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Friday, November 28, 2008

Holiday Wish List

The end of the year is nigh. The mad dash for gifts people will return or leave in a closet to re-gift to someone else later is here. It started off with people coming into McDrugggie's ever so often to use the restroom. No purchases, just restroom trips. These nut-jobs had been in line at Best Buy since 4pm on Thanksgiving so that they could get the magic coupon that got special prices on certain items. I hate to break their plates but all of the items in the ad were available on-line at the sale prices without the magic coupon.....could have shopped at home and enjoyed your family instead of sitting in a 200 people line all night long....I will never understand....

A lady that calls all the time called asking if there was a virus going around because she will only take a Xanax but never anything for her allergies because medicine makes her "sick." She always asks me if I am seeing patents with colds or flu symptoms and if I am sick because I sound sick. I told her I had some allergy related congestion and she told me she had the cure for that....a nettie pot. I let her know ever so politely that if I wanted warm saline in my nose I would go to the beach and play in the waves because inevitably a big one comes along, knocks you down, and cleans your sinuses for you. I of course was joking but seriously do not like the sensation of any liquid in my nose, no matter how congested if may be.

The opposite week manager was filling in for the regular manager and was telling me stories of how the other pharmacist refuses to recommend OTC products because "The body makes snot for a reason and if you take OTC meds it just prolongs the illness." She then told me that he always tells people that none of the OTC vitamin products are regulated and each bottle contains a different potency and concoction than the one before so you shouldn't take any of them.

He also told a pregnant lady one night that she shouldn't take Sudafed because it is what junkies use to get high and did she really think that was a good idea for the baby. That was hilarious. I would never say that to a pregnant lady. I would tell her to use saline nasal spray until she talked to her OB/GYN. He also likes to tell people to ask me questions when I am back on duty. I have had several of those patients but in his defense when he went to pharmacy school they had to compound everything and aspirin was the only real drug. On the other hand he is a pharmacist and should be up to date and comfortable with most of the medications on the market and health issues patients have questions about.

So for the rest of the evening I fed the robot with pills, cleaned, and restocked supplies for a lack of anything medical to do. Then I had a patient come in with a prescription for Duragesic 75mcg patches. For those who don't know, this is a powerful pain patch used in patients who don't tolerate opiate pain relievers like morphine or oxycodone. So I ran it and to my surprise he picked up Oxycontin 60mg (twice daily dosing) from CVS a couple of days ago. These DUR notifications are about the only good thing insurance companies do anymore because without them I would have no idea about the other prescription. Now I am concerned because I have NEVER seen or heard of these two medications being used together. So I had to have a serious conversation with the patient.

He said he had been on the combination before but I told him we needed to consult with the physician to make sure the doses had been properly titrated and the physician was aware of complications that could result from the combination. The patient really had no problem with taking both together. Because I have no recent prescription history to prove the doctor was aware of the situation I told the patient they are both powerful meds that are never used together in high doses because of breathing complications that could result in death. He left the prescription for me to call on and still was not concerned about any complications. What I really wanted to say to him was "Sir, I cannot dispense these without talking to your doctor because Murder One is not on my Holiday Wish List." Alas, I could not vocalize but merely ruminate on that which my brain wanted to scream out...

On the bright side the day was easy and over before I was completely bored stupid. On to the next day...

Wednesday, November 26, 2008

Pass The Turducken!

It that time of year again when families gather to feast upon that most magical of beasts, the turducken. Not technically a creature of the natural world but the design of some culinary dementia where a turkey just wasn't enough so a duck gets stuck up its hole where intestines and organs used to lie. This foodie contraption is dressed and cooked in various not-at-all healthy ways, combined with other unhealthy abominations of foodie dreams to be devoured by family and friends at a rate that would astonish the starved inhabitants of a remote tribal village that only sees a "full" meal once daily if lucky.

