Pictures Are Worth a Thousand Words

 

So, I realized something today. I realized how much I’ve become a part of some of my patients’ lives. I know that a pharmacist is a familiar face many people see; however, forming a bond with a patient is something special and doesn’t happen with just any patient and any pharmacist.

Today, I had a woman share pictures of her grandson’s graduation from college. She had them in a cute photo album and everything. I didn’t think anything of it until she told me she has been carrying it with her the past few times she came to the pharmacy, hoping it would be my day to work. I suddenly felt very prominent in this woman’s life and not just in a healthcare professional way. It made me smile to know that she has connected with me in such a way. It ultimately benefits her and will make the quality of healthcare she receives from me even better. I’m not saying I will treat her better than other patients, but that she will be more receptive to what I advise her to do. She will be more open to patient education that is important to share with her. And, that is a great thing.

After that, I realized that there are several other people who have made similar, more personal connections with me. I feel very privileged to be able to experience such wonderful things. Days like theseĀ  make me enjoy my job and profession even more than I already do. =)

So, what personal connections have you guys made with your patients? Patients, what personal connections have you made with your healthcare professionals? I would love to hear.

 

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Stole Our Hearts

 

Today’s story is a sad and difficult one.

One of our pharmacy’s favorite patients stopped by today. He’s a man in his nineties and loves to make us laugh. He didn’t have a prescription, but he said he had some other shopping to do. He stopped by and said hi to everyone. We all smiled and were glad to see him, as always.

Our smiles quickly faded, though, because we were informed by our store manager that she caught him stealing candy and a few other items. We didn’t want to believe it. We asked if it was just forgetfulness or senility, and we were told it wasn’t, as he had stuff shoved in his pants and jacket pockets and began walking out the doors without purchasing anything else. It made us wonder how many times he had done this before. =(

This is probably once of the most difficult things I have come across at this pharmacy. Luckily, I was not the one who had to approach him about it. Now, our trust in him as a patient and a person is gone. I wonder if he was stealing due to a lack of money, but still, none of the items he attempted to steal were necessities. Overall, it’s just so disheartening.

 

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Routes of Administration

 

Today, I ran into an issue that should be shared with all patients. I saw one of my favorite wife/husband patient combinations during my shift. I met them not long after starting at my current pharmacy, and I was able to help them save some money on prescriptions. They have sought me out for advice ever since.

Today, they came into the pharmacy to return a steroid cream. I asked them why, and the wife responded that the list of side effects on the medication guide scared her. She said she had decided not to use it. I asked her if she has discussed not using it with her physician, and she told me she had not. So, I started to go through the medication guide with her sentence by sentence to see what was the most troubling for her.

After some explanation, I realized the side effect she was most worried about was the immunosuppressant effect steroids can have. I explained to her that this adverse reaction was not one that should concern her too much. I told her that this effect happens after months of therapy and is more likely to occur with oral steroids. She calmed down immensely afterwards. She ended up taking the medication back home with her. I encouraged her to call or come back if she had more questions.

I have come across this situation a few times before. A patient has a non-oral therapy. They decide to read the warnings and other patient information, and they come across side effects that are mainly related to the oral form of the drug. It scares them, and they stop taking it. Once they realize there is no reason to worry about side effects A and B, though, they calm down and become more adherent.

One thing patients need to realize is that the medication guides that print out with the prescription labels at the pharmacy are required to include everything under the sun for that drug. It will include the side effects for the oral form, as well as other routes of administration (topical, rectal, vaginal, etc). So if you are picking up a prescription for a non-oral medication and are concerned or unsure, ask the pharmacist which side effects are the ones most likely to happen while you’re on it. Try not to scare yourself out of using the medication before you ever use it. As a general rule with many medications, you will probably never experience most of the side effects listed on the medication guide, especially if the prescription is for something non-oral. They are there to tell you all the possibilities for every person who might ever use the medication, not to forecast what will definitely happen when you use it.

