatly for years after thymersol was discontinued in childhood vaccinations in the early 90s.

Perhaps autism is happening because people are so ready to pump developing infants full of medications for every little sniffle, sneeze, or cough. "The baby's fussy so lets give it an antibiotic and some Motrin!" I hate dispensing prescriptions and OTC meds for young children. They are still developing and their bodies cannot process these chemicals as effectively as adults. Unless the child has a fever (above 102 you should take them to the ER because they are at risk of seizures and brain damage) or a physician confirmed infection you shouldn't be pumping them full of medications. I also DESPISE people who pump their kids full of antipsychotics, antidepressants, and ADHD medications. Children are hyper and jumpy because they are children. They have lots of energy and have to touch, see, smell and taste everything because it is part of the human condition and how children learn about their environment before they know how to communicate on a speaking level. Stop vegetating them with drugs!!!

Perhaps it is all the fat-free and preservative/additive full crap you feed your kids with and ate during pregnancy. That is where my bet is. Children do need a certain amount of dietary fat for proper neurological development but when your "food" contains a list of barely pronounceable ingredients maybe you shouldn't be eating it or feeding it to your kids. I liken that to drinking or smoking formaldehyde....it preserves dead flesh, so gee whiz, it is gonna do the same thing to yours Johnny smartass. I can't wait for studies to prove that food preservatives are toxic. Go science!



**Apologies, sometimes I go on a idealogical rampage.

Last Minute Gift Ideas When Everything Else Is Closed

It's time for those last minute Xmas gifts because you didn't want to shop with the crowds at the mall, you waited too long for Amazon.com to ship Drug Monkey's book before Xmas, or you had an unexpected gift, or you just plain left someone off your shopping list. Here are some ideas from McDruggie's to bring holiday joy to those you love.

*Gift cards for mediocre chain restaurants like Applebee's and Red Lobster

*Cameras that use 35mm film because they are one of the few places that still carry it.

*35mm film for the aforementioned cameras for family members that fear the future of digital photography.

*Cha Cha Cha Chia! Chia pets.

*Clap on! Clap off! The Clapper.

*Digital photo frames for those who embrace technology.

*Sony Blue-ray DVD player for those who don't own a Playstation 3.

*A speaker set or radio to plug an iPhone or iPod into for listening enjoyment. This is also a great gift for pharmacy employees who tire of hearing the same 50 songs and ads over and over and over and over...

*Candy, candy, candy.

*Liquor because "Candy is dandy but liquor is quicker!" (disclaimer: only some stores have an actual liquor department, other stores only carry beer and wine)

*Tons of Toys! (Be sure to buy some extra toys for Toys for Tots! Some kids may not get presents otherwise and what a crappy Xmas morning that would be.)

*Kleenex, hand sanitizer, antimicrobial hand soap, etc for your favorite germaphobes.

*Illicit Drug test kits for nosey/concerned parents of teenagers.

*A breathalyzer for your favorite alcoholic.

*Laser pointers for your cat or squeaky toys for your dog.

*OTC medications for all your sick relatives.

*Flu shot gift cards.

*Shake Weight! You've seen the commercials now own the legacy!

*Anything from the As Seen On TV collection.

and I saved the best for last...

*It's a pillow, it's a pet, it's a pillow pet! (Yes I have been psychologically damaged by hearing that ad on the muzak over and over and over to the point I can't help but make it my greatest and last recommendation!...stupid suggestive selling ads...)

Shameless Product Endorsement

I had the worst sore throat ever yesterday. I went to see a band and it hurt so bad to scream or sing that I thought I was going to lose my voice. After the show I went to McDruggie's to get some throat spray and there was a wonderful surprise: Chloraseptic Max.

This magical concoction was so much better than the crappy tasting alternatives and previous formulations that it was love at first spray. It has 1.5% phenol for anesthetic/analgesic purposes, 33% glycerin to coat the throat, and a berry flavor that makes phenol tolerable. It has been my new best friend for two days and my throat feels a lot better.

Thank you Chloraseptic Max! You will be one of my new recommendations for sore throat from now on!

Holiday Cheer!

I had a lady call to request a refill on her Darvocet-N 100. I explained to her that it had been discontinued so we would need to contact her physician to get a suitable replacement to treat her pain. She was terribly irate and felt the need to make it my fault that she could not get her medication that she so desperately needed, even though her last refill was 6 weeks ago on a thirty count prescription. She made it sound like I was kicking puppies and drowning them in a bathtub for shits and giggles.

She proceeded to whine and complain about how we mistreat our patients and maybe we should take better care of people. I apologized for her inconvenience (which I should not have done) and this Scrooge then had the nerve to say hatefully "Nobody ever apologizes for anything anymore! You should apologize to me!" I then said "I just apologized to you for something completely out of my control and you are the one being hateful about it. We will contact your physician in the morning because they are not in the office at 7pm." She then had the nerve to repeat herself on how nobody apologizes so I just told her we would call her doctor, said good night, and hung up on her.

I was pissed off. We were doing the work of 20 people with 5 staffers and her attitude was not acceptable. Some people are just inconsiderate assholes! I took the high road and faxed her doctor anyway even though my first instinct was to wad up the request and throw it in the DPI box. I am just too committed to the job sometimes.

I bet she is a miserable old hag and has forgotten what it was like to have a happy holiday. I pity her and hope that none of you are insufferably hateful during the holidays no matter how busy it gets!


***DPI boxes are where we put all patient info for destruction.

Thankful

Another Thanksgiving is rolling through and I want everyone in the United States to think about a few simple things.

1. No matter how much you complain about copays and having to sit in a waiting room for an extended amount of time to see your doctor to get a prescription be thankful that you have access to health care and medications.

2. In the event that something goes tragically wrong you can dial 911 and have police, fire, or emergency medical support in a matter of minutes (in most areas).

3. Public sanitation, indoor plumbing, and water treatment facilities all prevent disease by taking away waste that can contaminate your living environment, drinking water, and draw pest infestation.

4. Despite the punditry bullshit you hear about this being a "Christian" nation on television, you have the freedom to practice any religion that fits your spiritual needs but does not encroach on the freedoms or well being of others.

5. Routine vaccinations protect you from horrible diseases. You may not think this is important because we don't see these diseases on a regular basis but with world wide travel and shipping we are going to be exposed to these diseases and have had incidents of preventable disease run rampant in unvaccinated populations.

6. You have access to unlimited amounts of almost every food you could possibly ever want to eat and more. My aunt and uncle had a Russian foreign exchange student living with them. He wept openly the first time he walked into a grocery store. There is more food in each single supermarket here than most people see in a lifetime in other countries.

7. You have the right to keep a gun in your home and pop a cap in the ass of any douche bag that thinks he/she can snatch your stuff with no consequences.

8. You can type or speak or peaceably gather to let the powers that be know your frustrations and opinions on what they are doing.

9. Our welfare people live better than Chinese factory workers.

10. We have lower income taxes than most industrialized nations.

11. If you have a roof over your head, a job, money in your pocket and money in the bank then you are in the upper 8% of the wealthiest people in the world.

12. Our library system gives you tomes of entertainment and education information just for being a resident. It is free unless you forget to return the book in its allotted time...those fees add up...

13. Each and every one of us is guaranteed up to a 12th grade education. You can use this opportunity to better yourself or just piss it away. It is entirely up to you.

Thank you America! Even with all our problems you still f*cking rock when it comes to quality of life and being the land of plenty and if I was a citizen of another nation you can be f*cking sure I would be an illegal immigrant by any means necessary just to peruse your grocery stores!

For all of my holiday travelers, don't forget to pack medications in your carry on luggage!!! For all of my diabetic patients, please try not to over do it and make sure to have extra insulin on hand because you might need to go a little higher on your sliding scale this Thursday if you do.

Happy Thanksgiving!!!!!

Follow Through

I posted a comment for the "Darwin Award of the Month" blog entry that apparently pissed someone off. Filet didn't want to post it but I am going to comment on it because I laughed my ass off when I read it. For those of you who didn't read the post it was about a pharmacist who failed rehab and was busted passing fake rxs for narcotics for personal use. My comment was as follows:

See...rehab doesn't work 99.9% of the time. I just call junkies Lindsays...as in Lindsay Lohan...and damn that douche bag to hell (if there is one) for besmirching the title of pharmacist. I hope someone in prison shanks him!


So someone using the title Peacemaker had this to say:

Big & Tasty...What a lame screen name...You would be popular in the prison system. You are full of yourself, intellectually stunted at best, and write things that at least should get YOU shanked for stupidity, and at best are not even the least bit humorous. I would say that before you start quoting %'s about drug rehab, you should reread your code of ethics as a pharmacist. Assuming you are one, I am guessing that you probably sell weed out in the WalMart parking lot, and therefore consider yourself a pharmacist. I would begin a battle of whits with your dumb ass, but as the saying goes, it would be unair as you are clearly unarmed.



