Um Houston, We Have Problem!

Our world is full of amazing and wondrous things that like to hijack our cells and reproduce themselves.  They also have the ability to mutate rapidly in response to outside threats and maintain their stealthy lives.  These things are viruses.

My concern is with the H1N1 virus.  It has been prominent in the news for a few years now and since 2008 a small amount of cases have popped up that are the A(H1N1) pdm09 virus with H2754 neuraminidase substitution.  So you are like "What does this mean for me?"  For all of us this particular little beastie is immune to the effects of Tamiflu (oseltamivir) which has been the preferred first line treatment for the past few years.  There was a point in time where every child that went to the ER got tamiflu and amoxicillin which I find completely ridiculous.  Test for it don't guess and just prescribe shit and pat yourself on the back to feel like you treated the patient.  Antibiotic over prescribing is just as big a problem for bacterial resistance and also perpetuates the populace myth that antibiotics treat the common cold.

If this strain becomes prominent and resistant to all of the currently available antivirals we will run out of viable treatments and have to rely on vaccination as the only means of defense.  I pose the question "Will we ever reach a point in time where vaccination is no longer a viable preventative for H1N1?"  Can a virus mutate enough that our immune system cannot make a viable weapon out of its vaccine formulation to protect us? I probably need to consult with the CDC for that answer because if anyone would know it would be them.

The future could hold a worldwide population decline greater than when Bubonic plague wiped out most of Europe.  Could this be the tipping point for humanity?  Sweet dreams!

I Still Hate F*cking Coupons

It is infuriating to run a claim, fill a prescription and bill the copay discount card.  The prescription sits in the ready bin like the perfect little Christmas gift and the patient decides to pick it up at a different location.  Not a problem. The magic of technology will reverse both claims at my store so the other store can bill them.

Phone rings. Shit! The secondary claim did not reverse and the other location called the card hotline but they need someone from out location to call to reverse the claim.  Shit! Now I have to waste my time on the phone with these discount card f*ckers to do something this f*cking computer system was supposed to do for me.

AAAAARRRRRGGGHHHH!!!!

Happy f*cking Saturday... Just a tech and me in the pharmacy, lines blowing up with people and phones ringing off the hook.  Customer service is in the shitter and it won't get any better unless a miracle happens and we get more tech hours.  Does it take a human sacrifice? At this point I know several pharmacists and pharmacy managers who would be willing and have a list of names for the ritual.


I need a vacation more than a naked Randy Travis needs cigarettes...

What Broils My Patty

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New Taste Sensation!!!

Too hard to get your Oxycottin on? Sick and tired of the same old Purple Drank? If you're not a rookie or a promethazine fiend and need a new S-Y-R-UP have I got a new taste sensation for you!

Dirty Sprite

This fabulous mix of 2 ounces codeine liquid, 12 ounces of Sprite and 1 or 2 grape Jolly Ranchers will have you shaking your shit maker til your pimp slaps you down! Want to get your lean on instead? then make it even dirtier with a crushed up bar of Xanax!

Dirty Sprite, get some!




**The bloggers at FFP do not condone the abuse of any prescription medication and believe that emergency services should stop treating overdose morons and let natural selection take precedence.

**Fake prescriptions for any and all controlled substances are a felony.

Congratulations! You're a Loser!

I am a body that fills in a space at any number of chain pharmacy locations in the large midwestern state I dwell in.  Different cities and counties have different laws concerning sales of Sudafed containing products.  Most areas have an rx only requirement but when I work at the ones that allow Sudafed sales with a government issued photo ID the antics ensue.

The only acceptable forms of ID are passports, military photo ID, driver's license or state ID.  Some people try  to pass off expired IDs, stolen IDs, library cards, public pool photo ID, employment badge, etc.  Each person seems overwhelmingly surprised when an ID is denied.  Sorry!

Depending on the white trashiness/ghettoness of a neighborhood I will keep a tally of how many IDs get denied.  It is kind of funny because they are always like "I haven't bought any in a long time." but the online state registry says you have so I give them the rejection printout with website that explains why they can't have Sudafed even though they already know damn good and well why.  I'm talking to you lady shake'n baking meth in the loss prevention room at a Wal-Mart...

