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Wednesday, January 7, 2009

Legacy Of The Nude Dude

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

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

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

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

Sunday, January 4, 2009

It's All About Choices

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

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

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

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

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

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

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

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

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

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

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

Thursday, January 1, 2009

Future Predictions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

THE FUTURE ROCKS!

Wednesday, December 17, 2008

Rectotab - A 100% All-Natural, Clinically Proved Rectal Prolapse Treatment

****CLICK ON THE LINK, READ THE WEB PAGE AND THEN YOU MAY BE ENLIGHTENED, GRASSHOPPER****


Rectotab - A 100% All-Natural, Clinically Proved Rectal Prolapse Treatment:




OK, so now that you are familiar with Rectotab I can explain how I found it. Of course I am a fan of any and all grotesqueries the human body can produce. I was giggling to myself about a patient I had a few days ago. I have been soooooo busy I completely blacked out about it until today.

It was around 10:30PM on Saturday night. A gentleman asks for the pharmacist for a question.

Patient: I am pretty sure I have thread worms. I don't know if I should be asking a woman because this is kind of embarrassing. I can feel them crawling around and I need to know what to use for the itching. I have been using Vaseline but I am looking for something stronger. I know I need to wash my sheets and everything but what can I do about the itching?

Brain: (AAAAAAGGGGGGHHHHHHH!!!!!) For reals????? He has an army of worms overpopulating his poop chute and he is only worried about the itching when Ponce De Squirm-on and his merry band of explorers escape from the Fountain of Poop?????? WTF???

Me: There is an over the counter product available that will get rid of the worms so you don't have to worry about the itching anymore. Let me show you.

By the time I had given him Reese's Pinworm Medicine and reaffirmed the home cleaning regimen he went on his merry way to exterminate the explorers. It also reminded me of another patient I talked to fresh out of pharmacy school.

She came to the pharmacy because she had a prolapsed rectum. For the uninitiated, a prolapsed rectum is where the rectum is actually protruding from the anal opening and causes a great deal of discomfort until repaired surgically, not to mention awkward social situations. The most common causes are chronic intestinal parasite infestations (mostly documented in third world countries), lifting way too much weight, and in some cases from rough anal sex.

She had a surgery scheduled for the next morning but was having a very uncomfortable time and kept grabbing at her behind like she was trying to push it back in with her hand as she spoke to me so I told her to call the hospital where the surgery was to be performed and see if they could admit her early and start the pain meds now. They took her in early. Another rectum saved....

So after I thought about that I remembered a video I saw a few years ago of a weight lifter that had a huge amount of weight to lift and actually blew his rectum out and covered the camera crew behind him with feces. It was classic so I plugged "rectal prolapse" into my Google search and what to mine eyes did appear but a "guaranteed remedy" for that situation called Rectotab.

Hmmm, my curiosity was peaked. I read the magical claims of Rectotab and assumed if it worked the $79.99 was far cheaper than surgery but alas the ingredient list was not promising. I am sorry, but if my rectum is protruding from my anal sphincter I am not taking these crappy tablets I am going to do something useful for society and make a YouTube video of it wriggling and undulating to that Rick Astley song that was so horrible in the 80's then go to the nearest hospital for surgery. Another rectum saved....

"Never gonna give you up. Never gonna let you down. Never gonna run around and desert you. Never gonna make you cry. Never gonna say goodbye. Never gonna tell a lie and hurt you"....ooooooohhhhh......never gonna give, never gonna give....give you up......damn you McDruggie's muzak!

Wednesday, December 10, 2008

Chalk One Up To House

I was flipping through mind-numbing programming and stopped to watch House for a few minutes. If you have never heard of it the show focuses on the demented, crippled, and pain-killer addicted doctor House as he fumbles his way through "mystery" illnesses and tortures his medical team as much as possible.

There was a scene where Dr. House is seeing clinic patients and he has a female patient who says she is using one inhaler a week and her breathing is not getting any better. He asked her if she knew how to use her inhaler and she replies "Do I look like an idiot?" He says she does not but asks her to demonstrate how she is using the inhaler. The lady sprays it on the left and right sides of her neck like perfume. I almost wet myself I was laughing so hard. It was a wonderful laugh at an unfortunately common problem: inhaler misuse.

Please do not assume that telling a patient how to use the inhaler ensures that they will actually use the inhaler properly. This includes discharge from the emergency room because an even more common problem is that a patient will say they weren't told anything at the hospital when I know for a fact the nurse discharging the patient goes through all the paperwork with them including medication use.

Make the patient go through the motions as you describe it to them then discuss the medication, see if they have any questions or concerns, then have them demonstrate again how they are going to use the inhaler. This may not ensure proper use but it is the best we can do even with instructions in the inhaler packaging.

If there is anything the medical world teaches you is that most people have no common sense. This leads the U.S. government to over regulate things that are available without a prescription in other countries. Basically, most Americans are idiots, including the ones in power. It is with shame I hang my head and seek a mail-order husband from another country...

Wednesday, December 3, 2008

Holiday Wish List Part 2

You know Santa, there are several things we need that I don't really need to explain why. These are: universal health care coverage, better education systems, better libraries, more family time, less violence against each other, an end to telemarketing, a cure for all viruses transmitted through genital fun time, renewable alternatives to fossil fuel energy, cost effective stylish transportation, responsible personal spending and savings, and better entertainment programming.

I would also be forever indebted to you if you grant me one wish.....that someone of such great intelligence that I feel like I only had a 3rd grade education comes up with a definitive and infallible way to measure and treat pain. I vision a neuro scan that can locate the area of origin of the pain signals and the intensity at which the brain translates this signal into "pain." This would allow us to effectively treat pain while avoiding drug seekers who pretend to be in pain so they can get "high."