My response:

1. Big & Tasty is a fun name for a blog called FAST FOOD Pharmacy because it is an item off the McDonald's fast food menu. You also probably didn't read our blog mission statement.

2. I would be extremely popular in the prison system because I have double D's and can do some fun tricks with my tongue.

3. I have found different rehab centers have different statistics for failure. Once an addict, always an addict. Rehabs just train you to exchange your "bad" addiction for a "socially acceptable" addiction such as methadone, benzodiazepines, cigarettes, alcohol, macrame, suboxone, etc.

4. I follow the Pharmacist's code only when I wear the white coat and fight the good fight at the Pharmacy. When I am in my civilian life I can say and do whatever I want. When I blog I still leave out names and places for patient privacy but like to vent about the situations and people I deal with on a regular basis rather than "Go Postal" and pop some caps in some asses.

5. I think junkies are the shit of the earth falling somewhere below welfare scammers and somewhere above child molesters.

6. I have a Bachelors in Pharmaceutical Science and have passed all examinations necessary for licensure in two states. I am a legitimate pharmacist, not a hustler.

7. I do not expect people to like me or find my thoughts humorous. I expect people to take what I say with whatever gravitas they want it to have. I am neither savior nor comedian, only one voice amongst thousands of bloggers. I like to read all commentary, especially if it is critical or asinine.

8. I feel the battle of wits would be more humorous for me as I rarely take people seriously when they lash out with hostility. I do wonder if you are Mr. Maister from the article or maybe a close associate of his? It would explain the hostility or maybe you just wanted to audition to be the "Jenny tail" for my human centipede?

To quote a really crappy movie for all who like to comment "Bring it on!"

Well this hits home

WOW!! Too true! Makes me kinda sad that others get the same abuse I do-daily!

Flu Vaccine Query

I know this has little or no relevance medically but I am curious to know what Vegans have to say about the flu vaccine being cultured in chicken eggs. I already know that PETA frowns upon this.

I have no problem with it because I believe that whatever I eat I can wear or use. For example I like eating beef so that gives me the right to wear leather but I still have issue with people who wear fur because I know you motherf*ckers aren't eating the animals that the fur came from. It is a waste not, want not approach to carnivorous endeavors. Some people have issue with eating animals no matter what but I want to know how they feel about using chicken eggs to grow vaccines.

Seriously, I am super curious to know. What's your opinion?

File under "Are you kidding?!"

"Drive-throughs aren't just for burgers.

Five Bon Secours sites will offer drive-through flu shots Saturday, Oct. 16, from 9 a.m. until noon or until supplies run out.

More than 700 residents rolled down their car windows and rolled up their sleeves last year for Bon Secours Hampton Roads' drive-through clinics. "

If you think I am not serious, check it out. I can't wait until corporate pharmacy follows along with this *brilliant* idea.

So You've Made A Human Centipede (First Sequence)

So you've made a human centipede. Now that you have achieved your ultimate creature creation and almost clinched that position with the Legion of Doom I need to let you in on the expensive and tedious upkeep of your new "pet."

(If you are confused at this point, Human Centipede First Sequence is an independent horror flick about a German doctor who was internationally famous for separating Siamese twins. He retired to his own demented experiment: linking animals or people anus to mouth to form a "centipede". You really should watch it. I found it hilarious, creepy, and inspirational while not being terribly graphic or a gore fest.)

* Each segment will need an open port for medications, fluids and parenteral nutrition. The port will need to be placed where it will be hard for the free arms of the 'pede to pull it out. You may even need some form or restraint that allows arms movement for walking but not enough movement to reach out and damage itself or others.

* Antibiotic therapy. You have essentially linked a rectal cesspool of bacterial activity to a human mouth & throat which leaves many opportunities for disaster. You will need serious antibiotic therapy for several months while the GI tracts "merge" and the surgical wounds heal.

* Antacids and anti emetics. "Segments" will need antacid therapy to prevent ulceration of the merging GI tracts while the anti emetic will prevent the risk of aspiration pneumonia if a "segment" regurgitates when the segment in front of it defecates.

* You will need to assess the fluid, caloric, and vitamin needs of each "segment" and fulfill them with parenteral nutrition. The merging GI tracts will not function at normal capacity and will need time to heal. You will also have to start with an oral liquid diet and slowly work up to solids as the healing continues. It would be such a waste if your creation died from malnutrition before it was even completely healed. Even after healing the middle and tail segments may need parenteral supplementation in order to maintain health.

* You will need to flush the ports on a regular basis to prevent bacterial growth and "crust" that could lead to a potentially fatal blood clot. The loss of one segment could be devastating for the 'pede as a whole.

* Mental health. It is going to be a task of Herculean proportion to get each "segment" to perform and succumb to the will of the whole. Humans tend to be stubborn and their will to survive unstoppable. It may take many weeks of benzodiazepines and antidepressants to bend the will of the "segments" to become the "whole." If you want to go a faster route I would recommend frontal lobotomy for all but the lead segment. Your 'pede will be easier to train when lucid.

* Housebreaking. Since each segment will need to urinate housebreaking will be essential to a cohesive and happy home environment. Cage training is the easiest. Follow the same procedure as if you were housebreaking a dog. Otherwise you will have to devise a diaper to fit the new configuration of the back end with exception of the tail "segment" which should do just fine with Depends.

* Hygiene. Since some of your "segments" are female you might want to give hormone therapy to prevent menstruation or consider hysterectomy to prevent a bloody mess each month. You will also have to bathe your 'pede on a regular basis and use deodorant for underarms.

* You will need to design a "shoe" to protect the dragging parts below the knees and to cushion the knees which will be supporting the brunt of the weight. It may even be necessary for amputation below the knee to prevent issues with poor circulation and blood clotting.

As you can see it isn't enough to just create the human centipede but to carefully and expensively care for your centipede to make it a happy, healthy, show-stopping part of your demented genius that would make even Mary Shelley proud to witness.

Lock It Up, Lock It Down!

I have seen it all. It used to be that people would just steal condoms, pregnancy tests, maybe a snack or soda, items to be used in illegal substance abuse, etc. I worked at a store that has to lock up infant formula, electric toothbrushes, body wash, shampoo, Tide laundry detergent, some makeup & skin care items and a whole slew of other items...

All night long the overhead pager rang out with "security scan all aisles" and it was just as annoying and much less amusing than the muzak. They also have a mix of off duty police and security officers most of the afternoon and all night long. They even have a special parking space reserved by the front door for police emergency. Those spaces aren't just at Target and the grocery store anymore...

The best thefts I know of were at the store I worked in as a student. For several months there was a small TV/VCR combo sitting on the cosmetics counter spouting its advertiserial poison. Then there was silence. For a few weeks no one really noticed that it was gone. Someone had stolen it during the overnight shift and nobody really noticed...or for that matter missed it.

Another time around X-Mas a lady walked out of the store with 2 perfume sets that set off the alarm. When the security guard nabbed her she was like "Well I don't want them now." Thinking she wasn't going to get arrested. Merry X-Mas b*tch, you goin' to jail.

On a separate X-Mas promo end stand we had TVs and DVD players chained to the shelf. Some ballsy motherf*cker walked out with the shelf, TV, DVD, and chain. You sir have mad street cred for that one! Did I forget to mention he never got caught? Well he didn't hence the street cred.

Back to the store at hand. I also got several calls from city corrections officers to verify medications for detainees. None of the people they called on were in our system. What do these douche bags think? "Maybe if I tell the officer I have Klonopin for seizures I can get some happy pills for my incarceration." N.O. If we have nothing on file for you the department of corrections is not going to magically make drugs appear for your enjoyment. In fact, I believe the officer you annoy with your stupid little game should get to b*tch slap you once for each time you lie. Ugh! Just another day of our taxpayer dollars being wasted.

When does it stop?

Speaking of Diabetes...

A few weeks ago I had a morbidly obese Type 2 Diabetic patient who was on oral hypoglycemics and insulin for blood sugar management. Her medicaid 3rd party prescription provider no longer covered the syringes or lancets so she told me to put them back because she would rather have her cable tv.

This left me wondering if she would just stop her insulin therapy. I explained to her the importance of her medication regimen in preventing further complications and increasing the quality of her daily life. She again stated that she would rather have her cable tv. I am talking $22 for 100 syringes and 100 lancets. She only used them once per day so she would get over 3 months out of each but still cable was more important than her personal health and well-being.