I can guess with 95% accuracy which IDs are going to reject.  Such stereotypes are:  black guy with dreadlocks and stupid tattoos, black lady with scabby face and dazed look, white lady scabby and bruised (will probably also want a 10 day supply of insulin syringes for her grandma/cat/friend's dog), older black guy with bluetooth earpiece in and currently conversing to make sure he has the right package size/product, white guy/girl that is unsure and has to go out to the car or another person in the aisle to confirm desired product size/contents, emaciated young female wearing stupid sparkly clothing/eye makeup/smells of weed/already fucked up on something or another, dirty fingernail girl with dirty fingernail boyfriend both buying same product usually replete with stupid tattoos, homeless looking guy/girl with relatively new ID and exact amount of cash, guy that opens wallet with multiple different state IDs, guy/girl with ID from a municipality 2 or more hour drive away .  If you work in a pharmacy with ID sales you have seen and sent away empty handed all of these stereotypes because stereotypes have their start in truth and reality.

I emailed the DEA to see what they were doing about it and suggesting they take a statistical approach to weeding out meth cooks.  I told them they need to get the math geeks that helped Target figure out when a woman was pregnant around the 2 month mark.  Why can't law enforcement take all the sales records of IDs and match multiple purchases and state IDs then cross reference with welfare, tax, disability, and unemployment records attached to these same IDs and hunt the fuckers down like the worthless shit that they are.  Maybe I'm a little overzealous in the war on this particular drug but I despise what was once limited in scope to biker gangs in the 70s to now rotting the infrastructure of every neighborhood in modern society.

I leave you with my favorite rejection.  I had a middle aged black lady come in with a half smoked Blunt in her mouth.  She handed me an expired $2 off coupon for Aleve D Cold & Sinus. I told her it was expired and she was like "Auight."  So I scan the product then the ID.  It rejects.  She gave me the most well rehearsed stink/surprise face I have ever seen with the head cocked back and eyes wide.  She even took the Blunt out of her mouth and said "Say what?"  I almost lost my shit!  It took every ounce of self control I could muster not to double over on the floor with laughter.  It could have only been better if I threw confetti and released balloons like the Publisher's Clearing House Prize patrol.  Congratulations!  YOU'RE A LOSER!

I Hate Diet Pills

Yay!! The FDA has finally approved the first prescription diet drug in 13 years despite concerns of heart valve damage.  I have a feeling this one will go the way of all the other diet drugs that were discontinued due to an unacceptable rate of morbidity and mortality.  See ya...


Our "I want it now" society is so willing to stuff pills, potions, and shakes down its gullet that most people don't care about safety or keeping the weight off long term they just want to drop it now.  The fastest ways to lose a lot of weight fast are liposuction and starvation (ie lap band or stomach bypass or just plain old sew the lips shut starvation).  Both methods give rapid results with serious risks if you really want it now.  I do not recommend either option.

I am not a fan of over the counter diet pills which are basically high ass doses of caffeine and its analogs that raise your blood pressure and heart rate in a body that probably already has high blood pressure.  Drinking coffee on top of those or taking prescribed amphetamine analogs with them could land you in the emergency room or in the morgue.

There is a tried and true way to lose weight and keep it off.  It involves the two most dreaded words in the English language: lifestyle modification. Oh yes, you will lie to your doctor about making all the changes he/she suggested even though you didn't make any attempt at them.  The doc knows you are lying if the weight isn't coming off. I know you are lying and most of all you know you are lying.  The only person you hurt is yourself.

Weight loss is super easy and steady if you make even the slightest changes so I am going to give you simple sure fire tips to drop weight.  Mind you it will be a slow process but you are more likely to keep the weight off with these tips, feel better in the long run, and if your heart could it would leave you a big sloppy thank you note.

1.  Stop making excuses for yourself.  Big is beautiful, I'm big boned, it's a thyroid problem, etc.  All of these are excuses that pretty much set yourself up for ridicule and failure.  You have this wonderful biochemical machine at your disposal that will do wondrous things and can last for 100 years or more if you take care of it.

