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)

random haps

One of my favorite things to do when someone calls on the phone to ask "Do I have refills on my hydrocodone?" is to look up their info (so they hear me typing) and then answer quickly "Oh, no." I usually get a squawk of rage- "Yes I do!"- to which my mental reply is "Then why the F&@k did you just ask me? Ask if it's too early, fool."

I kept having people ask me today to repeat things they just told me, or for doctor's offices, to resend requests for PAs. One nurse, when I repeated that we had sent it multiple times, just asked for the info again as if this couldn't possibly be an issue. Rage, I tell you.

One of my customers called to ask me what a doctor had written a script for. She said she was going to spell the drug, and then went "M-A-I-N-S-T-R-E-E-T. What drug is that?"

"Ma'am, I think you spelled Main Street."

"Oh yeah, that's my address."

*headdesk*

She ended up never telling me the drug name- she skimmed the rest, figured out it was her Ambien, that it was too soon to refill and then hung up.

I had a guy get a flu shot, and he asked me to help him with his consent form. Being a soft touch (sometimes) I read him the questions, kinda begrudgingly, until he said, kinda to himself, "I haven't learned to write with the other hand yet, after the stroke."

Of course, then I was perky and helpful.

We have this one office that usually e-scripts nowadays, but sometimes they'll have to call something in. What do I hear when I answer the doctors' line "Hello, this is Hell Pharma, technician speaking?"

"Pharmacist."

No hello, please, thanks or even attempt to be nothing but rude. Seriously, I tell every patient considering switching docs to avoid this office like the plague. I don't see why saying a greeting is taking up precious moments of your day.

January is fast approaching, or as I call it, Pharmacy Apocalypse Month. With the Express Scripts/Walgreens kerfluffle, everyone's going to see shifting people and it's gonna be nutty. I plan to stock up on sweet, sweet rum now.

Glucose Testing

I was looking at videos on YouTube of ideas for noninvasive blood glucose testing. There is a huge project looking at measuring glucose in human tears. I have a lot of issues with this.

The team working on this is making testing devices that are meant to touch the surface of the eye to get tears then analyze the glucose content. The device itself has way too many limitations to be clinically feasible. Any degree of Parkinsonism, tremors, many physical handicaps, contact lens wearers, visual difficulty, and poor hand-eye coordination will limit the ability to touch the testing device to the eye. The actual touching of the eye is quite disturbing in itself. Scratching they eye, poking the eye too hard and sterility of the device are all very real hazards.

The eye is very delicate. Please leave it alone and try to find a noninvasive way to measure blood glucose through the finger like a pulse oximeter measures oxygen saturation. There has to be something in the blood stream that will react with a different spectrum of light that will allow for quantifiable and reproducible results. It took about 40 years for the original pulse oximiter to be redesigned and put into widespread use but I believe somewhere out there in research land there is a team of scientists that can make this happen.

I want a viable noninvasive cost effective means of blood glucose measurement and like Veruca Salt "I want it now!"