Wow.....Happy Turducken Day! or if you are vegan Happy Tof*cken Day! (where a tofu mass shaped like a duck is stuffed into the hole of a tofu mass shaped like a turkey and sounds dirty when you say it out loud...). Don't forget to gather around the table and switch the salt with a Lipitor shaker so you can pretend that cholesterol won't be the catalyst for your ultimate demise.


Don't forget to be thankful for all the things you love like "clean rooms" and antibacterial soaps, birth control and lubricant, or whatever floats your boat. I am thankful for laundry machines because washing a large load by hand would suck more than having fecal impaction...or so I imagine it to be.


And Remember: If you have a roof over your head, money in the bank, and money in your pocket (no matter how small the amounts), you are part of the richest 8% of the world population! Yay!

Thursday, October 30, 2008

Pickled Pink

I think back to Biology 101 and the little pickled animals and parts we dissected, poked, and prodded to "learn" what insides look like and get an idea of how structure and function relate to the electrochemical magic we call "life." It is fascinating but are we pickling ourselves?

Since the dawn of the TV dinner science has produced chemicals that make food stay in an edible form for periods of months to years. We have also seen a steady rise in neurological disease and gastrointestinal cancers. Sure, skeptics would say that the rise in many diseases of aging happen simply because our life expectancy has greatly increased beyond that of people from 200 years ago. I am not so sure.

I looked through a catalog of government approved food additives. There is a whole lot more than color going into those Pop-Tarts, kids. There are pages and pages of protein, fat and sugar substitutes, colors, flavors, antimicrobials, texture stabilizers, etc. I don't even think Kosher hot dogs are "Kosher" anymore because several additives are derived from animal and bacterial origin. I was taken aback by the practically unending array of things you can put in food to make it appeal visually, odoriferously, and tastefully.

Consider colon cancer. The colon is basically the sewer system of the human body. The upper digestive tract breaks down food so nutrients can be absorbed and passes the rest of the material to the small intestine for further processing. The intestines have secretory cells that coat the lining with a mucus layer that assists in moving waste out while bacteria finish processing waste. While the waste is moving out some things get stuck in the mucus layer. If you don't eat enough fiber these trapped wastes can lead to irritation or infection in the intestinal lining. These irritations sometimes form polyps that eventually have the potential to become cancerous years down the road.

The real problem with colon cancer is that you can be asymptomatic for years after the cancer starts. Once it has spread to other areas of the body and you start showing symptoms it can be damn tough to treat and often fatal. This is where routine screenings for certain age groups come in. Sure the test is very uncomfortable but if you can catch it early you can stop it early. How many of the additives in food contribute to this? We have no idea.

Another problem we see more and more is Alzheimer's disease. This neurobiological breakdown of brain tissue leads to serious problems relating to being able to care for one's self or becoming a burden on the family. The saddest statistic is that most of these patient's end up in long term care facilities on a chemical cocktail that keeps them "manageable". It is a horrifying sight to behold and I will die in a well orchestrated "accident" before I let that happen to me. It does run in my family so I will more than likely be afflicted. Tick tock...not sure how long but I know my brain is waiting to turn to useless mush in about another 50 years... Pudding, it is turning into pudding...

Another neurobiological issue is Autism. There are many degrees of cognitive failure in Autism. For the lucky ones the damage is minor and they appear to function on a time delay. Others are not so lucky and seemed trapped in a repetitive nightmare that makes them a burden on the family. Could it be from food additives during a baby's time in the womb that cause this?

I like to think there are many contributing factors. First, neurological problems can be inherited. Alzheimer's, seizure disorders, and several forms of mental retardation are known to be inherited. We all have a "crazy" relative somewhere in the family tree. That one relative is evidence that your genetic stew can go bad when it comes to cooking up a new member of the family.

Second, diet plays a major role in fetal development. There are certain nutrients we know pregnant women need to prevent specific developmental problems. There are also certain foods pregnant women should not eat because they are in a state of decreased immunologic function. I am curious to see what women ate the entire time they were pregnant if the child was diagnosed with autism. I doubt that would be a good study though because people always lie about eating better to scientists or medical personnel.

