A Continuation On Communication (Side Effects And Allergic Reactions)

Some True Experiences Taken From
http://www.drugnet.com.hk/joke/joke_pharmaracy.html
One guy I worked with back in the early 80's tells of one patient and his med. Well you see some medication require that the patient not stop taking them without the advice of their  MD, since sometimes the patient has to be weaned down on the dose slowly before they can get off the med.
One doctor had put on this patients prescription (and wanted it put into directions on the bottle) that the patient was not to stop taking the med abruptly.
So being a good pharmacist my fried typed the label:  "Take one tablet twice a daily. Do not stop abruptly."
The patient gets his prescription and takes out the bottle and reads the label and comes back to the pharmacist and says I have a question.
Pharmacist says, "sure what can I do for you?" (being a good pharmacist we are ALWAY ready and willing any question posed by our patients).
The patient says I see here that the directions say  "not stop abruptly" but what if something runs out in front of my car?
I'm sure glad this guy asked before heading home cause I'd have hated to have him go through his life slowing down while walking up to a corner or into a checkout line at the store.   (actual source unknown)
Another pharmacist tells of kidding with one of his patient who took him seriously:
The pharmacist typed the label of an eye drop: "Place on drop in both eyes twice daily."
The patient got the prescription and read the label and asked?  "How am I supposed to get the same drop in both eyes?  How do I get a half a drop?"
Okay, my friend figures he this guy has got to be kidding so he tells him how to do it.  Do you know?  Well it is something they don't teach you pharmacy school...but this guy had an answer.  He said, "Well first you get a razor blade and position it up between your eyes.  Then you take the dropper and get one drop on the end of the dropper and kinda flip the drop up in the air.  When it comes down you get underneath it and make sure it hits the razor blade right in the middle.  The 2 halves of the drop will go into each eye at the same time."
to which the patient replies straight faced and serious, "I don't think I can do that".  Makes you worry about where these pharmacist work and you'll ever have to encounter them on the other side of the counter some day. (Actual source unknown)
All I know is if this pharmacist worked  for me, he or she would have been seeking new employment the next day.
Please forgive the spelling and grammar I pulled these stories as is from the above referenced web site.
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Sharing another personal experience.

I just wanted to share one more story of the many that have happened to me over the course of my career.  I will share more of these stories with you in future blogs if I feel they are appropriate and tie into the topic I am blogging about.
I was just out of pharmacy school and working at my cousin's pharmacy on Saturdays.  I had a woman come into me to complain about the prescription she had filled two days earlier.  The prescription was for promethazine suppositories and the directions the pharmacist typed on the label read "Remove foil prior to using one suppository four times a day for nausea and vomiting."  The problem she had was two fold,  First she said they were not very effective and second they were to large and had to be chewed before she was able to swallow them.  She explained that not only did they taste bitter and make her want to vomit, but they were leaving a waxy paste all over her teeth and wanted to know if we sold a special toothpaste or a toothbrush with stronger bristles to remove the wax from her teeth.  I apologized to her explaining that the pharmacist should have explained that the suppositories were to be inserted rectally not orally.  First I assured her that taking it this way although not as effective it would not hurt her in any way.  Then I apologized to her explaining that the pharmacist should have explained to her that they were to be inserted rectally when she picked them up.  Even though not typed on the label the words "for rectal use only" was printed twice in bold letters on the box.  She said it was not really are fault because her husband  picked them up on his way home from work and did not bother to ask any questions of the pharmacist because he was rushing to get the medication home to his wife.
I learned a valuable lesson that day.  First always apologize to the patient no matters who is at fault and never take the defensive position.  It helps calm the patient down and let them  know that you are empathetic to their needs and concerns.  The second was never take anything for granted when it came to the wording on the prescription label, e.g. "Remove foil or wrapper prior to inserting one suppository rectally (,vaginally, etc.) four times a day as needed for nausea or vomiting."
Remember always ask questions!  If you feel uncomfortable about asking questions on the spot, like when picking up your prescription(s), then go home  carefully read the information (monograph(s)) supplied by law with each prescription.  The Monograph contains information you should know about medication(s) you have picked up.  Next, make up a list of questions so you are prepared and know precisely what information you want to be clear about.  Call your health care professional and ask for a few minutes to clarify the information you have been given.  No question is to trivial or inconsequential when it comes to understanding your health care concerns.  If your health care professional makes you feel like you are waisting his or her time or makes you feel like you question is trivial or ridiculous it is time to find a new health care professional.  Being a great health care professional is only part of the equation the second part is one that takes a true genuine interest in their patients.  It may sound like I took it a little bit too far, but during the seventeen years I owned and operated my pharmacy I would try attend either the viewing or funeral service of each of my patients that past away. I would send little baby baskets (with powder, lotion shampoo, etc.) to the families of newborns and send a get well cards to those who were sick. It is your body and you should feel comfortable about how and who you are being treated by and what treatment course(s) you are being asked to follow or medication(s) you are ingesting.
It is important to remember that a lot of times there is an initial adjustment period where you may experience side effects when starting a new course of therapy, a new medication, or a regimen of medications.  It is always a good idea to check with your pharmacist or doctor to check if these initial side effects will pass or if they are something you will be able to live with. Most times the body will adjust to side effects of a new medication or medication, other times it can be as simple as having your doctor make a dosage adjustment.
However, sometime these side effects can not be alleviated and that is when you need to talk to your pharmacist or doctor about alternatives. Many times it is just a matter of finding a different medication in that category of drugs that does not produce the side effect you're experiencing. Remember, this not only corrects the disease state being treated, but it does not detract from your quality of life.  This in turn enhances compliance and your health.