If that is too complicated then maybe you could grant me a drug or implant that deadens the receptors that contribute to addiction. Our current treatments for addiction all focus on weaning the patient off the addictive substance by using a different addictive substance. It almost always fails. I have seen so many people go into rehab programs only to be right back on the addict wagon a few months later. It is sad and terrible because these are the people who are "f*cked up" all the time and cause fatal auto accidents that kill the innocent and destroy the lives of their surviving relatives. There needs to be a change made.

I also want people to take a look at themselves and see that there is more to life than being stuck with a loser. Why are some people so mentally damaged and devalue themselves to the point where they feel the need to stick by a total douche bag instead of finding someone that truly cares about them? Please give them the strength to take a look in the mirror and like the character Stuart Smalley realize that "I'm good enough, I'm smart enough, and gosh darn it, people like me." I can't stand it when a woman is beaten and stays with the man and tells lies to cover up the cuts and bruises. I tell those people that the beatings will never stop unless they walk away. There are shelters specifically for this purpose if a person is unwilling to ask their family for help. There are counseling programs to help work through the feelings that keep them in danger and help them to become whole again. It scares me to think that so many of these women and gays (yes it happens to some of them also) do not reach out for help. That is no way to live...please help them to overcome the fear and escape for a chance to start over.

Santa, I need to ask that you inspire prescribers to minimize the amount of drugs used to treat any one disease state with maximum results. For example, I see hundreds of patients who take more than 5 drugs for blood pressure and heart problems. There is no need for all of that. With combination drugs on the market and several drugs used for blood pressure that do other things like regulate heart rhythm and conduction that there is always a better choice for each patient's problems.

I try to tell doctors that "new" does not mean "better." Why risk your patient's life on a drug that has not been out in the market enough to know all the bad things it can do and not have a proven track record? How many patients suffered from all of the drugs that were pulled off market less than 5 years out of the gate? Why would you base treatment on what a drug "salesman" tells you or what money the drug company is giving you under the table than on a person's health and well-being?

Maybe it would just take prescribers to remember that these are real people with real lives and real problems, not just cattle to be penned in a waiting room for 4 hours while you get schmoozed by drug reps, only to get 5 minutes of face time with your P.A. and none or almost none with you so the dollar signs in their bank account get bigger and patients get piss poor health care. I hate that. I really hate that. It makes American modern medicine a bigger joke than the "war" in Iraq that was supposed to be an "occupation" to restore a government of the people, by the people, and for the people. You need at least an hour per patient to really address all issues and questions a patient has. I am sorry that you may not be able to afford the gold swimming pool you wanted to put behind your McMansion but it is about the patient's health not your wallet. The guilty ones know who they are...

Ugh, I guess that one is a losing battle until medicine gets "socialized." So I will ask for one last wish. Santa, this is a very very important wish. It is an easy one to fulfill and could actually be done by almost every person alive today. Instead of wallowing in the gluttony of commercial expenditures this holiday, I want everyone to celebrate the greatest gifts of all, life and love. These are things that go beyond religious barriers and petty disputes.

I want children and animals to be adopted. What better way to celebrate than to open you heart and home to a new child or a new pet. I want everyone to celebrate life not stuff because at the end of the day the most precious thing we have is life. In the words of John Lennon "All you need is love." and that is how I intend to celebrate the holidays. Won't everyone celebrate with me????

Thanks Santa!

Tuesday, December 2, 2008

Holiday Wish List Part 1

Dear Santa,

This year I think I will embrace the possibilities of hope and change and ask for the impossible. If we are ready for a non elderly white guy to lead the nation we are ready for some super special wishes to be granted.

First, I would love people to stop being rude. I don't understand why one miserable son-of-a-b*tch has to ruin the day for the rest of us. What happened to peace and good will towards men when people are getting trampled to death trying to get a bargain at Wal-Mart? Seriously, it is just some piece of cheaply built crap that is getting returned a day or so after it gets opened anyway.

Next, I would LOVE a world where people put careful thought in a piece of artwork that is going on their body instead of picking a pic off a wall and having it inked. It is also stupid to tattoo the neck, hands and face where it can't be covered up by hair or clothing. You really just look like a smack hound instead of a respectable citizen. I have a few large relatively involved pieces that took years of planning before I was sure I wanted them on me permanently and they can all be covered up at work so people don't question my advice like it came from a box of Cracker Jacks.

I would also love it if people got their tattoos while completely sober. Seriously, if you can't take the pain then you don't need the ink you f*cking p*ssy! I suffered through every prick of my ink and you should too.

Next, I want everyone in the world to examine their eating and exercise habits and make changes as necessary to prevent the need for specialty clinics serving people who had to be crane lifted out of their homes because they have a refrigerator and microwave within arm's reach of their beds and haven't seen their feet since 1972...

We have serious problems when gastric bypass surgery and liposuction procedures are becoming as common as impacted wisdom tooth extractions because we are overrun with people weighing in excess of 400lbs. That may be normal for a 7 foot tall linebacker but not for John and Jane Q. Public who struggle to move throughout the day because most transportation and public facilities were not built to accommodate those of massively excessive girth. Yes, I know that about 5% of them have legitimate hormonal and metabolic disorders that cause the weight gain but the other 95% are just plain irresponsible for their own well being and need a Christmas miracle to fix whatever underlying mental issue fuels their desire to shovel food in their gullets and just keep on going...