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RudeDoggy
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Name: Michael
Country: Netherlands Antilles
Interests: drinkin' louis xiii out of my iced out cup, hittin' tha clubs with my Cartiers on
Expertise: pimpin' hos and makin' paper
Occupation: Operations
Industry: Hospitality
Message: message me
Website: visit my website
Member Since:
11/1/2003
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It's been a while since I've done the ol' blogging thing. I thought I would describe an encounter I had last week. It involves Proctosedyl. In case you aren't aware of this wonderful product, it is a drug (available in various forms - ointment or suppository) that is actually a combination of drugs that essentially gets rid of hemorrhoids.
So a lady in her late twenties comes in and hands me a prescription for "Proctosedyl supp BID and after each BM" --translation: Insert 1 suppository twice a day and after each bowel movement. So I go ahead and process the prescription and begin my counseling session. I won't be able to recreate the conversation verbatim but the essence of the conversation will be recreated here:
Me: Hi. So you're getting a prescription today called Proctosedyl. Have you had it before?
Her: No.
Me: Ok, I will go over with it you. They are suppositories and you have to insert one twice daily and after each bowel movement.
At this point she was giving me a blank stare so I tried again.
Me: Are you familiar with suppositories?
Her: No. What do you do with them? Eat them?
Me: <stifled laughter> No, you insert them rectally.
Another blank stare.
Me: Rectally....you know, up your anus?
Her: Oh, ok. <somewhat blank stare>
I see where this is going so I start opening the box to show her the individually packaged suppositories wrapped in hard plastic.
Me: So you take one of these suppositories and you unwrap it and then you insert it up your anus.
Her: Oh, ok. Do I have to wear underwear with this?
What?!!! This question absolutely dumbfounded me. I think it was my turn to have a blank look on my face.
Me: <stifled laughter once again> Yes, you should wear underwear with this.
Her: Ok thanks.
Now, I don't assume that all people know what suppositories are, but I find some of her questions extremely puzzling, and frankly, a bit scary. Do I need to come up with a rap counseling session for Proctosedyl??? (Any other suggestions for raps for the next time I'm bored at work and have time to waste?) | | |
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In case you didn't know, that's a tablet of Apo-metformin 500 mg. Why did I choose a picture of this? Because, unlike Nirodha, I actually choose pictures that actually make sense (sorry to call you out like that dawg). Like pirates_ahoy, I too had a problem involving metformin. Who could have thought this wonderful diabetes drug would result in a threat of personal injury? Let me start from the beginning.
So it was 7 pm in a community pharmacy in a smaller town (just outside the GTA) and it was a slow night. A few people were calling in to renew their prescriptions but there was no rush as they were all coming in the next day. Now, this lady (I shall use the initials JM) called in asking for a repeat on her metformin. When I pulled up her profile, I realized that she was more than a month early on her refill. (For anyone that cares, she was 40 days early on a 100 day supply and she had an Assure/BCE Emergis plan. i.e. They ain't gonna pay.) When I asked her why she needed her refill so early (since the doctor prescribed it as twice a day) she promptly (and with a bit of indignation) said that her doctor told her to take four a day. I told her that it was not a problem and that I could probably get a new prescription with those directions from her doctor the next day. In a huff, she said, "Forget it," and hung up the phone.
Five minutes passed.
I received another phone call. This time it was a male. He asked for the "druggist" so I said that I was the "pharmacist." He then asked for a repeat and gave me the Rx number. Funny enough, it was the same prescription JM had called in five minutes earlier. I explained to him that it was early. He asked why it was early and I explained that the doctor had written it as twice a day so to the insurance, they figured she had more than a month left at home and as a result would not pay for it. He seemed to accept this and repeated it to his wife. I could hear his wife chirping in the background, "The doctor told me to take four a day!" This is where the man lost it.
"You guys always screw up! This isn't the first time you guys have done this. Last time you guys screwed up and you didn't resolve it properly."
"Sir, this happens all the time. Doctors will write one thing but tell patients another. It's not a problem; we can call the doctor tomorrow and hopefully get this straightened out."
"You guys messed up! You're in the wrong. Why do you guys always mess up? You know what? We will never get another prescription filled here again."
"I'm sorry we were unable to meet your needs---" (I was in the middle of my "fuck off" but-in-a-nice-way-speech* when he cut me off.)
"And another thing. I'm going to call the college of pharmacists about this."
This is when I lost my patience.
"Do you need their number? Let me get it for you."
"If I were to come down to the store right now, I'd give you a slap upside the head for being cheeky."
"We are open until 8 pm if you'd---"
He didn't let me finish my offer of him coming down that night because he hung up on me.
So not like I'm keeping track or anything, but in the one year and one month I've been working as a community pharmacist:
- I've given advice on a cat eating someone's birth control pills (although now I suspect it was a prank call)
- I've given legal advice for someone charged with driving under the influence (now before someone from the Law Society of Upper Canada gets pissed off, I told him to contact a lawyer)
- I've witnessed kids barfing right in front of my counter while in the process of counseling
- I've had someone threaten physical harm towards me
Whoever said that working with the public wasn't interesting?
* How to tell someone to "fuck off and never come back" in the nicest way possible (I feel anyway): [I'm sorry / It's obvious] we are unable to meet your needs here. Please feel free to have your repeats transferred to another pharmacy. Personally I don't find that too inflammatory but what do you guys think?
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Now does anyone else see a problem with this combo? What's the big deal, you ask? So some guy has a respiratory infection and superficial basal cell carcinoma?
Now what if I said that the Zithromax was written as 1 g stat? (In case you aren't familiar with that dosing guideline, that's usually for chlamydia.)
