Beginning Flu Vaccinations

Since certified pharmacists have been able to give flu shots for a few weeks now in Ontario, my pharmacy has been giving out tons of flu shots. With this expanded scope of practice, we have been receiving a million questions. There have been excellent questions like "What is the difference between the cold and the flu?" and there have been questions that seem like their aim is to bait us into an argument.

These people who seem to want to pick a fight mostly ask about the fact that two of the available types of flu vaccines have been voluntarily recalled recently due to floating particles in the vials. People ask questions about the quality of the service that we are giving as well as whether or not we are giving "dangerous" shots because of these particles. So far from my knowledge, the voluntary recall is probably to prevent people from freaking out. The manufacturer has stated that these particles contain bits of influenza virus (not the intact virus) which is not uncommon in vaccines of this nature, and that noone has felt any adverse effects so far. In addition, it helps to know that the vaccine we are distributing is not the one that is being recalled.

Today I had a woman of this nature who seemed like she wanted to pick a fight and I would not let her. THEN, she asked a question which took me by surprise (and she couldn't even pronounce it correctly).

Me: *after a bit of conversation* Is there any other question I can answer?
Woman: Does your flu vaccine cover AJSKQWIORJKKER? (She mumbled something and I was waiting for her to ask H2N3 or something like that.)
Me: Sorry I could not understand you. Do you mind repeating yourself?
Woman: DOES YOUR FLU VACCINE cover UIOQWEUIERKLJDSFJK?
Me: Sorry?? I really do not understand.
Woman: You know...the flesh eating thing.
Me: Uh...necrotizing fasciitis? Flesh eating bacteria?
Woman: YEAH!
Me: This is the FLU VACCINE. It covers the FLU.
Woman: Oh. *hangs up*

I didn't even get to ask her why she thought that or wanted to know. Why would you routinely vaccinate against flesh-eating bacteria? lol.

Can You Read This?

This isn't that bad because you can probably make out every drug name and can confirm if you ask the patient what kind of drugs they are on...but the handwriting is so unclear that you probably would never be 100% sure every letter, which is why I'm posting this.

Problem Prescriptions

After going to a pharmacy conference I was pooped and was too tired to post. Today I have an assortment of problem prescriptions discovered only THIS WEEK. I define "problem" as: requiring clarification/extra-work-that-shouldn't-be-necessary, erroneous, disgusting, etc.

1. This reads "1000/cc Mitte: 10cc". This lovely doctor decided to omit the drug name on the prescription. (Note: More experienced pharmacists would probably take a guess that this could possibly be the Vitamin B12 injection, but really you can't assume.) I had to type up and fax a note to the doctor then wait for a response. Another classic example of WHY it takes so long to fill your prescription (or the next person's).

2. This only makes you go "OMG" when you've checked the patient's file and realize that he was previously taking 5 tablets TOTAL per day of the Levocarb 100/25mg. This doctor decided to write "4.5 tablets FOUR TIMES daily", totalling 18 tablets per day, which is 3.6 times the patient's previous dose. Even if the patient's Parkinson's disease had worsened significantly I'm not sure they would've made such a huge jump in dose. 

3. This prescription is not the worst that I've seen (I've seen some miscellaneous red/brown droplets/fingerprints), but this is ranked as the most disgusting prescription I have dispensed this week. Unfortunately the photo doesn't really display very well the depth of colour on the prescription indicating its pure filthiness. Even though I have lots of things in my purse, I don't think any of my papers in there have ever turned colour or gone this wrinkly...did the prescription get stored in an armpit or crotch? How did it get so brown and dirty? As soon as my assistant brought this prescription to me to ask me a question about it, I immediately used a thick roll of tape and taped the surfaces of both sides to prevent ourselves from catching the plague. People, please be respectful of your prescriptions AND your pharmacy team.

(For whatever reason, blogger will not align these photos! So annoying...lol.)

