January 2007 Archives

Dear Patients...

By The Angry Pharmacist on January 31, 2007 8:42 AM | | Comments (17) | TrackBacks (0)

  • Please don't call in for your medication refill (for cellcept, prograf or any other really expensive ordering-it-just-for-you drug), wait until I get the prior auth renewed, special order and fill it BEFORE you tell me that the strength, quantity, AND sig have been changed. That tends to make me mad.
  • If you wish to get your medication at a mail order pharmacy, its customary to let us know this BEFORE we fill all of your medications. Contrary to popular belief, it does cost the store money to fill each and every Rx regardless if we dispense it or not. I realize that your time is worth zero to you; doesn't mean mine and my staff are the same way.
  • You call in your medication to be refilled if you indeed want it filled here, not because you want it transfered to a store down the road that charges you $1 less for your soma.
  • You cant read minds, neither can we. If you are going out of town for a week and need your medications early; please tell me this when you call in the refill - not while you are sitting there yelling at me because I didn't fill your drugs because its 2 weeks early. I don't like to be put on the spot when there are 10 other things to be done.
  • I am not your insurance rep, so please don't have me do their job by calling your insurance company to get your ID numbers. You were stupid enough to lose the cards, you can be the one who sits on hold for an hour.
  • Yelling at me over a $0.10 increase in your copays (for that $300 medication) isn't going to do a damn thing but make me upset and you feel better about yourself. When I tell you that you need to call the insurance, you in fact do need to call the insurance.
  • When I am trying to consult you in the proper instruction of a bunch of OTC meds you are getting for free because you are poor (and unable to afford the 2 sick children you brought into this world) - please have the common courtesy to not be talking on or answering your cell phone while I show you how much to give. Your children's lives may not be worth anything to you, but they mean something to me. I guarantee that how much to give is more important than who your "baby-daddy" is banging this week.
  • Please don't get offended if you are here to pick up lice medication, and I refuse to talk to the doctors office whom are currently on your dirty cell phone. The "I get no cell reception back here" really means "I don't want your lice".
  • Please don't get offended if I refuse to touch the used tube of vaginal cream that looks like it has had the soul sucked out of it. Though making the Rx label see-through with grease and who-knows-what is a neat yet disgusting trick.
  • Please control your children. The pharmacy is not a playground. For every shelf that your child destroys, the higher your copay becomes and the longer the wait is. If your children are so out of control that I need to yell at them (because I'm a nice guy like that), please don't get offended and feel you are a bad parent. I know its hard to be 16 and have two children. Obviously you didn't learn after the first one, so I wont hold it against you for being a complete idiot.
  • Its fine to brag to us about your child's accomplishments. Your daughter pregnant at 14 isn't one of them. Getting pregnant is not hard. Its putting a round peg in a round hole. On that same note; neither is bragging about how many baby-daddies you have.
  • When I say its okay if you use the pharmacy phone to make a call, its not okay to call in your refills to the pharmacy down the road.
  • Please give me all of your insurance cards when I ask for them. This isn't a game. I really don't like seeing you whip out the one card I need after I spend 10 min's on hold. Doing so may result in stabbing of the face. This also holds true for prescriptions that you 'lost' and i'm trying to get from the doctors office.
  • When we ask to see your ID when picking up narcotics; its not because we don't like you, its because we cant trust you or your 'caregiver'.
  • Spending the only $10 you have on your Valium and not your child's antibiotics makes my heart sad for humanity. Please don't do that.
  • Showers.... I heard they are making a comeback this year. Maybe you should take one.

    • "Medical" Marijuana

    By The Angry Pharmacist on January 30, 2007 6:14 PM | | Comments (21) | TrackBacks (0)

    Now the last few entries haven't been very angry. This one is to make up for that.

    How many of us have been merrily working along, to have some fucking douchebag come into your store and ask if you stock "medical" marijuana? How many of you have had said douchebag argue with you when you say that marijuana is illegal to have on the basis of "I have a prescription".

    Let me clear the air here. Marijuana is a C-I substance. It is illegal. End of story. Cocaine is a C-II substance, cocaine is legal with an Rx!

    I don't care if you have an Rx from some quack in some hippie-dirt-eating-town like San Francisco or Seattle. I don't care if you have a letter from God himself saying "Thou Shalt Smoke The Weed". Its fucking illegal. Let me repeat it again because you were baked the first time I said it; its fucking illegal. Don't care what your city says, what your county says, what your liberal fruity-motherfucker mayor says, its illegal. State law cannot relax a federal law, get used to it.

    Where do people get off arguing with me about this shit? I could care less if there is a clinic down the road that sells it for "medical purposes". A quick call to the DEA and that clinic wont be around for much longer, why? ITS FUCKING ILLEGAL TO GROW OR SELL MARIJUANA! Is prostitution legal for people with erectile dysfunction (with an Rx of course)? Think about that one for a while.

    Now I know that people are going to blow me shit about how you have "glaucoma","wasting", "blah blah chronic pain", "blah blah you dont know how it feels" that require smoking out three times a day. My response? There are a whole shitpot full of other agents out there that are safer, cheaper, and work a whole lot better than smoking out. Stop using those lame ass cop-out excuses and stop inviting me to your pity party. Go see a "real" doctor and get a "real" Rx for some Soma or Vicodin instead of going to a quack and getting an "Rx" for some pot. I may not know how it feels to need pot, but you obviously don't know how it feels to be annoyed while you're trying to work (you know, work? The thing you don't do. A job? Ring any bells?)

    When you're 24 years old, reek of pot walking in the front door, then stumble over your words saying that you have glaucoma and HIV/AIDS wasting (when you're a good 260lbs) and you need some marijuana, it makes me want to kick you in the face and give you a real reason to smoke out everyday. Then you hand me your medicaid card which really makes me mad that you're doing this shit on my tax dime!

    And for god sakes, quit arguing with us about the legality of it! You're a stoner hippie (still living with your mother) arguing with someone who's not baked, went to college, has use of most of his brain still, can remember things for longer than 3 mins, and legally deals drugs for a living! In fact, you wont remember this conversation 10 min's from now (but your glaucoma will be excellent!).

    God help us if they decide to make pot legal. If you think Americans are fat and lazy now, imagine when a good majority of the population is sitting around eating Big Macs and smoking out all day. Oh wait, thats our welfare system. Sorry about that.

    Paying for our time, making money, and screwdom

    By The Angry Pharmacist on January 28, 2007 11:48 PM | | Comments (9) | TrackBacks (0)

    Currently the only way that us pharmacists get paid in a retail setting is by filling a prescription. The store makes zero dollars directly on phone calls, walk-in advice, or anything other than filling a prescription. Now I realize that being nice and giving advice = more patient support = more Rx's for that patient filled at your store vs other stores = more money in your pocket. However, taking that phone call to help Ms. Jones find out what white pill is her lasix = 5 less Rx's you can fill/day = less money made vs if Ms. Jones had not called.

    So we already are giving away a valuable service for free rather than just machine-gunning Rx's out and making the store some money. Here is where the insurance companies take a good natured thing that we do for society, and bend us over for it. Medicare Part D is forcing many of the smaller independents out of business. AWP-95% + 0.01 (here is your 1 cent dispensing fee, just hand the pills out in ziplock baggies with the drug/patient name written in sharpie on the outside).

    So, stuck in a clusterfuck between the Insurance companies and being the most benefit to society, we have painted ourselves in quite a corner. Our choices?

  • Screw patient care, hammer out the Rx's as fast as you can, and stay in business. Possibly fuck up and kill someone in the process by a medication error.
    vs
  • Maintain patient care, be the most trusted profession, and flip burgers on the side because your store went out of business.
    vs
  • Charge for services, have patients go to corpo-chain X where they get treated like shit, but dont have to pay the pharmacist for sorting out their pills because they dumped them all into a candy dish and forgot which ones is which.

    Pretty screwed arent we? But alas, here is the kicker:
    Insurance companies are the cause of this. They are the driving factor in why we need to hammer out at least X Rx's a day to break even (but cutting reimbursement rates). However by making us do this, they are increasing the chance of medication errors which will land their patients in the hospital costing them /more/ money in the long-run. So they force us to fill more Rx's per day with less staff, yet they gladly pay out the ass when we fuck up and someone lands in the hospital! Ingenious!

    So how do we fix this? Obviously the insurance companies are reporting record high profits year after year, so the answer isn't to increase our reimbursements. Medicare part D has that patient care thingy (where they pay us like $65 bucks for an hour of consultation or something like that). But if you get a net profit of $10/Rx (HAHAHA! Quit laughing you guys!!) you can do at least 20 Rx's an hour and make more than that. Plus you have a set amount of time to bill for the Medicare part D consulting before it sunsets and you cant get anything. Not to mention its probably paper-billed and not online billing.

    Answer? We're screwed. Plain and simple. Short of selling the narcs out of the back door (or not taking any insurances and just charge patients your usual&customary) we will never truly be paid for our time and knowledge.

    • The Gospel according to Me.