 

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Sticks and Stones May Break Your Bones…

 

Today, I got to see one of my favorite patients. It helped make the otherwise hectic day a bit easier. There’s a funny story about how I connected with this person that I must explain first.

Not long after I started working at my pharmacy, this woman came in to get her husband’s medication. She was very rude to all of our staff, so I took note to remember her name, so I knew when I needed to be extra nice and calm. Then one night, she came in to get some inhalers filled and had no idea how to use them. I took the time to explain the technique, and, ever since, we’ve been on great terms. She looks for me and trusts me.

Back to the present… She came in to get her husband’s meds filled and shared a shocking story with me. Almost two years ago, he had extensive surgery in multiple areas of his body. Ever since, he has been nearly bed bound due to the pain resulting from the surgery. They told him he just handled the procedure poorly, and that his only option was pain management. So, for the past 18 months, the poor man has been on and off all different pain regimens.

Desperate for any answers, the couple decided to get a second opinion because he did not like being on all the pain meds. His wife told me today that the other facility he went to informed him some of the rods, pins, and screws were placed incorrectly during his original surgery. She told me the original surgeons refused to go back and fix it. She stated they were going to go out of the area to try to get it fixed.

I was appalled by her story! This man has such a poor quality of life right now, and the surgeons won’t attempt to fix the mistakes they made? That screams unethical to me. It also has “potential lawsuit” written all over it. Even if they don’t feel comfortable opening him up again, they should have at least told the man the truth about the surgery outcome instead of covering it up. According to his wife, the second facility needed only to look at basic imaging studies to know that the hardware was placed incorrectly, so the original surgeons should have been able to tell a mistake had been made.

Lying to a patient is bad and unethical, yet healthcare professionals do it. It usually comes back to bite you in the end. My only hope is that this man can get the mistakes fixed to a point where he can have a decent quality of life again. =/

 

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A Breath of Fresh Air

 

Today, I have a lovely story to share. It warmed my heart and made my day. ^_^

Around lunch time, I received a call from a physician’s office inquiring about an elderly woman’s most recent fill date for a rescue inhaler. Looking at her profile, I noticed it was filled less than a week ago. The nurse I was speaking with told me the woman stated that her inhalers are always defective when she gets them filled. I remember a month or so ago the patient had contacted the manufacturer about it, and they sent a replacement to our pharmacy to give to her. I told the nurse to have the woman come to the pharmacy, and I would be able to determine if the defect was real or if this was simply a case of the patient not knowing the correct administration technique. The nurse thanked me and hung up.

A few hours later, the patient stopped by. Now, I love my elderly patients, especially the little, old ladies. They are full of stories and generally appreciate the pharmacy staff’s help. I tend to go out of my way to help them, since they seem to put the most blind faith in us. The woman handed me her inhaler. I pushed the canister down, but nothing came out. I told the woman I would be right back. I went over to our sink and gently cleaned out the mouthpiece with a paper towel and warm water. Putting it back together, I found that a good clean was all it needed. I returned it to the lady, who used a puff right then and there as a test. I gave her a few tips on inhaler technique and the proper way to clean it. She looked at me with a very serious face, waved her index finger, and said, “Come here for a minute.” Thinking she was going to ask me something else about the inhaler, I was happily surprised by the big hug I received from her with a whispered, “Thank you,” in my ear. She said I relieved her fear of not being able to breathe. She told me I would be her go-to person for help from now on. It’s amazing how one small action can mean the world to some people.

^_^

It is days like these that make everything worth it. I am proud to be a pharmacist, and I love my job.

 

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Slow Day

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Today was a very slow day. As much as hectic days make me want to scream, slow days are worse in my opinion. The day tends to drag by and seems to last forever.

I saw a few sweet elderly couples today that warmed my heart. The way they interacted was a lovely addition to my day. It wasn’t even big actions. But, it’s the little things that count in life many times. An elderly man, who was walking with a cane, held out his arm for his wife to support herself as she stood up from a chair in the waiting area. Even as feeble as he was, he still treated his wife like a gentleman would treat a lady. The wife told me they just celebrated their 55th anniversary. It amazes me when I see how long some people are together.