These are the patients that are the reason government funded health care needs a huge overhaul and strict conditions for qualification. If you don't give a shit about your health care why should the hard working tax payers cover for your ass? Why should the ambulance wheel your ass to the ER to fix you when you stroke out or have that first heart attack? Why should the doctors bother to help you when you are not going to follow their advice and use the medication? Why should you get free health care when there are others out there who cannot afford health care yet make too much money (which ain't a whole hell of a lot) to qualify for medicaid?

The system was a good idea in the beginning but it has lead to a subculture of people who take no personal responsibility for their health care or the healthiness of the "food" they eat. On the other hand most Americans overindulge in "food" in general because restaurant portions are way out of control and the corn industry plus government subsidies make junk food much cheaper than everything else. I use the term "food" loosely because you have all witnessed the bullshit that most folks put in their carts at the urging of their children or because it tastes good or because it was a new product that had a coupon, etc.

Do you know we have children under the age of 10 on statins to lower cholesterol? Do you know we have doctors performing gastric bypass on children under the age of 18? Do you know that we have more Type 2 Diabetic patients than any other nation on the planet? Did you know that complications from morbid obesity are rising to the top of the most common causes of death in America? Did you know that mortuaries now carry super-sized coffins because morbidly obese people who die are not gonna fit in that already over sized regular coffin that everybody else gets buried in? Did you know our military believes that the rise of childhood obesity will leave us with a huge deficit of eligible people to serve and protect over the next 30 years?

WHAT THE F*CK AMERICA???? Have we lost all sense when it comes to obesity and diabetes? I am waiting for the study to be done that proves that Type 2 Diabetic parents produce Type 1 Diabetic children. We are seeing rates of Type 1 Diabetes skyrocket or is it that Type 2 Diabetes is starting really really early due to childhood obesity? It is going to take a whole hell of a lot more than Michelle Obama's urging and public speeches to change this problem. Perhaps we could get Oprah, Jerry Springer, and Judge Judy to take a stand and educate everyone on nutrition, diabetes, and the horrible co-morbidities and dreary outcomes of being fat from the get go. The general population seems to listen to them more than their health care providers anyway. What a world, what a world.

Open Letter to the FDA

Dear FDA,

It is with great concern that I write this. I am baffled by the approval of Victoza (liraglutide) injectable for the treatment of Type 2 Diabetes. In the pre-clinical trials it gave rats and mice cancer. The rate of cancer increased with increased doses and prolonged use. Did you not see this in the paperwork submitted by the drug company or did you choose to ignore it and just put a warning in the packaging?

Are you f*cking kidding me? Were we at a loss of options for Type 2 Diabetes treatment that you were like "F*ck it, let's give them cancer so the last thing they will be worried about is diabetes!" Was that the great and wonderful solution for diabetes: cancer???

I urge medical practitioners and patients not to use this medication. In the past we have found that certain chemicals and medications that give rats and mice cancer also give people cancer. It is only a matter of time before we start seeing predatory lawsuit commercials touting the tag line "Did you or anyone you know get cancer or die from cancer while being treated with Victoza? You may be eligible for monetary compensation! Call XX Predatory & Pals Law Firm today!"

Every time I fill a prescription for Victoza a little piece of my soul withers and dies because I know I am contributing to a greater evil than diabetes and putting a patient's life in danger. These patients are not going to see their doctor for a little throat swelling, soreness, or problems swallowing because they will discount it as something from their acid reflux or some seasonal virus that just won't go away so that by the time they do see their doctor for the tumor that has been churning around in their endocrine system and spitting off little pieces of itself to the rest of the body it will be hard to treat.

I urge you to pull this drug from the market before anyone dies! I hope you realize that by approving this drug each and every life lost because of it IS YOUR FAULT! Fix this mistake before it causes irreparable damage to families across this nation!

Sincerely,

Big N Tasty RPH

Would you like some cheese with your whine?

This happened to me awhile ago at work, and I still get burned up thinking about it:

I was out in the OTC aisle for some reason, and this well-dressed lady came up to me and said: Can I ask you a question? I said sure. She goes on to say that her 9 year old daughter has felt very itchy between her legs for a few days now and wants to know how to make the itch disappear. First, I had to pick my jaw up off the floor, as I have a daughter around that age, and if she were ever to tell me that she was itchy in her southern regions, we would be going to the doctor Right Away! I asked the customer if she has taken her daughter to see a doctor yet. Then comes my next jawdrop. She goes on to say that they do not have time to see a doctor, as she works a high-powered job, her daughter has 3 hours of private school homework every night, plus important extra curricular activities, and that they have no desire to burden the medical system for something so trivial. All sorts of things are spinning through my head (none of them particularly good!) so I said that without a definitive diagnosis even from a walk-in clinic physician, I wouldn't feel comfortable recommending a product that may or may not be effective for your daughter. Poor kid. While you're at it, maybe get yourself a lifestyle overhaul for your family - sounds like they could sure use one.

Darwin Award of the Month

The stupidity of this guy just astounds me. The director of pharmacy, and this was the best that he could muster? Smart enough to pass the board, but way low on common sense.


WESLEY CHAPEL - A University Community Hospital pharmacist was arrested by Pasco deputies Thursday, accused of forging three prescriptions for himself.

James "Jim" Mathew Maister, 45, of 4810 Diamonds Palm Loop, admitted to deputies that he wrote the prescriptions for Norco, which is hydrocodone, under a doctor's name and had them filled at the Target pharmacy at 1201 Bruce B. Downs Blvd., a report states.

On Aug. 19, Maister gave a prescription forged on a University Community Hospital prescription pad to a pharmacist and had it filled, according to reports. On Aug. 29, he returned and asked for a refill prior to its expiration, saying he was going out of town. That one was filled, too.

On Sept. 17, he returned again to refill the prescription, but this time he was told it would not be filled unless the pharmacy contacted the doctor, surgeon Xavier Canella, to approve it. This time, according to a report, he didn't hand over the prescription and left the store. Still, the pharmacist contacted the doctor and confirmed he did not write or authorize the prescription for Maister.

The pharmacist, who knew Maister as a pharmacist and past customer, spoke with him, and he asked her not to report the fraudulent prescription, a report states. She told him it was her duty to report it. Later, Maister reportedly text messaged the pharmacist asking her again not to call police

Deputies contacted Cannella, who said he has known Maister for several years from UCH in Tampa and has treated his wife.

A deputy met with Maister this week at a Dunkin Donuts in Land O' Lakes, and the pharmacist told him he has an addiction problem, a report states. He admitted several years ago he was an addict and went through a treatment program.

"He admitted he used all the medications for himself," the deputy wrote in a report.

Maister turned himself in at the Land O' Lakes Jail on Thursday and was booked in on three counts of attempting to obtain a controlled substance by fraud. He was released a few hours later after posting $6,000 bail.

Maister declined to comment today. In 2002, his pharmacist license was revoked after similar charges when he worked as director of pharmacy at LifeCare Solutions, Inc. in St. Petersburg, according to state records. The Florida Board of Pharmacy fined him $10,000, plus cost of $1,230.

After drug treatment, his license was later reinstated with a probationary period that included working directly another pharmacist and not working more than 40 hours per week. It was not clear if he's still employed by UCH

I can't contain my joy over flu shots.

I had a busy summer, gearing up to the big announcement that now our pharmacists were going to give flu shots. The hype was crazy. Except, not at all, because people come in confused that we're offering them every day. I understand our big advertising push hasn't started yet, but our Muzak announces it every 5 minutes and all of our signage says something like "for the love of god, let us stick you!" Not to mention the big ugly button all of the pharmacy staff has to wear declaring "ask me about flu shots!" None of this is unusual, but let's just say I'm having issues with some of my coworkers. Most of them are really opposed to getting one and have no problem letting our customers know that. Me being me, I told one of our techs outright that she couldn't tell patients "I never get them, they will give you the flu and I was really sick the last time!" She's also an idiot so I didn't feel that guilty. Another tech is opposed to all non mandatory shots, but she's also not slow and doesn't broadcast that.
The one I came to talk about, though, is the one we lovingly call "the boy." He's our only tech of the male persuasion and the youngest on staff, so he gets more than his fair share of teasing. He was so violently opposed to a flu shot that I bribed him to get his done with a soda. (Hey, I'm a tech and cheap.) My pharmacist took one for the team and in her words, he cried. Cried! I still laugh over that. This was two weeks ago and he's still complaining about how his arm hurts and now he's gonna end up with SARS. No wonder he's single.

New job, life updates

So I've gotten a new job... keeping my part time job in retail, partially for the benefits, partially for the lulz. I apologize for the lack of updates.

I now work in a hospital, with nothing major to report yet except for the fact that DAMN, we have a huge staff for a relatively small volume of prescriptions. I honestly watched Netflix for part of my day today. I am either going to be bored to tears very quickly, or love this job more than children love puppies.

-- Fries with That

Who's Your Daddy?