    By The Angry Pharmacist on January 26, 2007 6:30 PM | | Comments (16) | TrackBacks (0)

    I've seem to have made a few doctors upset with my last few posts. I want to help clear up some confusion about this blog, and other items of interest. I type at over 40 wpm, so expect grammar and spelling errors (yes, i'm talking about you grammar nazis out there).

  • This blog is the distilled down anger of the profession of pharmacy. This is the kind of stuff that really annoys us pharmacists. This is an insiders look at the profession. No matter where you work you'll find that we all get annoyed by this
  • The statements made are just generalized. Seriously, take it with a grain of salt. Its meant to be angry and postal. This isnt my day-to-day life here, just aspects that really irk me.
  • I am no way this angry at work, nor treat my patients like this. I do however refuse to fill narcotics early and stand my ground using a firm and polite tone. If they want to get it filled somewhere else, thats fine. Doctors (and their staff) know that when they put down "Do Not Fill Until 2/5/07" that the patient will not get a single tablet until 2/5/07. Doctors respect that, I'm not a cave-in who can be threatened for medication.
  • This blog is used to blow off steam, steam that a lot of us pharmacists generate by working with the public. As you can see by the comments, a lot of people agree with what I say. I think that says something.
  • I'm never an asshole to any doctors (when I get to speak with them). Sometimes i'll act a bit short to get my point across, but my main concern is to get the medication covered and out to the patient in a timely manner. When I tell a doctor that drug X is covered, and he wants drug A, B, or C (and gives me no justification to even try to get a prior auth, other than 'im the doctor, this is what i want') it irks me. We need to listen to each other, and this blog (i hope) will help doctors understand what we deal with on a daily basis. Im sure that you wouldnt want your grandmother spending $400/month for the (not covered) latest and greatest vs having a drug thats covered thats not being pushed by some drug rep (and not even give justification for the latest and greatest)
  • When a doctor makes a drug or dosage mistake, do I tell the patient "Hey, your doctor screwed up, i need to call them to get it fixed"? No, of course not. I say I need to call for a dosage clarification. I never ever bash individual doctors to the patients. Never ever ever.
  • I am never an asshole to your office or front-end staff. They have to deal with the public just like I do, and I feel that we are in the same boat (with respect to dealing with asshole patients).
  • Keeping us in the loop really means a lot to us. Nothing makes us happier than to get a call from a doctor in town saying "Hey, I need help with patient X". I will drop everything i'm doing to help that doctor out to get exactly what his/her patient needs. I'll gladly research whats covered. Got a patient with CHF and not really sure what the 4-5 medications he/she needs to be on? Call me up! I'll tell you. Wondering why that ACE-I isnt working in that African American patient of yours? Gimme a call! We know the answer! The 'ego' that you all say I have isn't myself at all, its having a person who took 3+ years of pharmacology a phone call away, and ignoring our advice.
  • Pharmacy is the only profession where we aren't paid for our time or advice. Try getting legal advice from a lawyer and you'll get a bill. A doctor? A bill. A pharmacist, a smile and advice. Even though I may never ever see this patient, nor fill a drug (and make money) from them. Igive advice to that frantic mother at 7pm on how much tylenol to give her sick baby (whom i'll never see) the same as I do to a patient who has been here for 20 years.
  • We are the most accessible healthcare providers. We answer the stupid questions so you don't get a phone call or a page during dinner. I have no problems doing this for any doctor. It really makes my day when a doctor calls up and says "Hey, you talked to patient X about Y last night after my office was closed, thanks a ton!" This sounds sappy, but sometimes your local pharmacist just needs a quick call saying thanks for the work they do and the service they provide to our patients. Those simple words will really make an impact on us.
  • We are the translators of big words, and make scary sounding procedures sound not as scary. We are your translators from medical to common. We are also the translators of your handwritten notes to the patient (which they cant read).
  • We are your eyes and ears outside the office when patients go doctor shopping, or swipe one of your Rx pads. We let you know whats going on so you can take care of your 'problem' patient on your turf, not the DEA.
  • I treat all patients with dignity and respect. I am never initially hostile to any patient regardless of sex, creed, religion, blah blah blah. However when the 5th phone call from the same patient in a day comes asking for an early fill on vicodin, I lose my temper. I don't lose it at them, but on this blog. I never lose my temper in front of patients, nor scream at them from across the store. I write about the 1 patient that ruins my day and not the 300 that made my day. This isn't a day-to-day blog about a pharmacist working, its about the frustrations that come with the one asshole that walks through my front doors.
  • When a medication isn't covered, and we ask you (the doctor) to change it to a covered medication, give us a reason why the covered wont work. We will be happy to fill out the initial Prior Auth paperwork for you just to sign. Saying "well this is what I want" isn't respectful to someone who is trying to help you out.
  • If a new drug comes out, and you (the doctor) have a question about coverage, usability, or just want to know if its just more of the same, call us! We probably read about it in Drug Topics while taking a shit, and we'll be really upfront with you if we think its just another money-maker for a dying pharmaceutical company. We don't get paid by the manufacturers, so why would we lie and say the latest = the better unless we really do mean it.
  • All pharmacists have a sense of humor. Sometimes twisted (like myself), but we like a good joke, or a tounge-in-cheek comment when you call in that Viagra Rx.
  • My opinions about things are just that, opinions. "Opinions are like assholes, everyone has one and they all stink". They don't reflect upon the profession, other pharmacists (even though they may agree to some degree) or even other doctors.
  • I don't belittle doctors, think they are all idiots, or slaves of drug-reps. Although I must admit the nicest (and most willing to work with you) doctors I have experienced are pediatricians, podiatrists, psychiatrists, and medical residents. Male OB/Gyn's can be a kick and I've never talked to a proctologist.

    This list could go on and on and on. However:

  • Listening to a peon drug-rep vs your local pharmacist is really upsetting, seriously. Its like thinking the only way to make salsa is via some new rocket chef gizmo on paid-sponsoring television
  • Treating us like bean-counters is also upsetting. There is a reason why we went to college and have degrees (sometimes even doctorates). Sometimes we feel like we are your pharmacology book sitting there on your shelf (collecting dust) holding something up.
  • We are as much "wanna be doctors" as you are "wanna be pharmacists". Anyone can work on a car, but a mechanic is going to get the job done right the first time.

    So if I offended any doctors out there reading, my apologies. This blog is like going out for beers after work with your colleagues and bitching about what happened. I had a really angry response to a nasty comment (from a doctor) I received, but I think i'll just sit on it for now.

    Now approve my damn refill requests! Its been a week! :)

    • FDA, What the Hell?

    By The Angry Pharmacist on January 25, 2007 8:02 PM | | Comments (9) | TrackBacks (0)

    Quinine. Yes, quinine.

    Turns out that the FDA is going to pull this oldie-but-goodie off of the market. Why you say?

  • No published studies to show that it works for leg cramps
  • There have been deaths related with its use.

    Uh, hello? Quinine has been out since God was a boy. Its only been dispensed bazillions and bazillions of times to people for nocturnal leg cramps. Obviously it works. Do you see any published studies for aspirin? Of course not, but FDA wont get its panties in a bunch about that.

    Deaths with quinine. Since 1969 guess how many deaths there were. 100? No, 1000? No, a billion? No! 93. Thats right, 93 people have died due to quinine since 1969. Hell, pull tylenol off of the market if you're afraid of killing people. Aspirin has caused more deaths in its lifetime than any drug to this date. But no, the FDA needs to justify its existence by targeting quinine

    FDA, if you're reading this, get a fucking clue and quit getting sucked off by the drug companies. We're onto your little scheme. It'll go like this:

    1. FDA pulls quinine due to lack of evidence of it working for leg cramps
    2. Drug company X does some half-assed study showing it works better than placebo
    3. FDA approves NewQuinine.
    4. Drug company X charges $10/tablet vs $0.04/capsule for the old generic
    5. Profit!
    6. America grabs their ankles.

    The FDA is ran by a bunch of old doctors who haven't practiced medicine for 30 years. They have no clue what the hell is going on and approves medications to whoever will give them a dollar and a reach-around. They'll sit on tons of generics in the pipeline to be approved, but will pull a drug that has been around forever and is still in common use. They need to wake the fuck up. Yes, drugs have side effects. Yes, if you take 100 of drug X you will die. Doesnt mean pulling it off the market will fix it.

    Or maybe we just need to slaughter all the lawyers. Hmmmmmmm....

    • Drugbuyers.com, final thoughts...

    By The Angry Pharmacist on January 24, 2007 7:15 PM | | Comments (24) | TrackBacks (0)

    This is going to be the last post about drugbuyers.com. I'm just going to point out a few points, paste a few hate mails, and leave it at that. I dont think drugbuyers.com administrators nor I want to deal with the aftermath of a full on flame war.