2.  Go to your doctor, find a new doctor, just get to a doctor and get a good baseline on all your biochemical values.  You need to know your current weight, blood pressure, your HbA1c (indicator of blood sugar levels over the past 3 months), if you have vitamin deficiencies, if you really do have a thyroid imbalance, your liver function, full cholesterol panel and if there are any indicators of underlying disease that have been undiagnosed so far because you haven't bothered to see a doctor in X amount of years.  These tests let you know how much neglect and stress your body has suffered so far.  These tests also will let the doc evaluate what types of dietary changes and exercise changes would be best for your situation.

3.  Keep a food diary.  You may think this is stupid but most people don't realize how much and what types of food they consume on a daily basis.  Forgot you had 3 iced coffees and a donut for breakfast?  Those four items could have already put you over 1200 calories and you still ate 2 more times that day. I'm not gonna tell you to micromanage your calorie intake but I do want you to be aware of portion sizes and types of things you eat and drink in a day.  Everything you put in the body pretty much stays with you as stored fat if you don't burn it off.

4.  Stop drinking your calories.  Changing from regular soda to diet or zero versions of that soda can save the average person 600-1200 calories per day.  Drink a small glass of juice with breakfast instead of a large one.  Don't use half a pound of sugar when you mix a packet of  Kool-Aid.  Switch to skim milk.  It can take some getting used to but you still get the vitamins and flavor without all the fat content.

5.  Drink more water.  I prefer to filter my tap water through a Brita pitcher to get out most of the chemicals and things that pass through in the cleaning process from water treatment facilities.  It makes a huge difference in the taste of tap water and it is significantly cheaper than buying cases of bottled water, most of which are tap water or spring water (which is full of microscopic critters and dirt, ew).

6. Eat more colorful foods. I'm not talking Fruit Loops and candies I'm talking veggies and fruits.  The more natural whole foods you eat the better off you are.  Whole veggies and fruits are chock full of vitamins, antioxidants and water which ALL help your body take care of itself and don't give you the lazy tired feeling of a high fat, high carb meal.  If you are leery of pesticide residue buy organics or grow a small garden of your own.

7. Eat lean cuts of meat and fish.  You don't have to give up meat completely just leave the fatty steak behind and go for a leaner option.  Any piece of meat can be awesome when properly cooked and seasoned to personal preference and fish is not only delish but also full of omega-3 fatty acids (heart healthy fats).

8.  Limit carbs like bread, pasta and rice.  Make them a significantly smaller part of your food intake because they are calorie/sugar dense which can add the pounds if not moderated.

9. Don't be afraid to treat yourself once in a while.  Make your favorite sweet or restaurant meal a reward for your hard work.  Lost 15 pounds?  It is okay to celebrate with an ice cream bar, just one because if you get a little crazy  that 15 will be right back on.

10. Make exercise fun!  You don't have to go to a fancy gym and have a trainer beat you up to lose weight.  Make exercise a family affair.  Play sports that the whole family enjoys or take daily family walks so you all get exercise.  Walk those golf clubs around instead of taking the little cart. Swim. Vigorous dusting, sweeping, mopping and vacuuming will not only get the heart pumping but your house will be squeaky clean!

11.  Expect failure and small victories.  Nothing is built in a day and years of self neglect takes a lot of time to reverse.  It is better to try and try again than to quit or never start at all.

I leave you with the words of the dumbest promotion ever, Thank you (for reading) and be well!

Way Too Deep: Signs You Might Be Overinvested

Or as I like to call it, "Looking Around My House".
I was thinking about 'tells' of people's jobs. You'd probably find steel-toed boots in a construction worker's house, or a waitress that reflexively straightens a table after a restaurant meal. For me, it's a combination of the two- so here's how I can tell if someone is in the pharmacy.
1. Their OTC meds have Xs on them.
2. If not Xs, then expiration dates, and sometimes both.
3. Lab coats. Lab coats in places you wouldn't expect them.
4. Constantly irritated with misuse of drug names/classes in media. "You idiot, you can OD on a benzo, but 'Benzodiazepine' is not an actual drug name!"
5. Constantly irritated with friends/family's misuse of meds. No, giving your kids penicillin when only one is sick is a terrible idea. Yes, by all means, throw out the bottle of Alka-Seltzer that still says it was made in Indiana out, please.
6. If they're in retail, everything that can be sold by their employer will be bought. Look at your store brands, if you buy them. If your vanity/nightstand looks like it came from one of their store-ads, well...
What do you consider a tell?

