Level 12 Diabetes

A woman came to the counter today with a gallon on GatorAde fruit punch. She wanted to know if it was good for her diabetic husband to drink GatorAde all day. I scanned the ingredients...water, high fructose corn syrup, sucrose syrup. I say no, that doesn't sound good for a diabetic. She challenged me, "since I am the pharmacist".

Suzy Q:"He has gone from a level 4 diabetic in June to a level 12 diabetic now so he needs to drink electrolytes. What exactly are electrolytes anyway?'

Oh my, so many many things wrong with these questions. I know this discussion will end badly.

Me:"Has your husband been sick? Did your physician recommend electrolytes?"

Suzy Q: "Everybody needs electrolytes".

Kudos to the great marketing team of GatorAde, they have earned their salaries.

I quickly skim over the basic science and again ask her if her husband has been sick with the flu, vomiting, diarrhea?

Suzy Q: "He has level 12 Diabetes"

Me: "I'm not familiar with that terminology. What were his last few blood sugar levels?"

Suzy Q; "Oh, you don't know anything about diabetes?"

Sigh. Maybe she is a friend of The Channeler. Remember him? He told me that aliens whispered the cure for diabetes to him in his dreams. He has a huge volume of information to share with the world. Nobody can read it because it's written in the alien language but he's working on a translation and will bring it in when he is finished. Maybe he gave Suzy Q a copy of the translation. So I guess that I don't know anything about diabetes after all. And I'm still waiting for my copy.

The Pharmacist (1946)

Video courtesy of the Prelinger Archives.

My favorite part is the line that "women make good pharmacists" but the film shows a woman mixing what could be cake icing. They are hoping that a woman who looks like she's in the kitchen will be more acceptable? ANYway, this film is a quaint ode to pharmacy, a field that serves all humanity.

Question-of-the-day: "Can I have my salad with Italian dressing if I am taking an antibiotic?" This stumped me so I asked why she was asking me that particular question. She said that her drug info said to "avoid grapefruit". I am still puzzled. :-/.

Rising Drug Costs

Link to an article snatched from the NYT about rising drug costs. My instinctive reaction is that Big Pharma wants to establish higher costs, so that when their payments are reduced by any newly changed healthcare policies, they will have the same revenues as before. Remember how some banks increased some credit card fees and rates before some new regulations took effect? Same thing. Brace yourself for higher drug costs.

http://www.nytimes.com/2009/11/16/business/16drugprices.html?partner=rss&emc=rss

I am amused by my little old ladies who cannot remember to take their Alzheimer's pills. Those little old ladies are my favorite patients and I look forward to helping them when they come to my counter. I am also amused by the little old ladies with thick glasses who cannot find the Ocuvite on the shelf. They come in armed with their magnifiers but still need my help. Good times!

Quip-of-the-day: Obama planted the swine flu so senior citizens would have to sign up for the new healthcare.

Exacta Zen

Counting all day can get tedious. You need ways to keep your mind fresh and focused. I keep tally of the number of times that I pour out exactly the right number of pills in one pour. This has to be a quick unhesitant pour. No shaking the bottle as the pills fall out one by one. Over a decade ago, one of my technicians called these pours "Exactas". The name stuck. I admit that I tally my Exactas most days. I have a strict definiton of Exacta. It only counts if you pour quickly. It only counts if there are pills remaining in the stock bottle after you pour. Unit-of-use packaging doesn't count. I average about 3-4 Exactas in a 10 hour day. It's going to be a good day if I pour an Exacta before 9am. Last week I had 11 in a 10 hour day. That was a great day! Throwing Exactas somehow reassures me that I am in the zone, I am focused and clear and ready. You can't forcefully enter the zone, you have to be loose and let it come to you. If you focus on the zone, it evaporates. It's a meditation of motion and rhythm. It's Zen................
.....then both phonelines ring, consulation is needed, override codes are needed, blah, blah, sigh.

Need a tech?

My boss tells me to be sure to use my techs effectively. Let's see.....
Techs are supposedly here to help me process, fill and sell prescriptions. Hopefully they can relieve my stress by stepping in to carry on any procedure when the heat is on. Great in theory!
My techs are not allowed to fully process any prescription. They are required to interrupt me so I can signoff the computer with one of my two passwords depending on the situation. Techs are not allowed to sell any rx until I have checked it. Techs are not allowed to sell any new prescription without the pharmacist (that would be me again) counseling the patient. Techs may answer the phone, but they are not allowed to answer any medical question, take a new prescription or transfer a prescription. Those tasks fall to the pharmacist (that would be me again). So....my question is, what do I need a tech for?
Currently accepting any and all suggestions.