    Here is where they say how much they love me

    Points to make:

  • The Angry Pharmacist and the DrugNazi/Monkey are two different people. Two sites, etc. Please dont get us confused, its probably insulting to the both of us.. :)
  • I am a licensed pharmacist in good standing actively working in my state which I reside. I'm not a disgruntled tech, a fired pharmacist, or any sort of shit like that. I have no ambition to go to medical school nor have I ever applied. Why would I want to become a doctor?
  • I'm not short and fat. Neapolitan is an ice cream flavor, not a personality
  • Im a very nice and compassionate person in the store. If you are retarded (or just 'dont get it'), being nice and friendly on here does not equal www.theANGRYpharmacist.com. I tell it how it is, nice or not.
  • Topics such as these dont help your argument.
  • Having pricing for Soma, Tramadol, and Fiorcet (they all arent controlled, but are commonly used for abuse and not for severe chronic pain) on the top of the forum board dont help your argument either. Chronic pain people know that (with the exception of soma) those (especially fiorcet) arent used to treat chronic pain. I've seen Norco for breakthrough with a timed release C2, but never ultram or fiorcet.
  • If you think that just throwing opoids at chronic pain is 'pain management', then you have a lot to learn. Pain management involves including a bunch of different agents including Neurontin (or a TCA,SSI, Cymbalta, etc or both) for neuropathy in back/diabetes patients, Ibuprofen/NSAID/Cox-2/prednisone/Decadron/etc for inflammation, etc. Timed released agents for baseline pain vs short acting agents for breakthrough pain, analgesic equivalent conversions (in mg of morphine units) of all the oral/IM/IV agents, figuring out how much timed release to give based upon your breakthrough frequency rate, etc are all a part of 'pain management'. All of this has to be tailored by a doctor who needs to SEE you, not just see your text. They also need to be looked at by a REAL pharmacist who talks to you, not just accepts your credit card and fedex's your shipment.
  • I worked in pain mangement for hospice. I was the one who would scream at gunshy doctors to prescribe C2's so these poor people could die in peace and pain-free. So dont think I dont know what i'm talking about when talking about pain control. The doctors would say "those are addictive!" i would say "so what?". Ever give Ritalin to an elderly so you could increase the morphine dose to control pain without making them sleep all day? I have. Ever been personally thanked by the family of the patient because their loved one died without pain? I have. Ever have patients shake your hand and thank you because for once they slept a full night pain-free? I have. Dont talk to me about not knowing about chronic pain or pain mangement.
  • Think about what you are doing and preaching. Out there a dumbass politician with no medical knowledge is looking at online doctors/pharmacies (ie: drugbuyers.com and others) and thinking "diversion, save the children, reelection". You have forum topics about drug tests, online pharmacies, online doctors, harassing the UPS man for your 'shipment', etc. Doesnt look good. Now think of what this politician is going to do? Thats right, create more stupid ass laws to stop this sort of stuff. This means locking down controlled drugs even more which makes my job (and a doctors) even harder. So the people who need these medications to survive have to deal with the aftermath due to the people who take these drugs for less-than-ethical purposes. Thats a pretty shitty deal if you ask me.
  • Making threats to take my webpage down isnt very smart. Because if the site goes down due to attack, my hosting provider and his ISP are going to want to know who did it. I point them to drugbuyers.com forum thread above and the subpoenas start flying. I dont think you or drugbuyers.com want that kind of attention from lawyers and law enforcement (even though what drugbuyers.com is doing isnt illegal in the least, its a hassle for everyone involved). Huge red-flag for everyone associated with drugbuyers.com over a topic that you dont happen to agree with.
  • Online pharmacies may be convenient, but online doctors with online pharmacies are shady at very best. It may be legal to the letter of the law, but not the spirit of the law. International importing of controlled medication is just asking for trouble. Doctors are supposed to make an educated decision based upon your symptoms, and doing it over email or a computer is just plain unethical. If you're in chronic pain you need to be followed by a "real" doctor in person, not killing your liver with vicodin from some online quack and some fly-by-night pharmacy. You know as much about the doctor as he knows about you, thats pretty damn scary when you trust your health and well being to someone who is just text on a computer monitor.
  • I have nothing against the people who run drugbuyers.com. They do what they want to do, provide a place for people to discuss. If thats what floats their boat, thats great, but what goes on there could possibly have an impact on my patients and my profession, and thats where I get upset. My hats are off however to their administrative staff for putting the kebosh on the threads about the DrugNazi and myself.
  • There are people on DB who are legit, however when you have a hammer, everything looks like a nail. All these strict narcotic laws weren't passed because of the actions of legit patients.

    Enough Jerry Springer-like "Final Thoughts". On with the hate mail!!!

    Your a fucking dick...get your facts str8 or shut up bitch! You sure your not a "junkie"? you seem to know soo much about DB.com and the people there. Just to get your facts str8 (and you should know this) you cannot get a schedule 2 med from an online or edoctor

    I can spell 'straight', so no, I am not a junkie. Yes, you cannot get C2 narcotics online. However if you had enough brainpower to read the main page of drugbuyers.com, it does in fact say:

    Where are the best sources for hydrocodone, oxycodone, and other strong pain meds?

    Im sure the answer to this question would be "A Pharmacy", but im sure it goes a little deeper than that.

    I sure hope that you never cir cum to a debilitating disease.

    You seem to be quick to give out your advice but, in reality you have no
    idea. Just remember what goes around comes around and Karma (Whether you
    believe in it or not) is a bitch.

    In other words, if you keep up your shitty and piss poor attitude toward
    your fellow man, Then I have no doubt you will end up disabled and alone.

    Seems a fitting end to someone of your stature

    Cir cum? Woah! I have enough positive karma to forgive Saddam, Hitler, and the DrugNazi. I bail people out of jams day in and day out. I advance people medication at no cost to them to keep them out of the hospital because their doctor took a week to okay the refill request. People love me at work, and I use this site to blow off steam at my fellow man. I keep my fellow man alive because he is too ignorant to call in for a refill a few days early vs a day after he's out when the bottle states 0 refills remaining.

    Oh, and since I fully suspect you don�t have the guts to post any negative feedback on your site, I�ve taken the liberty of posting your little screed on alt.support.chronic-pain newsgroup along with my response.

    Thats great. Most of those patients probably go to a legit doctor, and get pain medications from reputable sources. Im sure a good majority of them would agree with what im saying, since this online doctor/pharmacy shit just supports the passing of stricter laws that make it harder for them to get the pain medication that they need. So I hate to say it, but your little plan to get angry mobs of chronic pain people after me might backfire.


    "...who else buys their fucking pain medications from an "online" doctor and an "online" pharmacy"

    How about chronic pain patients who can't get adequate pain relief because their doctors are either chickenshits or selfish pricks. Many, if not most of the people who frequent drugbuyers.com suffer from chronic pain. If you read some of the discussions you'd know that.

    The American Pain Foundation estimates that 50 million U.S. citizens suffer from significant pain daily, but only about a quarter of them are getting adequate treatment.

    That's because the DEA campaign against prescription drug diversion has stigmatized patients in need of pain medication. DEA intimidation tactics against doctors have created a climate of fear, with the predictable result that many doctors now won't prescribe opiates at all or are only willing to prescribe amounts that are totally inadequate. The DEA is killing chronic pain patients by intimidating their doctors. Many more people die from not having the prescription pain medications they need, than die from the drug abuse the government is trying to prevent.

    One of the major causes of those deaths is the overuse of OTC NSAIDS like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) by people who are desperate for pain relief. The Food and Drug Administration estimates that 200,000 cases of gastric bleeding occur each year, resulting in nearly 20,000 deaths.

    Read more at deasucks.com

    If you are in true chronic pain, and your doctor wont prescribe you anything stronger than Vicodin ES, then you need to find a doctor that knows something about medicine. Plain and simple. Skirting a gray-area of the law with an online doctor and online pharmacy is not only going to force more laws to be passed to limit narcotics (via your beloved DEA), but in the end result going to harm more people who are in chronic pain. So by going to these online joints you're shitting in your own bed.

    But what do I know? I only spend 8 hours a day, 5 days a week calculating how long a 30 day supply of soma (90 divided by 3 is a long lost art) will last to the same person every day (because they dont remember they called) , and hearing excuse after excuse after excuse on why they need their pain pills early (none of which are 'they arent helping' and they never seem to lose their BP/DM meds). Oh, and its never for the C2 narcotics either, because they cant be troubled to go into the doctors office for a new handwritten Rx. Yes, these doctors do write for C2's. Yes, these same doctors do have chronic pain patients who are on C2's, have a good quality of life, and who are never early on their medications. Yes, there are pain management clinics and doctors who actually listen what I have to say because they know that I talk with the patient a whole lot more than they do.

    So thats the end of it (I hope). I hope I made my point clear.

    • Mag Citrate, Taco Bell, and Yours Truly

    By The Angry Pharmacist on January 24, 2007 1:53 PM | | Comments (13) | TrackBacks (0)

    I figure that since I rag on everyone else on here, I mine as well post a dumbass move by yours truly.

    A few days ago, during work, I decided to eat 5 soft tacos from Taco Bell. Now any pharmacist knows that lunch time is much like bathroom time; a race to finish the quickest. So I inhaled those 5 soft tacos, drank about half of my large drink, and went back to work.

    About 2 hours later, I had the worst cramps on the planet. My intestines decided to make a run for the border. I was hoping to just rip a loud fart (AKA a tech call, because your tech always walks right behind you no matter how quietly you fart) and be done with it.

