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Thursday, January 20, 2011

Take It To The Limit

This song parody is dedicated to all the disgusting filthy meth addicts that come into the pharmacies of Missouri in all states of f*cked up trying to buy sudafed containing products but get blocked by the state wide monitoring system. Hopefully the state legislature makes all sudafed containing products prescription only soon! I would much rather go out of my way to get a prescription than watch methamphetamine destroy thousands of lives.

Sing to "Take It To The Limit" by the Eagles

All alone at the end of the evening
Any my meth high crash is leaving me blue
I was thinking about another
Methamphetamine high, but I was out

You know i really need a picture ID
(Still getting the run around)
So I'll steal identities
(Need more ephedrine)
But meth is all I need
Keep on turning out and burning out
And turning out the same

So put me on a highway
And find a drugstore
And take it to the limit one more time

You can sell meth to make easy money
You can take meth to be high all the time
If it all fell to pieces tomorrow
Would I do jail time?

And when you're looking for Sudafed
(Pharmacists don't care)
And you can't buy no more
(Can't buy it anywhere)
When there's nothing to get high on
Still you're coming back, you're running back
You're coming back for more

So put me on a highway
And find a drugstore
And take it to the limit one more time

Take it to the limit
Take it to the limit
Take it to the limit
One more time

Take it to the limit
Take it to the limit
Take it to the limit
One more time

Take it to the limit
Take it to the limit
Take it to the limit
One more time

Tuesday, January 18, 2011

What Melts My Cheese

You know what melts my cheese? Patients that bitch and moan about the wait times at the emergency rooms and circumvent that by going to the quickie clinic at the pharmacy to get a prescription. Yet here I am seven days later returning that clinic prescription back to stock because you "were gonna die without it" so I just want to know: Did you die? No? Then why the f*ck did you even bother to go to the clinic?! Why the f*ck did you waste the practitioner's time? Why the f*ck did you waste the pharmacy staffs time? Why the f*ck didn't you take the medication that was going to keep you from "dying"? Why the f*ck didn't you get the prescription because it was covered at a super duper reasonable copay of $10?

It gets better. It wasn't just one patient that I returned a clinic prescription to stock, it was seventeen different patients. Some of them with multiple prescriptions. Only one patient's prescription wasn't covered on insurance. You got to be f*cking kidding me! This is why many people just don't deserve health insurance while the ones who sorely need it and would pick up and take their medications can't afford it. Stupid f*cking American medical sytem! Stupid f*cking ungrateful/irresponsible people! That doesn't just melt my cheese, it smoked the shit out of it!

Sunday, January 16, 2011

Extremely Limited Offer

I was flipping through the sale ads in the Sunday paper and stopped because I thought I was hallucinating. My favorite blood glucose meter is on sale. Yep S-A-L-E! Normally this glucometer is $74.99 but today (1/16/11) through Saturday (1/22/11) Walgreen's has it for a mere $9.99. Yep, you read right, $9.99. That my friends is a recession busting price if I ever saw one.

So if you are a tech savvy diabetic, know a tech savvy diabetic, or are the tech savvy caretaker of a diabetic I urge you to get this machine! For those who didn't read the original post about it the Contour glucometer is a USB device so you not only test your blood sugar but when you plug it in to your computer it uploads all of your readings with date, time, whether it was fasting/after meal/etc. and you can make a graph or chart to better visualize what your blood sugar is doing. It also gives you the option of emailing your results log to your physician or you can print it out for own personal perusal. It is also smaller than a cell phone so it is convenient to take with you.

I highly recommend you call your insurance provider now and see if they will cover the test strips with a doctor's/nurse practitioner's/physician assistant's prescription and buy this machine. I am not diabetic but I am buying one for myself because type 2 diabetes runs in the family and it is nice to check my fasting blood glucose periodically so I know if I am hitting close to diabetic levels or if I am A-ok plus I love anything I can plug into my computer.

**Disclaimer** I do not get ANY kickbacks, payments, etc for pimping this meter. It is just my personal favorite and it is damn cheap for a short period of time so "Get it while it's hot!"

Friday, January 14, 2011

Why States' Medicaid/Social Services Are Going Broke

1. EBT (food stamp) cards pay for junk food and sodas plus have a cash spending limit each month depending on what your level of benefits is.

2. For most patients Primary Care Physician = Emergency Room

3. Most patients have a complete lack of personal care/responsibility/hygiene

4. If meds are "free" why change eating habits and exercise?

5. Why stop smoking if inhalers are "free"?

6. Multiple patients with repeat trips to clinics/ERs for venereal disease treatment.

7. New baby = more benefits

8. Have a heart attack/stroke/other coronary event? The hospital will fix you up and give you meds for "free"!

9. Wreck your kidneys with poor self-care or drug abuse? Dialysis is "free" and so is the transport to and from the dialysis center.