About Cold Medications and What Happened to Neo-Citran

I've had a million people ask me about Neo-Citran in the last few weeks and about where they might find it because it hasn't been found on the shelves in a while. According to a Toronto Star news report , it is because the parent company Novartis had voluntarily closed their manufacturing plant down because of issues with drug mix-ups and needing to improve their manufacturing standards. (http://www.thestar.com/news/gta/article/1201516--the-gta-runs-out-of-maalox)

For whatever reason, people believe that Neo-Citran is a magic drug that "makes their cold get better", and that drives me crazy; I'm not sure if other pharmacists are feeling the same way. As you should know, the cold is caused by a virus, and there's nothing to really kill it except your immune system.

Most packages of Neo-Citran contain a first-generation antihistamine which is normally used for drying up a runny nose, and THIS is the medication that makes people pass out. I think that if people DO feel better it's probably because this drug knocked them out with drowsiness and made the person actually have a good night's rest which in turn made their immune system more effective at fighting off the cold virus. The other ingredients in your box of Neo-Citran probably also helped with a stuffy nose, and headache/pain so you feel much better with these floating in your system - it may not have been that you actually got much better...you just FEEL better.

To prevent you Neo-Citran fans from freaking out because this product might still be off the shelves for a while, as long as you can read labels, the next section of this post will be beneficial to you. NOTE that these medications are pretty much the same thing that's in Neo-Citran.

How to figure out which cold medicine to get, pharmacist-style: 
Rules:
1. Understand that the cold is caused by a virus. You DO NOT need antibiotics (they kill bacteria which are a different germ).
2. Understand that the cold usually lasts around 7 days. You will feel the WORST around day 3-4 and you will slowly get better after that.
3. Understand that these will make you feel more comfortable and WILL NOT CURE YOU. You will cure yourself.
3. Treat ONLY the symptoms you have, and you will not be taking unnecessary medication.
4. Don't read the front of the box - read the medicinal ingredients in the tiny print on the side.

What ingredients to look for if you have certain symptoms : 
- This is what's usually found in your cold medicine...find the ones that are applicable to you...that's why there are SO MANY COMBINATIONS of cold medications (every brand almost carries some of the same thing, so you can't go by brand!)

1. Pain and Fever: something with acetaminophen or ibuprofen
2. Cough: cough suppressant like dextromethophan
3. Stuffiness: decongestant like pseudoephedrine or phenylephrine
4. Runniness (nose/eyes): first-generation antihistamine like chlorpheniramine, brompheniramine, diphenhydramine
5. Phlegm (aka mucus): guaifenesin. *note: this doesn't have much evidence for efficacy. You might as well drink tons of fluids to loosen phlegm up or use a humidifier*

If you have certain allergies or medical conditions and you're not sure if these ingredients are safe to take, then go ask your pharmacist! Note though, that there are pretty much only 5 types of cold medications and they just come in different pretty colours and packaging. I've just memorized which boxes contain which ingredients, lol. I hope this helps - I would be more efficient in the pharmacy if I answered only 10 questions per day on colds rather than 50. Thanks. =P

Overly Sensitive People

The pharmacy was really busy today. While busy checking prescriptions in the dispensary, this young guy (late 20s, early 30s?) decided to come up to the counter to ask a question. Maybe I didn't choose the best words, but seriously, anyone would've understood the intent. All I have to say is that this guy needs to remove the stick from up his behind or he is going to suffer a stroke before he's 40. 

Guy: Where are your Band-Aids? 

Assistant: Over in Aisle 8. *guy goes to aisle 8 and comes back*

Guy: I'm looking for something that you tape to the back of your heel to protect it from forming blisters. 

-----

STOP. What do you think of when you think of shoes and blisters and protection? Most of the time when I deal with this in the store the majority of people are looking for protection from their pretty high-heels. 

-----

Maybe I stopped thinking for a second, but I blurted something out. 

Me: Is this for high-heels? 

Guy: No, it's for leather shoes. 

Me: OHh...*understood* okay, there's something called moleskin that you can use. *I look up from checking my prescription and see that the guy looks like he could murder me. Holy crap*.