    No way, Taco Bell wasnt going without a fight. I try to go #2 in the bathroom, no go. The cramps were getting worse and worse. So I did the most drastic thing i've ever done in my life.

    I grabbed a bottle of magnesium citrate and put it in the freezer.

    Now I can see all of you retail people laughing hysterically. For those of you not in retail, Mag Citrate is what people use to clean themselves out. It usually comes in a small 10oz green bottle with a twist off lid. It comes in Lemon and Cherry flavor, but they both taste like ass. They usually produce a very explosive bowel movement. I'm not talking about soft-serve ice-cream poo, i'm talking about firehose KERPOW slop-dumping-in-toliet poo. The stuff that you dont want to do in a public restroom, because everyone present starts to giggle.

    Ever play with those water rockets when you were a kid? Yanno, you fill them up with water, put them on a little air pump, and put a couple dozen PSI into them? You know how the water shoots violently out as it propels itself into the air? Well imagine that coming out of your ass. Thats Mag Citrate.

    Anyhoo, the cramps are coming in waves, and after trip 4 to the potty to try to go #2 I proceed with the Mag Citrate Challenge. I dont want to take it at work, because I dont want my staff (and the rest of the store) hearing me shooting a stream of ass-slop into the toliet. So I wait until I get home.

    I get home, crack open the almost frozen bottle of mag-citrate, and give it the ole college chug-a-lug. I chase it with about 16 oz of water, and prepare to turn myself inside out.

    4 hours pass, and my intestines are talking to me in chinese (or maybe korean). Then, without warning, all I could say was: 'Oh My God' as I ran down the hallway into the restroom with my pants around my ankles.

    You know that rocket I was talking about earlier? Yeah, that was me. I could of pressure washed my car with the force of the liquid that shot out of my brown eye. My insides felt like they were deflating. At this point both of my legs had gone numb from the sitting, and my ass had a hickey on it. But no, it gets better.

    Imagine now small but fierce pockets of air mixed in with all of the juice. Thats right, we dont need a clean toilet here! Lets just atomize everything coming out into a fine mist and get it all over everything!

    I wont even go into how much toliet paper was used to clean up this mess. All I can say is that there are some sad hippies around these parts from all the trees I used to wipe my ass.

    Yeah, that was my evening.

    Taco Bell - 1
    The Angry Pharmacist - 0

    Uh oh, I made a doctor angry!

    By The Angry Pharmacist on January 23, 2007 6:20 PM | | Comments (15) | TrackBacks (0)

    Jeezus H Christ ive been getting a lot of hate mail lately. Heres the latest from a real life doctor!

    ***NOTE***
    I am friends with a ton of doctors. Dont take this as me bashing all doctors. Seriously, there are tons of shitty pharmacists as well as shitty doctors out there. However when a doctor writes what he/she said below (for no reason really, I havent said anything about doctors in a while) you know I cant keep my mouth shut.. :) Plus im really sick and tired of hearing that we're "wanna be doctors" (which we arent)

    You pharmacists are real jerks arent ya? First off....alot of people that are on medicaid are not all on welfare. Most of those people are the ones who have pre-existing conditions that can not get private insurance or insurance through a job!

    Uh, medicaid = state assistance = welfare. They may have a huge Share of Cost on their Medicaid, but its still state assistance. Plus I hope you realize that im not against /everyone/ who is on the state tit. I see plenty of people who this really does help, my response mostly was about women who want to get pregnant when they cant afford to take care of themselves.

    For example...I have a patient who is type 1 diabetic who uses a insulin pump. I script my patient humalog...my patient calls and tells me the pharmacy is wanting 90.00 per vial for her insulin and it was going to cost her over 450.00 for her 5 vials to last her a month. I tell her to contact her local medicaid office and see if they will give her insurance. They did...that same day! This woman works, goes to school and has children but with her other medical conditions and other scripts I write for her there is no way in the world she would be able to take care of her family if she is not taking good care of her diabetes.

    Bad example Doc. Type-1 diabetes is not a pre-existing condition that insurance companies will reject one on. Lets elaborate a bit further.

  • I realize that this example is someone who is using the system for what its intended for.
  • You dont realize (because you never leave the comfort of your little protected office) that there are 25 year olds on the system who dont work, who sit around pop out kids, and will never do anything with their lives. Thats who I have a beef with.
  • What does this hate mail have to do with anything ive written? It was in response to a bitch that women on welfare should not have children. I think thats a pretty good common sense idea.
  • Where did this patient get the insulin pump for the Humalog? They don't just grow on trees. How did she afford this? Why would a person get setup with a specialized piece of equipment (insulin pumps are indeed specialized) when they cannot afford the maintenance cost? Looks like bad foresight on someones part. Humulin R, N, 70/30 have been the mainstay for years and years, so why go with the latest and greatest. Oh, a drug rep told you.
  • Humalog does in fact cost $90. Not the pharmacies fault. Im sure you don't work for free, so why do you expect us and the drug manufacturers to do the same?
  • I don't see you putting out the $90 for this patients insulin. Why don't you sweet talk the rep into getting some samples to give to your patient.

    So for you ignorant pharmacists who "wanted" or "wished" to be doctors and couldnt be because you couldnt pass the tests, you need to shut the fuck up about people who are on medicaid! Alot of people that are on medicaid need to be on it in order to LIVE! You pharmacists think you are gods gift to this earth all because you stand behind a counter and "play" doctor.

    Great, way to go and posting this little vent where thousands of pharmacists are going to read. I hope you have a lot of space in your inbox. Lets get the primer going shall we?

  • We bail your ass out when there are 3 specialists all writing for the same therapeutic class because you cant get off your high horse to talk with each other.
  • We talk to the patients for free because you cannot due to your patient load
  • We take the phone calls when your patient has a problem because you're too 'busy' to talk with them
  • We get that $300 medication (that the drug rep told you was the magical cure-all) changed to something that the patient can actually afford (that has worked for the past 20 years, but for some reason doesnt work as well because its generic).
  • We don't listen to drug reps who love to blow smoke up your ass, and you love every minute of it for the free schwag and the glimpse of fake boobs and a short skirt.
  • We don't cave in because some crackhead needs his vicodin early for the 10th month in a row for some bullshit excuse even though you caved in and authorized the refill
  • We have to deal with the fallout of you not taking a patients insurance, and suggesting what doctor they go to for patient care.
  • We are your backbone and scapegoat. You blame us for everything so you don't take the heat. How many times have you said "oh, talk to the pharmacist about that" because your little PDR didnt have information on drugs over 10 years old.
  • We keep your patients out of the hospital because you cant be troubled to approve that refill request until 10 days have passed and your patient is long out of medication.
  • You use the PDR for your drug information. Enough said. Any pharmacist will tell you that is the most horrible and shitty drug information book on the planet. Facts and Comparisons and LexiComp win hands down. Im sorry if the CYP450 system confuses you.

    Now you may be saying "I'm not like that". You can paint us pharmacists with a broad brush, so I can paint you doctors with an equally broad brush.

    So I have a fair right to bitch about Medicaid, because unlike you, I actually spend more than 5 mins hearing my patients bitch about early narcotic refills, and why they have to pay $3 on a $200 rx (because some drug rep told them that the new extended release cipro for $5/pill is better than the generic at $0.06/pill). They vent to me, not you. The come to me, not you.

    99% of pharmacists can go on to medical school and become doctors (AKA: The Dark Side). But why don't we? Because we fill a niche just like you and everyone else does in the healthcare industry. Why don't you go to pharmacy school and become a pharmacist. Oh, right, pharmacology, the hardest class in medical school to pass (says 3 of my friends who are in fact in medical school right now).

    So yes Dr, we are Gods gift to earth. You're just bent out of shape that most patients will take our advice because you are too busy to speak with them.

    • The Pharmacy Challenge

    By The Angry Pharmacist on January 22, 2007 8:46 AM | | Comments (9) | TrackBacks (0)

    So since the last week or so have pissed off a bunch of people, I have pulled some old not-so-angry posts from the unpublished archives of TAP for your viewing pleasure.

    This isnt an angry post, but mostly out there for the students.

    Here is some shit that i did when I was in pharmacy school (and out on rotations) that made life a bit more interesting.

  • The Ambien Challenge: 2 guys take a 10mg of ambien, and the first one to fall asleep loses. I managed to win long enough for my legs to go numb, upon which i crawled to my bed. My victory dance involved only the top half of my body, and from what I can remember it looked like I won the special Olympics.
  • The MagCitrate Challenge: 2 guys, 2 bottles of MagCitrate, 1 toliet. Its a race, whoever can explode out of their ass first is the winner. Needless to say the urge for me to NOT shit my pants was my undoing. The secret is to chug the Mag Citrate, and lock yourself in the only restroom. Squirting butt-juice as you hunch over in the backyard bushes isn't all that fun (especially after a few beers).
  • Wheelchair races: You haven't worked odd-hours in a hospital until you have done wheelchair races against the medical residents. Due to the compound they use on the rear wheels for traction, I strongly recommend to NOT power-break the rear wheels to slide into that sharp turn. You'll flip, trust me.
  • NS Fights: What do you do with old expired bags of Normal Saline? JUMP ON THEM IN THE PARKING LOT! They really explode quite nicely. You can also pin-prick a hole in them and spray your fellow interns. However doing so with D5W tends to make things a bit hard to clean up.
  • Monday Morning Flush: Make a few friends with the ER nursing staff or some medical residents who come early monday morning can load ya with a few liters of IV D5W after a hard weekend of drinking. Its magic I tell you, magic! If you open up a clinic that did nothing but this near a party-college and charged $50 a pop, you could make millions. If you totally do this I want a cut for coming up with the idea. You heard it first here!