Quip-of-the-day: Yes, I will need consultation as I have never had an STD from my husband before. :-O

Compliment-of-the-day: No way you need to lose a lot of weight. Maybe only 10 pounds.

Chuckle-of-the-Day

Conversation between me and female patient:

"My doctor prescribed this antibiotic and this other pill. Is this other pill for yeast?"

"Yes, it is."

"Good, I'm thinking in the right box then."

Um ...yes. Yes you are.

Question-of-the-day: Did you have to go to school to be a pharmacist? After all, it's not science.

Why is Pepto-Bismol pink?

Ok Target, thanks for the tv ad that has forced me to answer this question-of-the-day.

Pepto is pink because of the main ingredient, bismuth subsalicylate, AKA pink bismuth. This is the same ingredient that turns your tongue black. Pink bismuth reacts with the tiny amounts of sulfur in your saliva and forms bismuth sulfide, which is black, and it can coat your tongue after you take Pepto.

And no, you should not give Pepto to kids because that active ingredient, bismuth subsalicylate, is a derivative of salicylic acid, AKA aspirin.

Next question?

Pharmacy is BIG business

http://news.yahoo.com/s/ap/20090903/ap_on_go_ca_st_pe/us_pfizer_settlement

Excerpt from the above link from the Associated Press:

"WASHINGTON – Federal prosecutors hit Pfizer Inc. with a record-breaking $2.3 billion in fines Wednesday and called the world's largest drugmaker a repeating corporate cheat for illegal drug promotions that plied doctors with free golf, massages, and resort junkets.
Announcing the penalty as a warning to all drug manufacturers, Justice Department officials said the overall settlement is the largest ever paid by a drug company for alleged violations of federal drug rules, and the $1.2 billion criminal fine is the largest ever in any U.S. criminal case. The total includes $1 billion in civil penalties and a $100 million criminal forfeiture.
Authorities called Pfizer a repeat offender, noting it is the company's fourth such settlement of government charges in the last decade. "
____________________________________________________
Pfizer makes some of the top selling drugs, including Lipitor and Viagra. If you don't take these drugs, you probably know 27 people who do. How does it feel to contemplate the notion that the hard-earned money you paid for your expensive medication was partially used by Pfizer to ply "doctors with free golf, massages and resort junkets"? So that your doctor would choose Lipitor for your medication, which costs you and your insurance company more than a generic statin? Your collective prescriptions for these drugs and some others added up to $43 billion in sales for Pfizer last year. That's $43,000,000,000. That's a 43 and nine zeros. That's BIG. Do you think that a fine of $2.3 billion means that much?

Wrong pills

I really hate it when movies get pills wrong. There's a billion dollar budget and they can't pay someone a few dollars to call the pharmacy and check whether the pills look right or not? Nothing will pull me out of a movie faster than the moment the character pours some pills in his hand, and the pills are the wrong form, shape or color. This can ruin the whole film for me. I have casually polled my peers and they agree. C'mon Hollywood! Get it right!

Concept-of-the-day: when you take your blood pressure pills and your readings are lower, your blood pressure is not cured. Your pills are working and you need to keep taking your pills to maintain those low readings.

Famous Pharmacists

You may not have known that these people were pharmacists...

President Hubert Humphrey
Author Agatha Christie
Founding Father Benjamin Franklin
Sir Isaac Newton
Author O. Henry
Playwright Henrik Ibsen
Benedict Arnold

From http://www.who2.com/famouspharmacists.html

The first professional pharmacies are said to have been in Baghdad in the 13th century. As a practice distinct from that of medicine and healing, modern pharmacies developed in the 18th century, and by the 20th century had expanded to include general merchandise and even food counters. Below we list several famous people who spent time behind the pharmacist's counter, a sampling that includes apprentices to apothecaries, clerks for chemists, and owners and operators of the family drugstore.