Third, certain medications are known to cause birth defects and increase the risk of birth defects. I would like to know what prescription and OTC medications women were on along with vitamins, herbal supplements, health drinks, etc. the entire time they were pregnant if their child had neurological problems.

I don't know what the answer is as I have written myself into a vortex of practically unanswerable questions. I think I have to side with the Vegans on this one. Unprocessed foods seem like the best choice to me. Beyond foods, I don't think I will use any medications unless 100% necessary during pregnancy. Not that I am planning on children but you never know when an accident will happen....

Sunday, October 26, 2008

Shame On You, CNN

So I am in Orlando, Florida for a fun weekend of theme park rides and I flip through the channels to find something to amuse until we leave for the parks again. I stop on CNN hoping to get some of "The Most Trusted Name In News" and see a lady (I don't remember her name) talking about how medical doctors are notorious for prescribing placebos when they don't know what is wrong with a patient.

Here is her list of "placebos":

*vitamins
*anti-inflammatories
*antibiotics
*saline
*sugar pills

This is the definition of placebo:


pla⋅ce⋅bo   /pləˈsiboʊ for 1; plɑˈtʃeɪboʊ for 2/ Show Spelled Pronunciation [pluh-see-boh for 1; plah-chey-boh for 2]

–noun, plural -bos, -boes. 1. Medicine/Medical, Pharmacology. a. a substance having no pharmacological effect but given merely to satisfy a patient who supposes it to be a medicine.
b. a substance having no pharmacological effect but administered as a control in testing experimentally or clinically the efficacy of a biologically active preparation.

2. Roman Catholic Church. the vespers of the office for the dead: so called from the initial word of the first antiphon, taken from Psalm 114:9 of the Vulgate.
--------------------------------------------------------------------------------Origin:
1175–1225 for def. 2; 1775–85 for def. 1; ME < L placēbō I shall be pleasing, acceptable



To set this lady on the right path anti-inflammatories, antibiotics and vitamins cannot be placebos because they actually are chemicals that perform a specific function in the body. The case can also be argued for saline. It performs as a tear replacement in eye drops and a fluid replacement intravenously for volume deficiency (ie dehydration) and as a vehicle for medication delivery. So technically saline does have activity in the body so it is not technically a placebo.

Should I go as far as to say that sugar pills can be argued to not be a placebo.... For diabetic patients on insulin therapy drops in blood sugar can be dangerous to the point of being deadly. These people take sugar pills to help in the regulation of blood sugar so in specific cases sugar pills do not count as a placebo unless they are being used as a "control" in an experimental evaluation.

The lady further went on to breed mistrust between patients and physicians when the "interviewer" asked if this was "legal" and she replied that the practice of giving placebos is "..legal but unethical." How do you like them apples...now the "most trusted name in news" wants you to revolt against your primary care physician. Is this how the government plants seeds to discourage "socialized" medicine or is this lady just another ill-informed media puppet?

This post just proves two things: CNN should not be the self-proclaimed "most trusted name in news" and I am an opinionated, angry c*nt.

Monday, October 20, 2008

No Good Deed Goes Unpunished

So I get a call at McDruggies's and a lady wants to know if the rash she has is from her cat. She is elderly and has a "feral" rescued cat that she keeps in her house and has had for a long time. It lets her pet it when it feels like letting her pet it. Other than that she is the "food giver" and "poo box cleaner" in the one-sided relationship. She said sometimes the cat likes to sleep with her on the bed and lounge on the couch. So I ask for more details about the rash.

She has a lot of swelling from the knees down and on her arms. It started this morning and is getting worse. She also has a lot of itching and some "spots" on her upper arms and a couple of "spots" on her face. I ask for more details.