Guy: THAT WAS ***NOT*** FUNNY. *deathstare* That was REALLY NOT FUNNY. 

At this point I'm kind of shocked that I've managed to offend someone in such a short period of time. 

Me: Oh, sorry, usually people who often ask are asking about high heels and I thought maybe you were asking for a friend. 

Guy: THAT WAS ***NOT*** FUNNY. (No one was laughing.) WHAT IS YOUR NAME?!?! TELL ME YOUR NAME NOW. 

Me: *I tell the guy his name while he stomps off*

So apparently this guy was really pissed and I was shocked that I managed to imply something horrible in his eyes...that he was a drag queen? ...Liked women's shoes? ...WORE women's heels? 

I looked at my assistant who was there and asked "Did I say something REALLY wrong? I am kinda shocked" and he was like "Oh Man. That guy was overly sensitive, lol."

I've been thinking about this conversation all night feeling quite bothered, and now I have to really work on modifying my future behaviour so that the 1% of the population that will get seriously offended will not be as likely to get seriously offended. I should've probably asked "Is this for you? What kind of problem with shoes are you having?". Being that I already feel like I talk too much, this is going to be an extra 9 words compared to asking "is this for high-heels?".  

Being Clueless

In the past I have had many husbands who pick up medications for their wives and have no idea what illness she is experiencing or what she went to see the doctor for. I also have had fathers not know their child's illness or what they went to see the doctor for. Also a lot of the time I get "let me ask my wife" when I ask for their child's weight or problem but usually I don't have this problem when I ask the woman of the family. I wonder if it is just in the woman's nature to know. =P

Anyway, in my family, everyone always knows what is happening with everyone else, so situations like these are surprising, or at least I wonder what the family dynamics are at home. But I guess being a pharmacist, my husband does not do anything regarding illness without asking me first. =P

A dad brought in a prescription for his daughter for Zithromax (azithromycin) and Alupent (orciprenaline). It's their first time at our pharmacy, so I had to make a new profile. Sometimes I wonder when people are very clueless about their children.

Selective parts of our conversation while processing the prescription:
Me: Last name? First name?
Dad: ______ s-i-n-e. (*blanked out the beginning part of the name for confidentiality*)
Daughter: No, it's _____ s-i-n-i!
Dad: OH.
Me: Birthday?
Dad: Um...July.
Me: What date?
Dad: 21st? 25th? ... Uh...25th.
Me: Year?
Dad: Um...well...*speaks to daughter* you're 6 right? So...2006.
Me: What's your address?
Dad: Um...hold on. Let me give you my driver's license. (This is where I noticed that the street name was spelled incorrectly on the license and I told the dad he should probably get it fixed because it's an official ID).
Me: Phone number?
Dad: Um...*starts scrolling through his cell phone*...Uh...can I give you my cell phone number? It's ____.
Me: Because these are medications for a child I need to verify her weight. How much does she weigh?
Dad: 16kg I think.
Me: *calculates dose and realizes it's high - should be around 10mg/kg/day, and it was around 16*. Hm. This antibiotic dose looks high then if that is her weight. Are you sure?
Dad: Let me call my wife. *wife says it's 13kg making the dose even more high (making it around 19mg/kg/day)*
Me: Hm. The dose is even higher then which isn't good.
Dad: *lifts up his child* well, it seems like it should be 13-16kg.
Me: I guess I have to call the doctor to verify then.

Worst part is that the doctor's office kept giving excuses for why they did not fax back after I sent them a note. The dad decided to take his prescription back with my note indicating the improper dosing, and take it to his old pharmacy which is beside the doctor's office. I wish we got paid for this stuff. I caught a drug-related problem and spent over 5 minutes explaining to the dad what was happening, and then did a bunch of work writing up a letter to fax, calling the doctor's office and holding for quite a while sometimes, only to have the business leave the store. Oh, and this was for an Ontario Drug Benefit patient for which we would've gotten a reduced fee if I HAD filled the prescription.