We have pretty much seen it all in the pharmacy. First you could get a genetic test in a box to find out "Who's your daddy?" and now you can get a test in a box to find out if you are having a boy or a girl. This comes in handy when you live in an area where infanticide has become commonplace when one gender is preferred...not mentioning any large country that supplies most of America's imports, especially my favorite Mardi Gras beads and Le Vian jewelry knockoffs, but you know who you are....

We have become so super duper advanced that we can't possibly wait to find out if that little munchkin blooming in the womb has a stick or a hole. Why do we need a test in a box for this? Shouldn't you be seeing an obstetrician and making sure your babe is getting the best in nutrition so it isn't born looking like an extra in "The Hills Have Eyes?"

Some of the over the counter test kits have gotten way beyond ridiculous! What's next the "Liver Cirrhosis Test Kit" or the "Herpes, Wart, or Syphilis Sore Test" or maybe an "Is This Vaginal Scraping Cancer Test"? It is seriously starting to sound like the parting gift from some crappy game show and we are all gonna get the "Dr. Oz Home Game" on our way out the door. Thanks, Oprah...

I just don't approve. There are several conditions that you absolutely should see a doctor for. For example: There is a dark tarry substance in your poop. You don't need to spend $35 for the Fecal Blood Test. I guarantee you have blood in your poop so go see a doctor. "But Tasty, I don't want to drink that horrible liquid and crap myself for a day so a doc can stick a camera on a tube up my butthole." Stop your whining because I don't give a crap what you think about the necessary evils of bowel prep! You need that test to see if you have a large perforated ulcer (ie open hole somewhere in the digestive tract through which digestive juices and bacteria can seep out amongst your other soft tissues and organs nearby and have an Armageddon party at your expense) which requires surgical repair or if you have cancer which can be biopsied and treated. The longer you let something like those go the smaller and smaller your chances of successful treatment and survival.

The point is this: Many of the over the counter diagnostics are unnecessary and may lull you into a false sense of security. That HIV test in a box may give a negative in someone who is infected because it can take many months before the virus has replicated enough to be positively identified. Why do you think the Red Cross won't take blood donations from men who love that sweet sweet man on man back door action after 1977? Or for that matter prostitutes after 1977. They do put it ever so delicately on the questionnaire...

The best thing you can do when a problem arises is ask your friendly neighborhood pharmacist and we will let you know if it is something you can try to treat for a few days or if you should call your physician immediately. You don't need to use test kits unless your physician advises you to. Most people that use over the counter testing are doing so for blood sugar and/or ketones and to determine pregnancy. Those really should be the only over the counter tests we need and everything else should be done through a clinic or doctor's office.

Patent Infringement???

Look closely at the upper right side of the picture. Is it just me or does this particular drug delivery design look like the Clorox Toilet Wand? I was filling in at a 24 hour pharmacy and noticed the package when I was getting something else and I just chuckled. I hope it is just being used to treat back acne or maybe it is treating those "freckles" on your arse?

Dear Clorox, maybe someone should look into this? Maybe it is not worth the time. Maybe it is different enough to not infringe on your patent for the Toilet Wand, which does an awesome job of keeping my bowl tidy! Just thought you might want to know. Thanks! Big N Tasty RPH

Delish!

Behold the glory and magically delicious awesome that are these sixty Skittles. It is in fact the whole small bag minus the one Skittle that I just had to eat because it was looking at me funny. Sixty is a mighty big number of Skittles but it is even bigger when I took this particular pic of sixty Skittles to represent the sixty medications a patient is on.

Let that sink in: S-I-X-T-Y different medications.

Seriously S-I-X-T-Y different medications. Not only is that a Herculean task to keep track of dosing but are you even hungry after eating that many pills?

I happened to be filling in at a non-24 hour pharmacy and a lady came in with two Ziploc bags of medication bottles for us to transfer from another state because her sister moved in with her so they could help take care of her. We transferred about 12 prescriptions that day and the pharmacist at the other pharmacy told us she had 60 medications so we would probably be calling her back sometime soon for more of them.

I have not seen her entire list of Skittles but her sister said she was "real sick" but I just have to ponder how many of those Skittles she really needs. I am just saying when you get in the double digits of Skittles you are in duplicate therapy territory, not to mention ready for a stomach ache. I also wonder how many Red Skittles she takes to counteract side effects of Yellow Skittles and how many Green Skittles are treating the same disease state. The interactions can be limitless.

I also wonder if any of her doctors have seen her list of Skittles from her other doctors. This is where we have a problem with Skittle therapy in general. It is imperative for pharmacists to identify issues of over treatment, duplication, toxicity, etc. I am a firm believer in the minimalist approach to Skittle therapy. For each desired effect of a Skittle there are a possibility of hundreds of undesired effects. Some Skittles are worse than others and it also depends on how well a patient tolerates each Skittle and if the Skittles interact with each other. It is an increasing problem when patients use multiple physicians and multiple pharmacies to treat multiple disease states.

The moral to this story is that every patient should keep a current drug regimen list with them in their wallet or purse at all times. This will help keep drug therapy to a minimum and could save your life in an emergency situation. The other point to this post is that Skittles aren't only the most awesome candy on the planet but it is fun to say and I want the world to use the word Skittle just like those annoying little blue Smurfs overused their name. Don't make me Skittle you in the Skittles!

Ahead Of The Curve

According to several web sites the official start to "Cold & Flu" season is November. If this is true why the hell do I have a cold? I guess I have always been ahead of the curve when it comes to rhinovirus infestations. Good ol' Typhoid Tasty is back in action! Be happy I can't infect computers or everyone with Internet access would be so screwed...

I am the worst patient when it comes to snot. Nothing screams sexy like sleeping with a box of tissue so that you can jam one up your nose to stop the constant drip imparted by el rhinovirus and dive back into a Nyquil fueled semi-coma. Even better is when I use the Kleenex with Aloe so in the middle of the night I don't know if I have already used this particular tissue for snot or if it is the slimy semi-wet feel of an unused tissue. Either way it is getting a new slime coat courtesy of my sinuses.

Simply put the attacking rhinovirus sucks burro genitalia ie. donkey balls and makes you feel like you have been beaten and left for dead. A billion uses of hand sanitizer will not stop an airborne rhinovirus and neither will that waste of time and money fizzy tab Airborne crap that pharmacies nationwide schlep in the name of the almighty dollar by profiting on fear and misinformation.

Your only hope is to live in a hermetically sealed bubble or just avoid sick people all together. When you do get a rhinovirus all you can do is treat the symptoms and wait for your immune system to do its job. PLEASE don't go running to an MD, NP, or PA looking for an antibiotic! Antibiotics are for BACTERIA not VIRUSES. Follow my lead and leave yourself in the warm embrace of a Nyquil semi-coma and let work know you won't be in for a few days (unless you really despise everyone you work with then who am I to tell you not to go in and breathe and/or snot on everyone).

Yay Nyquil!!

Unnecessary Asshole!

A lady peers into the window holding an OTC medication. She looks at the tech and says "I know he doesn't know the answer but this box says compare to Tylenol on it so is it the same as the Tylenol infant drops?" I told her it was our store brand of the Tylenol infant drops and she walked away.

The tech was appalled at the rudeness of the lady and was lamenting upon how he was having a hard time dealing with the rudeness of society and unsure of staying in the pharmacy for the rest of his life. Even funnier was the fact that she had flunked out of the EMT program they were both in so of course she wouldn't know crap about medication.

Everyone in the pharmacy got into the discussion of how many people are rude and just don't realize it because they tragically have no moral compass or respect for other humans. They probably kick puppies for fun. Unfortunately these are the people we and everyone who works retail have to deal with every day. These are the people who travel to other countries and give Americans a bad name then get us bombed by radical terrorist groups.

Some people are so f*cking rude!

Back In The Saddle

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A Little Time Off

Sing the following to the tune of The Beverly Hillbillies:

Come and listen to a story about Big 'N Tasty
Disgruntled pharmacist, sick of living by the sea.
Everything was great 'til the housing bubble blew,
And she was left with a house worth less than kittie poo.

Upside down that is, shit hole, money pit.

Well next thing you know old Tasty's out of there,
Kinfolk said "Tasty move away from there!"
Said "Back home is the place you ought to be!"
So movers loaded up the truck and she headed northerly.

Midwest that is, meth labs, missing teeth.

Well now it's time for Tasty to work retail again,
So she will have tons of stories to make you split a grin.
You're all invited back to peruse this blog locality,
To have a heapin' helpin' of her work hostility.

Sarcasm that is. Sit a spell, laugh your ass off!

Y'all come back now, y'hear?

Names

Nothing makes me giggle inside more then a patient who named their child something bizarre, with an even more unusual spelling, forgets how to spell the name.

Karma, perhaps?