    • Here we go again

    By The Angry Pharmacist on January 21, 2007 11:27 AM | | Comments (6) | TrackBacks (0)

    Angry noob,

    Disability often begins on welfare then migrates to the longer term SSD. I know you dont know this since you have yet to walk yourself through it.

    I never plan to walk through it. Plus, ask any pharmacist and you'll find out that there are a shitpot more 25 year olds on SSD + Welfare than welfare alone.

    Glad to see you looked up endo. Most doctors do know what it is, did you read they dont somewhere? The problem is getting diagnosed (surgery). As you can imagine, a woman going in with the symptoms of "pelvic pain" doesnt tend to raise a whole lot of red flags. Doctors often do nothing until one is totally disabled or infertile. But it is not because they dont know.

    You saying that right there tells me that most doctors dont know what it is. If pelvic pain so bad that it makes one disabled, it tends to raise a red flag for something not normal. Chronic pelvic pain, or disabling pelvic pain isn't normal. Obviously you and I have enough common sense to realize it, and we're not "doctors".

    I think most any endo patient would agree with what I said to you. Point being, there could actually be a valid reason.

    Lets say this was the case, it would probably be a hail mary as many women know after pregnancy things can get worse. But it all depends on what position a person is in at the time and how much education they have about it. Then it is personal choices which obviously are always up for disagreement.

    Would be a pity if someone were to judge and make fun of someone in such a situation for choosing to try while they can with the hopes of it helping their condition as well as possible plans for hysterectomy afterwards to solve the problem completely allowing one to return to health.


    However if you cannot take care of yourself (being on welfare) because of this. You are in no position to do a 'hail-mary' call as to if a child is going to fix you, or make you worse. Sure, having a child could magically fix you, but if it doesnt? Not only is your quality of life going to get worse because of your condition, but you are also bring a child into the world which you arent going to be able to take care off to the best of your ability because of a botched judgement call.

    So you sit there, in disabling pain, watching your child grow up, unable to do anything or act as a 'normal' mother. You call this helping? I call it hell. I bet you like to sit there with a garden house in your hand as your house is burning down. Thats what it would feel like.

    Sure you can have a hysterectomy afterwards and be done with the whole thing, but now not only do you have to be able to support yourself (you cant, you're on welfare remember), but now a child. I'm in the camp that if you choose to reproduce, you best be financially and morally fit to raise that child to the best of your ability so it too can get a job, succeed at life, and not become a burden like most children seem to be now days.

    If us (the taxpayers) are footing the bill for someones life, then I think we should be able to judge all we want. If she doesnt like it? Get off of welfare or dont have a child.

    Let me spell this out for you

    Hysterectomy is any womens best shot at ridding herself of endo, endo often causes infertility,
    Pregnancy to have a much wanted child ->hysterectomy isnt as bad of a plan as
    no hysterectomy/no hormones/hormone failure/surgery failures -> stay disabled for ten years until you cant have children anyways and then opt for the hysterectomy.

    How about:
    If you cant afford to have a child -> Dont have one
    If you are unable to have a child due to a condition -> Dont have one
    If you require outside medication to get pregnant -> Dont have one
    If you have a good chance of not being able to have a child due to a condition, and having a hysterectomy would fix that problem rather than suffer for 10 years because you're he-hawing thinking about reproducing (which you probably couldnt anyways) -> Have hysterectomy

    Its simple. If you cannot afford something, you dont buy or obtain it. Its like being on welfare and driving escalades.. wait, bad analogy. :)



    Im glad this gave your blog some more fodder, surely it will entertain someone.

    Self proclaimed nurse.

    Actually everyone is quite bored with this already.

    Drugbuyers.com? Gimme a Break.

    By The Angry Pharmacist on January 21, 2007 1:25 AM | | Comments (23) | TrackBacks (0)

    Turns out that the DrugMonkey and I are in a little bit of hot water at a popular addic..er..'drug information group' message board as viewed Here

    Guess we're too bitter for the peons who happen to frequent a message board dedicated to buying pain medication from online doctors. Gee, thats an ironic twist isnt it?

    From the site www.drugbuyers.com:

    Our goal is to help you locate the best legal sources for prescription drugs and to offer the best information about buying meds online.

    We offer a free site based on member feedback
    We can help you - We need your help

    Online Pharmacies, Online Doctors, and Referral Services
    US, Canadian & Foreign Pharmacies
    Best Pharmaceutical Sources
    Free Pharmacy Watch Group

    Plus my personal favorite:

    Where are the best sources for hydrocodone, oxycodone, and other strong pain meds?

    Enough said.

    Now I get plenty of hatemail from asshole druggies like these. Why do I call them asshole druggies? Because who else buys their fucking pain medications from an "online" doctor and an "online" pharmacy? I've seen terminal cancer patients able to see a doctor and have a family member pick up their pain meds for them. No excuse.

    I can see the doctor consulation IM dialog now:
    Druggie: I have back pain doctor
    Doctor: On a scale of 1 to 10, how bad is your pain?
    Druggie: 345!
    Doctor: Oh, that is bad. I think you should see someone local
    Druggie: I cant! My pain is toooooo bad!!!!@#!@
    (har har har, little does he know that i've been kicked out of every pharmacy/doctors office in town for early fills, harassment, and other shit that pharmacists bitch about)
    Doctor: Will I will give you some Vicodin and Soma.
    Druggie: That does not work! I need perc0cet and Diazep4m and S0m4 and V|agr@!!!
    Doctor: That'll be $45, and go to this easy online pharmacy (who will ask you no questions, contain no history, and is ran in someones basement with diverted hospital stock) to get your drugs!!!
    Druggie: Thank you doctor! You are the most ethical, prestigious, and a pillar to your profession!
    Doctor: Yeah yeah, Credit Card Charged, NEXT!

    Oh, and whats even better, is that if you read the message thread they talk about diverting pain medication (the ones that fell on the floor) and who accounts for inventory. LOVELY! And these douches are giving the DrugNazi and I a bad time? Im surprised nobody has written a how-to on there about altering prescriptions.

    Now I know a good majority of you pharmacists out there just wanna go and blast them off of the internet. Now usually i'm all for skimming the turds that float to the top of society, but I must repeat what the DrugNazi said:

    Go over and read their board if you must, but please, don't start a pointless flame war. I would much rather turn the wrath of the drugmonkey army loose on those that are truly evil, like Republicans. Remember these people are doing us a favor by getting their fix through the mail, as opposed to endangering our licenses with bullshit reasons why they need that early Soma refill.

    Yay! Someone who thinks they know something!

    By The Angry Pharmacist on January 20, 2007 6:29 PM | | Comments (11) | TrackBacks (0)

    Look what some smart-ass had to say in response to my entry about Welfare + Clomid = WTF?:


    Ever heard of endometriosis? No course not, youre not a doctor lol.

    Yes, I do know about endometriosis. I would explain it to you, but the words are too big for your tiny brain to comprehend. But to those out there, its a condition where uterine tissue grows in places that is not your uterine (in a really general nutshell)
    Actually, most all doctors with the exception of OB/GYN's and maybe oncologists wouldn't know what endometriosis is. So you can 'lol' that up your ass.


    If a girl had endo, which can be disabiling, I could see her point in
    trying. 1. sooner the better 2. pregnancy often kicks endos ass. Becoming
    pregnant used to be the main offerings for treatment but women who have
    been horribly disabled by endo changed that.


    What does this have anything to do with my post about people on welfare getting fertility drugs? In fact, this has nothing to do with the people wanting to have children when they cant even support themselves! Did you even read my rant before responding?

    Let me spell it out for you:

    I AM TALKING ABOUT WOMEN ON WELFARE WANTING FERTILITY DRUGS TO GET PREGNANT. I AM NOT TALKING ABOUT ALL WOMEN WANTING FERTILITY DRUGS, ONLY THE ONES THAT CANT AFFORD (meaning, they dont have the money) TO TAKE CARE OF THEMSELVES LET ALONE A CHILD. IT IS LIKE SELLING THE CAR FOR GAS MONEY.

    However, since you can spell endometriosis (and are probably a self-proclaimed "Nurse"), i'll give this another 2 seconds of brainpower. According to the standard treatments, pregnancy isn't even on that list. In fact, im sure most women would rather be on some sort of oral contraceptive rather than bare/raise a crotch-fruit for 9 months + 18 years. Furthermore, since 30-40% of these women are sterile, why would they be taking Clomid? Not going to do them one damn bit of good except to waste money. Nature has a funny way of saying "maybe you shouldn't have kids". I think some women need to read the writing on the wall rather than trying to override nature and get some horrible burden they may not expect.