I'm a Mother, So I Know!

A get a lot of questions in the pharmacy, and most people tend to take the advice, or at least listen without an argument and then do whatever they wanted in the first place.

A few days ago, a mother came to the dispensary with her son who was about 1.5 years old, asking if there was a medication she could give him for his runny nose. After a bunch of questioning, she had come to Canada recently from somewhere-that-I-will-not-mention, and she was worried because her son seemed sick. He recently had had an ear infection and she had just finished a course of antibiotics. He recovered from that, but he was now presenting with "lots and lots of runny nose". After asking more questions, I found out that he had a "very very runny nose" for two days, but had no fever, and the nasal discharge was not colourful. He also was acting normally, eating well, and in the pharmacy while mom was speaking to me, all I saw was her son picking up bottles of drugs off the shelves and moving them around – very energetic!

Mom wanted a drug "to cure her son". I told her that given the symptoms presented, it's possible that he had caught a cold. Because of their change in location, or even because her child was young, it was very possible that he had never been  exposed to these germs and was sick again. I then said that there was no medication for her son that would cure him. I explained that here in Canada, all cough and cold medications were for children older than 6 years old due to the safety of the drug, or even just its lack of effectiveness in younger kids. Also, even if her child were over 6 years old, this medication just comforted the child, rather than curing them. If she needed a medication, she could perhaps use some saline solution to help with stuffy nose.

Maybe that was offensive.

Mom: What do you MEAN there is no medication for my son?! He has a very, very runny nose! It's runny every few minutes! (Note that she never wiped her son's nose the entire time we were talking.)

Me: Well, your son seems to just be having a cold, and there isn't really medication for younger children, especially since he doesn't have a fever. You can just wipe the runny nose gently with a tissue.

Mom: Well, last time he got sick, he had minor symptoms then he got worse! I need a drug to give him RIGHT NOW so that he doesn't get worse!

Me:  There's no way of telling right now if he will get worse, but it looks like he just has a cold right now, and there isn't really medication that will cure him.

Mom: YOU ARE CRAZY. THIS IS CRAZY! How can there be NO medication?! I'M A MOTHER, AND I AM SAYING THAT MY SON NEEDS MEDICINE! At the other pharmacy, someone said that there was something "0 to 9" that would help.

Me: Oh, you're probably talking about the homeopathic medication. That stuff isn't well studied, and the science behind it doesn't make any sense. If you want to try giving that medication to him you can, but it probably won't do very much. It's likely that your son will get better with or without the medication. (Despite not believing in homeopathic remedies, I showed the bottle to the mother.)

Mom: I GAVE this already and IT DOESN'T WORK! I'M A MOTHER AND I KNOW MY SON NEEDS MEDICATION!

Me: Well, you could just wait a few days and monitor your son. Colds usually last about a week. If he develops fever or starts losing his energy then maybe you can do something about that, but he looks perfectly fine right now.

Mom: YOU ARE CRAZY! YOU have NO medication?! THIS IS RIDICULOUS! YOU ARE CRAZY! I CAN'T BELIEVE THIS! *and…she stomps away….*

I don't think I've been called crazy by a customer before for giving perfectly sound advice, although I've received some other rude comments. I also have never heard anyone use the reasoning "I'm a mother, so I know" (but I'm sure this happens more than I am aware). I find it funny that people think that just because they carried a baby for a few months and gave birth to them makes them more educated than a health professional. I really wonder what kind of health education this person from an unmentioned country has received and I feel really bad for these kids who are shoved medicine every time they have a sniffle or a runny nose.

Really, parents are doing a disservice to their kids when they MUST get them medication. It's better to let your kid (or yourself) be sick once in a while to give your immune system a work-out. I work in the pharmacy exposed to sick people all the time, and I probably get sick at most twice a year (generally it's a very mild cold). I think the last time I took antibiotics was 2 years ago, but that was for an infected mosquito bite, haha.