Monthly Archives: January 2007

The Wonderful Public

Dear Patients…

19 Comments
  • 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.
    • Drug Trivia and Rants

    “Medical” Marijuana

    67 Comments

    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.

    Insurance Companies, Medicare Part D, Pharmacists

    Paying for our time, making money, and screwdom

    9 Comments

    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.

    • Doctors and Stuff, Drug Trivia and Rants, Pharmacists

    The Gospel according to Me.

    16 Comments

    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! 🙂

    • Drug Trivia and Rants

    FDA, What the Hell?

    10 Comments

    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….

    • Hate Mail

    Drugbuyers.com, final thoughts…

    30 Comments

    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.

    • Pharmacists

    Mag Citrate, Taco Bell, and Yours Truly

    16 Comments

    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

    Hate Mail

    Uh oh, I made a doctor angry!

    16 Comments

    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.

    • Pharmacists

    The Pharmacy Challenge

    11 Comments

    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!
    • Hate Mail

    Here we go again

    6 Comments

    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.