A scene I saw today reminded me of when I was small. I saw an elderly man with his granddaughter. She couldn’t have been older than three or four. Her little fingers were wrapped around his index finger as they walked down the aisle. One of my earliest memories is doing just that with my own grandfather, only we were at an amusement park. It made me smile, especially when I could hear her happy giggles. [Insert nostalgic reverie here.]

It seemed like most of the people that I spoke with on the phone today were very thankful for my help and generally in a very good mood. It broke up the monotony of the day (thank goodness). The most interesting thing I did otherwise was clean and dust. It’s disgusting how dirty the pharmacy can get.

 

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Expiration Dates

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Today’s theme was drugs past their beyond use dates and what that actually means. There were several people who called or stopped by to ask about it. People tend to call it the expiration date, but that’s not the best choice of words, since most drugs do not actually go bad at that date.

One person that stuck out in my mind was an elderly lady who called to ask if her husband could use the Nasonex they had in their house. I asked when it was dated for and she told me February of 2010. I told her it was best to get a new one if possible. She told me money was tight, so I told her to ask her physician for samples or to see if they had any copay coupons available for their patients. I also told her to ask about generic alternatives, since he had never been on anything but Nasonex. She thanked me and hung up.

So, what is a beyond use date? It’s the date that’s stamped on drugs (prescription and OTC alike) that you should use it by. So what happens on this magical date? Does the medication suddenly turn into a pumpkin, like the carriage in Cinderella? No. Most of the time, all that date represents is the date at which the medication is no longer guaranteed to be more than 90% effective. There are only very few drugs that actually go bad or become toxic after their beyond use dates. So, what does this mean for you? Well, if you have something in your cupboard that is dated for a few months ago, taking it is probably not going to cause any harm. You’re just not going to get the effect from it that you would if it were new.

There are a few exceptions to this. The following should not be taken past their beyond use dates. The list is not all inclusive, so always ask a healthcare professional before using a medication beyond its date on the container.

1.) Tetracycline and all other drugs related to it. These drugs actually become toxic once the date passes, so for them, it truly is an expiration date. Do not take it, even if the date has very recently passed.
2.) Birth control pills and other female hormonal supplements. Typically, women using these are trying to either prevent pregnancy or prevent other reproductive medical problems. Taking these when the date has passed can result in an unwanted pregnancy or the return of gynecological symptoms.
3.) Antibiotics besides tetracyclines. You want your antibiotics to be as effective as possible, so it gives your body that best chance it can to fight off that infection.
4.) Nitroglycerin tablets. These are meant to stop a heart attack in its tracks until you can call an ambulance. Once their brown glass container is opened, they are only effective for 6 months afterwards. Keep these up to date in case you ever need to use them. You want them to work as well as possible, since they can save your life.
5.) Blood thinners, such as Coumadin (warfarin), Pradaxa, aspirin, etc. Some blood thinners have a very narrow window of opportunity to do their jobs correctly. By using these after the date has passed, you’re at a risk for blood clot development and all the things that come with it.
6.) Digoxin and its family members. These control the heart rhythms of people with heart arrhythmias. It seems like it would be common sense for these to be as effective as possible, since your heart is (in many ways) in charge of your life.
7.) Insulin. Once the vial or pen is opened, it only stays effective for 28 days. Using it after that point will not keep blood sugar levels controlled as well.
8.) Test strips and control solution for blood glucose meters. They will not give you accurate readings if they are past their dates.
9.) Anything in a pharmacy provided amber vial. This vial can only guarantee a year of efficacy, which is why they all say to dispose of any unused medication after a year from the date it was filled.

Like I said, this list is not all-inclusive, so always double check with a healthcare professional first. These were just the most important ones that popped into my mind.

I hope your days are all going well!

 

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