Another Explosive Ebay Find

Glass and tin graduated enema irrigation system. The current price on this baby is over $200. Ain't medical history grand?

You Really Can Find Anything On Ebay

A 19th Century Vulcanite Rectal Dilator or what looks to me like an antique butt plug. Treating constipation must have been worse than the constipation. Spelunking for intestinal polyps was an adventure in a brave new world. I think I would rather drink castor oil...

F*ck You, Hollywood!!!!

It has become a horrifying trend that I go to a theater with great expectations from some creatively edited promo preview that makes me want to watch a movie. So I go to the theater and plunk down a wad of my "I work to satisfy the whims of over privileged douche bags and bow down to the ridiculous demands of my corporate puppet masters" money to buy a ticket then bleed out a kidney to afford a soda and popcorn so I can sit for over 70 minutes to be let down and kicked in the face with your smug "We made this and you suckers paid to watch it" piece of shit movie. The money I spent on the ticket alone would have been put to better use if I wiped my ass with it.

I could have stayed home and watched the television programming that I pay a premium for instead of wasting any money at a theater. You know what's scary, Hollywood? Fighting for your life or your child's life due to cancer, physical therapy after a horrible crippling accident, trying to survive after being severely burned, losing your home because you lost your job, a death of a loved one that literally destroys your outlook on having any shred of happiness ever, growing up not knowing if you will have any food or water for that single day, growing up in a place where things are bombed on a regular basis, the shit I dream about on a daily basis when I am trying to rest, rape, politicians preventing women from having choice or access to birth control, etc.

What I am saying is this: better content, better story lines, better dialog, better cinematography and guaranteed refunds if the movie is a total piece of shit!

That is all.

What Would You Do??

So with the possibility of losing my job I was tossing around ideas of what would I do if I got fired. There are so many things but I go back to an idea some friends and I had in college but with an added twist. I want to share with you and in turn would like you to share with me. Please leave a comment with your dream job or a job you would do if you got fired.

I would use my unemployment time wisely and attend cooking school for baking and pastry. When finished some friends and I are going to open a multipurpose business. It shall be called Dia Betty's. Dia Betty's will specialize in homemade beers in limited edition that will only be available at our bar until they run out or until we decide to stop making that particular beer and change the recipe. The bar part will be open at 5pm for happy hour until last call at 2:30am. After we toss out the drunks and hose down the bar the magic happens in the other part of our facility.

The other part of our facility is a state of the art bakery. We will have a pastry of the day, a bread of the day, and whatever the hell else we feel like baking. We won't do specialty order cakes or any of that crap. It is a first come, first serve this is what we made today deal. When we sell our last baked item the shop is closed so come early or you aren't getting any carb-loaded goodness. If you sleep in your car after last call you might score some sweet sweet pastry before it sells out.

The beauty of Dia Betty's is that everything we serve is unhealthy, super delicious, and there ain't nobody named Betty working there. The hours will be limited as well as the days of the week we are open because the beauty of owning your own business is that you set the hours and the only standards you have to meet are set by the government and not some douche in a suit that has never worked in a retail pharmacy or have any idea what impact limiting medications and one-on-one time with a drug expert has on a human being's quality of life.

Cheers!