Knowing the difference between a side effect and an allergic reaction.


Allergic reactions is your bodies immune systems attempt to reject a substance it considers foreign and dangerous to your body.  Whether it be pollen from a plant or flower, pet dander, a fruit or food, an insect or animal bite, a medical treatment modality, a chemical, or drug.  The list of things that people can be allergic to are endless.  An allergic reaction can also happen at anytime when coming in contact with allergic substance (antigen).  For example you could eat citrus fruit all of your life thousands of times over with no reaction and then one day out of the blue you could develop an allergic reaction to citrus fruit.  The same with medication you could take penicillin fifty different times then on the fifty first encounter you could suffer from an allergic reaction.  Although, it is uncommon it does occur.  However, let me make it clear that if you are taking a maintenance medication every day this is something that would not occur.  It is rare and only seen when there have been extended periods of time between when the medication is given. It is very important to be able to determine between side effects and allergic reactions such as rashes, itching, and swelling of various body parts (like your lips, gums, tongue, throat, or extremities), changes in vision or shortness of breath.  These are common allergic reaction, but are not all of the allergic reaction that can occur so make sure to check the information that accompanies each prescription you receive.  The life you save could be your own.  It is always a good idea to keep a quick acting as well as a short acting antihistamine on hand at home when starting a new prescription or over the counter medication.  Benadryl (diphendydramine HCl) is my preference.  Allowing that you do not have any pre-existing conditions which preclude you from taking the antihistamine, then at the first sign of what you perceive to be  allergic reaction take the doseage of the antihistamine prescribed on the bottle or box.  Then use your best judgement in determining whether to call your pharmacist, doctor, 911, or head for the nearest emerganency room.

EDUCATE YOURSELF, KNOWLEDGE IS POWER AND THAT POWER CAN NOT ONLY INCREASE THE QUALITY OF YOUR LIFE, BUT IT COULD EVEN SAVE YOUR LIFE OR THAT OF A LOVED ONE.

 

SAD

SAD; Seasonal Affective Disorder

It is the time of year that Seasonal Affective Disorder usually affects millions of people worldwide.  Seasonal Affective Disorder or SAD as it is prominently referred to more than adequately describes this condition.  SAD is a mood disorder that is also known as winter or summer depression or more commonly as the "Winter Blues" or "Summertime Blues".  It usually effects women more than men and the people effected have normal mental health most of the year, but experience this depression in the winter months sometimes overlapping into the spring time and rarely instances occur during the summer months.  If this condition occurs during the summer months it is usually referred to as reverse SAD and can be accompanied by heightened feelings of anxiety along with the depression.  Some studies have linked it with bipolar depression.  There are several symptoms that differentiate this mood disorder from other types of depression.

• Difficulty waking up in the morning Wanting to sleep all of the time.

• A tendency to oversleep and over eat.

• Weight gain usually caused by an increased craving for carbohydrates.

• A lack of energy and a problem finishing tasks.

• Withdrawal from family and friends as well as social events.

• A decreased libido (decreased sex drive).