You mean they actually WATCH those camaras? (Darwin Award of the Month) Oh yeah, also Mother Of The Year

NEW PORT RICHEY — Jill Borrero slipped the pills in her pocket, behind the counter of the Kmart pharmacy where she worked, thinking no one was looking, authorities said.

But the newly installed security camera caught her on tape.

Kmart's loss prevention district manager alerted New Port Richey police, who arrested Borrero on Wednesday afternoon on a charge of grand theft. She was released on $2,000 bail.

Borrero, a 50-year-old pharmacy technician, is accused of stealing hundreds of prescription pills over the past two months — a pocketful at a time.

"I didn't feel I was taking enough to cause anybody any grief," Borrero told Bay News 9, the St. Petersburg Times' coverage partner. "It was just a few."

But it added up. Over the past few months, police said, Borrero pocketed:

• 1,451 pills of 2-milligram Xanax.

• 149 pills of 1-milligram Xanax.

• 132 pills of 2.5-milligram hydrocodone.

• 20 pills of 1-milligram Lorazepam.

Altogether the pills are worth $999.58, New Port Richey police said.

Borrero, of 4424 Rudder Way, told police she took the pills for her sons.

"The two sons appear to have a substance abuse problem," said Lt. Steven Kostas. He added, "I'm sure there might have been a little drug sales going on on the side."

Borrero gave a different explanation to Bay News 9:

"The Xanax I took as a stress thing," she said. "The Vicodin I took because my son has very bad teeth, and he's always got a toothache, so I was just trying to help him out."

The manager at the Kmart at 5725 U.S. 19 referred media inquiries to the company's corporate spokeswoman, who declined to comment other than to say the store is fully cooperating with the police investigation.

It's unclear how long Borrero had worked at the store. But Kostas said the security camera was just installed in the pharmacy on Sunday.

He said it caught footage of Borrero pocketing a handful of pills Monday — and a whole bottle Tuesday.

Guess Who Found a Mess From the Overnight RPh?

I figured out a way to save my employer a truck-load of money. Our store is 24 hours, which equals 24 hours of pharmacist-on-duty. Our overnights give away more drugs for free (because you can totally trust people that come in as a new patient at 2am) then we get reimbursed for. So, I figure if we just leave the pharmacy open, without a pharmacist, and just have a "log book" of sorts, we'll actually be ahead of the game because we won't be paying the overnight pharmacist any money.

Sure there are flaws to this, like that pesky state board, but really, we are a corporation, we should be able to get around that no problem!

OKAY!

It starts with a simple YouTube video that gets parodied by a cartoon that gets another parody/redemption on a TV web show. I of course had to parody it again after some laughter, rewatching the original, and talking to some friends who read the blog following a phone call late one night that began with "CHANGE THE CHANNEL NOW!! YOU'VE GOTTA SEE THIS!!" I am talking about the one and only "What what In The Butt" by Samwell, parodied by Butters Stotch on South Park, and the interview/acoustic redemption on Tosh.0 featuring Josh Homme from Queens of the Stoneage that sparked that frantic late night call.

The Anti-emetic Suppository Action Song version:

I said: "What what, in the butt"
I said: "What what, in the butt"
I said: "What what, in the butt"
I said: "What what, in the butt"

You wanna put it in my butt, in my butt?
You wanna put it in my butt, in my butt?
You wanna put it in my butt, in my butt?
Let's put it in the butt,
OKAY!

I know you see me puking, over there
Come help me, if you care
Don't sit and stare, it's just not fair
Stop my puke, if you dare

What what

I said: "What what, in the butt"
I said: "What what, in the butt"
I said: "What what, in the butt"
I said: "What what, in the butt"

You wanna put it in my butt, in my butt?
You wanna put it in my butt, in my butt?
You wanna put it in my butt, in my butt?
Let's put it in the butt,
OKAY!

It's okay, I don't wanna puke tonight
Please hurry, I don't wanna puke tonight
If you insert it, I'll bend right over
Just be gentle, use lube and a glove

I said: "What what, in the butt"
I said: "What what, in the butt"
I said: "What what, in the butt"
I said: "What what, in the butt"

I'm still puking on my knees
All I want is that suppository
Give it to me if you please
Give it to me if you please

I'm still puking on my knees
All I want is that suppository
Give it to me if you please
Give it to me if you please

I said: "What what, in the butt"
I said: "What what, in the butt"
I said: "What what, in the butt"
I said: "What what, in the butt"

You wanna put it in my butt, in my butt?
You wanna put it in my butt, in my butt?
You wanna put it in my butt, in my butt?
Let's put it in the butt,
OKAY!

I said: "What what, in the butt"
(I'm still puking on my knees)
I said: "What what, in the butt"
(All I want is that suppository)
I said: "What what, in the butt"
(Give it to me if you please)
I said: "What what, in the butt"
(Give it to me if you please)

You wanna stick it in my butt, in my butt?
(Give me what I need)
You wanna stick it in my butt, in my butt?
(All I need is that suppository)
You wanna stick it in my butt, in my butt?
(Give it to me if you please)
Let's put it in my butt
(Give it to me if you please)
OKAY!

I said: "What, what"
OKAY!

WHAT IS YOUR NAME?

Dear customer/patient/dipshit standing at the counter with your mouth open or calling me again about your vicodin "subscription",

For the LOVE of sweet baby Jesus and Allah-you gotta start the conversation with your NAME!! I don't know who the fuzz you are if you don't give me a name!! Throw me a bone folks!!

My new fave thing to say to your people after you've rambled on why your refill is too early (you went to the moon again? yeeehaaaa) or your dog ate your vicodin (bring me your dog yo!) or why isn't it all your meds $4 (thanks for that, Wal-mart), is to say "let's start with your name". Total silence. I get nothing but total silence from you. Why is this? No one taught you to start a business transaction with your name? I don't have caller ID, you don't wear a name tag and by God, I am not psychic! Now give me your name and we can get somewhere. Pretty please? With Kadian sprinkles on top? Yeah-that got your atttention!!

Love,

Filet

Phrases I Hate In Pharmacy

I think everyone has certain phrases or key words that just set them off.

• "Every time I come here there is a problem."
• "You people" followed by some ignorant non-issue.
• "Do you have $4.00 prescriptions?"
• "How long is this going to take?"
• "Did my insurance not pay anything?"

What are the comments that send you off the deep end, if only in your head?

To The Skanky,Flirty Seeker

Damn it. Leave me alone. No, I can't refill your Lortab yet. No, I'm not married, but I tell you that I am. No I can't "front" you a couple of pills until next Friday. No, I don't frequent any bars or clubs in town. No, I don't have a "personal" stash at my house. No, I didn't know that your boyfriend just left you. Don't I have Chera-Tussin? Sorry, fresh out 'till next week. What's the best way to get a prescription for Oxycontin from your doc instead of Lortabs? I don't know....try losing a leg? You're 22 and I'm 39. I may be a fool, but I'm an educated one, honey.

Pharmacy and eating habits (lame!)

For the last several months, I've been going to the gym and trying to watch my food intake. Bringing my lunch to work instead of eating convenience foods and fast food was the biggest problem I had. Still, we always have some sort of terrible snack food in the pharmacy... this week I have surely eaten my body weight in Cheetos, Starburst, and dark chocolate. They live in a drawer that is way too easily accessed - whose idea was it to have a junk food drawer?! Do you guys deal with this too, or do you just have much better willpower than I do?

We Are Not As Stupid As You Think We Are

Shopping list: pill crusher, insulin syringes, rx for roxicodone from several counties away

Duh, we know you are going to shoot up your pills. So don't try to act all shocked and amazed when EVERY pharmacy for 50 miles tells you they don't have oxycodone tabs in stock. Also don't be so shocked and amazed that you can't buy a bag of syringes in Broward county without a prescription. Saying "But I can buy them in Pensacola and Jacksonville." earns no sympathy and does not magically produce a baggie of syringes for you. It is people like you that this type of law targets you f*cking worthless piece of sh*t furuncle on the taint of humanity!

It is douche bags like you that end up corrupting the pain management system by supplying the cash to corrupt greedy physicians and supplying tabs to first time users who either overdose and die or end up hooked for life. This also makes it damn near impossible for legitimate pain management patients to get their necessary medications. If the law would allow it I would do a handy dandy pharmacy spatula castration so you could not breed!

To take it a step further, the law should allow us to kill junkies like this one. Just send them to the worm pile like the worthless sh*t that they are! Why waste tax payer dollars on rehab facilities and jails? Let's cut out the middle man and save the tax payers millions of dollars! Rehab failure rates for first time attendees is 95% so why bother? Seriously, why bother?

Laziest.Doctor.Ever

Hey lazy bones, MD!