Corporate Vision

Sing to the song "Innervision" by System of a Down

I have a job, maybe not long

I'll have to find one, you'll have to find one

We speculate, no one will say

Will I be fired, I cannot see the

Corporate Vision, Corporate Vision

More hours cut, no twenty four

Manager silence, staffers all scared

Some put in notice, already left

Will I be fired, I cannot see the

Corporate Vision, Corporate Vision

We speculate to reinvent the process

New rolls we will play

Giving you drugs, giving advice

Scumbag suits always cut the payroll

Skeleton crew

Suits get more, we get less

Vision

Corporate Vision

Corporate Vision

Corporate Vision

Corporate Vision

Corporate Vision

Manager silence, manager silence

What Sours My Mayonnaise

You know what sours my mayonnaise? When there is a SARAA alert because some dumb ass parent takes their kid out of the hospital after the kid got a kidney transplant with no medications. This isn't like changing batteries in your remote control f*cktard! You can't just swap out the kidneys, stitch 'em up and you're ready to roll.

Let me break it down for you: Each individual has a set of protein markers throughout the body that tell the immune system "This is me." We find a "match" for a patient that has the most protein identification markers on it that are as close to the patient's protein identification markers as possible. Before, during, and after the transplant a patient has to be on drugs that keep the immune system from poking around the new kidneys and saying "Hey, that doesn't belong here so I have to kill it to protect myself!"

When the immune system decides to kill the new kidneys toxins will no longer be filtered out of the body. These toxins build up in the blood stream and are circulated in the blood to poison the rest of the body. Given enough time the rest of the body will shut down such as the liver, the lungs, the brain, the heart, etc. You have essentially put your child into the land of slow painful death.

Congratulations! You're a murderer whose reckless stupidity sours my mayonnaise!

***Update: On a happy note the child turned up at a hospital in a different state. I hope she gets the best of care and her dumb ass parent goes to prison.

Cough Syrup Query

We got an email question from someone wanting a good cough syrup. Unfortunately the best thing over the counter everywhere is Delsym liquid. In some states various brands of guaifenesin/codeine syrup are available by signing a registry. The catch is that chain and big box retailers will not sell them OTC even if the law allows. It reduces insurance and DEA liability to not sell without a prescription. The even better cold/cough liquids like Tussionex and Promethazine/codeine are rx only and controlled substances. Since some douche bag rapper made a song about "drank" which is prometh/codeine as a recreational beverage many physicians are reluctant to write for it. Another option is Tessalon Perles which are rx gel caps that most practitioners will have no issue with prescribing because they won't get you high but they will quiet the cough. There are cough quelling options but sometimes they are hard to come by.

Turnabout Is Fair Play

Long long ago, in a pharmacy not so far away a girl began her career. The hours were normal but the work load was always slamming. She bitched and moaned about being understaffed, overworked, and people just being plain rude. Other pharmacists worked at different retailers where the working was easy and the hassles were minimal.

Now a change in the business brought about by a corporate divorce has worked to her advantage. The chaos has shifted from this girl to the others. No more complaining, less people being rude, her working is now super easy. The others now have 2 hour wait times and no technician help. Oh the sweet sweet irony of the others now being slammed.

She now laughs at the others when she tips her glass. No more drinking because she is bitter now only drinking for sport. Sweet sweet irony...

Welcome 2012

OK so I am a slacker. Well...WAS a slacker. It is a new year and I must write more. We all should. Big N Tasty-this is practically your blog but we have writers so let's all help her out, OK??

So big news! I no longer work retail. I work for a hospital now doing a fun, creative, new project that is going well. More details to follow but here are some observations:

1. Hospital gowns are not fashionable nor do they cover enough of the nether regions. That is TOO bad bc I like fashion (kidding) and I really am NOT used to seeing so many balls and tits just hanging free. Oh well. In a perfect world...

2. Residents may be hot but not all are smart. OMG did you really just send over an order for multi-vit with fluoride for your 92 year old LVAD patient??

3. Nurses are messy but I like it! Plus they are way fun to socialize with. They have some nasty stories. Why did I ask what "code brown" meant?

4. Hospital food isnt so bad after all. I just so happen to work at a place with a natural food store. Amazing!! Plus so many options at the cafeteria-gluten free, curry a day, fish of the day, a mile long salad bar. No excuses for being a fatty if you work there. OH wait! I forgot to mention the pie case...sigh

5. I work at a teaching institution. Fabulous!!

6. Do NOT leave food out in the open in the breakroom. This is free game for nurses, CNA's, etc. They will gobble it up in no time.