Before he opened his printer's shop in Philadelphia, BENJAMIN FRANKLIN -- what didn't that guy do? -- was engaged to be a clerk for a mercantile store. For a short time he sold a variety of items, including herbs and medicines. Later, of course, Ben became famous for his many inventions and statemanship, and for dispensing healthful advice through his Poor Richard's Almanac, including "An ounce of prevention is worth a pound of cure" and "An apple a day keeps the doctor away."

Italy's great poet DANTE joined a Florentine apothecary guild in 1295 or 1296. It's doubtful he ever had to mix compounds or sell toothpaste, however. Dante probably joined the guild because in those days a guild membership was required in order to participate in city politics.

A good student from England's Grantham Grammar School, young ISAAC NEWTON served as an apprentice in an apothecary shop in Woolsthorpe. He lived at the shop and for a short time was even engaged to the shop owner's daughter. The job and the romance ended when Newton went off to Cambridge University and started his brilliant career in mathematics and physics. We can only wonder what kind of a druggist he would have been.

American short story writer O. HENRY (the pseudonym of William Sydney Porter), considered one of the finest in the game and very popular in his day, had an unusual career path. Before he became a writer in New York, Porter had had several odd jobs in Texas and had spent three years in prison for embezzlement. And before that he worked for his uncle as a licensed pharmacist in Greensboro, North Carolina.

The great Norwegian playwright HENRIK IBSEN joins the ranks of those who spent their teen years surrounded by drugs. In 1844, at the age of 16, he became an apprentice in the coastal town of Grimstad pharmacy. After his apprenticeship Ibsen worked as an assistant pharmacist, leaving in 1850 to study in Christiana (now Oslo).

Minnesota Democrat HUBERT H. HUMPHREY served as the Mayor of Minneapolis, a U. S. senator and the vice president of the United States under President Lyndon B. Johnson, a pillar of the party for his stand on civil rights and social reform. His long political career came after Humphrey had a brief career as a pharmacist in his dad's drugstore. Forever a friend to pharmacists, Vice President Humphrey was named Pharmacist of the Year by the St. Louis College of Pharmacy in 1966 (Humphrey himself attended a college of pharmacy in Denver). Since 1978 the American Pharmaceutical Association has given the annual Hubert H. Humphrey Award to pharmacists who are also known for their public service.

BENEDICT ARNOLD is one of the most infamous figures in United States history, a smart military tactician who fought for the colonists before he switched sides and fought for the British. Before the Revolutionary War, Arnold was the owner of his own apothecary shop in New Haven, Connecticut. As a teenager he learned the trade as an apprentice in a shop owned by his relatives Daniel and Joshua Lathrop -- when he wasn't running off to fight wars, that is. As a young man he toured Europe, then returned to Connecticut and opened his own shop, with his sister Hannah as his assistant. Once the Revolutionary War started, he apparently abandoned his apothecary business so he could go down in history as a traitor.

Customer Quote of the day: "Those people at W**m**t are nice enough but they are just not very smart, not like you are." That's why I cost more than $4.

Quote of the Day

"I need an early refill on my Soma because some chick called me a crackhead and punched me in the face in the Walmart parking lot. All in front of my 9 year old daughter. I called the cops right away and they came right away and they already had her mugshot and asked me if that was her and I said yes and they arrested her and my neck is killing me all because this lady just hauled off and punched me in the face for no reason."

Quote of the Day

Quote of the day: I was eating at a restaurant and started to cough, then started to choke and I had to be Heimlisch Removered.

Healthcare Reform #1

Many of my patients/customers complain about the proposed Healthcare Reform everyday. I hear this one ALOT, "I don't want restrictions on my healthcare". Valid enough concern. Most people deal with healthcare restrictions already. The HMO tells us what drugs they will pay for, how many tablets they will pay for, and when they will pay for it. The HMO tells us which doctors, which emergency room and which hospital they will pay. And we comply with those restrictions in exchange for the medical coverage. So we have shown that formularies and networks are acceptable limits for us. So what's the problem again?

Welcome!

Ever wonder what goes on behind the counter at the pharmacy while you wait for your prescriptions? Come with me and I will tell you. Whatever happens that seems blogworthy, I will tell you. Sometimes good, sometimes not, sometimes hilarious, sometimes not so much, but I will tell you. I may just share a topic that is on my mind. Whatever it is, read it and feel free to comment. See ya on the interweb.