All of these lead to a poor outlook on life generally leading to further depression.  These seasonal variations in mood are thought to be directly related to light.  That's right, this mood disorder can be correlated with the exposure to diminished sunlight.  That is why it usually occurs during the winter months when the sun appears for a shorter period of time in the sky.  As, the days are shorter during these months the cases increase.  The incidents also increase in numbers as people live further away from the equator.  Studies in the United States show its incidents effects less than 1.5% of the population, while people who live in New Hampshire and Vermont have an incidents of over 7.5%.  Other studies have shown the incidents to be over 14% in Nordic Countries.

Treatment for seasonal affective disorder tries to deal with the symptoms that initiate the disorder which include, but are not limited to light therapy (phototherapy), psychotherapy and medications. Don't brush off that yearly feeling as simply a case of the "winter blues" or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.  Remember there are treatment modalities.  Reiterating there are treatments such as light box therapy, ionized-air administration, prescription supplementation of the (OTC) hormone melatonin which should only be performed by a qualified physician who has specific knowledge as to the dosage and time it needs to be administered as well as a few specific prescription drugs and homeopathic medications, and behavior modification.  It is my recommendation that you talk to you healthcare professional or have them refer you to a specialist.  I also recommend that you perform your own search on the Internet to obtain valuable information that this article has not included. Who knows it could save your life or enhance the quality of care your are looking for. Remember never try to treat yourself. See you primary care physician explaining all your symptoms and let him see if you need to be referred to a specialist to treat this condition. Do not let your your doctor diagnose you and dismiss the symptoms you have explained to him or her.  If you do not feel comfortable it is your right to be referred to a specialist.

Suggestions And Tips For Picking A Primary Care Physician

Suggestions and Tips for Picking A Primary Care Physician

The first thing you must decide is the type of doctor you are looking for in a primary care physician (PCP).  They generally fall under three categories; general practitioners, family practitioners, and internists.

  

General Practitioners are family practice doctors who have received their training before Family Practice became a certifiable specialty with specific training requirements.  They are also doctors who may include osteopaths and are more likely to not have board certification depending on state laws and requirements.

Family Practitioners are certified or are board eligible in the specialty of Family Practice and have completed specific training in Family Medicine.  They treat patients of all ages from infants to geriatric adults. They are able to treat widespread illnesses and conditions, including those sometimes treated by specialists.

Internist are certified or board eligible and have completed specific training in the specialty of Internal Medicine.  They usually only treat adults and although they treat a wide variety of medical conditions, they usually don't treat more serious conditions that require specialized care.

Please note that I have purposely left out Pediatricians for all of you adults with children and plan on covering that topic later.

Now that you have a basic understanding of the types of doctors to choose from the next thing to do is to narrow the list down to fit your specific needs. 

First you have to look at your general state of health and determine which type of doctor best fits your needs.  For instance if you had a wide array of medical problems you may be better served by a Family Practitioner rather than an internist who may likely refer you to different Specialists to treat your various disease states, thus increasing your out of pocket expenses (copays, deductibles, etc.).

The question then arises about healthcare insurance do you have an HMO or PPO, do you have major medical or are you covered by medicare or medicaid  or even a state funded program and unfortunately there are those of us who have to pay out of pocket.  These monetary factors have a definite impact on the medical care you are able to access. Now it is time to look at a list of physicians that are available to you under your insurance carriers. Narrow the list down by talking to friends and relatives in the area.  However, my advice is look for a local independent pharmacy in your area and go in and ask the the pharmacist if he or she could spend a few minutes with you that you are looking for a new pharmacy and a new doctor. Ask him or her for their recommendation.  Remember, these pharmacist deal with these doctors every day and know a lot of them personally as well as how their patients feel about them.  I owned and operated my own pharmacy for seventeen years and each week I would stop into a different doctors office before work with a box of donuts and free samples trial size hand lotions, etc. for the staff.  Granted I only got into see the doctor about three out of each five visits, but I got a feel for how the office was run and operated. Then as the years went on I was able to develop a relationship with these doctors and felt very comfortable about which doctors I recommended to patients when asked. Let me stress, however, ask an independent pharmacist this question, not a chain store pharmacist who has no stock in getting to know the doctors in their area. The other thing an independent  pharmacist gets to know is each and everyone of his patients by name their medical histories and the relationships they have with their doctors both likes and dislikes.  An independent pharmacist must get to know all his patients personally. They are the people who keep him in business.  Believe me when I say they take an interest their patients, their patients' families and of course their patients' doctors. Otherwise, their doors don't stay open very long competing with the big chain drug stores. These independent pharmacist hold a wealth of knowledge and are willing to share that knowledge with you as long as it does not violate any of the HIPPA regulations.