I cannot believe you refused to dose your patient's cefuroxime suspension, you LAZY POS (piece of shit in case you don't know the lingo). Good GOD! Why in the hell did you become a doctor? Not only did you make me pick the drug, you refused to look up the dosing in mg/kg, didn't know the child's weight, nor did you give me the duration plus you got totally got pissed off when I asked for your name. YOU SUCK! I hope you get sick and I get to dispense your medicine b/c believe me-you are going to get quite a verbal lashing that I should have given you today but I was too damn frustrated with your douchery so you are super lucky I just hung up on you.

FUCK YOU on behalf of all pharmacists and your patient.

No love this time,

Filet

About blister packs

Just once, I would like to be caught up on the blister pack schedule. Or even ahead, for a change. But even though I don't interact with the regular customers while I'm in the back processing blister packs, there are always some kind of pitfalls or drama or both. I have a nice caregiver come in one weekend that I work and ask if her client can transfer his blister packs from his current pharmacy to us. Sure, no problem, as long as he has refills, it's all good. Monday morning comes and the caregiver calls for those blister packs. Hmm, let's call the other pharmacy for that transfer. No refills, you say? Ok let's call the Dr. and ask for a new med list. And you want these 15 meds done when? In an hour??? Considering that I'm off in 10 minutes, and there is no hope of that getting finished in time, I get to leave a detailed note for the next victim who is lucky to do blister packs. Next day, I heard that we got the blister packs done in record time for this client, and the caregiver comes to pick them up, and asks "Where's the rest of it?" We generally fill 1 month or less at a time, with about 2 months of refills on file. Apparently they were expecting all 3 months of his medication to be blister packed at one time. My boss said no, here's one month for you now, come back next month for the next set. They refused to take the blister packs, so now I get to return it all back to stock. That's 1 hour out of my life that I will not get back, thanks to them. Oh yeah, three guesses which shift I get to work tomorrow?? Let the games begin!

Pharmacy Hotties quote

makes me laugh every time I read it!!

"Pharmacists are little minxs. They are super intelligent, but not nerdy enough to be doctors. So, that means they have an untamed wild side. Dirty little pill poppers. Apparently they also have big tits (who knew). You’d better believe they take drugs. They see how effective they are on a daily basis. They also get to see people just before they kick the bucket so they know that they have to make the most out of life. Never underestimate a smart chick."

I am sure a Mr. VR would agree!!

xo xo

Filet...

Dear Cheap Ass doctors-do NOT do this unless you enjoy pissing me off!!

Hey you know who you are special MD's who like to boss us low life pharmacists around,

Do NOT put what the cost of the medication on the prescription. We have our own prices set by corporate. DO NOT ever write $4 on the script unless you are sending your patient to a pharmacy that definitely does not care about being a pharmacy and are strictly a factory drug farm. Even then how can you guarantee that pharmacy is going to honor that price?

What kind of bullshit is this?! How about I write "no copay" on their prescription, send their happy ass back to your office and demand a refund for their visit?

Stop playing games! I don't have time for that!! I spend too much time explaining why YOU chose to do something so incredibly stupid! Who does this? Total douchebags screwing over the pharmacist again and again.

THANKS for nothing!!

Filet

Bad Doctors

Perhaps it is the hormones speaking, but I have just had it with doctors today. First script problem today, a doctor wrote for Macrobid 200mg. Three phone calls put on hold for around 20 minutes by the office and finally received a call back to clarify that is in fact Macrobid 100mg. Duh.

Second issue was with a doctor who either wrote the quantity wrong or the directions and his office number at the hospital goes straight to voice mail. After three attempts I call the main desk to have him paged. Do you know what the genius of all doctors says to me? Is there a direct line because he doesn't like to push buttons and usually won't even bother calling a pharmacy back. SERIOUSLY? Is he kidding? Nope, so I didn't hold back and let him know it is the same thing as calling his office number and not being able to speak to a human over his inability to write a script right.

ARGHHHHH!

Summertime Summertime Sum Sum Summertime!

Oh kids, it's once again that glorious time when school is out for summer and the days of unstructured time lie ahead! Woohoo! I want to give you some small pointers to enjoy yourself and come out unscathed.

If you have asthma you should have your "rescue" inhaler with you at ALL times! If you have severe insect sting allergies you should always have an Epi-pen with you at ALL times! It may seem a little dorky but it will save your life! You don't get to play video games or sports in the grave...what a bummer...not to mention your family and friends would be really really sad to say goodbye one last time.

Enjoy the daylight hours outdoors. Save the video games for rainy days and evenings when the mosquitoes are out because who wants to risk getting West Nile Virus when the stunningly absorbing worlds of God of War or Mario Galaxy 2 await to cripple your fragile little fingers with hour upon hour of button mashing joy. You know what else is really fun getting family and/or friends together and "kicking it old school" with a board game. You can't beat an evening with Hasbro or Milton Bradley and a small crowd. I know you find it difficult to believe the world was without electronic gaming but there are a lot of classic board games with silly phrases like "You sank my battleship!", "Yahtzee!", and "Go to jail, go directly to jail. Do not pass Go, do not collect $200." to be enjoyed over and over and over again.

Speaking of being outside, don't forget sunscreen. This is one of the most important fundamentals for fun in the sun. Each and every little sunburn accumulates over your lifetime and not only leads to dark "liver" spots but can lead to different types of skin cancer not to mention the excruciating pain and itching resulting from a sun scorched carcass.

Keep yourself hydrated! Drink plenty of water instead of sugary Kool-Aid, disgusting adult sports drinks and sodas. You won't be able to play at full tilt if your body is screaming out for moisture. You can't just soak it in like Sponge Bob you have to drink it.

Enjoy sports, playgrounds, parks, your yard, and anywhere you can interact with the beauty and serenity of nature. Play fetch with your dog, ride a bike, skateboard, join a summer sports league, swim, theme parks, etc to fend off obesity and so the kids are worn out at the end of the day which allows parents some quality down time for a little adult enjoyment...brown chicken brown cow...if you catch my drift... Better yet adults, summer camp can give you and your honey plenty of quality alone time this summer, wink wink.

So whatever it is that you do this summer (I am headed to Universal Studios & Disney for Star Wars weekends with my brother and nephew) make sure to take a few small precautions to ensure maximum enjoyment with minimal annoyance because it is all good and fun until someone ends up in the emergency room!

Contest winner

Holy slacker I am! Sorry peeps but I forgot about the contest until Tasty reminded me.

Here is the winner of the Amazon gift certificate. Please contact me so that I can get that out to you.

the RPh said...

So I was working at "Big Chain Pharmacy" and called a Dr's office to verify a very iffy control Rx. I left the message on the "urgent" line. About 20 minutes later the nurse/office manager called back and asked my tech what our address was so she could send 911. I got on the phone and told her we didn't need 911, that we were a pharmacy. She said that since I left a message on their "emergency" line, I must need 911 and asked for the address once again. After two more attempts to tell her my reason for calling and her insisting that I must need 911...we got into an arguement and I told her she change her voicemail message to make it clear that they would call 911. She told me she would relay the message to the Dr and I said for her to try to not be a b*tch wehn she did. Long story short, I no longer work for "Big Chain Pharmacy"...but I'm proud of myself for standing up against rudeness!

A shorter line to our counters soon? (please!)

Successfully treating chronic pain with opioids such as morphine and oxycodone — minus the side effects (such as euphoria) — may soon become a reality, bringing relief to millions of people who suffer from debilitating pain, according to Distinguished Professor Linda Watkins of the University of Colorado at Boulder….

(And also put and end to opioid abuse, once and for all: no buzz=no reason to abuse, sorta like advil)

Recent work by Dr. Watkins, a neuroscientist, and others has shown that glial cells in the central nervous system act as key players in pain enhancement by exciting neurons that transmit pain signals. They also found that glial cells hinder the ability of opioids to suppress pain.

Now they believe they have figured out how morphine affects glial cells and neurons. “We’ve found that different receptors are involved in how morphine suppresses pain through its actions on neurons versus how morphine activates glial cells,” Watkins said. “What this means is that you should be able to separate the suppressive effects of morphine — its pain-reducing effects through its action on neurons — from all of its bad effects when it excites glial cells.”

A paper on the topic was published online in August in the journal Brain, Behavior and Immunity.

Under normal circumstances glial cells are thought to be like housekeepers, said Watkins. They essentially clean up debris and provide support for neurons.

“What’s become evident is that glial cells have a Dr. Jekyll and Mr. Hyde personality,” Watkins said. “Under normal circumstances they do all these really good things for the neurons, but when they shift into the Mr. Hyde formation they release a whole host of chemicals that cause problems like neuropathic pain and other chronic pain conditions.”

The challenge was to figure out how to let morphine do its work on the neurons, without alerting the glial cells, which are known to suppress morphine’s ability to kill pain, she said.