    Anyways, mighty pharmacists dont know it all, which is why we have
    doctors.

    Uh, dig that hole a bit more sweety. I'm sure that there is a bit more you can do to completely make a total ass out of yourself.

    Welfare + Clomid = WTF?

    By The Angry Pharmacist on January 18, 2007 8:36 PM | | Comments (26) | TrackBacks (0)

    I got this comment from Sandi, and could not believe it:

    This patient takes the cake.

    I normally do a fair amount of grumbling over how much stuff is paid for by Medicaid, but this time I had to be proud of what was not covered...
    A lady came in with a prescription for Clomid. I did not ever in a million years expect she would be on Medicaid, so I had to look twice and still ask her if she had a new insurance card. Nope, she really is on Medicaid. Then she was just downright surprised that Medicaid would not pay to get her pregnant! Yeah, sure, why don't you bring a few more into the world...on us. Not.

    For those at home: Clomid = Makes women have babies. Just don't stand downwind of a guy, you might become his baby-momma.

    Sandi, you showed restraint unknown to those of us in retail. I personally would of called up the doctors office and asked them why they were writing a fertility drug to a patient that obviously could not take care of her self, but for some reason thought that bringing a child into the world would magically make her problems go away. What kind of dipshit retarded doctor would write for this? Oh, one of those "Everyone has a right to a family, blah blah blah". Yeah, you pay for that fucking kid so we don't have to.

    I would of just told her it wasn't covered, and if she asked if I could call the doctor to get it changed or get a prior auth, I would just say "If you cant afford this medication, how can you afford a child?". Tough questions, tough love, only here on the angrypharmacist.

    What i'm most surprised from this story, is that there really is an infertile welfare female out there. I thought that the cure all for infertility was to just go on welfare. In no time you'll have one on each tit and another in the oven.

    Yes, i'm going to hell. Straight to hell.

    Lancet Devices, Free Copays, and Fatties on Ensure

    By The Angry Pharmacist on January 16, 2007 6:27 PM | | Comments (14) | TrackBacks (0)

    Whats the issue with people and keeping a loaded lancet device in their diabetic meter case. I mean its bad enough that I get handed this meter that looks like its been used as a tampon, but when I look at the lancet device (dont get me started) it has a friggin loaded lancet ready to go.

    Im sorry, but its bad enough that I need to touch your nasty ass meter, but leaving your lancet device loaded it just asking for trouble. What if I stick myself on it? Then what? Do you also keep loaded guns in your child's bedroom? Do you drive drunk or under the influence of Soma or Vic-er.. never mind that part. The point is, when you bring in your meter to be looked at by me (who's already swamped with work), PLEASE remove any uncapped lancets from your device. Whenever I get one (today I got 2), I always say "oh, thats nice, ready for me to stick myself on". They don't get it. Seriously, they just don't fucking get it. Pisses me off to no end this does. What makes it even better? Is when they receive the meter from a mail order pharmacy and expect ME to show them how to use it. Fuckers, I wish i could kill them with my brainpower.

    Another thing. For some reason, Medicaid and Medicare people always seem to think that ANY copay is too much. You got $150 bucks worth of Levaquin for $3.10? Too much. $2000 worth of Epogen for $3.10? No way. It has to be fucking free. Im sorry Medicare reciepients, but its not MY fault that you didnt save your money when you were young. Cricket and the ant man. All of us working people are the ants, and your sorry ass are the Crickets. Winter is a coming.

    Also, Its not MY fault that i'm paying a good deal of my check into this 'system' for which I will never be able to draw a dime off of. Im sorry you're poor and on a fixed income and forced to eat dog food. But yanno what? I gotta eat, I gotta pay my power bill too, and to hear you bitch about your $3.00 copay on your $2000 prescription really isn't worth my time. In fact, its insulting, because 2 years ago you would of gotten NOTHING covered under MediCare part A and B. So QUIT FUCKING BITCHING and go watch Jag reruns.

    Now, heres the best of them all. Why do MediCare/MediAid folk think they are entitled to Ensure? Why is it you NEVER see a private pay or someone with private insurance get an Rx for Ensure? For you at home, Ensure is one of those food replacement drinks that you take when you cant take solid food. Now I've gotten tons of prior auths for people with AIDS+HepC wasting, and throat cancer where they cant swallow, or people with GT Tubes. But when some fat son of a bitch waltz's in with an Rx for Ensure because "I'm losing weight" I want to stab him and his doctor in the face with my pen. Does Medicare/aid pay for a loaf of bread? Can I bill /my/ lunches to /my/ insurance? NO! So why should Medicare/aid pay for your Ensure unless you have a good fucking reason to be on it?

    Seriously, I had to do a Prior Auth from (where else) the County Hospital for this patient who "hasnt eaten in 2 weeks". I thought she was a chemo patient, or had some serious problems. She was out in the car, so I asked her "caretaker" (don't get me started) for her to come in so I could ask her some questions for the PA. Well, she didn't walk in, she waddled in. She wasn't eating food for 2 weeks, she was eating bacon fat soaked twinkies for 2 weeks. I seriously turned to the other pharmacist behind me (and the techs) and gave the "What the FUCK" look. Immediately they retreated to the back room to laugh. This chick was large. She started into this sob story how she needed this because she didn't eat for 2 weeks, blah blah blah, brain turned off. I seriously had to make a conscious effort to remove the "you have got to be fucking me" or "wheres the hidden cameras? This has to be a joke" look on my face. Did she just want Ensure so she didn't have to raise the fucking BigMac to her fat face?

    So I get the info, and contact her doctor to find out exactly what the diagnosis and her latest BMI (Body Mass Index) was. The doctor called, and first thing after she gave some diagnosis about "not eating for 2 weeks" was "Have you seen the patient?". Yeah, to make a long story short, when I submitted the Prior Auth I got a phone call from the insurance company asking me if maybe I transposed some numbers when writing down the BMI. I said no, and they promptly denied it with laughter in their voice.

    Oh, and if you think you can somehow convince me to feel sorry for this lady, please dont invite me to your pity party. You have no idea what she milks out of our tax dollars.

    Soma, the Magical Drug

    By The Angry Pharmacist on January 13, 2007 2:02 PM | | Comments (7) | TrackBacks (0)

    So I saw DrugNazi's little soma display window pictures here

    So I have to jump on the bandwagon for those non-pharmacists. If you're a pharmacist, just ignore this explinations.

    As DrugNazi said, Soma is a non-controlled muscle relaxant used along with Vicodin or Valium to help increase their effects. Abused to all hell. In fact, the crackheads want the ones manufacturered by Watson Labratories (Formerly by Danbury) because it has "DAN" written on the tablet. So when they call and ask for a price for soma, they ask how much the "DANs" call. Sorta like how quaaludes were just called 'ludes. Street lingo, ya dig?

    Ironically, Soma was created in fiction long long before some drug company decided to press it into tablets and sell it to addicts. It was in Aldous Huxley's Brave New World as a "Miracle Drug". Hmmm.. thats a little too close to be scary.

    So when I found this out many years ago, I found a page of quotes from the book about Soma. I printed it out, and hung it on my wall for shits and giggles. The page is still up, so without further adeu (pharmacists, dont shit yourself from laughing, this shit is from a long time before soma came out):


    Soma in Aldous Huxley's
    Brave New World
    http://www.huxley.net/soma/somaquote.html
    "All the advantages of Christianity and alcohol; none of their defects."

    "..there is always soma, delicious soma, half a gramme for a half-holiday, a gramme for a week-end, two grammes for a trip to the gorgeous East, three for a dark eternity on the moon..."

    "Benito was notoriously good-natured. People said of him that he could have got through life without ever touching soma. The malice and bad tempers from which other people had to take holidays never afflicted him. Reality for Benito was always sunny."

    "you do look glum! What you need is a gramme of soma."

    "Soma was served with the coffee. Lenina took two half-gramme tablets and Henry three."

    "the warm, the richly coloured, the infinitely friendly world of soma-holiday. How kind, how good-looking, how delightfully amusing every one was! "

    "Swallowing half an hour before closing time, that second dose of soma had raised a quite impenetrable wall between the actual universe and their minds."

    "The service had begun. The dedicated soma tablets were placed in the centre of the table. The loving cup of strawberry ice-cream soma was passed from hand to hand and, with the formula, "I drink to my annihilation," twelve times quaffed."

    "By this time the soma had begun to work. Eyes shone, cheeks were flushed, the inner light of universal benevolence broke out on every face in happy, friendly smiles. Even Bernard felt himself a little melted."

    "I don't understand anything," she said with decision, determined to preserve her incomprehension intact. "Nothing. Least of all," she continued in another tone "why you don't take soma when you have these dreadful ideas of yours. You'd forget all about them. And instead of feeling miserable, you'd be jolly. So jolly,"

    “Was and will make me ill,
    I take a gram and only am."