7. Patients are just as demanding in their private room as they are in public. That is OK bc I am no longer ringing up their KY jelly, handheld mirror and a bar of soap (yes-that was a real purchase I rang up years ago) nor listening to their whining about multiple non-pharmacy related BS.

8. I miss my vacation days!! I have to accumulate them now. OMG their goes my 21 days in Spain!! sigh...you must wait you young, handsome Spanish men. I will arrive some day!

9. I still dispense meds just not 350 a day. I spend a lot more time being a pharmacist now. so strange...but SO good.

10. NO MORE THIRD PARTY ISSUES!! yippee!!! pee in my Myla panties!!

Please don't get me wrong-I liked, at times, being a retail pharmacist and they are some of the smartest people I know. I just had a tough time with my retailer cutting things left and right and people's jobs were dropping like flies and I just felt like a zombie after work somedays. This is refreshing change but the lure of more vacation time and sick days pulls at me. I just wish I could do a more hybrid job or win the lottery! LOL

Happy belated New Year to all of our LOVELY readers, especially the methadone crackheads that are still sending me love/HATE letters. You all rule too!

love,

Filet

New Year's Day: The Scriptpocalypse Begins

Football has March Madness and Christmas has Black Friday but retail pharmacy has New Year's Day. NYD is a magical time when practically all prescription insurance copays go up, people forget they have a massive deductible or their insurance completely changed and they conveniently have no who/what/when/where/why/how knowledge of their new insurance provider and an ID card has not shown up in their snail mail box. These are the worst of times because pharmacy employees generally become punching bags and the root of all evil when it is no fault of our own.

An extra special addition for 2012 is the fallout from the ESI/Walgreens divorce. I am floating and have witnessed very sad partings of long time patients having to leave because ESI suits are a bunch of money hungry douche bags. Okay, all suits are money hungry douche bags, they can't help what they are... I have even witnessed patients change insurance or start using their spouse's insurance because they are on a first-name basis with their store's employees and are treated like family. Why would you walk away from that if you don't have to?

This all began many many months ago when Walgreens acquired a small chain known as Duane Reade. Mergers require the review of all financials for both companies. In this review Walgreens found that the "best reimbursement rate in the industry" they were getting from ESI was deplorably lower than what DR was getting. After figuring out how much money Wags was losing on each ESI rx they asked for a match of DR reimbursement rates. ESI would not budge and has been bashing Wags ever since.

What ESI has not been letting the public in on is that ESI itself is a corporation. A corporation that has its own set of highly compensated suits, thousands of employees who get insurance, holiday pay, sick pay, retirement plans, etc, and a larger set of shareholders to answer too. The main goal of any corporation is to be as profitable as possible. ESI figured if all of its maintenance rxs are required to go through its own mail order service it no longer becomes a middle man, it becomes "the man" and keeps at least 75% of the money it would have been reimbursing other companies with to itself. I don't hate them for that but I do have a problem with limiting a patient on access to medication when noncompliance is a huge issue. I also have a problem with any company that would limit medication access to the people who defend and die for our freedom. The primary point is any medication therapy no matter how effective and patient specific will fail when the patient is not taking the medication for whatever reason.

Walgreens has found other ways to retain as many patients as possible and I found it funny that Wal-Mart, who has its own pharmacies, dropped ESI so their employees would have access to meds at any pharmacy any time.

Aside from all that nonsense, finding new coverage information for Medicare Part D patients has been an unholy nightmare for all pharmacies......sooooo many plans......sooooo many patients..... I am also going to add "Rx Transfer Specialist" to my resume because I'm super proficient at it now as many of you will be too! So welcome to the Scriptpocalypse and all the joys it brings. I will be celebrating tonight with a gut-busting delicious multi-course dinner with pharmacy friends at The Melting Pot. Yum yum! (***this meal is definitely not recognized as part of any diet unless you are on the "See Food" diet which entails eating everything edible you see)