To keep the glial cells quiet, the team used a type of drug called naloxone to turn off what is called a toll-like receptor, which is found only on glial cells and not on neurons. Doing this blocks morphine’s effects on glia but not on neurons, resulting in effective pain relief without addiction and other side effects.

The team found a particular receptor, called TLR4, not only is important in driving pain but also detects all clinically relevant classes of opioids.

“So if you block this receptor, this should not only block chronic pain, but also make opioids work much better by suppressing pain, while avoiding the bad actions of glial cell activation,” Watkins said

Letter To Santa

Insurance?

I have a terminal patient whose lovely insurance has decided to not cover her Roxanol. I am so appalled right now, I can barely speak.

Luckily, I have a little discretion in the pricing, so I was able to make it bearable, but still, I cannot help but hope that reform will eliminate such arbitrarty idiocies.

Will sombody please burn my C-V sig book?

My store is one of the very few in Alaska that still has the old C-V signature log. Which of course creates a super-funnel to the front door of every Chera-Tussin chugger within 100 miles. The main reason we have it is because of the cruise ship passengers from who-knows-where are usually coughing up their guts by the time they get here. We literally cannot keep it in stock because of the local codeine junkies. Besides the obvious, any imput as to curbing the flow? I'm needing some creative ideas here! I remember that my father used to limit the regulars to 4oz./wk., but the flow up here is too damn distracting.

Phentermine!

Does anyone else apparently have a weight loss clinic right around the corner? I swear we must do a half-dozen Rx's/day for phentermine+citalopram from the same guy.

And when he wants generic Fastin, it's always Sandoz brand, not that we carry any others.

At least we finally got the walk-in clinic doctor to stop writing Phenergan w/Codeine #240mL to everyone who walked through the door. We called to verify an Rx from someone from out-of-state who saw him, and apparently he was writing 20-30 of them a day. He's an ex-orthopedic doctor, and apparently had no idea why he had a dozen people in his waiting room at a time all with a cough.

Happy Spring?

Yet another whine about the vagaries of the weather and the evil drive-thru window that opens into the wind.

You warm, safe, patients drive up in your mostly sealed-up, into the lee of the wind car, and can't understand why we shudder, squint, and spit out rain, sleet or snow.

But, if we close the window for our own warmth and sanity, you stomp in, complaining all the while at being "forced" out into the weather.

Where, oh where, is Spring?

Nice Try Jackass

A man in his 40's walked up to me, a customer we'll just call "Mr. Seeker", and thrust his bottle at me, demanding to know why his Oxycontin wasn't working. So, upon investigating the pills that were left, at first glance they appeared to be 20mg. Oxycontin. But when I checked the pill I.D., it turned out to be a generic (AURO) simvastatin. When I informed Mr. Seeker of this, he seemed enraged that we could mess this up so bad, and demanded that I fix the problem. Since I was the only one filling the CII's here the day it was filled, the possibility of a tech or someone else tampering was not a reality, especially since Mr. Seeker told me that he waited on the Oxycontin to be filled that day. It never even hit the 'will-call' box. "I'm sorry Mr. Seeker, but I filled this prescription personally, and I can guarantee you that that bottle was filled with 60 Oxycontin when it left here." Of course he just stared at me, wondering what to do next. So I told him that if he would be able to wait for a spell, I could do some checking to 'verify' this. Not that I have anything else to do, jackass. "Good, you do that", Mr. Seeker said, with hope in his eyes. Well, when I pulled up his file, guess what other drug (among many) that Mr. Seeker takes? You guessed it, simvastatin 20mg filled two weeks before the Oxycontin. For the hell of it, I ran a quick inventory of my Oxycontin 20's, and as I thought, it was tight on the spot right-on. "Mr Seeker, I'm sorry, but it looks as if you might have gotten your pills mixed up. Do you ever remove all of the pills from one bottle and mistakenly put them in another? Because these pills here are your simvastatin 20mg." He looked hurt and pointed at me and shouted,"I'll have your job for this!!!!".
Sighhhhhhhh. Mr.Seeker, you can have it right about now.
Well, my 15 minute lunch is over. Errrrrrrrrrrrrrrr.

I Don't Pay For That!

To keep life schlepping pills for the man interesting I will on occasion fill in at other locations during the day. It is like going to the zoo except we are the animals in the cage and the patrons are usually hostiles.

One day I worked at a busy store in a relatively sketchy north Miami neighborhood that I had covered a few overnights previously. I am not sure why people don't like working there. I rather enjoyed it. The rapid pace made the time fly and I actually had 2 techs to talk to so that I didn't have to talk to myself and look schizophrenic. I was also amused one night when I covered because a police car was in front of the store and had a flat but the officers didn't know how to change a tire so they had to call for someone to fix it. I took an extra few minutes to drink my Red Bull and giggle at the evening's entertainment. Poor little piggies...

I have never had a problem or been yelled at by a patient there until this glorious day when a lady pulled in the drive thru. You could see from the window that all 3 of us were busy helping patients inside and one tech told her on the drive thru phone that we would be with her in a moment. The lady starts honking her horn repeatedly then knocks on the window like a jackass. Before anyone has a chance to assist her she pulls away.

The smack-smack-smack of flip-flop shod feet trumpeted her majesty's arrival followed by a purse being slammed down on the counter and a jingle of keys. She then proceeded to chew us out for making her wait all of 2 minutes in the drive thru before she decided to come in the store. In the time it took her to park and walk in we could have assisted her at the drive thru.

I pull her prescriptions from the bin and let her majesty know that one of them was not covered for 360 pills of SOMA. She loudly rebuked and said "I don't pay for that!" She said she would come back at the beginning of the month when her Medicaid would pay for it. She then proceeded to pull the upper part of her dress down to show me her shoulder and how badly warped it was so that she really needed those pills. I had to bite my tongue not to laugh at her.

Her majesty was the poster child for someone who becomes an addict and it was even funnier that her addiction induced emaciated ass had been out on a date and her consort was another poster child for addiction. He even inquired into the next refill day for his 240 pills of Xanax even though he knew it was 2 weeks to soon. Such a charming pair. Ain't love grand?

Open Letter To The Self Rightous Cunt At The Counter

Dear Self Righteous Cunt At The Counter Screaming At My Day Staff,

I overheard you screaming because your medication was not in stock and you were pissed off that no one called you to explain what "back order" means. There is in fact an automated computer dialer that will call and leave a message saying "This is Walgreen's calling to let you know there will be a delay with your prescription. Please contact {store info here} if you have any questions." You obviously didn't even bother to listen to the message and assume Walgreen's on the caller ID means your prescription is ready.

The other problem is that some phone services will call block corporate numbers, so unless you have put Walgreen's in as a business to not call block you will never get a message, the same applies to the spam filter on your e-mail.

A consequence of screaming that the solution to letting her know was to call (954) xxx-xxxx (I won't publish out of privacy concerns) was stupid on your part. When not on the clock I have a penchant for evil and the will to see it through. I remembered your home phone number and have since given it to the Mormons, the Jehovah's Witnesses, and a couple of fringe religious groups so your immortal soul can be "saved."

The reality is that screaming at people who know your personal info can be damn annoying if not lethal. Have some common courtesy for the staff that has to do 400 prescriptions with 1 pharmacist and 2 technicians. They are way overworked and if you are lucky don't miss fill your prescription and kill you. Actually they would probably be doing the world a favor.

I also hope you overheard me talking to the store manager about how self righteous hateful bitches like you were the reason I quit. That was my intention after all just so you are aware that everyone knows you are a cunt. I think the gentleman standing in line behind you was ready to punch you in the face so it would not have made any difference if I did it or not.

If you are lucky the only other consequence will be that the day staff transfers your shit to CVS so they can deal with you. I have a feeling CVS would be quick to transfer your shit back to us because you are a total cunt! The end result of this is usually that the ones who do get sent back to McDuggie's are a lot nicer after the entire profile transfer fiasco. It has been a tried and true system for the last 16 patients I have done it to. I believe the Dog Whisperer would approve with this method of dealing with bitches. I hope this works for you!

Sincerely,

Big N Tasty

Mayday! Mayday!

I am a pain junkie which ensures that I will never be a pain pill junkie. My latest foray into pain is a multi-session tattoo that pretty much covers my whole back. I was lucky enough on my last session to be entertained by a newbie who was getting a black/gray portrait done on his upper left chest.

For the unanointed-tattoos hurt. It is a fact that having a needle jammed repeatedly into flesh really fires up those nerve endings and they are definitely not happy about it. So when newbie asked if it hurts I just giggled and said "Of course it does but after a while you just notice the sound and the vibration more than the pain." It also helps if you engage in conversation so that you are not concentrating on the needle and where it is going.