    "When the Warden started booming, she had inconspicuously swallowed half a gramme of soma, with the result that she could now sit, serenely not listening, thinking of nothing at all, but with her large blue eyes fixed on the Warden's face in an expression of rapt attention."

    "Bernard also laughed; after two grammes of soma the joke seemed, for some reason, good. Laughed and then, almost immediately, dropped off to sleep,..."

    ""But it's terrible," Lenina whispered. "It's awful. We ought not to have come here." She felt in her pocket for her soma - only to discover that, by some unprecedented oversight, she had left the bottle down at the rest-house. Bernard's pockets were also empty."

    Lenina was left to face the horrors of Malpais unaided."

    "Lenina was still sobbing. "Too awful," she kept repeating, and all Bernard's consolations were in vain. "Too awful! That blood!" She shuddered. "Oh, I wish I had my soma." "

    "A gramme is better than a damn," said Lenina mechanically from behind her hands. "I wish I had my soma!" "

    "Her tears began to flow again. "I suppose John told you. What I had to suffer - and not a gramme of soma to be had. Only a drink of mescal every now and then, when Popé used to bring it.""

    "As soon as they got back to the rest-house, she swallowed six half-gramme tablets of soma, lay down on her bed, and within ten minutes had embarked for lunar eternity. It would be eighteen hours at the least before she was in time again."

    ""By his heretical views on sport and soma, by the scandalous unorthodoxy of his sex-life, by his refusal to obey the teachings of Our Ford and behave out of office hours, 'even as a little infant,'" (here the Director made the sign of the T), "he has proved himself an enemy of Society, a subverter, ladies and gentlemen, of all Order and Stability, a conspirator against Civilization itself. For this reason I propose to dismiss him, to dismiss him with ignominy from the post he has held in this Centre...""

    "So the best people were quite determined not to see Linda. And Linda, for her part, had no desire to see them. The return to civilization was for her the return to soma, was the possibility of lying in bed and taking holiday after holiday, without ever having to come back to a headache or a fit of vomiting, without ever being made to feel as you always felt after peyotl, as though you'd done something so shamefully anti-social that you could never hold up your head again. Soma played none of these unpleasant tricks. The holiday it gave was perfect and, if the morning after was disagreeable, it was so, not intrinsically, but only by comparison with the joys of the holiday. The remedy was to make the holiday continuous. Greedily she clamoured for ever larger, ever more frequent doses. Dr. Shaw at first demurred; then let her have what she wanted. She took as much as twenty grammes a day.

    "Which will finish her off in a month or two," the doctor confided to Bernard. "One day the respiratory centre will be paralyzed. No more breathing. Finished. And a good thing too. If we could rejuvenate, of course it would be different. But we can't."

    "Surprisingly, as every one thought (for on soma-holiday Linda was most conveniently out of the way), John raised objections.

    "But aren't you shortening her life by giving her so much?"

    "In one sense, yes," Dr. Shaw admitted. "But in another we're actually lengthening it." The young man stared, uncomprehending. "Soma may make you lose a few years in time," the doctor went on. "But think of the enormous, immeasurable durations it can give you out of time. Every soma-holiday is a bit of what our ancestors used to call eternity." "

    "In the end John was forced to give in. Linda got her soma. Thenceforward she remained in her little room on the thirty-seventh floor of Bernard's apartment house, in bed, with the radio and television always on, and the patchouli tap just dripping, and the soma tablets within reach of her hand - there she remained; and yet wasn't there at all, was all the time away, infinitely far away, on holiday; on holiday in some other world, where the music of the radio was a labyrinth of sonorous colours, a sliding, palpitating labyrinth, that led (by what beautifully inevitable windings) to a bright centre of absolute conviction; where the dancing images of the television box were the performers in some indescribably delicious all-singing feely; where the dripping patchouli was more than scent - was the sun, was a million saxophones, was Popé making love, only much more so, incomparably more, and without end."

    ""The Savage," wrote Bernard, "refuses to take soma, and seems much distressed because of the woman Linda, his m---, remains permanently on holiday. It is worthy of note that, in spite of his m---'s senility and the extreme repulsiveness of her appearance, the Savage frequently goes to see her and appears to be much attached to her - an interesting example of the way in which early conditioning can be made to modify and even run counter to natural impulses (in this case, the impulse to recoil from an unpleasant object)."

    "Helmholtz and the Savage took to one another at once. So cordially indeed that Bernard felt a sharp pang of jealousy. In all these weeks he had never come to so close an intimacy with the Savage as Helmholtz immediately achieved. Watching them, listening to their talk, he found himself sometimes resentfully wishing that he had never brought them together. He was ashamed of his jealousy and alternately made efforts of will and took soma to keep himself from feeling it. But the efforts were not very successful; and between the soma-holidays there were, of necessity, intervals. The odious sentiment kept on returning."

    "When one has leant forward, nearer and nearer, with parted lips-only to find oneself, quite suddenly, as a clumsy oaf scrambles to his feet, leaning towards nothing at all-well, there is a reason, even with half a gramme of soma circulating in one's blood-stream, a genuine reason for annoyance."

    "What's in those" (remembering The Merchant of Venice) "those caskets?" the Savage enquired when Bernard had rejoined him.

    "The day's soma ration," Bernard answered rather indistinctly; for he was masticating a piece of Benito Hoover's chewing-gum. "They get it after their work's over. Four half-gramme tablets. Six on Saturdays."

    ''Hug me till you drug me, honey;
    Kiss me till I'm in a coma;
    Hug me, honey, snuggly bunny;
    Love's as good as soma."

    "Drying her eyes, Lenina walked across the roof to the lift. On her way down to the twenty-seventh floor she pulled out her soma bottle. One gramme, she decided, would not be enough; hers had been more than a one-gramme affliction. But if she took two grammes, she ran the risk of not waking up in time to-morrow morning. She compromised and, into her cupped left palm, shook out three half-gramme tablets."

    "Soma distribution!" shouted a loud voice. "In good order, please. Hurry up there."

    ""No shoving there now!" shouted the Deputy Sub-Bursar in a fury. He slammed down he lid of his cash-box. "I shall stop the distribution unless I have good behaviour."

    The Deltas muttered, jostled one another a little, and then were still. The threat had been effective. Deprivation of soma-appalling thought!

    "That's better," said the young man, and reopened his cash-box. "

    ""Don't you want to be free and men? Don't you even understand what manhood and freedom are?" Rage was making him fluent; the words came easily, in a rush. "Don't you?" he repeated, but got no answer to his question. "Very well then," he went on grimly. "I'll teach you; I'll make you be free whether you want to or not." And pushing open a window that looked on to the inner court of the Hospital, he began to throw the little pill-boxes of soma tablets in handfuls out into the area."

    For a moment the khaki mob was silent, petrified, at the spectacle of this wanton sacrilege, with amazement and horror."

    "Free, free!" the Savage shouted, and with one hand continued to throw the soma into the area while, with the other, he punched the indistinguishable faces of his assailants. "Free!" And suddenly there was Helmholtz at his side-"Good old Helmholtz!"-also punching-"Men at last!"-and in the interval also throwing the poison out by handfuls through the open window. "Yes, men! men!" and there was no more poison left. He picked up the cash-box and showed them its black emptiness. "You're free!"

    "The policemen pushed him out of the way and got on with their work. Three men with spraying machines buckled to their shoulders pumped thick clouds of soma vapour into the air."

    "Two minutes later the Voice and the soma vapour had produced their effect. In tears, the Deltas were kissing and hugging one another-half a dozen twins at a time in a comprehensive embrace. Even Helmholtz and the Savage were almost crying. A fresh supply of pill-boxes was brought in from the Bursary; a new distribution was hastily made and, to the sound of the Voice's richly affectionate, baritone valedictions, the twins dispersed, blubbering as though their hearts would break. "Good-bye, my dearest, dearest friends, Ford keep you! Good-bye, my dearest, dearest friends, Ford keep you. Good-bye my dearest, dearest ..."

    ""Because our world is not the same as Othello's world. You can't make flivvers without steel-and you can't make tragedies without social instability. The world's stable now. People are happy; they get what they want, and they never want what they can't get. They're well off; they're safe; they're never ill; they're not afraid of death; they're blissfully ignorant of passion and old age; they're plagued with no mothers or fathers; they've got no wives, or children, or lovers to feel strongly about; they're so conditioned that they practically can't help behaving as they ought to behave. And if anything should go wrong, there's soma. Which you go and chuck out of the window in the name of liberty, Mr. Savage. Liberty!" He laughed. "Expecting Deltas to know what liberty is! And now expecting them to understand Othello! My good boy!""

    "Bring three men," he ordered, "and take Mr. Marx into a bedroom. Give him a good soma vaporization and then put him to bed and leave him."

    The fourth secretary went out and returned with three green-uniformed twin footmen. Still shouting and sobbing. Bernard was carried out. "

    "And if ever, by some unlucky chance, anything unpleasant should somehow happen, why, there's always soma to give you a holiday from the facts. And there's always soma to calm your anger, to reconcile you to your enemies, to make you patient and long-suffering. In the past you could only accomplish these things by making a great effort and after years of hard moral training. Now, you swallow two or three half-gramme tablets, and there you are. Anybody can be virtuous now. You can carry at least half your mortality about in a bottle. Christianity without tears-that's what soma is."