You have now narrowed your list of potential primary care physicians.  The next thing is to determine if they are still taking new patients if so ask the following questions to the receptionist over the phone when contacting them about becoming a new patient.

1.  Does the doctor see patients in more than one office? (Are all the offices convenient to either your home or office.)

2.  If you need to be seen quickly and your doctor is practicing at another office that day does he have a partner or partners that can see you in the office  that is most convenient for you that day.

3.  Are you going to actually see your doctor or are you going to spend most of your appointments visiting with a nursing practitioner or physicians assistant.

4.  Does your doctor take emergency calls after hours or have someone "on call" to take your calls in case of an emergency. Try calling the office after hours. If you do get a recording that states "If this is a true medical emergency please hang up and call 911 or go to the nearest emergency room".   Scratch that doctor off your list.

Now the final step involves making a visit to the doctor's office you have chosen;

1. Sit down in the waiting room for about 15 to 30 minutes and observe how long patients are waiting to be seen and do they look distraught or frustrated when exiting the office? 

2. Watch the staff do they seem happy, are they attentive and organized and are the phones answered in a reasonable amount of time?

3. Next approach the receptionist tell her you looking for a new doctor and ask the following questions. How far in advance do I usually need to schedule an appointment and would the doctor be able to squeeze me in the same day if I had an emergency?   What days and times does the doctor see patients?   Who provides care in the doctor is absent?  What hospital does the doctor admit patients to?  And Lastly, can I set up an introductory visit with the doctor?

If all has gone according to plan you have found your new doctor, but if you feel at all uncomfortable or you don't communicate well during your introductory visit with your new PCP then start looking for a new one.  Most insurance providers allow you to switch PCP in the 1st year more than once until you feel comfortable with the choice you have made.

    

Communication is Key

A majority of problems occur in healthcare when there is a breakdown in communication.  Always make sure that you and your healthcare provider are on the same page.  Unfortunately, there are many healthcare professionals out there (doctors, dentists, pharmacists, and nurses) who take for granted that you understand everything they communicate to you.  However, whether they use words you don't quite understand or they speak too fast, not giving you ample time to process the information they are relaying can lead to disastrous results. Remember, your complete understanding of what your healthcare provider has told you is vital to the best possible outcome from your time together.  Also remember, no question is too stupid to ask.  Especially, if you do not completely understand the information you have been given.  Never feel embarrassed or ashamed if you do not understand your consultation with your medical provider.  ASK, ASK, and ASK again until you comprehend what has been conveyed to you.  If anyone should be embarrassed, it should be your healthcare professional for not being able to adequately relay information to you in a language that you can understand.  If this is the case, I recommend finding a healthcare provider who you can relate to and has the time and compassion to make sure your needs, knowledge, and concerns are met.  After all, who is paying who? This is your health being discussed. I understand that in this world of HMOs and PPOs, doctors are under time constraints also and have to squeeze as many patients in as possible as the insurance companies have cut their reimbursement; but, if they don't have enough time for you, they should have a support system in place to make sure all your questions are not only answered, but understood.

I would like to refer to two true stories that are both funny and sad that occurred because of a simple miscommunication and a minor misunderstanding.

The first happened to my father-in-law, a physician. This incident occurred in his clinic.  He treated a patient with a respiratory tract infection and upon discharging her, he gave her a prescription and told her to take it four times a day for 10 days.  Then six days later, the woman returned to the clinic telling my father-in-law that she was almost out of medicine and needed more to last her the ten days.  My father-in-law exclaimed, "I prescribed enough medication for the pharmacy to dispense for 10 days".  At this point, she pulled out a small piece of paper from her pocket.  She said, "This is all the medication I have left".  She never took the prescription to the pharmacy to fill. She thought the prescription paper itself was the medication and had been tearing off a piece of it four times a day and eating it.  Sad but true!

The second happened to me about seven years ago.  I had a patient come in to my pharmacy with a question about an anti-fungal cream that her physician prescribed a few days earlier.  She was on her way to Florida and wanted to know if it was okay to take the cream with her and apply it while she was away on vacation.  I told her yes, that her doctor wanted her to use it for a 14 day period. She then explained to me that her doctor directed her to apply the medication "locally" three times a day and she was concerned because she was going outside of her local area. Her understanding was that she only had to apply it while she was at home.  Again sad, but true.

Remember communication and understanding are key when it comes to positive outcomes in healthcare.