10. Don't have a car? An ambulance ride is "free"!

11. Don't want to take responsibility for your kids or interact with them in any meaningful way? Psych meds and ADHD meds are "Free"! As an added bonus you and your new baby daddy can use these medical grade amphetamines to get high and sell some on the side for extra spending cash.

12. Want to be a 350 pound slob that smokes pot and eats Cheetos all day? Have a baby of unknown parentage and everything you need is "free"! (none of the states drug test for eligibility, all you have to do is say no one in your household is on illegal drugs)

13. Want to piss your pants and put on a crazy show for a social worker? Just do it and everything is "free"!

14. Have your daughter or granddaughter get pregnant from unknown parentage then call social services and tell them she is an unfit mother and that you will foster the child to keep it with the family and the state will give you over $100,000 in monetary compensation to "foster" the child income tax free plus you get food stamps and healthcare all free! (actual amount varies by state but it is is pretty close to a six figure tax free income in every state and it works with any foster not just one of blood relation)

15. Somebody turns you in for claiming two kids and no man living in your 3 bedroom state paid for apartment? Have your man crash at someone else's house for a few days and get both kids for a couple days to cover the case worker visit and lie lie lie about how you have no idea why someone would turn you in because you are the greatest mother on the planet!

16. Get a prescription for 100 count boxes of diabetic test strips and resell them on e-bay/craigslist/some other sale site or try to return them to a store that sells them without a receipt with some stupid story about how these aren't the right ones for your machine to get cash back.

17. Wanna get high? Go to the ER with a "hurt back", "pulled muscle", "other random terrible pain" and get a handful of narcotic pain pills. It's all "free"! Added bonus: this may be repeated multiple times at multiple ERs before the ER docs or pharmacy figure out your game and stop giving you narcotics.

18. When that trick stops working find a shady pain management clinic and claim you have "sciatica" so you can get an assload of oxycodone/morphine/hydromorphone for your pleasure and resale.

19. Don't want to pay for Tylenol or Motrin OTC products? Go to the ER and get a prescription because that way it is "free" at the pharmacy. Added bonus: Some states allow the billing of OTC items like toothpaste, diapers, baby wipes, shampoo, soap, deodorant, etc. at the pharmacy on your prescription card so you can get those items for free and resell them later depending on your level of benefits.

All of these examples are based on actual things I have witnessed in the grocery store and things I have heard people talking about at the grocery store, pharmacy, Wal-Mart, and Target while shopping.

Example 15 is a person I know that has been turned in to social services for fraud on 4, count em 4 separate occasions and each time she gets the kids, has the boyfriend stay at his mom' s for a few days, and schmoozes the case worker. She is always let off the hook and had the balls to tell one of her children she couldn't get married until he turned 18. What a cunt!

Example 14 is a lady that fosters 3 to 4 kids (no blood relation) at a time and uses the money from the foster program to buy and rent Section 8 housing. (Section 8 housing is welfare housing paid for by the state) I probably don't have to mention that all of the kids she fosters are on serious ADHD and antipsychotic meds. Turning her in to social services also yields no results.

One of the ER pain pill junkies was mentioned in a previous post about Ultram (tramadol) addiction.

These are just a few small examples of the atrocities that entitlement programs breed...and they do breed... This has not touched on fraud by unscrupulous medical offices, medical supply firms, etc. that also cost an assload of taxpayer dollars. These entitlement programs also breed stupidity because the kids only have to go to school one out of every 9 or 10 days depending on the state and I guarantee most of them only show up every 9 or 10 days. With "No Child Left Behind" policies this means that a lot of kids are being pushed through the system and are doomed to graduate high school (if they make it that far) and not be able to read beyond a fifth grade level. We as a society are doomed unless entitlement programs get military strict and stop paying for unnecessary bullshit like junk food and ER visits for Tylenol and Motrin prescriptions.

Friday, January 7, 2011

Breaking Up Is Hard To Do

This was passed along to me from a coworker of Anonymous who has left retail pharmacy for a better paying, less stressful life. Anonymous, I salute you! It would have been a 21 gun salute but we aren't allowed to carry weapons at work or even have them in our lockers.

Things I Won't Miss by Anonymous

*People walking up to the counter and shouting hello as though they've been waiting forever even though they JUST walked up to the counter and have barely been there for more than 12 nanoseconds.

*Running around like a crazy person from station to station because either (a) there's no one here or (b) because the people that are here are slow.

*The phone. Oh that f*cking phone.

*The customers. Should I name drop because I really f*cking want to.

*The words "I need a refill." or "I don't have the bottle." or "It says I have four refills until July 2011."