    "Benighted fool!" shouted the man from The Fordian Science Monitor, "why don't you take soma?"

    "Get away!" The Savage shook his fist.

    The other retreated a few steps then turned round again. "Evil's an unreality if you take a couple of grammes."

    "Kohakwa iyathtokyai!" The tone was menacingly derisive.

    "Pain's a delusion."

    "Oh, is it?" said the Savage and, picking up a thick hazel switch, strode forward.

    The man from The Fordian Science Monitor made a dash for his helicopter."

    "It was after midnight when the last of the helicopters took its flight. Stupefied by soma, and exhausted by a long-drawn frenzy of sensuality, the Savage lay sleeping in the heather. The sun was already high when he awoke. He lay for a moment, blinking in owlish incomprehension at the light; then suddenly remembered-everything.

    "Oh, my God, my God!" He covered his eyes with his hand."


    PS: If you try to post any comments regarding soma, my server might yell at you and punch you in the face. Like me, its tired of getting hounded by people wanting to sell/get soma. So you can find creative ways around that.. :)

    Lovenox, Heparin, and Mr Clot

    By The Angry Pharmacist on January 13, 2007 2:30 AM | | Comments (33) | TrackBacks (0)

    Its very rare that I rag on an entire healthcare system. I don't expect anything to be perfect (except myself of course.. :) ) and my standards for nurses is at an all time low, so you impress me if you can manage to pronounce 'Atenolol' correctly.

    Today however, I completely lost my faith in a particular health care system. Now I wont tell you which group this doctor came from (it rhymes with Kaiser), but heres how it all went down.

    I get this phone call from a nurse at a local hospital here in town. She is calling in discharge medications for a patient who recently had hip surgery. She calls in 100 vicodin (of course), and Lovenox given once a day for a month. Now I can see all of the retail pharmacists assholes puckering at the cost of a month of Lovenox, and I can see all of you "I'm Mr Clinical Hospital Pharmacist, look at my fancy pants and PharmD title! Call me doctor!" chumps roll your eyes. Oh no, it gets better.

    I politely tell the nurse that there must be a mistake. First off, Lovenox is given twice a day (its half-life is 12 hours). Second, no doctor who graduated medical school would give it for an entire month. Lovenox really isnt designed nor intended for that! The nurse politely told me that this was a Kaiser doctor, and thats what was ordered. I asked the nurse to page the doctor, it was time for some schooling!

    For all you students and non-pharmacists out there, heres what the problem is.

    When you get any hip surgery, they usually put you on some sort of anticoagulant (such as Coumadin) to prevent a clot from getting stuck in your noggin or your lungs. The problem is that Coumadin takes about 5 days (60 hours or something like that) after you start taking it to start working. Coumadin inhibits your body from producing clotting factors (its a Vitamin K analog that Taliban's the clotting factories), and some of those clotting factors hang around for a few days before your body coat hangers their life and recycles their little innards. So you need to wait until the existing clotting factors are cycled out so your body cant produce more (because of the Coumadin). With me? Good! You now know more than this doctor does.

    Now in the hospital, nurses give the patients Heparin to prevent clotting. Heparin does magical things with your existing clotting factors to make them stop clotting. They don't inhibit the production of the clotting factors. The problem with heparin is that it causes this nasty condition called Heparin Induced Thrombocytopenia (HIT) that basically makes you stop producing platelets. Bad news. So they only give heparin in the hospital so they can watch you die vs having you die at home. You may be asking "Why cant they give Coumadin before surgery?". Ah, if you bleed out on the operating table because you're loaded up with Coumadin, that tends to make your family less than happy.

    So in steps Lovenox. Its a Low Molecular Weight Heparin which doesn't cause HIT, thereby it can be given at home. Person gets a shiny new Rx for Coumadin and Lovenox, starts taking the Coumadin while giving themselves shots of Lovenox twice a day for 5 to 10 days, then when they have used up the box of Lovenox their Coumadin has already started working and you're good to go. Its called "Bridge Therapy" because Lovenox acts as a 'bridge' between Heparin in the hospital and Coumadin tablets at home.

    Now you can impress your friends and family with useless pharmacy knowledge. If I got any of the above wrong, blow me, its 2:30am on a Friday night/Sat Morning, and I'm sitting here in front of my computer sober rather than asleep or drunk.

    So the doctor calls back. He asks what the problem was. I explain my problem with his orders and he still doesn't get it. His excuse for the month of Lovenox: "The patient wasnt going to be seen at Kaiser, so she'll have to use this". Yeah, riiiiight. As if any insurance company is going to say "Sure! I'll pay $3000 for a month of Lovenox vs $30 for a month of Coumadin!" So I explain to him that maybe we should just do a 10 day run, and she can go and see her primary care for Coumadin therapy. Nope, wanted a month of Lovenox at once/day. So now I bring out the big guns. I ask him why he is giving it once daily, when the half-life is 12 hours? Stammering and silence on the phone. Then a "This is how we do it at Kaiser". Bull-Fucking-Shit. I guess if thats the case, they are spending all of their cash on Lovenox and not on hiring decent doctors. After much 'this is how its going to be' and basic pharmacology lesson of Coumadin and Lovenox, I manage to get him to do what I say and authorize a 10 day run at twice daily. Patients life has been saved thanks to yours truly. I slammed down the phone, and waved my pharmacology penis all around for everyone to see.

    This is basic shit. This isn't a super complex protocol. Its not like we are putting her on a MAO-I *shudder* or even titrating up her Coumadin! Maybe I put too much faith in doctors in knowing their medications. Oh, and to any of the pharmacists at Kaiser who might be reading this, just don't get me in trouble. :)

    Medicare Part D - 1 year later

    By The Angry Pharmacist on January 2, 2007 9:26 PM | | Comments (10) | TrackBacks (0)

    If you're a pharmacist, and reading this, you're probably drunk (or hung over). I just had about 5 shots and a bottle of wine with a dentist friend of mine, so this might not make too much sense (im pretty hammered). But you'll understand why (if you're not a pharmacist) if you read this entry.

    Needless to say, today was chaos, hell, and a bit of clusterfuck all rolled into one. Words cannot describe it. All I can say is that if you were working in pharmacy 1 year ago (when Medicare part D shit hit the fan) it was like Deja Vu.

    Prescription Solutions was down for a good majority of the day. In fact, it was down the entire day. I must of gotten less than 50 prescriptions transmitted through them, and god only knows how big my switching bill is going to be from all the failed transactions and retransmissions that I did today. I got error messages from 'Server Busy' to 'Non Contracted Pharmacy' to 'Please process with 2007 card if in 2007, 2006 card if claim is in 2006' to getting paid.

    To make matters worse, some Medicare Part D programs decided it would be a good idea to issue 2007 cards that have a different ID number than the current 2006 cards. Way to go! Lets really drive the pharmacists crazy!

    This combined with the 1+ hour wait time on hold makes for a really really drunk pharmacist.

    Seriously, the PBM seriously need to get their shit together. I mean lets take Prescriptions Solutions (RxSoln) for an example. As of 1/1/07 they took over processing for the AARP Medicare Part D program. Common sense would tell you; "Hey! As of the first we're going to have a fuckload more traffic! Lets put more servers in place, and hire more staff, etc to take the increased load!". Did they do this? FUCK NO! So as a result they were down all fucking day. They must of learned from Argus how to be a shitty PBM. So in my drunken haze, I have written them a letter:

    Dear Prescription Solutions,

    This is The Angry Pharmacist. Most of my patients use you for their Rx Processing. Unfortunately today (since your systems were offline) they could not get their medications. As your CEO's are sleeping soundly in their beds, most of your customers are in the ER without medication because of your lack of server scaling and planning for the increased load of the AARP customers you took over (like hell i'm giving them any medication, you've fucked us over last year on the first, what makes us think you're not going to fuck us over this year on the first). I hope you sleep well knowing that you have just fucked over a good majority of patients, and pissed off a ton of pharmacists who took the brunt of your ignorance and lack of planning. The same pharmacists who are going to suggest that their patients move off of plans administered by you and your shitfuck cronies. But of course you are making record high profits, so obviously you dont need our business to afford your sailboat, RV and your house in Maui. I pray that your own family does not use your processing company for their prescriptions.

    Love,
    The Angry Pharmacist

    PS: Fix your fucking shit.

    Oh, and if you havent already; Drop Humana. Seriously, they pay cost + 1.50 for all of their prescriptions. If you work for a corpo-chain, talk to your district manager about it. If we keep on accepting shitty plans, the other PBM's are just going to walk all over us.

    Im too drunk to type any more. I hope you all have a good first week of the new year; and remember, when slitting your wrists its 'down the road not across the street' (and if you do it under hot water, you wont feel it) :)

    I <3 scotch. Mad props to my homies in Ohio. You read this blog, you know who you are.

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