He was having a rough go. It was highly entertaining to watch him squirm and moan while I am trying to not move from laughing as an 11 gauge needle is ripping through my back. The other problem is that my tattoo guy was laughing and I had a friend with me and as he laughed harder so did I while trying not to move. It is damn near impossible not to move when in the midst of a giggle fit.

When he was finally done we left him with some parting advice along with a few tasty bites I threw in here for my sick little monkeys:

1. Be sure to tip or the next one is gonna give you an intensely bad experience for a definition of the word "hurty."

2. It's not rocket science, it's basic wound care. You don't need anything fancy. Washing a tat with your household Dial antibacterial or antibacterial hand soap is enough to keep it from getting infected.

3. DO NOT SCRATCH!! This can lead to chunks of skin coming out and taking the ink with it. I have a small spot that I did that to and will have to have it fixed.

4. It rubs the lotion on its skin or else it gets the hose again. You don't need to slather a thick ointment all over it for healing. Lubriderm lotion with no perfume is perfect to keep the tat moist so it doesn't scar as it heals. Apply multiple times per day. I apply at least four times and more if it gets itchy. I f*cking despise itchy! Again you don't need to slather a whole lot on. We are not greasing pigs we are healing a series of puncture wounds.

5. Tattoo artists tend to be a disgruntled lot because they deal with many of the same ill-planned/ill-chosen/ill-mannered/uninformed/irresponsible people that we deal with at the pharmacy. Don't be a douche because that Japanese character for "strength" is just a few needle pricks away from being the Japanese character for "retarded." Caveat douche! (translation: douche beware)

6. It hurts a million times worse to have that tattoo lasered off (doesn't it Filet) than to have it put on. Make damn sure that when you get Satan's face tattooed at the base of your penis with the shaft of said penis tattooed as Satan's tongue it is forever! (To clarify it wasn't Filet that had Satan it was a guy at a gay bar that got his jollies showing it off. It happens sometimes that's why they call me the penis whisperer. For reasons unknown many gay and straight men have been compelled to show their penis for my amusement be it Mardi Gras, tattoo, piercing, or a pitiful attempt to let me see that they are a shower not a grower. Great power comes with great responsibility and as such none of you will see my tattoo as to protect my secret identity except for a small select group of close buddies who already know about my secret power.)

I leave you with my favorite advice: When it comes to ink and penises, go big or go home! (unless you are taking it up the ass then you might want to go small on the penis but I'm not judging, I'm just saying.) Always keep it classy and drink with your pinkies out b*tches!

Subutex shortage

Hear ye! Hear ye!

Subutex and its generic are on back order! The drug companies cannot keep up with the demand. This is NOT MY FAULT! Why the issue you ask? B/C of YOU people sucking it down like its your job!! Why are you so surprised? Well, hell-did you think YOU were the only person taking it? Yeah I know. You are going to an exotic island and NEED IT so if I can cough up a supply you would be willing to pay more. No can do. Deal with it like normal folks and hey-keep calm and carry on...

Love,

Filet

Pestilence

http://www.youtube.com/watch?v=UkytL3W6q6k


Watch this clip from Supernatural and you will experience just what I see with every cold patient that comes in to McDruggie's. I laughed my ass off when I saw it and wonder if the writer of that sequence had shopped at my McDruggie's when one of these patients came in.

For those of you that don't watch Supernatural it is a show on the CW about two sexy brothers that have a bitchin' car and hunt supernatural creatures (ie ghosts, demons, etc.) and are now trying to stop the Apocalypse. They have already offed two of the horsemen and now are after the other two. The end of this episode introduces Pestilence and really pegs what a mucusy mess a cold patient can leave behind.

Stating the obvious, over and over

The last few months, I've been away from my store, working on different projects around our district. The biggie was opening a new store. It was a lot of fun, because I was not in my store and hearing my customers, but still, it had its annoyances. Like, before the store could even get shelving in, we were shooing away customers. The lack of anything in the store didn't clue you in that it might not be open yet?
It only got worse as time passed. People were in our parking lot, so that means the store is open, despite the big "Store Close" on the door, right? (one of the SM typed the sign, and then handwrote a 'D' next to "Close". Stay classy.) Eventually all of us helping set up had a 'turned away a yahoo' story to tell. I especially loved the woman that asked me how did I get in if the store wasn't open yet. It couldn't possibly be the fact that I work for the company. One guy managed to get past the workers, open the doors that weren't automatic yet and started shopping before someone saw him taking stuff of the shelves instead of putting stuff on.
It was nice, though, seeing people that had shopped at the store's location back when it was our local chain pharmacy in a strip mall to it's huge freestanding incarnation. I love being in the Midwest.
Now I'm back at my store, where someone actually got mad at me for getting a hair cut. Because I always consult the customers in matters of beauty.

Moron Alert

Most of the time I give a customer the benefit of the doubt. I try to be nice to everyone, even if they are a repeat offender i.e. bothersome drug addict, on my shit list or a holier-than-thou HCP. However, today really pushed my "nice limits".

Oh where do I start?? Maybe it was the DB that kept confusing Suboxone and Subutex after I told him 3 times what the difference is and why a shortage existed for Subutex and its generic. Showed up with a wad of cash the size of Texas yet still bitched about the cost of Suboxone. Seriously dude!!

Perhaps it was the beeyotch that complained about the cost of Plan B. Shit! Have that kid! "18 years...18 years...she got you for 18 years" Look it up! It is the Gold digger song you will be humming soon enough. Like I've said before-if it was up to me, it would be F*R*E*E. Some babies don't need to be born. Maybe you were one of them??

Really, Dr. D? You told a patient citalopram had NO side effects? OMG you need to be punched in the head. The patient almost cried when I went over them with her! Why would you do that?

I cannot read your mind. If you ramble on about your refills, disease of the week, or pizza order, I still don't know who the f**k you are so please, please and for the love of GOD and sweet baby Jesus-start the conversation off with your name. Example: "Hello. My name is _______. I would like to refill my ______. I would like to pick that up by ________. Thank you. You are the best and the cutest pharmacist in the world (brownie points for that). OK bye" Yeah! Be normal! It is not that hard.

Middle aged women-you are not the only ones going through menopause (maybe Big N Tasty is? Ha ha). Don't take it out on me. I will likely add you to my shit list, which is growing longer by the day.

Receptionists-don't waste my time! Fax the PA informatoin over. I don't want to have an epic conversation about JJ's Ensure being approved. It is a "yes" or "no" check on the damn box. "Yes" he can have his chocolate Ensure for the month or "no" way, Jose. If you were on hold for more than 5 minutes, it is your own damn fault. If you listen to the message that interrupts "Brick House", you will hear an option for leaving a voice mail. Leave it! I check it allllll the time.

Now I realize not everyone is perfect like me, but I really wish they were. Sigh.

OK enough bitching. Night!

Love,

Filet

Things I Didn't Learn In Pharmacy School

I have always been fascinated by crime scene investigation and putting together the evidence puzzle that nails the bad guys. I recently read "Bodies We've Buried" that is a walk-through of what is taught at the National Forensic Academy in Tennessee. I learned some things there that I never learned in pharmacy school.

1. The medical examiner has far better stories than I do. For example: The world of the medical examiner is a strange one-a very strange world indeed. One day, the ME might perform an autopsy on an adolescent who has overdosed on Oxycontin, and the next day extract a gourd from the rectum of a cross-dressing traveling salesman who has accidentally strangled himself while masturbating with a Bic pen jammed into his penis (we kid you not). You just never know.

2. Blood will not pool where there is pressure or clothing when you die. For example: The commode is a common place for even the best of us to die (remember the king dying on his throne). If the person dies and remains on the toilet for some time, this person will form the most ungodly and unbelievably pale ring in the shape of the toilet seat-the rest of the undercarriage will be purple.

3. Sperm is spunky! For example: Sperm can survive for up to three days in the vagina of a living person, and has been known to survive for over three years in the rectum of a frozen cadaver. Another example: Hundreds of sperm heads have been known to survive between the cheek and gum for up to six hours after ejaculation.

4. We could be a valuable food source to urban foragers. For example: Furthermore, animals are attracted to a decomposing body in succession, much as insects are. Larger carnivores (raccoons, possums) arrive first, devouring most of the flesh. When most of the meat is gone, along come the smaller animals, like rats, whose interest lies solely with the joints of the cadaver. This is where the fattiest nutrients reside within the marrow. Next come the herbivores, such as squirrels. Squirrels nibble away at the small bones, like those in the ribs, searching for calcium and other minerals.

It makes me sad that only law enforcement officers or current crime scene techs are allowed to attend the school. Maybe they could be swayed by a sizable cash donation...come on Powerball numbers! I may have to make a career change because this book sounds far more interesting than what I do for a living!