*Customers coming up to the CLOSED drop off window and completely ignoring and sometimes pushing aside the HUGE red sign that says "Proceed to Pickup Window" and then looking at me like I'm crazy when I tell them it's closed.

*Dirty prescriptions that seem as though they've been raped and shat on by homeless people. Is it so difficult to keep that piece of paper from becoming a victim of sodomy?

*The f*cking phone.

*Working the drop off window and having to deal with questions like "Where's the ice?", "Do you sell toenail clippers?" "Where are the pencils?", "I'm looking for lotion?". Not a f*cking customer service window and I obviously don't work the f*cking floor so how the f*ck would I know where icy toenail lotion pencils would be?

*This dusty ass allergen trap called a pharmacy. This is the health industry?

*Scrubs. Actually won't miss those because I never put those sleep bags on. And I was also under the impression that wearing pajamas to work was against the dress code.

*The drive thru. Everything about it. Every. Single. Thing. Deserves its own separate list.

*People that smell like bathrooms. People that smell like four month old sweaty cheese. People that smell like they've never heard of showers. People that smell like dead kittens soaked in vodka stuffed in a moldy barrel inside the asshole of the Loch Ness Monster.

*That f*cking drive thru bell and that fucking drive thru buzzer. And I realize I said that the drive thru deserves its own list which is totally true but when the hell am I ever gonna write that list?

*People that drive up with their f*cking arms/canes/tree branches/artificial limbs hanging out of the window so that they can press that damned button before they even park their fucking cars.

*Speaking of cars, if you come through the drive thru and your f*cking car door/window/trunk/sunroof does not open and the only way you can communicate is by getting out of your car then why the f*ck didn't you just come inside?

*People that don't hand you the money or toss the money or put the money on the counter five f*cking feet from where I am (I'm over here at THIS register, you f*cking douche)

*Some of those f*cking slow as shit nurses. It doesn't matter which one. I've offended them all just by saying this.

*People that ask "How are you?" Like you f*cking care.

*Broken printers/scales/computers/people. Yeah this can happen anywhere but I won't miss it happening here.

*Old people who call in prescriptions because they are afraid of technology then take up most of whatever is left of their life reading you one prescription number off the bottle. That is IF they can read it. "Oh wait, I'm sorry baby, that was a six." AAAARRRRGGGGHHHH!!!!

*People telling me how I should do my job. "You guys would be a lot faster if you did this." "It would be easier for the customer if you did that." Well, I don't come to your house and tell you how to beat your kids, watch TV, make meth and be a worthless asshole so stop telling me how to do my job.

*Old people in general. Just because you're old doesn't mean you can walk all over me like something that old people walk on. Orthopedic shoes perhaps? Eh, whatever. Old people blow with a few exceptions (you know who you are).

*People who live on their f*cking cell phones and refuse to get off them even in the midst of physical interactions with people standing right in front of them. "Sir, I realize that Rochelle shouldn't have done that to Kenny and that you need to get to the grocery store before they run out of peaches which by the way I really don't see happening but I need your address."

*The approach. You're at the counter, you're at the window, even drive thru and you see someone approaching and you pray to God they are not coming to bother you. But they always are.

*The question "Can I pay for this stuff back here?" even though you've already emptied your one hundred plus items on the counter.

*Questions. I hate questions now. They say there are no dumb ones but I can without a shadow of a doubt tell you that there are. "What should I do about dry lips?" Really??

*Those severely f*cked up names that not even Dan Brown himself could decipher. And I'm the one that gets crazy looks when I can't say them. "And what is....uhm...Kuh-taw-buh-tee-air-eesh-ma-jah's birthday?" "It's pronounced Elizabeth!"

*Smart counts. I will not miss those and they will not miss me because I think they are assholes and they think I'm black. Telxons are some racist sons of b*tches.

*Screaming and crying banshee children that only know how to cough and sneeze on every open surface and annoy the shit out of me. Yeah, this place makes me want to cry too but do you see me acting like that?

*Pharmacists with big heads. Usually the fresh out of school pill jockeys who think they're better than the people to their left. Get off your fucking high horse and ring out that lady's pantyhose.

*People who pull money out of their bras/shoes/underwear/rectums and then expect me to handle it, F*ck no! Go learn what the f*ck hygiene means and make it you life's purpose.

*Medicaid patients who complain about having to pay 50 cents to two bucks for their prescriptions but will pay any amount of money for a cheeseburger or a candy bar or whatever other f*cking pointless thing they don't need.

*When I tell you that something will be ready, for instance, after 4. Don't ask me when it's going to be ready and don't try to argue with me about the time I gave you either. "Does it mean 4:15, 4:30, 4:45???" Shut the f*ck up you dumb motherf*cker because I just told you that it will be after four so I don't give two f*cks about what time after 4 you come because it will either be done or it won't be which is another thing I couldn't give two f*cks about so go f*ck your f*cking self, bitch.