It turns out she was going to be a sort of half-way house and that another "rescue" cat had been left with her two days ago and the rescue worker told her to take a towel and rub the new cat then rub her cat so they would recognize each other's scent. One teeny tiny problem.....the new cat has ringworm (a fungal infection of the skin) that no one told her about. This means that the resident cat has been thoroughly rubbed with the towel from the new cat with the skin infection. You know what happened next...

The last two days played like an outbreak movie in motion where the infected kitty and resident-now-infected kitty have rubbed against the lady's legs and arms from where she wrangled them to put antibiotic ointment around where they had scratched their ears raw. She then took two showers to try and soothe the rash, which makes the skin dry and makes the rash more irritating. The new kitty had gone to another half-way house.

At the point in the evening when I talked to her the new kitty was at a different home and may be coming back to her in a couple of days. I told her to call them in the morning and tell them "No." She now has to treat her infected "feral" cat, treat herself and do some significant cleaning everywhere infected cats have rubbed. That will be a daunting task because my cats are not "feral" and they are on e-v-e-r-y-t-h-i-n-g in the house.

Her next few days will involve a trip to the vet with an angry kitty, a trip to the drugstore/urgent care for her, and a lot of itching. I would rather be in pain than itch and there is only so much OTC products can do. After I talked to her a few times over the course of the evening to reassure her that it is a treatable condition I suffered some psychosomatic empathy itching.

The moral to the story is when taking in "rescue" animals, be sure to ask if there are any medical problems the animal may need treated. Have a vet give all necessary vaccinations, check for ringworm/heartworm/etc., and look for signs of skin infection, parasites, or open wounds. It is also a very good idea not to introduce your pet to a rescue animal without isolating the new animal for at least 48 hours to make sure it does not have anything that could pose a health threat to you or your pet.

Isolation is especially important with birds. They can carry many different respiratory illnesses and parasites that readily jump from bird to bird. When birds get sick they stop eating which leads to dangerous drops in body weight. Birds are like newborn humans, when things go bad they go bad fast and can easily be fatal.

Following these precautions can lead to a very rewarding new addition to your animal family. I know I love each of my little ani-pals like they were my own babies and wouldn't give them up for the world! ....an NO, I am not an animal horder. I have 2 cats that roam the house like they own it and 5 small birds that live in a large metal aviary (mainly to avoid becoming kitty treats). Happy adopting!

Friday, October 17, 2008

Think Happy Thoughts, Warm Safe Place

Sung to the tune of "Witch Doctor"

I told the politician I need some health care
I told the politician life was so unfair
And then the politician, he told me what to do
He said that....

Ooo eee, ooo ah ah ting tang
Walla walla, bing bang
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang

I told the politician my home would soon be lost
I told the politician I could not bear the cost
And then the politician, he gave me this advice
He said to....

Ooo eee, ooo ah ah ting tang
Walla walla, bing bang
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang

Now, you've been suffering like me
Just like you were homeless
And I'll admit I don't feel so well
So I went out and found myself
A guy that's so much wiser
And he bought me a bottle of Cuervo

My friend the politician, he took that bottle too
My friend the politician, he beat me black and blue
I know that he will smile while wiping me off his shoe
Oh, baby....

Ooo eee, ooo ah ah ting tang
Walla walla, bing bang
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang
Ooo eee, ooo ah ah ting tang
Walla walla, bing bang




****Ugh**** No happy thoughts left... Maybe Zach and Miri have it right, the only joy left is making a porno...

Monday, October 13, 2008

Off Topic: Do Not Use Travelocity For A Trip

I have had a terrible, terrible time with Travelocity and changing reservations. You will get f*cked really good because in order to change anything on your reservation after you have booked they will charge the FULL PRICE you paid again for the change. If you cancel the reservation they will also charge you double for a cancellation fee. What douche bags! The only customer service you get from them is rape.

Oh yes, their advertising makes it sound like you are getting a good deal and getting first class service, when in fact they are just greedy bastards taking your money and then fisting you for more later if something happens to need changing.

DO NOT USE TRAVELOCITY FOR ANY TRIPS!!!!!