And what's Aldara for? In addition to treating certain types of skin cancer, it's also commonly used for genital warts.
I'll let that sink in for a minute.
So, this is what I'm assuming*: This person has genital warts and is having it treated with Aldara (imiquimod). This person has also acquired chlamydia (or "the clap," if you will) and is having it treated with Zithromax (azithromycin). Now think about that for a minute. The only way to get either of these is through unprotected sex (usually with more than one sexual partner). He didn't get both the warts and the clap at the same time as the Aldara was a "repeat" prescription (i.e. an on-going prescription) and the Zithromax was a new prescription.
Like my previous patient (the Zithromax 1 g + Suprax 400 mg guy with his wife on his drug plan card), kinda makes you wonder what's going on out there. I think this is certainly a case, for me at least, of bliss being obtained from ignorance. I think I would rather not know.
*This is only my assumption. I did not ask the patient the purpose of either medication. And you know what they say about assumptions...
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| Two random thoughts came to mind today.
1. Two days ago on my way to work (in a rush as per usual) I came across a traffic accident. A lady was lying on the road, a pickup truck was stopped in the middle of the road, and there were a few bystanders standing around the woman. I noticed one man on a cell phone, another lady comforting the hit pedestrian and a couple of other bystanders (witnesses?) standing around. I didn't really stare too long (my pet peeve are the rubberneckers that cause the traffic tie-ups...) but I didn't notice any type of chest compressions or blood or anything like that.
I heard on the radio yesterday that she had died. I drive by this intersection every day on my way to work. I can't help but think about her every time I drive by. There are no flowers or any other type of mark to indicate that a woman had perished there recently.
Earlier this summer I came across another hit pedestrian. This was on my way home from work back to civilization (aka Toronto). It was a rainy night and there was a car stopped in the middle of the road with its 4-ways on. I slowed down to see a man lying on the ground and a few bystanders trying to comfort him. I stopped, pulled over, and offered my assistance. The man was bloodied up and his breathing was really jagged and shallow. I waited until the ambulance came. I checked the news every day for the next few days to hear anything about the man but never did. I hope he pulled through.
2. I filled two prescriptions two days ago for the same thing: Zithromax (azithromycin) 1g stat and Suprax (cefixime) 400mg stat. (For the uninitiated, this is pretty standard treatment for gonorrhea.) One was for a 21 year old male. It wasn't necessarily expected, but was certainly understandable. The other was a 40something male. As he handed me his drug plan card, I noticed that he had himself and his wife on the plan. So... did he get it from some other woman (thus confirming his extramarital affair) or did he get it from his wife (thus confirming her extramarital affair)? Ethical dilemma: If you were a doctor, would you tell the man that he had gonorrhea? Or would you just tell him that he had an infection and play it off like it was a "bladder infection?" I'm really curious to know what the doctor told him because I sure as hell didn't tell him what it was for.
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| Want to know what happens when you do six prescriptions in the last two hours of work? That's right: coming up with more counseling "rhymes." Like any sequel, these rhymes might come up a bit weak. Having said that, because I've catered to the requests, I fully expect these (or a variation of) to be used in practice.
Oh, and Trix, amoxicillin has Gram positive coverage, according to Sanford. So no rap for you. And Bruce, your Cipro counseling session was pure gold.
Plan B (levonorgestrel)
Plan B, ya'll know what's up
Plan B, it's what you need
Plan B, it helps, guaranteed
A moment of indiscretion
Or perhaps a transgression
Or maybe it was a mistake
Oops, I did it again-- like Britney Spears
It's ok, but let me make this clear
It only works within 72 hours
Of the plougher
Sewing his seed
I hope you're not peeved
Plan B, ya'll know what's up
Plan B, it's what you need
Plan B, it helps, guaranteed
Now that we got that outta the way
B, I got somethin' to say
Take two tabs at the same time
So no need to whine
But ya'll wanna take some gravol with that
Or you might just go splat
And ya'll don't want that
Cuz it'll be another $29.99 plus tax
Word
Marinol (dronabinol)
You can't eat and you want the munchies
But you don't wanna smoke some scent-seed?
Or you getting some chemo
And you don't wanna vomit, yo?
Then holla at me baby; I got what you need
It's called Marinol (Marinol)
It'll make you crunk, y'all (crunk y'all)
No stoned effect (effect)
It keep your mind in check (in check)
Don't worry bout the po-po (po-po)
This shit be legit yo (legit yo)
There be different ways to take Marinol
But none include taking with alcohol
Jus' take it the way your doc said
Do that and you'll keep yourself fed
But if you don't wanna listen to me
You can go and smoke some trees
Juss think of what to say to the po-po
Cuz Marinol be legit, yo
Dilantin (phenytoin)
Shakey shake, you got the shakey shakes
Shakey shake, you got the shakey shakes
Now tell me dawg, why you be shakin'?
Is that a new dance that you be makin'?
Or is that your brain outta control
Like when i'm doin' 200 on the speedo?
My bad yo, but here's what we gonna do
We go'an get you some drugs right here
They be legit so no need to fear
Shakey shake, you got the shakey shakes
Shakey shake, you got the shakey shakes
Brrrrap-- gimme 16 bars and imma spit you my rap
Phenytoin is the wack ass name
Or call it Dilantin; it's all the same
Take that shit the way your doc said
Cuz we don't wanna see you dead
Most of the time it's three times a day
Take it with food if it makes you spray
You might not be able to take a dump
But don't be like Wreckx-N-Effect and shake your rump
Make sure you talk to your pharmacist
Of any other drugs that you ingest
Cuz lotsa drugs can interfere with dis
If you got any questions feel free to ask
Just lemme sip some syzzurp from my flask
Paaayce
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