*It says Drop Off Window not Consultation Window, so why the f*ck are you in my face asking me what you should put on your rash?

*Benzonatate. A minor gripe but I will not miss your roly poly ass.

*Lazy motherf*ckers. You know who you are.

*Awesome motherf*ckers. You know who you are.

*In between motherf*ckers. Well, actually, you can only fall into one of the two groups above so, yeah, you know who you are.

*Wal-Act junkies. Vicodin junkies. Morphine junkies. Insulin junkies (those exist, right?). Junkies of all shapes and sizes.

Things are coming to a close around here so I leave you with these wise words of one Oliver Humperdinck, renowned author and indoor trumpeteer. "If any man hath his hands, he beateth with them slow time around the bolly bop tree when the weather is green and cheese is in bloom."

Powerful stuff.

Peace, bitches.

Wednesday, January 5, 2011

Open Letter To The FDA

I have noticed over the past several years that there is an increasing frequency of patients wanting refills for Ultram (tramadol) pain pills early. I am concerned that it is the new drug of choice for addiction because it relieves pain, makes you feel good, and is readily obtainable from practically any prescriber.

An extreme case I had was a lady who goes to a different emergency room every 3 or four days to get a prescription for Ultram. It is usually written with a muscle relaxer and naproxen. She always only fills the Ultram. On this particular evening her newest emergency prescription was one day too early for insurance to cover it. It is out policy to never fill pain pills early if the insurance company denies the claim. Our computer systems do not process next day insurance claims until after 3am. She sat in the pharmacy with 3 young children, one in diapers for 3 hours before the youngest kept screaming and fussing because it was way past bedtime for young children. She finally left the pharmacy at 12am with her children when she had planned to stay until she could get her pills as soon as possible because she was getting fidgety and cranky.

Please re-evaluate Ultram for its potential for abuse and addiction. At the least give it a Schedule V so we can try to prevent some of this personal and child abuse.

Thank you for your attention to this matter.

Big N Tasty RPh

Tuesday, January 4, 2011

One to One

I had a patient call concerned because she was having the "I'm gonna pass out" light headed feeling as she stands up from a sitting position. I asked her if she was on blood pressure medication and if she had any other changes recently. She was on Norvasc and had lost 60 pounds over the last few months. Bingo! We have a winner!

There is a lack of awareness for patients that significant weight loss will make major decreases in your blood pressure. This is especially important to know if you are on a blood pressure medication. As your weight and blood pressure goes down you will need to communicate with your physician and monitor your blood pressure. When blood pressure goes too low there can be complications far worse than falling down or passing out when standing up from a sitting position. Imagine if this happened while you were working with dangerous machinery or driving a 2000lb death machine, I mean automobile. Imagine if it dropped so low that you died from a chamber of the heart collapsing or got brain damage from lack of blood oxygenating the brain....crap, gonna get hate mail for that alarmist comment...

Reliable studies over several years have proven one significant finding in weight loss:

1kg = 1mmHg

For every 1 kilogram (2.2 pounds) of weight lost your blood pressure will drop approximately 1mmHg or one point on your reading. This correlation means that patients can see measurable results with only a 10 pound weight loss. As weight and blood pressure drop your blood pressure medications will need to be adjusted. Patients on multiple drug therapy can be dropped to single drug therapy and patients on single drug therapy can have their dose reduced. With enough weight loss and a good weight maintenance lifestyle change most patients can be MEDICATION FREE!

The added bonus: with significant weight loss in Type 2 diabetics we also see less insulin resistance and better beta cell function, which allows them to get off insulin and reduce their other medications and in many patients the same MEDICATION FREE status is achievable!

Another added bonus: with significant weight loss and better eating habits the same reductions can be seen in LDL and triglycerides with increases in HDL (the good cholesterol) and the same MEDICATION FREE status can be achieved by most cholesterol patients!

Long gone will be the days of patients bitching and moaning about taking multiple drugs and spending a lot on ever-climbing copays! Oh wait, reality check, this America... The land of high fructose corn syrup, ever present salty & sugary snacks, and a drive thru eatery on every other street corner! Optimism, I lay thee to rest. Say high to Jesus and Budda for me! I hear they throw great parties, I mean seriously, water into wine...How awesome is that?!

Please let your patients know the wonderful benefits of weight loss and healthy eating. Please let them know how to properly monitor their blood pressure at home at least on a weekly basis with any dietary and workout combo so they know to contact you when they are probably going to need that medication change to prevent any complications. And please only use optimism for them because making those changes should be done slowly and permanently. Slow and steady always finishes the race!